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highest injury rate (injuries/hours of training) of all military 6. Pearkes T, Buckley A, Acharya M. Planning and implementation
training activities. 2,13 The overall weighted medical encounter of medical support for a cross-country obstacle race. Trauma.
incidence in seven civilian OCE studies was 1.4% with ~6% 2016;18(1):46–53.
of these requiring higher-level medical care at a hospital. 6,19–24 7. The Spartan schedule is live. Available at https://www.spartan.
com/blogs/unbreakable-race-stories/spartan-race-2022-schedule.
Nonetheless, when participants were asked to self-report on Accessed 4 February 2022.
extremity injuries they experienced at any time during partici- 8. Find a race. Available at https://race.spartan.com/en/race/find
26
pation in a OCE, 27% reported at least one. Among medical -race/search?_ga=2.2327664.1721653971.1643978542-38680
problems experienced on-site during civilian OCEs, muscu- 0590.1643804692&what=&where&from&to. Accessed 4 Feb-
loskeletal and dermatological injuries (abrasions/laceration/ ruary 2022.
blisters) appear to be the most common. Few studies have de- 9. Tough Mudder Media. Available at https://toughmudder.com
/press-room/. Accessed 1 Feburary 2022.
scribed the types of musculoskeletal injuries or reported on the 10. Tough Mudder site map. Available at https://toughmudder.com/
anatomical locations most often injured, but those that have events/?view = map. Accessed 1 Feburary 2022.
indicated that sprains and strains have the highest incidence, 11. Rugged Maniac obstacle race series. Available at ruggedmaniac.
with the ankle and knee the most commonly injured anatomic com/events. Accessed 4 February 2022.
location. 23,24 There are also reports of microorganism infec- 12. Huedo-Medina T, Sanchez-Meca J, Marin-Martinez F, Botella J.
2
tions associated with the ingestion of contaminated water and Assessing heterogeneity in meta-analysis: Q-statistic or I index?
Psychol Methods. 2006;11(2):193–206.
mud during OCEs 27,28 and entry of microorganism into the 13. Knapik JJ, Graham BS, Rieger J, Steelman R, Pendergrass T.
body through lacerations, abrasions, or hair follicles. 37,38 Activities associated with injuries in Initial Entry Training. Milit
Med. 2013;178:500–506.
Ankle sprain risk can be reduced with proprioceptive training 14. Gwinn DE, Wilckens JH, McDevitt ER, Ross G, Kao TC. The
and prophylactic use of ankle braces. 44–47 Knee injury risk can relative incidence of anterior cruciate ligament injury in men and
be reduced with exercise-based programs that incorporate var- women at the united States Naval Academy. Am J Sports Med.
2000;28(1):98–102.
ious components of proprioceptive training, plyometrics, re- 15. Carow SD, Potter SM. Fracture of the lateral femoral condyle.
sistance exercises, stretching, and running technique training J Orthop Sports Phy Ther. 2013;43(12):933.
involving shuttle and bounding running. Reducing abrasions 16. Miller JM, Svoboda DJ, Gerber JP. Diagnosis of an isoilated pos-
51
and lacerations involve wearing low friction clothing covering terior malleolar fracture in a young female military cadet: a resi-
most of the body, wearing gloves to cover hands, and cover- dent case report. Int J Sports Phy Ther. 2012;7(2):167–172.
ing other areas prone to abrasions/lacerations with protective 17. Halle R, Dolbeer J, Goss D. Glenohumeral dislocation with engag-
materials directly on the skin. The likelihood of blisters on the ing Hill-Sachs lesion. J Orthop Sports Phy Ther. 2018;48(1):50.
feet can be reduced by the use of antiperspirants without emol- 18. Collingsworth KM, East KH. Simultaneous bilateral fracture of
the tali. J Orthop Sports Phy Ther. 2020;50(7):409.
lients, use of specialized sock systems, 57,58 and covering areas 19. Agar C, Pickard L, Bhangu A. The Tough Guy prehospital expe-
55
that might be prone to blisters with paper tape, Reducing po- rience: patterns of injury at a major UK endurance event. Emerg
56
tential infections from microorganism can be accomplished by Med J. 2009;26:826–830.
covering open wounds with durable and protective coverings 20. Luke S, Dutch M. Extreme sporting events and transport-mit-
before the event. After races, participants should thoroughly igating strategies: an Australian perspective. Ann Emerg Med.
59
2014;64(2):215–216.
rinse off mud and other contaminates with clean water and 21. Lund A, Turris SA, McDonald R, Lewis K. On-site management
soap, and avoid ingestion of food and drink contaminated with of medical encounters during obstacle adventure course partici-
mud. These chiefly evidence-based injury and illness prevention pation. Curr Sports Med Rep. 2015;14(3):182–190.
measures should minimize the risks associated with OCEs. 22. Coleby JL, Thibeault-Rivard E. Obstacle course racing: an anal-
ysis of Eastern Canada Spartan Race injury rates McMaster Uni-
versity Med J. 2016;13(1):3–6.
Disclaimer
The views expressed in this presentation are those of the au- 23. Hawley A, Mercuri M, Hogg K, Hanel E. Obstacle course runs:
review of aquired injuries and illnesses at a series of Canadian
thor(s) and do not necessarily reflect the official policy of the events (RACE). Emerg Med J. 2017;34:170–174.
Department of Defense, Department of the Army, U.S. Army 24. Rabb H, Coleby J. Hurt on the hill. A longitudinal analysis of ob-
Medical Department or the US. The use of trademark names stacle course race injuries. Orthop J Sports Med. 2018;6(6):1–6.
do not imply endorsement by the US Army but is intended 25. Greenberg MR, Kim PH, Duprey RT et al. Unique obstacle race
only to assist in the identification of a specific product. injuries at an extreme sport event: a case series. Ann Emerg Med.
2014;63(3):361–366.
26. Lyszczarz M, Kobierecki M, Mostowy M, Szadkowska I. An
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