Disclaimer: This article is intended to provide general knowledge and should not be used to replace medical care or diagnosis. Always consult a doctor if you are concerned about any injury, pain, swelling or other physical condition. Your safety is your responsibility.
Thankfully, most hiking adventures go off without a hitch. You head down the trail, take in the sights, bask in the serenity and return home happy—and in one piece.
Unfortunately, given the variable conditions, human error and, in the case of backcountry hiking, the inherent remoteness, there's always a chance that something could go wrong on the trail. "In the day-to-day on the frontcountry, we know our bodies," says Kevin Kochprapha, an REI Outdoor School regional guide lead in the Pacific Northwest. "If something happens at home, we can take a break or we can go to urgent care or to the doctor. When we're out in the backcountry, it's just us, and so we have to take a little bit more care of our bodies."
Before you go:
- Prepare yourself for the trek. Experts like Kochprapha agree that taking care on the trail starts with planning and preparing ahead of a hike—in particular, training properly for the effort, and familiarizing yourself with the conditions, creatures and dangers you might encounter—and then acting responsibly on the adventure. Related reading: How to Train for Hiking, How to Train for Thru-Hiking and How to Recover from a Hike
- Review the Leave No Trace principles. These guidelines offer a time-tested model for both preserving the outdoors and keeping yourself and those around you safe in wild places.
- Pack the Ten Essentials. Any time you're headed outdoors, carrying a well-stocked first aid kit on hiking adventures is a must. (Related reading: How to Choose First-Aid Kits and First-Aid Checklist.) Make sure you know how to use the tools in your kit by having a wilderness medicine instruction manual on hand or downloading a related app.
- Consider a wilderness first-aid class. Many REI locations offer first-aid and outdoor survival skills classes. Perhaps most importantly, equip yourself with enough knowledge to decide when it's time to evacuate the trail or access assistance, and always inform someone of where and how long you plan to hike, in case of an emergency.
Common Hiking Injuries
Below, we review the most common hiking injuries, including tips for preventing them and general steps for how to handle an issue if it does arise. Click on a topic below to be directed to each section or scroll to read more.
Allergies
It's possible to have an allergic reaction—an immune system flare-up in response to a foreign substance—in the backcountry. Pollen, animal dander, stinging nettles, poison oak and poison ivy are just some potential allergens. (Insect bites and stings are another. Read more about them below.)
Reactions can affect your skin, sinuses, airways, nasal passages or digestive system, and vary in severity from mild (such as feeling itchy or developing a rash) to life-threatening (like having constricted airways).
Preventative Tips
Plan ahead and prepare. Know how to identify potential allergens: Use a field guide and study common allergen plants in the region, like poison oak, poison ivy, ragweed and others. Learn about local insects as well: While mosquitos and wasps are prevalent in some areas, in others you might also encounter creatures like tarantulas, which have urticating hairs on their abdomen that can cause inflammation if touched. If you have severe reactions to specific allergens (like bee stings), talk with your doctor ahead of time about how to prepare and take care. If you have a history of allergic reactions and have an epinephrane auto-injector, like an EpiPen, make sure to pack it. Remember to check any trail snacks for allergens as well: Many people are allergic to peanuts, a common ingredient in trail mix and energy bars.
Cover up. Long sleeves and long pants can help prevent allergens from touching your skin.
Watch where you step and what you grab. Look at what's on the ground next to the trail before stepping off the path to let another hiker pass, for example. As a general rule, don't touch something if you don't know what it is. "If you're headed off into the woods to use the facili-trees, don't grab any trees that have vines on them," says Hannah Simmerman, a multiday adventure guide with REI Experiences in the Mid-Atlantic region. "Sometimes those vines are poison ivy."
Prevent spread. If you've been in an area where allergens are present, wash your hands well when you return to the trailhead to avoid spreading allergens to others. Remember that pets can collect allergens and oils from allergens on their fur; bathe them if necessary after your hike.
What To Do About Allergies
Keep allergy-relief products in your first-aid kit. Kochprapha recommends Tecnu products; After Bite Outdoor Insect Bite Treatment is another great option. Sarah Grothjan, Camp and Backpack editor for Expert Advice, also recommends adding an antihistamine like Benadryl to this list. While some can be taken orally, she says you can also crush them and add water to make them into a topically applied paste to avoid the drowsiness side effect: "It's great for addressing swelling or a hive without becoming groggy." If you have a severe allergy that requires immediate or specific attention, alert your hiking partners beforehand, plan ahead and make sure you have any medication you need in case of emergency.
Animal Attacks
Seeing an animal in its natural habitat can be one of the joys of the outdoors. Close encounters with animals, however, can be annoying, dangerous or even deadly. Be sure to research the local fauna ahead of time so you know whether you might be at risk of meeting bears, coyote, elk, moose, snakes, cougars or other wild creatures.
Preventative Tips
Store items securely. Make sure that all food, food wrappers, trash, toiletries and other aromatic items are stored in a bear canister or bear bag. (Note that hanging bear bags is no longer recommended by some experts; bear canisters are preferred.) Related reading: Bear Canister Basics and Food Storage and Handling for Campers and Backpackers
Keep your distance. The animals you see in the backcountry may look soft and friendly, but they're not tame. Learn about the wild animals you might see on your hike and the appropriate distance to give them—then heed that advice. (That's right: No bison selfies.) "The times that I've heard of animal bites happening or seen it are when people are getting too close to wildlife," Simmerman says.
Make noise. To avoid surprising animals on the trail, you can sing, hang a bell from your pack, talk loudly with fellow hikers, clap your hands or just yell, "Hey, animal!" every so often.
Hike in daylight hours. Animals are more likely to be on the move at dawn and dusk, and cougars tend to prowl after dark. Know what potentially dangerous animals may be in the vicinity, when they're most active and take necessary precautions.
Know how to identify tracks and scat. Both clues can give you important information about what to watch out for and how to stay safe. Related reading: Quiz: Can You Identify These Animal Tracks?
What To Do About Animal Attacks
What to do about an animal attack depends on the type of animal. Know what animals you might encounter and how to respond effectively. With mountain lions, for example, experts say you should face the animal down, make yourself as large as possible and fight back if attacked rather than retreat. With charging elk, bison and moose, you should try to find protection behind a boulder or tree. For bears, remember this rhyme: "If it's black, fight back. If it's brown, lay down." (If a black bear attacks, fight back as hard as you can, but if it's a brown or grizzly bear, playing dead is your best bet, says the National Park Serice.)
If you are bitten by any wild animal, take the wound seriously. Clean and bandage the area as well as you can, hike out and, as soon as possible, get to a doctor who can properly clean the wound and offer advice on next steps. For snake bites, the Center for Disease Control recommends removing rings or any other jewlery before cleaning and dressing the wound, in case of swelling, and never attempt to suck out the venom from a wound or handle the snake responsible for it (dead or alive). Related reading: Wildlife Safety Tips
Blisters
Blisters are a collection of fluid—typically a clear fluid called "serum" or, if there is capillary damage, blood—between layers of skin that can occur at a friction point where the skin rubs against another surface, when the skin gets pinched, or where toes or feet jam against footwear. They can occur anywhere on the body, but hikers tend to experience them on their feet or on their shoulders where pack straps can rub.
Preventative Tips
Wear footwear, apparel and gear that fits. Shoes that are too big or small are more likely to rub the wrong way against your skin, and it's important to select the right sock height, cushioning and fabric to prevent hot spots. (Related reading: How to Choose Hiking Boots and How to Choose Hiking Socks) Even shoes that do fit well may require a "break-in" period to become less stiff and less likely to rub. (Related reading: How to Break in Your Hiking Boots) Aim to break in hiking shoes and backpacks on shorter outings; avoid setting out on a long hike with a brand-new pack or pair of shoes. If you notice your shoes rubbing in a particular area, consider re-lacing them to help prevent rubbing in certain areas and relieve foot discomfort.
Practice good foot hygiene. Keep toenails clipped trim, as long toenails can rub against the front of your shoe, which may lead to irritation under the skin and painful blood blisters. Wet skin can rub painfully against wet shoes and create blisters quickly, so if you're hiking in wet conditions, consider gaiters to help your feet, socks and shoes stay dry. You may also want to bring along a pair of hiking sandals if the trail includes river crossings. Make sure your feet and socks are clean and that you shake out any rocks or dirt from your boots before you trek. Even small rocks or sand can irritate skin over time.
Treat high-risk areas ahead of time. Paper medical tape adheres without leaving a sticky residue, and it can be "your secret weapon against blisters," says Dr. Grant Lipman, former director of Stanford Emergency Medicine's Wilderness Medicine Fellowship and co-creator of the Global Outdoor Emergency Support (GOES) Health app. Applying paper tape to common blister-affected areas on your skin can create a barrier between surfaces that normally experience friction. Lipman's research shows that taking this preventative measure can reduce the occurrence of a blister significantly.
Stop hiking when you feel friction. A "hot spot" is a sign of pressure that occurs on the skin before it becomes a full-fledged blister. "Don't wait," Lipman says. Address the issue as soon as you feel an uncomfortable burning sensation. Depending on where the hot spot occurs, you can make adjustments or treat it accordingly. Consider lacing your hiking boots a different way, adjusting your pack, applying paper tape and/or simply making sure dirt or debris isn't adding unnecessary stress to your skin.
What To Do About Blisters
If a blister doesn't hurt, don't pop it, Lipman says. But, when it does begin to cause distress, it is best to drain it. Use an alcohol wipe to clean the area and whatever implement you're using to drain the blister. (Lipman says a safety pin works.) Puncture the blister, draining the fluid until the outer skin layer lies flat against the skin layer below. Next, put paper medical tape over the blister, followed by a second layer of thicker medical adhesive tape (avoid plastic tape, which doesn't breathe). Lipman says this "double tape" method offers more padding to an affected area, allows the blister to drain further if necessary and provides a sanitary barrier. Also, if you remove the outer tape, it can take the paper tape with it while leaving the blister's fragile roof in place. (It can be painful to tear off that layer.)
Cramps
If you're on the trail and unexpectedly feel a muscle (or muscles) tighten, you're likely experiencing a cramp. While you might be sore for a few minutes, hours or days, typically cramps aren't harmful in the long term.
Preventative Tips
Stay hydrated. Make sure to drink plenty of water. Consider bringing a water filter if you know there will be natural water sources along the trail. Beverages with electrolytes (essential minerals like potassium, sodium and calcium that aid your body's water retention and regulate muscle contractions) can help too. So can eating a salty snack, like trail mix.
Stretch appropriately. When you stop to eat a snack or look at the view, take a moment to stretch, especially focusing on muscles that feel tight. And stretch before you start your trek: Ouf guide Yoga for Hikers can help.
Be prepared for menstrual cramps. Consider bringing pain-relief medication along. Heat can help relieve the pain of menstrual cramps: See below for a tip about applying heat to a cramped abdomen. Related reading: Backpacking with Your Period
What To Do About Cramps
"Stop, take a water break and stretch out the muscle that's cramping," Simmerman says. "Massaging the muscle is also a good way to care for the cramp." If you can, apply heat to the affected muscle. Pro tip: Heat up some water, pour it into your water bottle and—once it's safe to touch and warm but not hot—rest it against the cramped muscle.
Cuts, Scrapes and Abrasions
Tripping over a tree root, rubbing against a rock, and encountering a thistle or thorn can lead to both surface-level and deeper skin injuries like cuts, scrapes and abrasions.
Preventative Tips
Dress for your surroundings. "If you're going through chaparral or scrubby plants, you might want to wear long pants or at least have some gaiters on, so you don't get scratches or cuts on your legs," Kochprapha says. Likewise, if you're going to be scrambling across sharp rocks, wear gloves to protect your hands.
Pay attention, especially when you're tired. "Most people will get a cut when they're tripping," Simmerman says, which can happen whenever someone is distracted or becoming weary. Always be sure to take care when using sharp tools.
What To Do About Cuts, Scrapes and Abrasions
First, control the bleeding by applying direct pressure. Then clean and disinfect the wound. (Kochprapha likes to keep a rinsing syringe on hand for this step. You can find one at any drugstore.) Dress and bandage the wound, and monitor the wound for infection. Related reading: How to Treat Cuts, Scrapes and Gouges in the Backcountry
Exposure
It is possible to have too much of a good thing. Exposure to too much sun or extreme heat or cold temperatures can be dangerous, potentially resulting in sun or heat stroke, hypothermia or other life-threatening conditions.
Preventative Tips
Check the weather. Be aware of climate conditions ahead of time to know what you're getting into. If it's going to be hot, hike early in the morning or later in the evening when temps are milder. (Just be mindful of wildlife in the area, as outlined above.) If it's cold, hike during sunlight hours. Remember that at higher elevation or during certain seasons the temperature can shift dramatically over the course of a few hours. It's also important to be willing to cancel the hike if conditions are too extreme.
Block the sun. A wide-brim hat can protect your head, face and neck. Kochprapha and Simmerman both advocate for wearing sun-protective apparel like sun shirts. (Related reading: How to Choose Sun-Protection (UPF) Clothing.) Always use sunscreen, even on cloudy days, and make sure to apply on easily overlooked areas like the tops of your feet (if you're wearing hiking sandals), backs of your hands, and the underside of your chin and neck. If you're hiking across snow or near water, remember the sun may be reflected onto your body. And don't forget to pack sunglasses to protect your eyes from the sun, wind and other elements. Related reading: How to Choose Sunglasses
Carry extras layers. Your body will heat up while you're hiking, but as soon as you stop to rest, eat or snap a photo, you will quickly begin to cool down. Put on an extra layer to stay warm. Bring a waterproof layer in case of precipitation.
Recognize signs of danger. Study up ahead of time about the signs and symptoms of exposure: Look for information about conditions like heat exhaustion and heat stroke in hot weather, and frostnip, frostbite and hypothermia in cold weather.
Eat and/or drink something. "The best way to stay warm is to stoke your internal furnace," Lipman says, which means give your body enough calories to shiver. Shivering is your body's way of warming itself up, but it uses up energy. Keep quick calories on hand, like energy bars or trail mix. On hot days, have enough water to help you lower your body temperature. Related reading: How to Choose Energy Food and Drinks and How to Stay Hydrated on the Trail
What To Do About Exposure
It's important to get out of the conditions as soon as possible. When overly hot, get out of the sun or humidity by finding a shady area and rehydrate and cool off by splashing your face with water or wearing a water-soaked bandana. For intense cold, find shelter quickly, cover up any exposed skin, change into dry clothing and/or eat something. Exposure can turn severe quickly and requires immediate attention. If you encounter a moderate or severe heat- or cold-related injury or illness, address it immediately and evacuate as soon as possible. Anytime you head into the backcountry, be aware of who to call if help is needed quickly and have a plan for how to get out in case of emergency. Related reading: How to Hike in the Heat and Cold-Weather Hiking Tips
High-Altitude Illness
The atmosphere at higher elevations, especially above 8,000 feet, is thinner and contains less oxygen than the air closer to sea level. That lower pressure and oxygen per breath can impact your body—especially your brain and lungs—in a range of ways, from mild to severe. Related reading: Why We Struggle at Altitude
Preventative Tips
Train for elevation. Prepare your body with a mix of cardio, strength work and flexibility exercises that suit the extra challenge that high-up conditions present. Professional long-distance trail runner and ski mountaineer Kilian Jornet advises running uphill to train, while high-elevation runner and repeat Hardrock Endurance Run competitor Darcy Piceu suggests checking in with yourself frequently to avoid burnout. Related reading: How to Conquer Elevation Gain (According to the Pros), How to Train for Mountaineering and How to Train to Climb a 14er
Acclimatize yourself gradually. When traveling from low to high elevation, try to gradually increase sleeping altitude over a few days. For example, if you're going from home in Miami (6.6 feet above sea level) to a hiking trip in Vail, Colorado (8,150 feet above sea level), plan a layover night in Denver (elevation 5,280 feet).
Avoid overexerting yourself. Especially on your first day at elevation, take it slow. Stay hydrated and resist the urge to drink alcohol or use sleeping aids, which can lead to a slower respiratory drive while sleeping and worsen your low-oxygen state (see tip below).
Recreate high, sleep low. Because our breathing slows while we sleep, we naturally take in less oxygen overnight. Combined with the physical effects of breathing thinner air during the day, this can exacerbate high-elevation sickness. Dr. Lipman suggests setting up basecamp at a lower elevation than what you climb or hike to avoid prolonged exposure to low-oxygen environments.
What To Do About High Altitude Illness
Any time you're at higher elevation—whether you're hiking, climbing or browsing in the gift shop—assume any sickness is altitude sickness until proven otherwise and go downhill to try to ease your symptoms if you're feeling dizzy, nauseated, fatigued and headachy. "Don't dismiss this as something else," Lipman says, adding that a decrease in as little as 1,000 vertical feet can make a difference. "To be safe, you can go down to the last altitude you felt well at." Don't stay high up if you're feeling uncomfortable.
Insect Bites and Stings
Insects, spiders and other creepy-crawlies are out there—whether we like it or not. Sometimes, our encounters with them are uncomfortable or even painful. Mosquito bites itch because your body reacts to the saliva they inject into your skin; bees and spiders can painfully penetrate skin with their stingers and fangs; and ticks are parasites (they bite and feed on warm-blooded hosts) that can infect humans and animals with bacteria, viruses and disease-causing single-cell organisms.
Preventative Tips
Repel pests. Know what insects are present where you're hiking and try to avoid peak times when possible. Wear and/or treat clothing with insect repellent as recommended on the product packaging to avoid flies, mosquitoes, no-see-ums and ticks. With bees and wasps, walk away in a calm manner if one or two is buzzing around you; if several are attacking you, run away. (Their stings may attract reinforcements.) Related reading: How to Choose Insect Repellents and How to Use Insect Repellents
Cover up. Wearing long pants and sleeves can prevent bites and stings. Looser-fitting garments are a good idea, Simmerman says: The gap between the fabric and your skin makes it harder for mosquitoes to penetrate. To protect against ticks, wear tightly woven fabric and consider tucking pant legs into your socks or shoes. It might not be the most fashionable look, but it makes it harder for ticks to crawl into your pant legs. Light-colored clothing can make it easier to spot pests that try to hitch a ride—or take a bite.
Check your surroundings, your gear, your pets and yourself. Don't reach into holes, under rocks or anywhere else without looking first. If you're in an area with scorpions, spiders and other crawlers, take a minute to shake out your shoes, sleeping bag or other items they might have gotten into. Simmerman advises checking for insects (especially ticks) on clothing and skin at the end of your hike. Ticks tend to crawl upward until they hit a point of resistance or someplace warm, so pay special attention to the backs of your knees, along your waistband and at the bra line. When you return home, toss your hiking clothes into the dryer for 15 minutes to kill stowaways. If your favorite hiking companion is a dog, remember to check their fur for ticks as well: Ticks can hitch a ride on Fido but wind up latching on you instead.
Carry medication. Individuals who know they may have an allergic reaction to insects—especially bee stings, which can be deadly for some—should be sure to pack their necessary medication. Always alert your trailmates if you have an allergy that requires immediate or emergency attention, and make sure you agree on a plan of action if something happens. (See also Allergies, above.)
What To Do About Insect Bites and Stings
Move to a safe spot away from the insect and/or hive. Remove the stinger or tick from your skin. If it's a tick, remove the insect by the head using tweezers or a tick-removal tool. Clean the wound. Reduce swelling and get pain relief by applying ice or a cold compress. f you're suffering from itchy insect bites, avoid scratching. "If you're not sure what bit or stung you, check on the bite regularly to see if it's swelling rapidly or if a rash is starting to form," Simmerman adds. "Those can be signs of a more serious sting or an allergic reaction." Related reading: How to Treat Insect Bites and Stings
Sprains and Strains
They sound similar, but sprains and strains affect different parts of the body. A sprain is the tearing or stretching of a ligament (fibrous bands that connect bones to each other), while a strain is an overstretching or tearing in a muscle or tendon (fibrous bands that connect muscles to bones). Ankle sprains are a familiar trail mishap for hikers, but sprains and strains can occur in other parts of the body too. For example, you can strain your back when picking up a heavy pack or sprain a wrist by falling on it.
If you suspect the injury is more serious, like a broken bone, Lipman advises cleaning any open wounds associated with the injury. (See Cuts, Scrapes and Abrasions above.) Then, immobilize the injury, "which should decrease pain as it limits movement," he says. "Unfortunately, at this point your adventure is over, and you should evacuate as soon as possible."
Preventative Tips
Prep your body. One great way to train for hiking? Go hiking. But there's more to it than that: Cross-training and stretching are both helpful ways to prevent muscle strain, and building core strength can help with balance, which can prevent falls and trips. Related reading: How to Train for Hiking, Yoga for Hikers and How to Recover from a Hike
Wear proper-fitting gear. You're more likely to trip or slip if your shoes are too big. Likewise, if your pack isn't sitting correctly on your hips, you're more likely to strain your back and shoulders. Whenever you're buying new gear, talk with a store associate to dial in the correct fit for your individual body and hiking needs. If you have a history of sprains and strains, consider wearing a brace. Related reading: How to Choose Hiking Boots, How to Choose a Backpack, How to Choose Trekking Poles and Hiking Staffs and How to Use Trekking Poles and Hiking Staffs
Consider using hiking poles. Poles can be especially helpful in slippery and wet conditions. "Having two extra legs basically to support yourself means that much more stability," Kochprapha says. If your poles are adjustable, shorten them for uphill sections of trail and lengthen them for downhill sections. This allows you to keep your body in a more constant, upright position that's better for balance, posture and speed. "You don't have to use them all the time," Kochprapha adds: You can stash them in a pack and "pop them out when you need them." Related reading: How to Choose Trekking Poles and Hiking Staffs and How to Use Trekking Poles and Hiking Staffs
Lift with your legs. When your backpack is full of the Ten Essentials, it can get heavy—and lifting, pulling and/or twisting the wrong way can wrench a muscle or tendon. "Learning to properly pick up a heavy backpack will save your back, [and it] will save your legs as well," Kochprapha says. Related reading: How to Pack and Hoist a Backpack
Maintain good form—even when you're tired. "Every time I've sprained an ankle," Kochprapha says, "it's been going downhill late in the day when I'm feeling loose and moving quickly without watching my footing." It's important to maintain your focus, take breaks when you need them to stay alert and watch your footing (especially on slippery and uneven terrain) until you've safely arrived at your destination to prevent injury or accident.
What To Do About Sprains and Strains
"If someone falls—and it isn't immediately obvious that they've broken or badly hurt something—I always give them some time to recover before they test their weight on the leg," says Simmerman. "Slipping can be scary, and you may not notice that it hurts right away if you start walking with adrenaline still high." If it is a sprain or strain, use the tried-and-true RICE formula to help manage pain: rest, ice, compress and elevate. Related reading: How to Treat a Sprained Ankle
Shop Hiking Emergency & Survival Gear
Photo credit: Braden Van Dragt. Illustrations by Emily Irelan
