Ultra Sports, Weekend Warriors, and the Implications for Primary Care

Contemporary “weekend warriors” are not impressed by the sporting and recreational pursuits of their parents. As a result, they have invented novel games and intensified other activities already considered rigorous a generation ago.

The new categories of sport include paintball and skimboarding; the expanded group-wherein competitors carry the label of “extreme” athletes- has added miles to marathons, thereby transforming them into ultra marathons.

For primary care practitioners, these activities present new challenges in preventive and follow-up care. For example, athletes who endure ultra marathons are at risk for severe hyponatremia with resultant brain injury.¹ When these athletes compete in exotic locales, they can acquire a host of infectious diseases ranging from malaria to leptospirosis.²

RISKS TO WEEKEND WARRIORS
Even less committed, weekend athletes are at risk. Recreational in-line skating can result in serious head injuries at a rate only slightly less than that of skateboarding. Mountain biking also poses the risk of falls and subsequent trauma, especially if riders do not wear helmets.³

Paintball, which is popular among multiple agegroups, is another weekend recreational activity that can result in serious injuries. Alliman and coworkers⁴ retrospectively analyzed 36 instances of ocular trauma caused by paintball projectiles; 33 of these injuries were multiple, including 1 orbital fracture. In half of those patients who sustained ocular injury, final visual acuity was less than 20/200. Eighty-one percent of the injuries required surgical intervention, including 7 enucleations. The serious injuries tended to occur outside of organized settings, which is why only 2 of the 36 injured players were wearing safety glasses.

Other reported injuries from this sport include penile-scrotal swelling from a paintball projectile that eventuated in circumcision and wide excision of edematous scrotal skin, followed 6 months later by further excision and a cosmetic procedure.⁵

PREVENTIVE STRATEGIES
My intention here is not to dissuade readers from paintball or any of the other newer avocations. With precautions, these sports are intended to be fun and healthy; in fact, many of them are very effective in cardiovascular conditioning. Rather, the information is designed to be a caution leading to appropriate preventive strategies.

A “review of systems” should include an inventory of recreational and sports activities. If a particular endeavor has a safety precaution- safety goggles for paintball or strict attention to water intake in longdistance races-provide the patient with the relevant details. This approach may obviate sight- and life-threatening injuries before they occur.

References:

REFERENCES:

1.

Hew-Butler T, Jordaan E, Stuempfle KJ, et al. Osmotic and nonosmotic regulation of arginine vasopressin during prolonged endurance exercise. J Clin Endocrinol Metab. 2008;93:2072-2078.

2.

Young CC, Niedfeldt MW, Gottschlich LM, et al. Infectious disease and the extreme sport athlete. Clin Sports Med. 2007;26:473-487.

3.

Toth C. The epidemiology of injuries to the nervous system resulting from sport and recreation. Neurol Clin. 2008;26:1-31, vii.

4.

Alliman KJ, Smiddy WE, Banta J, et al. Ocular trauma and visual outcome secondary to paintball projectiles. Am J Ophthalmol. 2009;147:239-242.e1.

5.

Agrawal V, Li C, Minhas S, Ralph D. Paint ball injury resulting in penoscrotal lymphedema. Urology. 2006;67:1288-1289.