BackPacker’s Pain

2013, January/February Adirondac Adirondoc

Believe it or not, back pain is the second most common reason for patients to consult with a primary care physician. The physical and financial burden of chronic lower back pain in the U.S. is substantial. Although the topic is extraordinarily complex and confusing, most experts agree that many individuals with chronic lower back pain can experience improvement with exercise, and that such pain may be more common among sedentary folks. Thus, there is no absolute prohibition against, and there may be benefit from, hiking, camping, or backpacking for individuals with chronic back pain.

Let’s consider two aspects of the relationship between back pain outdoor recreation: what to do if it develops unexpectedly on a hike or camping trip, and how someone with a history of back pain should approach backcountry hiking.

Sudden onset
I have talked with plenty of individuals who rather suddenly developed lower back pain during the course of a backpacking trek. Typically, this is something with which they awaken after a day or so on the trail-or, perhaps, it awakens them during the night. In the absence of a prior history of back problems, with no specific injury (e.g. a fall), and with no evidence of neurologic problem (e.g. weakness or tingling in the legs), such pain is most often nothing more than muscular soreness from new activity (“overuse”).

Although this pain may be quite disabling initially, the condition is likely to improve with time and some simple measures. As with any musculoskeletal pain, a non-steroidal anti-inflammatory (NSAID) medication such as ibuprofen will bring some relief. Be sure to take this with plenty of water. Some easy walking on a level surface may help as well.

Putting on and carrying a back pack may become a problem for someone with acute low back pain. Once a companion has helped you into your pack (and perhaps taken on some of its content), try making some adjustments to find the best positioning for minimizing back pain. Most packs allow field adjustment of the shoulder straps, sternum and strap, and hip belt. Such adjustments alter the mechanics of the pack, shifting the amount of weight placed on the hips, back, and shoulders. What to tighten, loosen, or leave alone is a trial and error process. In rare cases, if the pain has not improved sufficiently within a day, a “pack-free” walkout may be needed.

For the chronic sufferer
What is the best advice for someone who already has lower back pain? The days of enforced bed rest for back pain are thankfully behind us. There is now excellent evidence that exercise helps to maintain strength and flexibility, and may help back pain. Of course, any effect exercise may have on weight reduction is positive for back pain relief as well.

Obviously, the first step is to discuss your trekking plans with your health care provider, · if you are already seeing someone for back pain. this is especially the case if you have had recent surgery.

Realistically, however, it may be difficult for any examiner to judge the effect of hiking and camping on one’s back pain. The safest thing is probably to duplicate the planned trek in an environment from which an easy “escape” is possible. Most everyone lives near a park or recreational area with a hiking trail not too far from a street or highway. In my area (Syracuse), the Erie Canal towpath and Green Lakes State Park offer great opportunities for long hikes without getting too far from one’s car. One should be able to hike (with a pack) one’s planned wilderness distance in such an area before heading into the woods. Unfortunately, few duplicate the elevation changes of mountainous areas; walking downhill with a pack is often particularly problematic for someone with back pain.

The firm surface of level ground may be better for sleeping than some beds. Nonetheless, a trial in one’s backyard should insure that the combination of ground and sleeping pad is not going to be a problem.

Finally, remember that lifting is sometimes the trigger for a worsening of back pain. There are ample opportunities for this on treks: packs, tents, canoes, etc. Ask for help, and refer to one of the many online resources that provide lifting techniques. One useful site is

~Tom Welch, MD, is professor and chair of pediatrics at Upstate Medical University in Syracuse and an active member of the Wilderness Medical Society. He is a licensed professional guide, a certifying instructor for the Wilderness Education Association, and has guided groups in the Adirondacks, Montana, and Alaska. More information is available at his website and blog:

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Topics: General First Aid