Three Things Dr. Sarah Realized While Trekking the Inca Trail

It’s been about two weeks since I returned from trekking the Inca Trail. I’m mostly reacclimated (let me tell you, having a real toilet is AMAZING), and I’ve had ample time to reflect on the trip (12 hours on a plane to get home will do that). After reflecting, I came to three main observations that stuck out to me about the experience.

  1. Peruvians Have Impressive Physical Fitness For Trekking
  2. The Narrative Around “wear and tear” is Universal
  3. Despite Having Physical Pain, Most Do Nothing Productive About It

Also, if you’re curious, I would definitely recommend the trek, just be prepared to be quite uncomfortable. Now, let’s dive into each of these three things in more detail.

1. Peruvians Have Impressive Physical Fitness For Trekking

Here’s the thing – I thought I was in pretty good shape. I can run a sub eight minute mile, I can front squat 200#, and I’m currently training for a half marathon. However, my physical fitness paled in comparison to how fit our porters were. It was a humbling experience to be gasping for breath while carrying twenty pounds when our porters ran (yes, RAN) past us carrying fifty pounds.


I’m sure they were more acclimated to the altitude than we were (I don’t recommend arriving at 10,000 feet a mere 17 hours before trekking through a mountain range), but I couldn’t help but be impressed. The Inca Trail was one of the most difficult physical things I’ve ever done and they routinely do this 3-4 times per month!

In addition to the physical fitness of the porters, trekking the Inca Trail gave me an appreciation for how fit the Incas must have been to carry the stones that lined almost the entire trail. Carrying my pack alone was difficult, but the fitness required to transport the stone necessary to build the trail and the cities is beyond my comprehension.

2. The Narrative Around “wear and tear” is Universal

The second thing I noticed was that even in remote areas of Peru, the old adage of “wear and tear” exists with a vengeance. At Resilience, we try to dispel that as there is a plethora of research that shows gradual overload (slowly lifting heavier weights or running further distances) improves tissue health and makes you more fit. It does not destroy your body or cause it to gradually break down. However, the narrative around too much activity wearing things down is strong.

Now, there are nuances to this. If you perform a repetitive task without a sufficient prior level of fitness to accomplish the task, you’re likely to get injured. This is because you are asking more of the specific structure (whether it be a muscle, tendon, bone, or ligament) than it is able to provide you with. Consistently overloading a structure does lead to injury. This is what a lot of people are actually talking about when they talk about “wear and tear.”

The Overuse Example

A common example is a factory worker who needs a rotator cuff surgery after years of overhead lifting. However, during his time at the factory, he never did any rotator cuff strengthening to make sure his rotator cuff was working properly while he was lifting overhead. And, odds are the factory worker did not start the job with the necessary amount of rotator cuff strength to complete the task without placing undue stress on the rotator cuff.

Therefore, this individual went to work day in and day out, consistently overloading his rotator cuff (because it wasn’t strong enough in the first place). It’s not a surprise that surgery was eventually necessary. You can’t keep beating something up, not give it sufficient recovery, and expect things to go well.

The “My Athletic Days Did It To Me” Example

Another narrative we often hear in our culture goes something along the lines of “I played competitive sports when I was younger and I beat my body up so bad I now need surgery to undo the damage.” We’d also like to dispel this myth. When someone says something similar to that, the reality of the situation is usually different.

Too Much, Too Soon

What really goes on is the individual was previously in good shape, did sustain some injuries, but since has had a significant decline in their health and fitness. However, they forget they are no longer in their twenties and try to do what they previously did (but are nowhere near fit enough to do it now).

This either looks like going too hard from the beginning or progressing too quickly for their body to keep up. It’s not that they had extensive wear and tear, it’s that they don’t understand that their body has changed and they need to modify based on those changes (and mentally come to terms with them).

A lot of the time, this looks like typical middle-age injuries (Achilles rupture, early-onset arthritis, lateral hip pain, generalized low back pain, rotator cuff/impingement/bursitis, and more). The unfortunate reality is that it’s not the wear and tear from twenty years ago that did it. (If it was, you would have started having these symptoms in your twenties, not now). The reality is that those injuries all revolve around improperly loading the body.

Not Enough At All

What we just discussed revolves around someone who does too much when they try and be active. What about those who simply develop these “athletic” injuries without being active?

Well, the uncomfortable truth is that they aren’t active enough to stave off injuries. The large majority of injuries in America are due to people being out of shape or not strong enough. In fact, when I worked at a hospital, I ran a mini-experiment (nothing that would hold up in a research lab, but an experiment nonetheless).

Instead of being incredibly specific about injuries for individuals who were largely deconditioned, I simply did general strengthening. Low back pain? We strengthened the core and legs. Shoulder pain? We strengthened the arms and upper back. I tried to throw some general cardiovascular conditioning in too, but this didn’t go over too well (no one wanted to do it).

So, what happened? Everyone who did the strength training got better. It wasn’t rocket science. Deconditioning can cause injuries just as easily as overtraining.

Recapping a Mini Tangent

There’s a lot at play with this narrative. Mental health, the nature of our healthcare system to take a mechanical approach to a biopsychosocial being, and procedure-based billing are all at play. It’s a difficult topic to tackle, but simply acknowledging it is a start.


3. Despite Having Physical Pain, Most Do Nothing Productive About It

I was not shocked at how many people were sore or developed traveler’s diarrhea (I think everyone got both) while we were trekking. However, what I was shocked by was how most did nothing about their soreness. 

If It Hurts, Do Something About It

There were many people who wore knee braces during the trek. This made sense to me as a knee brace often will make a cranky knee more comfortable. The part that didn’t make sense was the comments I heard from those wearing the knee braces. It wasn’t uncommon to hear “My knee has hurt on and off for the past three years. I wasn’t sure I’d be able to make this trip. It’s really hurting now, but I think I’ll make it.”

If my knee had been hurting on and off for three years and was limiting my ability to do things I love, you could be sure I would have done something about it. After dealing with it for a few weeks I likely would have sought out some help (assuming I couldn’t figure out what was going on myself). I certainly wouldn’t have been willing to avoid doing things I enjoy for three whole years and then still have done nothing, especially with such an important trip coming up!

This blew my mind and opened my eyes to how people can think. I know my pain is solvable (if I put effort into it) and because of that, I do something about it (usually, I’m not perfect). But, I suppose, if I believed in the narrative of “wear and tear” or that some people were simply born with “bad joints”, I don’t think I would do anything about it – because it’s normal, right?

Common Doesn’t Mean Normal

Experiencing pain or incontinence on a consistent basis may be incredibly common, but it’s certainly not normal. And, there’s a lot that can be done about it. In retrospect, the fact that most people don’t know this or believe it to be true saddened me.

There’s so much more life and experience that awaits these individuals if only they knew something different. I also thought trekking the Inca Trail was hard enough without knee pain. Adding that to the experience would have made it even more difficult!

Wrapping Things Up

Overall, I loved trekking the Inca Trail. It was an amazing, culturally-rich experience that was more than worth the intense exhaustion. Seeing the world through different perspectives – in regards to culture and beliefs about the human body – is important and continues to push me to grow and learn. The question I am left with is, where do I go trekking next?

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