Plan & Prepare

Muscle and Bone Injuries

Injuries to muscles, bones and joints can happen quickly from a fall or misstep without warning. They can range in severity from mild sprains, unstable joints, to serious broken bones.

The severity of the injury often depends on whether or not the injured portion of the body can still be used. This will often dictate whether you should continue your activity or evacuate.

You can prepare for these situations by understanding the unique kinds of stress the outdoor activity can place on your body, recognizing different injuries, and by learning how to use field treatment techniques like slings and splints.

Symptoms and Description

If the injury is a direct blow or fall with immediate pain, always consider a broken bone or fracture.

If the injury is from a twisting motion with gradually worsening pain, a sprain or strain is more common.

For extremities (arms and legs) it can be helpful to look at the other uninjured extremity to compare deformity, joint angle, and overall appearance.

Keep in mind that overuse of an extremity can sometimes lead to inflammation, swelling, and pain without an acute injury. This pain and swelling from an overuse injury can be severe, and while it is usually not serious, it can potentially be debilitating.

Guidelines for Safe Travel

Traveling over steep or uneven ground can lead to unique stressors on the body’s joints, muscles, and bones. Training for the upcoming outdoor activity will strengthen and protect the body resulting in a more enjoyable and less painful experience. Guidelines for safe travel include preparing and maintaining the body to avoid weakness or stumbling which can cause muscle and bone injuries. Consider what type of terrain will be encountered, and considering how and where the adventure takes place will optimize ways to both prevent and treat injuries. If there is a history of an injured or unstable joint, consider bringing a brace and / or pain medication to be able to continue on with the adventure.


  • Drink when thirsty, which will allow comfortable exertion but not overhydration (see hyponatremia).
  • Take electrolyte supplements and salty snacks.
  • PACKING LIST: Water bottles, water filtration system


  • If planning a new outdoor activity or adventure, train for similar activity, duration, and intensity.
  • If planning on carrying a backpack, train with a weighted pack to strengthen both small and large muscles.
  • If a history of injuries or recent surgery, get approval from a medical doctor prior to embarking on a new outdoor activity.


  • Take proactive rest breaks as needed.
  • There is a much greater amount of energy needed to travel over steep or uneven terrain, so while going downhill is easy, uphill travel is much more tiring than expected.
  • Consider a walking stick or trekking poles to minimize compressive force (and pain) on the knees, especially on steep downhills.
  • PACKING LIST: trekking poles or hiking stick, ibuprofen or tylenol for pain medication.


  • If a history of sore knees or ankles, consider a brace for comfort and support.
  • Consider carrying a bandana and safety pins to improvise a sling
  • If planning on traveling on uneven ground, boots with ankle support can prevent painful twisted ankles. Fit boots in the evening for optimum fit (as feet swell throughout the day), and go on practice hikes and walks to ensure comfort and the footwear do not cause blisters (see blisters).
  • PACKING LIST: well fitted hiking boots, bandana, safety pins.

Sprains and Strains

If an injury is from a twisting motion, a sprain or strain is more common.

A sprain or strain are injuries to the rubber band-like connective tissues (ligaments and tendons) attaching the bones and muscles to each other. Depending on the severity of the tear to these tissues, there may be bruising, swelling, or joint instability. The ability to use that injured area may be based on individual pain tolerance rather than severity of injury.

Treatment Options

  1. If possible, immobilize the injured extremity with a sling or splint to limit movement which will decrease pain.
  2. If available, application of ice, a cold pack, or submersion in cold water can decrease swelling and pain.
  3. The decision to continue on with the activity may be decided by individual comfort to weight bear or use the injured extremity, if tolerable, it will unlikely cause further damage.

Are you or a companion experiencing any symptoms consistent with a sprain or strain?

If yes, launch medical assessment below.


Dislocations are disruption of a joint that results in an oddly shaped joint that cannot be moved with normal range. Dislocations may also be associated with a broken bone. The most common dislocations are the shoulder, finger, ankle, and knee cap.

Dislocations can be remedied with a special technique called “reducing.” Consider reducing a dislocation in the outdoors only if you have specific training in the technique, if the hurt person is amenable to an attempt, and/or if the pain severity makes immediate reduction a necessity.

If it’s an option, reducing should be formed as soon as possible. Delays will generally increase muscle spasms which can make reduction attempts more difficult.

Treatment Options

  1. Perform a reduction only if you have specific training in the technique.
  2. All attempts should be performed with a calm and reassuring voice.
  3. Apply slow, gentle, and constant effort to overcome muscle tension. Avoid sudden jerky movements which can increase pain and resistant muscle spasms. Sharp movements may also decrease the victim’s willingness to allow a second attempt.
  4. If there is pain or resistance, go slower. (think of the reduction movement like a minute hand on a clock, rather than the second hand), while maintaining constant force and a calming voice.
  5. Always check CSM after a reduction attempt to note any changes:
  6. Circulation: healthy pinking of the nail bed after pressure should take less than three seconds
  7. Sensation: dull versus sharp differentiation shows nerves are intact
  8. Movement: range of motion of the joint, which may be limited due to pain, ensure can move fingers or toes of the affected extremity.

Are you or a companion experiencing any symptoms consistent with a dislocation?

If yes, launch medical assessment below.


If the injury is a direct blow or fall, always consider a broken bone or fracture.

A fracture occurs whenever a bone is cracked or broken. To help identify a fracture, look for the following signs:

  • Angulation or movement where no joint exists.
  • Point tenderness on the bone.
  • Often there is an inability to bear weight.
  • Hear or feel the grinding of bones together.
  • Immediate swelling and/or bruising at the point of pain.

Treatment Options

  1. Remove jewelry on the affected extremity, as eventual swelling may make it difficult to remove later.
  2. Pad bony points with soft material.
  3. If the extremity is weight-bearing and usable, it is more likely a sprain/strain. Apply a compressive wrap for pain relief.
  4. If the extremity is not weight-bearing or unable to use due to pain, suspect a broken bone and apply sling or rigid splint to minimize movement and pain.
  5. Check CSM of the toes or fingers before and after splint application.
  6. Circulation: healthy pinking of the nail bed after pressure should take less than three seconds
  7. Sensation: dull versus sharp differentiation shows nerves are intact
  8. Movement: range of motion of the joint
  9. If there is open bone, irrigate copiously with drinkable water, apply antibiotics ointment if available, and securely cover with clean material.

Slings and Splints

Slings and splints may be used to help alleviate pain and help prevent further injury. The goal is to immobilize joints above and below the injured site, ideally in a natural position.

  • Wrist: Splint in position like holding a can.
  • Ankle/Elbow: Splint in a 90 degree angle, secure firmly but not tightly.
  • Collarbone: Immobilize the affected extremity with a sling, and can further minimize movement of the arm and pain with application of a swathe over the sling. A swathe is a band of material that circles over the arm and around the trunk.
  • Fingers: Broken fingers can be buddy-taped together.
  • Rib fractures: Broken ribs or the strain of the connective tissue between the ribs hurts. Wrapping a 3-4” wide circumferential band of material tight around the trunk over the injured site effectively buddy tapes the ribs and can minimize pain.
  • Lower leg: Apply a rigid splint on either side of the injured area. Make sure to put padding between the bones and the splint.

Do you need help creating a sling or splint?

If yes, launch medical assessment below.

Emergency Red Flags

Keep an eye out for the following symptoms. These red flags may be cause for evacuation.

  • Any patient with an irreducible dislocation.
  • Any patient with altered CSM before or after reduction.
  • Any unusable musculoskeletal injury, whether a suspected sprain, strain, broken bone, or dislocation. Either due to pain or joint instability.
  • Any open fracture with bone visualized either in or sticking out of the wound.

Are you concerned about a muscle, bone, or joint injury?

Download GOES to launch a digital medical assessment or speak with a wilderness medicine physician.