Stress injuries

I recently did the first 27 miles of the Mountains to Sea Trail, which has some wicked elevation changes & rough terrain. I'm in good shape, and do exercises geared toward conditioning me for hiking, but I hadn't actually backpacked in about a year. For the most part I experienced the types of aches & pains you'd expect, but there were two things that concerned me more, as I felt they might have forced me off the trail if I had been planning a longer trip (I was able to complete the 4 days/3 nights I'd planned this time). I'd love to hear from other people who have experienced similar issues along with any helpful information you obtained in terms of diagnosis (I know we're not doctors on here, yada yada), treatments, and prevention. They were:

Forearm swelling/pain: I used my trekking poles on this trip, and within the first day my left forearm had an area that was swollen and sore (but NOT red or warm to the touch). By the third and fourth days, it was so tender that even just rotating my forearm left/right or picking up something small like my 8 oz bear mace was very painful. If you hold your left arm out straight in front of you, palm down, the swelling is on the right side extending a bit onto the top of my forearm, near the wrist and farthest from the elbow. Driving home from the hike I thought I felt my cell phone vibrate my arm, but realized it was the swollen/irritated tissue in my arm...rubbing against itself I guess, as I rotated my forearm. It's been a week and it's still a bit swollen and tender, but seems to be slowly starting to resolve. I have been sleeping in a wrist-brace. All I can guess is that this is from me using my trekking poles on steep ascents & descents? I've hiked with trekking poles before with no problem, and my right arm is fine, it was just my left arm that had problems. Has anybody else experienced this? I'm seeing information on hands swelling, but not forearms. I'd hate for this to become a recurring problem.

Right knee: Became very sore & hot to the touch following steep descents, to the point that I had to descend sideways in order to keep my right leg straight, because bending it & lifting the knee upward was too painful. I was limping for ~24 hrs after the completion of the hike. However, this issue resolved quickly as soon as I was no longer doing steep ascents/descents. It even felt better each morning but would then act up again as I continued hiking. Has anybody successfully used a knee wrap/brace to alleviate this issue? I'm thinking of wearing a knee brace or wrapping it on my next hike.

Thanks!

Your knee pain sounds like you overdid it a bit. Keep getting out and I suspect you will be able to do that terrain and mileage pain free.

Those small muscles in the forearm can create all sorts of havoc if you use them heavily in a way they aren't used to. Painted a ceiling recently and had to sleep with my arms propped up to keep from crying :) I use poles frequently and don't have problems on trail. Use them when you don't need them to build up the muscles.

As for the knee, it band issues are common and similar to what you describe. Once a person starts to have issues they tend to keep having them. Start trying braces and see if that helps. If so you can start looking for one you can live with. Been using them for years and have a love hate relationship. They save my knee but tend to tear up my legs. Bought a new one just today to see if it is any different. :)

I ran into IT band issues, any suggestions on braces that have worked for you?

Sent from my G8441 using Tapatalk

Had debilitating IT pain until I switched to zero drops...prefer Altra LPs.

It didnt matter how I stretched or worked out or walked before, pain would come in knees. Now, 20 mile days no longer hurt my knees

Yes, some steep descents on Seg 1 of the MST.

Steep descents are one of the types of hiking terrain I witness folks using techniques that are highly impacting. Here's what I do: 1) shorten stride length 2) shorten riser height when on trail construction like steps or at rocky rolly polly wash outs. this may mean taking a step in two shorter height steps rather than one large riser height step down. NO big knee squat like bends. 3) go slower. going fast down hill with a heavy load out with a wide stride length pounding down high riser heights will fatigue or beat up joints 4) lose body wt 5) alternate which foot I step down first with. I may go sideways down hill to bring other muscles groups into greater service

As a general lifestyle, over the yrs, I've eliminated pro inflammatory response lifestyle choices including election of anti inflammatory food choices while adopting an anti inflammatory diet. I also take several supplements that have unequivocally assisted in recovery of joints and muscles and protecting cartilage and joint fluid. I stretch both at work at home and on trail. I've learned to listen to my body and will ratchet pace and MPD up or down based on terrain. I do not hike always at the same pace or stride. I used to have joint issues as a hardcore tennis and basketball player in HS and college and have been a runner and high impact aerobics participant 4-5X/wk. I now workout with less impact on the elliptic, trampoline, by walking on deep sandy beaches/sand dunes, and in a lake/ocean/swimming pool up to my waist wearing an old backpack to help with balance and strength for backpacking.

Hopefully this isn't not too far off topic. Can you share your workout routine? I'm curious to see what works and what doesn't work to apply to my own workout routine. Thank you.

Tom, I found success using the Cho-Pat Dual action knee strap. https://cho-pat.com/products/knee/du...on-knee-strap/

I had never hiked before I did my first LASH in 2016. I ended up with a sprained ankle and big knee problems, so off I went to the VA and physical therapy. The problem, they said, is weak muscles in the affected areas. They showed me some knee and ankle exercises to do. When I next went hiking, I was able to discard both the ankle and knee braces I used. Since then, I have concentrated on building up my knees and ankles and last year I did Wind Gap, PA to Gorham, NH with no knee or ankle problems.

There are a lot of good exercises shown on the Internet. They are no different than what the VA had me do. As for the problem with arms using poles, I lift weights and concentrate on the biceps and forearms. Never had a problem with my arms. Oh, yeah! I also lightened my backpack.

I hope so. Since I live near the coast it's all sea level around here, so no nearby mountains to head to. I've tried using a stepstool (while holding weights) in my workout to simulate climbing up/down. Might have to play around with more of that.

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Originally Posted by Malto

Your knee pain sounds like you overdid it a bit. Keep getting out and I suspect you will be able to do that terrain and mileage pain free.

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I hope so. Since I live near the coast it's all sea level around here, so no nearby mountains to head to. I've tried using a stepstool (while holding weights) into my workout to simulate climbing up/down. Might have to play around with more of that.

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Originally Posted by LoneStranger

Those small muscles in the forearm can create all sorts of havoc if you use them heavily in a way they aren't used to. Painted a ceiling recently and had to sleep with my arms propped up to keep from crying :) I use poles frequently and don't have problems on trail. Use them when you don't need them to build up the muscles.

As for the knee, it band issues are common and similar to what you describe. Once a person starts to have issues they tend to keep having them. Start trying braces and see if that helps. If so you can start looking for one you can live with. Been using them for years and have a love hate relationship. They save my knee but tend to tear up my legs. Bought a new one just today to see if it is any different. :)

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Good point...all the arm exercises target the biceps and triceps. I'll have to think of something I can do with light weights that will mimic using trekking poles.

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Originally Posted by Dogwood

Yes, some steep descents on Seg 1 of the MST.

Steep descents are one of the types of hiking terrain I witness folks using techniques that are highly impacting. Here's what I do: 1) shorten stride length 2) shorten riser height when on trail construction like steps or at rocky rolly polly wash outs. this may mean taking a step in two shorter height steps rather than one large riser height step down. NO big knee squat like bends. 3) go slower. going fast down hill with a heavy load out with a wide stride length pounding down high riser heights will fatigue or beat up joints 4) lose body wt 5) alternate which foot I step down first with. I may go sideways down hill to bring other muscles groups into greater service

As a general lifestyle, over the yrs, I've eliminated pro inflammatory response lifestyle choices including election of anti inflammatory food choices while adopting an anti inflammatory diet. I also take several supplements that have unequivocally assisted in recovery of joints and muscles and protecting cartilage and joint fluid. I stretch both at work at home and on trail. I've learned to listen to my body and will ratchet pace and MPD up or down based on terrain. I do not hike always at the same pace or stride. I used to have joint issues as a hardcore tennis and basketball player in HS and college and have been a runner and high impact aerobics participant 4-5X/wk. I now workout with less impact on the elliptic, trampoline, by walking on deep sandy beaches/sand dunes, and in a lake/ocean/swimming pool up to my waist wearing an old backpack to help with balance and strength for backpacking.

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I definitely think I was being careless in the beginning, trying to go downhill too quickly and letting my weight come down harder than necessary on my legs. Like you said, I might also try the sideways downhill thing before my knee starts acting up, next time.

Another thing I noticed is that, when continually going down a steep descent, I tended to keep my legs bent almost constantly. At one point I started to make myself fully straighten my leg after each step (which kind of pushes your body upward a little) instead of letting my leg stay slightly bent and tensed while the other leg starts down to the next step. It seemed to help. Maybe that distributes the impact throughout the leg better, vs a bent position which puts more weight onto the knee & adjacent muscles?

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Originally Posted by ldsailor

I had never hiked before I did my first LASH in 2016. I ended up with a sprained ankle and big knee problems, so off I went to the VA and physical therapy. The problem, they said, is weak muscles in the affected areas. They showed me some knee and ankle exercises to do. When I next went hiking, I was able to discard both the ankle and knee braces I used. Since then, I have concentrated on building up my knees and ankles and last year I did Wind Gap, PA to Gorham, NH with no knee or ankle problems.

There are a lot of good exercises shown on the Internet. They are no different than what the VA had me do. As for the problem with arms using poles, I lift weights and concentrate on the biceps and forearms. Never had a problem with my arms. Oh, yeah! I also lightened my backpack.

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I'll definitely look into exercises targeting the knee. In terms of the forearm issue, I think it was from the impact of the pole hitting the ground. I've used trekking poles numerous times before without issues. On this trip my arms were being jarred during descents, and supporting a lot of weight all-around. I almost think it was like a "shin splint" but in my forearm.

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Originally Posted by perrymk

Hopefully this isn't not too far off topic. Can you share your workout routine? I'm curious to see what works and what doesn't work to apply to my own workout routine. Thank you.

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I don't go to a gym because there isn't one close enough & I know I won't drive 20 min to go. So I do a combination of online videos & stuff on my own. I do subscribe to "Beachbody OnDemand" because they have a variety of workouts. I also do just basic workouts to build strength & endurance (weighted squats, lunges, dumbbell rows, jumping jacks, pushups, etc). In terms of my backpacker-specific stuff, I do some exercises I found online titled "Functional Exercises to become a "badass hiker"" https://sectionhiker.com/10-exercise...adass-hiker-2/ (although I don't have a bosu and my "high step" is a step-ladder). That article is focused on legs so I try to make sure to focus on arms, too. Once my forearm is completely healed I'm going to try using a really light weight (<2 lbs) to do some hand movements, trying to target my forearm muscles & the motions used to manipulate trekking poles. I really need to start doing more yoga again, too.

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Originally Posted by whatnot

Tom, I found success using the Cho-Pat Dual action knee strap. https://cho-pat.com/products/knee/du...on-knee-strap/

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Thanks, I appreciate it.

In my experience, these physical issues---muscles, ligaments/tendons, joints---skeletal---come and go endlessly. People who backpack for decades from youth to old age experience all sorts of issues and in my case they are temporary and can be "walked off".

Meaning: Each part of the body will hurt some time or the other. Last year my left wrist was completely ZONKED for various reasons---a main one using my left hand to do clipping and pruner work as I backpacked. It took about a year but it's back to normal and in fine shape.

So too my right hip and hip extender muscles: Some severe pain and cramps but now unnoticeable.

Currently my right shoulder is way out of wack but its pain will subside too in time.

I'm a firm proponent of continuing to backpack through all these ailments---and keep getting outdoors. In-the-field "treatment" options are slowing down, pulling more in-camp zero days to allow for proper recovery, some proper diet ideas and supplements as Dogwood says, and just Keep Moving.

Sorry your having trouble Tkip. On ride home and following week remember rice. (Rest, ice, compression, elevation). And anti inflammatory meds. (Motrin most commonly used). Agree with above comments. Be careful sleeping with wrist immobilizes, they can cause damage if too tight from swelling in night. On the road a bag of frozen peas are a great ice pack, pair with elastic wrap for mild compress, support and partial immobilization.

a few tears ago I did something to a thigh muscle while hiking bits on Georgia AT. Didn’t follow my own advice and drove 8 hrs to home. That really worsened the problem and delayed recovery. It’s resolved now but I learn best from my painful mistakes and won’t do that again!

Ha! Just noticed typo, ‘tears’ rather than ‘years’. I think that should stay in. :*)

Stress injuries are typically tendonitis, or stress fractures. Or even micro stress fractures.

The cause is repeated shocks, in excess of what the tendon, or bone can tolerate. Tennis elbow is good example.....bass or trout fisherman get this too. Cumulative trauma of many small shocks. Hiking pole shock....could do it too.

I had "tennis elbow " once, took 3-4 weeks to go away, doing stretches seversl x per day. Mine occurred from doing dips with 135 lbs hanging from waist.

Of course when something starts to hurt then everything starts to go south. Motion changes to minimize pain putting different loads on other muscles which are not accustomed to them, leading to muscle problems too, as well as a possible cascade of tendon issues.

The best thing to do is to condition your tendons to impacts in excess of what they'll be subjected to while hiking. Running is the best way I know to do this. plyometrics also works but it's can actually create tendon issues if done carelessly ( first hand experience!) I once used box jumps to try to break out of leg plateau.....ended up with sore knees for months. At time i was working out with really heavy leg wts too.....500+, .but simple jumping off 18"-24"box 20 times by 200 lb person was way too much stress on strong tendons. Consider the decelleration forces. Simple wt training, really wont do much. Heavyweight training thickens tendons and bones over time.

Stretching and massaging the sore muscles and tendons promotes blood flow which helps them to heal quicker. Tendons get very little blood flow and healing can take many weeks of rest.

I used to have many nagging injuries while lifting heavy weights. Some took months to go away, because of constant irritation of it, inability to just lay off.

I've found as a fairly active person that pain happens and mostly you just have to deal with it. It's really mostly a mental/attitude thing. If there's a serious injury you'll experience a different kind of acute pain and that's when you need to do something.

As a long-time runner I've dealt with achilles tendonitis in my feet on and off for years. For the most part I've been able to manage it through a combination of stretching, proper running footware, alternating with low-impact exercise like swimming, and wearing socks at night to improve circulation. Only a couple times has it gotten bad enough where I've had to lay off running for a few weeks to recover.

If it becomes a chronic problem then I'd go see a physical therapist. They can usually give good advice as to the kinds of exercises and lifestyle changes you need to avoid exacerbating the injury.

[QUOTE
As a long-time runner I've dealt with achilles tendonitis in my feet on and off for years. For the most part I've been able to manage it through a combination of stretching, proper running footware, alternating with low-impact exercise like swimming, and wearing socks at night to improve circulation. Only a couple times has it gotten bad enough where I've had to lay off running for a few weeks to recover.
If it becomes a chronic problem then I'd go see a physical therapist. They can usually give good advice as to the kinds of exercises and lifestyle changes you need to avoid exacerbating the injury.[/QUOTE]

Little Rock, I'm also a runner, but haven't had many problems with achilles tendonitis. That is until last week after a 70 mile hike (not sure what about this hike was different, but maybe because I wasn't running hills as much usual before the trip). Anyway, my achilles tendon became tight, hot and swollen. I've taken the last five days off running, iced and elevated a lot. It's nowhere near as painful, definitely not acute pain.
All that to ask, when do you know it's okay to run again? Do you wait until there is no more tightness, just a little, go for slow runs to test it out? I know you're probably not a doctor, just curious about your personal experience with this. The last thing I want to do is take weeks off, but then again I don't want to create a long term injury.
Thanks!

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Originally Posted by JackieO

Little Rock, I'm also a runner, but haven't had many problems with achilles tendonitis. That is until last week after a 70 mile hike (not sure what about this hike was different, but maybe because I wasn't running hills as much usual before the trip). Anyway, my achilles tendon became tight, hot and swollen. I've taken the last five days off running, iced and elevated a lot. It's nowhere near as painful, definitely not acute pain.
All that to ask, when do you know it's okay to run again? Do you wait until there is no more tightness, just a little, go for slow runs to test it out? I know you're probably not a doctor, just curious about your personal experience with this. The last thing I want to do is take weeks off, but then again I don't want to create a long term injury.

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One of the two times I had to lay off running was after hiking Pearisburg to Roanoke in VA. Several big ups and downs on that section, combined with high daily mileage (for me) and poor choice of footwear. The other time was after participating in the Blue Ridge Relay which involved about 20 miles of hill running over the course of 30 hours. Both times it hurt so badly afterward that I could barely walk for the first hour or so after waking up the next morning.

Here are some things I've done that seem to have helped. YMMV, of course.
1) After an acute injury - I waited until the pain was reduced to a morning stiffness that went away after less than an hour to resume running. This took 2-3 weeks. I started out with short runs of just a mile or two then slowly worked my way back up.
2) Stretching - I usually stand under a door frame, holding the top for balance, then raise up onto my toes and back down repeatedly for about a minute as part of my normal pre-running stretches.
3) Footwear - Both times I had serious issues I was wearing shoes that were very stiff in the heel. Now I always wear shoes that are slightly raised in the heel and have some give when you step down when running or hiking.
4) Low-impact exercise - I almost never run two days in a row anymore, instead I alternate between running and lap swimming at a local pool.
5) I wear snug (but not too tight) socks to bed every night as this seems to help increase circulation and reduce morning stiffness.

Sometimes I still wake up with stiffness, but I haven't had an acute injury in over 3 years.

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...I'm also a runner, but haven't had many problems with achilles tendonitis. That is until last week after a 70 mile hike (not sure what about this hike was different, but maybe because I wasn't running hills as much usual before...

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As a backpacker, trail, grass field, and asphalt runner weight on my back makes a difference in physical impact. Trail conditions including tread differences with not as much traction with loose gravel and rolly poly AT rocks and tree roots and slippery uneven slabs makes a difference. Grade makes a difference. Cumulatively, the impact forces can be greater as a backpacker. I had greater problems newly transitioning from hardcourt tennis, basketball, and being a runner on pavement to backpacking with 40-50 lbs on my back on sketchy non supremely maintained single track trails.

Little Rock, thanks for all the tips! Especially 1, that method makes since to me. Also, I did have to switch from my hiking shoes to zero drop running shoes near the end of the hike, so perhaps that didn't help.

Good points Dogwood, I did try to keep my pack light, but it's still 24 pounds more than my ankles normally support.
Ha, there is little avoiding of those roly poly rocks to be done. I already miss those damn rocks.