I haven't been this worried since I was a kid and afraid of heights.

September 10, 2012 1:16 PM

I want to start doing Tough Mudders / Warrior Dashes / other types of mud runs. But a (mostly) unfounded fear of disease is holding me back. Help me figure out how (un)reasonable my fear is so I can participate!

Before anyone jumps on me, I realize that a Tough Mudder is a very different event from a Warrior Dash. But both sound fun in their own ways, and I the same fear is keeping me out of both.

Early this summer my fiancée recruited me for a Warrior Dash. I was hesitant, but decided to give it a shot. We ended up having a conflict that weekend and didn't get to participate in that run, but said we would do it another time. After the race that we missed, several participants ended up in the hospital with necrotizing fasciitis (warning: an image search for that term is NOT for the sqeamish) and one even lost a limb.

A natural question is "are you sure that happened, and isn't just a rumor / urban legend?" Well, my sources (yes, more than one) treated the patients and I don't know them to exaggerate or present rumors as facts, so I'm as certain as I can be that this happened, that the diagnosis and outcomes are accurate, and that the common thread between the several patients was participating in the aforementioned mud run.

After that, my fiancée and I both got a bit spooked and lost interest.

I'm starting to get interested in these races again, but as soon as I get interested in signing up I find myself obsessing over the chance that I'll contract flesh-eating bacteria instead of committing to the race. This is especially unusual because I enjoy long camping trips, and am perfectly happy to get scraped up and endure endless dirt, mud, grime, and lakewater without worrying about disease. Despite being pretty confident that I'm unlikely to contract anything horrible when I go into the woods for a week, in my mind participating in muddy obstacle course runs is now inexorably linked with flesh-eating disease.

When I go camping, I feel reasonably healthy and prepared and I don't really fear injury in disease - I know things can happen, but I believe that I and my companions will be able to react appropriately and make it out safely. But when I think about mud runs (which I have never done before), I feel like I'm throwing caution to the wind and exposing myself to significant danger since there really isn't a preventative measure besides "don't have any cuts," which is not helpful because I frequently get minor cuts and abrasions. I suspect that's an unreasonable fear, but I have no data to convince me that it's unreasonable.

So help me out, hive mind - help me gauge my likelihood of contracting disease while participating in one of these events and get over my fear of picking up a life-threatening illness so I can go out and have fun! Any advice is welcome, but data such as "you are more likely to die in a car crash than have this happen" tends to work for me, so if you happen to have the statistics similar to (people who contract necrotizing fasciitis) / (people who participate in mud runs) to compare to traffic injuries that might fix me right up.

posted by Tehhund to health & fitness (11 answers total)

There are about 2.7 million injuries due to car accidents in the US annually vs a few thousand cases of necrotizing fasciitis, so that is the number you asked for (sourced from WolframAlpha). Of course virtually everyone drives/rides in a car vs. a small fraction of people who do strenous outdoor mud races, so I'm not sure it's the best comparison.

From a strict risk-analysis perspective attempting to move quickly through obstacles like barbed wire is indefensible, but that misses the point of these sorts of things. You're better off weighing the benefit (fun! adrenaline rush! accomplishment!) against the risk (minimal, especially if you examine yourself for injuries and clean yourself thoroughly immediately after the race instead of, say, getting trashed) and decide to go ahead.

NF can happen any time you break your skin, which everyone does all the time. The precautions you'd take in this case are the same as any other. Wash cuts or bruises as soon as possible, and pay attention to any sudden changes. It's also worth noting that 70% of NF cases are in patients that are already immunocompromised in some way.
posted by Wretch729 at 1:43 PM on September 10, 2012 [4 favorites]

Ending up with necrotizing fasciitis is like dying of a brain aneurysm at the age of 30: it happens to some people, there's basically nothing you can do about it, and you won't get anything done if you sit around worrying about whether you'll get it.

Furthermore, the mud run concept was developed by British Special Forces veterans to reflect their own training. Now, I don't know about you, but I am pretty sure that the British Special Forces is not suffering incapacitating casualties due to flesh eating bacteria. In fact, they seem pretty badass to me.
posted by deanc at 1:45 PM on September 10, 2012 [3 favorites]

Are your sources able to inform you of what the suspected reason is that the participants you heard about contracted necrotizing fasciitis, or whether they had any risk factors that made them susceptible to it?

As far as I can tell, there isn't any particular reason why you should be at risk for necrotizing fasciitis due to participation in Tough Mudders or Warrior Dashes versus any other athletic activity - usually the risk factor for cellulitis (MRSA bacterial infections, for example) for athletes is sharing sweaty, unclean gym equipment.

I'm an emergency department doctor and I've seen many people with MRSA/cellulitis (some of whom were athletes, usually wrestlers or football players), but very few with necrotizing fasciitis. It is a very rare condition. So I would definitely be curious as to why these folks contracted it and whether this is a Thing - googling doesn't seem to turn anything up, I doubt there is any data on mud runs etc specifically, but perhaps reading these articles about the epidemiology of necrotizing fasciitis will help you see that such events do not appear to be a known risk factor for it, and how rare it is.

One particular quote from the above:
"About 500 to 1,500 cases of NSTI occur per year in the United States. Although NSTIs occur in all age groups, they are most likely to occur in patients older than 50 years with comorbid medical conditions such as diabetes, hypertension, peripheral vascular disease, alcoholism or cardiopulmonary disease. Other known predisposing factors include HIV infection, history of IV drug abuse, cancer, and corticosteroid use."

To quote the eMedicine article:
"Minor insect bites may set the stage for necrotizing infections."

So, are you still going to live your life in fear? I recommend against it!

xposted with Wretch729
posted by treehorn+bunny at 1:46 PM on September 10, 2012 [5 favorites]

Medscape says: The incidence of NF in adults has been reported to be 0.40 cases per 100,000 population

Per Medscape (same article), the risk factors for it don't seem to have anything to do with things particular to a mud run--diabetes, being immunocompromised, cardiac issues, being on chemotherapy, etc.

So, I think the incidence in people who participate in mud runs is probably the same (or less--since there probably aren't too many people on chemo or with major heart issues who do mud runs) as in the regular adult population--0.40 cases per 100,000.

And if anecdata will calm the beast in your mind better than regular data, I got a laceration on my hand at a mud race in May. I was super muddy and it hurt like a mofo. I flushed with in some saline that I had around for my contact lenses, put a bandaid on it, and went home. It was fine within 24 hours.
posted by needs more cowbell at 1:46 PM on September 10, 2012 [1 favorite]

Thanks, these answers are already helping. Keep them coming!
posted by Tehhund at 1:57 PM on September 10, 2012

I got wounded pretty badly near the beginning of last year's Rugged Maniac in North Carolina. I then dragged the wound through dirt, streams, mud and stagnant pools with no ill effect. How did I injure myself? Tripping and falling down what was essentially a bulked up speed bump -- an injury I could have received walking down the stairs of my house. If you need an excuse to stay away from a mud run, necrotizing fasciitis seems like an extreme one to grasp on to. Suck it up and run!
posted by Rock Steady at 2:04 PM on September 10, 2012 [1 favorite]

The only person I actually know who got NF is in his 70s; he bikes a zillion miles a day, all over San Francisco and Marin. He theorizes that he got it when he was taking a break on a ride and sat on a bench in Golden Gate Park and got a tiny scratch on his thigh. This was a few years ago and he's fine and back to biking from his home in the southern part of the city to the top of the Marin Headlands every day.
posted by rtha at 2:28 PM on September 10, 2012 [1 favorite]

Oh, on a related note, this is such a no-brainer but you have had a tetanus shot in the last ten years right?
posted by Wretch729 at 4:08 PM on September 10, 2012

I met a girl this weekend whose explained her scratched-up shoulders were from crawling under barbed wire in a Spartan Race. Forget necrotizing fasciitis, that sounds like a great way to get a blood-borne disease, like hepatitis or HIV.

You can always choose not to do parts of the race, but it seems like it'd be a waste of your entry fee. Attend the next race of each genre as a spectator and inspect the course.
posted by homodachi at 4:30 PM on September 10, 2012

a relative got a really bad staph infection in one of these races. it just finally healed after six months.
posted by wurly at 6:40 PM on September 10, 2012

I'm not sure about this (can't Google it because I will die of heebie-jeebies, also just watched Cabin Fever soooo) but this is the same necrotizing fasciitis that can be contracted as a result of brown recluse spider bites, right? The first time I visited Texas I stayed in a recluse-infested house and became obsessed and terrified by the idea of getting necrotizing fasciitis from a spider bite. It turns out that this is actually quite rare, and typically a worst case scenario (often when people don't get proper treatment after a bite). So I realized that letting my fear of a tiny risk keep me out of the state of Texas indefinitely was unreasonable.

On the other hand, reading some of these answers about barbed wire-- I would be extremely reluctant to expose my bloody scratches to obstacles on which others had also been gouged and scratched. The risk of staph or necrotizing fasciitis or other infections and issues relating to blood exposure would actually be enough to keep me from performing in one of these events-- it's low, but you're deliberately exposing yourself to risk factors for what seems to me a low utility benefit. (I also don't kiss strangers because I don't want to get cold sores though, so I guess it depends whether you're that type of person or not.) I think the advice about sports and MRSA sounds pretty instructive, if this is the kind of thing you're really set on doing.
posted by stoneandstar at 12:47 AM on September 11, 2012