July 7, 2020
Growing up, the response “I can’t” was discouraged. Instead, my father encouraged my brother and I to practice, to try harder, and to not shy away from fear or uncertainty. That mentality stuck with me into my adult life, but presents a specific challenge with Ankylosing Spondylitis and corresponding chronic pain.
Life with a chronic illness involves frequent negotiations: shifting dinner plans because hip and lower back pain makes it difficult to sit at a restaurant for a long period of time, increasing or decreasing exercise goals based on joint pain levels and fatigue, and adjusting expectations depending on what my body can and cannot handle on any given day.
Chronic pain, unlike acute pain caused by short-term illness or injury, cannot easily be rested, iced, and medicated away either.
But learning about my body with a chronic illness has given me a new perspective on will power and quality of life. Those who suffer with chronic pain cannot simply will themselves through a strenuous activity because pain, unlike fear or uncertainty, won’t dissipate once the ordeal is over. Chronic pain, unlike acute pain caused by short-term illness or injury, cannot easily be rested, iced, and medicated away either. Instead chronic pain, especially pain caused by an inflammatory condition, may be greatly intensified (sometimes even days or weeks after the activity has ended) by putting excess stress on the body.
I like to consider myself an avid hiker and love weekends when I have nothing more planned than getting out and logging some trail miles. With that said, hiking with Ankylosing Spondylitis (the condition responsible for my chronic pain) comes with its own set of negotiations and shifting expectations. Here’s what I’ve learned to pay attention to while planning and executing a hike with chronic pain:
It’s crucial for me to assess pain levels the morning of the planned hike and adjust plans accordingly. I know chronic pain, even though chronic and constantly recurring, can be unpredictable, so if I have a moderately difficult hike planned for Saturday morning I cannot say that plan is 100% certain until the moment I walk out the door. If I wake up with intense joint stiffness or moderate hip pain on Saturday morning, I assess that pain and will either cancel the hike or go with a back-up plan involving less strenuous physical activity. Essentially, my hiking plans are always tentative and based on how I feel the morning of the planned hike.
Topical pain medications are a necessity for me. I cannot remember the last time I got through a day without any pain, but as long as I’m not experiencing a flare-up of my AS involving widespread joint discomfort and flu-like symptoms, I can usually subdue the pain with one of several remedies. I use diclofenac topical gel to treat localized arthritis pain and usually apply to hot spots before and after a hike. Any cream or gel with lidocaine also works well. Neither option erases the pain, but both help keep moderate pain manageable for me.
While not always successful, I do my best to anticipate any extra assistive tools or supportive items I may want mid-way through my hike. For example, I go through stretches of intensified pain and inflammation in my left knee and hip. This pain doesn’t usually prevent me from hiking as long as I use a fabric knee brace to lend support and limit the joint’s range of motion. On occasion, compression socks help with foot pain caused by tendonitis or plantar fasciitis. Trekking poles are great for hikes with elevation gain because they can help distribute impact on downslopes while also helping on upward climbs.
It’s taken me years to learn realistic expectations for my hikes, and those expectations are always changing based on how I’m feeling and how frequently I’ve been able to hike. If I’ve had to lay off hiking for several weeks, then it’s just not realistic for me to plan a 5-mile hike with or without elevation gain--my body will certainly suffer. On good days I like to push myself a bit, but it’s also crucial not to push too hard or I’ll end up with injury on top of chronic pain!
Lastly, I cannot stress enough how important it is to check-in with your body throughout the hike. Even with years of experience, chronic pain isn’t easy to figure out. Some days may begin with minor hip and back pain that will actually get better a mile into the hike (exercise often helps joint pain with Ankylosing Spondylitis), but the opposite outcome is also possible. That’s why my wife and I are persistent about checking in on my pain levels at different points along the trail. If I’m feeling good, we continue on and if I’m not, we don’t. It’s that simple.