Injury and illness profiles during the 2014 South African ironman ultra-distance triathlon
Smit, Charles Reinecke
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Background: The Ironman South Africa (IMSA) is one of 28 Ironman races worldwide and is one of the most prominent events on the South African sports calendar. The 2014 event was held on the 6th of April in the city of Port Elizabeth in Nelson Mandela Bay. Even though Ironman events are among the most popular long distance triathlons worldwide, there is a need for ongoing data gathering regarding the injuries and illness profiles of athletes during events. The importance of ongoing research is highlighted by the fact that these ultra-distance athletes are exposed to environmental conditions and physiological demands in excess of those that athletes participating in individual sporting events of similar duration experience. Consequently such an event requires a wellorganised medical and emergency system. Aim:The aim of this study was to analyse the medical information of athletes that received medical attention at the 2014 Ironman South Africa (IMSA) event (N=179). Demographic information and medical histories of the athletes that participated in the event were also collected. A detailed report of the weather conditions on race day was included as additional information in this study. The IMSA medical plan was also reviewed to analyse the treatment plans, medical resources and medical personnel that provided care at the event. Method: The study was a retrospective, cross-sectional study. Athletes that presented for medical attention and their related medical notes recorded as standard procedure during the 2014 IMSA event were included in this study. This study undertook to use the information by transferring the data recorded in the medical notes to a data collection form developed for this study. The captured data was then coded and analysed. Descriptive statistics for the measures of central tendency presenting frequency, percentages, means and averages were calculated. Results and Recommendations: Of the 2331 athletes who started the race8% required medical attention. This number is slightly lower than data documented for recent previous IMSA events. At the 2014 event weather conditions were mild and likely played a role in a somewhat lower incidence of injury and illness among the participants. However, the incidence is comparative with international data documented for international Ironman and other triathlon events. IMSA has seen a significant increase in participants and a 1% increase in female participation. Although analysis of the data did not find a statistically significant difference for gender between the group of athletes that did not require any medical attention on race day and the group of athletes that did require medical attention, the trend of an increasing number of female participants needs to be considered in future planning. A statistically significant difference was found for age between the group of athletes requiring medical attention and those athletes that did not. Younger athletes between the ages of 18 and24 years had the largest number of injuries (15%), followed by athletes in the 25-29 year age group (13%). IMSA also recorded an increase in novice participation in 2014 of almost 12% from the previous year. This information, together with the incidence of injury among younger athletes found in this study also deserves further consideration. Race participants, especially novice athletes, should be clearly advised on conditions that may exacerbate heat illnesses such as obesity, lower levels of fitness, dehydration, lack of acclimatisation, a previous history of heat stroke, sleep deprivation, certain medications including diuretics and antidepressants, and sweat gland dysfunction or sunburn. Exercise/exertion related diagnoses were made in 64% of these athletes, with 72 cases of Exercise Associated Collapse (EAC)/hypotension being diagnosed. This finding is supported by literature in which EAC is consistently listed as one of the most commonly encountered medical problems during Ironman and other endurance events. A significant finding of this study also supports existing literature highlighting pre-existing injuries and medical disorders as important factors in identifying the at-risk athlete with 19% of those athletes that received medical attention during the race were on chronic medication. The prevalent use of NSAIDs both before and during the event is another significant finding of this study. This finding may highlight an important need for more comprehensive preparticipation screening and continuous medical education among athletes. Specifically pre-participation screening, the viability of pre-race seminars, and comprehensive medical education by way of more effective and detailed communication with both medical personnel and race entrants needs to be investigated.