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Medical Advice & Guidance for Competitors

Covid 19 (Coronavirus) Guidance

Do not attend an event if you, or someone in your household, has symptoms of Coronavirus, are self isolating, or are in quarantine following a trip abroad. The NHS advice on symptoms can he found here https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms/main-symptoms/

You are advised to carry a face covering and hand sanitiser throughout our event, and comply with rules over social distancing and hand cleansing.

Although the pandemic is officially over, isolated outbreaks are still being reported. It is good practice to monitor the Government website on Coronavirus (Covid 19) measures and follow the current advice on controlling the spread of the virus.

Competitor Responsibility Prior to Entering

By entering one of our events we presume that you already have a good level of fitness and experience and that your current medical state and history are all in good order. We recommend that, where possible, all competitors visit their GP in the weeks prior to the event and complete a general health check, for the sake of a 30 minute appointment it will give you reassurance and it will also inform your GP of the activities you participate in, thereby allowing them to keep more accurate records. If your past medical history includes blood pressure, cardiovascular, cardiopulmonary or any other serious health problems YOU MUST visit/inform your GP in advance of the challenge.

If you are taking any form of medication YOU MUST visit/inform your GP in advance and check that there are no potential side-effects which may lead to problems during the event.

All our events are physically challenging and should not be undertaken without significant thought, planning and preparation. It’s unlikely that you will be able to complete the event if you are starting with illness or injury, so if you should develop any kind of injury or illness in the weeks preceding the event, don’t take the risk.

Anyone who has been on a flight or journey of greater than 3 hours within the last 24 hours should notify the event organiser so that the medics can monitor them throughout the event.


When you register online you will be asked to provide information about any medical condition or information that may be relevant in dealing with an incident during the event. This should include allergies, medication, any recent illness or injury that has resulted in you needing medical treatment. This information will be treated as confidential. We may not issue race numbers for every event, so making us aware of any medical issues when you enter is very important.

Before the Event

Ensure you prepare well. This involves getting plenty of rest, food, drink and sleep in the run up to the event. If you are recovering from another event, it may take your body a few weeks to recover properly. Back to back events require training and preparation.

During the race

Our event medical team will be in place at various points on the course and our checkpoint staff will be monitoring you as you pass through. They may ask you a few simple questions and ask you to sit down for a few moments, drink and eat something if they are concerned. Please listen to them and take their advice. You will be issued with a route card which contains a contact number for the event medical team - you can call  at any time during the event if you feel unwell or need advice between checkpoints.

In a situation where the medics recommend that it is unsafe for a competitor to continue their decision is final. Competitors cannot continue as part of the event against medics advice.

Common injuries, illness & treatment

There are many common injuries and illnesses which you may suffer as a consequence of competing in extreme running events. This is a list of the most common and is not a definitive list, it has been compiled to raise your awareness of their occurrence.

Ibuprofen vs Paracetamol

Ibuprofen – one of a group of drugs known as Non-steroidal anti-inflammatory drugs (NSAIDs) which include Nurofen, Ibruprofen, Naproxen, Aspirin and Indomethacin. NSAIDs are commonly used in sports medicine and have known anti-inflammatory, analgesic (pain relief), antipyretic (temperature reducing), and antithrombotic (clot reducing) effects.

NSAIDs analgesic action is not significantly greater than paracetamol for musculoskeletal injury but does have a higher risk profile, with side-effects including asthma exacerbation, gastrointestinal and kidney failure, amongst others. If you are on a very long race and require analgesia, Paracetamol is a safer drug.

For more advice or to discuss personal circumstances, please speak to our medical team or your own doctor before you race.

Foot care

Something as simple as lack of foot care may well cause you to drop out of the event. Blisters can cause extreme pain and make it impossible for you to run and walk and prevention is always better than any attempt to cure. Use trusted socks and shoes, especially over rough terrain which will cause shoe ‘twisting’ and increase the likelihood of blisters – as will wet feet. Consider changing into dry socks at check points. If you blister easily consider pre-taping, plasters or Vaseline to reduce likelihood but do try these out in advance. Take a blister treatment pack with you and stop as soon as you feel the start of blisters rather than continuing to the next check point.

Sprains and strains

Uneven terrain increases likelihood of sprains and strains, especially when you are tired and travelling in low light or darkness. Wear correct footwear and ensure that they are fastened snug to remove excess movement. Most sprains and strains can be dealt with by use of an ice pack, compression, rest and elevation.


It is possible that you may fall and the impact may cause trauma such as a broken bone or torn muscle. In this event you will be forced to withdraw but you should be prepared to self-treat as you may be several miles from the next checkpoint. Ensure that you have a first aid kit to include bandages and dressings and you also have sufficient clothing plus emergency blanket / bag to keep warm. If you are unable to move, ask the next competitor to inform the checkpoint marshal and / or use your mobile phone if you have reception to inform the emergency services - 999 / 112 and the  Extreme Energy team. Remember even if you have no signal you can ring the emergency service, they can also triangulate your position through your mobile phone.

Concussion – Head Injury

A fall or banging your head into an obstacle may result  in a brief period of unconsciousness, or just feeling sick or dizzy – you may have sustained a serious head injury. Report any such instances as soon as possible to our medical team (via the Crew if a medic isn't at your location) and they will treat you and assess your fitness to continue. Physical activity in conjunction with concussion can lead to more severe symptoms and/or delayed recovery.  If in doubt please ask, your safety and well-being are a priority.


During periods of warm weather, increased activity/endurance events > 1hour or long journeys (especially long haul flights or long journeys), there is an increased risk of dehydration for all competitors and you should ensure that you drink regularly (guided by your thirst) to prevent its occurrence. (Normal fluid intake is about 2 litres a day in adults)There will be water available at all check points, carry a water bottle or similar between checkpoints to keep yourself topped up. Dehydration results in lowered blood pressure, increased heart rate and raised body temperature which can all lead to a decrease in performance - and it can raise your risk of blood clots in your calf (Deep Vein Thrombosis) or lungs (Pulmonary Embolism) which can be fatal.

Signs of dehydration are:

  • Drawn looking appearance
  • Pale / pasty skin
  • Low blood pressure
  • Difficult to find pulse
  • Very rapid pulse
  • Dizziness, weakness and confusion

The treatment for dehydration is rest and drinking fluids, re-hydration should take place slowly as opposed to drinking large amounts within a short time. Electrolytes are an important factor in this process.

Electrolytes in Sport

Typically, an athlete should aim to replenish fluids equal to 1.5 times their estimated deficit. Electrolytes are an important factor in this process.

Electrolytes are used during exercise to address high electrolyte loss or after exercise to help restoration of fluid balance. Rehydrating with plain water or fluids low in electrolytes can lower plasma sodium levels, causing heart and circulatory problems.

Sodium can be replaced by eating salty foods (cereal, cheese, crackers, marmite, chicken noodle soup etc) but electrolyte supplements can be useful for rapid targeted restoration of electrolytes. Salt tablets SHOULD NOT be used except under medical supervision/advice.

Please take advice from our medics if you are considering electrolytes for the first time.


Hypothermia is a reduction in body temperature caused by poor weather conditions and general fatigue. Heat is generated within the body through metabolism as a waste product of energy production. If energy production drops due to factors such as low blood sugar, then body temperature may also drop. One of the biggest factors which contribute to hypothermia is wind chill, most prominent on higher ground.

Sitting around for extended periods in cold/wet clothing is also a risk, especially at checkpoints. Keep out of the wind and consider additional dry/warm clothing if taking a break. Most heat is lost from the head - so always wear a hat or buff.

Signs of hypothermia:

  • incoherent speech
  • shivering
  • slow and weak pulse

Treatment includes warming up as soon as possible by removing the affected person from wind chill, changing into dry clothes, raising blood sugar and drinking warm fluids.

Heat Illness

Many factors — environmental and personal — contribute to heat stroke. Early warning signs of impending heat stroke may include irritability, confusion, apathy, belligerence, emotional instability, irrational behaviour, giddiness, undue fatigue, chills, goose bumps, and vomiting. Stimulants speed heat build-up, so products that speed athletes up heat them up. Amphetamine and cocaine are the most dangerous, but ephedra is the most prevalent. Many dietary supplements tout ephedra for weight loss or quick energy. But ephedra poses many health risks, including heat stroke. Heat-stroke risk is compounded by drugs that impair sweating, like some antihistamines, antispasmodics, and medications for depression.

Preventing and treating heat stroke in sports involves adequate hydration and rapid cooling of affected persons. Remember - cool first, transport second.

Research on recovery is sparse, but it seems likely that most athletes treated early for heat stroke can soon safely return to their sport.


If your question has not been answered here please contact us with your enquiry.

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