The course includes various types of terrain, steep elevation changes, and risks associated with the ecosystems it traverses
The time of year when the race takes place can bring significant weather variations — from heat and low humidity to snow and sub-zero temperatures — sometimes within less than 48 hours. These conditions, combined with the race’s distance and elevation, create challenges that lead both front-runners and back-of-pack athletes to seek medical support at some point during the event. In a race like this, solving a problem early increases your chances of finishing.
Traumatic injuries: foot blisters (most prevalent), joint injuries (sprains, minor wounds), and muscle issues (strains, cramps).
Effort-related symptoms: exhaustion, vomiting, diarrhea, headaches.
Dehydration is rare, but mild to moderate hyponatremia symptoms are frequent.
Pre-race and in-race conversations and advice are the most effective way to help athletes prevent these issues and succeed.
The medical team expects athletes to be as self-sufficient as possible.
Minor injuries can happen at any point, and most of the course does not have a doctor physically present.
You may need to travel several kilometers to reach the next aid station with medical help or medical post.
Therefore, being able to manage minor medical issues (blisters, small wounds, sunburns) and recognize signs of exhaustion, hypothermia, or hyperthermia is the first step to avoiding complications and finishing the race.
Just as you train your body, train basic skills to identify and manage these small problems.
What to expect from the medical team?
Medical support can be requested at any point during the race. The type of support depends on the severity of the issue.
All bases will provide basic care for treating wounds, blisters on the feet, recovery areas, and brief assessment of athletes' physical condition.
Priority for providing care will be given according to the severity of the situation identified—as would be expected in a hospital emergency room.
Examples:
1. Minor blisters will be observed and treated, but will not be a priority.
2. Problems related to exhaustion will take priority over skin problems.
Medical care outside the bases will be provided according to severity:
Minor injuries that do not compromise progress in the race will only be addressed by the medical team at the bases (athletes are expected to take care of themselves).
Medical problems requiring intervention between bases will be addressed at the athlete's location (after the request for support/rescue has been activated).
Common clinical situations
(to help you prepare and reduce the need for medical care)
Most common problems:.
Blisters (phlyctenes).
Diaper rash (maceration).
Sunburn
Blisters (phlyctenes): areas where the layers of skin have separated and filled with fluid.
Risk factors for blisters on the feet:
- Cycle of damp feet > wet feet > dry feet (increases skin fragility)
a. Water; b. Mud; c. Sweat (will always depend on socks and how often they are changed)
2. Terrain with steep slopes
a. Steep ascents and descents (strong traction on the tissues of the feet).
Poorly fitting or poorly secured footwear – friction on the tissues
Socks that allow too much or too little movement of the foot inside the boot
Unusual foot shape (e.g., bony prominences, toes/heel, etc.)
Presence of previous calluses.
Burning sensation in a specific area
| Cycles | Slopes | Footwear | Socks | Anatomy | Burning sensation | Calluses |
|---|---|---|---|---|---|---|
1 factor present = red flag, check your feet when you stop and protect areas with blisters or hot spots.
Prevention
1. Choosing the right shoes and socks is a key step in reducing friction and rubbing on the areas of the foot that experience the most stress.
2. Knowing the anatomy of your feet well allows you to reinforce (“tapping”) the areas most likely to develop blisters.
3. Be very attentive to signs of new blisters - “hot spots” - areas with a burning sensation, and protect them early.
- Ask for help/advice if you have blisters that you find difficult to deal with.
We encourage all athletes to have their own kits for treating foot blisters. If you need support from the medical team to manage this problem, you are expected to arrive at the place of care with clean and dry feet.
Tissue maceration/chafing
Tissue maceration or chafing is the result of repeated friction on the skin. The most common areas for this to occur are:
. Groin/inner thighs
. Areas of friction from backpacks/camel packs: shoulders, back/dorsum, waist
. Armpits
. Transition from sneakers to the leg
To prevent this problem:
. Transition from sneakers to the leg
. Wear breathable clothing made of lightweight fabrics
. Use backpacks with proper adjustments and that are not excessively heavy
. Adjust clothing so that it is not too tight
. Use moisturizing or healing cream if you experience heat, redness, or a burning sensation on your skin.
. Cover and protect the area if the situation is already known.
Sunburn
Whether it is sunny or cloudy, UV exposure will be high, as will the risk of developing sunburn.
To prevent this problem:
- Include applying sunscreen every day in your routine.
Dehydration is a common concern for athletes during training and trail and ultratrail events.
In reality, although dehydration is a real risk, it occurs infrequently in these events.
Dehydration occurs when the amount of water ingested is less than the amount of water lost. There are several ways to calculate water requirements during exercise, but the human body has an alert system that has evolved over millions of years and proven itself: THIRST.
When body water volume decreases by 1%, the sensation of THIRST is triggered.
A 1% loss of body water volume has no significant impact on athletic performance.
For these reasons, our recommendation is: drink water whenever you feel thirsty.
Speed of water loss:
Fast: vomiting, diarrhea, exposure to heat, and/or very intense exercise. (Very hot weather conditions are one of the main causes of rapid dehydration and may occur during this race).
Slow: Moderate physical exercise
Recommendation: drink water whenever you feel thirsty.
Knowing if you are dehydrated
1. If you feel thirsty, you are not dehydrated, but you have lost enough water to need to drink water.
2. Dry mouth.
3. Dry skin (from not sweating).
4. Dark urine. The darker the urine, the more dehydrated you are.
5. Red urine means urine with blood, which is a warning sign.
| Sem Sintomas | Sede | Cefaleia | Tontura | Exaustão |
|---|---|---|---|---|
| Light Yellow | Yellow | Dark Yellow | Amber | Reddish Brown |
Where to drink water:
There is plenty of water available at all bases.
There is drinking water available along the route for athletes to drink (indicated on the race map).
DRINK WATER WHENEVER YOU ARE THIRSTY.
Drink water whenever you are thirsty.
Why do we repeat this message almost like a mantra?
In one word: Hypervolemia. In two... Hypervolemia and Hyponatremia. These two problems are much more common than dehydration.
Fixed hydration plans can lead to both hypervolemia and dehydration. Why?
There are two distinct situations. Examples:
1. Physical exertion was greater than expected in hot and humid conditions, the volume of water lost is greater than expected, you drink a predetermined amount of water that is less than necessary. You become dehydrated.
2. Physical exertion was less than expected in mild weather, the volume of water lost is less than expected, you drink the predetermined amount of water. You become hypervolemic. Suggestion: DRINK WATER WHENEVER YOU ARE THIRSTY.
The second case is the most common, particularly if you do not replace the sodium chloride (salt) lost in sweat. The combination of hypervolemia and salt loss leads to the development of exertional hyponatremia, a potentially serious condition.
Exercise-associated hyponatremia is a decrease in the concentration of sodium chloride (salt) in the bloodstream that occurs during physical exertion.
This clinical condition is relatively common in long-distance athletes. In general, symptoms begin during the event, but the less severe manifestations are nonspecific: weakness, dizziness, headache, nausea, vomiting. In more severe situations, there may be altered consciousness and seizures (in people with no previous history of seizures).
Prevention
Prevention of this clinical condition involves a measure already mentioned: DRINK ACCORDING TO THIRST. It is also recommended that salt be ingested during the race, either with food or mixed in water.
Warning: exercise-associated hyponatremia, if not addressed in a timely and appropriate manner, can have serious consequences. If you have symptoms or questions, contact the medical team without hesitation.
In races such as this event, one of the main causes of osteoarticular pain is in the tibias/shins. The impact on the tibiotarsal joint and tibia structure is significant during descents and on more uneven terrain. The consequences are microfractures, stress on the tibialis anterior muscle, and the development of tendinitis.
Risk factors:
1. Related to gait dynamics
a. Variations in foot anatomy: flat feet
b. Footwear: shoes that are too new or too worn alter gait
2. Related to direct impact/recovery
a. Increased training load
b. Reduced rest time
c. Multi-day events
d. Hard or very uneven terrain
Prevention:
1. If it is a problem you are already aware of:
a. Talk to your doctor (medical team) to prepare for the race
b. Seek advice from a physical therapist
c. Adjust your footwear (if necessary)
2. If it is a recent problem discovered during training
a. Reduce your training load
b. Optimize recovery/rest time
c. Seek help to identify anatomical variations in your feet
Treatment during the race:
1. Ice/cold: ice can be used at the bases; during the race, water from springs, streams, and fountains has a similar effect
2. Rest: associated with cryotherapy (ice/cold), it is essential for recovery
3. Tapping: to strengthen the tendon
Hypothermia is defined as an accidental reduction in core body temperature to below 35ºC. Hypothermia is unlikely in this race.
The race takes place in spring when temperatures are mild. But in spring there is rain and wind, sometimes snow on the mountain peaks, and temperatures drop at night. Both in the humid valleys and on the windy peaks, conditions are right for hypothermia to develop.
Now think about this: on one of these peaks or in one of these valleys, you are tired and slow down... you reduce your muscle activity. The lower intensity of physical exercise reduces your heat production, and the evaporation of sweat accentuates heat loss. These conditions are conducive to heat stress and hypothermia.
During the race, hypothermia significantly affects performance:
1. It reduces overall cognitive performance.
E.g., it makes it difficult to read GPS information.
2. It reduces mathematical cognitive performance.
E.g. Difficulty managing “race times.”
- Increases reaction time.
Ex. More time to coordinate and execute movements.
- Reduces attention span/focus.
E.g. More consultation of the race map.
5. Reduces alertness.
E.g. Less attention to dangerous terrain.
- Reduces the ability to access memories (recent and old).
Ex. Confusion when making decisions about equipment for stages and food.
These signs are immediate warnings, whether self-perceived or identified in another athlete.
How to prevent hypothermia? (AMA)
- Anticipate (risk factors)
Low temperature. Wind . Nighttime . Low sun exposure . Clothing . Perspiration . Physical activity . Nutrition
2. Minimize (exposure to risk factors)
. Windbreaker - reduce heat loss
. Protective layers (2 to 3) – keep heat close to the body
. Extra inner layers (do not walk around in wet clothes)
3. Anticipate (problems during the race)
. Areas where physical intensity is lower (more layers of clothing)
. Prepare high-calorie food (keep metabolism high)
. Thermal blanket and/or chemical heat pack (or equivalent) – in case you need to stop.
Hyperthermia is an increase in core temperature to values above 38°C, with values above 40°C associated with high risks.
It occurs when heat production mechanisms are exceeded by physiological cooling capacity. In this event, the possibility of environmental conditions leading to hyperthermia is moderate.
Factors contributing to the rise in athletes' temperature are the heat produced by physical exercise, direct solar radiation, and the surrounding hot air (from the asphalt, stones, and terrain). The type of clothing worn can also be a problem as it interferes with the body's cooling through sweat evaporation.
The race is continuous and takes place both at night and during the day, with a potential significant variation in temperature between these two times. Thus, the layers of protective clothing worn at night can prove to be an impediment to adequate perspiration and cooling during the day.
Most symptoms of the hyperthermia spectrum are mild and easily identifiable. Failure to act early can put lives at risk.
The less serious symptoms are fatigue, weakness, thirst, headache, nausea, diarrhea, dizziness, cramps, feeling hot, and high temperature. If no action is taken to reduce the temperature, the condition can become serious, leading to syncope, convulsions, or death.
Repeating the principle of “acting early to prevent clinical worsening,” it is advisable to take the following preventive measures:
• Protection from radiation/sun – sunscreen, sun hat
• Clothing with good air circulation, not too tight (especially around the chest) – promote cooling by convection
• Maintain hydration and salt intake – drink whenever you are thirsty
• Manage physical exertion sensibly (actively adapt to the climate) – take strategic breaks, preferably in the shade and/or near water
• Use cold water to wet yourself and cool your body if you feel very hot.
We wish everyone an excellent race...
and hope you enjoy the mountains to the full.
