PDX Monthly has named Dr David Westerdahl one of Portland’s Top Sports Medicine Doctors for 2024. He is the only Doctor in that group recognized by his peers who is not part of a large medical group.

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Hiking for health

On a recent family trip to Glacier National Park, where we spent a large amount of time and energy hiking and enjoying the outdoors, I was amazed at the beauty, fun, effort, and dangers of hiking.  We had a wide ranging group of “hikers” in that some were old, some young, some willing to sleep in their car wearing all their gear in order to be the first on the trail the next day, while others wanted to sleep in and have their coffee before heading out to the easiest trail with the assurance of a great view that would make the hiking effort worthwhile.  While we hiked at different speeds and distances, we all enjoyed the experience.  Other than a couple of blisters, sore legs, and mild sunburn, we were fortunate not to experience any significant injuries. 

Hikers can encounter a wide range of environmental challenges that are important to prepare for to have a fun time and avoid injuries.  From hot to cold, wet to dry, depending on the time of year and terrain.  One of the most important decisions a hiker makes is to layer clothing correctly to stay cool/warm and avoid hypothermia and hyperthermia/heatstroke. 

Mild hypothermia can occur when the body temperature drops at least 2 degrees Celsius below normal. Commonly, this results in shivering, speech changes, coordination loss, and poor judgement.  Mild hypothermia is treated by removing wet clothing and replacing with dry clothes, insulating the person with blankets or other materials, and if they can swallow, drinking warm noncaffeinated beverages.

In my sports medicine career, I’ve seen several instances of hypothermia when covering running races in cold weather.  One particularly memorable one was when the runners got rained on while waiting for the race to start.  By the time some of them finished the race, they were experiencing mild hypothermia.

Another scary medical situation when covering a race medical tent or hiking in the wilderness is heat illness.  There are many risk factors for heat illness including high heat and humidity, dehydration, muscular exertion.  Age also is an important factor as the very young and older adults can be at greater risk of heat illness.  For those hiking in hot conditions, preparation and consideration of those in your hiking group is important.  Planning to have access to plenty of water, shade, and opportunities to cool down can help keep the hike fun and reduce the risk of heat related complications like heat cramps, heat exhaustion, and even heat stroke.  Heat stroke is a true emergency that can be deadly and requires rapid cooling.  I’ve encountered some of the most fit and prepared individuals suffering from heat stroke during fall football practices and race medical tents.  The ability to recognize it and rapidly cool the person is critical while simultaneously working to evacuate them. 

Foot and ankle injuries are common when hiking on trails due to the uneven, unstable, and steep terrain. Ankle sprains can happen for many reasons and are common injuries that bring hikers into our sports injury clinic in Portland, Oregon.  Sometimes what looks like an ankle sprain can actually be a more serious injury such as an ankle fracture, foot fracture, or midfoot sprain.  If you are on the trail and experience an injury to your foot or ankle, and are unable to weight bear, you may have a broken bone.  If you can weight bear, look to use a pole or stick for support and even consider taping or wrapping your ankle for stability until you are able to seek medical care.  A sports injury specialist can help you manage your ankle sprain or fracture and get you back to hiking and sports quickly.  

Because hiking involves a lot of uneven terrain and up and down hill walking, this creates additional stress on our knees especially the kneecap (patella) area along the front of the knee.  When walking up or downhill, there is intense pressure under the patella and this can contribute to knee pain and knee injuries.  Anterior knee pain is quite common in hikers and can be due to patella instability, patellofemoral maltracking, or patellar tendonitis.  Some initial ways to treat knee pain during a hike include rest, taking ibuprofen, using a knee elastic wrap, and using trekking poles to absorb impact.  Once you’re back home, seeking medical attention is important.  At Sports Health Northwest, our sports injury doctor can help you treat and prevent future knee injuries. 

Another common hiking injury affecting the arms is related to falls.  Its relatively easy to take a tumble when hiking and falls onto an outstretched hand can result in an injury to our wrists and elbows.  Fractures of the radius and radial head area of the elbow can commonly occur with a fall.  Also, sprains of the hand and wrist can result and benefit from early diagnosis and treatment.  If you’ve had a fall and notice pain and swelling along your wrist and hand, try to immobilize the area, rest, and seek medical care with a sports injury doctor. 


Whether you have the Alltrails pro membership and post about your frequent hiking experiences or you simply enjoy a leisurely walk in the woods, Sports Health Northwest wants to help you stay healthy and be at your best for that upcoming hiking adventure. 

Dr Westerdahl David Westerdahl MD FAAFP RMSK Sports Medicine Physician and owner Sports Health Northwest, Inc.

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