Take a hike, Arthritis!

I mean that in the kindest way. You can walk with me, arthritis, but I expect no complaints. Osteoarthritis has crept up on me in the past ten years, and it has forced me to change the way I hike. It can make any multi-day hiking trip difficult, but enjoyable hiking is possible if you manage your condition effectively and change the way you do certain things. If you like solving problems, this condition will give you hours of pleasure.

One way to get your pack on

Arthritis is a general term that describes inflammation in joints. Osteoarthritis (OA), often referred to as degenerative joint disease or wear-and-tear arthritis, is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of your bones wears down over time, most commonly causing painful, swollen, and hard-to-move joints in your hands, knees, hips, and spine.

Remember, if you have osteoarthritis, exercise, including walking, will help reduce pain and increase your quality of life. Lack of exercise can lead to more joint stiffness, muscle weakness and tightness, and loss of joint motion.

I won’t beat about the bush here. Accept the facts. Osteoarthritis will slow you down. You will spend much time pfaffing around trying to get dressed, remove tent stakes, light your stove, and pack your backpack. This could prove annoying to more agile hikers walking with you.

Personally, I’d rather do what I have to do, in my own good time, than watch the faces of frustrated hiking partners query me on how much longer I need before we can go. One solution towards minimising hiking partner tension is to set an earlier alarm and give yourself extra time to prepare. For me, this was an extra half to one hour. Or you could choose to be a solo hiker. There is certainly no harm in that. It might be lonelier, but you avoid the angst and are accountable to only yourself.

Here are my suggestions/hacks for how you can enjoy hiking despite your condition.

Disclaimer: Please note I have no medical qualifications. I base this information on my research and familiarity with treatment options. Please consult a qualified medical expert for a treatment plan suitable for your arthritic condition.

Medications

Medications that provide relieve for the following symptoms are:

Pain

  1. Paracetamol, also known as acetaminophen (Tylenol, Panadol, others) is an analgesic (pain reliever) chosen by doctors as the first line of treatment for people with osteoarthritis with mild to moderate pain. It acts on the nervous system to reduce pain and does not affect other symptoms such as joint swelling or stiffness. I use Panadol Osteo regularly. Panadol Osteo is cheaper than regular Panadol. It does the same thing but has a slighter higher dosage of active ingredient (655mg vs 500mg in regular Panadol) and is formulated for slow and sustained release.
  2. Duloxetine Hydrochloride (Cymbalta), belongs to the group of medicines called Serotonin Noradrenergic Reuptake Inhibitors (SNRI) used to treat depression. Duloxetine can treat different chronic musculoskeletal and lower back pain, caused by conditions such as osteoarthritis. Stopping duloxetine abruptly can cause symptoms such as dizziness and nausea. Seek medical advice if wanting to pursue this treatment. I do not use this drug and am unfamiliar with its use.

Swelling

  1. Nonsteroidal anti-inflammatory drugs (NSAIDs) (Ibuprofen, Nurofen) reduce inflammation, joint swelling, and stiffness. They can also relieve pain that is not controlled by analgesics alone.
  2. Oral Corticosteroids are usually preferred to help control inflammation affecting multiple parts of your body, more commonly used for inflammatory forms of arthritis like rheumatoid arthritis, or if an area is difficult to inject.
  3. Local Corticosteroids, via injection, or delivered as skin creams, eye drops, or ear drops depending on your inflammatory issue. Common corticosteroids include prednisone, cortisone, and methylprednisolone, but oral forms of corticosteroids can come with significant side effects and risks such as elevated blood sugar and blood pressure. Not good for a type 1 diabetic like me, so I avoid this medication.
  4. Cortisone Injections of Intra-articular corticosteroids (IACSs), usually combined with analgesics (local anaesthetic), are commonly performed to treat pain related to osteoarthritis (OA), particularly to treat a single inflamed joint.

Long term use of NSAID’s can cause abdominal discomfort, constipation, and nausea. Ibuprofen should not be taken on an empty stomach. There is a moderate interaction between Ibuprofen and prednisone.

They should only be used together on the instruction of a doctor. I use Mobic (meloxicam), another NSAID, a commonly prescribed drug used to treat pain or inflammation caused by arthritis.

IACSs provide higher doses of medication to treat a specific problem area. Locations such as the CMC (carpometacarpal and metacarpal bones at the base of the thumb), wrist, elbow, shoulder, knee, ankle, and big toe are common locations. Doctors often use imaging, such as ultrasound, for precise placement of the injection. While the procedure is common and may work to relieve inflammation and pain, the benefits are only short term. Sometimes people with OA do not get any relief and they are not without their risks.

Doctors limit the number of steroid injections in a joint to three to four times a year. Multiple IACS injections over time seem to be significantly detrimental to cartilage and joint health and may even speed up the development of OA.

I have had this procedure in my big toe with favourable results in the early stages, waning over time with later injections, and have experienced negligible improvement from several injections in my shoulder. I refer you to Arthritis NSW site here for a detailed discussion of the pros and cons.

Joint Motion

The medications and treatments briefly described above are just one part of an overall treatment plan. For Osteoarthritis, experts recommend you combine these treatment options with exercise and physical therapy, maintaining a healthy weight, and heat and ice therapy when needed.

All I want you to do is get out there and hike. Once I have taken my medication, made breakfast, packed up my belongings, strapped on my heavy backpack and put trekking poles in my hands, I can happily hike for hours with little pain or discomfort. Osteoarthritis mostly affects my hands and feet. If I can avoid knocking these joints, I am good for the day.

I always cover my feet in bandages, high-quality socks, and durable shoes. My fingers just grasp my poles or hold my camera. My mind returns to the Pacific Crest Trail (PCT) where the exceptionally beautiful terrain constantly distracts me from thoughts of painful joints. Nature will invigorate you, make you appreciate that you can still walk, and essentially offer the best medicine for plenty of ailments.

The rest of this article gives you handy tips for easing wear and tear on specific joints, which might show signs of progressive Osteoarthritis. If you minimise straining them more, beyond what normal exercise activities need, such as walking, you will fine.

Hands

Fine motor skills desert you. I find I can manage tasks better if I adopt gross motor skills, such as a wide pendulum motion. This works well for hoisting your pack onto your back but can prove problematic if you need the same motion to light a stove with a ferromagnesium rod in a confined space, such as your tent vestibule, where you could end up igniting your tent if you strike is not perfect. Here are the products I recommend you try.

Trekking Poles

Find the lightest weight pair you can find that is easy to adjust. I use Gossamer Gear’s LT5 three-piece carbon trekking poles because, as a pair, they weigh an amazing 280g. They are super lightweight, have the most comfortable cork grips, and they cause no cramping or pain in my hands. They are telescopic in design with two adjustable sections that you twist to open or tighten to close. If the mechanism works well, I can easily twist the sections to get my desired length, but sometimes my grip struggles to tighten each section. Despite breaking two of these trekking poles landing my entire body weight on them, they are still my preferred trekking pole.

Outdoor Gear Lab testing Leki Women’s Micro Vario Carbon Trekking Poles in High Sierra, California

The lightness trumps other options so far, but I am very tempted to look at the new Leki Women’s Micro Vario Carbon trekking poles because of recent fantastic reviews. They are 174gms heavier than the Gossamer Gear LT5s weighing in at 454gms a pair, but their new Speed Lock 2 Adjustment System with its new External Locking Device (ELD) has me intrigued. They are designed for easy adjustability and break-down. This could help hikers with osteoarthritis.

“The new ELD lever makes it easy to lock the segments into place when lengthening the pole, with only one length-adjustment point, extending the pole up to 20cm (8in), at the top. To break down the pole, even wearing gloves, simply push on the lever, and the pieces come apart. The one lever lock comes with a small thumbscrew that you can easily loosen or tighten without carrying more tools into the backcountry.”

The Leki Women’s Micro Vario Carbon is among our favourite trekking poles, and our first choice to take on alpine climbing and mountaineering trips because it collapses and stows away so easily. It rates the highest in comfort, with edgeless foam grips, grip extensions, and breathable “Skin Straps.” With simple adjustability and versatility, the Micro Vario is among our top choices for any multi-day hike or trek and winner of our Editors’ Choice Award. The shaft rapidly breaks-down with the push of a button for easy stow-ability in a daypack. The burly carbon construction gives this pole great durability and shock absorption while keeping the weight low.” sourced from Outdoor Gear Lab.

I recommend you read their full review here for a thorough comparison with other market leaders. Their report might tempt me to try this heavier trekking pole if the lockability and adjustment features are easier for arthritic hands, which struggle with twisting motions and securely locking stiff levers, common amongst many trekking poles.

Easy squeeze flip top containers

I find pump bottles, often used in sunscreen, insect repellent, and hand sanitiser, difficult to depress. Seek packaging with an easy-to-use flip lid ideally made of soft plastic, which helps you squeeze out the contents more easily.

Easy to open flip-top lid with soft plastic bottle

That said, avoid tight flip caps found on 700ml Smartwater bottles, which I used on the PCT for my filtered water storage. In trying to open these bottles I had to push much harder on the lid than a non-arthritic person and I often broke the lid. This meant I now had a leaky water receptacle. When hiking in areas of scarce water supply, you do not want to diminish your water carrying capacity by breaking the bottle’s lid.

Tent set up

The hardest part for me is staking and removing my tent stakes, particularly in hard soil. When hiking long-distances, you focus on keeping your pack weight as low as possible. Often you end up using a nearby rock to hammer in the stakes and much time grunting in the morning as you wriggle the stakes back and forth in an effort to remove them. Tedious and painful on the hands, hammering the stakes in with a rock is often the only way.

But for car camping or base camp expedition use, I recommend MSR’s Stake Hammer as an ideal travelling companion, where the hammer’s 316gm weight becomes secondary to its effectiveness. Once the hard work of banging pegs into the rocky ground is over, you can use the thing to pop the top off a cold bottle of beer and chill out in the sunshine. Yes, it’s slightly over the top, but it works effortlessly to stake and remove stakes with no personal discomfort or damage to your tent stakes. If not for the weight issue, I would never leave home without a stake hammer.

Stove

On the PCT, this proved my most arduous task. If you want a hot meal on trail everybody carries a small stove which you screw on top of a small 100 or 200g canister of isobutane/propane fuel mix. Use a small BIC disposable lighter to ignite the stove, expert hikers said. Except I found my stiff thumb could not scroll over the small wheel mechanism quickly enough to get the flame alight. I gave up and starting using waterproof matches instead, but this alternative solution was not without its problems. My jerky hand movements had more success shattering the inferior quality matchsticks than they did lighting my fuel source.

An American navy veteran suggested I try a Ferro rod, a small steel rod made from ferrocerium, a man-made metallic alloy, which produces sparks when you scrape it with a rough edge such as a rock, or a sharp-edged knife. It avoids the need for fine motor skills, but my jerky, wide-ranging gross movements made me hesitant to use this method. If I cooked in my tent vestibule, I could have sparks flying everywhere but my target – the stove. This method might work well out in the open, but it appeared fraught with danger in confined spaces.

Enter the SOTO WindMaster Stove with a push-button Piezo ignition switch. There are other good push-button ignition stoves available such as the Jetboil Flash, MSR Pocket Rocket Deluxe, and many cheap Chinese-manufactured stoves like the BRS-3000T on Amazon, but I enjoy using this stove because of its ease-of-use and its excellent performance in harsh windy conditions. The PCT Class of 2019 Survey, of which I was a part, ranked SOTO’s WindMaster stove at the top of their list based on 846 completed surveys. Read the Halfway Anywhere Survey results for more information on this product.

SOTO WindMaster Stove with Piezo Ignition

Meal preparation, with my SOTO WindMaster Stove, is a simple affair. I do everything I can to reduce the need to chop, dice and stir ingredients and scour and clean up pots afterwards as much as possible. I spoon my meal ingredients for breakfast and dinner into Ziplock freezer bags. When it’s time to prepare my meals, I boil the required amount of water on my stovetop and pour it into my meal, give it a quick stir and wait the recommended time for rehydration. To save fuel and guarantee a warm meal, I rehydrate the meal off the stove top, in a pot cozy.

My Ramen bomb meal is a personal favourite. It is a mixture of lightweight ingredients that come to life when you add boiling water to them. Best of all, it causes no added wear and tear on my hand joints. I discard the freezer bag into my Dirty Bag to make sure I Leave No Trace (LNT) in the wild. And I need not burden myself later with tedious washing and scouring of my Toaks Titanium Light 550ml cooking pot for any baked-on ingredients. My pot is only being used to boil water so it’s always clean and ready to go. At dinner time my hands are still getting over the painful tent staking to be interested in any further discomfort.

Compression

Putting on compression anything hurts. Unless you absolutely need them for some medical condition, I would avoid Compression socks completely. Their tightness hurts my hands when I try to put them on my feet. I know of a company that produces a wonderful short compression sock for avoiding blisters, which I wanted to love, but I avoided using them for the PCT because I simply could not handle painfully squeezing these socks onto my feet each day for a 170-day long-distance hike.

Clothing

Select clothes that are loose and easy to put on, like t-shirts and hoodies. For base layers, choose products that are not too figure hugging. While manufacturers design base layers tight to stop warm air escaping, I prefer leggings made with looser elastic, particularly at the ankles. Otherwise, I avoid using them because they are too troublesome to slide on and off.  

If not loose, look for clothing with press studs, zips or elastic. For sun protection I like the Columbia PFG Bahama Fishing shirts, as seen in this photo below, for its durability, sun protection and comfort, but I found the buttons hard work. I got around this by just slipping it over my head, buttoned which required fewer adjustments.

My favourite Columbia PFG Bahama hiking shirt

I recently found another Long sleeve Sun shirt by Columbia called the Tamiami II model, which buttons using press studs. I find dressing in this shirt much easier, but I prefer the Bahama model. While they make both of ultralight synthetic fabric, the Bahama feels cooler. Everything is a trade-off but if we are looking at ways to reduce arthritic pain the Tamiami II is my recommendation.

Columbia Tamiami II hiking shirt with push buttons

Shorts and Pants should not be a problem, but elasticised waists work well. I loved my RAB Momentum Men’s Shorts (longer in the leg than the Women’s version) but they were so ultralight, comfortable, and easy to wear and adjust.

Pack

Backpack clasps or side-release buckles common on backpacks and dry bags can sometimes be impossible to open with arthritic fingers. I cannot count the times I resorted to using my teeth. They are great securing clasps, but frustrating as hell if you cannot open them.

I won’t go into why I use an Osprey pack covered in side-release buckles, but I have recommendations for people with arthritic hands. There is presently a huge ultralight movement in America with many cottage industries producing ultralight minimalist hiking packs without the bells and whistles to cut weight. Essentially the packs are one large seam sealed bag made of Dyneema® Composite Fabric (Cuben fibre) or nylon which you roll up and fasten at the top with one main clasp. They add shoulder straps and hip belts to the bag. Exterior pockets are elasticised for safe storage and easy extraction of gear.

Check out the options available from Hyperlite, Zpack, Gossamer Gear and Waymark. Established brands, like Osprey, Granite Gear, and ULA, are now producing similar ultralight options.

For day trips, using a smaller pack, I recommend choosing packs littered with zippers. I use the Lowe Alpine Eclipse ND32, a quality day pack, primarily because I find zippers easier to use than clasps.  

Accessories

This may sound excessive, but I seek rubber or rougher textured devices for a better grip. Things slip out of my hands easily, especially if they are smooth and shiny. I don’t want to drop and break an expensive item like a phone, camera or power bank. To avoid this, I use a rugged matt-finish Otter brand phone cover to buffer any accidental drops and make it easier for me to hold. Fortunately, my arthritic index finger has deformed itself into a permanently bent digit, which forms a perfect claw around my phone. I never drop it when this finger is holding it and the matt finish minimises further accidental drops.

As for the Anker brand power bank I use for charging devices on the go, I recently bought their newer PowerCore Essential 20000 mAh power bank, with a sleek new fabric exterior which might make it easier for me to hold.

Anker PowerCore Essential 20000mAh Power Bank with fabric finish

I could go on endlessly with suggestions here, but you get my drift. Look for ways to make your hiking experience more enjoyable and get on with the business of hiking.  

Feet

Shoes

I am flat footed with fused arthritic big toe joints. There is no way Zero Drop shoes, the Pacific Crest Trail’s most popular trail runners, were ever going to work for me. I need more support than most with my inflexible feet.

A normal walking gait that involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe is impossible for me. Experts recommend you avoid flat-footed steps or striking the ground with your toes, but this slapping motion is unavoidable for me and it keeps me hiking. I offer no footwear recommendations bar suggesting you look out for shoes or boots with a strap or loop at the back of the heel to help pull your shoes on. Be aware foot joint arthritis may limit your choice of suitable hiking shoes or boots. It will be a matter of thorough research and trial-and-error testing to find a workable solution. Set aside time for this task to make sure you enjoy and complete your desired hiking trip.

“May your feet take you where your heart wants to go.”

Orthotics or Innersoles

I have been hesitant to buy orthotics for a long time, but I am now a fan. One of my earlier aversions to them is that people wearing them squeaked. Not a fan! My orthotics do not squeak and their ability to relieve pain hotspots far out ways any earlier embarrassment I might have felt at being heard upon approach.

Orthotics are expensive, but that is because they are custom made inserts, designed to correct your specific issues, and fit your feet perfectly. They offer support for joints affected by arthritis and have enabled me to work over 2,655kms of the Pacific Crest Trail. They can also correct the way we stand and walk. Even the slightest deviation in your feet can lead to knock-on effects that go right up your body. Improper posture or gait can adversely affect body parts such as shins, knees, and back.

If the price is prohibitive, I suggest you look at cheaper mass-produced innersole varieties, sometimes referred to as ‘foot beds’ or ‘insoles’, that are available from most chemists or health speciality shops. For better-quality innersoles, as recommended by podiatrists, such as the Superfeet® GREEN, Sole and Sofsole brands, visit any reputable hiking store. They rarely last as long as orthotics, but they may give short time relief for shorter hiking trips.

Knees, Hips and Spine

If you fix your feet, you may see improvement in your knees, hips and back but these joints are favourite hot spots for arthritic wear and tear inflammation. I recommend the following gear to lessen the pain.

Trekking Poles

Gossamer Gear LT5 Carbon Trekking Poles weighing 280g a pair

Studies have shown that using trekking poles significantly reduces the amount of compressive force on the knees, especially on downhill sections. They offer extra stability and can lower the stress on your legs and knee joints by taking the weight onto the poles through your arms. Using trekking poles, or even a single pole, will reduce knee pain and increase hill-climbing power and endurance. Winner! Winner! They are not daggy. I love using them as leverage points to catapult my way down hills. I find hiking swiftly downhill, if you take extreme care on uneven surfaces, helps me minimise knee pain, which becomes more noticeable when I adopt a slower pace. No need for further discussion. Just bring them.

Sit Pad

Inexpensive foldable foam sit pad

These inexpensive little foam seats are great for sitting on for lunch breaks when the rock surface you are perched on is uneven or the ground is damp. Another handy use is as a knee pad to lean on when you are sorting things out in your tent. Give it a go. It is amazing what relief a small piece of foam can offer.

Sleeping Pad

The best ultralight minimalist sleeping pad is the Therma-rest Z Lite Sol. Cheap, lightweight, durable, requiring no inflation and easy to pack, this product is great, except if your joints hurt. Arthritic joints need padding. Get an inflatable sleeping pad, protect your joints and get a good night’s sleep. I was thrilled with my Therma-rest NeoAir XLite Women’s Sleeping Mat. There are plenty of other brands to choose from – Sea to Summit, Nemo, Exped, Big Agnes – to name a few. The important thing is to invest in one to avoid aggravating troublesome joints.

Therma-rest NeoAir Xlite Women’s Sleeping Pad

Shoulders

If you cannot lift your arm or put on a bra properly, you may have tendonitis or bursitis in your shoulder joint, possibly caused by arthritis. How am I ever going to put a heavy backpack on my back, let alone put on a bra?

Let’s get the bra out of the way first. A loose not-too-tight athletic bra with no back hook attachments may be the way to go if you can easily slip it over your head and it provides adequate support. Alternatively, if you cannot hook the bra in place at your back with your hands because of the pain, rotate the bra to your stomach, attach hooks and swivel it back to your back into the correct position and then adjust the straps over your shoulders. Or keep it on until your next town stop, minimise further pain, and put up with the stench of dirty underwear.  

My backpack weighed 20kg (44lbs) daily when I walked the PCT. Try as I might, I could not reduce this weight, for many reasons. Learning how to get my pack on my back was a fine balancing act with wild trajectories of arm movements. Without raising my shoulders, it took two quick gross motor moves. One to swing it from the ground to rest on top of a bent knee and the second one to swing it around to rest on my bent back. Once positioned, I then carefully wiggled my shoulders under the shoulder straps and buckled myself into the pack. Effectively, I avoided using my shoulders. They could easily carry a heavy load pain free with a good load-bearing backpack and most of the time you do not need to raise your arms with most hiking and camping activities.   

Kit Kat (PCT trail name) with all the gear to carry a hefty load

In summary, arthritis is a degenerative disease that will not go away. You will constantly need to find alternative ways of doing things for activities that were once effortless and pain-free. But we all have our problems. How you deal with them determines what enjoyment you can still get out of your life. For senior hikers, retirement brings you the opportunity to explore the world at your own pace. If arthritis slows you down, so be it. It should not stop you from reaching your goals. Multi-day hikes and even long-distance hikes are still achievable. A positive attitude will help you achieve your goals and keep hiking. Take a hike, arthritis, with me. You are in for one hell of an adventure.    

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