Survey of Musculoskeletal Injuries, Prehike Conditioning, and On-Trail Injury Prevention Strategies Self-Reported by Long-Distance Hikers on the Appalachian Trail.

Abstract

Studies show that 40 to 60% of long-distance hikers on the Appalachian Trail experience musculoskeletal (MSK) injuries, but these studies are over a decade old. The increasing popularity of hiking and injury prevention advances warrant re-evaluation of injury patterns. We sought to determine the frequency of self-reported MSK injuries in long-distance hikers on the Appalachian Trail and associations with prehike conditioning and on-trail injury prevention strategies. The Appalachian Trail Conservancy surveys registered hikers annually. Our orthopedic team added 10 questions specific to MSK injury, training, and equipment to the 2018 to 2019 electronic, cross-sectional Appalachian Trail Conservancy survey. Descriptive statistics and frequencies were calculated. Categorical variables were compared using χ2 analysis. Correlations were performed for associations between training and gear and MSK injury. Logistic regression assessed the effect of training on MSK injury. Statistical significance was set at P<0.05. Of 1295 respondents (52% response rate), 61% (n=791) reported MSK complaints; 28% (n=363) reported overuse/chronic MSK injuries, and 18% (n=238) reported acute injuries. MSK complaints resulted in 11% (n=147) stopping their hike. Respondents who did not train (13%, n=168) were significantly more likely to report an MSK injury (odds ratio 2.82; 95% CI 1.92-4.24; P<0.001). Strength training, stretch/yoga, and endurance training were associated with less injury (all P<0.001). Stabilizing footwear and poles/sticks were associated with fewer MSK complaints (all P<0.001). Prehike training and hiking gear correlate with fewer injuries. Further research is warranted to elucidate whether promoting injury prevention strategies can reduce MSK injuries among long-distance hikers.