Figuring out what to be prepared for on a backpacking and hiking trip can be a bit challenging. The information we have about what poses a threat to hikers often varies from the dramatized views we might have.
There are far more splinters and twisted ankles than raging bear attacks in the wilderness.
Most illnesses in the backcountry really just boil down to nausea, vomiting, and diarrhea.
While professional outdoor guides are often trained to deal with everything from cardiac arrest to hypoglycemia, what we really do most of is treating blisters and allergies.
Most hikers need to be prepared for upset stomachs, sore muscles, and the occasional cut or twisted ankle. So, let’s take a look at some of the most common hiking injuries, how to deal with them, and what to bring with you to be prepared.
My background is in both backcountry trip leading, wilderness medicine, and front country emergency medicine. I have held certifications in all of the following: EMT-B, WFA, WFR, and WEMT.
This article is not intended to take the place of proper training and certification – it is for educational purposes only! This is not a comprehensive guide to wilderness medical techniques.
What You'll Learn
Hiking Injuries: the Numbers
According to a recent study done by the National Outdoor Leadership School the most common injuries and illnesses are easy to narrow down. They may not be the ones you expect, either!
- Nausea, Vomiting, Diarrhea (26%)
- Allergies (11%)
- Infection (8%)
- Flu, Respiratory, Abdominal Pain, Other (all tied) (7%)
- Mental Health (6%)
- Athletic Injuries (Sprains, strains, etc.) (45%)
- Soft Tissue Injuries (34%)
- Dental (5%)
- Cold Injuries (4%)
- Dislocation (4%)
Keep in mind that these numbers are gathered from institutional hiking programs. You can read the entire article from the 2015 study here. There is some small variance in occurrence of injuries based on other situations all collated in that study which can be fun to look through.
Most interesting to note is the data gathered from Search and Rescue (SAR) on pages 4-5. These data are representative only of injuries which resulted in an evacuation by a SAR team.
Of all the injuries that are most likely to force you into a situation to call for a SAR evacuation, broken bones are the most common, followed by severe sprains. In order of occurrence, SAR responses seem to be:
- Fractures (33%)
- Sprains (18%)
- Wounds (18%)
- Hypothermia (9%)
- Frostbite (3%)
Again, most of these – while severe – are relatively mundane injuries that are resulting in SAR responses.
So, what can we learn from all this? Let’s get into that!
Common Mundane Injuries
By far the most common of all hiking problems, blisters will cause you or hikers in your group more problems than anything else except, perhaps, mosquitoes.
A soft tissue injury, and so contribute to that 34% of soft tissue injuries above. However, they’re usually undocumented in wilderness medicine. If they were, I’d guess that soft tissue injuries would be more like 80% of all injuries simply because blisters are so prolific.
To be ready for dealing with blisters, you need a few basic supplies:
- Antiseptic wipes
- A lance (needle)
- Mole Skin
- Antibiotic cream
- Alcohol Prep Pads
- Gauze 4×4’s
- (Good) Medical Tape/Leukotape
There are other added goodies that might help such as Hiker’s Wool, which you put in your shoes / boots as protection.
To Lance or Not?
That’s the question for the ages. You’ll find conflicting answers but it’s simple to make your own call.
If the blister isn’t causing problems and you don’t suspect infection or complications, just leave it be. There’s no need to lance it! Just keep the area around it clean and use moleskin. Keeping it clean will help avoid infection when it does burst.
If the blister is causing problems you need to lance it. Reasons to lance:
- It’s so large it’s causing other blisters (like between the toes)
- It’s becoming discolored or odd
- It’s in an area where it’s causing pain
Lancing a blister is easy peasy!
- Just sterilize the lance and the area around the blister with an alcohol prep pad.
- Lance the blister by poking the top layer and gently pressing out any contents with a gauze pad.
- Leave the skin intact unless you suspect infection.
- Cover the wound with antiseptic ointment.
- Then, treat the blister with moleskin padding and hike on!
Stop at least twice a day and re-clean the lanced blister and treat it with antiseptic. Allow your feet to air out as often as you can and you’ll be blister-free in no time!
Make sure your hiking boots actually fit – and are broken in properly before hitting the trail.
In the worst case, blisters can become severely infected. I had to treat a blister on the trail on another hiker that was massively infected through several deep layers of skin. It took weeks to heal and left scarring. Keep those blisters clean and treat them with care!
Read more about blister prevention and treatment.
This one is not pleasant and I’ve never encountered it even with hundreds of nights on the trail leading and treating groups. It’s common enough that others struggle with it, however, so I’ll cover it here.
Jock itch is a fungal infection that causes redness, itching, and skin irritation usually in the groin area.
To treat it, keep an antifungal on hand while hiking. If you have no history of chafing or jock itch, you may choose not to bother carrying these preventative measures.
That doesn’t mean you won’t get it, however, as it’s highly contagious and can spread rapidly on congested tracks such as the Appalachian Trail.
- Lamisil is an antifungal cream that lubricates and treats this problem. Worst case scenario, get off trail and make a run to the nearest pharmacy ASAP.
- Keep your hands clean and try not to spread it to fellow hikers!
To avoid or aid in treatment, use a daily cleanliness routine. Don’t be afraid to wash and switch underwear often! Use the Ziploc washing machine method to clean out used underwear. Many athletes also use cornstarch or baby powder to help prevent or relieve.
It’s amazing what a good cleanliness routine can do to alleviate wilderness illnesses.
Exercise-induced vasculitis, as it’s called in the medical world, is commonly known as hikers rash.
This nasty little condition can happen to practically anyone at any time. Other than the irritating rash-like symptoms, most people are otherwise just fine.
Generally speaking red patches and lesions will appear on areas of exposed skin of the legs and ankles. This can also include swelling and intense itching or pain.
Symptoms of hikers rash may continue for several hours or days. They generally resolve in about a month.
This condition usually affects older people and is generally thought to be a result of a failure to properly manage lower leg circulation. Unfortunately, there’s nothing that can be done to truly stop it and it is most common in warm weather or summer walking.
It’s important that these symptoms not be mistaken or confused for other similar symptoms of poor circulation that could be much more dangerous or systemic.
For the hiker, unfortunately, there’s little that can be done to avoid this problem. Some solutions, however, include:
- Elevation of legs
- Compression socks or leggings
Some believe that wearing compression socks can help prevent this problem in the first place.
Nausea, Vomiting & Diarrhea
Maybe the lamest illness of all time, these signs and symptoms can be indicative of almost anything. NVD, as medical professionals often call it, is a set of gastrointestinal issues that are so common we’ve almost all grown used to them as part of hangovers, mild dehydration, colds, and bad food.
On the trail, NVD together represent an impressive 26% of illnesses reported in the study above.
Without a conclusive study on the source of the NVD cases on the trail it can be hard to conclusively say how to prevent these illnesses.
- However, it’s easy to recognize that trail cleanliness and hygiene often leaves something to be desired.
- Dehydration is a factor in warm weather
For both NVD (26% of cases) and infection (8% of cases) cleanliness could undoubtedly help prevent many of the issues. So, how can you help reduce your chances of the nasty stomach upset?
- Clean your utensils and pot/bowl each night with Dr. Bronner’s soap.
- Ensure you drink only purified and sterilized water – don’t drink from that muddy river!
- Clean your hands often and particularly before you eat and after every time you relieve yourself.
- Instead of shaking hands on the trail, use a fist bump or elbow touch. Other hikers are often unaware of how unsanitary they have become after days or weeks in the backcountry.
Be careful about hiking after severe NVD episodes. You may be dehydrated or malnourished. Take it slow and reduce your daily mileage for a day or two while you get back on track!
Get medical help immediately if symptoms are severe, or persistent.
Sprains & Strains (Athletic Injuries)
These account for nearly half of all recorded trail injuries in the NOLS study based on over 1,000 individual cases. Unfortunately, properly treating sprains and strains requires a lot of training and knowledge.
The best way to learn to handle these injuries is with a good Wilderness First Aid or Wilderness First Responder certification course.
Identifying and treating sprains and strains is difficult. There are lots of ways athletic injuries can present, and several variations of appropriate treatment based on many varying factors in the field.
It’s beyond the scope of this article for me to teach you how to treat serious athletic injuries. However, I’ll outline a few guidelines and thoughts that the average hiker can use to help themselves and others!
- If it’s so bad you have to favor the other limb to compensate – get off the trail and heal. Compensating usually will cause the unaffected limb to become injured from overuse. Use trekking poles.
- Carry ibuprofen to help with swelling and pain. Stay aware of the injury, however, because painkillers can mask the body’s indicators that the injury is getting worse.
- Remember the basics – RICE: Rest, Ice, Compression, Elevation. Get off the injury, cool it with water from a stream on a rag (or ice if you can find it), use compression if you know how to properly wrap, and get the injury elevated a bit.
- Don’t push it! The trail will be there after your injury has healed. When you’re not sure if you should continue, just get off the trail and seek appropriate medical care.
- If you have a history of athletic injuries, talk to your care provider to address specific problems that may occur. Have a plan. Stretching before hitting the trail can help, and wearing the right shoes.
I have hiked for hours on crippling knee pain and swelling that eventually resulted in permanent damage because of my stubbornness. Don’t join me in making that mistake.
Wilderness medicine courses can provide much more thorough training on dealing with athletic injuries. Because they’re complicated to assess and treat I can’t teach you much here in any good faith.
General Soft Tissue Injuries
These include cuts, scrapes, bruises, etc. There’s a lot that can fall in here – including blisters – but we’re going to focus on cuts and scrapes.
If your cut fits any of these criteria you may need stitches:
- More than ½” long
- Gapes open notably
- Continues deep into the flesh
- Is oddly shaped or ragged
Get off the trail ASAP and seek medical care! It will be hard to clean and heal this wound on the trail and it could lead to severe infection.
Most hiking medical kits come with some general supplies, but I suggest you do a little alteration. Good equipment to have in your first aid kit for cuts and scrapes are:
- Sanitary 4×4 Gauze (Petroleum/Antibiotic)
- Antibiotic cream
- Butterfly Sutures
- Good Medical Tape
- Alcohol Prep Pads
If you are using butterfly sutures or other wound closure and protection, the wound merits getting off the trail. Go get medical care for a wound sizeable enough that it needs to be closed!
That said, in the worst cases it’s good to have something on hand to deal with nasty wounds until you can get out.
- For cuts and scrapes that don’t require more medical attention, keeping them clean is paramount! As we’ve already discussed, infection is a major cause for incident and evacuation on the trail.
- That’s why I always carry a ton of extra alcohol prep pads. Hydrogen peroxide isn’t a terrible call but it can actually kill a small amount of living tissue.
- Irrigation syringes with sterile water are a better idea but most people aren’t carrying sterile water on the trail so you’ll have to carefully boil some.
- Irrigate or sterilize the would and then wipe around it with alcohol pads. Then cover with a sterile gauze pad that’s well covered with antibiotic or antiseptic cream. If the gauze is impregnated, use antibiotic ointment on the wound.
- Impregnated gauze is important so that it doesn’t clot into the wound. Then you’ll end up destroying the clot when you try to remove the gauze which is a big step backwards.
- For scrapes I’d just sanitize well and then cover with a light layer of antibiotic ointment. Cover it up with a dressing so it doesn’t get dirty and change it twice a day.
We’ve covered 6 of the most likely scenarios that you may encounter on the trail. The majority of hiking injuries you may have to deal with are on this list.
Of course, there are the oddities that can occur anywhere. Fractures, seizures, heart attacks, etc. can all happen and it is well beyond the scope of this article to prepare you to deal with these.
The best advice I can give you is to call for SAR evacuation as soon as you possibly can if you encounter any “life or limb” situations on the trail. Read more about Staying Safe on the Trail.
There’s a lot that can go wrong on the trail, but most of the time it’s boring stuff and fortunately so!
Become a master of blisters, be ready to deal with minor cuts and scrapes, and have a pair of tweezers to pick out slivers. Make sure you’ve got a good first aid kit.
Keep your wits about you and you’ll enjoy many days of trouble-free hiking!