HOSPITAL PRIVILEGES

Day Hiking Has Inherent Dangers and Great Benefits (Phoenix, AZ)

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, scorpion 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, 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:

There are a wide variety of choices for hiking in the Phoenix area all the way from desert canyons to the higher
elevations near Flagstaff. In the Flagstaff area, 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. In the lower desert
regions, start in the morning and return by 10 AM to avoid painfully hot weather. Try to pick hikes in canyons that
offer shade. 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 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 if you are hiking in the higher elevations, 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. In
the lower desert regions, wear clothing with a good UPF (ultraviolet protection factor) rating if you will have much
sun exposure, if not cotton is probably OK. 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. Use a lighter version for lower elevations and thicker for higher elevations. 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 if you are at higher elevations 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 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 the Phoenix area. We do
have plenty of moose around Flaggstaff. 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 Phoenix area. They are in some of the more remote locations as they are usually afraid of
people. They tend to become more aggressive as you go further south towards the harsher 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 many varieties of venomous spiders and scorpions. 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 if you are stung. This is available over the counter.
Ask your pharmacist for advice. There are rattlesnakes. 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 Flagstaff and in riparian (where there is water) areas at lower elevations. 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 may be 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 Flagstaff. This is more prone to happen starting towards the end of August
until the hiking season ends. 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 Flagstaff, 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 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. When hiking in the Phoenix area, check the weather forecast before starting out. Remember
a storm many miles away can cause a flash flood where you are. You may not even see the storm. As many of the
hikes are in dry washes, where there is shade, it makes it even more important to check the weather forecast.

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 or scorpions. 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 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).
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 (higher elevations)
Extra tee shirt (optional)
Gloves, lightweight such as work gloves, optional but highly recommended
Raingear (higher elevations)
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. He has been assigned as a reservist to the 944th Fighter Wing at Luke AFB since August
2001.



Mark Hopkins, M.D.
Board Certified Orthopedic Surgeon
P.O. Box 680518, 1205 Ironhorse Drive
Park City, Utah 84068