Some of the most common injuries hikers experience include blisters, sprains, and strains. Many times these are caused by overusing muscles and tendons during strenuous and sustained activity, i.e. a thru-hike. The fix (or prevention), generally, is to start with low mileage and gradually increase over time in order for your body to adjust to its new reality. Sometimes, though, this advice is not followed and can lead to more serious conditions, as was the case for me.
To provide some context, I planned to thru-hike the AT in 100 days. In order to do this, I needed to hit the ground running and keep a consistent pace throughout – I simply couldn’t afford to spend two weeks doing 8-mile days through Georgia. I was in good shape and had recently set the FKT for a 165mi trail in Cyprus where I averaged between 30 and 40 miles per day, so I figured that starting the AT at 20-25 miles per day wouldn’t be an issue. It wasn’t, until it was.
I reached the Cosby Knob shelter (mile 230) after 10 days and began to have recurring soreness in my right knee. I never twisted it or fell, it just began to hurt when I would go downhill or try to take a high step. The pain was concentrated on the outside of my knee, not the kneecap or backside, so I didn’t think it was as serious as a torn ligament or meniscus. Not only that, it usually wouldn’t hurt until sometime in the late afternoon – after I had hiked 15 or more miles that day. However, as I kept pushing high miles the pain persisted and my knee began throbbing earlier and earlier each day. I bought a generic knee brace in Hot Springs, which seemed to help, but by the time I got to Boots Off Hostel in Hampton, TN it was hurting bad enough that I took an unplanned zero to see if some extra rest would help.
Even though I have been involved in sports for many years, including long-distance trail running, I had never experienced this injury so I had no idea how to treat it. As I hung out on my day off, I Googled my symptoms in an effort to determine exactly what was happening and how I could fix it. While I was able to figure out that I likely had “hiker’s knee” (AKA “runner’s knee”), I was inexplicably unable to find any conclusive information about how to treat it. Like, nothing. There were tons of articles and blog posts mentioning the condition, but barely anything about how to heal. This made me very nervous.
After leaving Boots Off the following day, I made my way to Damascus (42 miles away) and was feeling a bit anxious. My knee hurt the entire time and it was clear that the day off hadn’t helped. Shit. When I rolled into town, it was pouring rain and my knee was so sore I could barely walk. I hobbled toward Woodchuck’s Hostel, limping my way across Beaver Dam Ave in excruciating pain. I had hiked over 450 miles in three weeks, but I was paying the cost.
I took a second unscheduled zero at Woodchuck’s and even purchased a new pair of shoes at Mount Rogers Outfitters thinking that my trusty Altras may be to blame. I then spent several hours at the library poring over my guidebook and spreadsheets to come up with an alternate schedule as it appeared I would not be able to keep pace as planned. Not only that, I began to fear the worst: that I may have to end my thru-hike. I went back to the drawing board and came up with a loose schedule of reduced-mileage days that I hoped would allow my injury to heal. I concluded that I would take it easy and re-evaluate when I reached Harper’s Ferry, and if my condition didn’t improve I’d get off the trail. I hated to consider that this could be my fate, but I needed to be realistic.
The next day, I headed back to the trail en route to the Lost Mountain Shelter – a mere 16 miles from town. The new shoes were killing my feet and my knee felt only slightly better after another day off. When I arrived that night, the shelter was full as per usual so I set up my tent in the woods. Despondent about my condition, I joined the other hikers for a fire they had started outside the shelter. The typical conversation ensued, wherein I announced to the group that things had started well for me but taken a turn for the worse. When I described my symptoms, a hiker who I would later know to be “2 Clicks” (@northbound_ryan) piped up. He mentioned that he was a personal trainer and knew exactly what my problem was: Iliotibial Band Syndrome (ITBS). Better yet, he said he knew how to fix it.
ITBS – The Trail Provides
ITBS is, succintly, “an overuse injury of the connective issues that are located on the outer thigh and knee. Inflammation and irritation of the iliotibial band can occur as it travels back and forth, crossing the bony prominence of the femoral epicondyle as the knee flexes and extends” (source). That’s exactly what I was feeling. When 2 Clicks said he knew how to relieve my pain, I was skeptical. If the almighty Google didn’t have my answer, how likely was it that a smelly thru-hiker had the magic touch?
Despite my uncertainty I listened to what he had to say, and it made a lot of sense. The way he described it, I was likely experiencing tightness in my glutes, low back, and hips from the long days and big climbs which caused tension on my IT band. Because the band is weakest at its connection point on the knee, that’s where the pain manifests itself. He said that if I could relieve the tightness in those muscles it would reduce strain on the IT band and my pain would go away. Mind blown.
2-Clicks went on to show me a couple of various stretches that I could do to loosen up the aforementioned muscles, and said that if I did them a couple of times per day I should see results within a week. Again, I was apprehensive about this claim but figured it couldn’t hurt to try.
For the next week, I made sure to stretch my glutes and legs several times per day. The pain was consistent throughout that time until, unbelievably, it began to dissipate. After almost exactly seven days, the pain was all but nonexistent. I hesitated to claim victory, and even purchased an ITBS knee strap to take some of the pressure off just in case it reemerged.
However, as time went on I continued to experience pain-free days and the injury never reared its head again. My knee braces ended up in hiker boxes and, despite taking unplanned zeros and getting off track initially, I was able to make up those miles later on and ended up summiting Katahdin in 97 days – a full three days ahead of schedule.
How I Treated ITBS on The Trail
It was incredibly frustrating and disheartening when I couldn’t find any practical or appropriate information online about how to treat ITBS without the standard “rest and ice” recommendation. While that advice may make sense for the weekend warrior who gets to go home that night, it doesn’t do much good for a thru-hiker who’s on a schedule and has 1,800 miles left in their trip. If I had known that the solution was simple, it would have saved me a lot of stress, worry, and pain. So, here are the stretches I used to successfully treat and eliminate my ITBS on trail which, effectively, saved my thru-hike.
Standing side bend
This movement stretches the IT band in the area of your hip, which is where some people feel pain instead of, or in addition to, the knee. This is an easy one to do on the trail, as you only need to find a tree to lean against. To perform this stretch, stand at arm’s length distance from a tree, wall, post, etc., and cross your left leg over your right so that it’s closer to the tree than your right. Then, lean to your right and feel the stretch in your hip. Hold this position for one minute and then switch sides.
Seated figure four
This stretch is great to do while taking a break on the trail or at the end of the day, as it is performed from the seated position. To do this, sit on a log, rock, or whatever with your feet planted flat on the ground. Lift your right leg and place the ankle on top of your left thigh, creating a triangle space between your legs. Then, simply lean forward to feel the stretch in your gluteus. If you’re flexible and not feeling the stretch by leaning forward, you can place a hand under your right knee and lift upward softly to increase the sensation. Hold for one minute and switch sides.
This stretch was my favorite and it worked really well for me. Start by dropping to your left knee with your right leg at a 90-degree angle. From there, shift your right leg across the front of your left so that your right heel is to the outside of your left knee. The further the distance between your right heel and your left knee, the deeper the stretch will be. From there, simply lean forward slightly and slowly to feel the stretch in your gluteus. For more stability, place your right hand on your knee. For an even deeper stretch, apply gentle inward pressure to your right knee and continue to lean forward.
Utilizing the three stretches outlined above, I was able to effectively relieve the tension in my gluteus, hips, and low back that was causing ITBS. Because of that, I was able to continue hiking and increase my daily mileage until I was back on track to finish the AT in under 100 days. If it wasn’t for the chance encounter with 2 Clicks at the Lost Mountain Shelter that night, I may have never figured out the problem and may have ended my thru-hike early instead of finishing strong. I hope someone comes across this when researching their own ITBS problems and they’re able to work it out as I did. Even if you’ve never experienced this injury before, it helps to know that there may be hope in solving the issue. That being said, if these stretches don’t help make sure you seek the advice of a real physician or physical therapist (as I am neither). Good luck out there!
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Brandon Chase is a writer, endurance athlete, and guide based in Maine. He is a former Foreign Service Officer with the U.S. Department of State and spent nearly a decade overseas serving at embassies in Egypt, Cyprus, and Pakistan.
Along with a 98-day thru-hike of the Appalachian Trail, he has summited Mt. Kilimanjaro, hiked the West Highland Way, fastpacked in the Himalayas, and trekked around New Zealand and South Africa. He also regularly competes in ultramarathons at the 50k, 50-mile, and 100-mile distances.