Motivation Mondays | Rhabdo Update: Essential Warning Signs for Everyone

“It’s a common misconception that only unfit or out-of-shape people get rhabdo. People in great shape, such as firefighters, marathon runners, and professional athletes, get rhabdo. It can happen to anyone, even after activities you have done before without a problem.” Emergency Medicine Clinical Team, Centers for Disease Control and Prevention (NIOSH)

Motivation Mondays Rhabdo Update: Essential Warning Signs for Everyone

The condition can also result from injuries, seizures, certain infections, and some medications or drugs. For example, cholesterol-lowering statin medications have been linked to rhabdomyolysis, although this side effect is uncommon. The higher the dose of the statin drug, or if there is severe underlying dehydration, the greater the risk to the kidneys. Dr. John Graves, MD, Nephrology and Hypertension, Mayo Clinic News Network

People also falsely believe dehydration causes rhabdo. Dehydration doesn’t cause rhabdo, but it can make it worse. Dehydration impairs the body’s ability to get rid of the proteins and electrolytes in the bloodstream released from damaged muscle. These proteins and electrolytes cause organ damage.Emergency Medicine Clinical Team, Centers for Disease Control and Prevention (NIOSH)

It can happen when extreme effort combines with other risk factors: heat, dehydration, painkillers like ibuprofen, a recent virus, or a hidden genetic condition… Dr. Sohaib Imtiaz, Chief Medical Officer, People

On the Illusion of Physical Invincibility: As athletes, educators, and coaches, we must prioritize health literacy alongside our physical training. I invite you to read this latest update on my journey, research, and lessons learned from rhabdomyolysis; please share it with your local running/fitness/family communities, and commit to listening to your body every single day. Rhabdomyolysis, or rhabdo for short, can happen to ANYONE. Many people think it happens only to extreme sports enthusiasts or workers, like firefighters, in pressure-cooker environments. It is imperative that we read the CDC and other reports so we won’t dismiss those signs when they happen to a family member or us

Marathon running is the ultimate test of human endurance, but our dedication to pushing through the pain should never come at the cost of our lives. As runners, we pride ourselves on hitting our targets and pushing past “the wall,” but a life-saving difference exists between standard race-day fatigue and a medical crisis. Unfortunately, while athletes have a higher propensity for developing Rhabdo, no one is immune.

Recently, Rachel Apa, a 24-year-old former Division I field hockey player, collapsed near Mile 24 during her first-ever New York City Marathon and passed away from severe rhabdomyolysis after experiencing rapid, catastrophic muscle breakdown during the race. Her family described her as being in perfect health. The heartbreaking news spread quickly through the Internet and served as a somber reminder of a silent threat in the endurance community: Rhabdomyolysis (Rhabdo). Rhabdo is a condition, not a disease, that occurs when damaged skeletal muscle cells break down and release their contents, including myoglobin, creatine kinase (CK), potassium, and other substances, into the bloodstream. In severe cases, this process can disrupt the body’s chemistry and damage the kidneys. Complications can include acute kidney injury, compartment syndrome, dangerous electrolyte abnormalities, abnormal heart rhythms, and even death.

As athletes, knowing the line between grit and danger is the most critical skill we can bring to any race. It is a fine line, and many of us cross it from time to time; however, becoming acutely aware of the implications and potential medical crisis can save our lives.
READ: Motivation Mondays | Rhabdo: Warning Signs for Runners
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” There are several common causes of rhabdomyolysis, including medications (statins, SSRIs, diuretics), heat stroke, or any injury where the body is crushed (such as a car crash). But the one you’re worried about is intense exercise. Professor William Roberts, writing for Runner’s World

Motivation Mondays Rhabdo Update: Essential Warning Signs for Everyone

There are two distinct pathways: traumatic and non-traumatic. Traumatic rhabdo can be caused by blunt force, electrical shock, or crush injury. However, non-traumatic causes are far broader. Skeletal muscle tissue can break down from simple blood flow restriction or prolonged immobilization—such as when an individual is bedridden or unconscious following an accident—causing muscle cell walls to rapidly break down and leak toxic waste into the system. Dr. Boyd W. Haynes III, MD, Orthopedic Sports Medicine Specialist.

It is difficult to predict who will develop exercise-induced rhabdomyolysis before a race … The most important risk factor is unusually strenuous or unaccustomed exercise, particularly a sudden increase in training intensity or volume. Even well-trained athletes can develop rhabdomyolysis under extreme physical exertion. Dr. Marie Vangstad, Oslo University Hospital in TIME

Typically, in the strength training adaptation phase, you create a little bit of injury to the muscle, but the strength comes from when that muscle heals itself, and you recover. Rhabdomyolysis happens when you create more injury to the muscle than your body can adapt to. Dr. Chad Asplund, Orthopedic Surgeon, Mayo Clinic Minute

Key Warning Signs for Runners/Non-Runners: Rhabdomyolysis is a highly dynamic condition. What I learned firsthand is that rhabdo is never a static, “one-and-done” injury; instead, it is a fast-moving, constantly evolving process where your health, symptoms, and lab results can change drastically from one hour to the next. Warning signs can vary greatly from person to person. Still, there are some consistent ones to watch out for: extreme muscle pain, weakness, swelling and stiffening of the muscles, dark urine, dizziness, fainting, and an overall feeling of profound body changes, even extreme fatigue that shows as a loss of physical control or a strange sensation of floating out of your own body. I experienced some of these, but not all at once.

When my muscle tissue broke down, the aftermath triggered a multi-day chain reaction where cellular damage kept building and vital blood markers, like Creatine Kinase (CK), became moving targets. A single blood test only captures a tiny snapshot in time, and those numbers can skyrocket hours later before they finally peak. This fluid, shifting nature is also why the most dangerous complications often develop slowly. You might feel relatively stable when you first arrive at the hospital, only for your kidneys to come under severe, progressive stress 24 to 48 hours later as fluids aggressively shift into your injured muscles. Surviving rhabdo taught me that you cannot measure this condition by how you look or feel in a single moment; you have to closely watch the trajectory of where it is going. To help look out for yourself and your running/training partners, it is vital to understand the direct indicators of severe muscle breakdown that demand immediate emergency care:
• Extreme, deep muscle pain: Pain or throbbing that feels far more intense than standard delayed-onset muscle soreness (DOMS) or typical race cramps.
• Severe swelling or tightness: A firm, “locked up” feeling in the limbs, often accompanied by a visible loss of muscle function.
• Profound, sudden weakness: An inability to lift or move the affected limbs, or a sudden, unexplained drop in physical capability.
• Coca-Cola or Tea-colored urine: A classic hallmark of rhabdo indicating that muscle breakdown products are overloading the kidneys, which can quickly escalate to acute kidney failure.
• Systemic symptoms: Sudden nausea, vomiting, severe dizziness, or an elevated heart rate that does not stabilize with rest.

What are some Actionable Prevention Tips? While an athlete’s risk can never drop completely to zero, sports medicine professionals emphasize several primary defensive behaviors:
• Gradual mile progressions: Avoid sudden, drastic jumps in workout intensity or distance. Keep weekly mileage adjustments capped at a stable 10% increase to let skeletal muscle adapt.
• Strategic pacing & heat de-escalation: Environmental heat and humidity drastically amplify muscle breakdown rates. When racing in warm climates, proactively ditch rigid time goals, lower your pacing targets, and run strictly by physical effort.
• Sweat-rate and hydration: Formulate an intentional hydration protocol well before race day by evaluating your unique sweat rate. Drink small amounts frequently rather than chugging massive volumes infrequently, and incorporate targeted sodium and electrolyte replacements to maintain balanced cell integrity.
• Avoid racing while sick or impaired: Do not push through viral or bacterial illnesses. Exercising with an active fever significantly lowers muscle cell stability, leaving your body highly vulnerable to acute trauma.

“Rhabdomyolysis can occur after strenuous exercise, particularly when someone pushes beyond their usual activity level. The good news is that complications are rare and the majority of patients do great after being treated with IV fluids.” Dr. Mark Supino, MD, Emergency Medicine Physician

Motivation Mondays Rhabdo Update: Essential Warning Signs for Everyone

Rhabdomyolysis can result from exercise, a crush injury, or alcohol or illegal drug use, among other traumatic and nontraumatic causes. If rhabdomyolysis is related to an underlying medical condition, such as diabetes, an uncontrolled thyroid disorder, or viral infections, appropriate clinical management of that trigger is vital. WebMD Editorial Contributors.

Being fit doesn’t eliminate your risk… Rhabdo will often impact already in-shape athletes who push themselves too much. Dr. Sunny Sharma, MD, Sports Medicine Physician

Medical Testing and Treatment:  After Rachel’s NYC Marathon death, leading medical professionals weighed in to clarify how quickly this condition can escalate, who is vulnerable, and how to treat Rhabdo. I revisited the topic because it isn’t just an educational talking point for me; it’s a reality I survived firsthand. During the Boston Marathon in April, my own competitive drive turned into a near-catastrophic health crisis when a severe episode of rhabdomyolysis landed me directly in the ICU. To be clear, I wasn’t running faster or at an unfamiliar pace, but we can all agree that marathon running pushes us to compete by testing our boundaries and adjusting accordingly. I was and always have been my own competition.

As I approached Mile 19-20, the suddenness and sheer fright of watching my body unravel mid-race changed how I view training forever; it made me more cautious. Navigating the grueling road of physical recovery and advocating for my health after that emergency taught me that no finish line or personal record is worth an organ-failing crisis. We share these stories not to breed fear, but to foster deep respect for our bodies’ limits. If you cross the finish line and suspect something is genuinely wrong, understanding what happens next can save your life:
• The gold-standard test: Clinicians confirm a rhabdo diagnosis by measuring blood serum levels of Creatine Kinase (CK)—a muscle enzyme that spikes rapidly following cellular damage. An official diagnosis typically shows CK levels elevated to 5 times the normal upper limit.
• Supplemental lab work: Doctors will also test your urine for myoglobin (the oxygen-binding muscle protein that blocks kidney structures) and run diagnostics to monitor critical electrolyte levels, as cellular dumping can disturb the heart’s electrical rhythm.
• Primary clinical treatment: The cornerstone of rhabdo therapy is immediate, aggressive intravenous (IV) fluid resuscitation. This medical flush dilutes toxins, preserves kidney filtration pathways, and corrects life-threatening electrolyte imbalances. Of course, each case varies from patient to patient, and emergency room physicians are fully equipped to handle any additional complications that a rhabdo episode might trigger or affect.

If you walk away with one critical message from this post, I hope you remember this: Rhabdo can happen to anyone. Listen to your body, look out for yourself, your family member, or running/training partner, and never run or exercise through or ignore a medical crisis. If you, a family member, or a running/training partner experience trauma or any of the aforementioned causes that trigger extreme swelling, a sudden loss of muscle control, or tea-colored urine after an incident or grueling workout, please don’t wait; get to an emergency room immediately, flag a medic, and tell them you suspect rhabdo. If you’re in a facility where staff seems unfamiliar with the condition, speak up about how critical it is and remind them it can worsen quickly. Let’s stay safe, educated, and healthy.

Disclaimer: This Post is for informational purposes only. For medical advice or diagnosis, consult a professional.

Sources & Additional Reading

• The New York Times: Marathon Runner Dies After Collapsing Near Finish Line.   Background on the incident at the New York City Marathon.
• Centers for Disease Control and Prevention (CDC/NIOSH): Rhabdomyolysis Awareness and Workplace Safety Information. Authoritative background detailing how non-exertional and environmental factors trigger rapid muscle breakdown.
• Cleveland Clinic: Rhabdomyolysis
• ABC News / Good Morning America: What to Know About Rhabdomyolysis After Marathon Runner’s Death. Public health focus detailing the systemic risks of exertional rhabdo.
• TODAY Show Health: Rhabdomyolysis Explained After NYC Marathon Tragedy. Devastating breakdown of family confirmations and the typical timeline.
• Mayo Clinic News Network: A Variety of Causes Can Be at the Root of Rhabdomyolysis. A very helpful medical analysis by Dr. John Graves, MD, explaining non-exertional triggers like medication side effects and systemic illnesses.
• FrontPackSports: What Is Rhabdomyolysis? What Every Athlete Should Know. More insight on Rhabdo and Runners
• WebMD Reference Guides: Rhabdomyolysis: Symptoms, Causes, and Treatments. This is a full clinical guide detailing diagnostic laboratory screening, including Creatine Kinase (CK) blood thresholds.
• EveryDay Health: What Is Rhabdomyolysis, the Rare Condition That Took the Life of a 24-Year-Old NYC Marathon Runner? Revisiting Rachael Apa’s story and Rhabdo.

Positive Motivation Tip: Listen to your body and make informed choices. Information is power.

PHOTO CREDITS/ATTRIBUTIONS: All Photos: Rhabdomyolysis via Stock Adobe AND Rhabdomyolysis urine photograph — Wikimedia Commons, Muscle breakdown and rhabdomyolysis illustration — Wikimedia Commons,  CDC public-domain rhabdomyolysis image, RHABDO VIA OSMOSIS,  RHABDO VIA ERWIN MIYASAKA, ADOBE STOCK ON RHABDO

Until Next Time…
Ask. Believe. Receive. ©
Elizabeth Obih-Frank
Mirth and Motivation
Positive Kismet