Page 140 - JSOM Summer 2022

officials identified 19 additional cases by reviewing emergency incidence of new ankle sprains or the recurrence of previous
department logs and asking the local Nellis Air Force Base ankle sprains in athletes. 45–47 Proprioceptive training involves
community for self-identification. Investigators conducted activities like balancing on one leg with eyes closed, dribbling
case-control study comparing the 22 cases to 24 heathy con- a ball while standing on one leg, or balancing on a wobbly
trols. Cases were defined as those who participated in the board. This type of training involves using sensory informa-
event and developed gastrointestinal symptoms (diarrhea, ab- tion to maintain a set posture while actively involving and po-
dominal cramps, nausea, vomiting). Controls were those who tentially strengthening muscle groups that stabilize the ankle.
also participated in the event but did not develop symptoms. Ankle braces that have successfully reduced new or recurrent
Both groups (cases and controls) filled out a questionnaire that ankle sprains include the McDavid Ultralight (McDavid Inc.,
asked about inadvertent swallowing of muddy water, con- Woodridge, IL) and the Don-Joy ankle stabilizing brace (Don-
sumption of food and beverages provided by race organizers, Joy Inc, Vista, CA).
and other factors. Compared to the controls, cases were 3.12
(95% CI = 1.65-5.90) times more likely to have swallowed Another commonly injury anatomical location in OCEs was
23
muddy water than controls. None of the other factors dif- the knee. In general, knee injuries can account for 40% of all
fered significantly between cases and controls. In 4 of 11 cases athletic injuries and the most common of these is an anterior
(36%) where stool samples were obtained, these tested posi- cruciate injury. 48,49 Systematic reviews with meta-analyses in-
27
tive for Campylobacter, an organism also reported in other dicate that training programs that incorporate proprioceptive
diarrheal outbreaks after muddy events. 34,35 and neuromuscular control can reduce knee injuries overall
and anterior cruciate specifically. 50,51 Neuromuscular control
programs generally involve plyometric (jump) training, re-
Discussion
sistance training, stretching, and running technique training
OCEs are relatively new mass participation athletic events. involving shuttle running and stretching. Surprisingly, no sin-
They began in 1987 with the Tough Guy competition in the gle component of these programs seems more effective than
United Kingdom, but they have only been conducted in the US another suggesting that these activities should be performed
50
since 2010. There appears much to be gained further studies holistically to reduce the risk of knee injury. Specific programs
of medical encounters during these events. The current data is include the Prevent Injury and Enhance Performance, and
52
53
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limited by ill-defined diagnostic categories (i.e., types of injuries SportsMetrics. Rayner and Smale provide a concise sum-
and illnesses), approximations rather than firm counts of par- mary of important components of exercise-based knee injury
51
ticipants, and a lack of information on potential risk factors. prevention programs while Arundale et al. provide a more
An international consensus statement has been published that comprehensive evaluation and summary.
defines diagnostic categories for encounters and methods for
reporting data in mass participation athletic events. Report- Although there are no studies on prevention of abrasions
39
ing of injuries and illnesses are based on a modified Orchard or lacerations a reasonable approach is to wear low friction
Sport Injury Classification System. 40,41 Besides standardization clothing that covers the majority to the skin so that direct fric-
24
of this type, identification of injury rates for specific obstacles tion on the skin is reduced. One study indicated that some
6
could provide important safety information. One study com- abrasion/laceration injuries were caused by movements up
mented that new obstacles or obstacles that were modified had or across ropes so wearing gloves may assist in reducing the
increased injury risk, but only provide one example. likelihood of these injuries on the hands and fingers. Areas
were friction or cuts might develop can also be covered with
Prevention and Mitigation of Hazards protective materials such as Moleskin (Dr Scholls, Memphis,
Based on the information presented here, the major hazards TN) or Nexcare Coban (3M Company, Saint Paul, MN). The
associated with obstacle course races appear to be musculo- likelihood of blisters on the feet can be reduced by the use of
skeletal injuries, dermatological injuries (abrasions, lacera- antiperspirants without emollients, covering areas that might
55
tions, blisters), and the possibility of infections from ingestion be prone to blisters with paper tape, using a low friction skin
56
or topical entry of contaminated water and mud. Intervention covering (e.g., Bursatec, or Dr Scholl’s Moleskin Plus), and the
studies provide evidence-based methods to mitigate some of use of specific types of sock systems. 57,58
these hazards, but in some cases, clinical experience and logic
must be used since studies have yet been conducted. Studies on potential infections during OCEs point to the im-
portance of avoiding ingestion of mud, muddy water, or food
While many investigation in Table 3 cite musculoskeletal in- or drink contaminated with mud while on the course. Open
juries as one of the most common (Table 3), only one inves- wounds acquired before or during the race can also be con-
tigation has provided an adequate description of the types taminated with microorganisms. Before the race, all open
23
musculoskeletal injuries. Hawley et al. reported that strains wounds should be covered with durable and protective cov-
23
59
and sprains were the most common injuries. While the au- erings. After races, participants should thoroughly rinse off
thors did not specific the anatomic location of these sprains/ mud and other contaminates with clean water and use soap (if
60
strains, they did show that the ankle was the most commonly available). Hands should especially be washed and appropri-
24
59
injured location overall. Another investigation also noted ate wound care for lacerations and abrasion initiated. Par-
that the combined foot/ankle was the most often injured lo- ticipants should avoid post-race ingestion of food and drink
cation (Table 3), but the type of musculoskeletal injuries were contaminated with mud.
not specified. The literature shows that during athletic events
the ankle is one of the most often injured anatomical location
42
and sprains are the most common type of ankle injury. Sys- Conclusions
tematic reviews with meta-analyses indicated that propriocep- Obstacle courses accounted for ~5% of injuries in IET and
tive training 43–45 and prophylactic ankle bracing can reduce the Special Force selection testing, but obstacle courses had the
136 | JSOM Volume 22, Edition 2 / Summer 2022