Portal de Periódicos da CAPES

A Muddied Industry

2014; Lippincott Williams & Wilkins; Volume: 18; Issue: 3 Linguagem: Inglês

10.1249/fit.0000000000000037

1536-593X

Sarah Young, Margaret C. Keiper, Gil Fried, Todd Seidler, JoAnn M. Eickhoff‐Shemek,

Winter Sports Injuries and Performance

FigureFigureFigureFigureFigureOdds are that before 2006, if asked about a mud run, most people would have never heard of one. Fast forward to 2010 and the familiarity with the term "mud run" likely increased, and many people involved in fitness were familiar with the term. Fast forward again to 2014 and chances are not only that a large majority of the population has heard of mud runs but it is likely that many people have either participated in one or know someone who has. Chase (4) referred to this new phenomenon as obstacle course mud runs (OCMR). The increase in OCMR popularity from 2006 to 2010 is evidenced by an 85% increase in participants reported by the Outdoor Industry Association (9). The growth of OCMR also is supported by the millions of participants and multimillion dollars of revenue realized by commercial obstacle-racing companies (18). OCMR may seem to be a new and trendy phenomenon of the 21st century; however, obstacle racing has long been used for assessing physical fitness for youth (12), and military training is well known for its boot camp style of challenging the trainees with obstacles and certainly mud! Robinson (15 p. 1) dated mud runs back "to 1819 for school boys and 1867 as a sport for adults" and specifically to a group of runners in London who called their runs steeplechases. So, whereas the concept of OCMR is not new, the popularity of these events is soaring, and not just with fitness fanatics. With participation in these events soaring and the number of organizations providing one or more obstacle course events, Helliker and Terlep (6) called OCMR events the "fastest-growing participatory sport in American history." Despite the fact that the OCMR is not a novel idea, there still remains a distinct contrast between the historical use of OCMR-type training and the OCMR phenomenon today. In military obstacle training and physical assessment courses, there is a purpose or rationale for mud, obstacles, and extreme conditions. In the commercial OCMR industry, there is not a justification for the extreme nature of many of these events that include nets walls, extreme obstacles, and mud — other than the OCMR events appear to fulfill individual needs. Thus, one may question the necessity of providing such psychologically fulfilling entertainment at the risk of illness, injury, and even death. Why are these events so popular? There seem to be a variety of reasons for the popularity of OCMR. Mullins (12) suggested two theories of physical activity motivation, including achievement goal theory and self-determination theory. Yet, despite a theoretical basis, many people are attracted to these events simply because of the novelty, fun, and diversity they provide in comparison with traditional running events. Also, there is the influential impact of social and mass media. Nearly every event, whether provided by a commercial service provider or a local organization, uses Web site, Twitter, and Facebook sites to promote, advertise, and register participants. Many of the media outlets convey the message that OCMR provides a chance to overcome a physical challenge while bonding with friends in a fun atmosphere. Mullins (12) commented how the media serves as a catalyst for participants who otherwise might not register for OCMR. These media outlets "show people striving, succeeding, smiling, supporting others, and celebrating their obstacle challenge achievements, as well as report spirited accounts of their invigorating experiences."FigureSpartan Race®, Tough Mudder®, and Warrior DashSM are the three most prominent commercial OCMR providers. Of the three, the Tough Mudder® is possibly the most widely known, boasting earnings of more than $150 million in 2013 alone (2). The popularity of OCMR is evident with the number of races that are being organized. It is estimated that, in 2011, more than 300 mud runs took place (16). However, not all of the race organizers are commercial providers because many nonprofit or local municipal parks and recreation programs are getting into the act by providing their own versions of OCMR (10). In 2011, in Florida, it was estimated that there were more than 40 different race organizations providing OCMR (16). The problem is people sign up and participate without always realizing that serious injury is possible and that a handful of individuals have died from their participation in these events. Although media sites also contain the warnings, the lure of the physical challenge and the fun that is portrayed often overshadow the caution people should take or questions they should ask. Without a governing body, there are no uniform safety rules or standards. This creates a legal issue and implications not only for the providers but also for insurance underwriters. Beil (2,3) has suggested that both lawsuits and insurance carriers' willingness to provide appropriate coverage for OCMR may very well shape the future of these events. With the growth and popularity of mud runs increasing exponentially, it is essential for fitness professionals to understand the OCMR industry and possible dangers associated with these events. The link between OCMR and the fitness industry is evident; there are many fitness programs and gyms offering training, boot camps, or classes specific to preparation for an OCMR event. This will be the first of two columns on mud runs presenting incidents occurring during mud runs leading to legal issues and implications. The second column will emphasize risk management for mud run participants, sponsors, and organizers. INCIDENTS IN MUD RUNS Obstacle course mud runs, although varying in difficulty, distance, and obstacles, all have a similar foundation based on a hybrid of running combined with an obstacle or penalty. Common obstacles found in OCMR are mud pits and climbing walls or net walls that participants must climb over. An example of a penalty found in mud runs comes from the Spartan Race® where participants, if they do not complete an obstacle, must do a mandatory set of burpees to move on in the course. It is believed that some of the appeal in OCMR is associated with the combination of these obstacles/penalties, camaraderie, and the idea that to complete an OCMR does not require months of disciplined training (3). However, the reality is that most OCMR, despite typically marketing to an inclusive target audience, are not made for everyone. There are many risks associated with OCMR events, including health-, natural element-, and obstacle-related risks. Health-related risks in OCMR events come in a variety of forms, including environmental illness caused by hypothermia. Typically, during a race, runners would protect themselves from moisture, wind, and cold air (1), yet, in OCMR events, getting wet is often part of the event. For example, in the Tough Mudder®, the participant's first obstacle is a plunge into ice-cold water before embarking on the 10- to 12-mile course, often resulting in numerous accounts of hypothermia. Examples of hypothermia at OCMR include a 2011 Tough Mudder® with more than 150 cases of hypothermia reported (11) and the Tough Guy 15k mud run, which reports more than 1,000 cases of hypothermia since entry into the market (8). Another environmentally linked health risk is heat exhaustion or heat stroke. Heat exhaustion often occurs when individuals become dehydrated or are not acclimatized to exercising in the heat. In the racing industry, it is suggested that summer events are scheduled in the early morning to minimize solar radiation and temperature (1). However, many of the commercial OCMR events often have upward of 10,000 participants per event resulting in waves of participants running at staggered times dispersed throughout the day. Consequently, participants can be exposed to high temperatures resulting in serious heat illnesses. For example, two participants after running in temperatures exceeding 100 degrees, died from heat complications in back-to-back weekends at Warrior DashSM events in Kansas City (17). Heart attacks are another health-related risk from OCMR events. In a 2013 Tough Mudder® event in Pennsylvania, physicians in the local hospital treated 38 people from the event. The symptoms of many of the patients were indicative of heart attacks, which doctors concluded were exacerbated by an obstacle called "electroshock therapy." In this obstacle, participants run through mud and water while dodging electrical wires delivering a jolt of electricity. Calling these obstacles "exceptionally risky," the physicians did not recommend these participants engage in this obstacle and called for "a public health initiative to explore the potential for injury" in OCMR events (7). Bacteria, rashes, and infections are yet another health-related risk associated with OCMR events. In a 2013 Michigan Tough Mudder®, it was reported that more than 200 participants were infected with norovirus from being exposed at some point during the race (14). With thousands of participants going through communal water or mud, the risk of being exposed to bacteria is increased especially if someone is injured or has an open wound, cut, or sore. Cases of methicillin-resistant Staphylococcus aureus (MRSA), flu, and poison ivy are scattered throughout the OCMR social media outlets and various blogs. The actual obstacles also are a source of risk in OCMR events. A number of catastrophic incidents have occurred in the water or mud-related obstacles, which are often the most appealing obstacles to participants. At a 2013 West Virginia Tough Mudder®, one race participant died from drowning in a muddy pool, and in 2012, a Texas man drowned in a river crossing while participating in a mud run (17). Another incident occurred in Michigan where a 21-year-old college student was paralyzed from the chest down as a result of a headfirst dive into the mud pit (13). Similarly, in 2010, a participant was paralyzed as the result of a headfirst dive into the mud pit during the Richmond Filthy 5k Mud Run in Virginia (17). LEGAL IMPLICATIONS Some of the preceding incidents have resulted in lawsuits claiming negligence, or gross negligence, against the race organizers. As stated by Cotten (5), to prove negligence against a race provider, the four elements of negligence must be present: 1) Duty; 2) Breach of Duty; 3) Damage or Injury; and 4) Proximate Cause. Many of the legal implications in the OCMR industry link back to the duty that race organizers owe to participants. With the high number of participants in the OCMR industry, there are legal duties that OCMR race organizers owe to participants. Examples of such duties owed are: Duty to warn participants of dangers and risks associated with OCMR Duty to inspect and ensure safe course and obstacle design Duty to provide sufficient first aid and emergency care Duty to provide trained and qualified staff Injuries are an inevitable consequence of participation in any sport or activity, and the occurrence of an injury does not denote that there is a legal issue. Legal problems emerge when a risk is unreasonably increased or there is failure to act as a reasonably prudent person would act under similar circumstance. There is no other sport or recreation activity that involves participants being shocked for the sake of the event, climbing over net walls, and swimming through mud pits in the same event. Arguably, a reasonably prudent and careful person in any other recreation or sporting activity would not shock its participants. Because of the nature of OCMR, it becomes nearly impossible to compare standards of the OCMR industry with any other sports or recreation accepted standards. Undoubtedly, there is no activity that is completely risk-free, and it is impossible to reduce risks to the point of nonexistence without completely changing the nature of the activity. However, without a governing body in place, it is difficult to assess what is an accepted level of risk with the OCMR industry because of the differentiation between OCMR and other activities. Until there is a type of industry-wide management system in place for OCMR, individual race organizers, sponsors, and participants need to be informed of ways to manage, evaluate, and assess the risks within the obstacle course and mud run industry.