What could possibly go wrong? A lot: Injuries from the Tough Mudder

Nov. 15, 2013 — The Tough Mudder, an extreme sports event that bills itself as "probably the toughest event on the planet," resulted in injuries ranging from multiple electrical burns to seizure-induced Todd's paralysis. A case series of serious injuries sustained by participants in one such race was reported online today in Annals of Emergency Medicine.

"No training on earth can adequately prepare participants for elements such as jumping from a nine-foot height or running through a field of electrical wires while wet and hot," said lead study author Marna Rayl Greenberg, DO MPH, of Lehigh Valley Hospital and Health Network in Allentown, Pa. "The volume and severity of injuries in the Tough Mudder race we studied was unusually high, possibly leading to some permanent disabilities. The 1.5 million people who are predicted to enter obstacle races like this in the next year should be well aware of the risks they are taking."

The Tough Mudder is a 10 to 12 mile endurance obstacle course known as "MOB (mud, obstacles, beer) runs." Dr. Greenberg and her team reported in depth on five patients injured at a 2-day event, who were treated (along with 33 other participants not included in the case series) at a local emergency department.

One patient, who had received 13 electrical shocks during the last obstacle in the Tough Mudder, had multiple burn marks from electrical injuries and inflammation of the heart muscle. After being treated in the emergency department, he was admitted to the hospital.

The second patient had sustained multiple electrical shocks to the head while running through water, which resulted in fainting and altered mental status. After being treated in the emergency department, he was admitted to the hospital.

The third patient, after completing 20 out of 22 obstacles, developed seizure-like activity and altered mental status. He was unable to move his entire right side. After treatment in the emergency department, he was admitted to the intensive care unit with Todd's paralysis and discharged from the hospital to a rehabilitation center 4 days later. Six months after the injury, he still had lower right leg disability.

Patient number four sustained face and head injuries after being struck by two electrical cords and landing face first in a hard mound of dirt. He was treated at the emergency department and discharged against medical advice.

A 25-year-old woman who sustained an electrical shock to the chest just before the finish line, after which she was given a beer to drink, was admitted to the hospital for dehydration and rhabdomyolsis, or muscle breakdown.

"In the past few years, obstacle racing has experienced a rate of growth that may be unprecedented in the history of participatory sports," said Dr. Greenberg. "Organizers, participants and local emergency services need to be prepared for a large number of diverse injuries at Tough Mudder and other similar obstacle races."

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Single mild blast exposure can cause brain injuries similar to Alzheimer’s disease

Sep. 24, 2013 — A new study published in the September issue of the Journal of Alzheimer's Disease reports that even a single mild explosion can cause changes in the brain that have similarities to those found in diseases like Alzheimer's disease and chronic traumatic encephalopathy.

Flying debris or getting thrown against other objects are not the only things that make explosions so dangerous. The primary shock waves that emanate from explosions also can kill a person if they are intense enough. However, most blast survivors experience less powerful shock waves that cause less severe immediate symptoms, such as temporary disorientation or headaches, but on the surface leave victims apparently unscathed. Scientists are especially concerned when these mild blast exposures happen repeatedly--likening them to the repetitive hits endured by boxers and other athletes.

"Some of the big questions in mild traumatic brain injury are about a molecule called tau" said Dr. David Cook of VA Puget Sound Health Care System and University of Washington. "In many brain diseases, tau gets chemically modified to create something called 'phospho-tau'. Phospho-tau is important because it is the starting building block of 'tau tangles', which can build up over time and damage brain cells."

The Seattle team used a rodent laboratory model to study brain changes caused by mild blast exposure. Dr. Cook noted, "We were a bit surprised to find that after only a single mild blast, phospho-tau remained elevated for at least a month."

"Tau pathology is part of end-stage TBI," said Dr. Iboja Cernak of the University of Alberta, Canada and a co-author on this report, "so, it is very interesting to discover that persistent phospho-tau increases also appear to be part of earlier phases of blast-induced neurotrauma."

These new findings raise the possibility that early-intervention with tau-based treatments may someday prove valuable in treating blast-induced neurotrauma.

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