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Outdoor First Aid

A Speedy Recovery

Sidelined by injury? Get back on the trail fast with this easy treatment plan.

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A twisted ankle. Back pain. A sore shoulder. If you’re physically active, you’re familiar with sports-related injuries. According to the American College of Sports Medicine, one out of four active adults suffers musculoskeletal injury in a lifetime, mostly to the lower extremities. Many more experience swelling and pain from previous injuries that didn’t heal properly, says Robert Duggan, DPM, an ankle surgeon and sports medicine consultant to ABC’s Wide World of Sports.

But a little hurt shouldn’t force you to the sidelines–not for long. Doctors say fast, aggressive treatment will dramatically shorten your road to recovery. “Athletic injuries should be managed initially and immediately with RICE,” says Steve Platz, National Outdoor Leadership School instructor and physician’s assistant at Wyoming’s Teton Orthopaedics. “If you spend a few days resting, icing, compressing, and elevating the injury, you’re going to bounce back quicker,” he says, explaining the acronym.

After RICE, you should follow a routine specific to your injury. We asked doctors and physical therapists to help us develop at-home plans for recovering from pains in the ankle, knee, back, and shoulder–the most common injuries to backpackers. They also told us how to spot serious injuries requiring a physician’s expertise.


The pain: When you twist your ankle, you’re likely to feel some serious hurt and experience a disturbing wobble and lack of balance. That’s because the injury has disrupted your proprioception, the intricate system that allows your body to react to exteral stimuli.

The plan: While sitting, trace the alphabet (capitals and lower case) with your toes, flexing at the injured joint; repeat three or four times daily. If that’s too painful, rest 2 more days and try again. As soon as you can stand pain-free on the injured foot, try balancing on it. Next, bounce on it gently. When you can hop pain-free from one foot to the other, start hiking.

When to call a doc: “If you can’t take more than four steps,” says Platz. Most ankle injuries eventually heal without professional care, but disabling pain or instability warrants an X ray.


The pain: Front-of-the-knee discomfort is the number one complaint at sports medicine clinics. It’s usually attributed to taking big steps up or down, to running, or to overuse.

The plan: Try the following exercises, which are designed to strengthen the muscles that support your knee.

>>> Leg lifts: Sit on the floor with the bad leg straight in front of you and the good leg bent. Tightening your thigh muscles, lift the injured leg up about 8 inches, keeping it straight, and lower it slowly to the floor. Complete a set of 10, then roll onto your uninjured side, and repeat. Now straighten both legs, roll onto your stomach, and do two more sets of lifts with the injured leg.

>>> Sit-downs: When leg lifts become easy, stand against a wall and slide down until you’re in a sitting position. Keep your head and back against the wall. Hold the position for at least 10 seconds, then slide back up. Repeat this 10 times.

>>> Lunges: As your knee improves, try a few lunges. Stand with your feet apart and in line with your hips. Step forward with one foot, letting your knee bend when the foot lands. Push back to a standing position by straightening your knee and stepping back. When you can repeat 10 lunges without pain, you’re ready to hike.

When to call a doc: Knees are more likely than ankles to suffer serious ligament or cartilage damage. “If the knee swells quickly or feels unstable when you walk, get a professional evaluation,” says knee expert Joe Costello, certified strength and conditioning specialist and founder of the Coreance Rehabilitation Center in Boulder, CO.

Lower Back

The pain: Back pain is usually caused by chores that require lifting, or by a fall or auto accident. Exercise can aggravate resulting weaknesses, causing chronic throbbing and stiffness.

The plan:

>>> Rest easy: Sleep on your side or back with thick, stiff padding under your knees. Avoid sitting, especially for long periods, since it stresses the lower back more than standing does.

>>> Walk: Stroll around the neighborhood to relieve stiffness in the initial phases of the injury.

>>> Crunch: These modified sit-ups help stretch back muscles. Lie on your back with your knees raised and feet flat on the floor. While tightening your abdominal muscles, lift your head and shoulders and press your lower back into the ground. Do 5 to 10 crunches, and stop if you feel pain.

>>> Massage: A good rub at any point in your recovery may speed healing.

>>> Add weight: When you can walk pain-free, try hiking with a light pack.

When to call a doc: If the pain doesn’t diminish in a week to 10 days, if it wakes you up at night, or if pain, tingling, or numbness begin to creep down your legs.


The pain: Soreness in the front or side of this joint is often caused by activities that require reaching: climbing, swimming, tennis, and softball.

The plan: Start with simple movements. Bend over at the waist with your arm hanging down and do a series of small circles, first with your palm facing your body and then facing away from your body. Slowly enlarge the size of the circles. As the pain goes away, you can start exercising with a little weight. Hold a can of soup with your arm out to the side at a 30-degree angle to your body and your thumb down. Raise your arm up, but not higher than your shoulder, and repeat until your shoulder tires. When you can wear a daypack and walk without pain, you’re ready for the trail.

When to call a doc: If you don’t feel better after a week, or if you experience acute pain and severe swelling.

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