Coping with injury on a multi-day trip

I’ve had my fair share of moments where I have felt that my body has failed me. Every time I have inevitably learned that it was because I had asked it to perform outside of its normal parameters. This particular knee injury occurred on a multi-day winter hike in the Scottish Highlands and resulted in me not being able to complete the trip as planned. My hope is that by sharing this you will learn, as I have, from my mistakes. And also, how to deal with injury while in remote regions.

Let’s begin in the same format that any physiotherapist would start in your first visit to their clinic, with the context. I’ve had experience of knee injuries before as it is somewhat of an occupational hazard in my industry. My first was in late September 2020 and my body was pretty unconditioned to mountain walking after the first covid lockdown. I was living in Northern Scotland at the time, so the Nevis Range was fairly accessible, and I had my eye on a fantastic circular route just South of Ben Nevis. Called the Ring of Steal, the route is full of ascents and descents with a total 1571m elevation gain, the last descent a punishing 1050m over a rough distance of 2km. Not particularly steep in the grand scheme of descents but quite sustained. Prior to the lockdown, I was very fit and would have had no problem blasting down this hill. Neither would I have considered using walking poles. I had sufficient strength in my quads and glutes to control each step down to reduce the shock on my knees. It’s important to point out that I am very thorough at warming up and down for mountain walking, I will always maintenance stretch the working areas afterwards. However, after the first rapid 400m descent, I started feeling a stabbing pain underneath my left kneecap with each step. I began to favour my right foot for larger steps down. Soon that too began to cause me grief and added around 45 painful minutes to the hike. After a trip to the physiotherapist, I was soon training in deadlifts, squats, lunges, and core, during periods on ‘no hillwalking’. It has been my three times weekly workout regime since, and I have not suffered the same problem.

This multi-day trip was going to be most ambitious that I had attempted in the UK during winter, and the Polaris team trained hard for it. Largely consisting of deadlifts, squats, lunges, split and box squats, and step downs. Targeting the quads, hamstrings, glutes, and core. The plan was to walk from the Northern shore of the stunning Loch Affric, immediately up to the peaks that separate it from Loch Monar to the North, then West towards Kintail. We would walk the reputably epic ridgeline of the five sisters of Kintail, before heading back via the Southern side of Glen Affric. Expected trip length was 115km.

The first three days went well, if a little slowly as above 600m the snow was knee deep in most places and there was a constant windspeed of 30-35 miles an hour. These two factors made staying on our feet a constant challenge on the steep slopes. We made alterations to the route due to the slow pace and the fact that new deer fences had been erected in the Glen that would have made sticking to the intended route less feasible. The ability to be flexible with your route through mountainous regions is important because weather conditions can be different than expected on the day or other factors can make the route impassable. It’s something to constantly assess, especially in winter where the risk of avalanche is a very real possibility.

A big part of the context for this injury were my boots, which were semi stiff in the sole and designed to wear with a crampon. In of itself this is not a problem, I have had these boots a long time and I am used to wearing crampons for winter mountain walking. With this type of walking boot, the foot does not work much at all, as if it were in a ski boot, which means the muscles higher up in the thigh are working much harder. However, for the past two years I have predominantly worn bare foot or minimalist shoes for most activities, including summer mountain walking. With these boots, the foot and stability muscles are all working as intended so less stress put on the thigh muscles. Additionally, I had the added weight of a bag loaded for a multi-day winter trip. Unfortunately, I did not foresee this change in muscle use as being a problem and, perhaps naively, did not implement this change in my training.

It’s worth a note, I am an advocate for barefoot shoes because I have flat feet and there is evidence to suggest that barefoot shoes can help stabilise and make flat arches more comfortable, as well as improving balance and posture while decreasing stress on the joints. If you are interested in this, I can recommend the Vivo Barefoot Tracker Forest ESC. A fantastic boot that has a stitched sole so do not fall apart in the way Vivo’s other chemical sealed shoes are notorious for doing. They are not Gortex lined so I coat mine in leather waterproofing and dubbing wax once a week (for constant use in wet conditions).

Combine this with frequent lateral movement from dropping through the snowpack with a weight on my back and added instability from a moderate wind, it’s a perfect storm for a knee injury. Sure enough, during the third days final ascent as dusk approached, I began to feel pain on the left side of kneecap moving up the lefthand side of my thigh. Bending and straitening particularly were problematic, and this slowed our pace to the point where it was becoming clear I would not be able to continue with the team. We camped at 1111 meters and that night made a new plan to descend back into Glen Affric and double back to the car where I could make my way to Inverness and get treatment while the team continued on.

The descent was literally painfully slow. Thankfully, I have learned from previous mistakes and now take walking poles on big trips. These spread the load of your body and backpack, reducing stress on your joints and muscles, making your movement less taxing across particularly uneven terrain, great distances, or down steep descents. Though, I find they get in the way if I’m micro navigating in difficult conditions or if the terrain is so uneven that I need to use my hands, when scrambling for example. The Back Diamond Distance Carbon Z is super lightweight and very strong. They are not the cheapest, but reliability and weight are two factors I will not compromise on with walking poles.

When we reached the vehicle, my knee has swollen to the point where I feared ligament damage. These types of injuries take months to recover from and, at the time of writing this, we have upcoming expedition to the Arctic. Thankfully, after an emergency visit to the physiotherapist I learned that I had “aggravated” the sartorius muscle. This runs from the hip diagonally down across the front of the thigh to the inside of the leg and inserts just below the knee. As I have described above, the physio said probable causes where a combination of footwear type, deep snow, bag weight, and wind. After some hands-on work and ultrasound therapy, I was advised to avoid all aggravating factors until the swelling had receded, then to start gentle strength conditioning and stretches to rehabilitate the offending muscles. Meaning, no more hiking on this trip. And much sadness.

While a bitter pill to swallow, this was a valuable lesson in how to avoid this injury from reoccurring. The advice I was given was fantastic and I would like to say a big thank you for the that and the treatment I received. Importantly, I learned that due to the nature of multi-day hikes, it is advisable to give attention to the main working muscle groups to promote recovery at the end of each day, in preparation for the next day or activity. I have always known that stretching at the end of each long day is important, but so is massaging those muscle groups. In the case of the sartorius muscle, this could be buy using a water bottle applying pressure in a rolling motion on the front and left side of the thigh. This type of recovery is likened to that of athletes who compete several times over a multi-day period, which seems to me like a prudent  mindset to adopt.

It’s important to accept that our bodies are not indestructible and require frequent maintenance, especially when undertaking sustained strenuous activity. It is essential to condition the body in preparation for multi-day hikes, especially in winter. Factors to be consider include are the type of terrain you’ll be covering, and therefore the boot you will wear, the weight you’ll be carrying, the length of the trip. If you are not sure how to train for this, talk to a personal trainer or a physiotherapist. Either will send you away with list of strength conditioning exercises that are appropriate for what you are doing.

Consider a remote first aid training. These are defined by a sixteen-hour course that generally covers similar content to the first aid at work but applies it to a context where you have to sustain a first aid situation for up to three hours. This is usually the maximum time in which it takes mountain rescue to get to your location in the UK, assuming you know exactly where you are. This level of training is required by all mountain leaders to take groups out in UK mountains. Each team member should carry a basic and personalised first aid kit, I would highly recommend including some ibuprofen in this. If you cannot take this because of an allergy, then speak to your GP for an alternate appropriate pain relief that has an anti-inflammatory element.

Always be prepared for something to go wrong. In the planning stage of an expedition, build escape routes into each day or travel so you have a viable means on getting you and your team safely down and back to a vehicle. Cover all of these bases, and you can take on a trip of epic proportions safe in the knowledge that if something goes wrong, you have robust procedures to fall back on to keep you and your team safe and happy.

Being Comfortable in the cold

“I can’t handle the cold.”

I hear this phrase a lot when talking to people about what I do for a living. It’s the most common reaction to the idea of sleeping outside, 500km inside the Arctic Circle, at -25°C with a sleeping sack, bivvy bag and air mat for shelter. Indeed, this latest spate of rare cold snaps that saw -6°C on the Southern coast of England has sparked grumbled conversations and a longing for the summer months.

But how is it that we can take a group of 10-year-old students to Northern Finland, walk them through the tundra, to sleep in in a snow grave, and return with the same number of students that we set out with? How do they cope?  Is it just down to being able to afford the best clothing and equipment? No, in short. Having gear that is designed for the environment in which you operate is an advantage, but it is by no means the final answer.

We are in the latter half of January, and the Polaris Outdoor team has just returned from a trip to one of the most remote regions of Scottish Highlands, where we undertook a challenging multi day winter walking expedition. From the stunning shores of Loch Affric, heading west and over the snow-covered peak of Càrn Eighe to the winding knife-edge ridgeline of the Five sisters of Kintail, and back via the peaks that dominate the Northern slopes of Glein Shiel.

The winter has been good so far in terms of snow coverage and reliable low temperatures. The first 3 days saw constant wind speeds of 30-35 miles an hour. The snow line beginning at 600m and dropping right down to sea level with the onset of a high-pressure system that gave us fiercely beautiful sun rises and sets, with crisp and clear vistas for nearly 100km. All for the small price of sleeping in temperatures as low as -17°C at 1100m.

It’s important to note that there is a fundamental difference between the dry cold of northern Europe and temperate weather systems that frequent the West coast of the UK. Higher moisture content in the air can lead to much more rapid cooling of the body because water moves heat away from the body 20 times faster than air via convection. Additionally, increasing physical activity in wetter environments means the body will sweat more in comparatively higher temperatures. This can compound the issue and hugely increase the risk of hypothermia when  the hard work finishes.

So what solutions are needed?

Shelter…

This starts with the clothes on your back. A layer system is the best approach here that functions as insulation and wicks away moisture, and keeps external moisture from penetrating inwards. Starting with the base layer, a merino wool and synthetic blend works well for multi-day cold weather trips. Merino wool is a fantastic insulator and during stop-start activities like winter mountaineering it retains far more of those thermal properties when wet compared with other materials and is very good at wicking moisture away from the body. It is odour resistant which is ideal for long trips where washing is not practical. The addition of synthetic materials will make the garment keep its well-fitting shape while giving it more durability and elasticity. On this trip, I used the Seige Base Layer by Thrudark, which is an astonishingly warm garment for its thickness. The geometric construction of the fabric was fantastic at quickly removing sweat.

A mid-layer serves a similar purpose and therefore can be made from similar materials. Remember to have an extra layer in your bag to put on when you come to rest. A top tip is to wait until you cool to a comfortable temperature thereby getting rid of moisture before adding a backup layer.

The outer shell layer’s function is to prevent the precipitation from reducing the effectiveness of your thermal layers. It also prevents the bite of a cold wind from cutting through you. Gortex is a lightweight synthetic material that accomplishes both of these objectives and is my go-to for a waterproof top and bottom for mountain walking in any season. However, being waterproof means that sweat will quickly build up so garments with ventilation zips in the armpits, outer and inner legs are ideal.

As for hands and heads, an insulative glove with a lightweight Gortex over mitten is a powerful combination. To take the opportunity to dispel a myth, it is untrue that most of our body’s heat is lost through the head. Heat is radiated fairly evenly across the surface of the skin. A merino hat is very a good insulator but may lose its shape rather quickly. Again, a blend of merino with stretchy synthetic fibres works well.

When considering materials for any garment remember the old adage, cotton kills! It is a poor insulator, and this is further reduced if it gets wet, while taking a long time to dry. I have endured enough cold damp, feet during my career that I no longer hesitate to spend a bit more money on a decent pair of wool socks. Bridgedale do excellent merino wool socks that I combine with their synthetic liners.

Hydration, food, and things to avoid…

Our blood is made up of 51% water and this is integral to our body’s ability to regulate temperature. Become dehydrated and the blood begins to become more viscous, preventing it from carrying heat around the body. Don’t wait until you are thirsty to drink as you will already be dehydrated, and cold temperatures will reduce your thirst. Straw-coloured urine is a robust indicator of hydration and is usefully easy to measure against the white of snow! It doesn’t take a master tracker to identify the previous night’s camp of a dehydrated hiker.

Your body breaks down food into glucose, which is released into your bloodstream, known as blood sugar, and is the main source of fuel for the brain. Run too low, and the brain will have reduced function, this includes temperature regulation! You therefore need to eat more in colder climes.

I hope it’s fairly common knowledge now that alcohol does not keep you warm in the snow. Quite the opposite in fact, as one effect on the body is vasodilation (making larger) of the blood vessels. This allows more blood carrying heat to the surface of the skin where it radiates into the air, increasing the chances of hypothermia. Caffeine and nicotine do likewise. I can, however, suggest warm sugary drinks like Ribena or Vimto. Rock and roll.

Tips and tricks…

Battling with fine tasks with cold hands while attempting tasks that require fine motor control can be frustrating at best. Vigorous star jumps are a quick way to increase the core temperature as well as using central fugal force to encourage warm blood to the extremities. Hand warmers are great for those who suffer from poor circulation. Boots that are too tight will restrict blood flow and the feet will go numb so loosen the laces a little.

“There’s no such thing as bad weather, only unsuitable clothing”

Alfred Wainwright

This quote from prolific hillwalker Alfred Wainwright rings true. But as I’ve mentioned above, it is only part of the story as to how an individual could get into real trouble if prior research, preparation, or self-care is neglected. I make a point of gently challenging someone who declares that they cannot handle the cold. If cold weather is only to be avoided at all costs, it is not only comfort that is sacrificed when it inevitably sinks its teeth into your bones. Just imagine all those crisp and clear mornings where a fiercely beautiful sun rises seemingly just for you because no one else wants to ‘brave’ the cold. Think about making just a few small changes to develop your self-reliance so that when you hit that summit and take in a stunning mountain vista that makes your breath catch, you’ll barely notice the bite of the wind.