It's the time of the year for triathlons, running and swimming races, but for those who really want a challenge, there is the obstacle adventure run.
It's a race that often promoted as healthy and fun way to get out and get dirty, but critics say these events can go too far.
Sarah McDowell competes in as many as 30 runs a year and sometimes she likes to mix it.
Adventure runs let participants slither through, jump through flames, and offer military-inspired obstacles.
"It's a lot of fun," McDowell said. "It's a great way to get together with girlfriends, get a little exercise and have a lot of fun."
But along with the good and maybe not-so-clean fun, some of competitions can be risky. Dr. Balu Natarajan with the American Medical Society for Sports Medicine says he's seeing patients with different injuries than those typical of a marathon or 10k.
"Jumping over fire, going through mud walls, twisting, turning, if the athlete thinks it's just three miles it's not that big a deal, those are the ones who approach this an almost brazen manner that are most likely to get injured. Three miles with a lot of obstacles, is fraught with risk," said Dr. Natarajan.
Risk that can put more strain on the body, leading to bruises, breaks and sprains, as McDowell learned after injuring her ankle during one muddy obstacle race.
"It was the first time that I had ever really thought, wow this is a little bit more in the danger zone than I wanted to be," she said.
"There's been other things like 2nd degree burns and drowning and things like that," said Troy Farrar of the U.S. Adventure Racing Association.
Farrar's organization used to insure some obstacle races, but not anymore.
"A lot of people started getting injured, and basically our underwriters won't, cover them anymore," Farrar said.
Ben Johnson with Tough Mudder had this to say:
"Our top objective is and has always been to deliver safe events. We work with engineers and industry safety experts to continually review our obstacle designs and on-site response capabilities..."
But Farrar says the problem is a lack of standardization.
"They don't have a governing body laying down any safety standards. Some guys are doing a really good job of keeping their obstacles safe, and other guys arent doing quite as good a job," he said.
For now, participants are on their own to research the group hosting the event, look at reviews, and find reports of previous injuries.
McDowell still signs up for the occasional obstacle run, but avoids them when she knows she has another race on the horizon.
"It's just too high of a risk of injury for me," she said.
Participants in these races are required to sign a waiver accepting the risk of serious injury or death.