The Extreme Athlete

Introduction

• The definition of extreme sports (ES) includes any sport featuring high speed, height, real or perceived danger, a high level of physical exertion, highly specialized gear or spectacular stunts, and involving elements of increased risk for major injuries or fatalities. ES activities tend to be individual and can be pursued both competitively and noncompetitively.

• Often taking place in remote locations and in variable environmental conditions (weather, terrain), there could be little or no access to formal medical care, and even if medical care is available, it usually faces challenges related to longer response and transport times, access to few resources, limed provider experience because of low patient volume, and more extreme geographical and environmental challenges.

• Popular ES include mountaineering; hang-gliding and paragliding; free diving; surfing (including wave, wind, and kite surfing); personal watercraft; whitewater canoeing, kayaking, and rafting; BASE jumping and skydiving; extreme hiking; skateboarding; mountain biking; inline skating; ultraendurance races; alpine skiing and snowboarding; parkour; and all-terrain vehicle (ATV) and motocross sports.

• In the past 2 decades there has been a major increase in both the popularity and participation in ES, with dedicated TV channels, Internet sites, high rating competitions, and high-profile sponsors drawing more participants.

• The popularity of ES has been highlighted in recent years by the success of the X-games, an Olympic and Olympic like competition showcasing the talents in ES.

• Social media has had a major impact on ES because it enables extreme athletes to exhibit their talents to a wide audience on a regular basis. Maintaining their popularity on social media can often push extreme athletes to attempt new high-risk maneuvers.

• The risk and severity of injury in some ES are high, and participation in ES is associated with risk of injury or even death, and therefore the extreme athlete—amateur or professional—and the medical personnel treating these athletes must consider the risk of injury and measures for injury prevention.

• Medical personnel treating the ES athlete need to be aware of the numerous differences between the common traditional sports and this newly developing area. These relate to the temperament of the athletes themselves, the particular epidemiology of injury, the initial management after injury, treatment decisions, rehabilitation, and protective and injury prevention measures.

Epidemiology of Injuries in Extreme Sports

• Injury mechanisms in ES are less studied, particularly the injury pattern in many sports.

• The highest injury rates in ES are justifiably found in two groups: new and inexperienced athletes who have just started engaging in ES and experienced extremists who wish to push beyond their limits.

• Reported injury rates in ES may be expected to increase during competition rather than training—a trend well recognized in common team sports as athletes are trying to push their limits even further for prizes, audience, or fame.

• In some ES disciplines, the injury and fatality rates are hard to establish because of a lack of formal recorded events, hours of participation, or number of participants.

• In many situations, the extreme athlete competes against oneself or the forces of nature and the sport is practiced in relative isolation.

• Unlike expected terrain and environmental conditions, which are similar in most traditional sports (i.e., soccer is played on a real or synthetic grass field), comparison of injury rates across ES is difficult, given the large variance in terrain and environmental conditions—often changing variably during a single competition or event.

Specific Extreme Sports and Their Associated Injuries