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As a former instructor for Exum Mountain Guides, Brian Prax helped clients conquer the rugged terrain of Wyoming’s Teton and Wind River Mountains. As a practicing physical therapist, he treats joints and muscles when the combination of steep trails and heavy packs does the conquering. To stay on the trail (and off a PT’s table), follow Prax’s expert advice.
Trauma Climbing steep trails puts excessive force on the spot where the underside of your kneecap rubs against your femur (the patellofemoral joint), causing pain that can become chronic.
Treatment Take a week off, if possible. If not, take smaller steps, pop ibuprofen, and apply a cold pack to your knee when you get to camp.
Trauma Your Achilles tendon connects your heel to your calf muscle, providing essential power for ascending. But too many of these raises can irritate the tendon, causing calf pain that worsens with each step.
Treatment Stretching helps: Stand facing a tree and brace the ball of your foot against the trunk. With legs straight, lean toward the tree to extend and stretch the calf. Hold each side for two to three minutes.
Trauma Rolling your ankle too far inward with each step–called overpronating–passes the impact (and resulting pain) of downhill hiking up to the ankle, knee, and hip. Detect overpronation by looking for excessive wearing of your shoes’ tread on the inside of the forefoot.
Treatment On the trail: Descend with an even, rolling motion. Let your heel impact gently, and then roll your weight onto the outside of your foot before rocking inward and preparing for the next step down. At home: Buy an aftermarket insole with extra arch support.
Trauma Repetitive compression can cause internal swelling (effusion) in your hips, knees, and ankles. “It feels like a toothache inside your joint,” says Prax. Besides being painful, this reduces the ability of your joints’ stabilizing muscles to control your descents.
Treatment Use trekking poles. Studies have found found that leaning on poles while hauling a pack reduces compressive force on the knees and ankles by up to 25 percent.
Originally published in 2010; last updated February 2023