Five tips to avoid lower limb overuse injury on the PCT

By Dan Feldman

No one knows, till he tries, how easily a habit of walking is acquired. A person who never walked three miles will in the course of a month become able to walk 15 or 20.

— Thomas Jefferson, correspondence to Thomas Mann Randolph Aug 27, 1786.

There’s a definite ring of truth to Thomas Jefferson’s point of view. Hundreds of new and experienced long-distance hikers discover this every year on the Pacific Crest Trail.

Though Jefferson was a steadfast supporter of walking for distance, he unabashedly waxed poetic in his writings, leaving the reality of blisters, stress injuries and other walking-related afflictions for us to discover for ourselves.

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Hikers who venture out to hike long distances on the PCT risk developing a class of injuries to the lower limb called overuse injuries. These have familiar names such as Achilles tendinopathy, shin splints (known more formally as medial tibial stress syndrome or MTSS) and plantar fasciitis.

The American Orthopedic Society for Sports Medicine defines an overuse injury as being caused by “repetitive micro-trauma to the tendons, bones, and joints.”  Simply put, an overuse injury is caused by using a body part in a repetitive, excessive manner without enough time for normal healing. It should come as no surprise that hikers are at risk. According to an October 2010 study published in Medicine and Science in Sports and Exercise, if you’re an American adult, you take an average of 5,117 steps per day. Multiply that by 2.2 to 2.5 feet per step and you’re probably walking a little over 2 miles per day in everyday life. Building up to Thomas Jefferson’s 15-20 miles per day and then adding a full pack and PCT terrain does not come without a few aches and pains along the way for many hikers.

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Source: A survey of 123 PCT thru-hikers conducted by the author in 2013. Hikers were asked if they sustained injury or experienced more than a few days of aches and pains.

Surveys of former PCT thru-hikers offer confirmation: 123 from the class of 2013 were asked if, while on the trail, they experienced injury or more than a few days of aches and pains. Of them, 55 hikers (45%) answered yes.  When asked where they experienced the worst problems, the knee, ankle, lower leg and foot comprised 89% of responses with injuries of the foot comprising 47% of the total.

Source: A survey of the 55 PCT thru-hikers who reported injury (above) conducted by the author in 2013. Hikers were asked the location of their most significant injury.

Source: A survey of the 55 PCT thru-hikers who reported injury (above) conducted by the author in 2013. Hikers were asked the location of their most significant injury.

Being able to avoid or minimize the risk of sustaining a lower limb overuse injury is one key to having a more comfortable hike. Here are five tips that will set you down the right path to a less painful transition to life on the trail:

1) Get fit

While there’s no perfect way to prepare the body for hiking all day for weeks on end, maintaining a good general fitness level prior to a hike will prepare the body to absorb the rigors of daily trail travel. When designing a fitness program with hiking preparation in mind, emphasize low-to-medium-load, long-duration strengthening exercises that target the muscles of the hips, thighs, and lower leg. Mix in cardiovascular exercises like long walks or light jogging. Consider consulting your physician or an exercise professional who can help you design a program that’s right for you.

2) Have the right footwear

Carefully choose your shoes and socks. Whether going with trail runners, boots, or something else, make sure that footwear is broken in and fits comfortably before heading out on the trail. If expecting to be on the trail for a long time, feet may grow. Some hikers buy shoes that are slightly big for their feet and make up the difference with thick socks until their feet grow. Some go with shoes that are accurately sized. Whatever you choose to do, be prepared to adjust lacing and even sock thickness to accommodate your changing feet as you go along.

3) Use four-heel drive

Use trekking poles. Poles can help ease the transition into hiking by transferring some of the load borne by the hips, knees, ankles and feet. Some hikers will transition away from trekking poles once they feel strong enough to hike full days comfortably.

4) Build up your miles slowly

Ease into daily mileage changes. Rather than going directly from 10-mile days to 18-mile days, build the body up to accepting the higher mileage through slower increases in miles per day. Sudden changes to what the body is accustomed to will raise the risk of an overuse injury. Even hikers accustomed to very high mileage days (25+) can raise their risk of injury by increasing mileage too quickly.

5) Get checked

Have a professional check out your gait (walking style) and posture. Several large review studies published in 2014 in the Journal of Foot and Ankle Research identified risk factors for lower limb overuse injuries. The strongest finding was that a pronated foot posture increased the risk for shin splints. Podiatrists and physical therapists are examples of accessible, helpful professionals who are qualified to examine gait and posture.

In the spirit of Thomas Jefferson, have a safe and fun PCT journey!

Dan Feldman is the author of Long-Distance Hiking and thru-hiked the PCT in 2007. He lives in Bowdoinham, Maine and works in early intervention and early childhood special education as a pediatric physical therapist. Dan and his wife enjoy hiking, trips to Quebec, and raising their flock of Polish chickens and Indian Runner ducks. Dan maintains a website at distancehiking.com