Madina Alam thought she was just sore. Instead, the 34-year-old licensed mental health counselor ended up in the emergency room four days after a workout, her arms swollen by 12 pounds, with a diagnosis that doctors say can also cause kidney failure and potentially fatal heart rhythms: rhabdomyolysis.
Alam's ordeal, which she detailed in an account published by the New York Post, began in Charlotte, North Carolina, in 2022, when she completed a round of eccentric pull-ups, also known as negative pull-ups. She said her arms swelled almost immediately after she struggled through too many reps. At first she brushed it off, later telling the outlet she did not realize the workout was causing a serious problem until a friend suggested she might have rhabdo.
A Week in the Hospital
By the time Alam was admitted to the emergency room four days after her workout, her creatine kinase levels had spiked to 80,000 units per liter — hundreds of times above the normal range of under 200 units per liter, according to the Post's report. She spent a full week hospitalized, receiving intravenous fluids and electrolytes along with morphine to manage the pain, the outlet reported.
Rhabdomyolysis occurs when muscle tissue breaks down rapidly, often after excessive exercise without adequate rest, flooding the bloodstream with proteins and electrolytes that the kidneys struggle to filter. Typical clinical features include severe muscle pain, weakness and swelling, often accompanied by dark-colored urine, according to a clinical review published in BMJ Open Sport & Exercise Medicine. The condition can injure the kidneys badly enough to cause acute kidney injury or damage, as reported by ABC News.
The Danger Isn't Always Obvious
Rhabdomyolysis can occur during endurance events such as marathons, high-intensity workouts and other demanding physical activities, the New York Times reported. Symptoms typically develop one to three days after muscle injury, though they can appear much sooner, which can make the condition easy to dismiss as ordinary post-workout soreness. Doctors typically diagnose it through blood tests measuring creatine kinase, and treatment generally includes intravenous fluids, per the same report.
A prospective study of 136 patients treated at four hospitals in Oslo and Akershus between 2019 and 2022 found that most cases — 106, or 78% — followed strength training rather than endurance sports, according to the BMJ Open Sport & Exercise Medicine review. In that cohort, 5 patients, or 4%, developed acute kidney injury, while 62 were managed as inpatients and 74 as outpatients. Notably, no patient with normal creatinine levels at admission went on to develop kidney injury during follow-up, the study found.
A Marathon Runner's Death Puts a Spotlight on Rhabdo
Alam's story resurfaced in public conversation after 24-year-old marathon runner Rachel Apa died hours after running the 2026 New York City Marathon, a race that was her first. Apa, a former Division I field hockey player at Bucknell University who had trained for the race for months, was captured by her mother on video at Mile 14 in Queens, smiling as she ran, according to the New York Times.
Apa's father, Steve Apa, told The New York Times that his daughter died of rhabdomyolysis. ABC News reported that the New York Road Runners had not confirmed her cause of death. A separate account from the Athletic noted that the city medical examiner's investigation remained ongoing and that no official cause of death had been determined. Rhabdomyolysis can cause acute kidney failure and potentially fatal arrhythmias or cardiac arrest, conditions that underscore why doctors treat the diagnosis as a medical emergency regardless of how it is ultimately resolved in Apa's case.
Medical Coverage Along the Course
The New York Road Runners marathon includes medical tents.
Listen to Your Body, Survivor Says
Alam is urging personal trainers to learn about rhabdomyolysis so they can recognize warning signs in clients pushing through unfamiliar or intense exercises. She also advised people to listen to their bodies rather than power through swelling or pain that feels disproportionate to a workout. Experts recommend gradually increasing exercise intensity, allowing adequate recovery time, staying hydrated and avoiding overheating, according to the New York Times, guidance that applies as much to someone attempting eccentric pull-ups for the first time as to a runner tackling 26.2 miles.
