Holistic Recovery Methods for Obstacle Course Racers and Tactical Athletes
Obstacle course races (OCR) such as Spartan Race and Tough Mudder share some common aspects to tactical training for those in the military. The overall stresses of tactical military training are far greater than that of high-level OCR athletes, but there are injuries that are similar and need to be addressed. There is far more research on military training than there is on OCR training and events which is another reason these research and protocols for recovery have been combined here. The rise of interest in obstacle course races has grown with an approximate participation level of 80 000 people over 3 seasons (in only one country) with an injury amassing to almost 1800 incident reports (Rabb & Coleby, 2018).
In both types of training and field action, there are many environmental unknowns such as terrain, weather, wildlife, and high-risk obstacles in the way. Each of these factors increases the chance of at least some sort of musculoskeletal, which is one of the highest ranking of injury reports (Rabb & Coleby, 2018; Wise & Trigg, 2020). The high physiological demands involved in the training leading up to an event or the call-of-duty, comes with its own severe threats and indemnities. What is less frequently reported on or addressed, are the invisible injury risks and occurrences that can and do occur (Baghurst, 2019; McBratney & De La Motte, 2018). It is for the reason of multifactorial injury risks to all body systems that it is recommended to use a holistic approach in prevention or rehabilitation of injuries.
Injury Risks/Mechanisms and Prevention/Treatment
Exertional Rhabdomyolysis: Exertional rhabdomyolysis is a dangerous and possibly fatal state where there is such severe damage to muscle tissue that apoptosis occurs. The intracellular components of the muscle tissue, often inclusive of myoglobin, creatine kinase and lactate dehydrogenase, leak into the extracellular space and into the bloodstream creating a cascade of overloading on endogenous filtration systems such as the kidneys, as well as affecting autonomic responses and biochemical processes (Torres et al., 2015). This type of rhabdomyolysis typically occurs when training volume and load is beyond what the host is able to manage and recover from. In order to prevent this clinical condition from occurring, it is important to have a gradual increase in training with inclusion of deload periods, and maintenance of proper hydration status.
Physiological/Neuroendocrine Overtraining Syndrome: In order to prevent the physiological and neuroendocrine detriments possible when reaching the level of overtraining syndrome, planning, periodized preparation with data monitoring and tracking of heart rate variability (HRV), Profile of Mood States (POMS), and nutrition and fluid intake, training volume tracking would be essential. The complexity of monitoring and tracking can go far beyond what is listed, but the simplicity and low cost of wearables that monitor and track HRV and heart rate, coupled with simple paper tracking of training volume, nutrition, and POMS keeps things fairly manageable. Minimizing extra stresses of learning new technologies that often go with data monitoring and tracking can improve the likelihood of adherence and most new technology has built in feedback (Xu et al., 2018).
Rehabilitation or recovery once neuroendocrine and physiological damage has been done can take the form of hypoxia/hyperoxia exposure, complete rest, nutritional supplementation, and other clinical nutrition strategies (Canadian Academy of Sports Nutrition, 2020; Susta et al., 2017). Social and psychological supports are just as valuable in the recovery process as the inability to perform can have psychological repercussions not to mention the likelihood of negative mood-states becoming a clinical issue when the OTS level has been reached (McBratney & De La Motte, 2018; Wise & Trigg, 2020).
Musculoskeletal Injuries: The most common musculoskeletal injuries have been reported as being at the knee and ankle joint (Rabb & Coleby, 2018; Wise & Trigg, 2020). Acute responses to the incident would depend on the severity of the injury. Ice, compression, elevation, and immobilization of the area with a reduction of weight bearing for at least a week would be a safe generalized guideline. Proprioceptive and neuromuscular exercises, gentle controlled range of motion exercises, and hip abductor strengthening protocols are useful in the rehabilitation of these joint segments (Chen et al., 2019; Yuenyongviwat, 2020). Depending on the state of the tissues and the response to the initial treatments, direct strength work involving eccentric loading can commence and a reintroduction of compound movements and closed-chain exercises can be reintroduced at a progressive level of muscle endurance to hypertrophy to strength to power moves.
Other: Biochemical risks involving dehydration, heat illness, hypotension, myocardial infarction, muscle cramps, and hypoglycemia can occur and put individuals in greater danger of secondary mechanisms of injury, impairments, or even death. For these reasons it is paramount that a personalized nutrition and/or supplementation protocol be put into place for peri-workouts and surrounding the actual event. A carbohydrate, electrolyte, EAA/BCAA beverage is but one generalized example of strategy to use in the time surrounding and/or during the session/event (Berardi & Andrews, 2017).
The extent of stress upon tactical athletes and OCR athletes differ tremendously, but both often use similar types of training protocols and can face similar injury mechanisms due to this. The data on OCR athletes is not as extensive as that of tactical athletes but when delving into the OCR events, it is easy to see how success in the race can have a heterogeneous risk of injury. Due to the complexity of not only the pre-training involved in OCR and the actual event completion, a similar holistic approach that is becoming more known in military training that addresses multiple body systems is key in prevention and rehabilitation of injuries.
Baghurst, T., Prewitt, S. L., & Tapps, T. (2019). Physiological demands of extreme obstacle course racing: A case study. International Journal of Environmental Research and Public Health, 16(16). https://doi.org/10.3390/ijerph16162879
Berardi, J., & Andrews, R. (2017). The essentials of sport and exercise nutrition: certification manual. Precision Nutrition, Inc.
Canadian Academy of Sports Nutrition. (2020). Overtraining Syndrome. https://www.caasn.com/overtraining-syndrome.html.
Chen, E. T., McInnis, K. C., & Borg-Stein, J. (2019). Ankle sprains: Evaluation, rehabilitation, and prevention. Current Sports Medicine Reports, 18(6), 217–223. https://doi.org/10.1249/JSR.0000000000000603
McBratney, C. M., & De La Motte, S. J. (2018). Collaboration Needed on Human Performance Optimization for Combat Athletes. Military Medicine, 183(7–8), 143–145. https://doi.org/10.1093/milmed/usy020
Rabb, H., & Coleby, J. (2018). Hurt on the Hill: A Longitudinal Analysis of Obstacle Course Racing Injuries. Orthopaedic Journal of Sports Medicine, 6(6), 1–6. https://doi.org/10.1177/2325967118779854
Susta, D., Dudnik, E., & Glazachev, O. S. (2017). A programme based on repeated hypoxia-hyperoxia exposure and light exercise enhances performance in athletes with overtraining syndrome: A pilot study. Clinical Physiology and Functional Imaging, 37(3), 276–281. https://doi-org.ezproxylocal.library.nova.edu/10.1111/cpf.12296
Torres, P. A., Helmstetter, J. A., Kaye, A. M., & Kaye, A. D. (2015). Rhabdomyolysis: Pathogenesis, diagnosis, and treatment. Ochsner Journal, 15(1), 58–69.
Wise, S. R., & Trigg, S. D. (2020). Optimizing Health, Wellness, and Performance of the Tactical Athlete. Current Sports Medicine Reports, 19(2), 70–75. https://doi.org/10.1249/JSR.0000000000000684
Xu, X., Tupy, S., Robertson, S., Miller, A.L., Correll, D., Tivis, R., Nigg, C.R., 2018. Successful adherence and retention to daily monitoring of physical activity: Lessons learned. PLOS ONE. doi:10.1371/journal.pone.0199838
Yuenyongviwat, V., Duangmanee, S., Iamthanaporn, K., Tuntarattanapong, P., & Hongnaparak, T. (2020). Effect of hip abductor strengthening exercises in knee osteoarthritis: A randomized controlled trial. BMC Musculoskeletal Disorders, 21(1), 1–7. https://doi.org/10.1186/s12891-020-03316-z