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

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.