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You can quit if you want and no one will care. But you will know the rest of your life.

John Collins, founder of the Ironman® World Championship triathlon, 1978

Over the past decade, the popularity of multisport endurance (MSE) athletic events has skyrocketed. As traditional distance races (marathons and ‘century’ cycling rides) have continued to prosper, multisport/triathlon events and obstacle course racing have shown increased participation, particularly in the young adult age group (20–39 years), and with a heavy male preponderance.1

Previously these were considered to be the realm of professionally sponsored outdoor athletes. Now these ‘adventure races’ have also become much more accessible to the general public, as the ease with which one may advance from extended obstacle course racing to self-supported MSE events is now considerably greater, both financially and logistically (Fig. 40.1).

Figure 40.1

Obstacle course racing involves various disciplines and occurs over a variety of terrain


The main medical features of MSE athletic events are:

  • overview of injury prevalence

  • approach to physiological changes occurring in MSE athletic events

  • field management of injuries

  • extrication and evacuation implications.

Athletes attracted to MSE events tend to push their physiological safety envelope, both during training and on race day. Given that these events may span a variety of geographic locations, occur over multiple days and intentionally lack the number of event support services that accompany urban footraces, medical professionals should be aware of additional considerations during preparation for providing medical care at these events (Figure 40.2).

Figure 40.2

MSE events may call upon technical skills requiring additional training and equipment



During previous generations of endurance racing, regimented training programs, including strict supervision and nutrition, seemed to be a factor in what may have been fewer overall and less severe injuries. The most common injuries were soft tissue injuries of the lower extremity, predominantly non-operative sprains and strains, muscle cramps and stress fractures.2 These were followed in incidence by metabolic and environmental problems, such as dehydration, dilutional hyponatraemia, heat-related illnesses and cold-induced tissue injuries. The vast majority of these problems were treated by competitors or on-site medical staff and rarely required hospital-based intervention.1, 3, 4

With the evolution of MSE races to include multiday, multidiscipline events with greater (and sometimes profound) exertion over more difficult terrain and under adverse environmental conditions, the variety and severity of medical injuries became greater. In these competitions, competitors are expected to carry their own food, personal protective equipment and basic first-aid supplies. In some instances, they are ...

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