A Physiotherapist's guide to injury prevention and management on the Camino

[Physio_pilgrim]

Hello Pilgrims!

My husband and I have just finished our 33 day journey from St Jean to Fisterra and it was an absolutely incredible experience. We are both physiotherapists and you can imagine that we saw plenty of pilgrims needing assistance along the way, so I thought I'd post a few tips that may help some of you. Feel free to ask me anything as well and also to add a few things you feel may be useful to others.

****INJURY PREVENTION****

TRAINING
The majority of people who we saw injured did zero training, and according to the guidebook only something like 10% of people do any. Personally I do feel training is vital, especially for those who have very limited hiking experience or those who are generally not very active. Ideally training 3 months beforehand would be fantastic, but I would say the bare minimum would be to do 2 x 15-20km walks (with breaks of course) per week with a backpack for the 4 weeks leading up to the Camino as well as 2-3 sessions per week of global leg strengthening would also be beneficial. Obviously if you are a regular hiker this may not apply to you.

CORRECTLY FITTED BACKPACK
A huge complaint people mentioned to us was how sore their shoulders were but that they thought this was a good thing as it would strengthen up their shoulders muscles. This is COMPLETELY INCORRECT. Having such significant weight bearing down on your shoulders ends up depressing your shoulder blades which often over stretches your neck muscles thus weakening both your neck and shoulder muscles which could learn to long term issues such as neck pain, headaches and shoulder pain. If the backpack is correctly fitted you should feel close to nothing on your shoulders. The main error most people make is the waist belt sits too low. Ideally it should sit above your pelvic bones and be pulled in relatively tight so that the weight of the pack goes through your hips and not your shoulders.

PACING
Go at your own comfortable pace. Don't feel like you have to keep up with anyone or slow down for anyone if it doesn't feel natural to you. Everyone has a natural pace and if you get out of your rhythm for long periods you may find yourself a little bit worse for wear

REST
Ensure you have regular rest breaks during the day even if its for 5-10 minutes and at least once a day (usually during lunch break), take your shoes and socks off and rest your feet somewhere off the ground. You will definitely feel better for it. Rest is also important at night, ensure you get 8 hours of sleep to enable your body to get a chance to recover.

HILLS/INCLINES
It seemed that a lot of pilgrims started noticing their joint issues after Day 1 or 2 after the steep ascents and descents. The most common issue we saw were shin splints and front of knee pain. I'd say the best way to tackle this type of terrain, especially if you already have a pre-existing condition is to go slow and walking in a zig zag or snake-like pattern. This style of walking essentially reduces the angle that your joints have to bend, therefore reducing the amount of strain going through them. I'd also highly recommend the use of two hiking poles as that gives you both that extra balance but also reduces the amount of work your leg muscles have to do.

FOOTWEAR
Waterproof hiking boots are highly recommended as they are designed for rough terrain, can drastically reduce the impact through your joints and are usually very durable. There were quite a few people walking in basic trainers and did make it to the end, but it isn't something I would recommend as they are not designed for rough terrain and often do not give you the same amount of stability. If you are coming into the Camino with foot pain, make sure you see a podiatrist first who may find it necessary to prescribe you some orthotics you can place in your boots.

BLISTERS
I'm definitely not an expert in this area, and I know its a topic that's been discussed about a million times on this forum, but having completed a 33 day journey with only one blister and my husband with none, hopefully these tips may be useful to someone
- Vaseline your feet every morning especially between and around your toes, your forefoot and the outside border of your foot and heel
- Wear anti-blister socks which are thick two-layered socks which help to cushion feet and prevent friction
- If you feel any rubbing in your feet, stop immediately and check the situation, if you see some redness place a plaster on it to stop any further rubbing, if it's starting to form a blister there are a few options such as Compeed or popping with a sterilised needle and thread then leaving the thread in for a few hours to drain

STRETCHING AND MASSAGE
There is very mixed evidence on the benefits of stretching and whether it actually prevents injury. So for this, I'll say if you feel better for it, then go for it, if it makes no difference then don't bother. As for massage, it is worth spending 5 minutes massaging the soles of your feet at the end of the day just to release any pressure going through the tendons and small muscles that have been working hard all day.

***INJURY MANAGEMENT***

This is a difficult area to cover as there are so many different injuries you can have in the a Camino. So I'm going to be quite general and give a few specific pointers to the most common hiking injuries only. I think my most hated quote is 'no pain, no gain', this saying alone is the single cause of so many people pushing through serious issues thinking it will go away. You know your body better than anyone, and if something doesn't feel right, it probably isn't right.

If you feel a:
- sharp pain - stop immediately and assess the situation. Often sharp pains can indicate there is potential for serious damage. If after a bit of rest the pain is relieved, you can continue walking but carefully. If the pain remains sharp I would suggest attempt to massage the area or applying a sports tape horizontally across the area to see if that provides you with some relief. In the end you will know whether you can continue to walk the day or if you need to rest at the closest town for the night
- dull ache - monitor the situation. Dull aches are usually a sign of muscles either working too hard or there is too much load through the joint. Try to slow it down and if tackling steps go up with your good leg, but go down leading with your bad leg

COMMON INJURIES
- Anterior knee pain - often a result of increased loading through the joint especially with steep descents. If the pain is more than a 5/10 at is worse, I'd suggest you take a rest day and tape the knee up like this http://blog.physical-sports.co.uk/2014/08/08/patellar-tendinosis-knee-taping/

- Shin splints - again a result of inclines, more so with fast descents as the muscles at the front of the shin have to repetitively control the foot whilst it's dropping down. This causes the muscle to pull in the shin bone excessively causing the pain. I would suggest a rest day if you do experience front of shin pain only because it is a condition that can worsen very quickly. I would suggest adopting the zig zag walking pattern when going up and down hill so the angle that your ankle has to move is reduced. It may also be worth massaging yourself with an ice cube along the area of pain. Please note that if you notice any sudden redness with excessive swelling and difficulty weight bearing, you should attend A&E for risk of compartment syndrome.

- Achilles pain - this usually occurs purely because you're doing significantly more work than you're used to and your calf muscles are not strong enough to cope with it. Attempt some calf stretches throughout the day and also a nerve gliding exercise as the neves in the area can often become slightly stuck between the tightened muscles and tendons (see slump slider section: http://www.raynersmale.com/blog/2014/4/28/improving-hamstring-flexibility-part-2-treatment)

So that's about all I can think of, but would definitely appreciate your input. Hoepefully this is beneficial to someone. Also happy to answer any questions regarding injuries and to provide you with some links that may be useful.

Buen Camino

 

[VNwalking]

Wow, Physio_pilgrim, how I wish I had met you--and had been able to read this post before going. Thank you for it!

Last year it was blisters--solved this year by prevention and lots of paper tape/lambswool.
Not one this year. Instead I had weird pain on the inside of one ankle and after a while was totally unable to point my toe on that foot...downhills were quite unpleasant unless I walked like a geisha with tiny little short steps.

It was x-rayed when I got back and there's no skeletal damage, but there's also not much support from my GP. As far as he's concerned, 59 year-old women who do this kind of thing will have any number of overuse injuries and he told me not to walk so far. Sorry, not an option. Instead I went online for a better education and have since learned to use KT tape to support the PTT. It really makes a difference. (It's about 75% back to normal but still aches. So if you know of useful links about posterior tibial tendinitis--or tips on how to work with it, I would be very grateful to know them.)
I wonder what will happen next year? (Miracles do sometimes happen. Maybe I will have a physically uneventful journey.)

 

[Physio_pilgrim]

Hi Viranani, great to hear from you - I see you have been given the diagnosis of tendinitis. Usually it's a term we use its a term we use at the very early stages of of a tendon injury and the 'itis' suffix suggest an inflammatory response. Once you are a few weeks down the track there is unlikely to be an inflammatory response, so it's then described as a tendinopathy, suggesting a more chronic overloading issue with the tendon. With what you're describing it sounds like you probably have a Tibialis Posterior Tendinopathy which is something I've seen quite commonly in practice. It's hard to give you a recipe of exercises because everyone presents differently but here is an article you may find useful
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC534847/

Also, this condition is quite common in people with flat feet so it may be worth seeing a podiatrist about some orthotics if you think that could be of use. If it still doesn't recover in a few months, it's definitely worth visiting a physio who can thoroughly assess you and give you specific exercise.

All the best with your future Caminos and your recovery!

Wow, Physio_pilgrim, how I wish I had met you--and had been able to read this post before going. Thank you for it!

Last year it was blisters--solved this year by prevention and lots of paper tape/lambswool.
Not one this year. Instead I had weird pain on the inside of one ankle and after a while was totally unable to point my toe on that foot...downhills were quite unpleasant unless I walked like a geisha with tiny little short steps.

It was x-rayed when I got back and there's no skeletal damage, but there's also not much support from my GP. As far as he's concerned, 59 year-old women who do this kind of thing will have any number of overuse injuries and he told me not to walk so far. Sorry, not an option. Instead I went online for a better education and have since learned to use KT tape to support the PTT. It really makes a difference. (It's about 75% back to normal but still aches. So if you know of useful links about posterior tibial tendinitis--or tips on how to work with it, I would be very grateful to know them.)
I wonder what will happen next year? (Miracles do sometimes happen. Maybe I will have a physically uneventful journey.)

Hi

 

[VNwalking]

All the best with your future Caminos and your recovery!

Thank you, Physio! And for this fantastic PubMed link. Real information, with significant depth.
Well...the foot is not flat yet...and hopefully it won't go that far. I have quite high arches...but an ankle with a history of 2 serious sprains, and either no or not enough rehab. Hence the consequences...........

And I'd love to see a physio. IME, you tend to have more depth of understanding about rehab and treatment than some docs (sorry docs on the forum, but that's been my experience--not having access to orthopedic or sports med specialists). Alas...'managed care' means I need a referral from said GP. Well, I will 'push back' if it continues to be an issue.

 

[Angel-hart]

Excellent Advice and methods: I am training for my Camino and noticed that what was lacking for me was not distance, or weather conditions, but terrain and hills. I walk on city streets and sidewalks. I know its not the best, its what I have, with some parks and trails getting out in the country when I can to diversify my walking.
Having arthritis in my knees makes walking a task, however the more I walk the better my knees improve, mid 60s is a time of use it or lose it in knee issues, Ive trained slowly over a year and its working out well.
Your advice is just perfect timing for us and I appreciate you posting it we will use it. Thank you again!!

Angelhart

 

[Phillypilgrim]

Great post Physio-pilgrim.
What is a Physiotherapist? Is this the same as a Physical Therapist here in the states? I have always wondered.
Thanks, Pam

 

[David]

Nice post indeed - though I would leave out the 'thread through the blister for a few days'. I would add that one should at least halve the length of one's stride on ascents and descents and to carry the (well fitted!) pack in such a way that one walks upright as if one isn't wearing a pack and if one cannot do that then the pack is too heavy.
Roman legions marched with really short steps and they were able to march all day with their heavy kit, every day, day after day. Short steps, not strides.

It really is about being aware of one's body isn't it.

When the moon shots were starting Nasa had the problem of how you keep astronauts fit in zero gravity. They found that to exercise every day was debilitating but to exercise every other day led to stronger muscles and more supple bodies. Exercise causes wear and the break down of muscles. A day rest in between allows the body time to rebuild them stronger than they were before. To exercise every day does not allow that natural strengthening process.

It isn't going to happen but for the first week the unfit should really walk only every other day!

 

[movinmaggie]

Hello Pilgrims!

My husband and I have just finished our 33 day journey from St Jean to Fisterra and it was an absolutely incredible experience. We are both physiotherapists and you can imagine that we saw plenty of pilgrims needing assistance along the way, so I thought I'd post a few tips that may help some of you. Feel free to ask me anything as well and also to add a few things you feel may be useful to others.

****INJURY PREVENTION****

TRAINING
The majority of people who we saw injured did zero training, and according to the guidebook only something like 10% of people do any. Personally I do feel training is vital, especially for those who have very limited hiking experience or those who are generally not very active. Ideally training 3 months beforehand would be fantastic, but I would say the bare minimum would be to do 2 x 15-20km walks (with breaks of course) per week with a backpack for the 4 weeks leading up to the Camino as well as 2-3 sessions per week of global leg strengthening would also be beneficial. Obviously if you are a regular hiker this may not apply to you.

CORRECTLY FITTED BACKPACK
A huge complaint people mentioned to us was how sore their shoulders were but that they thought this was a good thing as it would strengthening up their shoulders muscles. This is COMPLETELY INCORRECT. Having such significant weight bearing down on your shoulders ends up depressing your shoulder blades which often over stretches your neck muscles thus weakening both your neck and shoulder muscles which could learn to long term issues such as neck pain, headaches and shoulder pain. If the backpack is correctly fitted you should feel close to nothing on your shoulders. The main error most people make is the waist belt sits too low. Ideally it should sit above your pelvic bones and be pulled in relatively tight so that the weight of the pack goes through your hips and not your shoulders.

PACING
Go at your own comfortable pace. Don't feel like you have to keep up with anyone or slow down for anyone if it doesn't feel natural to you. Everyone has a natural pace and if you get out of your rhythm for long periods you may find yourself a little bit worse for wear

HILLS/INCLINES
It seemed that a lot of pilgrims started noticing their joint issues after Day 1 or 2 after the steep ascents and descents. The most common issue we saw were shin splints and front of knee pain. I'd say the best way to tackle this type of terrain, especially if you already have a pre-existing condition is to go slow and walking in a zig zag or snake-like pattern. This style of walking essentially reduces the angle that your joints have to bend, therefore reducing the amount of strain going through them. I'd also highly recommend the use of two hiking poles as that gives you both that extra balance but also reduces the amount of work your leg muscles have to do.

FOOTWEAR
Waterproof hiking boots are highly recommended as they are designed for rough terrain, can drastically reduce the impact through your joints and are usually very durable. There were quite a few people walking in basic trainers and did make it to the end, but it isn't something I would recommend as they are not designed for rough terrain and often do not give you the same amount of stability. If you are coming into the Camino with foot pain, make sure you see a podiatrist first who may find it necessary to prescribe you some orthotics you can place in your boots.

BLISTERS
I'm definitely not an expert in this area, and I know its a topic that's been discussed about a million times on this forum, but having completed a 33 day journey with only one blister and my husband with none, hopefully these tips may be useful to someone
- Vaseline your feet every morning especially between and around your toes, your forefoot and the outside border of your foot and heel
- Wear anti-blister socks which are thick two-layered socks which help to cushion feet and prevent friction
- If you feel any rubbing in your feet, stop immediately and check the situation, if you see some redness place a plaster on it to stop any further rubbing, if it's starting to form a blister there are a few options such as Compeed or popping with a sterilised needle and thread then leaving the thread in for a few days to drain

STRETCHING AND MASSAGE
There is very mixed evidence on the benefits of stretching and whether it actually prevents injury. So for this, I'll say if you feel better for it, then go for it, if it makes no difference then don't bother. As for massage, it is worth spending 5 minutes massaging the soles of your feet at the end of the day just to realise any pressure going through the tendons and small muscles that have been working hard all day.

***INJURY MANAGEMENT***

This is a difficult area to cover as there are so many different injuries you can have in the a Camino. So I'm going to be quite general and give a few specific pointers to the most common hiking injuries only. I think my most hated quote is 'no pain, no gain', this saying alone is the single cause of so many people pushing through serious issues thinking it will go away. You know your body than anyone, and if something doesn't feel right, it probably isn't right.

If you feel a:
- sharp pain - stop immediately and assess the situation. Often sharp pains can indicate there is potential for serious damage. If after a bit of rest the pain is relieved, you can continue walking but carefully. If the pain remains sharp I would suggest attempt to massage the area or applying a sports horizontally across the area to see of that provides you with some relief. In the end you will know whether you can continue to walk the day or if you need to rest at the closest town for the night
- dull ache - monitor the situation. Dull aches are usually a sign of muscles either working too hard or there is too much load through the joint. Try to slow it down and if tackling steps go up with your good leg, but go down leading with your bad leg

COMMON INJURIES
- Anterior knee pain - often a result of increased loading through the joint especially with steep descents. If the pain is more than a 5/10 at is worse, I'd suggest you take a rest day and tape the knee up like this http://blog.physical-sports.co.uk/2014/08/08/patellar-tendinosis-knee-taping/

- Shin splints - again a result of inclines, more so with fast descents as the muscles at the front of the shin have to repetitively control the foot whilst it's dropping down. This causes the muscle to pull in the shin bone excessively causing the pain. I would suggest a rest day if you do experience front of shin pain only because it is a condition that can worsen very quickly. I would suggest adopting the zig zag walking pattern when going up and down hill so the ankle that your ankle has to move is reduced. It may also be worth massaging yourself with a nice cube along the area of pain. Please note that if you notice and sudden redness with excessive redness, swelling and difficulty weight earring that you should attend A&E for risk of compartment syndrome.

- Achilles pain - this usually occurs purely because you're doing significantly more work than you're used to and your calf muscles are not strong enough to cope with it. Attempt some calf stretches throughout the day and also a nerve gliding exercise as the neves in the are can often become slightly stuck between the tightened muscles and tendons (see slump slider section: http://www.raynersmale.com/blog/2014/4/28/improving-hamstring-flexibility-part-2-treatment)

So that's about all I can think of, but would definitely appreciate your input. Hoepefully this is beneficial to someone. Also happy to answer any questions regarding injuries and to provide you with some links that may be useful.

Buen Camino

Great post; I was surprised not to see others zigzagging. It may be more steps, but far less energy expelled, both incline and decline. Thanks for this very helpful info.

 

[Physio_pilgrim]

You are corrct Pam! Physiotherapist is the same as a physical therapist

Great post Physio-pilgrim.
What is a Physiotherapist? Is this the same as a Physical Therapist here in the states? I have always wondered.
Thanks, Pam

 

[Physio_pilgrim]

Great advice David! Yes will remove the thread part written in haste.

And very much agree with you regarding the need for rest! Something that is not emphasised enough.

Nice post indeed - though I would leave out the 'thread through the blister for a few days'. I would add that one should at least halve the length of one's stride on ascents and descents and to carry the (well fitted!) pack in such a way that one walks upright as if one isn't wearing a pack and if one cannot do that then the pack is too heavy.
Roman legions marched with really short steps and they were able to march all day with their heavy kit, every day, day after day. Short steps, not strides.

It really is about being aware of one's body isn't it.

When the moon shots were starting Nasa had the problem of how you keep astronauts fit in zero gravity. They found that to exercise every day was debilitating but to exercise every other day led to stronger muscles and more supple bodies. Exercise causes wear and the break down of muscles. A day rest in between allows the body time to rebuild them stronger than they were before. To exercise every day does not allow that natural strengthening process.

It isn't going to happen but for the first week the unfit should really walk only every other day!

 

[Physio_pilgrim]

Angelhart, great to hear you're training and continuing to be active in spite of the arthritis. There is some excellent research evidence to support the use of weight bearing strengthening exercises to reduce the symptoms of Osteoarthtis, so that may be of interest to you. Let me know if you want any further details

Excellent Advice and methods: I am training for my Camino and noticed that what was lacking for me was not distance, or weather conditions, but terrain and hills. I walk on city streets and sidewalks. I know its not the best, its what I have, with some parks and trails getting out in the country when I can to diversify my walking.
Having arthritis in my knees makes walking a task, however the more I walk the better my knees improve, mid 60s is a time of use it or lose it in knee issues, Ive trained slowly over a year and its working out well.
Your advice is just perfect timing for us and I appreciate you posting it we will use it. Thank you again!!

Angelhart

 

[Sailor]

. . . so I thought I'd post a few tips that may help some of you . . .

Yes, this is good information. Thanks for your help. Que la luz de Dios alumbre su camino.

 

[Tom Leonard]

Good report and wish I saw this before my Camino (9/16/15) . I trained hard ( 6 miles x 5 days x 8 weeks ) mostly on city walks but some in hills . Thought I was in very good shape ( and was for 67 yrs ) but was surprised by steep down hills on day 1 . Both knees had pain and had I seen your directions on taping it could have helped somewhat . I bought two knee wraps on Day 3 but only helped a little . Treking poles really helped . I wish I had trained for the knees and thus had to simply tough it out ( only did Sarria - Santiago ).
New Camino walkers need to read this forum often before their walk as posts like this are valuable. Still reading two months later

 

[scikowski]

Thank you so much for this valuable information. Like others, I wish I had had this before any of my caminos! For me, it is always something different!

 

[Kitsambler]

Short steps, not strides.

Indeed - this is how the Swiss climb mountains. I have it on good authority - my Swiss pilgrim friends. A very helpful approach.

 

[VNwalking]

Indeed - this is how the Swiss climb mountains. I have it on good authority - my Swiss pilgrim friends. A very helpful approach.

Going up and up and up. Step step step...slow, steady, and unstoppable. The first person to the pass on a recent pilgrimage in Ladakh was a 70 year-old Swiss lady with a very positive outlook...and while she knows her limits, there was no avoidance of a little discomfort. This helps too.
The Swiss. Wonderful people--I bow to you, my mountain teachers!

 

[2kiwis]

Agree with all the coments about zigzagging and taking small steps ,It is how it happens here as well ,NewZealand Has lots of mountain ranges and rugged tracks so lots of tramping and hunting happens here.
One thing I would add if you want to walk in a group or stay together let the slowest person take the lead ,it is easier to slow your step to fit with theirs than for them to match someone faster.
Hopefully 2016 is the year of my Camino ,planning on 6 weeks from St Jean to Finistere ,either June or Sept ,just need to find the right person to do it with or I will go on my own

 

[Kanga]

Hi @Physio_pilgrim and welcome to the forum. Your knowledge will be a welcome addition.

I agree with most of your advice. Training for me consists of 12 km walks, with loaded pack, about 3 times a week, up and down short but sharp hills. That seems to work for me. I don't like waterproof hiking boots - unless walking in winter. My experience is that waterproof boots don't breath much (regardless of what the manufacturers say) and, combined with heat, that is a recipe for blisters. If they do get wet inside (invariably they do in a downpour, water drips down into them) they take much longer to dry. The lining also starts to break down after a while and that can cause problems. Structurally, boots do not suit me and do not suit many others - just do a search on this forum and check out the opinions, experience and surveys. I think they are overkill on the camino, it is not bushwalking or mountaineering, but, of course, some people love love them. More important than what goes on top of the foot, I think, is a supportive sole that will last the distance, and plenty of cushioning for walking on hard surfaces (roads).

I'm over sixty, and after nine caminos in the last 14 years, all except one more than 700km in length, I now wear Ecco offroad hiking sandals, use trekking sticks and an Aarn balance pack that splits the weight between the front and back and has an outstanding harness and hip belt. The pack is bigger than most need on camino but is so unbelievably comfortable I forget I'm wearing it, even carrying a tent and extra gear. Usually no blisters, never problems with my knees although both are severely damaged from skiing accidents, and no other problems. However, pride goeth before a fall, so my next camino might be a disaster - in which case I'll rethink everything!

 

[movinmaggie]

Hi @Physio_pilgrim and welcome to the forum. Your knowledge will be a welcome addition.

I agree with most of your advice. Training for me consists of 12 km walks, with loaded pack, about 3 times a week, up and down short but sharp hills. That seems to work for me. I don't like waterproof hiking boots - unless walking in winter. My experience is that waterproof boots don't breath much (regardless of what the manufacturers say) and, combined with heat, that is a recipe for blisters. If they do get wet inside (invariably they do in a downpour, water drips down into them) they take much longer to dry. The lining also starts to break down after a while and that can cause problems. Structurally, boots do not suit me and do not suit many others - just do a search on this forum and check out the opinions, experience and surveys. I think they are overkill on the camino, it is not bushwalking or mountaineering, but, of course, some people love love them. More important than what goes on top of the foot, I think, is a supportive sole that will last the distance, and plenty of cushioning for walking on hard surfaces (roads).

I'm over sixty, and after nine caminos in the last 14 years, all except one more than 700km in length, I now wear Ecco offroad hiking sandals, use trekking sticks and an Aarn balance pack that splits the weight between the front and back and has an outstanding harness and hip belt. The pack is bigger than most need on camino but is so unbelievably comfortable I forget I'm wearing it, even carrying a tent and extra gear. Usually no blisters, never problems with my knees although both are severely damaged from skiing accidents, and no other problems. However, pride goeth before a fall, so my next camino might be a disaster - in which case I'll rethink everything!

Kanga I forget where you are located. Is the Aarn pack one that is readily available? I do love my Osprey but had a challenge with getting at my water bottle so finally rigged up the little sac that my poncho goes in, to my waist belt to carry it. I never carried a large bottle of water; it was never necessary.

 

[Lynda t]

I had shin splints on my first Camino. I bought a reusable ice pack, took arnica tablets (which I had never heard of before) and occasionally for a few strides walked backwards. That seemed to receive the muscles plus a couple of days rest. Thank you for your info. Really helpful.

 

[jumpingin2014]

Great post!

Just a thought to add to "TRAINING" which is to emphasize the need to train with a weighted pack. I have met people who have done the Camino thinking if they can walk 8-12 km per day that they are capable of making the adjustment to the Camino say 20-25km per day which is what a lot of guides seem to recommend. I fell into this trap too thinking I had all day to cover the ground. The biggest impact was the weight for me which I felt confidently I was strong enough to carry but my knees and ankles seem to disagree with. Next trip I will cut my pack weight to 6-7kgs - possibly lower if I can. I will also use walking sticks - something like pacer poles.

Thanks for the post

Mark

 

[Kanga]

@movinmaggie I'm in Australia. The Aarn packs are from New Zealand.

 

[Urban Trekker]

What about swelling of the ankles. I suffer pitting edema of my lower legs and with inflation just above my socks walking the camino. Doesn't slow me down or cause pain just feels tight. I do take a water pill for BP. BUEN CAMINO

HAPPY TRAILS

 

[spursfan]

Great post!
Next trip I will cut my pack weight to 6-7kgs - possibly lower if I can.
Mark

Why stop at 6-7kgs - during the most popular months you could get by with a silk sleeping bag liner instead of a sleeping bag and save between 0.5-1.0kg alone

Also think of using wool that will keep you warm over a wide range of temperatures

And cut down on bringing too many phones, cameras, iPads and the like

 

[Anemone del Camino]

@movinmaggie I'm in Australia. The Aarn packs are from New Zealand.

@Kanga , I have a question about the Aarn packs, boys, stop reading......... Now, ladies, the question, how do the cront packs work over the .... ? .... Just because I know he boys will read, though not chime in, like we did in the men's undies thread

 

[Anemone del Camino]

Going up and up and up. Step step step...slow, steady, and unstoppable. The first person to the pass on a recent pilgrimage in Ladakh was a 70 year-old Swiss lady with a very positive outlook...and while she knows her limits, there was no avoidance of a little discomfort. This helps too.
The Swiss. Wonderful people--I bow to you, my mountain teachers!

On my 1st Camino people made fun of me, saying I wLked like a Geisha: tiny steps. I'm short, how else can I walk? But if it's good technique, good for me!

 

[Kanga]

No problem Anemone - they have a bendable rod which you shape so they sit over the, ahem, hills. I am rather generous in that department but they are still fine. I just bend them as feels comfortable, holding them out further from the body at the top. The rods also allow air circulation. I've come across a few who make the mistake of removing the rods to lose weight - the pockets don't work properly without them.

 

[nomadko]

Hello Pilgrims!

My husband and I have just finished our 33 day journey from St Jean to Fisterra and it was an absolutely incredible experience. We are both physiotherapists and you can imagine that we saw plenty of pilgrims needing assistance along the way, so I thought I'd post a few tips that may help some of you. Feel free to ask me anything as well and also to add a few things you feel may be useful to others.

****INJURY PREVENTION****

TRAINING
The majority of people who we saw injured did zero training, and according to the guidebook only something like 10% of people do any. Personally I do feel training is vital, especially for those who have very limited hiking experience or those who are generally not very active. Ideally training 3 months beforehand would be fantastic, but I would say the bare minimum would be to do 2 x 15-20km walks (with breaks of course) per week with a backpack for the 4 weeks leading up to the Camino as well as 2-3 sessions per week of global leg strengthening would also be beneficial. Obviously if you are a regular hiker this may not apply to you.

CORRECTLY FITTED BACKPACK
A huge complaint people mentioned to us was how sore their shoulders were but that they thought this was a good thing as it would strengthening up their shoulders muscles. This is COMPLETELY INCORRECT. Having such significant weight bearing down on your shoulders ends up depressing your shoulder blades which often over stretches your neck muscles thus weakening both your neck and shoulder muscles which could learn to long term issues such as neck pain, headaches and shoulder pain. If the backpack is correctly fitted you should feel close to nothing on your shoulders. The main error most people make is the waist belt sits too low. Ideally it should sit above your pelvic bones and be pulled in relatively tight so that the weight of the pack goes through your hips and not your shoulders.

PACING
Go at your own comfortable pace. Don't feel like you have to keep up with anyone or slow down for anyone if it doesn't feel natural to you. Everyone has a natural pace and if you get out of your rhythm for long periods you may find yourself a little bit worse for wear

REST
Ensure you have regular rest breams during the day even if its for 5-10 minutes and at least once a day (usually during lunch break), take your shoes and socks off and rest your feet somewhere off the ground. You will definitely feel better for it. Rest is also important at night, ensure you get 8 hours of sleep to enable your body to get a chance to recover.

HILLS/INCLINES
It seemed that a lot of pilgrims started noticing their joint issues after Day 1 or 2 after the steep ascents and descents. The most common issue we saw were shin splints and front of knee pain. I'd say the best way to tackle this type of terrain, especially if you already have a pre-existing condition is to go slow and walking in a zig zag or snake-like pattern. This style of walking essentially reduces the angle that your joints have to bend, therefore reducing the amount of strain going through them. I'd also highly recommend the use of two hiking poles as that gives you both that extra balance but also reduces the amount of work your leg muscles have to do.

FOOTWEAR
Waterproof hiking boots are highly recommended as they are designed for rough terrain, can drastically reduce the impact through your joints and are usually very durable. There were quite a few people walking in basic trainers and did make it to the end, but it isn't something I would recommend as they are not designed for rough terrain and often do not give you the same amount of stability. If you are coming into the Camino with foot pain, make sure you see a podiatrist first who may find it necessary to prescribe you some orthotics you can place in your boots.

BLISTERS
I'm definitely not an expert in this area, and I know its a topic that's been discussed about a million times on this forum, but having completed a 33 day journey with only one blister and my husband with none, hopefully these tips may be useful to someone
- Vaseline your feet every morning especially between and around your toes, your forefoot and the outside border of your foot and heel
- Wear anti-blister socks which are thick two-layered socks which help to cushion feet and prevent friction
- If you feel any rubbing in your feet, stop immediately and check the situation, if you see some redness place a plaster on it to stop any further rubbing, if it's starting to form a blister there are a few options such as Compeed or popping with a sterilised needle and thread then leaving the thread in for a few hours to drain

STRETCHING AND MASSAGE
There is very mixed evidence on the benefits of stretching and whether it actually prevents injury. So for this, I'll say if you feel better for it, then go for it, if it makes no difference then don't bother. As for massage, it is worth spending 5 minutes massaging the soles of your feet at the end of the day just to realise any pressure going through the tendons and small muscles that have been working hard all day.

***INJURY MANAGEMENT***

This is a difficult area to cover as there are so many different injuries you can have in the a Camino. So I'm going to be quite general and give a few specific pointers to the most common hiking injuries only. I think my most hated quote is 'no pain, no gain', this saying alone is the single cause of so many people pushing through serious issues thinking it will go away. You know your body than anyone, and if something doesn't feel right, it probably isn't right.

If you feel a:
- sharp pain - stop immediately and assess the situation. Often sharp pains can indicate there is potential for serious damage. If after a bit of rest the pain is relieved, you can continue walking but carefully. If the pain remains sharp I would suggest attempt to massage the area or applying a sports tape horizontally across the area to see of that provides you with some relief. In the end you will know whether you can continue to walk the day or if you need to rest at the closest town for the night
- dull ache - monitor the situation. Dull aches are usually a sign of muscles either working too hard or there is too much load through the joint. Try to slow it down and if tackling steps go up with your good leg, but go down leading with your bad leg

COMMON INJURIES
- Anterior knee pain - often a result of increased loading through the joint especially with steep descents. If the pain is more than a 5/10 at is worse, I'd suggest you take a rest day and tape the knee up like this http://blog.physical-sports.co.uk/2014/08/08/patellar-tendinosis-knee-taping/

- Shin splints - again a result of inclines, more so with fast descents as the muscles at the front of the shin have to repetitively control the foot whilst it's dropping down. This causes the muscle to pull in the shin bone excessively causing the pain. I would suggest a rest day if you do experience front of shin pain only because it is a condition that can worsen very quickly. I would suggest adopting the zig zag walking pattern when going up and down hill so the angle that your ankle has to move is reduced. It may also be worth massaging yourself with an ice cube along the area of pain. Please note that if you notice and sudden redness with excessive redness, swelling and difficulty weight earring that you should attend A&E for risk of compartment syndrome.

- Achilles pain - this usually occurs purely because you're doing significantly more work than you're used to and your calf muscles are not strong enough to cope with it. Attempt some calf stretches throughout the day and also a nerve gliding exercise as the neves in the are can often become slightly stuck between the tightened muscles and tendons (see slump slider section: http://www.raynersmale.com/blog/2014/4/28/improving-hamstring-flexibility-part-2-treatment)

So that's about all I can think of, but would definitely appreciate your input. Hoepefully this is beneficial to someone. Also happy to answer any questions regarding injuries and to provide you with some links that may be useful.

Buen Camino

Hello Physio-Pilgrim!
Wow! What invaluable information... thank you for posting. I have recently been diagnosed with illiotibial band strain - any suggestions to speed up recovery? I would greatly appreciate any info you can share - walking the Camino in March and would like to get back to training as soon as possible.
Thank you in advance.
nomadko

 

[saiprem]

I have chronically bad knees. Just before my walk this year I heard of something called Copper Fit or Miracle Copper knee sleeves. I got a pair and my knee pain nearly disappeared for the entire hike except for the steepest downhill slopes. One day I overheard some pilgrims saying they saw a guy walking downhill backwards. I tried it and it was surprisingly easy and very helpful to painlessly make those descents. I just looked over my shoulder to see where I was going and had my walking poles to keep balanced and it worked fine. I recommend at least giving it a try or two if you are experiencing downhill knee pain. It was also good for stairways.

 

[Physio_pilgrim]

Hi @nomadko

Great to hear from you. Its very unusual to have an illiotibial band (ITB) 'strain' as it is a tendon, but it is quite common to get significant tightness in the ITB which subsequently causes rubbing on either the outer side of the knee or the hip.

One of the most common things we see in people who have ITB issues is weakness in the gluteus medius muscle which have fibers that attatch directly into the ITB. If the muscle is weak, it often compensates by becoming tight which then causes it to chronically pull on the ITB.

The main ways to manage it are:
- rest from the activity that aggravates it
- stretch both the ITB and glutes
- self massage of the ITB with a foam roller or tennis ball
- gluteus medius strengthening (must be pain-free)

Now without seeing you I can't give you specific exercises so its probably worth googling some gluteus medius exercises, but it would be better if you booked yourself an a appointment with a physiotherapist.

Hope that gives you a bit of an idea of how to manage the condition

Hello Physio-Pilgrim!
Wow! What invaluable information... thank you for posting. I have recently been diagnosed with illiotibial band strain - any suggestions to speed up recovery? I would greatly appreciate any info you can share - walking the Camino in March and would like to get back to training as soon as possible.
Thank you in advance.
nomadko

 

[nomadko]

Hi @nomadko

Great to hear from you. Its very unusual to have an illiotibial band (ITB) 'strain' as it is a tendon, but it is quite common to get significant tightness in the ITB which subsequently causes rubbing on either the outer side of the knee or the hip.

One of the most common things we see in people who have ITB issues is weakness in the gluteus medius muscle which have fibers that attatch directly into the ITB. If the muscle is weak, it often compensates by becoming tight which then causes it to chronically pull on the ITB.

The main ways to manage it are:
- rest from the activity that aggravates it
- stretch both the ITB and glutes
- self massage of the ITB with a foam roller or tennis ball
- gluteus medius strengthening (must be pain-free)

Now without seeing you I can't give you specific exercises so its probably worth googling some gluteus medius exercises, but it would be better if you booked yourself an a appointment with a physiotherapist.

Hope that gives you a bit of an idea of how to manage the condition

Thank you for your invaluable advice. I have done quite a bit of searching on the internet and found a monumental amount of info about ITB. 'Patience' is probably in order here... we were doing so well with our training and are so excited about our upcoming trek that I want to get back to our walking routine 'now'! Oddly enough the leg doesn't hurt when I walk - at least not for 4 miles... haven't tried longer.
Again... thank you for your input!

 

[nomadko]

I have chronically bad knees. Just before my walk this year I heard of something called Copper Fit or Miracle Copper knee sleeves. I got a pair and my knee pain nearly disappeared for the entire hike except for the steepest downhill slopes. One day I overheard some pilgrims saying they saw a guy walking downhill backwards. I tried it and it was surprisingly easy and very helpful to painlessly make those descents. I just looked over my shoulder to see where I was going and had my walking poles to keep balanced and it worked fine. I recommend at least giving it a try or two if you are experiencing downhill knee pain. It was also good for stairways.

Hi Saiprem! Thank you for your input. I'm willing to try anything that works I never knew I had any knee issues until I 'really' started to train for the Camino. I heard other folks mention the copper knee sleeves... I'll have to give them a try. Thank you!

 

[owms2323]

Hello Pilgrims!

My husband and I have just finished our 33 day journey from St Jean to Fisterra and it was an absolutely incredible experience. We are both physiotherapists and you can imagine that we saw plenty of pilgrims needing assistance along the way, so I thought I'd post a few tips that may help some of you. Feel free to ask me anything as well and also to add a few things you feel may be useful to others.

****INJURY PREVENTION****

TRAINING
The majority of people who we saw injured did zero training, and according to the guidebook only something like 10% of people do any. Personally I do feel training is vital, especially for those who have very limited hiking experience or those who are generally not very active. Ideally training 3 months beforehand would be fantastic, but I would say the bare minimum would be to do 2 x 15-20km walks (with breaks of course) per week with a backpack for the 4 weeks leading up to the Camino as well as 2-3 sessions per week of global leg strengthening would also be beneficial. Obviously if you are a regular hiker this may not apply to you.

CORRECTLY FITTED BACKPACK
A huge complaint people mentioned to us was how sore their shoulders were but that they thought this was a good thing as it would strengthen up their shoulders muscles. This is COMPLETELY INCORRECT. Having such significant weight bearing down on your shoulders ends up depressing your shoulder blades which often over stretches your neck muscles thus weakening both your neck and shoulder muscles which could learn to long term issues such as neck pain, headaches and shoulder pain. If the backpack is correctly fitted you should feel close to nothing on your shoulders. The main error most people make is the waist belt sits too low. Ideally it should sit above your pelvic bones and be pulled in relatively tight so that the weight of the pack goes through your hips and not your shoulders.

PACING
Go at your own comfortable pace. Don't feel like you have to keep up with anyone or slow down for anyone if it doesn't feel natural to you. Everyone has a natural pace and if you get out of your rhythm for long periods you may find yourself a little bit worse for wear

REST
Ensure you have regular rest breaks during the day even if its for 5-10 minutes and at least once a day (usually during lunch break), take your shoes and socks off and rest your feet somewhere off the ground. You will definitely feel better for it. Rest is also important at night, ensure you get 8 hours of sleep to enable your body to get a chance to recover.

HILLS/INCLINES
It seemed that a lot of pilgrims started noticing their joint issues after Day 1 or 2 after the steep ascents and descents. The most common issue we saw were shin splints and front of knee pain. I'd say the best way to tackle this type of terrain, especially if you already have a pre-existing condition is to go slow and walking in a zig zag or snake-like pattern. This style of walking essentially reduces the angle that your joints have to bend, therefore reducing the amount of strain going through them. I'd also highly recommend the use of two hiking poles as that gives you both that extra balance but also reduces the amount of work your leg muscles have to do.

FOOTWEAR
Waterproof hiking boots are highly recommended as they are designed for rough terrain, can drastically reduce the impact through your joints and are usually very durable. There were quite a few people walking in basic trainers and did make it to the end, but it isn't something I would recommend as they are not designed for rough terrain and often do not give you the same amount of stability. If you are coming into the Camino with foot pain, make sure you see a podiatrist first who may find it necessary to prescribe you some orthotics you can place in your boots.

BLISTERS
I'm definitely not an expert in this area, and I know its a topic that's been discussed about a million times on this forum, but having completed a 33 day journey with only one blister and my husband with none, hopefully these tips may be useful to someone
- Vaseline your feet every morning especially between and around your toes, your forefoot and the outside border of your foot and heel
- Wear anti-blister socks which are thick two-layered socks which help to cushion feet and prevent friction
- If you feel any rubbing in your feet, stop immediately and check the situation, if you see some redness place a plaster on it to stop any further rubbing, if it's starting to form a blister there are a few options such as Compeed or popping with a sterilised needle and thread then leaving the thread in for a few hours to drain

STRETCHING AND MASSAGE
There is very mixed evidence on the benefits of stretching and whether it actually prevents injury. So for this, I'll say if you feel better for it, then go for it, if it makes no difference then don't bother. As for massage, it is worth spending 5 minutes massaging the soles of your feet at the end of the day just to release any pressure going through the tendons and small muscles that have been working hard all day.

***INJURY MANAGEMENT***

This is a difficult area to cover as there are so many different injuries you can have in the a Camino. So I'm going to be quite general and give a few specific pointers to the most common hiking injuries only. I think my most hated quote is 'no pain, no gain', this saying alone is the single cause of so many people pushing through serious issues thinking it will go away. You know your body better than anyone, and if something doesn't feel right, it probably isn't right.

If you feel a:
- sharp pain - stop immediately and assess the situation. Often sharp pains can indicate there is potential for serious damage. If after a bit of rest the pain is relieved, you can continue walking but carefully. If the pain remains sharp I would suggest attempt to massage the area or applying a sports tape horizontally across the area to see if that provides you with some relief. In the end you will know whether you can continue to walk the day or if you need to rest at the closest town for the night
- dull ache - monitor the situation. Dull aches are usually a sign of muscles either working too hard or there is too much load through the joint. Try to slow it down and if tackling steps go up with your good leg, but go down leading with your bad leg

COMMON INJURIES
- Anterior knee pain - often a result of increased loading through the joint especially with steep descents. If the pain is more than a 5/10 at is worse, I'd suggest you take a rest day and tape the knee up like this http://blog.physical-sports.co.uk/2014/08/08/patellar-tendinosis-knee-taping/

- Shin splints - again a result of inclines, more so with fast descents as the muscles at the front of the shin have to repetitively control the foot whilst it's dropping down. This causes the muscle to pull in the shin bone excessively causing the pain. I would suggest a rest day if you do experience front of shin pain only because it is a condition that can worsen very quickly. I would suggest adopting the zig zag walking pattern when going up and down hill so the angle that your ankle has to move is reduced. It may also be worth massaging yourself with an ice cube along the area of pain. Please note that if you notice any sudden redness with excessive swelling and difficulty weight bearing, you should attend A&E for risk of compartment syndrome.

- Achilles pain - this usually occurs purely because you're doing significantly more work than you're used to and your calf muscles are not strong enough to cope with it. Attempt some calf stretches throughout the day and also a nerve gliding exercise as the neves in the area can often become slightly stuck between the tightened muscles and tendons (see slump slider section: http://www.raynersmale.com/blog/2014/4/28/improving-hamstring-flexibility-part-2-treatment)

So that's about all I can think of, but would definitely appreciate your input. Hoepefully this is beneficial to someone. Also happy to answer any questions regarding injuries and to provide you with some links that may be useful.

Buen Camino

What about hip bursitis?

 

[Physio_pilgrim]

Hi @owms2323 - was there anything you wanted to know if particular regarding hip bursitis (otherwise known as trochanteric bursitis)?

What about hip bursitis?

 

[wonzi]

I completed my 2nd Camino in August - from Le Puy to Santiago de Compostella and I ended up with plantar fasciitis. Since returning home I have tried to rest it as much as possible by not doing any walking to speak of and it has gotten better but after 3 months, I felt it was feeling good enough to take a hike. So, yesterday I walked on mostly flat ground for about 12 miles and by the end of the walk, the pain was returning. I so want to do one more Camino before I have to call it quits (age) and wonder if you can shed any light on what I might do to avoid any more injury. Thanks!

 

[Physio_pilgrim]

Hi @wonzi

Sorry to hear of your injury.

Interestingly enough there has just been new research to support a form of exercise for managing plantar fasciitis. It is an eccentric strengthening program which pretty much involves strengthening the calf and foot muscles whilst they are in a stretched position. (See here for the exercise http://www.running-physio.com/pf-new-research/)

A few other things may also help:
- calf stretching
- ice massage of your arches
- a podiatry assessment to see if orthotics may help

I hope you get a chance to get an assessment by a physiotherapist so they can give you more specific advice

All the best
Ann

I completed my 2nd Camino in August - from Le Puy to Santiago de Compostella and I ended up with plantar fasciitis. Since returning home I have tried to rest it as much as possible by not doing any walking to speak of and it has gotten better but after 3 months, I felt it was feeling good enough to take a hike. So, yesterday I walked on mostly flat ground for about 12 miles and by the end of the walk, the pain was returning. I so want to do one more Camino before I have to call it quits (age) and wonder if you can shed any light on what I might do to avoid any more injury. Thanks!

 

[Christian Hiriart]

Great information Physio Pilgrim, thanks for sharing.

Chris

 

[wonzi]

That is a great article and one that I will try for exercises. I certainly will make an appointment with a physiotherapist to get a thorough evaluation, thanks to all your information. I do so want to make another journey in 2016 and hope this will work for me. Again, many thanks for the great information.

 

[urbanhiker]

Hello Pilgrims!

My husband and I have just finished our 33 day journey from St Jean to Fisterra and it was an absolutely incredible experience. We are both physiotherapists and you can imagine that we saw plenty of pilgrims needing assistance along the way, so I thought I'd post a few tips that may help some of you. Feel free to ask me anything as well and also to add a few things you feel may be useful to others.

****INJURY PREVENTION****

TRAINING
The majority of people who we saw injured did zero training, and according to the guidebook only something like 10% of people do any. Personally I do feel training is vital, especially for those who have very limited hiking experience or those who are generally not very active. Ideally training 3 months beforehand would be fantastic, but I would say the bare minimum would be to do 2 x 15-20km walks (with breaks of course) per week with a backpack for the 4 weeks leading up to the Camino as well as 2-3 sessions per week of global leg strengthening would also be beneficial. Obviously if you are a regular hiker this may not apply to you.

CORRECTLY FITTED BACKPACK
A huge complaint people mentioned to us was how sore their shoulders were but that they thought this was a good thing as it would strengthen up their shoulders muscles. This is COMPLETELY INCORRECT. Having such significant weight bearing down on your shoulders ends up depressing your shoulder blades which often over stretches your neck muscles thus weakening both your neck and shoulder muscles which could learn to long term issues such as neck pain, headaches and shoulder pain. If the backpack is correctly fitted you should feel close to nothing on your shoulders. The main error most people make is the waist belt sits too low. Ideally it should sit above your pelvic bones and be pulled in relatively tight so that the weight of the pack goes through your hips and not your shoulders.

PACING
Go at your own comfortable pace. Don't feel like you have to keep up with anyone or slow down for anyone if it doesn't feel natural to you. Everyone has a natural pace and if you get out of your rhythm for long periods you may find yourself a little bit worse for wear

REST
Ensure you have regular rest breaks during the day even if its for 5-10 minutes and at least once a day (usually during lunch break), take your shoes and socks off and rest your feet somewhere off the ground. You will definitely feel better for it. Rest is also important at night, ensure you get 8 hours of sleep to enable your body to get a chance to recover.

HILLS/INCLINES
It seemed that a lot of pilgrims started noticing their joint issues after Day 1 or 2 after the steep ascents and descents. The most common issue we saw were shin splints and front of knee pain. I'd say the best way to tackle this type of terrain, especially if you already have a pre-existing condition is to go slow and walking in a zig zag or snake-like pattern. This style of walking essentially reduces the angle that your joints have to bend, therefore reducing the amount of strain going through them. I'd also highly recommend the use of two hiking poles as that gives you both that extra balance but also reduces the amount of work your leg muscles have to do.

FOOTWEAR
Waterproof hiking boots are highly recommended as they are designed for rough terrain, can drastically reduce the impact through your joints and are usually very durable. There were quite a few people walking in basic trainers and did make it to the end, but it isn't something I would recommend as they are not designed for rough terrain and often do not give you the same amount of stability. If you are coming into the Camino with foot pain, make sure you see a podiatrist first who may find it necessary to prescribe you some orthotics you can place in your boots.

BLISTERS
I'm definitely not an expert in this area, and I know its a topic that's been discussed about a million times on this forum, but having completed a 33 day journey with only one blister and my husband with none, hopefully these tips may be useful to someone
- Vaseline your feet every morning especially between and around your toes, your forefoot and the outside border of your foot and heel
- Wear anti-blister socks which are thick two-layered socks which help to cushion feet and prevent friction
- If you feel any rubbing in your feet, stop immediately and check the situation, if you see some redness place a plaster on it to stop any further rubbing, if it's starting to form a blister there are a few options such as Compeed or popping with a sterilised needle and thread then leaving the thread in for a few hours to drain

STRETCHING AND MASSAGE
There is very mixed evidence on the benefits of stretching and whether it actually prevents injury. So for this, I'll say if you feel better for it, then go for it, if it makes no difference then don't bother. As for massage, it is worth spending 5 minutes massaging the soles of your feet at the end of the day just to release any pressure going through the tendons and small muscles that have been working hard all day.

***INJURY MANAGEMENT***

This is a difficult area to cover as there are so many different injuries you can have in the a Camino. So I'm going to be quite general and give a few specific pointers to the most common hiking injuries only. I think my most hated quote is 'no pain, no gain', this saying alone is the single cause of so many people pushing through serious issues thinking it will go away. You know your body better than anyone, and if something doesn't feel right, it probably isn't right.

If you feel a:
- sharp pain - stop immediately and assess the situation. Often sharp pains can indicate there is potential for serious damage. If after a bit of rest the pain is relieved, you can continue walking but carefully. If the pain remains sharp I would suggest attempt to massage the area or applying a sports tape horizontally across the area to see if that provides you with some relief. In the end you will know whether you can continue to walk the day or if you need to rest at the closest town for the night
- dull ache - monitor the situation. Dull aches are usually a sign of muscles either working too hard or there is too much load through the joint. Try to slow it down and if tackling steps go up with your good leg, but go down leading with your bad leg

COMMON INJURIES
- Anterior knee pain - often a result of increased loading through the joint especially with steep descents. If the pain is more than a 5/10 at is worse, I'd suggest you take a rest day and tape the knee up like this http://blog.physical-sports.co.uk/2014/08/08/patellar-tendinosis-knee-taping/

- Shin splints - again a result of inclines, more so with fast descents as the muscles at the front of the shin have to repetitively control the foot whilst it's dropping down. This causes the muscle to pull in the shin bone excessively causing the pain. I would suggest a rest day if you do experience front of shin pain only because it is a condition that can worsen very quickly. I would suggest adopting the zig zag walking pattern when going up and down hill so the angle that your ankle has to move is reduced. It may also be worth massaging yourself with an ice cube along the area of pain. Please note that if you notice any sudden redness with excessive swelling and difficulty weight bearing, you should attend A&E for risk of compartment syndrome.

- Achilles pain - this usually occurs purely because you're doing significantly more work than you're used to and your calf muscles are not strong enough to cope with it. Attempt some calf stretches throughout the day and also a nerve gliding exercise as the neves in the area can often become slightly stuck between the tightened muscles and tendons (see slump slider section: http://www.raynersmale.com/blog/2014/4/28/improving-hamstring-flexibility-part-2-treatment)

So that's about all I can think of, but would definitely appreciate your input. Hoepefully this is beneficial to someone. Also happy to answer any questions regarding injuries and to provide you with some links that may be useful.

Buen Camino

Thanks for this posting. I have read on this forum where people say not to worry about training too much before a Camino, because the Camino will be your training ground. This to me has always been a very bad idea and bad advice. While it has perhaps work for some it is not a smart tactic. I have done quite a few Caminos over the last 4 years (4 complete Caminos and half of two others, that I will finished next year), and the number of recurring injuries I see are with people's feet, primarily blisters.

To take on a challenge like a Camino and not prepare properly just doesn't make sense. One should make sure their footwear fits properly and that they are capable of walking long distances. Soreness and muscle aches are part of the Camino, but one should attempt to prepare properly. One should try and cut down the possibility of not finishing. Things happen that cannot be prevented, but not being able to finish because one did not prepare is a shame.

Camino take a lot of time, travel, money, and returning to try and complete it because of an unnecessary injury is not always possible. Sometimes it takes years to get back on the Camino because of our daily life getting in the way. I hope future pilgrims follow your wise advise.

Ray

 

[Anemone del Camino]

@urbanhiker , I will agree with you that training may be important but only if one has decided their walk is a one of and must be completed in a set amount of time. But I would propose that that is what needs revising rather than not training. If you are willingto walk what you will walk the there is no reason to stress about training. Now, this does not mean not ensuring your equipment works. That is a must.

 

[koilife]

I echo the general need for good (but not obsessive or stressful) training. Proper preparation prevents poor performance, and the body is the most important piece of equipment that we have. If I have problems because "stuff happens" then I need to roll with that and accept what comes. But given the cost and sacrifice required just to reach Spain's shores, then it makes sense to prepare.

As to the OP discussion of knee pains and walking technique, I would also mention what I've commonly heard referred to as the "sherpa step" for handling steep ascents and descents. This is a very short step (less that 12" toe to toe).

When going uphill, the weight is slid laterally to front leg which then lifts directly upwards until it is straight, but ever so slightly bend, but definitely not hyperextended. Then, the other foot is moved forward with all the weight on the straight leg. When it's planted, we shift laterally, and then vertically.

When going downhill, the lower leg is extended (again very slightly bent and definitely not hyper-extended) and the foot set firmly, then the weight is shifted downwards only after the foot is set. Then, the upper leg is moved downwards, set fully, and weight shifted again.

The method feels awkward at first (it's definitely lacks the smoothness of a normal stride or even a short step). However, once you get the hang of it, it becomes second thought on steep slopes, and you can move surprisingly quickly. Coupled with poles and zig-zagging, it's very effective. My teenage son strode swiftly up and down the mountains, while I sherpa stepped far more slowly. By end of the first week, he hobbled and needed knee braces, and I walked without discomfort, even though I weigh far more and am far less fit. (I tried to teach him in training, and warned him repeatedly in the first few days . . . but nothing teaches like experience. By the time we climbed to Orrison, he sherpa stepped with the best of them!)

 

[soozansings]

Hello Pilgrims!

My husband and I have just finished our 33 day journey from St Jean to Fisterra and it was an absolutely incredible experience. We are both physiotherapists and you can imagine that we saw plenty of pilgrims needing assistance along the way, so I thought I'd post a few tips that may help some of you. Feel free to ask me anything as well and also to add a few things you feel may be useful to others.

****INJURY PREVENTION****

TRAINING
The majority of people who we saw injured did zero training, and according to the guidebook only something like 10% of people do any. Personally I do feel training is vital, especially for those who have very limited hiking experience or those who are generally not very active. Ideally training 3 months beforehand would be fantastic, but I would say the bare minimum would be to do 2 x 15-20km walks (with breaks of course) per week with a backpack for the 4 weeks leading up to the Camino as well as 2-3 sessions per week of global leg strengthening would also be beneficial. Obviously if you are a regular hiker this may not apply to you.

CORRECTLY FITTED BACKPACK
A huge complaint people mentioned to us was how sore their shoulders were but that they thought this was a good thing as it would strengthen up their shoulders muscles. This is COMPLETELY INCORRECT. Having such significant weight bearing down on your shoulders ends up depressing your shoulder blades which often over stretches your neck muscles thus weakening both your neck and shoulder muscles which could learn to long term issues such as neck pain, headaches and shoulder pain. If the backpack is correctly fitted you should feel close to nothing on your shoulders. The main error most people make is the waist belt sits too low. Ideally it should sit above your pelvic bones and be pulled in relatively tight so that the weight of the pack goes through your hips and not your shoulders.

PACING
Go at your own comfortable pace. Don't feel like you have to keep up with anyone or slow down for anyone if it doesn't feel natural to you. Everyone has a natural pace and if you get out of your rhythm for long periods you may find yourself a little bit worse for wear

REST
Ensure you have regular rest breaks during the day even if its for 5-10 minutes and at least once a day (usually during lunch break), take your shoes and socks off and rest your feet somewhere off the ground. You will definitely feel better for it. Rest is also important at night, ensure you get 8 hours of sleep to enable your body to get a chance to recover.

HILLS/INCLINES
It seemed that a lot of pilgrims started noticing their joint issues after Day 1 or 2 after the steep ascents and descents. The most common issue we saw were shin splints and front of knee pain. I'd say the best way to tackle this type of terrain, especially if you already have a pre-existing condition is to go slow and walking in a zig zag or snake-like pattern. This style of walking essentially reduces the angle that your joints have to bend, therefore reducing the amount of strain going through them. I'd also highly recommend the use of two hiking poles as that gives you both that extra balance but also reduces the amount of work your leg muscles have to do.

FOOTWEAR
Waterproof hiking boots are highly recommended as they are designed for rough terrain, can drastically reduce the impact through your joints and are usually very durable. There were quite a few people walking in basic trainers and did make it to the end, but it isn't something I would recommend as they are not designed for rough terrain and often do not give you the same amount of stability. If you are coming into the Camino with foot pain, make sure you see a podiatrist first who may find it necessary to prescribe you some orthotics you can place in your boots.

BLISTERS
I'm definitely not an expert in this area, and I know its a topic that's been discussed about a million times on this forum, but having completed a 33 day journey with only one blister and my husband with none, hopefully these tips may be useful to someone
- Vaseline your feet every morning especially between and around your toes, your forefoot and the outside border of your foot and heel
- Wear anti-blister socks which are thick two-layered socks which help to cushion feet and prevent friction
- If you feel any rubbing in your feet, stop immediately and check the situation, if you see some redness place a plaster on it to stop any further rubbing, if it's starting to form a blister there are a few options such as Compeed or popping with a sterilised needle and thread then leaving the thread in for a few hours to drain

STRETCHING AND MASSAGE
There is very mixed evidence on the benefits of stretching and whether it actually prevents injury. So for this, I'll say if you feel better for it, then go for it, if it makes no difference then don't bother. As for massage, it is worth spending 5 minutes massaging the soles of your feet at the end of the day just to release any pressure going through the tendons and small muscles that have been working hard all day.

***INJURY MANAGEMENT***

This is a difficult area to cover as there are so many different injuries you can have in the a Camino. So I'm going to be quite general and give a few specific pointers to the most common hiking injuries only. I think my most hated quote is 'no pain, no gain', this saying alone is the single cause of so many people pushing through serious issues thinking it will go away. You know your body better than anyone, and if something doesn't feel right, it probably isn't right.

If you feel a:
- sharp pain - stop immediately and assess the situation. Often sharp pains can indicate there is potential for serious damage. If after a bit of rest the pain is relieved, you can continue walking but carefully. If the pain remains sharp I would suggest attempt to massage the area or applying a sports tape horizontally across the area to see if that provides you with some relief. In the end you will know whether you can continue to walk the day or if you need to rest at the closest town for the night
- dull ache - monitor the situation. Dull aches are usually a sign of muscles either working too hard or there is too much load through the joint. Try to slow it down and if tackling steps go up with your good leg, but go down leading with your bad leg

COMMON INJURIES
- Anterior knee pain - often a result of increased loading through the joint especially with steep descents. If the pain is more than a 5/10 at is worse, I'd suggest you take a rest day and tape the knee up like this http://blog.physical-sports.co.uk/2014/08/08/patellar-tendinosis-knee-taping/

- Shin splints - again a result of inclines, more so with fast descents as the muscles at the front of the shin have to repetitively control the foot whilst it's dropping down. This causes the muscle to pull in the shin bone excessively causing the pain. I would suggest a rest day if you do experience front of shin pain only because it is a condition that can worsen very quickly. I would suggest adopting the zig zag walking pattern when going up and down hill so the angle that your ankle has to move is reduced. It may also be worth massaging yourself with an ice cube along the area of pain. Please note that if you notice any sudden redness with excessive swelling and difficulty weight bearing, you should attend A&E for risk of compartment syndrome.

- Achilles pain - this usually occurs purely because you're doing significantly more work than you're used to and your calf muscles are not strong enough to cope with it. Attempt some calf stretches throughout the day and also a nerve gliding exercise as the neves in the area can often become slightly stuck between the tightened muscles and tendons (see slump slider section: http://www.raynersmale.com/blog/2014/4/28/improving-hamstring-flexibility-part-2-treatment)

So that's about all I can think of, but would definitely appreciate your input. Hoepefully this is beneficial to someone. Also happy to answer any questions regarding injuries and to provide you with some links that may be useful.

Buen Camino

I know this is an old thread but i could use a little advice, if you don't mind. I've been gently training for about 6 weeks, worked up to about 8 miles easily with pack. About 3 days ago I started having right hip pain, in the ball and socket, at about 1.5 miles. I stop and stretch and I'm good for about another 1/4 mile before i have to stop again. Trying to avoid a doc visit, and hoping maybe you have some advice. I'm 56.

 

[Physio_pilgrim]

Hi @soozansings
If the pain is quite a deep ache (rather than a sharp pain) it is more than likely just an overuse injury (i.e. you're doing a little doing too much so you need to cut back slightly on the distance and inclines then work your way back up. If the pain is more sharp then it is possible you have strained a muscle/ligament, in which case you should rest for about 5 days or so and then gradually start walking again. As it is a new injury, the main thing is do not push into the pain. Once you feel pain make sure you rest for a bit then keep going. This rule also applies to stretching, if stretching is causing you pain, avoid it for the time being.

Sorry I can't be more specific with exact exercises as its a bit difficult without actually seeing you face to face

Good luck and let me know if there's anything else I can do to help

 

[soozansings]

I will, and I appreciate your response. Over the past year I've developed adhesive capsulitis in both shoulders and tendon issues in both hands and I sincerely hope it's not traveling lol. Hoping my hip will settle down long enough for me to experience my Walk. Thanks again, so very much.

 

[Tommybhoy]

Hi @Physio_pilgrim , excellent advice throughout this thread. I'm doing my first Camino in September with a heavily strapped ankle after numerous operations due to an old rugby injury (new tendon, ligament, metal plate etc.) so the prevention tips are priceless! Thanks again.

Buen Camino!

 

[Physio_pilgrim]

Hi @Physio_pilgrim , excellent advice throughout this thread. I'm doing my first Camino in September with a heavily strapped ankle after numerous operations due to an old rugby injury (new tendon, ligament, metal plate etc.) so the prevention tips are priceless! Thanks again.

Buen Camino!

Thanks so much for the feedback @Thomas Woods ! Great to hear that you're soldiering on despite having an injury. If you haven't done so already, it would probably be worth you doing some proprioceptive training for your ankle such as standing on a wobble board/bosu ball. This will help strengten the muscles you rely on to negotiate uneven terrain on the Camino. Also keep in mind that if you plan to keep your ankle strapped the entire time, this will end up putting a lot more strain on your knees (as your ankle won't be doing much work), so if there are relatively flat days, it might be worthwhile trying to go without tape - just a suggestion, but obviously you know your body best.

Have a fantastic journey and Buen Camino!

 

[Tommybhoy]

Thanks so much for the feedback @Thomas Woods ! Great to hear that you're soldiering on despite having an injury. If you haven't done so already, it would probably be worth you doing some proprioceptive training for your ankle such as standing on a wobble board/bosu ball. This will help strengten the muscles you rely on to negotiate uneven terrain on the Camino. Also keep in mind that if you plan to keep your ankle strapped the entire time, this will end up putting a lot more strain on your knees (as your ankle won't be doing much work), so if there are relatively flat days, it might be worthwhile trying to go without tape - just a suggestion, but obviously you know your body best.

Have a fantastic journey and Buen Camino!

Thank you for the additional advice @Physio_pilgrim , I'll definitely carry out the proprioceptive training as I was really hoping not to carry out most of the journey being strapped up and experience it like most other pilgrims. I began my Camino training a few weeks ago, so the strengthening work will help greatly. Thank you!

Buen Camino

 

[Stivandrer]

Old thread & haven´t read it all.
Just come from my osteopath; had a severe Sacro Iliac problem to the left in the back (provoked due to sitting 6 hours in a train recently and further prolonged by regular training.
My favourite OP lives a bit far off and I do not visit her taht often, but after patiently waiting for a fortnight my turn in the queue and not sleeeping well at all, it turned out that me left leg was constricted ( I knew but had forgotten) . I have never been able to kick sideways when swimming for example...
After stretching and extending the range of mobilty, she turns to my foot and discovers my heelbone is " tight" and ask for possible injuries to my foot..
Turns out that some years ago I have landed awkwardly in a pool in the shallow end and injured my foot and since has had a couple of bouts of peroneal tendinitis in the left foot some years in a row. Last camino in spring ´17 I had Kinesiotape on my left foot as a precautionary measure in order not to provoke a flare of the old tendinitis.
A small walk in a pair of clogs over the lawn to the refuse bin would sometime mean a bulge of inflammation on my outside heelbone at the slightest tilting of the foot....
Thought I had cured it this summer and I always carry my boots caus they have inlay soles.

But she attacked this problem by manipulating my heelbone from the sole, and jerked my foot and leg along the gurney so I slid half a foot !!
I feels absolutely fantastic afterwards and just goes to show that problems are connected.
Having marched many miles / kms with a faulty heel probably activated a bad hip problem as a result !!

- on this line; I have always had flat feet, but after my operation and my turning to walking instead of cykling to the job, I can see that my wet imprint on the tiles out side my bathroom now presents aperfect print.
It does not, however , that I still have a depressed front arch, but who´s perfect.
Old model, but benefitting from updates !!

 

[Fay Clarke]

Hello Pilgrims!

My husband and I have just finished our 33 day journey from St Jean to Fisterra and it was an absolutely incredible experience. We are both physiotherapists and you can imagine that we saw plenty of pilgrims needing assistance along the way, so I thought I'd post a few tips that may help some of you. Feel free to ask me anything as well and also to add a few things you feel may be useful to others.

****INJURY PREVENTION****

TRAINING
The majority of people who we saw injured did zero training, and according to the guidebook only something like 10% of people do any. Personally I do feel training is vital, especially for those who have very limited hiking experience or those who are generally not very active. Ideally training 3 months beforehand would be fantastic, but I would say the bare minimum would be to do 2 x 15-20km walks (with breaks of course) per week with a backpack for the 4 weeks leading up to the Camino as well as 2-3 sessions per week of global leg strengthening would also be beneficial. Obviously if you are a regular hiker this may not apply to you.

CORRECTLY FITTED BACKPACK
A huge complaint people mentioned to us was how sore their shoulders were but that they thought this was a good thing as it would strengthen up their shoulders muscles. This is COMPLETELY INCORRECT. Having such significant weight bearing down on your shoulders ends up depressing your shoulder blades which often over stretches your neck muscles thus weakening both your neck and shoulder muscles which could learn to long term issues such as neck pain, headaches and shoulder pain. If the backpack is correctly fitted you should feel close to nothing on your shoulders. The main error most people make is the waist belt sits too low. Ideally it should sit above your pelvic bones and be pulled in relatively tight so that the weight of the pack goes through your hips and not your shoulders.

PACING
Go at your own comfortable pace. Don't feel like you have to keep up with anyone or slow down for anyone if it doesn't feel natural to you. Everyone has a natural pace and if you get out of your rhythm for long periods you may find yourself a little bit worse for wear

REST
Ensure you have regular rest breaks during the day even if its for 5-10 minutes and at least once a day (usually during lunch break), take your shoes and socks off and rest your feet somewhere off the ground. You will definitely feel better for it. Rest is also important at night, ensure you get 8 hours of sleep to enable your body to get a chance to recover.

HILLS/INCLINES
It seemed that a lot of pilgrims started noticing their joint issues after Day 1 or 2 after the steep ascents and descents. The most common issue we saw were shin splints and front of knee pain. I'd say the best way to tackle this type of terrain, especially if you already have a pre-existing condition is to go slow and walking in a zig zag or snake-like pattern. This style of walking essentially reduces the angle that your joints have to bend, therefore reducing the amount of strain going through them. I'd also highly recommend the use of two hiking poles as that gives you both that extra balance but also reduces the amount of work your leg muscles have to do.

FOOTWEAR
Waterproof hiking boots are highly recommended as they are designed for rough terrain, can drastically reduce the impact through your joints and are usually very durable. There were quite a few people walking in basic trainers and did make it to the end, but it isn't something I would recommend as they are not designed for rough terrain and often do not give you the same amount of stability. If you are coming into the Camino with foot pain, make sure you see a podiatrist first who may find it necessary to prescribe you some orthotics you can place in your boots.

BLISTERS
I'm definitely not an expert in this area, and I know its a topic that's been discussed about a million times on this forum, but having completed a 33 day journey with only one blister and my husband with none, hopefully these tips may be useful to someone
- Vaseline your feet every morning especially between and around your toes, your forefoot and the outside border of your foot and heel
- Wear anti-blister socks which are thick two-layered socks which help to cushion feet and prevent friction
- If you feel any rubbing in your feet, stop immediately and check the situation, if you see some redness place a plaster on it to stop any further rubbing, if it's starting to form a blister there are a few options such as Compeed or popping with a sterilised needle and thread then leaving the thread in for a few hours to drain

STRETCHING AND MASSAGE
There is very mixed evidence on the benefits of stretching and whether it actually prevents injury. So for this, I'll say if you feel better for it, then go for it, if it makes no difference then don't bother. As for massage, it is worth spending 5 minutes massaging the soles of your feet at the end of the day just to release any pressure going through the tendons and small muscles that have been working hard all day.

***INJURY MANAGEMENT***

This is a difficult area to cover as there are so many different injuries you can have in the a Camino. So I'm going to be quite general and give a few specific pointers to the most common hiking injuries only. I think my most hated quote is 'no pain, no gain', this saying alone is the single cause of so many people pushing through serious issues thinking it will go away. You know your body better than anyone, and if something doesn't feel right, it probably isn't right.

If you feel a:
- sharp pain - stop immediately and assess the situation. Often sharp pains can indicate there is potential for serious damage. If after a bit of rest the pain is relieved, you can continue walking but carefully. If the pain remains sharp I would suggest attempt to massage the area or applying a sports tape horizontally across the area to see if that provides you with some relief. In the end you will know whether you can continue to walk the day or if you need to rest at the closest town for the night
- dull ache - monitor the situation. Dull aches are usually a sign of muscles either working too hard or there is too much load through the joint. Try to slow it down and if tackling steps go up with your good leg, but go down leading with your bad leg

COMMON INJURIES
- Anterior knee pain - often a result of increased loading through the joint especially with steep descents. If the pain is more than a 5/10 at is worse, I'd suggest you take a rest day and tape the knee up like this http://blog.physical-sports.co.uk/2014/08/08/patellar-tendinosis-knee-taping/

- Shin splints - again a result of inclines, more so with fast descents as the muscles at the front of the shin have to repetitively control the foot whilst it's dropping down. This causes the muscle to pull in the shin bone excessively causing the pain. I would suggest a rest day if you do experience front of shin pain only because it is a condition that can worsen very quickly. I would suggest adopting the zig zag walking pattern when going up and down hill so the angle that your ankle has to move is reduced. It may also be worth massaging yourself with an ice cube along the area of pain. Please note that if you notice any sudden redness with excessive swelling and difficulty weight bearing, you should attend A&E for risk of compartment syndrome.

- Achilles pain - this usually occurs purely because you're doing significantly more work than you're used to and your calf muscles are not strong enough to cope with it. Attempt some calf stretches throughout the day and also a nerve gliding exercise as the neves in the area can often become slightly stuck between the tightened muscles and tendons (see slump slider section: http://www.raynersmale.com/blog/2014/4/28/improving-hamstring-flexibility-part-2-treatment)

So that's about all I can think of, but would definitely appreciate your input. Hoepefully this is beneficial to someone. Also happy to answer any questions regarding injuries and to provide you with some links that may be useful.

Buen Camino

Hi, l am on the Camino now about to go to Sierra after walking from Burgos. I am having trouble with my calves, they are like rocks and l stretch, massage and see a Maggie person about once a week with some results. This seems to be the area l suffer from. Any tips please? Fay

 

[roseficke]

Hello Pilgrims!

My husband and I have just finished our 33 day journey from St Jean to Fisterra and it was an absolutely incredible experience. We are both physiotherapists and you can imagine that we saw plenty of pilgrims needing assistance along the way, so I thought I'd post a few tips that may help some of you. Feel free to ask me anything as well and also to add a few things you feel may be useful to others.

****INJURY PREVENTION****

TRAINING
The majority of people who we saw injured did zero training, and according to the guidebook only something like 10% of people do any. Personally I do feel training is vital, especially for those who have very limited hiking experience or those who are generally not very active. Ideally training 3 months beforehand would be fantastic, but I would say the bare minimum would be to do 2 x 15-20km walks (with breaks of course) per week with a backpack for the 4 weeks leading up to the Camino as well as 2-3 sessions per week of global leg strengthening would also be beneficial. Obviously if you are a regular hiker this may not apply to you.

CORRECTLY FITTED BACKPACK
A huge complaint people mentioned to us was how sore their shoulders were but that they thought this was a good thing as it would strengthen up their shoulders muscles. This is COMPLETELY INCORRECT. Having such significant weight bearing down on your shoulders ends up depressing your shoulder blades which often over stretches your neck muscles thus weakening both your neck and shoulder muscles which could learn to long term issues such as neck pain, headaches and shoulder pain. If the backpack is correctly fitted you should feel close to nothing on your shoulders. The main error most people make is the waist belt sits too low. Ideally it should sit above your pelvic bones and be pulled in relatively tight so that the weight of the pack goes through your hips and not your shoulders.

PACING
Go at your own comfortable pace. Don't feel like you have to keep up with anyone or slow down for anyone if it doesn't feel natural to you. Everyone has a natural pace and if you get out of your rhythm for long periods you may find yourself a little bit worse for wear

REST
Ensure you have regular rest breaks during the day even if its for 5-10 minutes and at least once a day (usually during lunch break), take your shoes and socks off and rest your feet somewhere off the ground. You will definitely feel better for it. Rest is also important at night, ensure you get 8 hours of sleep to enable your body to get a chance to recover.

HILLS/INCLINES
It seemed that a lot of pilgrims started noticing their joint issues after Day 1 or 2 after the steep ascents and descents. The most common issue we saw were shin splints and front of knee pain. I'd say the best way to tackle this type of terrain, especially if you already have a pre-existing condition is to go slow and walking in a zig zag or snake-like pattern. This style of walking essentially reduces the angle that your joints have to bend, therefore reducing the amount of strain going through them. I'd also highly recommend the use of two hiking poles as that gives you both that extra balance but also reduces the amount of work your leg muscles have to do.

FOOTWEAR
Waterproof hiking boots are highly recommended as they are designed for rough terrain, can drastically reduce the impact through your joints and are usually very durable. There were quite a few people walking in basic trainers and did make it to the end, but it isn't something I would recommend as they are not designed for rough terrain and often do not give you the same amount of stability. If you are coming into the Camino with foot pain, make sure you see a podiatrist first who may find it necessary to prescribe you some orthotics you can place in your boots.

BLISTERS
I'm definitely not an expert in this area, and I know its a topic that's been discussed about a million times on this forum, but having completed a 33 day journey with only one blister and my husband with none, hopefully these tips may be useful to someone
- Vaseline your feet every morning especially between and around your toes, your forefoot and the outside border of your foot and heel
- Wear anti-blister socks which are thick two-layered socks which help to cushion feet and prevent friction
- If you feel any rubbing in your feet, stop immediately and check the situation, if you see some redness place a plaster on it to stop any further rubbing, if it's starting to form a blister there are a few options such as Compeed or popping with a sterilised needle and thread then leaving the thread in for a few hours to drain

STRETCHING AND MASSAGE
There is very mixed evidence on the benefits of stretching and whether it actually prevents injury. So for this, I'll say if you feel better for it, then go for it, if it makes no difference then don't bother. As for massage, it is worth spending 5 minutes massaging the soles of your feet at the end of the day just to release any pressure going through the tendons and small muscles that have been working hard all day.

***INJURY MANAGEMENT***

This is a difficult area to cover as there are so many different injuries you can have in the a Camino. So I'm going to be quite general and give a few specific pointers to the most common hiking injuries only. I think my most hated quote is 'no pain, no gain', this saying alone is the single cause of so many people pushing through serious issues thinking it will go away. You know your body better than anyone, and if something doesn't feel right, it probably isn't right.

If you feel a:
- sharp pain - stop immediately and assess the situation. Often sharp pains can indicate there is potential for serious damage. If after a bit of rest the pain is relieved, you can continue walking but carefully. If the pain remains sharp I would suggest attempt to massage the area or applying a sports tape horizontally across the area to see if that provides you with some relief. In the end you will know whether you can continue to walk the day or if you need to rest at the closest town for the night
- dull ache - monitor the situation. Dull aches are usually a sign of muscles either working too hard or there is too much load through the joint. Try to slow it down and if tackling steps go up with your good leg, but go down leading with your bad leg

COMMON INJURIES
- Anterior knee pain - often a result of increased loading through the joint especially with steep descents. If the pain is more than a 5/10 at is worse, I'd suggest you take a rest day and tape the knee up like this http://blog.physical-sports.co.uk/2014/08/08/patellar-tendinosis-knee-taping/

- Shin splints - again a result of inclines, more so with fast descents as the muscles at the front of the shin have to repetitively control the foot whilst it's dropping down. This causes the muscle to pull in the shin bone excessively causing the pain. I would suggest a rest day if you do experience front of shin pain only because it is a condition that can worsen very quickly. I would suggest adopting the zig zag walking pattern when going up and down hill so the angle that your ankle has to move is reduced. It may also be worth massaging yourself with an ice cube along the area of pain. Please note that if you notice any sudden redness with excessive swelling and difficulty weight bearing, you should attend A&E for risk of compartment syndrome.

- Achilles pain - this usually occurs purely because you're doing significantly more work than you're used to and your calf muscles are not strong enough to cope with it. Attempt some calf stretches throughout the day and also a nerve gliding exercise as the neves in the area can often become slightly stuck between the tightened muscles and tendons (see slump slider section: http://www.raynersmale.com/blog/2014/4/28/improving-hamstring-flexibility-part-2-treatment)

So that's about all I can think of, but would definitely appreciate your input. Hoepefully this is beneficial to someone. Also happy to answer any questions regarding injuries and to provide you with some links that may be useful.

Buen Camino

Excellent advice! I’ve done a lot of back country backpacking and half marathons over the years and training is so very important. My friend did the last 100k a few years back with a group and she thought because she walked a lot in the city she would be fine. She ended up with terrible foot problems and is still having some residual issues, even now.
Thanks for the links. I’ll keep those book marked, just in case. I’m heading out on the Camino this September with my bestie since grade one, celebrating turning 60 this year. Life’s an adventure and we’re looking forward to adding one more!