横纹肌溶解症（rhabdo）是什么：罕见但需辨识的激进运动风险

At the New York City Marathon on Sunday, 24-year-old Rachel Apa of Lewisberry, Pennsylvania, collapsed two miles from the finish line. She later died at the hospital.

The medical examiner’s office is still investigating her cause of death. Her father, Steve Apa, told the New York Times that the cause was rhabdomyolysis, commonly known as rhabdo. The rare condition occurs when skeletal muscle breaks down, releasing its contents into the bloodstream, says Robert Glatter, MD, an emergency room doctor and an assistant professor of emergency medicine at Lenox Hill Hospital.

Apa’s death comes amid growing conversations about rhabdo on social media. People have shared their experiences with the condition after intense exercise, particularly at cycling classes. https://www.tiktok.com/@bryybell_/video/7693630991839153421?_r=1&_t=ZT-9Axae4rjSXu

But while these stories are alarming, rhabdo is still relatively rare. Yet they raise questions about the risks of intense exercise, how to recognize when something is wrong, and just how concerned the everyday exerciser should be. Here’s what experts want you to know.

What is rhabdo?

Rhabdomyolysis happens when skeletal muscle breaks down and releases its contents into the bloodstream. The resulting spill can produce dangerous electrolyte imbalances and kidney injury, particularly when someone is dehydrated, Dr. Glatter says.

Although rhabdo is often associated with intense exercise, physical exertion is just one possible cause. “Rhabdomyolysis can also follow crush injuries, seizures, prolonged immobilization, heat stroke, severe infections, certain drugs or toxins, metabolic abnormalities and, more rarely, inherited muscle disorders,” Dr. Glatter says.

Exercise-related rhabdo typically happens when an individual suddenly performs an unusually difficult, repetitive workout involving large muscle groups—particularly when doing eccentric exercise, or when the muscle contracts while lengthening. The risk may be higher when the activity is unfamiliar or far more intense than the person is accustomed to. Some examples include high-repetition squats, lunges, downhill running, and intense cycling, Dr. Glatter says.

“The key issue is often not simply that the workout was ‘hard,’ but that its intensity or volume was far beyond what that person’s muscles were conditioned to tolerate,” he says.

Symptoms include muscle pain "dramatically out of proportion to ordinary post-workout ache,” Dr. Glatter describes, as well as dark-colored urine, swelling, weakness, and difficulty moving the affected muscles. Other possible symptoms include dizziness, fainting, confusion, persistent vomiting or feeling generally ill, he says. “Someone who develops severe or rapidly worsening muscle pain or swelling after a strenuous workout—especially together with marked weakness, dark urine or substantially decreased urination—should be evaluated urgently.”

It’s important to note that symptoms can start while someone is still exercising. An athlete may notice muscle pain that feels disproportionate to effort, unusual heaviness or weakness, severe fatigue, or a drop in pace or intensity that would normally be manageable, Dr. Glatter says. In severe cases, athletes can collapse, appear confused, or develop nausea, dizziness, and swelling.

Other risk factors also include dehydration, exercising in extreme heat or humidity, a recent viral illness, certain medications or drugs, and underlying genetic or metabolic disorders, such as sickle cell.

Although many recent social media accounts of exercise-related rhabdo have come from women, it’s important to know that an unaccustomed high-intensity workout can overwhelm muscles regardless of sex. Those stories don’t necessarily reflect who is most likely to develop the condition, and studies have shown generally higher rates in men.

Is rhabdo becoming more common?

It’s complicated. “It’s probably a combination of greater awareness and a genuine increase in some types of exertional rhabdomyolysis, but the evidence does not support describing rhabdo as a new epidemic,” Dr. Glatter says.

Rhabdo has been around for decades, and it’s difficult to determine overall incidence rates because mild cases may never be diagnosed. Still, some research suggests that exercise-related cases have increased in certain settings. A 2022 analysis published in the Physician and Sportsmedicine looked at emergency department data from 2000 through 2019. It estimated more than 40,000 cases of exertional rhabdomyolysis and found an increase over that period.

Dr. Glatter suggests this might be, in part, due to shifts in exercise culture. An increase in the availability of fitness classes such as high-intensity interval training, cycling, and CrossFit-style workouts can expose people to unfamiliar movement patterns at high intensities.

“These workouts are not inherently dangerous, and millions of people perform them safely. The risk arises when workload increases too quickly relative to conditioning, particularly when heat, dehydration, illness, medications or inadequate recovery are added to the equation,” Dr. Glatter says. “A highly motivated newcomer trying to keep pace with a class may continue well past the point at which her muscles are accustomed to working.”

It’s also important to note: Being well-trained does lower the risk of rhabdo, but it does not eliminate it. “In a trained athlete, rhabdomyolysis is often best understood as a ‘multiple-hit’ phenomenon, where several physiologic stresses occur at the same time,” Dr. Glatter says. Someone may be proportionally prepared for the activity, but factors such as unusually high intensity or duration, heat and humidity, dehydration, recent illness, inadequate recovery, electrolyte abnormalities, and certain medications or supplements can lower the threshold for injury. Rare underlying conditions, such as sickle cell trait or certain metabolic conditions, can also predispose a healthy athlete to rhabdo.

That doesn’t mean you should fear strenuous exercise. Starting at a manageable level, building up gradually, and staying hydrated can help reduce the risk.

“The body adapts extraordinarily well to exercise when intensity and volume are increased gradually,” Dr. Glatter says. “Going from relatively little training to an all-out, high-repetition workout involving large muscle groups is a very different physiological challenge.”

The Bottom Line

Exercise-related rhabdo is uncommon, but can happen when a workout places demands on muscles that are far beyond what they’re accustomed to. High-intensity exercise can be part of a healthy routine; the key is to build toward it gradually and pay attention to how your body responds. If you develop severe muscle pain or swelling, weakness, dark urine, or substantially decreased urination, seek urgent medical care.

Cori Ritchey, C.S.C.S., is the fitness editor at Women's Health, as well as a certified strength and condition coach and group fitness instructor. She’s reported on topics regarding health, nutrition, mental health, fitness, sex, and relationships for several years. You can find more of her work in Men’s Health, HealthCentral, Livestrong, Self, and others.