Mailbag with Jennifer Pharr Davis: Handling Injuries on Long-Distance Trails

The Trek Editor’s Note

Welcome to Mailbag with Jennifer Pharr Davis.  In case you missed it, we’re taking hikers’ questions and passing them off to the trail legend for her wisdom and analysis.

JPD has solo thru-hiked the AT and PCT, set the self-supported FKT on the Long Trail, and the supported FKT on the Appalachian Trail.  Her AT FKT landed her the honor as one of National Geographic’s Adventurers of the Year. But the real reason we love JPD and ask for her input? For such an accomplished hiker, she is down-to-earth and incredibly humble. She has figured out how to have a life off-trail as a wife, mother, and professional… and continue hiking. She has kept it classy amid the negativity and tense confrontations that can be part of the hiker trash community, and she has always found ways to give back to the trail and conservation organizations.  JPD’s newest book, The Pursuit of Endurance is now available, and you can read our review here.

Have a question for an upcoming Mailbag? Email [email protected] and we’ll pass it on.


Have you ever had IT Band Syndrome (ITBS) on trail? How did you/would you manage it? -Brandon Chase

*Disclaimer: This is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding injury or medical condition.

This week’s mailbag is real specific and I can answer it quickly. Yes. 1. Roll. 2. Stretch 3. Ibuprofen 4. Hike through it and hope it doesn’t get worse. 

But this brings up a much larger and relevant question: How should you handle injuries on long-distance trails?

If you decided to take up long-distance hiking, you will get injured. It is not a question of if, but when. There will be acute injuries such as the sprained ankles that are part and parcel with the Pennsylvania rocks, or the skinned knees and bloody elbows that come from hiking through the White Mountains in a torrential rainstorm. Then there are the chronic overuse injuries that hobble us for days and states at a time: Plantar Fasciitis, Achilles Tendonitis, IT Band Syndrome, Bursitis, Shin Splints…. the list goes on.

I have been fortunate in that I have been able to hike through most of my injuries.

I went into my first AT thru-hike still dealing with moderate but after one week on the trail, the pain completely disappeared. Problem solved. I have never again suffered from plantar fasciitis. Hiking made it better.

When I went for the Fastest Known Time (FKT) on the AT, I started in Maine. I developed shin splints by the time I reached New Hampshire. I wrapped my legs, soaked them in cold rivers, took ibuprofen, and cried. With every step, it felt like someone was stabbing my lower leg with a knife—particularly on the exposed granite and steep descents in Maine and New Hampshire. When I hit the softer tread (read: mud) in Vermont, the pain gradually decreased. The discomfort transitioned from agonizing to annoying and lasted 1,000 miles, but ultimately it went away.

When I hiked the 500-mile GR-11 through the Spanish Pyrenees, I struggled with a tight and painful IT band. I was also in my second trimester of pregnancy, dealing with thigh chafing, and a yeast infection (TMI?). There was a lot going on that summer. That said, I never found a way to make the IT pain go away. Stretching didn’t help, improvising a foam roller with fallen tree limbs didn’t do anything, and resting never made a difference. My leg was always tight and always in pain.

When I got home, the doctor told me it was an overuse injury and I needed to stretch more and do at-home PT. Six months later I went back with worse pain, so the doctor gave me cortisone shot. Another six months passed and I felt more crooked than before. Finally, the doctor ordered an X-ray and MRI. The MRI revealed a cyst that was growing on the backside of my knee and putting increasing pressure on my IT band. A month later I had knee surgery to remove the cyst, and after a season of PT and rehab, I have been able to hike and run without pain.

There are different types of pains and injuries on the trail. Some you can hike through. Others you can’t.

My general rule of thumb is that if the pain is bearable (the word “bearable” will vary with personal pain thresholds) and it seems to be getting better or staying the same, then you can generally keep going. If the pain continues to get worse then you should stop and seek medical attention.

As it can be challenging to access healthcare facilities on a long-distance trails, I recommend having a personal health care provider you can call during your hike. Even before you hit the trail, it is a smart idea to have a physical with your primary care doctor and discuss your upcoming plans with them. Per my doctor’s recommendations, I have carried JIC prescription drugs on several remote trails. I have also called from trail towns and mountaintops to ask questions such as: How do I tell the difference between stress fractures and shin splints? Can I take ibuprofen while nursing?

It is important that you listen to your body and advocate for yourself on trail—and the doctor’s office. Long distance hikers can inadvertently worsen their injury by trying to keep up with their miles or a hiking partner. For most overuse injuries a doctor will recommend rest, ice, compression and ibuprofen. It’s a good idea to start there and see how your body responds. If decreased mileage and self-care does not relieve your discomfort, try to find a doctor. If you are not satisfied with the assistance or treatment you receive from a medical professional, don’t be afraid to seek additional help or a second opinion.

Perhaps the biggest risks to long-distance hikers when it comes to injury is the that we all deal masking pain that comes from backpacking for weeks at a time, and we can be stubborn asses blinded by the goal of making it to the last mountain. Rest can help minimize the common aches and unveil more problematic ailments. But being mule-headed is more difficult to identify and overcome. If you are hiking through extreme discomfort that does not improve, ask yourself, “Is making it to the end of the trail more important to me than a life of hiking?”

Remember, stopping for an injury does not mean that you will fail to complete a trail. It is a pause. Sometimes the pause takes a few days, a few weeks, or a few months. Maybe you have to return the next year. In the meantime, the trail is not going anywhere. You can come back and finish later, and you will enjoy it a whole lot more without trying to push through debilitating pain.

Want to chat with JPD about this subject? She’ll be hosting a live session on her Facebook Page on Friday, May 11th at 12:00pm EST.


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