Long Distance Hiking Injuries, Part 1

Injury probably ruins more long distance or thru-hiking aspirations than any other single factor.  This might sound a bit like speculation, but there’s some truth supported by numbers.  Distancehiking’s 2013-14 survey of 1,038 long distance hikers included a subset of 196 Pacific Crest Trail hikers who hiked at least 454 miles, intended to thru-hike, but ultimately did not finish.  When asked what the most influential reason was for not finishing, the most popular answer was injury.

chart of Reasons for not finishing the PCTIs it a surprise to anyone that injury heads this list by a comfortable margin?   After all, can any of us get out from behind a desk, strap on a pack, and set out to hike 2,000-plus miles without expecting to encounter some growing pains?  I think not.

The topic of hiker injuries is complex and wide-ranging, so I’m going to tackle it in two posts.  This first post will offer a descriptive analysis hiker injuries, answering questions such as:  What are the most common injuries?  What is the hiker injury rate?  Are there differences between trails?  Do most people take time off when they get injured?  How long is the average healing time?  The second post, which I hope to publish within a week’s time, will explore the following potential preventive or causative factors: pack weight, footwear, prior injury, prior experience, and warm-up routines.

Injury Rate

I want to first define injury to be sure you and I are using the same construct.  When asked about injury in the 2013-14 survey, hikers were asked “Did you experience injury or more than a few days of aches and pains?”  Intuitively, this means that the hiker’s own perception of injury was measured with instructions to also include a somewhat chronic nagging pain or ache.  The aches and pains piece was added because some hikers might only classify a broken bone or sprained ankle as an injury and this might have resulted in a significant underestimation of hiker injury.

Because this is survey data, the perception of injury, aches, and pains will admittedly differ from hiker to hiker.  However, Distancehiking.com doesn’t pay its mortgage or fund its own hiking jamborees from blogging and was, therefore, not able to assign a team of doctors to Walker Pass for this survey.   From here on out, I’m going to use the term “injury” to mean “injury or more than a few days of aches and pains.”

Amongst the 777 hikers in the survey who hiked the entire AT or PCT in a single season (and answered the injury question), 457 (58.8%) reported  injury.

Although the injury rate in women was a fingernail’s width higher than in men (59.2% vs 58.6%) this difference was not statistically significant.  (chi square, p=0.866)

AT hikers were injured at a rate of 61.2% and PCT hikers at a rate of 55.3%.  Though these figures also did not reach statistical significance (chi square, p=0.099) they were a lot closer to being significant than the sex differences.

Injury Location

The 457 thru-hikers who reported injury were asked to identify the location of their most significant injury.  Two hikers didn’t answer this question, leaving a sample of 455 hikers.  For this analysis, it’s meaningful to look at separate trails, since the AT is far steeper and with poorer footing than its west coast cousin (harder on the knees?)

Graph of Most Significant Injury LocationThere is a difference between injuries on the AT and the PCT.  Nearly half (45%) of hikers on the PCT chose the foot as the location of their most significant injury with knee (17%) and low leg (14%) coming in at a distant second and third.

Only 35% of AT hikers chose the foot as their #1 injury location and the difference between the trails is significant (chi square, p =0.027).  Another significant difference between trails can be seen in the number of hikers reporting knee injuries as the being the #1 location.  On the PCT, this number was 17%, but on the AT the rate was nearly double at 31% (chi square, p < 0.001).  The hip/thigh, though making up a minority of hikers who felt this was the location of their most significant injury, still comprised 8% of hikers on the PCT.  The rate on the AT was only 3.2%.  The difference between trails is significant (chi square, p = 0.021).  There was no difference between trails for hikers who chose the low leg or ankle as their #1 location.

This all makes sense.  The PCT is a long, dry, often hot and exposed trail with a treadway frequently composed of compacted sand.  It’s tough on the feet.  The AT, as mentioned above, is steeper with a more uneven treadway.  It’s also tough on the feet, but can really shred the knees.

Healing Times

This data is interesting to explore as it gives some indication as to which injuries were the most pernicious to the 457 thru-hikers reporting injury.  Longer heal times for certain injury locations might indicate that the injuries tended to be more serious.  On the other hand, longer heal times might also indicate a less serious, but more chronic injury where the pain was at a low enough level to allow hikers to continue hiking.  Your theories welcome…

Graph of Injury Heal Times and LocationThis is a complicated graph and I find it easiest to look at the injury location, then scan down through heal times.  Just on visual inspection, it seems as though injuries to the lower leg tended to heal quickly, with 60% lasting no longer than 2 weeks and only 14% lasting more than a month.  Foot injuries, on the other hand, fell at the other end of the spectrum with 60% lasting more than a month or never getting better.  Only 28% healed within a 2 week time span.  Why would this be?  Are hikers with foot injury experiencing more serious injuries or are they simply hiking through the pain?  Is a lower leg injury more acutely painful and consequently drives more hikers off the trail?

Let’s explore!  The same 457 hikers were also asked “Did you have to take time off the trail due to your injury or aches and pains?”  The results, segregated by injury location, are noted below:

graph of Time off Trail vs. Injury LocationNow this is where things start to get interesting!  By a pretty notable margin, hikers who reported low leg pain as their most significant injury took time off at a higher rate than any other injury location.  In fact, low leg injury was also the only category where more hikers took time off than did not.  Could this explain why low leg pain sufferers clustered in the faster heal time categories?  Is taking time off the trail associated with faster heal times?  There’s one more comparison to make!

graph of Time off Trail vs. Healing Time

What can be seen from this graph is that taking time off didn’t really affect the faster healing time categories, but it dramatically lowered the number of hikers in the longer heal time categories.  Among those hikers who reported that their injuries took more than a month to get better, only 35% reported taking time off.  Similarly, only 29% of hikers who reported their injuries never got better took time off the trail.

The moral?  Well, this isn’t airtight science, but the data suggest that taking time off to heal might lower the risk of experiencing a long-lasting injury on a thru-hike.  For those who suffer foot injuries, try taking some time off!  You might lower your suffering in the long run.  Once again, science supports common sense!

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