Morbidity Among Athletes Presenting for Medical Care During 3 Iterations of an Ultratrail Race in the Himalayas

Abstract

IntroductiondAlthough ultratrail races are increasing in popularity, there is a dearth of data regarding illnesses and medical care at these events. Data about injuries and illnesses for races taking place in the Himalayas, where the nearest medical facility can be hundreds of miles away, are even harder to find. This study aimed to describe the injuries and illnesses befalling the participants of a 7-stage 212 km (132 mi) trail race at high altitude. MethodsdEthical approval was obtained from Nepal Research Health Council. A retrospective study of the record of medical encounters among the 100 participants competing in the Manaslu trail race in Nepal from 2014 to 2016 was performed. Diagnoses were classified into various categories. Informed consent was taken from all participants. ResultsdAcute diarrhea was the most common ailment reported among the participants (18%), followed closely by musculoskeletal problems (17%). Altitude illness made up 6% of care provided. Approximately 35% of the athletes were using acetazolamide as prophylaxis for high altitude illnesses. The 1 case needing evacuation in the 3 iterations was high altitude pulmonary edema. ConclusionsdUltratrail races at high altitude pose a challenge in terms of provision of medical care in a remote setting with limited resources. However, most of the illnesses are minor in nature and easily managed by the race doctor. Knowledge of common illnesses among travelers to the area can help aid in preparation and provision of proper care, especially in remote settings with limited resources.

Musculoskeletal Injuries in Ultra-Endurance Running: A Scoping Review

“…They were all similar and comparable in length, and duration, of between 5 to 7 days, covering 219-240 km but differed in environmental conditions, with 3 of them in hot or desert environment (Krabak et al, 2011;Scheer and Murray, 2011;Graham et al, 2012) and one in cold environment, at altitude (Dawadi et al, 2020). Although two studies (Graham et al, 2012;Dawadi et al, 2020) did not provide specific diagnosis or incidences of MSKI, all injuries were minor and patterns observed were comparable to previous studies (Graham et al, 2012). The rate of MSKI were similar in three of the studies (17.0, 17.4, and 18.2%, respectively), varying between 0.7 injuries/runner and 1.8 injuries/runner (Krabak et al, 2011;Scheer and Murray, 2011;Dawadi et al, 2020).…”

“…The definitions of MSKI varied across the different studies, with some providing no specific definitions (Scheer and Murray, 2011;Graham et al, 2012;McGowan and Hoffman, 2015;Dawadi et al, 2020), whereas other defined MSKI as a disability resulting in a medical encounter (Krabak et al, 2011;Vernillo et al, 2016), or affecting performance (Bishop and Fallon, 1999). All studies reporting MSKI during a race were either documented by the attending medical team (through self-referral/self-reporting system via medical encounters) or by a routine daily medical assessment questionnaire (Hutson, 1984;Fallon, 1996;Bishop and Fallon, 1999;Krabak et al, 2011;Scheer and Murray, 2011;Graham et al, 2012;McGowan and Hoffman, 2015;Vernillo et al, 2016;Dawadi et al, 2020). Studies examining MSKI in training studies defined injuries as either an athlete reporting the diagnosis based on a health care provider encounter or through athlete self-assessment (Micklesfield et al, 2007;Hoffman and Krishnan, 2014;Malliaropoulos et al, 2015;Scheer et al, 2020d).…”

“…Four studies examined MSKI during multi-day UER events on off-road terrain (Krabak et al, 2011;Scheer and Murray, 2011;Graham et al, 2012;Dawadi et al, 2020). They were all similar and comparable in length, and duration, of between 5 to 7 days, covering 219-240 km but differed in environmental conditions, with 3 of them in hot or desert environment (Krabak et al, 2011;Scheer and Murray, 2011;Graham et al, 2012) and one in cold environment, at altitude (Dawadi et al, 2020). Although two studies (Graham et al, 2012;Dawadi et al, 2020) did not provide specific diagnosis or incidences of MSKI, all injuries were minor and patterns observed were comparable to previous studies (Graham et al, 2012).…”

“…Ultra-endurance running is not a uniform sport but can be defined as a broad category with different types of running activities, such as running events by distance (e.g., any distance in excess of the standard marathon distance of 42.195 km), time (timed-UER, e.g., any events over 6 h) and multi day/multistage events (distance or timed events over several days or stages) (Scheer et al, 2020a). UER events can be held on various surfaces (e.g., track, on-road, off-road) (Scheer et al, 2020a) and in extreme challenging environments, putting additional strain on the human body (e.g., extreme cold, altitude, mountain, desert, heat and jungle) (Knoth et al, 2012;da Fonseca-Engelhardt et al, 2013;Gill et al, 2015;Scheer and Murray, 2015;Dawadi et al, 2020;Suter et al, 2020). The most popular race distances are those of 50 km, 100 km, and 100 miles (Cejka et al, 2014;Scheer, 2019;Knechtle et al, 2020), but can also include distances in excess of 1000 km (Fallon, 1996;Schütz et al, 2012;Scheer et al, 2020a), whereas time-limited events often include 6, 12, or 24 h events, with some lasting several days (Hutson, 1984;Bishop and Fallon, 1999;Scheer et al, 2020a).…”

“…The most popular race distances are those of 50 km, 100 km, and 100 miles (Cejka et al, 2014;Scheer, 2019;Knechtle et al, 2020), but can also include distances in excess of 1000 km (Fallon, 1996;Schütz et al, 2012;Scheer et al, 2020a), whereas time-limited events often include 6, 12, or 24 h events, with some lasting several days (Hutson, 1984;Bishop and Fallon, 1999;Scheer et al, 2020a). Multi day/multi-stage events are often held in extreme environments, and athletes often need to carry their provisions, resulting in additional weight while running as a further challenge (Krabak et al, 2011;Knoth et al, 2012;Dawadi et al, 2020;Scheer et al, 2020a).…”