How to Prevent and Treat Trail Running Injuries

Trail runner and paramedic Keith Williams provides standby medical care at numerous trail races throughout the year.

“Road and trail runners share common issues like cramping and overuse injuries,” Williams says. “But trail runners have some specific dangers to deal with, plus it’s harder to receive help when you’re on the trail versus calling someone to pick you up on the road.”

Here’s what Williams says to be aware of – and what to do about minor injuries so you can continue to enjoy trail running safely.



Prevent it:

“Prevention for abrasions, lacerations and twisted ankles requires really paying attention and staying focussed, especially when you’re tired,” Williams says. “When we’re getting tired, we’re emotionally, mentally and physically tired, and the amount of concentration needed on trails is higher than on the road.”

Treat it:

To avoid infection, rinse an open wound with soap and water as soon as possible. If no soap is available, rinse the cut with “copious amounts” of drinking-quality water. If the cut is really dirty, Williams recommends using 1% povidone iodine solution.

“Pluck out as many bits of trail as you can. Each one of those flecks can set up shop in the warm environment of that wound. Keep it clean and covered. A lot of injuries can wait to be cleaned for a couple hours, but the longer you wait, the more prone you are to infection.”

Williams says when he runs, he carries enough first aid to take care of cuts and scrapes. “If I’m more than an hour away from my car, I take care of it on the trail. If I’m closer, I take care of it at the car.”



Prevent it:

Exposure to the elements becomes heightened on the trail, making trail runners more susceptible to frostbite and hypothermia. Know that noses, fingers, hands, feet and male genetailia are most prone to frostbite.

“When your feet get really cold, it affects your ability to travel quickly because you can’t feel the trail,” William says. “Slow down, and you’re looking at an increased risk of hypothermia.”

Be prepared:

Dress appropriately. “Think about your extremities. Maybe put on an extra layer of socks, a thicker pair of gloves.”



Prevent it:

Staying focussed on the terrain and your footing can help minimise twisted ankles. Be mindful, especially when you’re getting tired.

Treat it:

If you do twist your ankle on a long trail run, taping the injury can provide temporary support. Williams suggests carrying a metre of 4cm-wide athletic tape and taping by using three J-shaped strips around the ankle and a couple of straps around the leg.

“Ankle taping helps support an injured ankle and may be able to take an unstable injury and stabilise it to the point where the patient can walk out rather than have to get carried. Injuries continue to swell over a 24-hour period, so the taping needs to be watched to make sure it isn’t cutting off circulation. Once you’re out of the bush, the tape should be removed, and the injury RICE-ed (rest ice compression elevation). Get evaluated by a doctor as well to rule out a more serious injury.”



Prevent it:

Cramping is often caused by an electrolyte imbalance. Though cramping is a common occurrence for both road and trail runners, a cramping road runner can easily flag down or call for help if they’re cramping so badly they can’t go on. Trail runners have a harder time getting help on remote trails.

Be prepared:

Dialling in your specific hydration needs takes time, but be aware of balancing your water intake with electrolytes or salty foods.



Prevent it:

Don’t increase mileage too much too soon. And if you have an overuse injury like a tendinitis of some sort, consider testing it on a road run, not a remote trail run.

Be prepared:

On the road, you can call someone to pick you up at the service station. This is not so easy on a trail run.

“Make good choices before you get out there,” Williams says.

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