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9 Things to Consider Before Hiking with a Chronic Illness

Updated: Jul 5

June 16th, 2021

Hiking view of the Sangre de Cristo Mountains

I’m currently over 5 years removed from my diagnosis of Ankylosing Spondylitis and I’m happy to say that my disease is fairly well managed. Fortunately for me, that means I am able to still get out on the trails.


However, hiking with a chronic illness is not the same as I remember hiking to be a decade ago, when I contended with only mild lower back pain and had the stamina of an able-bodied 20-something year old. In the last several years I’ve had to learn what hiking can mean for a person who is disabled.


Here are nine things I now consider before heading out on a hike:


1. Trail Difficulty and Reviews


Do your research and don’t rely on able-bodied trail ratings and reviews.


I do a deep-dive into trail reviews and descriptions before heading out on a hike. I use AllTrails, National Forest or State Park or National Park trail descriptions, as well as photos and reviews on Google. I’ve learned to stop relying on trail ratings for the bulk of my information because the simplistic rating system of ‘easy--moderate--difficult’ is subjective and not intended for disabled bodies. The between ‘easy’ and ‘moderate’ can vary dramatically, and what’s ‘easy’ or ‘moderate’ for an able-bodied person may not be the same for someone who is disabled. For those reasons, I gather as much information as I can before selecting a trail.


Hiker on red rock landscape

2. Day-of-Hike Disease Activity


Observe your disease activity level closely before hitting the trail.


If you’re living with a chronic illness, you know that the severity of your disease activity can shift dramatically from day to day. I tend to know how my day is going to go in the first hour after I wake up. If my joints are extra stiff and my chronic pain widespread, I know I won’t be up for hiking. For me, it’s critical to check-in with my body on the morning before a planned hike. By paying attention to my body, I can avoid overly painful hikes or post-hike flares by simply postponing for a better day to come.


3. Hiking Footwear


Choose footwear wisely for comfort and support.


Whether you’re hiking a mile on a flat path or ten miles up the side of a mountain, good footwear is essential. Since my AS causes issues with joints, especially in my back, supportive footwear is a must. I choose hiking boots that have a thick sole so that my feet are not sore from trekking on rough terrain, I swap out my insoles often to ensure my feet are cushioned well, and I opt for boots that rise over the ankles to help avoid twisting or spraining injuries. Choosing the correct footwear can be the difference between moderate soreness post-hike or severe back and joint pain.


4. Weather Forecasts and Changes


Pay close attention to hourly changes in weather forecasts.


Whether chronically ill or not, it’s important to check the day’s weather forecast before hitting the trail. But it’s especially important when chronically ill if your disease activity and pain levels are influenced by changes in the weather. In my case, I suffer from increased joint pain with dramatic temperature swings. Summer months are infamous for bringing passing thunderstorms which can lead to temperature changes as well as precipitation. If you are also affected by weather fluctuations, be sure to check hourly forecasts and don’t be afraid to change plans, if needed.


Hiker with waist pack taking picture

5. Pack or Bag


Choose an appropriate bag or pack based on what and how you can carry.


My last hike with a backpack was at the end of September in 2020. Around that time I began to develop costochondritis, or inflammation around the joints of the ribs as well as the breastbone and collarbones. I am fortunate to have a partner who carries a backpack with some of our gear (water, first-aid kit, bear spray, etc.), but I still want to carry some of the weight. I recently discovered waist packs, which allow me to carry a somewhat light load of water and some supplies around my waist without putting stress on any of the joints that typically bother me. If a backpack doesn’t work well for you, consider some alternatives such as waist packs, vest packs, or sling packs.


6. Pain Management Tools


Hike prepared with tools to manage pain, especially pain that increases with activity.


No matter how great I feel at the beginning of a hike, I know that’s not going to last. For me, pain levels begin to increase after about 2 miles. Sometimes my hips or lower back hurts so bad during the hike that it’s hard to make it back to the car without excessive pain. Therefore, I never hit the trail without some sort of pain management tool. A lidocaine patch or lidocaine cream is my go-to pain reliever for hiking, but there are certainly other great options out there that can easily fit in a hiking pack!


Hiker with stone stairs in background

7. Distance to Trailhead


Consider how long the drive home from the trail will be.


I like to explore hiking trails near and far, and sometimes Stacia and I will drive an hour or two to reach a popular trailhead. But sitting in a car for that long can be difficult on my joints without adding strenuous exercise into the mix. If riding in a car for long periods of time is painful for you, I advise taking that into consideration when planning your hike. The last thing you want to do is be stuck in a car, in pain, for two hours after a hike instead of at home soaking your tired, sore joints in the bath.


8. Support Gear


Bring whatever supportive gear is necessary to get you through the hike.


Trekking poles are my best friend when hiking a trail with rough terrain or elevation gain. Unless hiking on ice in the winter, I prefer hiking with only one trekking pole instead of a pair. Trekking poles are excellent for providing support on uneven terrain as well as relieving strain on joints, especially when hiking downhill. I use other types of supportive gear as well, such as a knee brace when my knee pain acts up. If you fight through joint pain on your hikes, I recommend making room to carry supportive gear with you. It’s better to have it and not need it than need it and not have it!


Close up image of hiker's legs with trekking poles

9. Hiking Companions


Choose companions who are flexible and understanding.


Living with a chronic illness often comes with a good amount of guilt. I feel guilty for being uncertain about plans, for canceling or changing plans at the last minute based on my pain and fatigue, and for not always being able to deliver on promises that I make. I know I shouldn’t feel guilty, but I still do. That’s why I recommend choosing hiking companions that are aware of what your chronic illness may mean for the hiking plans, companions who are willing to be flexible and supportive if the hike doesn’t go as planned.


I hope this list helps other spoonies like me plan better for their outdoor adventures! Is there something missing from this list? Submit it in the comments!


-Jessica