Common Hiking Injuries - How to Avoid and Treat Them

Injury prevention and treatment is something anyone participating in any sport will eventually have to deal with.  While many people don't consider hiking to be a sport, it's very easy to draw comparisons between hiking and high impact exercise like running and ultrarunning.  While taking your time to ease into hiking is always a great way to begin, overuse injuries are extremely common in novice and experienced hikers alike.  Here are my tips to avoid and treat common hiking injuries.

Sprains and Strains: 

First, let's understand the difference between a sprain and a strain.  A strain is when you have a pull or tear in a muscle or tendon while a sprain is when you have an overuse injury in a joint that causes damage to a ligament.  Muscle strains in hikers are commonly seen in the hamstrings, while a sprain is more likely found in the ankle.  Regardless of the difference in terminology, prevention and treatment for both are very similar.  

Prevention: Begin your mornings by hiking a slower pace, giving your body plenty of time to warm up.  I always recommend that you take a minute to stretch your ankles by writing your full in name in cursive with each foot about 15 minutes into your hike.  Stretching out your quads and hamstrings is also helpful.  This is easy to do by making a "figure 4", balancing one leg just above the knee of the opposite leg and bending at the waist.  Bend only as far as needed before you begin to feel a slight pull in your hip.  

Treatment: For an ankle sprain, stop and sit down.  Remove your shoe and take a look.  If it is beginning to swell, it's time to take action.  While in the real world we would recommend the RICE method (Rest, ice, compression, elevation), on trail it's important to rest, elevate, and compress - in that order.  Since not everyone has an Ace bandage on them, rest and elevation for 30-45 minutes after the injury can significantly help.  If you're having pain, ibuprofen (Vitamin I as many hikers call it) can also be helpful for both the pain and the swelling.  I also recommend sleeping with your feet elevated the night of your injury.  Just use your pack to keep your feet off the ground.  Take a zero day if you're in a lot of pain and give your body time to heal. 

Shin Splints:

Shin splints are the most common overuse injury I've ever seen on trail - and I've seen a ton of them.  I'm also very prone to them myself and often get them during race training as a runner. Signs and symptoms of shin splints can include tenderness, soreness, and pain in the lower leg, which may or may not be accompanied by localized swelling.  Lower leg pain when walking is the most common complaint.  Unfortunately, if not treated, shin splints can lead to another nasty injury called a stress fracture!

Prevention: Wearing properly fitted shoes with insoles is the best thing you can do to help prevent shin splints.  For hikers who prefer a lightweight trail shoe, I highly recommend going to a RUNNING store, not a hiking store, to be properly fitted.  Many running stores are trained to analyze your gait and see what insoles and shoes would be best for you.  If you want a heavier hiking boot, go to an outfitter and be properly fitted.  Since shin splints are an overuse injury, I recommend taking your first days out on the trail a little slower and doing fewer miles to ease your body into carrying a heavy pack and doing long days. 

Treatment: When you're out on trail a few days from town, treatment options are limited. As a long-distance hiker, I always carry leukotape with me and it's invaluable! NoKey and I call this human duct tape - it can work as K-tape in a pinch and also stays stuck to skin that is dirty and grimy for weeks on end (seriously, I had it on my feet for 17 days of straight rain on the Finger Lakes Trail and I still had to rip it off!)  Learn how to tape a shin splint by watching a YouTube tutorial.  This will help you tremendously in getting to town.  Once in town, unfortunately a few zero days will be in order.  That handy RICE method I mentioned above is your best bet for treating a shin splint, along with an NSAID (nonsteroidal antiinflammatory) like ibuprofen or naproxen (Aleve).  Shin splints can take a long time to heal, so being patient is key. 

Blisters:

Ahhh, blisters.  Everyone I know has had more than a few blisters in their lifetime and ways to treat and prevent blisters can vary from person to person.  The advice I'm listing below is the method I was taught at my recent Wilderness First Responder program last month and is on point with how I've treated blisters for a few years. 

Prevention: Since everyone's feet are different, I highly recommend you find works best for you in terms of prevention.  For all hikers, I highly recommend a wool sock and properly fitting shoes that can breathe.  Gortex is not your friend on long hikes because it can actually keep moisture from sweat inside your shoes.  Some hikers who get blisters between the toes find that Injini toe socks can be helpful to alleviate their toes rubbing together.  If you get blisters on the tips of your toes, chances are you need a larger shoe size. 

Treatment: Again, everyone treats blisters differently.  For me, I use a sterilized safety pin (sterilized with an alcohol pad) and pop the blister from the bottom, going underneath the healthy skin before the blister starts.  Gravity will clear the fluid from the blister.  Do not apply any ointment inside the blister and leave the "blanket" in place.  Cut a donut-style hole with moleskin and apply it around the blister.  Secure in place with leukotape.  Make sure to change this every night before going to bed to allow the wound to breathe and heal. If you feel like infection is imminent, you can place triple antibiotic ointment around the outside of the blister, but avoid putting it in the actual wound. 

Muscle Cramps: 

We've all been woken up in the middle of the night with a Charlie Horse pain in our calf muscles.  When you're out on the trail and you don't hike much, it's common to have some muscle aches and pains, pop a few ibuprofen, and continue on your way.  

Prevention: Dehydration is very common not only in long-distance hiking, but also in America in general.   In fact, it's estimated that 75% of Americans are chronically dehydrated and probably don't even know it!  Muscle cramping on trail is usually due to the fact that you aren't drinking enough water, which sounds like a simple fix, right? I highly recommend using a Gatorate powder or Nuun electrolyte tab in your water you drink with your camp dinner at night before you go to bed.  Not only do they taste like something other than water, they will help replace the vital electrolytes you lost during your hours of hiking during the day.  

Treatment: Just like with the prevention, treatment for muscle cramps means eliminating dehydration.  Unfortunately, just chugging a bunch of water after you cramp up isn't going to help much.  This rehydrating process can take a day or two, so be patient.  I highly recommend drinking an electrolyte drink with each meal for a few days after the cramping began.  Also, drinking more water is important.  Try to remember to take a sip each time you stop to take a photo or talk to a hiker.  

Chaffing: 

No matter if it's your first long-distance hiker or your fiftieth, you're going to chafe when you least expect it.  Whether it's on your thighs, low back, or even shoulders, chafe is definitely irritating and can be prevented and cured while hiking. 

Prevention: A lot of hikers quickly discover Body Glide is their friend!  Simply apply to wherever you've got friction and it will help.  I also highly recommend marino wool undergarments.  I'm a huge fan of Smartwool bras and underwear to prevent chaffing.  

Treatment:  NoKey and I are huge fans of something called Boudreaux's Butt Paste.  It's essentially a zinc cream for treating diaper rash and that's pretty much what chaffing is.  We apply a thick layer of this to wherever is starting to chafe and it will not only soothe the pain, it will help heal the rash.  Also, prerinsing your hiking clothes with you in the shower before doing your laundry will help cut down on the recurrence of chaffing.  If you've been wearing the same shirt for months on end and washing it only 2-3 times a month, doing a prerinse will definitely help cut out some salt crystals.  

I'm NOT a physician and what you're reading here isn't considered diagnosis or treatment for your specific injuries - ask a doctor what is best for your specific injuries after you get back to civilization!  

These are only a few of the common injuries I have treated on both myself and other hikers.  Do you have any trail injury stories?  I'd love to chat with you about what you would do differently.  Leave me a comment or head over to the Facebook page to join in!

"I'm a Wilderness First Responder - can I help you?"

For nine days during the month of November I stayed at the Nantahala Outdoor Center doing an intensive program called Wilderness First Responder, WFR (pronounced Woofer) for short.  @@What is a Wilderness First Responder?@@  This means I've been trained to deal with backcountry emergencies ranging from sprained ankles to a heart attack to a sucking chest wound called an open hemopnuemothorax.  What does all this stuff mean to you guys?  This means that I'd be an excellent person to have on a backpacking trip!  My job as a hiking guide requires I have this training to deal with any injury or medical emergency that could possibly arise during a trip.  Being that we are in one of the most remote places on the Appalachian Trail, help could be many, MANY hours from arriving.  Learning the skills that are necessary for not only keeping my patient and group calm, but also how to help them and get more qualified help for them are mandatory.  Here my quick and dirty summary of taking a WFR class at SOLO Southeast - taught at NOC in Wesser, NC. 

Our class was relatively small due to the time of year I took it.  We had a total of 10 people, which is 1/2 to 1/3 of the usual size according to our instructor.  Brooks, our main instructor, is an Advanced Wilderness EMT and teaches at SOLO when he isn't working in his wood shop making custom furniture. He's worked as a rafting guide and survivalist at BOSS in Colorado - the same survival institute Cody Lundeen attended in the 1970s.  Our class was also diverse - ranging from a woman from Alaska looking to gain skills for her long winters to young people looking to be able to help their friends on trips, even a guy from Brazil who had spent a few months working on the Rocky Top AT crew in the Smokies.  We spent the first day mostly in the classroom learning medical terminology and the legalities of helping people in the woods versus helping people in the "real world."  Many of the training techniques I've learned are only applicable to working in the wilderness - meaning at least an hour from the trailhead/qualified help.  

The next several days were a crash course in learning how to deal with sprains and strains (and what the difference is between the two), building a splint for a fractured arm or leg, resetting broken bones in a wilderness setting, and even how to pull traction to get a broken femur back into place.  I also learned how to help someone with a dislocated shoulder, elbow, or knee joint.  We did a lot of practice building things from materials we would normally be carrying on a trip, like water bottles, sleeping pads, and even extra clothes and rain gear.  Later in the week we learned how to deal with everything from minor sunburns to extreme frostbite and everything in between.  The most helpful of all this training, however, was running what we called "scenarios."  Each person in the class chose a partner and one of us would be the patient while the other would be the rescuer.  They would use stage makeup to give us burns, broken bones, frostbite, etc.  We would take turns helping each other and then learning from our mistakes - which they would always have us make the mistake on purpose as to not forget the proper treatment.  We were also certified in CPR and the use of an AED during this period. 

My certification cards and my cool new t-shirt and patches! 

The real fun with this training started when we learned how to work together as a rescue group.  We were always encouraged to try different roles, like lead medic or incident commander, and work with different partners to learn our strengths.  I found this the most enjoyable experience of the entire training, mostly because I was extremely far outside of my comfort zone and working with different people kept me on my toes.  I was very lucky to be part of a group where no one had an ego that got in the way of everyone making decisions as a team.  Our biggest scenario came on the last night of the course, where we went up a trail in the dark to find three hikers who had gone missing in the woods.  The scenario was a thunderstorm was in the area and the home base was concerned about lightening.  The nine of us in the group walked in the dark up the trail until we heard people in pain.  My partner, Derek, and I ended up getting an unresponsive patient who had obviously been struck by lightening.  The other two patients had a case of ruptured ear drums and a dislocated elbow, respectively.  To throw in a curveball, a fourth patient - a guy tripping on mushrooms - happened to walk onto our scene and take the attention of some of our rescuers.  Nine people taking care of four patients is a lot of stressful work.  In the end, it took us 2 hours to get our patients evacuated, and our instructors overall said we did a great job. 

Just another day at WFR training - a badly bruised ankle indicating a sprain.  

On the very last day, we did our written test and our final scenario.  I partnered back up with Liz, whom I'd been working with all week.  She was a great partner who provided a lot of constructive feedback to me.  I seriously feel I wouldn't have passed the course without her!  For her scenario test, I had fallen on a ski slope and broken my arm.  She had to splint me and treat me for mild hypothermia.  For my final scenario, she had fallen while bouldering in cold weather and needed treatment for mild hypothermia and a broken lower leg.  The class ended on Sunday afternoon with sunny skies and nine people all getting certified as Wilderness First Responders.  It was hard to say goodbye to everyone in the class because we had all bonded over the course of the nine days we spend together.  

Our group after "graduating" the WFR course. 

For anyone who is trying to figure out if becoming a WFR is worth the money, I would absolutely recommend the course - especially if you have no prior medical training.  While the course was intensive and I was outside of my comfort zone (even though I have a 10-year history in medical careers), I feel like the information I've learned and retained was extremely helpful.  I wish I would have had this training prior to my thru hike just because so many things happened out there I could have helped with - like when a friend of ours began going into anaphylaxis on the side of a road in Shenandoah National Park or when NoKey fell and broke his fingers on Mt. Lafayette in New Hampshire.  The SOLO Southeast Course was approximately $650 and the lodging at NOC for the nine days was about $130 in a bunkroom. Once you become a certified WFR, you will be qualified to take the Wilderness EMT classes (a 3-week, $1900 course) as well.  If you are looking for a less intensive area of study, SOLO Southeast offers Wilderness First Aid (WFA) classes over the period of a weekend and they are significantly cheaper, although not as thorough as the training I received as a first responder.  They also offer a simple CPR certification.  

Are you interested in becoming a WFA, WFR, or WEMT?  I'd love to talk to you about it or even go into depth about the course with you!  Leave me a comment below or start a conversation over on the Facebook post!