Preparing for the Sabarimala trek: a physiotherapist's guide

The usual route from Pamba to the Sannidhanam is a few kilometres of steep uphill path and steps, climbed in crowds, often at night or in the early morning. The traditional forest routes from Erumeli and elsewhere are far longer and take a day or more of walking.

Climbing up works the thighs, calves and lungs hard. Coming down is harder on the knees: every step down puts several times your body weight through the front of the knee, and tired thigh muscles absorb less of it.

Many devotees walk barefoot for weeks during the vratham and on the trek itself. Feet that are used to footwear are not ready for this, and heel pain, blisters and cracked heels are common. The irumudi carried on the head also adds load on the neck and upper back.

Weeks 1 and 2: walk 30 minutes a day on flat ground, and climb stairs for 10 minutes, going up slowly and coming down with control. Start the strengthening exercises below, every other day.

Weeks 3 and 4: walk 45 minutes, including a slope or a hill if you have one nearby, and climb stairs for 15 to 20 minutes. Practise one longer walk of an hour or more on a weekend. Continue the exercises.

If you are over 50, have diabetes, heart disease or high blood pressure, or have not exercised in years, see your doctor before you start and before you travel. The climb is steep enough to strain the heart.

Build up gradually. Start with 10 to 15 minutes barefoot on smooth ground at home and increase over two to three weeks, rather than going from shoes to long barefoot walks overnight.

Stretch the calves and the sole of the foot every day. Tight calves are a common reason for heel pain when walking barefoot.

Look after the skin: moisturise cracked heels at night, keep nails trimmed, and check your feet every evening. If you have diabetes or reduced feeling in your feet, talk to your doctor before walking barefoot, as small cuts can become serious.

Pace yourself. Climb slowly and steadily, take short rests often, and drink water regularly. It is not a race, and rushing in the crowd is when people fall or feel unwell.

Take smaller steps going down, keep the knees slightly bent, and use the railings or a walking stick if you have one. Going down sideways for short stretches can ease painful knees.

Use the medical aid posts along the route if you feel chest pain, breathlessness out of proportion to the effort, dizziness or palpitations. Do not push on.

Knee arthritis does not have to rule out the trek, but preparation matters more. Strengthening the thigh muscles for four to six weeks beforehand makes the climb, and especially the descent, more comfortable.

Plan extra time, travel with someone who can help, and consider the facilities provided for elderly and differently abled devotees. A physiotherapist can assess how your knees cope with stairs and tailor the preparation to you.

Sore thighs and calves for two or three days after the climb are normal. Gentle walking and stretching help them recover faster than rest.

See a physiotherapist or doctor if knee swelling, heel pain or back pain has not settled after a week, or if a knee locks, gives way or swells up suddenly.