UW News

April 10, 2008

Going to extremes: Physician-athlete studies endurance

UW Health Sciences/UW Medicine

The 4 Deserts races traverse some of the most beautiful, inhospitable terrains in the world: the Gobi, Sahara, Antarctic, and Atacama Crossing in Chile. Temperatures in the series ranged from 120 degrees to 20 below zero, and altitudes from 14,000 feet to below sea level. The races course over rocks, sand, ice, snow, and through rivers.

What makes ultra-endurance athletes not only willing to enter, but also able to finish, races like these?

That’s what UW Medicine rehabilitation and sports medicine specialist Dr. Brian Krabak wanted to find out when he was asked to be a medical director for 4 Deserts races that were held this past year. He was a good fit for the job. He had competed in more than 30 endurance events: Iron Man, Half Iron Man, Olympic, and Sprint triathlons; TransRockies Challenge and XTERRA mountain bike rides; Marine Corps Marathon, and adventure races including Endorphin Fix, Mega Dose, and the Wild Onion Urban Race. Racing the Planet, which sponsors 4 Deserts, wanted physicians who could give medical care in Spartan settings and understand stresses on the athletes and their desire to finish.

Krabak had gained sports medicine experience as a fellow at the Mayo Clinic prior to joining the Johns Hopkins Sports Medicine Team. Since then, he has been a physician for athletes at the 2002 Salt Lake Winter Olympic Games and swimmers at the 2006 Athens Summer Olympic Games. He was also a team physician for the Baltimore Orioles and for the Johns Hopkins University athletics programs.

Today Krabak is a UW clinical associate professor of rehabilitation medicine and of orthopaedics and sports medicine. Krabak treats a variety of adult musculoskeletal problems at UW Medical Center- Roosevelt’s Sports and Spine Medicine Center. He also sees young people ages 10 to 18 at Children’s Hospital and Regional Medical Center’s sports health clinic. Krabak’s clinical interests relate to endurance runners, cyclists, and swimmers. The 4 Deserts races were an unusual opportunity to study a “captive audience” of high-endurance athletes over seven consecutive days of extreme racing conditions. His subjects were mostly men (80 percent) and mostly in their 30s, with an age range from late teens to early 70s.

“People in their 30s seem to do better at these races than do younger people,” Krabak said. “They may not sprint or run as fast, but they have more experience sustaining themselves.”

His study asked: What kinds of injuries occur and when? What medical problems surface during the race? What factors enable some people to finish the race or make them frontrunners? What causes people to leave the race? What types of injuries still allowed runners to finish safely?

Two years of data showed that 69 percent of the racers’ visits to the medical tents were for skin injuries, 18 percent for musculoskeletal injuries, such as sprained ankles, and 12 percent for medical problems. Most of the skin problems were friction blisters, abrasions, or blood blisters. If the skin tore off or an infection formed under the skin, these minor conditions became more serious. Some runners with inflammations like tendonitis and bursitis continued the race.

Medical problems such as dehydration, vomiting, fatigue, and hyperthermia were the prime reason for pulling a runner out of the race early. Medical problems were more likely to occur during Day One of the races, with a shorter peak at Day Four. Day One illnesses were often related to the harsh environment, improper hydration, hot or cold temperatures, poor nutrition, lack of sleep, and lengthy air travel. Athletes who started the last 50 miles on Day Five were apt to finish.

“The frontrunners looked fine throughout the race,” Krabak said, “This might be because they knew how to take care of themselves. It’s the middle runners who pushed themselves who ran into trouble. Frontrunners maintained their bodies and weight with proper nutrition and the right amount of fluids. Runners who gained weight from eating or drinking too much, or who lost weight because they ate or drank too little, were more likely to become ill.”

His study group was not an average population. Who was crazy enough, he said, to run through a desert? All the runners had proven themselves in other endurance activities. One man had never run a marathon before, but was previously an Olympic Nordic skier.

Diagnosing and treating people in remote deserts, without magnetic resonance imaging machines or sophisticated laboratories, forces a physician to rely on history taking and physical exam skills, Krabak said. In case of an evacuation, the ambulance might be hay-powered.

“We’ve used donkeys and camels to take runners out of difficult spots.”

Learn more about Krabak at: http://depts.washington.edu/rehab/contacts/krabak.html or


Learn more about Racing the Planet and see videos from the 4 Deserts races at: http://www.racingtheplanet.com/.