Trail technique should begin with adequate physical training prior to starting the hike. Though frequently neglected, this preparation will prevent many difficulties. It is essential for hikers with medical conditions (especially cardiac and back) to get medical clearance and physical conditioning to know if they can sustain the required effort without discomfort or damage.

Knees are a major concern. Striding hard and fast downhill frequently causes bad knees. This common and sometimes serious problem can be prevented or reversed by going downhill slower, not overstriding or jumping, with shorter and smoother steps, using handholds on branches and a hiking stick or ski poles. The pain and inflammation can be treated with ibuprofen (or other drugs), cold applications, rest and support of the joint.

Foot problems, including various pains and irritations about the foot, plantar fasciitis and Achilles tendonitis are very common and can be diagnosed and successfully treated. They can be prevented by wearing well-fitted boots of good quality, with cushioned inserts, padded socks and sock liners. Proper hiking technique (walking with a light tread, using a stick, etc.) is critical and includes low daily distances at the start of the hike. Soaking feet or other inflamed areas in a cold stream helps reduce inflammation. Air drying feet and socks during the day helps prevent blisters.

Don't step on tree roots, especially if they are wet or damp. My friend Elmer and others have broken their legs. I diligently avoid stepping on roots, wet or dry, to maintain the habit and vigilance. Avoid falls by watching every foot placement.

Trail medicine includes the use of ibuprofen, effective for aches, pains and inflammation. The current wide use should be limited to the lowest effective dose (200 to 1600 mg per day). Watch for gastrointestinal side effects. Hydrocortisone 1% ointment ("Cortaid", etc.) controls several skin problems including chafing, rashes, stings and inflammation. Your first aid kit should be small and confined to the few critical items. Include an antihistamine for allergic reactions. First aid training courses are available and advisable before starting on the trail.

For pure drinking water hikers should always filter, boil or iodinate uncertified water. Giardiasis and other gastro-intestinal diseases may occur without these precautions. There are several good filters available. Others are average and a few do not hold up under trail use. Just heating water to the boiling point is adequate to kill pathogens for safe consumption. Iodine, while effective, takes a long time to purify cold water (1 to 8 hours).

Average energy expenditure on the trail will require an intake of 4,000 or more calories per day to maintain adequate nutrition. During periods of heat and exertion adequate hydration is critical; you may need to drink more than 6 liters of water per day.

Arthropod are pests on the trail, especially insects. They potentially cause a number of diseases and discomforts. DEET on the skin and other repellents control some of these and permethrin on clothing can help prevent the attachment of ticks which cause Lyme and other diseases. Lyme disease requires daily examining for the small ticks, removing them and watching for characteristic lesion appearance if there has been attachment for 24 hours. An improved diagnostic test is available. Antibiotics work well when given early. An effective vaccine is now available. Other ticks carry Rocky Mountain Spotted Fever which can be serious if not treated early with antibiotics.

Bee stingers should be removed as rapidly as possible to reduce the amount of injected toxin. Treat with local hydrocortisone ointment and oral analgesics for pain. Sensitive patients should carry medically prescribed Epinephrine kits. Watch out for stinging caterpillars.

Mosquito bites are a bother but can transmit virus encephalitis of several types in areas near but probably not on the trail. Take care in preparing and storing food because flies and cockroaches can mechanically transmit foodborne infections.

Lastly, hantavirus disease, lightning strikes and snake bites are fearful and dangerous, but very rare, threats on the trail. Though we know of only one case on the trail, the possibility of serious and often lethal hantavirus disease is real. Since it is transmitted by mouse droppings in shelters and elsewhere, it can be minimized by careful avoidance. Lightning strikes are scary but are reported only once every 2 to 3 years. Take precautions during thunderstorms while in the open or on mountain tops by lying low. Poisonous snake bites are only reported every 5 to 6 years and can be avoided by carefully watching where you step or sit.

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