17 Common Hiking injuries (Prevention & Treatment)

All 17 common hiking injuries, from ankle sprains and blisters to knee damage, fractures after a slip and foot pain on long descents.

Weather and terrain do the rest, so heat exhaustion, sunburn, dehydration, hypothermia, insect bites and cuts from rocks or branches are covered too, each with prevention pointers.

Injury Rates and Numbers

The figures below come from injury surveillance data and peer reviewed studies. Each row names the population it was measured in, because rates from elite athletes and from recreational players are not comparable.

Finding	Measured in	Source
In a systematic review of trail injuries, blisters made up 8 to 33 percent of all reported hiker injuries, and the lower limb was the most injured region in every included study.	17,757 injured hikers pooled from 7 studies in a systematic review of trail users, systematic review published 2023	Braybrook et al., PLOS ONE (2023)
Among long distance Appalachian Trail hikers, 64 percent reported foot blisters and 36 percent reported acute joint pain during their hike.	280 backpackers who hiked the Appalachian Trail for at least 7 days (38,940 days of exposure), 1997 hiking season, published 2003	Boulware, Forgey and Martin, American Journal of Medicine (2003)
Slips and falls while hiking caused 67 percent of injuries in 22 years of search and rescue records, with the lower extremity the most common injury site at 31 percent.	754 search and rescue or medical incidents in Baxter State Park, Maine, July 1992 to June 2014, published 2015	Welter et al., Wilderness and Environmental Medicine (2015)
In the same park records, 84.4 percent of acute emergencies happened while hikers were descending rather than ascending, and trauma triggered 51 percent of all rescues.	754 search and rescue or medical incidents in Baxter State Park, Maine, July 1992 to June 2014, published 2015	Welter et al., Wilderness and Environmental Medicine (2015)

Overview

Injury	Body area	Typical time out
Ankle Sprains	Ankle	1 to 3 weeks, months if grade 3
Knee Injuries (ACL, Meniscus)	Knee	3 to 6 weeks, up to a year post surgery
Slip and Fall – Bone Fracture	Whole body	6 to 8 weeks, longer after surgery
Foot Blisters	Foot	0 to 14 days, longer if infected
Podalgia (Feet)	Foot	1 to 2 days, months if fascia or bone
Heat Exhaustion/Heat Stroke	Whole body	1 to 3 days, weeks after heat stroke
Sunburn	Skin	3 to 7 days, up to 2 weeks with blisters
Muscle Strains (Calves, Hamstrings)	Lower leg and thigh	2 to 3 weeks, 3 months if ruptured
Back Injuries (Muscle Strains)	Lower back	Days to 2 weeks, longer with leg pain
Wrist Injuries (Sprains, Strains)	Hand and wrist	2 to 6 weeks, 3 months if fractured
Shoulder Injuries (Rotator Cuff, Strains)	Shoulder	6 to 12 weeks, months after repair
Insect Bites and Stings	Skin	0 to a few days, weeks if infected
Cuts and Lacerations (from Contact with Rocks or Branches)	Skin	1 to 2 weeks, longer if deep
Head Injuries (Concussions, from Falls)	Head	1 to 2 weeks, longer if symptoms stay
Eye Injuries (Foreign Objects, Sun Glare)	Eye	1 to 3 days, longer if penetrating
Twisted or Sprained Fingers	Hand and fingers	2 to 6 weeks, 3 months if thumb torn
Hypothermia (in Colder Climates) / Dehydration (Hot and Cold Climates)	Whole body	Same day, weeks if severe
Subungual Hematoma (Hiker’s Toe)	Toe	0 days, nail regrows 6 to 12 months

Ankle Sprains

A hiking ankle sprain almost always injures the ligaments on the outside of the joint, most often the anterior talofibular ligament and sometimes the calcaneofibular ligament next to it. The foot rolls inward over a root, a loose stone or the edge of a step, and the ligament is stretched or torn before the muscles can react. Descending with a loaded pack makes this worse, because your body weight lands on a foot that is already tilting.

Symptoms

• Sharp pain on the outer ankle at the moment the foot rolls
• Swelling that builds over the first hours, often around the bony bump
• Bruising that appears a day or two later and can track down into the foot
• Pain when you put weight on the foot, especially on uneven ground
• A feeling that the ankle gives way on the next few steps

How serious it is: Sprains are graded 1 to 3: grade 1 is a stretched ligament with mild swelling and you can still walk, grade 2 is a partial tear with clear swelling and limping, grade 3 is a complete tear with marked instability. A sprain that comes with pain directly over the bone rather than the ligament raises the question of a fracture and needs imaging.

Typical time out: One to three weeks for a grade 1 sprain, four to eight weeks for a grade 2, and two to four months for a grade 3 or when a fracture is involved. The spread is wide because ligament healing depends less on the calendar than on how quickly you regain balance and full push off strength.

See a doctor if: See a doctor if you cannot take four steps on the foot, if there is pain directly on the bone at the back edge of either ankle bump, or if the ankle looks deformed.

What helps

• Load the ankle early within a pain limit rather than immobilizing it for weeks, since protected walking speeds recovery
• Short cooling in the first hours for pain relief only, not as a treatment plan
• An external support, either a lace up brace or taping, for the first weeks and for the first hikes afterward
• Balance and single leg standing work, progressing to unstable ground, because poor balance is the main reason sprains repeat
• Calf and peroneal strengthening so the muscles on the outside of the lower leg can catch the roll
• Imaging if you cannot bear weight or if pain sits on the bone rather than the ligament

Knee Injuries (ACL, Meniscus)

The anterior cruciate ligament runs inside the knee joint and stops the shin from sliding forward and rotating; the menisci are two crescent shaped cartilage pads that spread load between thigh bone and shin. On the trail both are injured by the same movement: the foot sticks on rock or root while the body keeps turning, or the knee buckles inward on a hard step down. Long descents also load the meniscus repeatedly through a deeply bent, rotating knee.

Symptoms

• A pop or tearing sensation at the moment of the twist
• Swelling inside the joint within the first hours
• The knee feels unstable or gives way on uneven ground
• Locking or catching, or the knee will not fully straighten
• Pain along the joint line when you squat or twist

How serious it is: Ligament injuries follow the same 1 to 3 grading as other sprains, from a stretched ACL to a complete tear. A small meniscus tear at the outer rim can heal, while a large tear that blocks movement is a different problem, and swelling that fills the joint within a few hours points to a structural injury rather than a bruise.

Typical time out: Three to six weeks for a minor sprain or a small stable meniscus tear, and nine to twelve months back to full mountain hiking after ACL reconstruction. The range is this wide because a complete cruciate tear and an irritated joint look similar on the trail but are treated completely differently.

See a doctor if: Get it examined if the knee swelled within a few hours, locks in a bent position, or gives way when you try to walk.

What helps

• An early clinical exam, since a locked or unstable knee needs a diagnosis before any training plan
• Structured strengthening of quadriceps, glutes and hamstrings, which is the main treatment for most meniscus tears and for many ACL injuries too
• Neuromuscular and landing control work so the knee stops collapsing inward on steps down
• Trekking poles and shorter steps on descents to cut the peak load on the joint
• MRI when instability, locking or persistent joint swelling continue past the first weeks
• Physical therapy rather than early surgery for isolated degenerative meniscus tears, where exercise performs as well as an operation

Slip and Fall – Bone Fracture

A fall on the trail breaks bone where the force lands: the distal radius just above the wrist when you catch yourself on an outstretched hand, the ankle when the foot twists under body weight, and the ribs or collarbone when you land on your side. Descending is the risky phase, because the leg absorbs impact while the pack pushes you forward and the quadriceps are already tired.

Symptoms

• Immediate, sharp, well localized pain over a bone
• You cannot use the limb or take weight on it
• Rapid swelling and later deep bruising
• A visibly crooked or shortened limb
• Pain when you press one specific spot on the bone

How serious it is: The important split is between a stable crack that keeps its position and a displaced or open fracture, where the fragments have moved or the skin is broken. Displaced, open and joint involving fractures usually need surgery, while a stable hairline fracture often heals in a cast or boot.

Typical time out: Six to eight weeks for bone healing in a simple fracture, and four to six months before full loaded hiking after a joint involving or surgically treated break. The lower limb takes longer than the upper limb, because you have to carry yourself on it.

See a doctor if: Treat any visible deformity, bone through the skin, numbness or a cold, pale hand or foot below the injury as an emergency and call for help.

What helps

• Splinting the limb in the position you found it, without trying to straighten anything, and getting off the trail with help
• Early medical assessment with x ray, because a fracture missed in the field heals in the wrong position
• Following the loading plan you are given, since modern fracture care moves toward controlled early loading rather than long immobilization
• Working the joints above and below the cast so you do not trade a healed bone for a stiff shoulder or hip
• Trekking poles and controlled descents afterward, since falls on the way down cause most of these injuries
• Rebuilding calf, thigh and grip strength before returning to a loaded multi day route

Foot Blisters

A blister is a split inside the upper skin layers caused by repeated shear, where the surface of the skin is dragged sideways against the sock while the deeper tissue stays fixed to the bone. Fluid then fills the gap. Heat and moisture soften the skin and make it tear at lower forces, which is why long descents, damp socks and a boot with too much heel movement produce them so reliably.

Symptoms

• A hot spot, meaning burning or rubbing in one small area, before anything is visible
• A raised bubble of clear fluid, most often on the heel, the ball of the foot or a toe
• Stinging pain with every step on that spot
• Raw, red skin if the roof has torn off
• Spreading redness, heat or pus if it has become infected

How serious it is: An intact blister with clear fluid is a minor problem that mainly costs comfort. A deroofed blister, a blood filled blister or one with spreading redness and warmth is a wound and carries an infection risk, which on a multi day route can end the trip.

Typical time out: Usually no time off at all with proper dressing, a few days to two weeks for a large deroofed blister to close, and longer if it becomes infected. Blisters rarely stop you outright, they just slowly wreck your gait and cause a second injury elsewhere.

See a doctor if: See a doctor if redness spreads out from the blister, if it becomes warm and increasingly painful, or if you develop fever, and get any foot blister checked promptly if you have diabetes or poor circulation.

What helps

• Stopping at the first hot spot and taping it, which is far more effective than treating the finished blister
• Leaving an intact blister roofed, covering it with a hydrocolloid dressing that takes the shear off the skin
• Draining a large tense blister at the edge with a sterile needle while leaving the roof in place, then dressing it
• Reducing shear at the source: correct boot size, a snug heel lock in the lacing, and socks that move moisture away
• Keeping feet dry with sock changes and airing breaks, since wet skin blisters at much lower loads
• Checking for the reason it always appears in the same spot, such as a hot spot from a seam, a pressure point or a foot shape that needs a different last

Podalgia (Feet)

Podalgia is the umbrella term for foot pain, and on hikes it usually comes from the plantar fascia at the heel, from the metatarsal heads under the ball of the foot, or from the small muscles that hold the arch. Hours of loaded walking, especially downhill with a pack, load these structures far beyond their daily habit. Stiff soles, worn cushioning and a foot swollen inside a boot that fit in the morning all add pressure.

Symptoms

• Aching, burning soles that get worse over the second half of the day
• Sharp heel pain with the first steps in the morning or after a break
• Burning or pressure under the ball of the foot
• Feet that feel tight and swollen inside the boot
• Pain that eases with rest and returns quickly once you load them again

How serious it is: Simple fatigue pain settles overnight and does not come back the next morning. Pain that is worse on the first steps of the day, that stays localized to one point on the heel or one metatarsal, or that keeps growing over consecutive days points to plantar fasciopathy or a stress reaction and needs a different plan.

Typical time out: A day or two for plain foot fatigue, six weeks to several months for plantar fasciopathy, and six to eight weeks of no loaded hiking for a metatarsal stress fracture. The gap is large because the same symptom covers everything from tired muscles to injured bone.

See a doctor if: See a doctor if one small spot on a bone stays painful when you press it, if pain wakes you at night, or if numbness or tingling spreads into the toes.

What helps

• Cutting daily distance and elevation for a while instead of pushing through, since this is a load problem first
• Progressive calf and foot strengthening, including heel raises with the toes propped up, which works well for plantar fasciopathy
• Cushioned insoles or a supportive orthotic to spread load away from a painful metatarsal head
• Footwear that fits at the end of the day rather than the start, since feet swell on long hikes
• Loosening the calf and gently stretching the fascia, which is a supporting measure rather than the whole treatment
• Imaging if one point on a bone stays tender and painful with every step

Heat Exhaustion/Heat Stroke

This is not a musculoskeletal injury but a failure of temperature regulation. In heat exhaustion, sweating and blood being diverted to the skin leave too little circulating volume, so the heart cannot supply muscles and brain at the same time. In heat stroke, core temperature keeps climbing and the brain itself stops working properly. Sustained climbing in sun, high humidity and a pack that blocks evaporation from your back are the classic setup on a hike.

Symptoms

• Heavy sweating, weakness and a pounding heartbeat
• Dizziness, headache and nausea
• Cramping in the legs, muscle exhaustion out of proportion to the effort
• Skin that is pale and clammy in heat exhaustion, often hot in heat stroke
• Confusion, slurred speech, stumbling or collapse, which mean heat stroke

How serious it is: Heat exhaustion leaves you unwell but mentally clear and recovers with shade, fluids and cooling. Heat stroke is defined by an altered mental state, meaning confusion, aggression, seizure or unconsciousness, and it is a life threatening emergency.

Typical time out: One to three days after uncomplicated heat exhaustion, and several weeks with a medically supervised return after heat stroke. Recovery is slow after heat stroke because heat tolerance itself stays reduced for a while.

See a doctor if: Any confusion, strange behavior, seizure or loss of consciousness in the heat is an emergency: call for help and start cooling immediately.

What helps

• Stopping the hike and getting into shade, removing pack and excess clothing
• Aggressive cooling of the whole body, with cold water, wet cloths plus wind, or cold immersion where possible, before anything else in a suspected heat stroke
• Drinking fluids with electrolytes rather than plain water alone when you have been sweating for hours
• Planning around the heat: early starts, long midday breaks, shaded routes, honest turnaround times
• Building heat acclimatization gradually over one to two weeks before a hot destination
• Emergency call for anyone whose thinking is affected, since heat stroke gets worse without active cooling

Sunburn

Sunburn is direct ultraviolet damage to the cells of the upper skin layer, which triggers an inflammatory response hours after the exposure has ended. On the trail the dose is higher than people expect, because UV intensity increases with altitude and snow, water and light rock reflect additional radiation upward onto the face, under the chin and behind the ears.

Symptoms

• Red, hot skin that appears hours after the hike, not during it
• Tenderness and a tight feeling, painful under pack straps
• Itching and later peeling
• Blisters in a severe burn
• Chills, headache and nausea with an extensive burn

How serious it is: A superficial burn is red and painful and heals without scarring. A burn with blisters affects deeper skin layers, and widespread blistering, especially with fever or feeling unwell, needs medical attention. Every burn adds to lifelong skin cancer risk, which is the real reason to take it seriously.

Typical time out: Three to seven days for a red, painful burn, and one to two weeks when blisters are involved. Sunburn rarely stops you hiking, but it makes a pack unbearable on the shoulders and the same skin burns faster while it is healing.

See a doctor if: See a doctor if large areas blister, if you develop fever, chills or confusion, or if a burnt area becomes increasingly red, swollen and painful after a few days.

What helps

• Getting out of the sun and cooling the skin with cool water or damp cloths
• A light moisturizer or aloe gel, drinking more than usual, and an over the counter pain reliever for the first days
• Leaving blisters intact and covering them with a clean nonstick dressing
• Broad spectrum SPF 30 or higher applied thickly and reapplied every two hours, and more often when sweating
• Physical cover, which works better than lotion on a long day: brimmed hat, neck cover, long sleeves in UV protective fabric, wraparound sunglasses
• Extra care on snow, water and above the treeline, where reflected and altitude related UV push the dose up sharply

Muscle Strains (Calves, Hamstrings)

A strain is a tear in the muscle fibers, usually at the junction where muscle passes into tendon. The calf muscles are strained on steep push off and on a sudden lunge to catch a slip, the hamstrings when the leg reaches forward on a long step down. Descending is the harder job for the muscle, because it has to lengthen under load rather than shorten, and that is where fibers fail.

Symptoms

• A sudden pulling or stabbing sensation in the muscle, sometimes with a snapping feeling
• Pain when you push off, climb or lengthen the muscle
• A tender spot you can find with one finger
• Swelling and, over the next days, bruising that tracks downward
• Weakness and cramping in the muscle afterward

How serious it is: Strains are graded 1 to 3: grade 1 is a few fibers with almost full strength, grade 2 is a partial tear with clear weakness and pain, grade 3 is a complete rupture, often with a visible dent and a bulge in the muscle. A dent you can feel plus the inability to push off means a doctor, not a stretching program.

Typical time out: Two to three weeks for a grade 1 strain, four to eight weeks for a grade 2, and three months or more for a complete rupture or a tear at the tendon attachment. Return depends on regaining full strength at length, not on when the pain stops.

See a doctor if: See a doctor if you felt a distinct snap, if you cannot push off or rise onto your toes, or if you can feel a gap in the muscle.

What helps

• Gentle pain guided movement within the first days, since immobilization leaves weaker, stiffer scar tissue
• Progressive strengthening under increasing load, especially lengthening work such as slow heel lowering for the calf and hip hinge work for the hamstring
• Controlled load increases afterward: distance, pack weight and descent added one at a time
• Trekking poles on long descents to take some of the braking work off the calves and hamstrings
• A clinical check when weakness persists beyond a couple of weeks, since a partial tear that is trained too early tears again
• Short cooling for pain only in the first hours, not as the treatment itself

Back Injuries (Muscle Strains)

Most hiking back pain comes from the muscles and small joints of the lumbar spine rather than from a disc. A pack whose weight sits behind you pulls the trunk backward, so the erector spinae muscles work continuously for hours to hold you upright, and the load runs through the lower lumbar segments. Bending forward under load to lift a pack from the ground is the movement that most often produces the sudden version.

Symptoms

• A dull, tightening ache across the lower back that grows over the hike
• Sudden catching pain when lifting or twisting with a pack on
• Stiffness after breaks and in the morning
• Muscles that feel hard and cramped either side of the spine
• Pain when standing upright or extending backward

How serious it is: Nonspecific back pain with no leg symptoms is the common form and settles as you keep moving. Pain that shoots down into the leg past the knee, or comes with numbness, weakness or problems with bladder or bowel control, is a different situation and needs an examination straight away.

Typical time out: A few days to two weeks for a simple strain, and six weeks or more when nerve related leg symptoms are involved. Ordinary back pain improves faster when you keep moving than when you lie down, which is why the shorter end of the range is realistic.

See a doctor if: See a doctor if pain runs down the leg below the knee, if you notice numbness, weakness or a foot that drags, or if you have any change in bladder or bowel control.

What helps

• Staying active within a pain limit, including short walks, rather than lying down and waiting
• Fitting the pack properly, so most of the weight sits on the hip belt and the load rides close to your back
• Cutting pack weight, which is the single most effective change for hikers with recurring back pain
• Trunk and hip strengthening between trips, since the back muscles have to hold a load for hours
• Lifting the pack in stages, onto a knee or a rock first, instead of hauling it off the ground with a rounded back
• Physical therapy if pain keeps returning on every trip or does not settle within a few weeks

Wrist Injuries (Sprains, Strains)

Catching yourself on an outstretched hand drives your whole body weight through the wrist joint, straining the ligaments between the small carpal bones, above all the scapholunate ligament, and often the ligaments on the little finger side too. Pole straps add their own mechanism: if your hand is fixed in the strap when a pole tip jams, the wrist is bent violently instead of releasing.

Symptoms

• Pain on the back or thumb side of the wrist after a fall
• Swelling and reduced movement, especially bending the wrist backward
• Pain when you push up from a chair or press on the palm
• Weak grip
• Clicking or a feeling of instability with rotation

How serious it is: Sprains follow the usual 1 to 3 grading. The important point at the wrist is that a sprain and a fracture feel very similar, and one particular bone, the scaphoid on the thumb side, is often broken while looking like a sprain, and it heals badly if it is missed.

Typical time out: Two to six weeks for a mild to moderate sprain, and eight to twelve weeks or more for a ligament tear or a scaphoid fracture. Poling and scrambling come back later than plain walking, because both load the wrist directly.

See a doctor if: See a doctor if there is tenderness in the hollow at the base of the thumb, if the wrist looks deformed, or if pain and swelling do not improve within a week after a fall.

What helps

• An x ray after any fall onto the hand with thumb side tenderness, since a missed scaphoid fracture is the costly outcome
• Short term splinting for comfort, then early movement rather than weeks in a brace
• Grip and forearm strengthening, progressing to weight bearing through the hand for scrambling
• Using poles without threading your hands through the straps on technical or rocky ground, so the pole can be let go
• Learning to roll or absorb a fall on the forearm rather than landing on a stiff outstretched hand
• Referral if pain, clicking or a weak grip persist past a few weeks, which can indicate a ligament tear

Shoulder Injuries (Rotator Cuff, Strains)

The rotator cuff is a set of four tendons that hold the head of the upper arm bone centered in its shallow socket, with the supraspinatus running through a narrow space under the roof of the shoulder. Pack straps compress this area for hours, and reaching overhead on a scramble squeezes the tendon further. A fall onto the point of the shoulder or onto an outstretched arm can instead tear the cuff or sprain the acromioclavicular joint.

Symptoms

• Pain on the outside of the upper arm, often worse at night when lying on that side
• Pain and weakness when lifting the arm out to the side or overhead
• A painful arc partway through raising the arm
• Aching under the pack straps that builds over the day
• Difficulty reaching behind your back or into the pack lid

How serious it is: Irritation of the tendon settles with load management, while a partial or complete tear leaves lasting weakness rather than only pain. Acromioclavicular joint injuries after a fall onto the shoulder are typed I to III, from a sprain to a fully separated joint with a visible step at the top of the shoulder, and types I and II are treated without surgery.

Typical time out: Six to twelve weeks for tendon irritation or a mild strain, four to six weeks for a low grade AC joint injury, and four to six months before carrying a loaded pack again after a repaired cuff tear. Tendon problems take longer than people expect because the tendon needs progressive load, not rest.

See a doctor if: See a doctor if you cannot lift the arm at all after a fall, if there is a visible step or bulge at the top of the shoulder, or if pain wakes you every night for weeks.

What helps

• Progressive strengthening of the cuff and the shoulder blade muscles, which is the main treatment and outperforms rest
• Reducing pack weight and adjusting the harness so the load sits on the hips rather than hanging from the shoulders
• Temporarily cutting the movements that provoke it, such as overhead reaching, while keeping the arm in use
• Physical therapy early when weakness rather than only pain is the leading problem
• Imaging if the arm stays weak after a fall, since a full thickness tear needs a decision rather than more exercises
• Treating a cortisone injection as an exception: it can relieve pain briefly, but for tendon problems long term results tend to be worse, so it does not replace loading work

Insect Bites and Stings

Bites and stings inject saliva or venom into the skin, and the reaction you see is your immune system responding to it. Most produce a local reaction of a few centimeters. Bees, wasps and hornets can cause a body wide allergic reaction in sensitized people, and ticks matter less for the bite itself than for what they can transmit while attached.

Symptoms

• A raised, itching, red lump within minutes
• Burning pain and local swelling around a sting
• A dark tick attached to the skin, often in the groin, waistband, armpit or behind a knee
• An expanding ring shaped rash appearing days to weeks after a tick bite
• Hives away from the bite site, swelling of lips or tongue, wheezing or dizziness, which mean an allergic emergency

How serious it is: A local reaction stays around the bite and settles within days. A large local reaction can swell an entire limb but remains local. Anaphylaxis is a whole body reaction with breathing difficulty, throat swelling or circulatory collapse and is a life threatening emergency regardless of how small the sting looked.

Typical time out: None for an ordinary bite, a few days for a large local reaction, and weeks with medical treatment for a transmitted infection such as Lyme disease. Anaphylaxis means hospital assessment and an allergy workup afterward, not simply resting it out.

See a doctor if: Call emergency services for breathing difficulty, swelling of the lips, tongue or throat, widespread hives, or faintness after a sting, and see a doctor for an expanding rash, fever or spreading numbness and weakness after a bite.

What helps

• Removing a tick promptly with fine tipped tweezers, gripping close to the skin and pulling straight out, then noting the date
• Cleaning the site and cooling it briefly for itch and pain
• An over the counter antihistamine or a topical anti itch preparation for local reactions
• Repellent containing DEET or icaridin on skin, permethrin treatment on clothing, and a full body tick check every evening
• Carrying an adrenaline autoinjector and using it immediately if you have a known sting allergy
• Medical review for any expanding rash, fever, joint pain or new neurological symptoms in the weeks after a bite

Cuts and Lacerations (from Contact with Rocks or Branches)

A laceration is a tear through the full thickness of the skin, sometimes into the fat and muscle beneath. On the trail they come from sliding across rock, from branch stubs at knee and eye height, and from knives during camp tasks. Shins, forearms and hands take most of them, and a deep cut on the inner side of a limb can cross the path of an artery or a tendon.

Symptoms

• An open wound with edges that gape apart
• Bleeding that continues after a minute of pressure
• Pain and reduced use of the limb
• Visible fat, muscle or a whitish structure inside the wound
• Numbness beyond the wound or an inability to bend a finger, which suggests nerve or tendon damage

How serious it is: A shallow scratch that stays closed can be cleaned and dressed on the trail. A wound that gapes, that keeps bleeding despite pressure, that reaches fat or deeper, or that has anything visible inside it needs professional closure, and heavily contaminated wounds carry the highest infection risk.

Typical time out: One to two weeks for a wound closed early, and three to six weeks when it is deep, contaminated or involves a tendon. Location matters: a cut over a moving joint takes longer than one on the forearm because every step reopens the edges.

See a doctor if: Get help if bleeding does not stop with several minutes of firm direct pressure, if the wound gapes or is deeper than the skin, or if you lose feeling or movement beyond it.

What helps

• Firm direct pressure on the wound with a clean pad, held without lifting it to peek, and a tourniquet only for bleeding that cannot be controlled otherwise
• Irrigating with plenty of clean drinking water, which matters more than any antiseptic in preventing infection
• Closure by a professional within roughly the first hours, since wounds closed late are treated as contaminated
• A clean dressing changed when wet or dirty, with the edges kept together and movement of the area limited
• Checking your tetanus vaccination status, especially with wounds contaminated by soil
• Watching for spreading redness, increasing pain, pus or fever, which means the wound needs to be seen

Head Injuries (Concussions, from Falls)

A concussion is a disturbance of brain function after a blow to the head or a force transmitted through the body, not a structural injury you can see on a normal scan. Hikers get them from falls onto rock, from rockfall and from walking into low branches. The important companion injury is a bleed inside the skull, which can develop quietly over hours after a fall that seemed minor.

Symptoms

• Headache and pressure in the head after the impact
• Dizziness, unsteadiness and nausea
• Feeling slowed down, foggy or unusually irritable
• Sensitivity to light and noise, blurred vision
• Memory gaps around the event, difficulty concentrating

How serious it is: Concussion covers a spectrum from brief fogginess that clears within days to symptoms that persist for weeks. What matters more than grading is separating it from a structural injury: a bleed or skull fracture is signaled by symptoms that worsen rather than settle, repeated vomiting, seizures, unequal pupils or increasing drowsiness.

Typical time out: One to two weeks for most concussions, with a graded return, and considerably longer if symptoms persist. Anyone on blood thinning medication, or with a fall from height, needs assessment even when they feel fine at first.

See a doctor if: Get emergency help for loss of consciousness, repeated vomiting, seizure, unequal pupils, worsening headache, increasing drowsiness or clear fluid from nose or ear.

What helps

• Stopping the hike immediately: anyone suspected of a concussion does not continue that day, and should not be alone
• A short period of relative rest for one to two days, then a gradual return to light activity, since prolonged complete rest slows recovery
• Emergency assessment for any warning sign, or when the person is on blood thinners
• Avoiding alcohol and sedatives while symptoms are present
• A stepwise return to hiking, adding exertion, then terrain, then exposure, and dropping back a step if symptoms return
• A helmet where rockfall or scrambling is part of the route, since prevention beats management here

Eye Injuries (Foreign Objects, Sun Glare)

Two different problems share this heading. A foreign body such as grit, sand or a piece of bark scratches the cornea, the clear front surface of the eye, which is densely supplied with nerves and therefore extremely painful. Intense ultraviolet light reflected off snow, water or bright rock burns that same surface, producing photokeratitis, which appears hours after the exposure with both eyes affected.

Symptoms

• A gritty feeling as if something is still in the eye
• Watering, redness and difficulty keeping the eye open
• Sharp pain with blinking
• Intense sensitivity to light and blurred vision
• Burning in both eyes hours after a bright day on snow or water

How serious it is: A superficial corneal scratch heals within a day or two. A deeply embedded object, a chemical splash or a penetrating injury threatens sight and must be seen immediately, and photokeratitis is painful but self limiting as long as the eye is not further exposed.

Typical time out: One to three days for a superficial corneal abrasion or snow blindness, and longer with an embedded object or an infection of the abrasion. The eye recovers fast, but you should not walk exposed terrain while your vision is impaired.

See a doctor if: Get seen urgently for an object stuck in the eye, a penetrating injury, loss of vision, or pain that keeps getting worse after a day.

What helps

• Rinsing generously with clean water or saline and not rubbing the eye
• Removing contact lenses before rinsing and leaving them out until the eye is comfortable again
• Leaving any embedded or penetrating object alone, covering the eye loosely and getting to medical care
• Resting the eyes in shade or darkness for photokeratitis, with lubricating drops for comfort
• Wraparound sunglasses or glacier glasses with side protection plus a brimmed hat, above all on snow and water
• A medical check if pain, redness or blurred vision persist beyond a day or two, since an infected abrasion is serious

Twisted or Sprained Fingers

Finger sprains injure the collateral ligaments or the volar plate at the middle joint of a finger, or the ligament at the base of the thumb when a pole strap or rock levers the thumb sideways. On the trail they come from grabbing a branch or rock at the moment of a slip, from landing on a splayed hand, and from a hand caught in a pole strap during a fall.

Symptoms

• Pain and swelling around one finger joint
• The joint stiffens and stays thickened for weeks
• Pain when the finger is pushed sideways
• A weak or unreliable pinch grip, especially at the thumb
• Difficulty making a full fist

How serious it is: Grading runs 1 to 3 as with other sprains, from stretched to fully torn. Two situations are not simple sprains: a joint that is obviously out of line and needs relocating, and a thumb base ligament that is completely torn, which often needs surgery to restore a usable pinch grip.

Typical time out: Two to six weeks for a typical finger sprain, with joint swelling that can persist for several months, and six to twelve weeks for a torn thumb ligament or when surgery is needed. Hiking itself resumes quickly; what takes time is a reliable grip on poles and rock.

See a doctor if: See a doctor if the finger is visibly crooked or dislocated, if you cannot bend or straighten it actively, or if the thumb feels unstable when you pinch.

What helps

• Buddy taping the finger to its neighbor for support while continuing to move it, rather than splinting it rigidly for weeks
• Early gentle movement, since finger joints stiffen faster than almost any other joint
• An x ray after any significant twist, because small avulsion fractures at these joints are common and change the plan
• Grip strengthening as the pain allows, working toward pinch and hook grip
• Keeping hands out of pole straps on technical ground, so the pole releases instead of levering the thumb
• Hand therapy referral for a thumb that stays unstable or a joint that will not regain movement

Hypothermia (in Colder Climates) / Dehydration (Hot and Cold Climates)

Hypothermia is a drop in core body temperature below the point at which the body can rewarm itself, and it is driven far more by wet clothing and wind than by the thermometer alone. Dehydration is a loss of body water and salts that thickens the blood and reduces the volume the heart can move. Both hit hikers on long days: cold when you stop moving on a ridge in wet layers, dehydration in heat and, less obviously, in the cold and at altitude where thirst is blunted and you breathe out a lot of water.

Symptoms

• Intense shivering that later stops, which is a bad sign rather than a good one
• Clumsiness, stumbling, fumbling with zips and buckles
• Confusion, slurred speech, apathy or unusual decisions
• Dark urine, headache, dizziness and dry mouth with dehydration
• Muscle cramps and fatigue disproportionate to the effort

How serious it is: Mild hypothermia means the person still shivers and can still think and act, and can be reversed in the field. Moderate to severe hypothermia means shivering has stopped, consciousness is clouded, and the person must be handled gently and evacuated, because rough handling can trigger a dangerous heart rhythm. Mild dehydration causes thirst and reduced performance, while severe dehydration causes confusion and collapse.

Typical time out: Same day recovery after mild dehydration or mild cold exposure once you are rewarmed and refilled, and several days to weeks with medical follow up after moderate or severe hypothermia. Frostbite injuries add their own much longer course.

See a doctor if: Call for help if a cold person stops shivering, becomes confused or drowsy, or if anyone collapses, cannot keep fluids down or stops passing urine.

What helps

• Getting out of the wind and into shelter, then removing wet layers and replacing them with dry insulation including a hat
• Insulating from the ground as well as the air, since the ground pulls heat out faster than cold air does
• Warm sweet drinks and food for someone who is alert and shivering, and nothing by mouth for someone who is not fully awake
• Handling a severely cold person gently and horizontally, wrapping them and evacuating rather than rubbing or actively heating limbs
• Drinking to a plan on long days, with electrolytes when you have been sweating for hours, and using urine color as a check
• Planning layers, turnaround times and refill points for the conditions, since both problems are far easier to prevent than to treat on a mountain

Subungual Hematoma (Hiker’s Toe)

On long descents the toe is driven forward into the front of the boot with every step, and the repeated impact tears small vessels in the nail bed underneath the toenail. Blood collects in the closed space between nail and bone, and because the nail cannot expand, the pressure itself becomes the pain. The big toe and the second toe are affected most, and the same mechanism can bruise the bone underneath.

Symptoms

• Throbbing pain under the nail that builds during and after a descent
• A dark red, purple or black discoloration under the nail
• Pressure pain when the toe touches the front of the boot
• Pain that eases as soon as the boot comes off
• A nail that loosens and comes off weeks later

How serious it is: A small painless dark patch under the nail is cosmetic and needs nothing. A hematoma covering much of the nail with throbbing pressure benefits from being drained. A toe that is painful when pressed on the bone, or that follows a direct impact rather than repeated rubbing, may hide a fracture of the tip of the toe bone.

Typical time out: No time off at all in most cases, since you can keep walking, but the nail takes six to twelve months to grow back fully if it comes off. Pain relief after drainage is usually immediate.

See a doctor if: See a doctor if the toe is deformed, if pain is sharply localized on the bone after a direct blow, or if the toe becomes red, warm and increasingly painful over days, which suggests infection.

What helps

• Draining a painful, tense hematoma, which relieves the pressure straight away and should be done sterile by a professional if you are unsure
• Fixing the cause in the boot: a half size larger for descents, a firm heel lock in the lacing so the foot cannot slide forward, and no slack in the ankle section
• Keeping toenails cut short and straight before a long trip, since a long nail meets the boot first
• Shorter steps and trekking poles on steep descents to reduce the forward force on the toes
• Thin, well fitting socks without folds, and a fit check at the end of the day when the foot is swollen
• An x ray when the pain follows a direct impact and sits on the bone rather than under the nail

First Aid for Soft Tissue Injuries: PEACE and LOVE

Sports medicine has moved on from RICE. The current guidance, published in the British Journal of Sports Medicine in 2019, splits care into the first days after the injury and everything that follows.

PEACE, the first two to three days

• Protect: unload the area and limit movement that hurts, but only briefly.
• Elevate: keep the limb above heart level when you can.
• Avoid anti-inflammatories: they may blunt the healing you need.
• Compress: a bandage or taping limits swelling.
• Educate: your body heals this on its own; passive treatments rarely speed it up.

LOVE, from day three onward

• Load: return to movement as pain allows, early loading builds tissue.
• Optimism: expectations shape recovery more than most people assume.
• Vascularization: easy cardio that does not hurt brings blood to the area.
• Exercise: restore strength, mobility and balance before returning to play.

Ice still helps with pain in the first hours. What changed is the evidence that long icing and routine anti-inflammatory drugs slow tissue repair.

How to Lower Your Risk in Hiking

• Treat descents as the risky part of the day: shorten your steps, slow down, and plan the return leg while you still have strength, because that is when most falls and overuse pain happen.
• Use trekking poles on steep and loose ground, but keep your hands out of the straps on technical terrain so the pole can be dropped instead of twisting your wrist or thumb.
• Cut pack weight and set the harness so the load sits on your hips, not hanging from your shoulders, which removes much of the load driving back and shoulder pain.
• Build up distance and elevation gradually between trips, and add strength work for calves, thighs, hips and trunk plus dedicated single leg balance work, since the trail asks for hours of loaded, lengthening muscle work and a rolled ankle is often a reaction time problem.
• Get the footwear system right and test it on a long training day: correct size for a foot swollen at day’s end, a firm heel lock in the lacing, moisture moving socks, short toenails, and tape on any hot spot the moment you feel it.
• Plan for the conditions rather than the forecast: dry insulation and a hat you can put on when you stop, sun cover and eye protection above the treeline and on snow, a drinking and refill plan, and an honest turnaround time.

When to Stop and Get Medical Help

Most of the injuries on this page are treated at home. These signs are not.

• Suspected fracture or dislocation: visible deformity, bone through the skin, or a limb you cannot use or take weight on.
• Head injury with loss of consciousness, memory gaps, repeated vomiting, a seizure or worsening drowsiness, and anything similar in a person taking blood thinners.
• New numbness, tingling or weakness in a limb, or a hand or foot that turns pale and cold below an injury.
• Confusion, slurred speech or strange behavior in heat or cold, which means heat stroke or hypothermia and not simple exhaustion.
• Breathing difficulty, swelling of the lips, tongue or throat, or widespread hives after a sting or bite.
• Bleeding that will not stop with several minutes of firm direct pressure, or chest pain and severe shortness of breath during exertion.

Sources

• Braybrook et al., PLOS ONE (2023)
• Boulware, Forgey and Martin, American Journal of Medicine (2003)
• Welter et al., Wilderness and Environmental Medicine (2015)

This article is general information, not medical advice. If you are hurt, a doctor or physiotherapist who can examine you is worth more than any web page. Last reviewed: August 2026.

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