tirsdag den 1. december 2015

Hvordan undgår jeg skader på pilgrimsturen ?

To engelsksprogede pilgrimme har i efteråret gået fra Saint Jean Pied de Port til Finestere på 33 dage. De mødte en del pilgrimme undervejs, som havde pådraget sig skader, dårlige skuldre, ankler, ryg, vabler m.m. De har lagt en række råd ud på nettet, som måske kan bruges af andre pilgrimme. Nogle af rådene, kan denne hjemmesides redaktør nikke genkendende til, andre råd siger mig ikke noget. Men læs selv og se, hvad du kan bruge. De henviser også til en række hjemmesider med anvisninger. Men her deres liste:

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 Physio Pilgrims