As a physical therapist assistant for the past five years as well as a personal trainer, I know that a lot of problems can start in the feet. Pattern recognition is key with injury types, and you learn how one area causes pain or creates problems elsewhere.
This deep dive series will look at some of the most commonly reported areas of pain by hikers and why these areas, in particular, may be an issue. I will also address ways you can reduce harm to these areas to help make your hike successful.
The survey results were found at the website The Trek, which does an annual survey for Appalachian Trail hikers. You should check it out, it’s pretty in-depth; these results are from 2017. The biggest age range in the survey was age 21-30, which is not that surprising until you see the percentage of hikers with common joint problems that are typically not present until later in life. I’m looking right at you generation Y and Z, so listen up!
According to the survey, hikers reported pain in the following areas:
- 63% Feet (I’m putting overpronation in this category)
- 58% Knee problems
- 21% Back Pain
- 18% Hip Pain
- 12% Headaches (generally posture related, but could also be dehydration which was reported by 37%)
To put it in other terms, nearly 1:5 hikers dealt with hip and low back pain and about 1:8 had issues with headaches! Posture and feet can affect these a lot, so let’s dive in!
This might feel a little like an anatomy lesson, but stick with it! Not only will this help to clear up your knee/hip/low back/shoulder problems, for hiking, it can help clear up other issues you may be experiencing as well. It comes full circle, I promise!
Overpronation is an excessive arch drop while walking or even standing. There is naturally some pronation that occurs with walking; this is just a more extreme version of that.
The implications from this fallen arch will move up the leg and affect the rest of your body.
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To begin, the body has a series of mobile and stable joints in alternating fashion. Take a look at the image to the left to get an idea of how this looks. When the body is missing motion that a mobile joint provides, the body will try to find that motion from a nearby stable joint. That’s what neighbors are for right?
Unfortunately, the body’s attempt to find the motion will not serve you well long-term.
For example, if you are missing ankle motion, your body will try to find that missing motion from the foot or the knee. Since these are considered stable joints, they don’t have much to offer for motion and that’s where the pain and discomfort start to creep in.
With overpronation, the body has too much motion creating ramifications for the knee, hip, and low back and even up into the shoulders. This can, for some people, be the source of their headaches!
What happens at the ankle, happens at the hip.
Let’s follow the fallen arch upwards. See how the arch collapsing creates knee movement inward? The opposite end of the femur from the knee is the hip. The ankle rolls inward, as does the hip.
Since the hip is now missing some motion and being asked for a more supportive/stable role, the low back is going to be asked to provide motion. Your lumbar spine disagrees with this notion of motion, and low back pain can now take root.
What Does That Mean?
This loss of motion, even a few degrees or millimeters, can create a muscle imbalance which can create even further issues. It can create knee pain, a pinching feeling in the front of your hip, low back pain, mid back tightness, and headaches.
You’ll note that the right side of the image above shows a “corrected posture” where the overpronation has been corrected with the use of an orthotic, like Superfeet. It can really be that simple!
In a more dramatic image, you can see again how that arch affects the knee and hip.
The knee responds to overpronation by hyperextending (going slightly beyond straight) and placing undue strain on the meniscus.
The hip responds by decreasing its full range of motion to provide stability and that can cause significant problems down the road (generally speaking, decades). Joints need a full range of motion in order to stay lubricated and healthy. If left unchecked, it can result in arthritis and joint degeneration, which is what causes people to get their knees and hips replaced.
Okay, Now What?
There are a few common courses to help address this: orthotics, better footwear choices and exercise. Being able to strengthen the foot is best long-term, as the orthotic can act as a supportive crutch and not actually allow the foot to get stronger.
Selecting a better shoe will also be really helpful. Altra’s seem to be the default shoe for hikers, but they don’t really offer much support. Hikers like them because they are cushy and offer a wide toe box. Shop around and find a shoe that works!
Sometimes with overpronation, the muscles simply tire out and can no longer help support the arch. A simple exercise like this can help to build the main muscle that supports the arch, Abductor Hallucis.
Perform 3 sets of 8-10 reps, holding for 7 seconds each repetition.
Why rely on an insole when a simple exercise will benefit you in the long run?
If you are experiencing discomfort in your ankles, knees, hips or low back with your training hikes or while out on your thru-hike, remember that it may be caused by your feet! Start the exercise to help strengthen your foot, walk around in your yard, park or beach and home barefoot more often.
By doing your shakedown hikes, you will be able to test out your footwear. Be critical in how they feel! If they are uncomfortable in the slightest, make adjustments. In addition to your training hikes, be sure to physically train for your hike too!
You can reach me email@example.com with any injury issues, past or present that you feel will impact your hike. Training questions are also welcome – I am happy to help!