Bouncing Back: How to Manage Thru-Hiking Injuries

Trends & Top 10Katie Houston

Thru-Hiking Injuries on Trail How to Manage AT Appalachian

I spent the majority of my teenage years pining after the thought of one day embarking on the journey of a lifetime: thru-hiking the Appalachian Trail. On a sunny morning in February, after five days of pouring rain, it seemed like the stars had aligned for me as I took my first steps on the Approach Trail and waved goodbye to my Dad at Amicalola Falls. I had more than 30 lbs on my back, most of which was thanks to my gigantic Kelty backpack and sleeping bag I had gotten from Santa Claus more than a decade earlier. 

Despite my relatively heavy pack, I started my pace at around 15 miles per day and quickly found myself pushing 25 miles in my first week; If you talk to the ranger at Amicalola, they will tell you that’s probably the worst way to start a thru-hike. But I was in the woods to hike and gosh darn it if I was going to get to a shelter at 2 pm and simply call it a day. So, I just kept hiking and quickly piled on the miles. 

Thru-Hiking Injuries on Trail How to Manage AT Appalachian

It didn’t take long before my body started rebelling against me. Every muscle in me felt sore —  from the long days of hiking, carrying the weight of the pack, and sleeping on shelters’ hard-wood floors. My left ankle started to swell and was painful to the touch; I had developed a minor case of Achilles Tendonitis. The prospect of hopping off trail when my journey had just begun was incredibly distressing, so I continued my hike north.

After 2 weeks I had successfully navigated through more than 200 miles of the AT and I was eager to take some well-earned zeros in my hometown of Asheville, NC. However, the Great Smoky Mountains National Park section had broken me. I could barely walk by the end and my lack of stretching and the condition of my ankle when I entered didn’t do me any favors. Now I had awful shin splints on both of my legs and my ankle throbbed anytime it was inside of a shoe.

The next day, my first official zero in Asheville, I limped my way into the sports medicine office for an examination. By the end of the appointment, I was in tears and was given zero hope that I would return to the trail for a thru-hike with a diagnosis just shy of a stress fracture and severe Achilles Tendonitis.

The next three weeks defined my first experience with post-trail depression. Breaking the news to my family and friends left me feeling like a failure and I resented their pity. I knew that they were happy to have me home, but I felt trapped not being able to return to my new home in the woods. In addition to that, my hiker hunger hadn’t subsided and I started gaining weight. My wild appetite and weight gain coupled with my prescribed inactivity made my resentment for my situation grow even stronger. There was so much initial frustration, anger, and disappointment at the prospect of my journey coming to a close before it even began that I could barely process anything else. 

As a woman who graduated college in 3 years while working multiple jobs both on and off campus… the boredom was the worst part. In hindsight, my distaste for having nothing to do really caused my injury because I found my hiking days that ended at 2 pm impossible to stomach. After a few weeks in the boot and with intensive physical therapy, I was desperate for another shot. Armed with the advice to stretch as much as possible from my very reluctant physical therapist, I continued at a snail's pace northbound down the trail.

When I returned to the trail, I had a much greater appreciation for the factors that would keep me there. These are the things I learned from my experience that allowed me to not only bounce back from my injury, but also made the rest of my thru-hike more enjoyable.

Thru-Hiking Injuries on Trail How to Manage AT Appalachian

Get off trail before you have to. Go get yourself checked out or slow the heck down once you notice symptoms beyond general aches and pains. Cranking out 20-mile days on top of your already exhausted joints isn’t doing you any favors and could keep you off trail in recovery longer.

Identify what went wrong. There are many factors that can make your NOBO hike turn south real quick. Figuring out what went wrong in the first place is key: in my case that meant high mileage, heavy pack, and my shoes becoming too small after my feet started to swell. Once you identify the cause of your symptoms, you can take steps to alleviate the problem.

Trust the experts but be optimistic. Understand that your doctors and physicians know best and take their advice to heart. Try and set reasonable goals with them and remain optimistic in the face of a diagnosis. People of all ages and abilities have successfully completed a thru-hike; draw inspiration from them and don’t let your injury quench your motivation.

Thru-Hiking Injuries on Trail How to Manage AT Appalachian

Take it slow. If you are back on trail after recovering from an injury, you have to go slow. Stretching multiple times a day and not stressing your body too much while it is recovering are both important to overcoming an injury (and preventing a new one from developing).

Smiles before miles. People have many reasons for wanting to thru-hike the AT. But what makes you stay on? In New York, I met a hiker named Legs. We quickly became roommates (well, tent-mates) and our philosophy was, “smiles before miles.” If we ever became unhappy on trail, experienced a rough patch of weather, or were just over not having flushable toilets, we decided to take a break. Chatting with locals, other hikers, making fires, watching beavers in their ponds all became a new normal for my hike. Eventually we always continued north with smiles on our faces. That brings me to my last point…

Thru-Hiking Injuries on Trail How to Manage AT Appalachian

It’s okay to quit. But remember that feeling that you had when you knew you weren’t going to be returning to trail for some time? If that feeling was relief, go home and recover and move on with your adventures in another way. If that feeling was like what I felt, anger, frustration and crushing disappointment, then give yourself permission to try again and give it your truly best shot.



Katie got bit by the thru-hiking bug in 2019 on her trek of the AT. She now lives in Texas with her partner and two pups and is currently converting a school bus into a tiny home. She has a goal of completing the Great Western Loop in 2022 and hiking 10,000 miles by 25.
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1 comment



Bravo Zulu Katie for a well-written and extremely important essay. As a recently retired Army “Doc” I patched up, wrapped up more knees and ankles in the first month on the trail. (Thanks to the SOLO office at the NOC for giving me old ace wraps and helping me teach hikers how to wrap your knee if you have lateral or medial pains). The thing that save my 5th decade old ass, was I wore my fully-packed ruck every day for almost 6 months before I set foot on the trail. I wore it working as a soldier, working out and again to work part-time for a NE outfitter. Actually the only time I took it off was to drive and go to sleep. My body learned every single pain and my shoulders, shoulder blades and lumbar areas began callousing from the wear.
What I didn’t plan for was the weight loss I would experience. My 195 pound Army frame suddenly became a 173 weakling and when I returned to my Connecticut home July 4th weekend my wife said she didn’t recognize me. When I left 4 days later, I was saddled with a 5 pound ziplock of protein powder and told to drink it 2-3 times a day (I actually sprinkled it on everything just to use it up and lighten my pack). It turned out that I continued to lose weight and on the tent platform at Sabbath Day Pond shelter outside Rangeley ME I experienced a small bowel obstruction that has caused me 7 subsequent surgeries and an additional 16 admissions for “close calls”. Currently, as I sit in Yale New Haven Hospital, 3 days post-surgery from number 7; I am completely an IRB application for my masters thesis. Called “Nutrition and the long distance hiker: if food weight is such a dynamic variable how can you ensure you are obtaining your RDAs”. I will follow a cohort of hikers during their hike and track inputs and outputs in the form of blood values, body weight and body comp.
Hopefully this research will help me create meal plans of dense, but lightweight food which will allow hikers to balance their estimated energy requirements with nutritious and satisfying input.
Please contact me to take an online survey of current long-distance hikers daily dietary habits, and if you are thinking of doing the Trail in 2021, join my team.
Katie I would be interested in talking with your post-trail eating habits. My professional email is above.

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