The first question usually is: Why? The next question: Who are these people? The next: Are they crazy? While not so blunt and far more respectful...

The first question usually is: Why?

The next question: Who are these people?

The next: Are they crazy?

While not so blunt and far more respectful, Seattle doctor Brian Krabak researches these overarching questions as he serves as medical director for extreme races in extreme conditions. He has tended to competitors in 150-mile races in the Gobi and Sahara deserts and Chile’s Atacama Crossing, and next week will be working an Antarctica race.

Unlimited Digital Access. $1 for 4 weeks.

It is part of the “4 Deserts” series, and each participant of this frigid leg has to have completed the other three races. Competitors will race 250 kilometers (about 155 miles) in stages over seven days.

Krabak, 40, specializes in nonsurgical prevention and treatment of sports-related injuries.

He came to the University of Washington Medical Center from Johns Hopkins, was team doctor for the Baltimore Orioles and worked two Olympic Games. He also was an extreme athlete who competed in more than two dozen endurance events himself, which gives him “street cred” when trying to tell an extreme athlete who has paid a hefty entrance fee (almost $9,000 for the Antarctic race) whether he or she should — or must — stop before the finish line.

His own endurance training taught him lessons about discipline and the importance of staged training and being in tune to the body’s signals.

But people kept asking him, are these people crazy? Why would anybody want to do this?

“As a doctor and medical researcher, I thought, these are good questions,” he says. “Who are they? What do we know about them? How do their bodies handle it? What are the physical implications of this? I thought, [as medical director of the races] I cannot only help them but try to understand them better, too.”

So for the past two years, Krabak and another researcher have been amassing information about the athletes — their medical issues, injuries and the variety of approaches toward fueling and rehab. The Italians use olive oil, the Americans pop electrolyte pills, the Koreans like to stitch, not pop, blisters.

As you would expect, the people who push themselves to the extreme are A-types. They are successful and so focused in everyday life that it seems counterintuitive that they could find an extra 40 hours a week to train. Competitors in the deserts series have ranged from 18 to 72 years old, but the average age is about 35. About three-quarters are men.

Most of the injuries Krabak and his staff tend to are lower extremity, such as ankles and knees. But the competitors carry packs, so shoulders and backs require attention, too.

The doctors treat these athletes without high-tech gadgets like MRIs, making their observation and interviewing skills critical.

About 80 percent finish, Krabak says, and day three seems to be when more serious injuries occur.

Doctors staff checkpoints along the course and at the finish line, but they must be flexible and plan for contingencies. During one race, Krabak had to walk about six miles up a mountain, carrying medical equipment. The racer was carried off the course by camel. (A helicopter is available for critical emergency.) Boats will patrol the shore of the Antarctica loop.

Each course has its own set of risks, from climate to terrain. Hypothermia seems a risk for this winter race, but experienced endurance athletes rarely allow themselves to become dehydrated, Krabak says.

In fact the fastest and slowest competitors seem to require less attention. It is often those in the middle, who will push their limits, that can get into trouble. Knowing the circumstance and the sophistication of the patients, doctors along the course are more willing to let aches go. But they are the final arbiters, too.

“I’ve had some heated discussions with a few racers who were unwilling to leave a race for medical reasons. But I’ve had to pull some out of the race,” he says. “They aren’t always happy about it, but once they’ve calmed down, they are usually appreciative.”

What all these athletes have in common, and especially worthy of study, he says, is focus. They pay attention to the task, their bodies, and are able to distinguish soreness and pain. When the weekend warrior hurts, he or she is usually advised to just stop, but are they reacting from merely taxed muscles?

“The mental aspect is fascinating,” says Krabak. “Athletes typically don’t think of that when training. We think of stretching and the amount of miles we log, but not about focus.

“These people can run through pain. What makes them different? A lot of it may just be how they have trained, slowly adapting their bodies to the task.”

Krabak says many of the people with training injuries he sees in his clinic try to go too far too fast.

So why do they do it? Part of it is about tapping potential and pushing boundaries. There seems to be some ego involved, maybe a midlife crisis or two. But Krabak says you can’t overlook the camaraderie. With “4 Deserts series,” sponsored by a group called “Racing the Planet,” competitors from around the world share more than they differ. They gather strength from competition. They aren’t going it alone.

Richard Seven: 206-464-2241