I’ve got an idea. Just for fun, to get some kicks, may I suggest the following trifecta? Start with a “Boa Constrictor Crawl” through a series of pipes up and downhill into freezing mud. Follow this with an “Arctic Enema,” such that you jump into and swim through frigid water, and then finish with an “Electroshock Therapy Run” through a field of live wires (10,000 V). Sound totally awesome? If your answer is yes, then I bet you’re interested in participating in Tough Mudder (registration now open for 2014!!!)

Haven’t heard of Tough Mudder? Well then, let me explain. The Mudder is a 10- to 12-mile obstacle course through a series of “MOB” (mud, obstacles and beer) runs. Billing itself as the “Premier Obstacle Course in the World,” the event has exploded in popularity since its inception in 2010, now with over one million participants worldwide. Intrigued? Well, before you jump up to sign up, I suggest you take a looksee at the newly released online content of the Annals of Emergency Medicine. There you will find a case series compiled by Marna Rayl Greenberg and colleagues documenting five severe medical complications (out of 38 people requiring emergency department [ED] evaluation) sustained during a two-day Tough Mudder event in Pennsylvania this past summer. Among them:

*A 31-year-old male who had completed 20 out of 22 obstacles before developing seizure activity along with right-sided weakness and confusion. Ultimately, he was diagnosed with a stroke complicated by seizures.

*A 28-year-old man with headache and confusion after sustaining multiple electrical shocks to the head while running through water. He was hospitalized for two days and treated for inflammation of the lining of the heart (this is called pericarditis).

*A 25-year-old woman who went down after taking a shock to the chest just before the finish line. In the ED, she was incontinent of urine, dizzy, and besieged by a racing heart. Ultimately, she was diagnosed with rhadomylosis (abnormal muscle breakdown due to over-exertion) and hospitalized.

Reading these cases, you may be asking, why did these people risk their health for recreation? It’s a fair question and, of course, the Tough Mudders are not alone. Many other thrill seekers join them; the big wave surfers and avalanche skiers, the marathoners and CrossFitters, and the free climbers and free divers. Their cohort also include the copycats of Jackass (if you decide to look these up, check out the “Toro Trotter” and “Alligator Tightrope”) and, overseas at least, devotees of zorbing, coasteering, and the Nevis Arc (the world’s highest flying trapeze!)

So, why are people drawn to such “adrenaline” pursuits? The simple answer, as you may have already surmised, is that for many, these activities fill a void left by the mund-sanity of modern life. But for others, their good health may depend on challenging themselves with a healthy dose of risk-taking. Take CrossFit, an extremely intense workout ethos with a devoted following despite the fact that it can, according to its founder, “kill you.” But for most CrossFitters, the risk is more than worth it due to the physical and emotional awards. For these and other extreme sport participants, recreation is inextricably linked to cardiovascular condition, muscle mass, flexibility, and adaptation and thus is a pretty good cure to the “smokadiabesity” that plagues much of sedentary America.

The Tough Mudder participant who conquers his or her fears along with the event may also garner confidence and optimism to face challenges elsewhere in life. It used to be that psychologists, especially those influenced by Freud, saw risk-taking as evidence of a diseased mind. Nowadays, though, the perception is changing. According to sports psychologist Ken Way, quoted in an article in Intelligent Life magazine, “personality studies and psychological profiling support the idea that those who regularly take on calculated risks tend to be the least anxious, the least neurotic. They are resilient people who manage their fear and still perform.” And, contrary to popular conception, it is not so much that thrill seekers are taking risks for risks’ sake, but rather that there is another reward at the end of it all. Whether it be physical fitness, increased confidence, an emotional boost, or something else entirely, the risk is a means to a recognized end.

So then, that’s the key: challenge yourself but do so with calculated risk. Know what you are getting into. Sometimes easier said than done, but good advice indeed. Wear a helmet when you cannonball down single track, take a buddy with you when you surf the big ones, and know when to say “when” to the CrossFit challenge. The smartest mudder is the one who pushes through obstacles until the point that his body tells him to stop.

Keep in mind, as well, that extreme sporting events can put a strain on our emergency medical services. Tough Mudder organizers and others must do their part to ensure that that there is an adequate medical professional presence at and around their events to help manage the inevitable health hiccups. And participants should do their own risk due diligence. So then, perhaps before signing up for the Arctic Enema and Electroshock Trifecta you should make sure that you are signed up for health insurance. Now’s the time – Californians should head on over to www.coveredca.com.