There are over 50 million hiking enthusiasts in the US. When consider backpackers, trekkers, and high peak summiteers, the numbers are impressive. Hikers who tackle the “Fourteeners” here in Colorado are an avid group. With all this high altitude trekking, injuries can occur. Hiking injuries typically involve strains and sprains, dislocations and fractures. These injuries can occur with even the most experienced 14er hiker.

Richard Cunningham, MD, a sports medicine specialist has the expertise to evaluate and treat hiking injuries. His professional experience in knee and shoulder injuries, along with that of his talented care team, are the top choice for an injured hiker. Dr. Cunningham’s goal for every hiking enthusiast is full recovery and a speedy return to bagging peaks.

What are common knee injuries seen in Colorado 14er hikers?

Colorado 14er hikers are exposed to a range of varying surfaces, unseen obstacles and unstable terrain that can present moments of improper footing, imbalance, and instability. Hikers can also push past the normal range of motion and strength of the knee joint. These common hiking demands increase the risk for a potential knee injury. Some hiking knee injuries include:

Sprains and strains

Overstretching a knee ligament is called a ligament sprain. A ligament can partially tear and heal itself or it can completely rupture in which case it may or may not heal depending on the ligament torn and whether it is protected after the injury. An injury to a muscle is a strain. Muscle injuries tend to heal as muscle has very good blood supply. Both of these injuries are painful and can limit a hiker’s ability to complete a hike.

If an injury is minor, conservative home treatment is indicated. If symptoms are severe, or worsen, medical care is needed. Worsening symptoms can include:

  • Increasing knee pain
  • Inability to put weight on the knee
  • Knee instability with giving way episodes
  • Catching or locking in the knee
  • Open wound to the knee

Prevention begins with proper hiking gear, and matching athletic ability to the terrain.

Tendon and ligament tears

Tears to the meniscus, quadriceps tendon, patellar tendon or knee joint ligaments can occur with even a simple fall while hiking. A forceful sharp turn or pivot is a common cause of a tendon or ligament tear, as is a fall while hiking that directly impacts the knee joint.

Torn meniscus: The meniscus is the rubbery, half moon shaped shock absorber cartilage in the knee. It can tear with a forceful twist or squat. Most patients report feeling something pop and have localized pain. Symptoms include pain, swelling, stiffness and difficulty walking. Conservative treatment including rest, ice, compression and elevation (RICE). Meniscus tears do not heal but they may get to a point where the pain is tolerable ad therefore not require further treatment. However, seek medical attention if symptoms persist, including worsening pain, locking, or swelling.

Tendon tears may involve either the quadriceps tendon connecting the quadriceps muscle to the kneecap (patella), or the patellar tendon connecting the kneecap to the lower shinbone (tibia). This often occurs with a forward fall and sudden and excessive bending of the knee while the full body weight is on the leg. Patients report feeling a tearing sensation and feel unstable. They may be able to put some weight on the leg if the leg is held perfectly straight but otherwise are unable to weight bear. There is severe swelling, pain, and one may feel a gap in the tendon. These injuries require evaluation by an orthopedic knee specialist.

Ligament tears may affect any of the four major ligaments of the knee joint complex including the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) which are both located in the center of the knee and provide front-back stability to the knee. Medial collateral ligament (MCL) tears are also common and occur when the knee is forced into a knock-kneed alignment with tearing of this ligament on the inside of the knee. Finally, one can tear the Lateral collateral ligament (LCL) on the outside of the knee, although isolated LCL tears are quite uncommon. A torn ligament will often require orthopedic evaluation, as some ligament tears can heal effectively if the knee is placed in a brace within a few days of the injury and then worn for 4-6 weeks depending on the ligament that is torn and the degree of tear. Dr. Cunningham can provide an expert evaluation and treatment plan for any knee ligament tear.

Knee and leg bone fracture: Ankle fractures are quite common due to a sudden slip and twist of one’s ankle. Clavicle fractures, wrist fractures, and shoulder fractures can also occur when one falls on an outstretched hand in an effort to catch oneself. Fractures cause severe pain and there is usually immediate swelling and a deformity present. If one fractures their ankle or any bones in the leg, one is not able to bear weight due to the pain. With an upper extremity fracture, one could hike out but it will be a pretty painful and miserable trip as any jostling of the extremity will cause the bones to shift and cause severe pain. A fracture requires urgent orthopedic evaluation. Not all fractures require surgery however. The need for surgery depends on whether the bone ends of a fracture are relatively aligned or whether the bone ends are severely displaced and therefore will not heal properly.

Hiker’s Knee

Hiker’s Knee is a common injury for 14er hikers, considering all the downhill required. With this, hikers experience severe pain around their knee cap (patella). Descent is more challenging than the ascent. Some may feel that the knee is going to give out at times. One may feel a grinding or catching sensation in the knee.

Science shows the downhill stress on the knee joint is a factor of greater than 7x the hiker’s body weight. When hiking downhill, the lead leg must absorb the impact of the full body weight as well as gravity and the knee must bend further. Repetitive use and this added force leads to pain, inflammation, stiffness and decreased range of motion. If a hiker has any abnormal body mechanics, due to imbalance in leg muscle strength, a poorly tracking kneecap, prior injury, or a host of other factors, the stress to the knee joint is even greater. Hikers’ knee can be alleviated by stretching out the IT band and strengthening the hamstring and gluteal muscles. The use of trekking poles to redistribute some of the forces from the knee to the upper body can also alleviate the pain.

What are common shoulder injuries seen in Colorado 14er hikers?

Richard Cunningham, MD, a sports medicine shoulder specialist, can address 14er Hiker’s shoulder conditions. The common injuries found in hikers include:

Shoulder inflammation from load bearing

Fourteener treks are frequently long and arduous. 14er hikers must pack enough supplies for a successful round trip to the peak and back. As such, hydration, fuel, first aid, safety and auxiliary necessities can make for a heavy pack, which impacts the shoulder. The weight of the backpack can inflame the muscle, tendons, ligaments and bones of the shoulder complex. The ensuing pain can impact a hiker’s performance.

Prevention of load bearing wear and tear on the shoulder is essential. Consider these tips:

  • Purchase a correctly fitted backpack. Tap professional guidance when trying different packs
  • Load the pack for proper distribution of weight, to avoid torquing the shoulders
  • Secure the pack close to the body
  • Adjust the waist and sternum belts to proper tension
  • Place the pack onto the shoulders carefully, avoiding overextension
  • Consider strap pads to reduce load

If the correct use of a well-fitted pack does not mitigate shoulder pain when hiking, consult with shoulder specialist Dr. Cunningham to have the shoulder condition evaluated.

Shoulder separation/dislocation With a fall on the hiking trail, it is not uncommon for a hiker to fall on the shoulder. One may separate their shoulder. A separated shoulder is a partial or complete dislocation of the acromioclavicular joint (AC joint). This joint is vulnerable to separation with a forceful impact. The ligaments that secure the joint can be damaged or torn on impact.

Mild to moderate shoulder separation injuries can be treated with conservative care including resting the shoulder, using ice therapy, pain management, and stabilizing the joint during the healing process. More severe injuries require orthopedic attention. Dr. Cunningham is a shoulder expert who can evaluate the shoulder condition and offer an optimal treatment plan.

Clavicle fracture The clavicle is a prominent narrow bone of the anterior shoulder complex that is also vulnerable to fracture during the impact from a fall. The clavicle, at its narrowest part, has little protection from muscles or ligaments. Being exposed, the clavicle can be fractured from direct impact to the front of the shoulder. In hiking, one may land on the side of the shoulder, and thus experience a clavicle fracture. This is because of the compressive force of the fall impacting the vulnerable thin clavicle bone.

Patients will experience pain, swelling, tenderness, and observe a visible deformity of the clavicle, along with a sensation of grinding from the bone ends rubbing together. Arm movement will be limited due to pain. Orthopedic attention is recommended for a full evaluation and treatment plan. Shoulder specialist, Dr. Cunningham is here in the high country to help Fourteener hikers and all hiking enthusiasts with clavicle fractures and all injuries to the shoulder.

In all of the miles covered by Fourteen hikers this hiking season, the winning mileage is that within which the hiking enthusiast is well matched to the chosen trail. This is the best way to lower the risk of injury. Not every injury is preventable, but preparation, proper gear, a comprehensive safety plan and a confident match between a mountain and its hiker can decrease risk from a 14er hiking injury. If you have sustained a hiking injury, contact shoulder and knee specialist Dr. Richard Cunningham and his team today.

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Dr. Cunningham specializes in the treatment of knee, shoulder, and sports injuries.

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