Running News Daily

For runners, pushing beyond physical limits is often celebrated as a sign of determination, discipline and mental strength. However, behind every demanding training session and exhausting race lies an important responsibility that should never be overlooked: understanding when the body needs rest and recovery.

One potentially life-threatening condition every athlete, particularly marathon runners, should understand is rhabdomyolysis, commonly known as rhabdo. Although it is not frequently discussed in everyday running conversations, this serious medical condition can have devastating consequences if its warning signs are overlooked and treatment is delayed.

Rhabdomyolysis occurs when skeletal muscle tissue becomes severely damaged and breaks down rapidly, releasing substances normally contained within muscle cells directly into the bloodstream. These include myoglobin, a protein responsible for storing oxygen in muscles, potassium and creatine kinase (CK), an enzyme found in muscle tissue.

While these substances are normally contained within muscle cells, their release in excessive quantities can create serious complications throughout the body. Myoglobin, in particular, can damage the kidneys, potentially resulting in acute kidney injury or kidney failure. Meanwhile, excessive potassium in the bloodstream can interfere with the heart's electrical activity, triggering dangerous and potentially life-threatening abnormal heart rhythms. Severe electrolyte imbalances can further complicate the condition.

Although rhabdomyolysis can develop following traumatic injuries, extreme heat exposure, certain medications and other medical conditions, strenuous physical exercise is another recognised trigger. Prolonged endurance activities, exceptionally demanding workouts and sudden increases in training intensity can place enormous stress on muscles, sometimes resulting in severe muscle damage.

For marathon runners, the risks deserve particular attention. Preparing for 42.195 kilometres requires months of physical conditioning, demanding training sessions and considerable endurance. However, inadequate recovery, excessive training loads, exercising in extreme heat and pushing through severe physical exhaustion can increase the risk of exercise-induced rhabdomyolysis.

Importantly, this is not exclusively a condition affecting inexperienced athletes. Even highly trained, physically fit and experienced runners can develop it. Athletic ability, years of training and previous marathon experience do not make anyone completely immune.

Recognising the warning signs can make a critical difference. Symptoms may include unusually severe muscle pain, swelling, muscle tenderness, cramps, weakness and extreme fatigue. One particularly alarming warning sign is dark, tea-coloured or cola-coloured urine, which may indicate the presence of myoglobin released by damaged muscles.

However, symptoms do not always appear immediately. They may develop hours or even days after strenuous physical activity. Furthermore, the absence of dark-coloured urine does not necessarily mean that an athlete is free from the condition. Some individuals may experience significant muscle damage without displaying every recognised symptom.

Another important concern is that rhabdomyolysis can initially resemble ordinary post-exercise muscle soreness. While temporary discomfort and fatigue are common after demanding workouts, unusually intense pain, significant swelling, profound weakness or symptoms that continue to worsen should never be dismissed as normal training fatigue.

Prevention begins with responsible training. Athletes should increase their mileage and workout intensity gradually, allow sufficient recovery between demanding sessions, maintain appropriate hydration and avoid exercising excessively, particularly in extreme heat. Adequate nutrition, sufficient sleep and recognising the body's warning signals are equally important components of a sustainable training programme.

Runners should also understand that hydration alone cannot eliminate the risk. Training load, environmental conditions, individual susceptibility and overall physical health all play important roles in determining the body's response to strenuous exercise.

Anyone experiencing severe muscle pain, unusual weakness, swelling or dark-coloured urine following strenuous exercise should seek urgent medical assessment. Rhabdomyolysis is a medical emergency that requires prompt diagnosis. Doctors commonly use blood tests to measure creatine kinase levels, assess kidney function and identify potentially dangerous electrolyte disturbances.

Treatment often involves intravenous fluids to support kidney function and help prevent kidney injury, alongside careful monitoring of electrolytes, urine output and other complications. In severe cases, hospital admission and specialised medical intervention may be necessary. Early recognition and appropriate treatment significantly improve the chances of recovery.

The importance of understanding this condition has been brought into heartbreaking focus following the death of 24-year-old Rachel Apa, who collapsed approximately two miles from the finish line during her first New York City Marathon on November 1, 2026. She tragically died hours later, with rhabdomyolysis reported as the cause of her death.

Her story is a painful reminder that even the most anticipated sporting achievement can become overshadowed by a medical emergency. It also highlights why runners, coaches, race organisers and the wider athletics community must take exercise-related health risks seriously.

Every athlete dreams of crossing the finish line, achieving a personal best or completing a race they have spent months preparing for. But no medal, finishing time, training milestone or personal record is worth risking a life.

Running should challenge us, strengthen us and bring us together, but it should never come at the expense of our health and safety. Recovery is not a sign of weakness, and recognising when to stop is not a failure. Sometimes, the strongest decision an athlete can make is to listen to their body.

Train with discipline. Race with awareness. Recover with purpose. Above all, remember that getting home safely is more important than crossing any finish line.

The New York City Marathon is celebrated as a day of courage, endurance and achievement — a race where thousands of runners push their limits while families and friends wait eagerly to see them cross the finish line.

For one family, however, November 1, 2026, became a day of unimaginable heartbreak.

Twenty-four-year-old Rachel Apa, a former Division I field hockey athlete at Bucknell University, was running her first marathon when she collapsed in Central Park with roughly two miles remaining. She never made it to the finish line.

Rachel had entered the race with a deeply personal purpose. She was running in honour of her late grandfather, who had battled Parkinson’s disease, while raising money and awareness for Parkinson’s research and care.

Her family followed her journey closely as she made her way through the five boroughs.

Rachel exchanged messages with her father, Steve, during the race as he monitored her progress remotely. At Mile 18, she sent a brief message: “Ow.”

One mile later, another message arrived: “Ow ow.”

Then, at Mile 23, came her final message: “Final stretch.”

Those words would become heartbreaking in hindsight.

Rachel’s mother, Michelle, was waiting around Mile 25 in Central Park, expecting to see her daughter approaching the finish line. She was preparing for a moment of celebration — to watch Rachel complete the biggest running challenge of her life.

Instead, Rachel’s tracking-app location stopped moving around Mile 24.

At approximately 1:30 p.m., Rachel collapsed near 85th Street in Central Park. Spectators rushed to help, including medical professionals who began performing CPR. New York Road Runners’ medical team soon arrived with a defibrillator, and Rachel was taken to Mount Sinai Medical Center.

Doctors fought for more than six hours to save her life.

But at approximately 9:40 p.m., Rachel was pronounced dead.

According to her father, doctors attributed her death to rhabdomyolysis, a serious medical condition in which damaged muscle tissue breaks down rapidly and releases substances into the bloodstream that can cause severe complications.

The tragedy sent shockwaves through the running community.

New York Road Runners, organisers of the New York City Marathon, expressed deep sadness over Rachel’s death and extended their condolences to her family, friends and everyone affected by the loss.

Rachel’s marathon was never simply about completing 26.2 miles.

It was about family. It was about memory. It was about honouring her grandfather and helping others affected by Parkinson’s disease.

She had already pushed through more than 24 miles of one of the world’s toughest and most demanding marathon courses. She was so close to the finish line that her final message to her father was simply, “Final stretch.”

But the finish line she had spent months preparing for would remain out of reach.

For Rachel’s family, the New York City Marathon will forever be remembered not for the finish line, but for the devastating moment when a day of hope became a night of grief.

Her mother was waiting to celebrate her daughter’s achievement. Instead, she was left facing an unimaginable loss.

Rachel Apa was just 24 years old.

She came to New York chasing a dream, carrying the memory of someone she loved and running for a cause close to her heart. She never got to finish the race, but her story will remain with the people who knew her and with a running community that mourns her loss.

To begin nailing your race fueling, it is important to understand the mechanisms behind it so that you can cover your bases.   Many runners go directly to calories as being the cause for all of their issues, but unfortunately it is more complicated than that.  Fueling properly requires a delicate balance of three keys: fluids, electrolytes, and calories.  If one of these gets knocked out of balance by too little or too much intake (or the wrong source), disaster can ensue.  

1. Get in those calories

Calories=energy.  Your body has about 1,800-2,000 calories of carbohydrates stored as glycogen in the muscles and liver (think of this as your gas tank). Once this tank is emptied, if you aren't taking in calories from outside sources, your body is solely relying on fat and muscle for energy production.  These systems can and will be utilized for energy production, but the process will be slower, leaving you to bonk, and can lead to serious health risks, such as heartbeat irregularities and rhabdomyolysis (kidney damage).

When setting up a target calorie intake for yourself, 200-300 calories per hour is often a good, general starting point for most runners.  Smaller-framed runners may be able to start on the lower end of this recommended intake, while larger-framed runners could start on the upper end.  

When considering calorie sources, carbohydrates are still king for energy production for endurance runners.  Even if your pace is slower, carbohydrates are going to provide an efficient energy source that will keep you alert and able to push hills and maintain pace.  

Aim for mostly carbohydrate rich calorie sources with a bit of protein and some fat mixed in is a good starting point.  Calorie sources for running events can come from a combination of hydration mix, whole foods, gels, and chews.  Figuring out what works best for you is where science meets art. 

Some runners like the convenience of getting calories from hydration mix, while others prefer just water and electrolytes, getting their calories from whole food sources.  Gels provide a quick source of energy that may be preferred for shorter events, while some runners have stomachs that can't handle them.  Take it from an expert: there is no one best way to fuel, and chances are the first thing you try might not be the best option. It takes time and testing to figure out what works for you.

2. Take in electrolytes

Electrolytes are key in  nutrient utilization, fluid balance and muscle contraction.  While all electrolytes including sodium, potassium, calcium, chloride, and magnesium play a role for these processes to occur in the body, focus on sodium intake, since it is lost fastest through sweat.  Sodium also helps fluid balance and sugar transport across the small intestine, which prevents cramping, bloating, and bonking.

Diving a little bit deeper, sodium itself allows for glucose (sugar) utilization because it acts like a key, allowing for a sugar transporter in the small intestine (GLUT4) to open.  Without proper replenishment of sodium from outside fueling sources, there is a risk of not having glucose transporters open quickly enough and a concentration gradient difference to form between the inside of the small intestine and the blood plasma.  When this occurs, water flows into the small intestine and can result in gas, bloating, diarrhea, and stomach cramping.  

A good starting place for most runners is 250-500mg of intake per hour.  Athletes with a low sweat rate (more on that later) can stick to the low end, and sweatier folks or runners racing at altitude or in the heat should aim for the higher end. Salt tabs, hydration mixes or food can provide a solid dose of sodium. 

3. Hydrate, hydrate, hydrate.

While race location, climate, and sweat rate will ultimately determine fluid needs, the main thing that needs to be considered is that for some runners, it is quite difficult to actually replace all fluids lost through sweat in a race during a race.  Ideally, we want to minimize fluid losses to no more than 2-3% loss of body weight in fluids, the point where we start to see performance impacts such as fatigue, cramping, and gastrointestinal distress due to dehydration.  A good starting point for most runners with no information on their sweat rate is 16-20 ounces of fluid intake per hour.  If this fluid intake causes a sloshing stomach, it may be too much, in which case, target amounts per hour should be reduced.  

If GI Issues Persist

It can sometimes be complicated figuring out what might be causing your fueling issues (nausea, swelling, fatigue, cramping, gastrointestinal distress), and if you find yourself lost without an answer, it might be time to work with a sports dietitian or doctor that can help you more closely dial in the details. 

For runners wanting to dial in their sweat rate and sodium losses a bit more precisely, at home or in person sweat tests can be useful.

While nothing is guaranteed on race day, putting together and practicing an individualized fueling plan ahead of time can increase the odds that you will successfully complete your event sans nutrition related issues.  

The organizers of the Ultra-Trail du Mont-Blanc (UTMB) World Series will be banning the use of painkillers within 24 hours and during all races. This includes all non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen. The announcement was made after the UTMB’s Quartz Event health program carried out post-event drug tests for the first time this year and three athletes’ samples contained NSAIDs.

The Quartz Event health program was set up in 2008 to protect the health of participants and contribute to clean sport. The rules of the program align with the banned substance list set out by the World Anti-Doping Agency (WADA) but goes a couple of steps further. Under the Quartz medical rules, athletes must not compete in any race if they have violated any of the following regulations:

Within 60 days before the start of the competition and during the competition: 

Intravenous iron infusions

Within 7 days before the start of the competition and during the competition:

Intravenous infusion

Gas inhalation

Substance subject to a Therapeutic Use Exemption (TUE) according to the WADA Prohibited List

All glucocorticoids regardless of the mode of administration

Thyroid synthesis hormones except in case of partial or total removal of the thyroid or hypothyroidism of medical origin.

Within 24 hours before the start of the competition and during the competition:

All beta-2-agonists regardless of the mode of administration

All painkillers including Tramadol and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) regardless of the mode of administration

All substances included in the WADA Monitoring Program

After the 2021 UTMB final, three athletes out of 30 who were tested had NSAIDs in their samples. The organizers did not disqualify the athletes because the rules were only implemented this year, it was their first violation and there was an assumed lack of knowledge of the new regulations. Moving forward, however, all races will be employing the Quartz Event program and any athletes found in violation of the rules will be automatically disqualified.

Why are painkillers being banned?

According to Doctor Patrick Basset, the medical director of Dokever, the company that manages the medical teams at all UTMB events, these regulations have been put in place to protect athletes from the dangers of self-medicating. “the most frequent type of self-medication seen is to treat two types of symptoms: osteoarticular pain and digestive problems,” he explains on the UTMB website. “As a consequence, the main medicines concerned are non-steroidal anti-inflammatory (NSAID), anti-diarrhea or anti-vomiting medicines.”

He continues to explain that in the context of a long-lasting endurance race, taking anti-inflammatories could be toxic to the kidneys and cause rhabdomyolysis, which is the excessive breakdown of muscle tissue to dangerous levels, potentially leading to renal insufficiency. This is even more likely to happen when combined with dehydration, hypoxia (lack of oxygen) and hypotension (a drop in blood pressure).

Many athletes are criticizing the ban as going too far since the Quartz program refers to these new rules as “legal doping,” and NSAIDs are not banned by WADA.