There is nothing like the exhilarating experience of running free in the hills over rugged terrain - but what problems do you need to look out for? Dr Catherine Farrow takes a look.

Covering rocks and tracks requires more concentration than pounding the tarmac, and it stimulates your mind as well. Many argue that running off-road reduces the impact on joints and therefore provides longevity in a running career. However problems and injuries can still arise and there is no substitute for common sense and experience. Many of these can be prevented, thereby maximising the enjoyment of running in the hills.

Health and fitness
It’s not surprising that there are benefits to be gained in running up hills - there is an improvement in leg muscle strength, an increase in stride length, development of the cardiovascular system and possibly even an improvement in the elasticity of muscles, tendons and ligaments. While consistent training is the best way to improve uphill running (along with positive psychology!), downhill running is more demanding than may be anticipated! The quadriceps are made to work eccentrically, and co-ordinating balance, angle of lean, and stride length all require practice.

When negotiating descents it is important to watch where you are placing your feet. Try to lean into the descent (yet remaining upright and perpendicular to the horizontal) and keep feet close to the ground at the same time as trying to remain in control! Tight leg muscles or sore quadriceps (leg muscles at front of thigh) following a large amount of downhill running can be due to overstriding. A sore lower back may be from leaning too far forward. Cross-training e.g. cycling, hill-walking can help to strengthen ankles/quadriceps and specific leg-strengthening exercises can reduce the risk of injury/soreness.

Injuries
‘RICE’ describes immediate, self-treatment of a minor injury.

• R-Rest
• I-Ice: Place an ice-pack/frozen peas wrapped in a tea towel or cloth on the injured part for 15 minutes. Do not place the ice-pack directly onto the skin. If you are in the hills you may be able to find a cold stream or river in which to immerse the injured part. Immersing tired legs at the end of a run in a cold lake or river can reduce swelling and inflammation in damaged tissues and speed recovery.
• C-Compression: Applying pressure to the injured part can also reduce inflammation
• E-Elevation: Also reduces inflammation

If the injury persists or is serious, seek medical advice. This can include the services of a physiotherapist, sports doctor or podiatrist.

Blisters
These are a fast way to ruin a good run. They are caused by friction on feet from wrong-sized shoes, hot conditions etc. Many runners get sore areas of their feet before blisters develop; stopping to rearrange socks/shoes or remove rock particles may prevent their occurrence (unless it’s a race!). Covering these ‘hot spots’ with Compede or similar material may prevent a blister occurring. Once a blister has developed, Compede or a piece of Moleskin with a hole cut in the centre the size of the blister can be placed on the effected area and prevents the blister popping and reduces pain.

Another piece of tape may be required to ensure it sticks as the feet become sweaty or get wet. Blister prevention includes correct fitting shoes and socks and regular removal of hard skin. Many have their own ways of treating a blister. I find popping it with a sterile needle, squeezing the fluid out of the hole and then taping or putting a plaster over it to prevent infection successful. This also relieves pain.

Chafing
Once you feel this, it’s usually too late to do anything about it! Prevention is an individual thing. Vaseline or another lubricant is popular for thighs, crotch, underarms and nipples but does eventually rub off, so may need to be re-applied. Some advocate wearing longer lycra shorts to avoid thigh chafing. Taping nipples with Micropore tape or plasters can prevent repeated rubbing from a sweaty or wet T-shirt.

A poorly-fitting bumbag or rucksack can also rub, particularly over bony prominences such as vertebrae. Ensuring it does not bounce around and it is correctly packed, and covering the affected areas with Compede or a plaster, can reduce this.

Black toenails
Most likely to occur if shoes are too tight and running downhill. They are unsightly but usually take care of themselves until they are ready to fall off. If the toenail is painful, it may be necessary to drain the fluid that has built up (haematoma) by using a sterile implement such as a hot needle to penetrate the nail and release pressure.

Sprained ankle
Following RICE, if the sprain is severe, seek medical advice as an X-ray may be required. Following recovery, the ankle will be weakened so strengthening is suggested. This can be done most simply by balancing on one foot and then progressing to a wobble board. A physiotherapist will give advice on this and may also suggest ankle taping as a way of strapping a weak ankle to try to prevent the injury recurring.

NSAID’s
NSAID’s (non-steroidal anti-inflammatory drugs such as ibuprofen or voltarol) are great painkillers as they relieve inflammation. Stomach irritation and ulcer formation are a common side effect and they should be taken with food and avoided by those who suffer these problems. All asthmatics, except mild sufferers, and particularly those who are sensitive to aspirin should avoid them. There are reports of kidney damage occurring as a result of taking these drugs during endurance events and while it is unlikely alone that they could cause this, it is possible in combination with other factors such as dehydration and electrolyte imbalance.

Safety
Running in a group might detract from the sense of adventure but it will minimise the risks associated with exposed, mountainous areas. If running alone you should at least leave a route description with someone. Many runners now carry mobile phones. When planning a long route it is worth identifying ‘escape routes’- paths leading to roads in the event of an emergency or severe weather.

Navigational skills are essential, and being able to read a map and take bearings will at the very least enable you to find endless new routes! I have found local orienteering events helpful for becoming familiar with the ‘multi-tasking’ of running - finding the best route over rough ground, taking a bearing, and reading a map. Knowledge and experience of mountain weather and the local forecast is useful.

With regard to first aid kits, everyone should carry their own personal medications for emergency use, such as inhalers if asthmatic. Many solo runners carry nothing for short excursions and races. I carry a plaster and a sterile needle for long runs, and add to that a sterile dressing/bandage and small roll of tape for mountain marathons.

Ticks can be a problem particularly in late spring, early summer and autumn because their bites can transmit Lyme disease. Ticks are found in vegetation, so the risk of being bitten is increased by running through overgrown areas such as ferns with bare legs. It is worth examining limbs that may have been exposed to the above and if a tick is found, it should be removed by gripping it closely to the skin with a pair of tweezers but ensuring that the whole body, head and mouthparts are removed without bursting it. Specialist tick tweezers are also available. The early symptoms of Lyme disease is a prolonged flu-like illness and sometimes a rash.

Equipment
All outdoor enthusiasts love kit and there is a veritable feast of clothing and accessories for trail and mountain running. At the bare minimum, a comfortable pair of shoes with appropriate sole and grip, a wicking T-shirt, leggings or shorts, thermals, lightweight waterproofs, gloves, a hat and emergency kit is required. I find a ‘buff’ a very versatile accessory.

The Fell Runners Association require mandatory kit at their events (waterproof/windproof whole body cover, map, compass, whistle and emergency food) as do overnight mountain marathon events. However what most wear and carry obviously depends on the duration, location, terrain and anticipated weather conditions.

Bumbags or small rucksacks such as CamelBaks are popular. They have built-in hydration bladders and a tube for drinking on the move. A chest strap and waist belt give extra stability and compression straps make it more stable when partially filled. Compartments on a waist belt or mesh side pockets mean easy access to snacks while running. The rucksack must have a narrow profile to allow arm movement.

Ultimately footwear comes down to personal preference. Trail running shoes tend to be more cushioned with square grips for more packed paths and tracks. Fell shoes are lighter and less cushioned with stud-grip soles to maximise grip over boggy, pathless terrains. These shoes also have lower heels (to reduce the risk of turning an ankle) and snug-fitting uppers.

Salomon make a good range of trail shoes while Walsh or Inov-8 shoes are popular in he fell-running fraternity. Short, ankle-height gaiters are ideal if running over scree or in areas where there is fine shale, sand or dust particles. Without them, these fine particles can get into socks and become abrasive, causing blisters.

Successful and enjoyable mountain marathoning demands a compromise between moving fast (therefore carrying the bare minimum) versus the risk of hypothermia. There is a large range of incredibly lightweight tents, sleeping bags and stoves available, and latest innovations include sleeping mats composed of a large stocking full of long balloons (apparently very comfortable unless the ground is rocky!).

Down sleeping bags can be warmer and lighter but risk becoming fairly useless if they get wet. A small sleeping mat (this may be enclosed in the back of a rucksack) I find essential even if just to provide some insulation for the torso. If you can bare the rustling noise, a foil survival blanket directly on the groundsheet may help by reflecting heat back. Personal preference will dictate the cold one can endure - I need to carry several extra thin thermals and a fleece. I find a dry pair of socks and two plastic bags essential for the overnight camp, to enable walking around without having to put dry socks back into inevitably wet shoes!

Nutrition & Hydration
Running at high intensities for over an hour starts to drain carbohydrate (carb) stores. Blood glucose is supplied by glycogen stores broken down from the liver and carbs consumed whilst running. Regularly eating small amounts during endurance events is vital to prevent ‘hitting the wall’ - it is important to start eating before you feel hungry.

Everyone has their own favourite hill snacks that they can digest while running - try jelly babies, flapjack, energy bars, dried fruit, cake, malt loaf and even cold boiled potatoes. Some gels need to be taken with water, but I find SiS gels useful as they are palatable even without water, which may not always be aplenty. ‘Powerbars’ or cereal bars which can be rock hard in cold weather can be chopped up pre-run into smaller pieces. Obviously all packaging should be carried home.

Performance during long or hard training runs/races can be improved by using a carb-based energy drink. Drinks containing glucose or maltodextrin (a slow-release carb) may speed recovery. Most energy drinks contain electrolytes to replace important salts lost in sweat and help reduce muscle cramps. Water alone is less effective at rehydrating than an electrolyte-containing drink. However, carrying vast volumes of energy drinks with or without electrolytes may not be practical. Electrolyte tablets are available which are simply added to water, as are sachets of energy drink powder. Some endurance athletes favour flat coke as an ‘energy drink’.

It is important to start a long run hydrated, and remaining hydrated is also important (dehydration reduces performance). This may be challenging in the mountain environment . Urine colour correlates with hydration status; a pale yellow colour indicates near optimal hydration. Many are happy to drink unpurified water directly from running streams/rivers, either by cupping a hand or carrying an empty plastic bottle/cup. With regard to water purification, it is clearly impractical to carry equipment to boil water on a run. Chemical tablets or ‘puritabs’ containing iodine or chlorine are available which can be added to water and after a certain time has elapsed it is ready for drinking. Disadvantages include a bad taste (can be improved with electrolyte powder), and they don’t get rid of particles (which you do by using a filter). They should be avoided if you are allergic to iodine.

Hydration systems, ranging from single- or multi-bottle waistbelts to backpack reservoirs, are popular for longer runs. There is evidence that distance runners can suffer potentially-fatal low blood sodium levels from excessive fluid consumption, but it is unlikely to occur during mountain running due to the minimal number of drinks stations in races and the fact there is less water freely available. A modest degree of dehydration is normal after long periods of exertion, and temporarily will not lead to serious medical conditions.

Altitude
At higher altitudes the partial pressure of oxygen is less than at sea level, requiring acclimatisation. Unless you are prepared to spend time and money in a hypobaric oxygen training facility, acclimatisation will take on average a couple of weeks. Unfortunately a high levels of fitness is not a guarantee for speedy acclimatisation and workout intensity should be lowered until this has occurred - bad news for anyone going straight to the Alps for a weekend mountain race. Staying hydrated while at altitude is vital. Anyone who is anaemic or at risk of this (usually women and vegetarians) may require iron supplementation due to the increased demand for iron in making more red blood cells.

Extremes of temperature: cold
Combatting cold weather when running may seem an everyday challenge in the UK! However running in extreme cold does require more energy as cold exposure increases the rate at which muscles use up their carbohydrate stores. Although many people do not feel thirsty  when it’s cold, sweating and the humidifying of cold dry air can cause a significant moisture loss, so it is important to drink enough. Breathing through the nose can help warm and add moisture to the cold air before it reaches the more delicate lungs.

Drinking cold water makes you cold - try warming it up by placing a bottle inside one of your layers. It is vital to keep moving to prevent hypothermia, and a cold body is also more vulnerable to injury. If you have to stop, do so in a sheltered spot - for example behind a wall or cairn. Wind chill can obviously enhance the effects of cold on any exposed or wet skin (water conducts heat away from the body much faster than air), so windproof jackets/leggings are important, not forgetting hat/gloves.

Dressing in layers means these can be removed as you warm up. Cotton tops are best avoided, as sweat can get trapped in them and freeze. The extremities are most at risk of cold injuries such as frostnip, where ice crystals actually begin to form inside the body’s cells. This can lead to frostbite if no action is taken - put cold hands under your armpits, do starjumps or perform ‘helicopters’ (the ludicrous waving of arms in a windmill fashion can help keep extremities warm!).

Hypothermia is best avoided by correct clothing, keeping moving and by early detection. Shivering is an early sign along with apathy and coordination problems. If one person has hypothermia it is likely that others are close to it. Best advice is to put on any extra layers you have, keep moving and get yourselves off the hill.

Anyone interested in running in the snow may find it possible in trail shoes or spikes but ‘ice cleats’ (such as ‘Spiky Plus’ rubber slip-over soles with carbon spikes) may be required to improve traction across snow/icy surfaces.

Extremes of temperature: heat
Mountainous areas by definition will have little protection from sun and exposure to heat is therefore inevitable. If running in this heat cannot be avoided, sweat-proof suncreen with a minimum SPF of 15, sunglasses and appropriate kit (light-coloured, synthetic fabrics) including head cover is required. A cap can be soaked in rivers/lakes to aid cooling. In such conditions hydration is even more important than usual.

A quick way to check hydration status is by looking at urine colour - the darker it is the more rehydration is required. Failing to drink or replace electrolytes can lead to heat exhaustion and cramps. Symptoms include headache, fatigue and nausea. Treatment includes applying cold water to the head/neck and restoring fluid and salt balance with electrolyte drinks. Heatstroke is more severe and requires emergency medical attention.
 

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