When I retired in my early fifties I chose North Wales as my idyll. It had everything scenically that suited me, quaint towns like Conwy and Llandudno, unspoilt rural villages but above all mountains and seascapes. The mountains are comparatively untramped and do not have the motorway- like tracks that are a common feature in Lakeland. Also, as yet, the dreaded ubiquitous wind farms haven’t spoiled the place unlike certain parts of Scotland’s wilderness, which are being ruined.I was delighted to discover a huge existing network of walking folk with over a dozen Ramblers Association groups and other individual club assemblages as well as ad hoc throngs that get together via a phone call or E- mail. It was a hiker’s El Dorado.

Walking poles - working the arms and upper body

One hoary old group leader who had tramped this region for 25 years advised me that whilst I could be hiking every day of the week if I didn’t watch out I would have no knees left within four years. This alarmed me somewhat because, whilst still a young man, I didn’t want to be chair bound before my true pension age kicked in!Mr hoary was right. Within two years I had knee and back pain necessitating some serious thought and research if I was to last the course. My superb cardiovascular system was a given but I didn’t want to trade in my walking for non-weight bearing exercise such as cycling or swimming.

I had spent a lifetime in healthcare-even picking up a degree in Osteopathy along the way and after ignoring my own academic experience I had to go back to the drawing board. What follows is a catalogue of how I manage moderate to serious exercise together with the negative physical manifestations that may accompany this effort. Many of you may think that you don’t exercise at this level but several of these conditions can occur due to advancing years. One word of caution: I don’t wish to override your own treatments or professional advice. Some of what follows is just plain common sense.

Foot pain is common amongst walkers. It can present as an ache or acute pain on the heel of the foot. There can be many causes of pain in the feet but a common one amongst ramblers may be due to a deteriorating internal (medial) arch. It’s fallen arches. Heaven forefend you say –I have never been in the army! The remedy can be simple and dramatic- is to fit inserts into the boot(s) to correct the pronation (twisting) of the foot. Outdoor shops and chemists sell a baffling array of these orthotics and I have examined dozens. Some come with wonderful claims but the reality is that some are hard and unyielding to the foot, are poor and baffling in construction and others (that appear to fit the bill) are just too expensive.

My G.P. referred me ultimately to a Podiatrist who had access (via the good old NHS) to a very durable form of insoles called Prothotics Semi-Flex. This is a superb product distributed in the UK by Foothealthcare.com. The inserts have a firm part graphite base that makes them suitable for my higher level of activity but are mostly made of a soft sponge- like Vygel material. Conversely, if you want to speed things up and don’t want the fuss of the NHS, you can buy them direct from this website: www.foothealthcare.com. They have a huge range of inserts that must suit just about every foot condition. I have recommended the semi flex type to dozens of my friends –I wish I were on commission!

Prothotics Semiflex Carbon Insole

When you get the insoles take existing foot beds out of shoes/boots – wear for 1 hr for the first day- 2 hours the second, etc.. Don’t just walk long distances or wear them for long periods straight away – you may be altering the biomechanics of the foot, knee and ankle and spine too quickly so easy does it. You may need to adjust the sock combination a bit in order to accommodate the small amount of boot room taken up by them so persevere for a few days it will be worth it. Having said that I have known people don their inserts and just go. One such person is my wife who fitted at pair from Algeos and walked all day in them. She was just fine but easy does it I say, particularly if you feel a little discomfort or pain anywhere. While we're on the subject, this fallen arch predicament can have a bearing on knee, hip and back pain too so the insert remedy may solve (and help prevent) a multitude of problems.

Another foot complaint that affects many ramblers is `fungal toe’s-a sort of an extension of athlete foot where the nails become thickened and turn white. One walker told me his toes had turned white because he walked downhill too much! The toes look awful but they are treatable with oral anti-fungals from your doctor. I found the creams useless but after a few months course of tablets and a year’s wait, my toes are brand new again. I even wear trekking sandals something I said I would never do-not because I think they are a poor substitute for boots but because I was a little embarrassed about my toes.

Now let’s carry on up to the knee. This is an area where all types of orthopaedic disorder may be present but generally the ones that affect chronic walkers are arthritis or mechanical issues. A doctor must see any acute or chronic knee pain first. Your G.P. may refer you to a physio. or other physical therapist. We have all seen an astronomical rise in the usage of Glucosamine and the trials are interesting though not yet fully conclusive. I have an interest in this supplement because I was fortunate just before retirement to see some of the trials being reviewed by eminent clinicians at an American College of Rheumatology meeting in San Diego. I must say I am a fan. It works for me and I find that it offers good pain relief at least comparable to anti-inflammatory drugs. Sometimes my walking friends tell me that glucosamine doesn’t work, I often wonder whether the correct dose is being taken, or is it being used for long enough for it to take effect. Some health experts say use it for at least six weeks. One of my walking colleagues said if you want to know whether your glucosamine is working –just stop swallowing it! The trials in knee pain are interesting and clearly more work needs to be done but for more information on glucosamine the GAIT study is very interesting. GAIT is the first, large-scale, multi centre clinical trial in the United States that looks at amongst other issues glucosamine treatment of knee osteoarthritis. See: http://nccam.nih.gov/research/results/gait/qa.htm and make your mind up for yourself. I reiterate again that knee pain must be seen by a doctor and we can take comfort that if surgery is needed it is often done arthroscopically (via a small telescope) so is less invasive, painful and recovery time is far shorter.

OK let’s move on. Hands up who hasn’t had back pain? Some walkers get low back pain after a prolonged walk –particularly when long descents are a feature. After ruling out all serious acute or chronic back pain, which requires specialist attention, I am a great advocate of maintaining flexibility of the spine so as to head off potential trouble. Good posture coupled with preventative stretching exercises are essential.

I always recommend the seminal book by Robin McKenzie, `Treat your own back`. The book is worth its weight as a way of saving on expensive and often needless therapist fees. Do not underestimate the value of a good remedial masseur. Massage has a rather tarnished image in the west but it can just be sufficiently therapeutic enough to ease the pain and spasm, which should allow free movement for you to do your McKenzie exercises. I would definitely avoid all forms of spinal manipulation except by a qualified osteopath, chiropractor or doctor.

Most of my article has focused on the area south of the midline but let’s not forget that in order to get a full cardio-respiratory-vascular workout we would be best advised to get the whole body involved. For this reason it’s good to see the progressive increase in the use of walking poles. These work the upper and lower body at the same time, strengthening your back, legs and arms. It also stabilises and relieves the knees and hips of at least the weight of one arm at each pace. This means a reduction in downward shock forces over the duration of a hike. You can get poles now with a built in anti shock system which further protects the arms. I don’t think dependence on the poles occurs and although the two-stick technique takes a little more practice, I think it is worthwhile sticking with it till you get the swing. For more information on the technique go to: www.nordicwalking.co.uk.

Well folks I hope you found some of the stuff useful. Rest assured that despite these periodic biomechanical complaints ramblers generally have a top notch cardiovascular and respiratory systems, which more than compensate for the odd niggling pain or ache. Our weight and body mass indexes are usually lower than the average. For me the effect on mood is a great benefit and well documented. After a day in the hills the `brain generated opiates` known as endorphins give a super high and a feeling of well being that can’t be purchased over a pub counter.

Russ Sheaf
North Wales November 2006