Medical Toll at Obstacle Race




A couple weeks ago I wrote about the medical toll at long-distance running events.  There was also a recent report on the medical toll at an obstacle course race that caught my eye.  On the face of it, the findings were surprising!

At the outset, let me issue a disclaimer.  I haven’t participated–or even spectated–at one of these obstacle course races, so I may not have the best perspective.  I’m talking, though, about races like the Tough Mudder, Warrior Dash, and Spartan Race, among others.  They’ve become very, very popular very, very quickly.  We’re talking 100’s of thousands of participants per year in the U.S.  One day, I’ll give it a try.  I’ll need to be brave!


The Study

A group of investigators headed by Marna Greenberg, DO, MPH, in the Department of Emergency Medicine at Lehigh Valley Hospital reported on a collection of patients who required hospital care stemming from their participation in an obstacle course race.  The event was the Tough Mudder Philadelphia race, held over the weekend of June 1, 2013.  As you may know, the Tough Mudder races are characterized by a 10- to 12-mile course with a series of 20-25 obstacles spread over the course.  By report, approximately 22,000 individuals participated in this particular race.

The investigators were the emergency room physicians at the hospital that was designated to care for participants who required hospital care for medical conditions or injuries that developed during the race.  In a report in the Annals of Emergency Medicine entitled “Unique Obstacle Race Injuries at an Extreme Sports Event:  A Case Series”, they share their first-hand experience which they characterized as surprising.


The Results

The report provides fair detail about 5 patients with “significant” injuries or diagnoses and compiles a list with pertinent findings in 43 total athletes who received care at the hospital. The 5 athletes with “significant” problems included:

  • 18 year old with myocarditis (inflammation of the heart muscle) caused by electrical shock during the event.  Required admission for 2 days.  Self-limited.
  • 28 year old with depressed level of consciousness and diagnoses of accelerated hypertension (high blood pressure) and pericarditis (inflammation of the sac that holds the heart).  Required admission for 2 days.  Self-limited.
  • 31 year old right-sided weakness who was found to have a stroke, seizure, and dehydration.  Required admission to the intensive care unit (ICU).  Was discharged to a rehab facility and at the time of writing, had persistent weakness due to the stroke.
  • 41 year old who experienced syncope (blacked out) after being shocked at an obstacle.  He fell, causing lacerations to the face.  He was discharged from the emergency room against medical advice to be hospitalized.
  • 25 year old woman with near syncope (nearly blacking out) because of electrical shock.  Required hospitalization for evaluation and was treated for dehydration and rhabdomyolosis (breakdown of muscle).

The 38 others had diagnoses that included:  heat injury, sunburn, ear barotrauma (pressure injury), shoulder dislocation, patella dislocation, heat exhaustion, vomiting, renal failure, various contusion injuries, rib fracture, dehydration, asthma, seizure, leg fracture, ankle sprain, and elbow sprain, among others.


The Takehome Messages

You never read about the medical toll at running races that are shorter than half marathon distance.  That’s not to say that athletes don’t have injuries or other medical problems manifest during those races.  It’s just that athletes are usually responsible for their own medical care or receive their care from the emergency medical system (EMS), rather than by race-supplied medical volunteers.  So nobody is keeping track of the “toll.”

This report is great peak into the issues with the obstacle races.  Kudos to the authors for sharing their experience.  Obviously, 43 victims among 22,000 participants is a small fraction.  We might reasonably expect, though, that additional athletes with minor injuries or medical conditions did not visit the hospital for care.

Some thoughts….

  • At an obstacle course race, the obstacles present a challenge and risk that is different from just running.  These events are certainly not risk-free.
  • There are typical medical issues like minor injuries, dehydration, and heat injury.  Some injuries and medical problems may be due very specifically to the obstacles themselves.
  • There will also be injuries that may not be expected–either by the athletes or by the nearby healthcare workers.  At this particular event, the myocarditis, pericarditis, stroke/seizure, and syncope diagnoses were examples.  Electrical shock was an unexpected causative factor.
  • Athletes should keep the potential risks in mind when they decide to participate and exercise great care while participating.

Like I said at the top, I’ll probably be a participant at some point.  But I’ll need to be brave!

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  1. says

    Great article! I completed the 2012 San Jose Gladiator Rock n Run, a hilly 4-mile obstacle course race. I was two years post -CABG for a rare coronary artery anomaly at the time. It was a grueling slog but also incredibly fun and challenging! In my opinion the most dangerous obstacle was the 40 plus foot long ice bath we had to wade through. Because I had some arrythmia issues at the time I chose not to submerge my head and would never do a run involving shocks. I’ve made the mistake of touching an electrical horse fence before, no thank you! These runs do pose risks and I think that’s part of the lure. I saw people requiring IV hydration and ambulance rides down the extremely winding 10 mile mountain road. Would I do it again? Absolutely except with severe lumbar disc issues I’ve been forbidden from running!

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