HOSPITAL PRIVILEGES

Day Hiking Has Inherent Dangers and Great Benefits (Park City)

Day-Hiking (leaving and hopefully returning on the same day) is one of those activities that many of us take for
granted or perhaps do on a spur of the moment decision. “Let’s go for a hike, com’on dad!” You figure you’ll be
out and back in no time, have plenty of water, but then you want to go just a little farther or see something “just
over that ridge”. Maybe you didn’t check the weather report because it was sunny when you started. Most of the
time, we can get away with this. But when things go wrong you will be thankful you have read this article. This is a
continuation of a series that started with walking for exercise.

First of all, why even bring up this topic? You might read this article and never hike again. Hiking is safe, isn’t it?
Or we can start with the famous statement, “What could possibly go wrong?” Here is a list of what can go wrong:
running out of water, becoming injured far away from help, small problems at the outset that can become bigger
problems later in the hike, wearing the wrong clothing or not bringing along the right types of extra clothing, poorly
fitting or tested hiking boots, getting lost, forgetting to tell someone your route in advance (together these form a
nice pair), hiking in unsafe areas, accidentally becoming a target for a hunter, poisonous insect and spider bites,
exposure to poisonous plants, venomous snakes, allergic reactions, being attacked by wild animals, falling or
having something fall on you, drinking unpurified water, succumbing to altitude sickness, being struck by lightning,
getting caught in inclement weather, flash floods in desert regions, sunburn, dehydration, hypothermia, blisters,
sore muscles, knee or ankle injuries, upper body injuries from falls, contusions, puncture wounds and abrasions,
painful corns and bunions, plantar fasciitis, malalignment of the feet causing secondary pains, shin splints and low
back pain represent a sampling of what can go wrong.  

This is not meant to scare you away, but only to educate and give a new enlightenment to an old sport. Regular
hiking can lower your blood pressure, cholesterol level and weight, slow aging and improve your mental well-
being, according to studies cited by the American Hiking Society. Like walking, hiking is a low impact exercise with
the added benefit of additional toning, balance and coordination that come from scrambling over rocks, stepping
over tree roots and climbing up and down natural hills. Hiking takes a walking program to a higher level. If you are
hiking to get aerobic conditioning, keep your heart rate at least 65% of your maximum heart rate, but even if you
go slower, you will still get plenty of great exercise. Hiking will build muscle strength, particularly in your calves,
hamstrings, quadriceps and gluteus muscles. Because it is a weight-bearing activity, it will help strengthen your
bones. Hiking burns 464 calories per hour for a 150 lb. individual. For each 10 lbs. above or below this weight add
or subtract 30 calories. Staying uninjured and healthy will increase your enjoyment and benefits from hiking, so let’
s go and learn what you should and should not to do “in a nut shell” because you need to get out to that hike.
Check with your doctor prior to starting any new exercise program.

Planning or preparation problems:

As the sun sets on the western side of the mountains, it can get surprisingly dark very fast, especially in the trees
making it easier to become disoriented towards later afternoon and during inclement weather. It is usually better
to start in the morning, as it is cooler, the sun is at a lower angle, you are more likely to get back in time and
thunderstorms are more likely in the afternoon hours. Bring a trail map and look at it before you leave. Most maps
will tell you the length of the hike. Trail maps are available free in Park City at many of the sporting goods stores.
Trails are marked according to the level of difficulty. Find one that matches your fitness and skill level. Pack 16 oz.
of water or replacement fluid for every two hours of a moderate hike and up to 24 oz. per hour for very strenuous
activities. This is a lot of water so have at least a small backpack or fanny pack so your hands can be free. A
camelback works well also. When your hands are free you can balance better and are less likely to fall. Plan on
getting injured, if you do get injured you will already know what to do.  Bring a cell phone. They don’t work in all
areas but it’s worth a try. Bring a whistle. Three blasts of the whistle is the universal signal for help. Try not to hike
alone. Bringing a friend gives you three extra options. If you are injured your friend can stay with you until help
arrives or help you get back to safety or if needed go for help. Pay attention to your aches and pains. They are
yours and you know them best. These aches may get worse during a hike, so if you are not sure, plan a small
hike first as a test. This will also be covered under the medical section below in more detail. Wear the correct
clothing. Wear clothes that protect you from the sun. Don’t wear cotton, when it gets wet it sticks to your skin and
dries slowly. There are many synthetic fabrics which dry quickly and are comfortable. Ask your local sporting
goods stores for advice. If you plan on a long uphill followed by a long downhill, consider bringing an extra tee
shirt for the way down, so you can have a dry one on the way down. It’s well worth the minimal extra weight. I
frequently do this while mountain biking. Use smart-wool socks rather than cotton and it will keep your feet drier
and reduce the incidence of blisters. These socks are thicker and will give you more protection against blisters.
Break in hiking shoes completely before wearing them. I would recommend from one to two months of short walks
or hikes before going on a long hike. Hiking shoes with sturdy soles or steel plates offer much more protection for
your feet from bruising which can occur from sharp rocks. An outdoor or camping shop would be an ideal place to
look for good quality hiking shoes. I recommend buying your socks and hiking boots at the same time as the
thickness of the socks may affect how the boots fit. If you already have boots, wear them when you buy new socks
or vice versa. Bring light weight gloves to protect your hands if you will be hiking in technical or steep areas where
you need to scramble. Keep your toenails trimmed to avoid bruising them and bring mole skin and an antiseptic in
case of blisters. Bring along an extra fleece as the weather can change rapidly from very warm to very cold even
in the summertime.

Orienteering problems (if you don’t know what this means, you may already be in trouble, please read this
section):

Now that you are out hiking it might be nice to know where you are going or what direction. Sometimes the trails
are not marked as well as you would like them to be and it helps to bring a compass. They are very lightweight
and don’t cost much. Practice using it before you go out and if you need to, have them explain how to use it
before you leave. Most trail maps are marked with coordinates. If you can, let someone know where you are
going, you could even leave your itinerary at the front desk if you are staying in a hotel. Tell them about when you
will be back as well. If something happens you will get help quicker this way. Obey posted signs and stay clear of
areas that marked off limits. If you stick to the trails you are less likely to end up in a precarious location.

Avoiding natural and man-made hazards:

The hunting season begins in August with bow hunting and runs through the end of October which normally
coincides with some of the best hiking weather. This takes us back to the preparation and planning part of a hike.
You need to know if you are hiking where hunting is allowed. If you are sharing territory with hunters, I recommend
wearing a bright, preferably orange tee shirt or wear an orange backpack (mine is orange) so that you can be
spotted. Do not wear any white clothing as you may be mistaken for a deer more easily if you do. The rear end of
a deer is white. Your other option is to hike at the resorts which are private property and hunting is not allowed or
go to state parks or areas where hunting is prohibited. If you are unsure about the area where you are hiking,
wear orange. An attack by wild animals is a remote possibility in Park City. We do have plenty of moose. The best
advice I can give is to stay away from these and admire them from a very great distance. Moose are unpredictable
and may attack with little provocation. There are also mountain lions in the Park City area. In our area they are
unlikely to attack as there is plentiful other food available. They tend to become more aggressive as you go
further south towards the desert regions where there is not as much indigenous food. They will more likely go
after something small. If you hike in groups it is usually quite safe. There are some varieties of venomous spiders,
such as the brown recluse. Treat a bite with local wound care and see a doctor on your return. If you are planning
on turning over logs and rocks, wear gloves as that is where these critters usually hide. Gloves are an excellent
idea if you will need to grasp on to objects for balance as you move along. Wasps and bees are abundant.
Benadryl can help with stings. This is available over the counter. Ask your pharmacist for advice. There are some
rattlesnakes, but normally they are at the lower elevations, although I have heard of some being spotted in the
Park City area. Look where you stepping and don’t put your hands in places where you can not see. Almost 100%
of the bites are in self defense. See a doctor as soon as possible if you are bitten. Poison ivy is common in Park
City. It occurs as a spreading ground cover or a vine. A good rule is “Leaves of three-let it be.” If you come in
contact, wash with soap and water immediately. If you know you are allergic, there are ivy block medications
available, consult your local pharmacist. Even though there are many streams as you hike along, do not drink the
water unless you know how to purify it. The water can look clear and still be infested with parasites or bacteria.
Carry enough water to last your entire hike. Finally, be aware of your surroundings. Be aware of overhangs for
falling rocks and pay attention to the ground to avoid falling. A hiking pole can be very helpful, either a stick can
be used or a commercially spring-loaded pole for more serious hikers. These are available at most outfitters. It is
easy to start looking at something, and then trip as you continue to move. It is better to stop when you are
looking, then move on when you are finished.

Dealing with environmental issues:

Weather can change very rapidly in Park City. I have literally seen it sunny in the 60’s drop to the thirties in less
than one hour and snowing (on several occasions), especially at higher altitudes, at or above 8000 ft. This is
more prone to happen starting towards the end of August until the winter season in October. Check the weather
reports before you leave and it’s a good idea to pack an extra sweatshirt or fleece in your backpack in case you
need it to stay warm. If you are planning on an all day hike, bring a water-proof garment. These are light-weight
and will take up very little room in your pack. The nights are cold and when you are wet and cold, it is quite
possible to become hypothermic, even in the summertime. It is, however more common in the late summer or
autumn when temperatures can change more drastically. Hypothermia is when your body core temperature drops
below 95 degrees F. Even minimal hypothermia decreases your ability to make good decisions and to hike safely.
The sun is more intense at higher altitudes and it is often cooler, so you may not feel a sunburn coming on until it
is too late. Use or pack sun block with a rating of 30 or higher. Again bring plenty of water or fluid. Anytime is
lightning time in Park City, even in the winter. During the summer and early autumn, lightning storms are more
prevalent in the afternoon as the temperatures heat up and convection occurs. Plan your hikes so that you are
descending in the afternoon rather than reaching the peak at 4:00 PM. Avoidance is the best policy. Storms come
up extremely fast and are difficult to see as they usually come from the west over the mountains, which block their
view until they are right on top of you. If you find yourself very close to a lightning storm, here’s what to do: move
out of open or unprotected areas, stay away from the ridges, stay away from sharp changes in terrain, if you are
caught and can not move, crouch down on the balls of your feet as lying prone is not as safe and stay away from
all metal gear. Altitude sickness is more common at altitudes above 7000 ft. and especially above 8000 ft. The
elevation of Main Street in Park City is about 7000 ft. The resorts surrounding us top off at 10000 ft. The first
symptoms are (not necessarily in this order) light-headedness, nausea, loss of appetite, shortness of breath,
fatigue and a sense of not feeling well. You want to seek treatment at this point and not let it go further. If you are
away from treatment, sometimes it helps if you sit down and rest for about 15 to 30 minutes and if your appetite
returns and the nausea subsides this is a good sign. At this point try to re-hydrate yourself and have a small
power snack. More advanced symptoms are severe headache and loss of coordination. If these symptoms
develop, descend to a lower altitude immediately. If you have underlying cardiac problems, you might want to
check with your doctor before undertaking a strenuous activity at higher altitude. There are several good ways to
help prevent or reduce the incidence of altitude sickness. For your first two to three days do not do any strenuous
activities that cause you to get winded. Mild exertion at this point is OK. Keep hydrated and drink more water than
you think you need. At higher altitudes your body tends to loose (diurese) fluids so you initially need to
compensate by drinking more. Get plenty of rest. Finally, be aware that flash floods can occur in many of our “dry”
stream beds, however this is not nearly as common here as it is in areas like Phoenix, because we have far more
ground absorption of the water.

Medical or injury problems:

It is recommended that regular hikers visit their physician once per year. Inform your doctor that you hike and he
or she can better evaluate you in terms of preventive medicine. After warming up for five to ten minutes, do some
stretching. It will help prevent injuries. Blisters can be prevented by proper shoe wear and good fitting socks.
Make sure your shoes are worn in before going out. Spend lots of time selecting your hiking shoes. Don’t use
sneakers or sandals as they don’t adequately protect you from sharp rocks which are plentiful around Park City.
Bring a little bit of mole skin and antiseptic along just in case. Sometimes the mole skin does not stick, especially if
you sweat a lot. In this case, first apply tincture of benzoine to the affected area, let it dry a little bit then apply the
mole skin. For chafing that can occur along the inner thighs, under the armpits or other areas bring some
petroleum jelly and apply to the affected areas as soon as you notice anything. Don’t wait too long, prevention is
better. If you have corns or bunions, make sure that your hiking boots have been modified to accommodate them.
This can be done at the store where you purchased them most of the time. The hiking boots’ toe box can be
widened to accommodate these deformities. If you plan on doing a lot of hiking see your local doctor if you have
any questions on whether you need orthotics. Although these are expensive, sometimes insurance covers them
and if not they are well worth the expense if you do need them. Alignment problems in the feet can cause
secondary problems ranging from foot pain to ankle, knee, hip and back problems. Plantar fasciitis is a condition
that manifests itself as heel pain or stiffness and aching in the heel especially in the morning. Achilles stretching is
the best prevention. There are pads and inserts available in many local stores that can temporarily help. Hiking
boots that come up around the ankles will reduce your chances of an ankle injury. Shin splints can occur from
hiking. The best prevention is not to overdo it, and to have good strength in your leg muscles, especially the
dorsiflexors. Check out your local gym or aerobics class for good ways to condition these muscles. The most
common knee pain that occurs is under the knee cap, known as patello-femoral pain. This can be caused by
alignment problems in the knee, muscular imbalance, or arthritis under the knee cap.  Over the counter medicines
such as glucosamine HCL, purified low molecular weight chondroitin sulfate can help. They are not all the same,
so ask your doctor for advice. These are a long term fix and can take up to three months to work, however.
Antiinflammatories such as ibuprofen can help but there are always possible side effects so it is better to check
with your doctor before self medicating. These offer a good temporary solution. The number one recommendation
from the ACR (American College of Rheumatology) for the treatment of osteoarthritis (the common type, not the
crippling type) is quadriceps strengthening. Again see your gym or talk to the aerobics instructors for advice. The
advice is free, other than the cost of going to the gym and most instructors are very experienced and
knowledgeable. If you do have knee conditions, try to plan your hike so it is steeper going uphill and not as steep
going downhill and your knees will tend to hold up better. Steep downhill hikes put increased stress on the knees.
The most common cause of hip pain in hikers is a tight IT (iliotibial band) leading to secondary hip bursitis. This is
a condition that causes pain on the outer aspect of the hip made worse by walking or prolonged standing or when
sleeping on the affected side becomes more painful to the point that one has to turn over. This can be prevented
by doing stretching for the IT band near the hip, again your gym or local aerobics instructors can help with this. If
it really flares up it usually responds quickly to a cortisone injection into the hip bursa, which is not painful when
administered correctly and usually completely alleviates the pain. Lower back pain can occur from longer hikes
and the culprit is often weak abdominal muscles. Your abdomen muscles should be strong to help support your
back, when they are not your back muscles have to overwork and become strained and fail to support your back
adequately. If you have underlying back problems, when the muscles stop working, your back will begin to hurt
more as it is losing its ability to compensate for its preexisting mechanical problems (eg, back arthritis, sciatica or
degenerated discs, if you have these you know what I am talking about, if you don’t consider yourself lucky).
Watch out for accidental falls (what other type is there?) and if you have a first aid kit available. Keeping in proper
medical condition will go a long way towards reducing sore muscles, but there is nothing better than hiking to get
in shape for hiking, starting with shorter hikes, and gradually building up. Finally, remember that any medical
problem you have before you hike has the potential to get worse, so follow the recommendations in this article. Be
proactive, stay uninjured and have fun!

Recommended Hiking Kit: Even though this seems like a lot it is not. As you pack your bag, just check off the list.

Dry matches in a water-proof container
Ground cloth
Flashlight with extra batteries and bulb
Length of rope
Extra high energy food
Fleece, preferably or sweatshirt as a sub
Extra tee shirt (optional)
Gloves, lightweight such as work gloves, optional but highly recommended
Raingear
Whistle and/or cellular phone
Trail and/or terrain map
Compass
Walking stick
Mirror
Multi-tool pocket knife
Insect repellant
Your normal 24hr medications
Sunglasses
Hat
Sunscreen
First aid kit including:
a.        adhesive bandages
b.        blister kit including mole skin and blister pads and tincture of benzoine
c.        anti-itch cream
d.        tissues
e.        stretch bandages
f.        bandaids
g.        benadryl tablets (check with your pharmacist first)


Dr. Mark Hopkins is a Board-Certified Orthopedic Surgeon specializing in sports medicine. He has worked as a
volunteer physician for the United States Olympic Committee. He is an avid mountain biker and likes hiking and
walking in the summers.