Latest Research

High Rates of Musculoskeletal Injuries Among AT Thru-Hikers

Researchers at Thomas Jefferson University have provided the first detailed look at injury patterns on the Appalachian Trail in more than a decade.

A recent study in the Journal of Wilderness and Environmental Medicine has found high rates of musculoskeletal injuries among thru-hikers on the Appalachian Trail (AT). Although not an unforeseen result, the study, conducted by Adam Crusch and Michelle Kavin at Thomas Jefferson University, provides the most up-to-date insight into common injuries among thru-hikers.

According to the authors, prior to the publication of this latest research, the most recent studies on musculoskeletal injuries among long-distance AT hikers are more than a decade old. Due to the increasing popularity of outdoor recreation and thru-hiking in recent years, the researchers were interested to see if there were any new injury patterns since the last major study.

The researchers found that, out of 1,295 respondents, approximately 61 percent reported experiencing some sort of musculoskeletal injury during their thru-hike. Approximately 28 percent of these injuries were classified as overuse or chronic issues while about 18 percent were acute injuries.

Out of all of the injuries sustained on the trail, the researchers found that knee and foot issues were the most common. In fact, approximately 37 percent of thru-hikers that completed the survey reported having knee pain or a knee injury while 29 percent had foot pain or a foot injury. Other common issues included ankle sprains, Achilles tendon injuries, and IT band syndrome.

Key Insights

Many hikers and outdoor enthusiasts experience musculoskeletal injuries at some point during their adventure careers. As such, the relatively high rate of injury among AT thru-hikers is not particularly ground-breaking.

However, the authors noted some interesting insights from their research. First, the researchers found that hikers that did not train before their AT thru-hike were significantly more likely to experience a musculoskeletal injury, particularly an overuse or a chronic injury. Additionally, hikers who didn’t train were more likely to have multiple injuries. 

Alternatively, hikers who did train for the thru-hike, either through strength exercises, stretching, yoga, or endurance training, were significantly less likely to report an injury. Hikers who used trekking poles were also less likely to get injured during the thru-hike. These findings further highlight the need to train properly for longer expeditions and the need for more research on the benefits of trekking poles.

Another key takeaway from this study was the need for more research on the optimal ratio between rest days and hiking days for injury prevention. The researchers attempted to learn more about how frequently hikers took rest days on the AT and whether this was correlated  with a higher rate of injury. However, this question had a large “no response” rate, so more research is needed on the topic.

All things considered, while the news that AT thru-hikers report relatively high rates of injuries is not revolutionary, the study offers up-to-date information about injury patterns on the AT. It also paves the way for future research on more nuanced topics in wilderness medicine.


Chrusch, A. & Kavin, M. (2021). Survey of Musculoskeletal Injuries, Prehike Conditioning, and On-Trail Injury Prevention Strategies Self-Reported by Long-Distance Hikers on the Appalachian Trail. Wilderness and Environmental Medicine, 31. (3), 322–331.

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