I have had a though start of 2014 from a runner’s perspective. While skiing in Åre, the largest Swedish ski resort, I was hit by a snowboarder from behind when I was skiing down a rather icy and steep piste/slope. I thought I was skiing fast, but apparently the snowboarder was either faster, or, more likely, had less control. Anyway I was hit on my right leg and I must have twisted my leg as the right ski binding released even though I did not fall. I did not feel a lot of pain right at the moment, I guess due to the adrenaline rush, but when I had come halfway down the slope after putting on my ski again it started to feel bad in my right knee. Fearing a serious knee sprain I stopped skiing for the day and, as my knee was not very painful and not swollen the following morning I went up with the cabin to the mountain high zone to ski again. It then felt really bad, however, so there was no skiing that day either and the following day my knee was so swollen and painful that I barely could walk. I went to the local primary care physician/general practitioner office and as Åre is in a ski resort they have both clinical experience and a fairly modern x-ray facility. Luckily, there were no broken bones or torn bone fragments from a ligament rupture (see X-ray picture), and the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) and the medial part of the knee appeared to be intact and stable. However, I had so much pain in the posterolateral corner of the knee that it was difficult to examine. There appeared however luckily not to be a complete avulsion of the popliteus muscle tendon or the arcuate ligament (popliteofibular ligament, fabellofibular ligament, popliteomeniscal fascicles, capsular arm of short head of the biceps femoris and anterolateral ligament). The swelling and pain has since last week subsided considerably and I have now started to bike to work and work on rehabilitating the knee. I was on a follow up visit with an orthopedic surgeon specialist in the end of last week and in the worst case scenario there is a damage to the lateral meniscus and I am now waiting for an Magnetic resonance imaging (MRI) of the knee. Anyway, it felt so good this weekend so I could not refrain myself from putting on my running shoes and go for a slow run in the snow which has now finally come to Uppsala as well.
|The plain X-ray looks good - now waiting for the MRI|
Being through a comparatively benign accident like this I started to think about how lucky I have been to never have injured myself through an accident while running. I have rarely even experienced a sprained ankle. Also thought about my wife who was in a serious car accident being hit by a large truck the past weekend; she was thankfully unhurt but our car was completely demolished. Thinking back to Tor des Géants (TDG) last year where the Chinese trailer Yuang Yang died during the first night of the competition as he fell descending Col Crosatie and sustained a head injury I wondered how common serious adverse events like that are in mountain trail running and skyrunning. Not surprisingly, I could not find any good studies on incidence, prevalence or mortality from accidents in mountain running. That they do exist is evident from tragedies similar to the one happening at this year’s TDG. Notable examples in recent years are for instance the tragedy at the Grand Raid du Mercantour in France in 2009 when the three runners Christine Gaussin, Hervé David and Philippe Burdin died of hypothermia after supposedly falling down a grassy slope at an altitude of 2,300 meters after being caught in a violent snowstorm; the similar death of hypothermia after a fall of Brian Belfield when he was competing in the Buttermere Sailbeck Fell Run in the UK in 2012; the strange disappearance and supposed death by a fall or similar accident of Michael LeMaitre in the 5 kilometer (3.1 miles) long Mount Marathon Race in Seward, Alaska in 2012; and the fatal fall of Thierry Delaprez over a cliff at a technical section of Le Grand Raid Réunion/ La Diagonale des Fous in 2012.
The best recent study of injury rates in ultramarathon runners is probably the study by Krabak and colleagues entitled “Study of injury and illness rates in multiday ultramarathon runners” published in Med. Sci. Sports Exerc. 2011; 43: 2314-2320. In this study they prospectively followed 396 runners competing in the RacingThePlanet© 4 Desert Series of ultramarathon races from 2005 to 2006. A total of 1173 injuries/illnesses were observed with 1111 (94.7%) considered to be minor in nature. Of the 62 (5.3%) major injuries/illnesses, resulting in a runner discontinuing the race, most were due to medical illnesses (58%) and less likely to involve a musculoskeletal injury (22.6%) or skin disorder (19.4%). There were no deaths or serious accidents.
|From Krabak et al. 2011|
In another study by Fallon entitled “Musculoskeletal injuries in the ultramarathon: the 1990 Westfield Sydney to Melbourne run“ published in Br J Sports Med 1996; 30: 319-323 did not observe any serious injuries in the 32 runners followed, but a great number of non-serious issues due to the strenuous activity, in inflammation of the particular the extensor retinaculum at the anterior aspect of the ankle ("ultramarathoner's ankle"). Comparing the studies in ultramarathon running with studies in regular marathon shows, not surprisingly, a similar trend in serious illness and death due to medical issues and a study by Mathews entitled “Mortality among marathon runners in the United States, 2000-2009” published in Am J Sports Med. 2012; 40:1495-1500 identified 28 people (6 women and 22 men) who died during marathon races among 3,718,336 total participants over the 10-year study period. The overall male and female death rates for the 10-year period were 0.75 (95% confidence interval [CI], 0.38-1.13), 0.98 (95% CI, 0.48-1.36), and 0.41 (95% CI, 0.21-0.79) deaths per 100,000 finishers, respectively.
There are no studies of mountain and trail running and I would perhaps expect a lower mortality rate due to cardiovascular illnesses as I expect the participants to be more experienced, fit and physically prepared for the races. There will also be a lower risk compared to high altitude climbing and other activities in the mountains. However, there will always be a certain risk for serious injuries and deaths due to the objective dangers also in mountain running and I fear that this risk might increase as the races tend to be more popular and the trails more spectacular. After all, the mountain environment is something to really respect even at the moderate altitudes of 2000 to 3000 meters common to many mountain marathon races and also at even lower altitudes it might be a challenge to pass a cliff in bad weather or when you are tired. Despite the best safety precautions by the race organizers and it comes down to the personal judgement and decision by the runner and even luck. After TDG last year I personally have begun to look at the races like I would climbing a summit and try to live after Ed Viesturs words: "Reaching the summit is optional - Getting down is mandatory".