Illness and Injury Among Long-Distance Hikers on the Long Trail, Vermont
Article Outline
Introduction
The popularity of recreational hiking has steadily increased since the 1940s, with millions of Americans enjoying backpacking and day hiking. This popularity in hiking increases the possibility for injury and illness among participants. Multiple studies have focused on specific types of injury faced by hikers, including load-induced musculoskeletal and metabolic injuries,1,2 high-altitude mountain sickness,3 and wilderness-specific infection.4 Surprisingly, however, formal documentation of hiking injury patterns and prevention is scarce.5 Furthermore, there are only limited epidemiological data addressing injury and illness during long-distance hiking.6,7
Long-distance backpackers, persons who hike hundreds of miles in a single trip, represent a subset of hiking participants with unique health care needs. Their numbers have also increased. For example, the number of hikers completing the Appalachian Trail (a 2200-mile footpath along the eastern United States) in 1 year has more than quadrupled since 1980.8 Among the most common injuries this group may experience are musculoskeletal complaints, such as overuse injuries; diarrhea; and trauma, including fractures, lacerations, and abrasions.7 Although long-distance hikers know of these potential risks, they are often unable to diagnose and treat basic wilderness medicine conditions. In fact, studies have recommended that long-distance backpackers be better prepared and equipped before starting their hike.9
The purpose of this study was to define the illness and injury patterns of a group of long-distance hikers and to examine the role of experience, conditioning, wilderness medicine knowledge, and first-aid supplies in injury prevention and treatment.
Methods
American hikers who completed the Long Trail in Vermont from 1986 through 1998 were identified by the Green Mountain Club (GMC), and a 5-page descriptive survey was sent to them. The GMC acts as the caretaker of the Long Trail, which starts at the Vermont/Canadian border, runs 270 miles through Vermont, and finishes at the Vermont/Massachusetts border. The GMC uses an extensive posthike interview plus a detailed experiential report to certify completion of the trail.
The survey solicited information on demographics, conditioning, wilderness medical knowledge, previous hiking experience, and medical supplies. Hikers were asked about details of the hike, including duration, illness and injury, and medications used. Finally, the survey asked respondents to retrospectively analyze their prehike preparation in light of their experience on the Long Trail.
Subjects were included regardless of whether they completed the trail continuously without a planned break (thru hikers) or hiked a section at a time over the course of months or years (section hikers). These 2 groups of hikers were analyzed separately. The returned surveys were scored and entered into the SPSS 9.0 for Windows data analysis program (SPSS Inc, Chicago, IL). Data were compared and analyzed for significant differences using chi-square and Spearman's rank correlation coefficient techniques.
Results
A total of 423 surveys were mailed; 207 (48.9%) were returned undeliverable due to an incorrect address, and of the remaining 216, 155 (72%) were completed; the overall response rate was 37% (155 of 423). Of the surveys returned undeliverable, 57% had been mailed to a college or university address. The median interval from completion of the trail to completion of the survey was 2.7 years (range, 1.5–14 years). Table 1 indicates hiker demographics. Thru hikers and section hikers were equally represented. The average age of all hikers was 45.2 years (n
=150), with thru hikers younger than section hikers. Male hikers were more frequently thru hikers than female hikers (57.4% vs 24.3%, P<.001). Nearly 80% of hikers were from New England states. When hikers were identified by employment status, 10% were students, 63% were regularly employed, and 15% were retired. Ninety-three percent of students were thru hikers compared to 44% of employed persons and 47% of retirees.
Table 1. Hiker demographics*
Table 2 indicates prehike preparations. Eighty-one percent of respondents participated in pretrek conditioning specifically geared toward hiking the Long Trail. There was no significant correlation noted between having a training program or the specific type of training program and experiencing injury or illness along the trail.
Table 2. Prehike preparations
Hiking footwear was worn or “conditioned” before the hike by 64% of respondents. Those who did not wear or precondition their footwear had an increased risk of developing blisters (32.1% vs 25.5%, P<.03). Only 6% of respondents visited a health care practitioner before their hike to specifically address health needs on the trail.
Hikers used several sources for prehike wilderness medicine knowledge: personal experience (76.1%), books or magazines (47.1%), other hikers (34.2%), organizations that provide some wilderness medicine training (19.6%), formal wilderness medicine courses (11.6%), and health care professionals (3.6%). Although only a small number took a formal wilderness medicine course, the highest percentage (50%) felt that this training was their best source of knowledge. Overall, 80.8% of respondents felt they had adequate prehike wilderness medicine knowledge. Those who felt they did not have adequate prehike knowledge went on to lose more hiking time to injury than those who felt they had adequate knowledge (20.7% vs 15.5%, P<.03).
Backpackers who completed the Long Trail had extensive previous hiking experience. Ninety-three percent had been involved in hiking activities for at least 2 years, and more than 50% had backpacked for at least 20 years. Most (65%) rated themselves “experienced” or “very experienced” hikers. Twenty-five (16%) had completed the Appalachian Trail.
An average of 25 days (range, 14–42 days) was taken to complete the Long Trail for thru hikers and 4.7 years (range, 2 months–25 years) for section hikers. There were 106 (68%) hikers who experienced 165 episodes of injury or illness. Section hikers (62.4%) were less likely than thru hikers (74.4%) to be injured (P<.02). Table 3 lists the types of injury and illness. Musculoskeletal problems such as ankle strain and back pain were the most common, affecting 41% of all hikers and accounting for the most time lost from hiking. Examples of traumatic injury included lower extremity fracture, ligament damage, and lacerations requiring suture repair. Forty-one percent of hikers lost at least 1 day, with a range of 1 to 365 days lost.
Table 3. Types of injury and illness among Long Trail hikers (n=155)
There was no significant difference in injuries experienced between section and thru hikers, although thru hikers suffered a greater proportion of the injuries causing loss of hiking time than section hikers (62.5% vs 51.3%, P<.05). No correlation was found between type of injury and age or gender. The hiker's background wilderness medicine knowledge and backpacking experience did not influence the type of injury or illness suffered. And, other than footwear, prehike conditioning demonstrated no correlation with injury pattern.
Eighty-nine percent of hikers carried a first-aid kit (Table 4). Hikers who carried a kit, irrespective of whether they were a thru or section hiker, were more likely to report an injury-free experience than were hikers who did not carry a kit (47% vs 29%, P<.05). Hikers overwhelmingly indicated that they felt prepared to deal with illness suffered on the trail; only 8.4% of hikers did not feel adequately prepared.
Table 4. Medications and first-aid supplies carried and used on the Long Trail*
Discussion
This study documents the health experience of a selected group of successful long-distance hikers. The results indicate that almost 70% of the participants experienced illness or injury while on the trail, and thru hikers were more likely to be injured than section hikers. However, most hikers were able to effectively deal with injury and illness and complete their hike.
Musculoskeletal injuries were the most common, a finding similar to another study of long-distance hikers.7 Blisters, gastrointestinal complaints, and trauma were also common. Although most adverse health events were seen with similar frequency between section and thru hikers, gastrointestinal complaints occurred more often in thru hikers, and hypothermia (subjectively described by the hiker) occurred more often in section hikers. There are possible explanations for these differences. It is likely that thru hikers had to find their own water and cook their food on the trail, which may have led to a greater potential for food and water contamination. Section hikers must pack their equipment for each hike, and it is possible that they would not accurately anticipate the weather and therefore not carry sufficient cold and wet weather gear for a given section hike. Section hikers may also have hiked more frequently during colder months. Lastly, they were older and could have been more prone to temperature intolerance.
The finding that prehike conditioning or experience did not have a significant influence on injury frequency or type is surprising and counterintuitive. However, this same result has been previously reported among long-distance hikers.7 This lack of influence could be because only hikers who successfully completed the Long Trail were surveyed. Thus, it is possible that those who failed to complete the hike had less conditioning or were less experienced in hiking long distances. Unfortunately, no data exist on the percentage of persons who are successful in hiking the entire Long Trail. A prospective analysis of all hikers who attempt the trail would be helpful in this regard. The only exception to the lack of effect of prehike conditioning was the importance of breaking in boots in preventing the development of blisters.10
A wilderness medicine training course was reported to be the best source of prehike information, although only a few hikers took such a course. Hikers felt they were well prepared to treat injury if they carried a first-aid kit. These hikers were also more likely to report an injury-free experience. This may reflect an improved overall preparedness for the trip.
There are several weaknesses in this study. The first is that only hikers who successfully completed the Long Trail were surveyed. This most likely biased the results toward fewer and less severe injuries and may have prevented any significant correlates of prehike preparation and conditioning on the success of the hike. The second is that there was a low overall response rate, because nearly half of the surveys were returned unopened. More than half of these were sent to a college address, suggesting that many younger hikers were not surveyed. Finally, because this study was retrospective, recall bias was inevitable, especially given the 2.7-year median interval since the respondents had completed the trail.
Nevertheless, this study documents the health experience and needs of a group of long-distance hikers and helps provide some general recommendations. All hikers should make sure they have footwear that is broken in and ready for many miles of daily hiking. This would prevent the most common adverse event caused by poor preparation. Anticipating health needs on the trail, having adequate measures to cook foods and treat wilderness water supplies, and carrying sufficient clothing for all weather conditions would avoid common problems. Carrying a first-aid kit may lend a sense of health security as well as provide the hiker with the necessary supplies. Anticipation of common illness and injury on the trail and the ability to manage them will contribute to a healthier experience for the long-distance hiker.
Acknowledgments
The authors wish to thank the Green Mountain Club for providing the list of Long Trail participants and Jo Ellen Petty for help with data management.
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PII: S1080-6032(02)70610-8
doi:10.1580/1080-6032(2002)013[0131:IAIALD]2.0.CO;2
© 2002 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
