Medical Advice

Preventing aches after a walk

If you do not walk often, you may experience aches after a walk, probably that evening, that night or the next day. A way to reduce these is by doing a few stretching exercises. The exercises are chosen to be done standing up, possibly at the end of the walk, and require a solid wall or similar for support. These simple stretching exercises should only be done, if you have already warmed up, so should not be done cold at the start of a walk.

Standing quadricep stretch

(The quadricep is the large muscle at the front of the thigh.) Put your left hand out against a wall for support, though if you can balance a wall is not necessary. Stand upright on your left leg and then, with your right thigh straight down, bend your right leg at the knee, so that your right foot almost touches your right buttock. Grab your right foot with your right hand and pull it even closer to your buttock. Hold this position for about 15 seconds. Swap legs and repeat the exercise.

Standing calf stretch

(This exercise stretches the gastrocnemius, the largest muscle of the calf, which is attached to the Achilles tendon in the heel. It is especially useful for people who wear high heels.) Stretch both arms out and place both of your hands against the wall for support. Put one leg in front of you and one behind. Now keeping the rear leg straight, bend the front leg at the knee and lean towards the wall, bending your arms as you do. Ensure that you keep both feet flat on the ground. You should feel tension in the calf muscles of the extended leg. Hold this position for 30 seconds. Repeat the exercise with the other leg behind you.

Standing hamstring stretch

(A hamstring is one of five tendons at the back of the knee.) Stand up straight facing the wall and put one leg out straight before you, resting it against the wall. Now slowly bend the supporting leg, so that your body is lowered, until you feel a stretching in the back of the thigh of the raised leg. Hold for 15 seconds. Repeat, switching positions of legs. (Note: instead of bending the supporting leg, you can get the same stretching effect by leaning forward with your upper body kept straight.)

Recognizing Strokes

(Information presented here has been vetted by a qualified doctor of medicine.

You can go to St John's Ambulance - life saving for more advice.)

If someone falls over in the fells, other ramblers will most likely think that the person has lost his/her footing. However, there is a slight possibility that the person has suffered a stroke* instead, which can eventually lead to severe brain damage, especially if the stroke goes unrecognised.

Firstly, if the patient is on steeply sloping ground, make sure the patient and those attending are as safe as possible by reducing the chances of a serious fall, even if it means moving the patient to flatter ground.

If the person seems dazed or unsure, bystanders can use the following procedure, which is relevant anywhere, not just the fells. Three simple questions, labelled S,T,R, (the first three letters of the word 'stroke') should be asked.

S stands for SMILE. Ask the person to smile. (You can also ask them to STICK out their tongue.

If the tongue is crooked and/or the face goes to one side, this is a sign of a stroke.)

T stands for TALK. Get them to talk by asking them to repeat (coherently) a simple sentence, such as 'It is sunny out today.'

R stands for RAISE both arms.

If the person has trouble with any one of these tasks call 999/911 as soon as possible and describe the symptoms. If a doctor can give the person medical care within 3 hours of he/she having a stroke, there is a fair chance the effects of a stroke can be reversed. However, time is of the essence.

*A stroke can be due to a blood clot blocking one of the the main arteries to the brain, an air bubble or fat globule being carried in the blood stream to the brain or a haemorrhage from a blood vessel, either inside the brain or on the surface of the brain. The latter causes pressure to build up on the brain as blood collects between the brain and skull.


Recognizing a heart attack

(Information presented here has been vetted by a qualified doctor of medicine.

You can go to St John's Ambulance - heart attack for further information.)

The warning signs of a heart attack* are:

a persistent crushing pain in the centre of the chest, which does not go away with rest. It can wrap around the body like a tight band and may spread to arms, especially the left arm, throat, back or abdomen, being short of breath even after rest from any exertion on the walk. feeling sick, dizzy or faint excessive sweating. pallor (i.e. complexion much paler than usual).

If you suspect someone is having a heart attack, help them relax and sit them down. Do not give them food or drink. Then go through the procedure already detailed above in the case of an accident by ringing 999 and asking for 'Police', giving name of location and grid reference. They may need rescuing by air ambulance. Don't waste time!

*A heart attack is often caused by the breaking away of plaque (a chalky deposit) which has built up inside the coronary artery. This causes a blood clot to form, which may be large enough to reduce severely the supply of oxygen-rich blood to the heart muscle, leading to it being damaged and eventually dying.


Recognizing cardiac arrest

(Information presented here has been vetted by a qualified doctor of medicine.

The links in this section are to relevant parts of the St John's Ambulance web site.)

If a person collapses, stops breathing and the heart stops pumping, then the person has suffered cardiac arrest *.

Firstly, if the patient is on steeply sloping ground, make sure the patient and those attending are made as safe as possible by reducing the chances of a serious fall, even if it means moving the patient to flatter ground.

Time really is of the essence and so it is important to get various members of the walking party to work as a team. Hopefully there are some who have cardio-pulmonary resuscitation (CPR) training. These should stay with the patient and immediately start the procedure detailed below in order to buy time, while every effort is made to bring qualified help with a defibrillator to the patient.. While the CPR is being carried out,

  • a competent map reader should quickly ascertain the grid reference of the patient's location. (A GPS receiver will be even quicker, if it already has satellite contact.)

  • A member of the party, with a mobile phone, should try to ring 999 and ask for 'Police' giving details of the patient's condition and location, including the grid reference if possible. The urgency of the situation must be emphasised. Hopefully, an air ambulance may already be in the vicinity.

  • If communication cannot be made, because of poor reception, a problem often encountered in the fells, then two or three of the fittest walkers should try to get to the nearest farm house, where communication by fixed-line may be available. Also consider taking a mobile phone to a nearby high point and try ringing from there. Don't make the matter worse, though, by taking unnecessary risks.


Cardio-Pulmonary Resuscitation procedure

The description that follows gives the latest basic CPR procedure for those who have already been trained in it but may feel they need to refresh their technique.

  1. Turn the patient on his/her back.

  2. Open the airway by placing a hand on his /her forehead and gently tilt the head back and then lift the patient's chin with the fingertips.

  3. Check for normal breathing, e.g. look for chest movement and listen for breathing sounds for a period of at least 10 seconds. If breathing is normal, try to find a flat area where the patient can be put carefully into the 'recovery position', i.e. lying on his/her side with the upper leg in front of the body, bent at right angles at the knee, which should be touching the ground. This prevents the patient rolling on his/her face. Now tilt the head back and lift the chin, propping it up, if necessary, so that the airway remains open. Then check breathing. (In hilly/rocky areas you may need to prop up the body, perhaps using spare clothing or even rucksacks. Spare gloves or other clothing could be placed under the patient's face to give protection from rough ground but make sure the airway remains clear.)

  4. If the patient is not breathing, start CPR.

    • Kneel at 90 degrees to the patient's side and place the heel of one hand in the centre of patient's chest with the other hand on top and then interlock the fingers. (Do not apply pressure on ribs, abdomen or breastbone. The diagram below shows how the hands interlock. In this case, the right hand is above the left but the positions can be reversed to suit yourself.

    • Position your shoulders vertically above the patient's chest and apply 30 compressions at a rate of just under two compression per second (100 per minute). Apply pressure via the heels of the two hands. The time of each compression and release should be equal, the chest moving about 4 - 5 cms (1½" - 2"), with the hands staying in contact throughout.

    • Open the airway using head-tilt and chin-lift and then close the patient's nose by gently squeezing it between thumb and index finger,

    • Take a normal breath and placing your lips around the patient's mouth so that you have a good seal, blow steadily into his/her mouth. Take about one second to make the chest rise and then take your mouth away. When the chest has lowered, repeat the process once more, so that 2 'rescue' breaths are applied.

    • Repeat the cycle of 30 compressions and 2 'rescue breaths' for 5 cycles and then have another rescuer take over, if possible. Changing rescuers helps prevent tiredness building up too quickly. Keep swapping between rescuers until exhaustion sets in or until qualified help, (an ambulance with a defibrillator), arrives.

  5. Hands only CPR

    For hygienic purposes or for those inexperienced performing the recommended method of CPR, the rescuer(s) may prefer to withhold mouth to mouth 'rescue' breathing, in which case continuous chest compression at a rate of 100 per minute or just under 2 per second, has been proved effective and should certainly be tried rather than do nothing at all. If the mouth of the patient is injured or cannot be opened, then mouth to nose 'rescue' breathing can be tried. In this case open the airway as before but keep the patient's mouth closed and blow steadily into the nose, keeping a tight seal with the lips.

* Cardiac arrest often occurs when the large pumping chambers of the heart (ventricles) quiver rapidly or irregularly due to damage to the heart's electrical system. Critically, this leads to little or no flow of blood to the body and, more seriously, to the brain.


Preventing Lyme disease

Lyme Disease or Borreliosis is a bacterial infection which is transmitted to humans by tick bites. Ticks are external parasites from the arachnida family (8 legs) of which 15 species attack humans in Britain. Ticks are not uncommon in urban environments but ramblers should be especially aware of them where deer, bracken or long grass is prevalent. This is because deer are used by a large proportion of ticks to complete their life cycle, while bracken and long grass hide the ticks and help keep humidity high so that ticks flourish. Wearing shorts in such habitats is foolhardy. Instead wear gaiters, tuck trousers into socks and, when walking through tall vegetation, have elastic/drawstrings at waist and wrists. Afterwards check hair as ticks can hide underneath it.

The incubation period of the disease is 3 to 30 days and early symptoms are a single expanding (bull's eye) rash in 50% of cases. Later, a combination of swollen glands, fever, sore throat and aching joints can occur. Sometimes vision loss, respiratory problems and even paralysis develop. Early treatment with tetracyclines or amoxicillin over a period of 4 weeks is usually successful but once an infection is established therapy is more likely to fail. Clearly prevention is better than cure. If you are bitten by a tick, do not touch it directly. Put on latex gloves or if unavailable protect the fingers with tissue or paper. In particular, don't squeeze or twist it as this could cause infected fluids to pass from the tick to you and may leave mouth parts embedded. Instead remove it carefully by placing fine tipped tweezers between its body and the hosts skin and lever the tick away from the incision. Further details and diagrams on how to do this and other information on ticks are on bada-uk's web site. If you remove a tick, save it for identification purposes in a sealed plastic bag and store it in a freezer, just in case you become ill some weeks later.