LVH doctor: ‘Disturbing’ injuries from Tough Mudder event led to journal article

Nov. 22--Organizers of the Tough Mudder challenge describe their obstacle course as a test of strength, toughness and camaraderie.

A report published in the current edition of the Annals of Emergency Medicine shows how challenging some of those tests -- including running through a muddy field of dangling electrical shock wires -- can be.

More than three dozen people were taken to the emergency department at Lehigh Valley Hospital-Cedar Crest in June after a weekend of Tough Mudder runs, the paper says.

Doctors saw patients with electrical burns, broken legs, dislocations, mental disorientation and more.

One participant came to LVH with "a full-blown stroke," said Dr. Marna Greenberg, who was working in the emergency department that weekend and was the lead author on the paper.

Others had varying degrees of heart damage and rhabdomyolysis, a condition that can lead to severe kidney damage, the paper says.

And those were the ones who consented to go to the hospital.

In all, 100 people out of what organizers claimed were 22,000 entrants over the weekend required care from emergency medical technicians, with 38 going to LVH, Greenberg said.

"I've never seen anything like this," said Greenberg, the director of emergency medicine research at LVH.

At first, Greenberg said she thought the patients with electrical burns were coming from "some tragic accident. ... To see quite significant injuries on young people was quite disturbing."

Tough Mudder officials declined to comment about the Annals of Emergency Medicine paper or answer questions from The Morning Call.

Tough Mudder, a worldwide event first held in 2010 at Bear Creek Mountain Resort & Conference Center in Longswamp Township, is not so much a timed race as it is an endurance competition where participants, often working in teams, make their way through 10-12 miles of obstacles.

Some events require strength, endurance and balance, including "Lumberjacked," two sets of hurdles that are 6 feet off the ground, and "Trench Warfare," a set of narrow, muddy trenches through which participants crawl.

Others, however, test competitors' fears and ability to withstand pain. "Walk the Plank" features a 15-foot jump into freezing water, and the final challenge, "Electroshock Therapy," is a run through a field of live wires over a muddy, rutted surface.

Training is essential to getting through some of the events, Greenberg said, but no amount of training can prepare competitors for electrical shocks while tired and wet or the impact of jumping off 9-foot-high ledges.

The report indicates that the athletes brought to the emergency department after the competition June 1-2 in Heidelberg Township were largely people who were in prime ages for strenuous competition.

The youngest patient, an 18-year-old man with no medical history or family history of heart disease, was admitted to the hospital with inflammation of his heart muscle caused by 13 electrical shocks on the last obstacle, the report says.

Another participant, a 31-year-old man, had completed 20 of 22 obstacles when he "developed sudden onset of speech difficulty, confusion and inability to move his entire right side."

Eventually, doctors determined he had suffered a stroke. Follow-up six weeks later showed he still had not recovered fully, the report says.

In writing the paper, Greenberg and her LVH colleagues were careful not to indicate that the competition caused all of the injuries, leaving the possibility that some may have happened simply by exercising strenuously in the warm June weather.

At the same time, she noted, emergency physicians have had a lot of experience with people being hit with electrical currents from weapons such as stun guns.

"They don't land you in the hospital with these injuries," she said.

Greenberg also said she and her colleagues published the paper in the peer-reviewed journal to "start the conversation" among medical professionals about extreme competitions. She said she searched medical literature and found nothing.

"Let's start to collect some data," she said, adding that researchers would want to know about the types of injuries, the different impacts on male and female participants and the implications of the electrical shocks.

Dianne Andresen, 46, of Upper Macungie Township said she understands what's at stake.

"To me, it's a personal challenge, it's a team challenge," she said. "It's really fun and we love it and we're going to do it again."

Andresen said she; her boyfriend, Jeff Newhard, 47; and family members have gotten hooked on extreme competition sports in recent years. She said she's worked out for years, but took up Tough Mudder and other competitions to test herself.

"You have to be smart about what you can do and what you cannot do," she said.

Tough Mudder came under scrutiny after a Maryland man accidentally drowned at an event in West Virginia this year. According to The Baltimore Sun, at least four people have died in extreme competitions like Tough Mudder, and injuries during competitions have spawned lawsuits in several states.

Andresen said she knows what happens sometimes when people run through the electrified obstacles.

"Yeah, I did get shocked and I went down and I was fine," she said about past events, adding that she's seen others fall on their faces.

Newhard, who said he recently competed in a 24-hour competition, said he doesn't like the feeling of being zapped, but it's over quickly and he can move on. Competitors also can walk if they're wearing down and skip the obstacles if they feel unsure about them, he said.

"There's no shame in walking," he said. "For the most part, people enjoy it and have fun."

Andresen and Newhard said they signed waivers before the contest. In addition, Tough Mudder encourages people to consult their doctors before registering, and says it provides insurance up to $100,000 per person to cover medical costs.

Those costs could include surgery, hospital stays and transport. Greenberg credited emergency medical services squads for heroic duty treating and transporting so many patients at the competition.

She said that unless organizers of such events can satisfy health officials that they have adequate EMS support and proper monitoring of the electrical current at the shock obstacles, "I'd have to tell my family this is not the best place to enjoy sports and athletics," she said.

To Greenberg, the paper at least can be a discussion point to consider what can happen in an extreme competition and the consequences of a serious internal injury.

That's Andresen's view as well.

"You can die running through the street and getting hit by a car," she said. There's risk in everything, "unless you want to sit at home in a box and do nothing."

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