Where's the Rub?
It's Only Skin Deep —
Coping With Chafe and Blisters
By Tamia Nelson
tamia@paddling.net
January 3, 2006
We've all suffered from them. I'm talking about
chafe and blisters. While they're only close cousins and not fraternal twins,
they still have a lot in common. Both originate "where the rubber meets the
road." Both are painful, sometimes exquisitely so. And both can lead to
something worse if not cared for promptly — and properly. As it is,
either one can turn a pleasant paddling excursion into agony. Yet they're
both preventable. How? To answer this question, it helps to begin by…
Looking Beneath the Surface
The human skin is a remarkable organ, flexible, elastic, and
self-renewing. But it's also vulnerable. Tough yet tender, in other words.
And — with a nod to Rodney Dangerfield — it don't get no respect.
Like cyclists and climbers, we paddlers soon learn that our muscles won't
perform if we don't keep them in condition between outings. So we sweat to
stay in shape through the winter
months, and we train for long trips. But though our muscles may be hard
when we get to the put-in, our skin is often soft. In short, we take our skin
for granted. Until it begins to hurt, that is. That's when we notice it.
We should pay more attention, much sooner — before the pain starts.
Structured, composite materials get a lot of buzz in paddling circles, after
all, and our skin beats the best of the bunch. From the horn-like scales of
the stratum corneum (the outermost layer of the epidermis and our
body's first line of defense) to the highly vascularized corium, or
dermis, whose projecting papillae lock epidermis and dermis together, our
skin is a study in organized complexity, constantly reengineering itself to
meet new environmental challenges. Given enough time, it will even harden to
withstand the demands of accelerated wear and tear. Unfortunately, paddlers
are often in a hurry to get stroking, and…
There's the Rub
Pressure and friction. Damp and heat. That's the recipe for chafe. And
chafe is the bane of runners, cyclists, and paddlers, particularly sea
kayakers. A tight wetsuit. A hot day.
A hard seat. A long
crossing. Sweat and sand and
salt water. Before you know it, your bum's red and raw. Keep going for a
little while longer, and it'll be covered with small sores. And by that time
you'll be mighty sore, too. Of course, chafe is happy to attack anywhere
there's a target of opportunity. Maybe your paddling jacket has a stiff, high
collar. No? OK. Then perhaps it's a little tight under the arms. You'll soon
find out. Or maybe you just crossed a three-mile portage in snug-fitting, wet
jeans. Now you know why cowboys walk the way they do in the movies. Chafe
doesn't need to be invited twice. It makes itself right at home as soon as
you open the door. Amphibious
paddlers face double trouble. Bicycle seats rub all the places that kayak
seats spare, and hauling a
trailer full of paddling gear behind a bike is hard, sweaty work. With a
little (bad) luck, you can experience 360 degrees of misery below the waist
in no time at all. It's no fun.
Is there any good news? Yes. You can't stop the rain
from falling or make the
blackflies go away, but…
Chafe Can Be Prevented
A little painful experience will tell you where your most vulnerable bits
are. Now go on the attack. Pressure and friction. Damp and heat. These are
your enemies. Take the pressure off with seat pads and properly sized
clothes. The amphibious brigade of paddling cyclists — it's more like a
corporal's guard, really, but our numbers are growing — have a
not-so-secret weapon: bicycle shorts. These tight-fitting Lycra numbers boast
synthetic "chamois" pads that make a hundred-mile day on a rock-hard bike
seat almost painless. They also take the sting out of some whitewater
saddles, and they're not bad on a touring kayak seat, either. (I'm partial to
the LiquiCell® chamois myself. It holds less water than foam.) Next,
fight friction with something slick. Experiment. Some paddlers go for dry
lubes like talcum powder. Others prefer slippery goo. Petroleum jelly and
coconut oil are popular choices, and Bag Balm®, long a favorite with
cyclists, works for paddlers, too. Whatever you use, apply it as often as
necessary to keep things sliding smoothly.
Damp and heat are harder to combat. One expert kayaker simply advises you
to "avoid sweating." That's a good trick. I wish I could manage it. No, I
don't. Heat stroke is worse than chafe any day. So what is the best
course? Slow down. Ventilate when you can. Stop often and air-dry your sweaty
bits. Keep both your body and your clothes as clean as possible. Wash in fresh
water daily, but don't scrub! You don't want to damage intact skin. Use a
mild soap or detergent, never a harsh soap, and pat yourself dry. Your
clothing choices matter, too. Wool is wonderful stuff, yet many paddlers
start to chafe just looking at it. They're better off with wicking
polyester.
But what happens when you miscalculate, or when an approaching
storm (or a can't-miss rendezvous with a floatplane) forces you to ignore
the early warnings? It's too late for prevention now. You're already red and
raw.
What Next?
Stop as soon as you can. Wash the affected area gently with mild soap or
detergent. (NO scrubbing. Remember? And no rubbing alcohol, either.) Air dry.
If the skin is broken, cover with a sterile, nonadherent dressing. Then keep
the area dry and clean until it heals. Be patient. Healing takes time.
I told you that prevention was better than cure, didn't I? And that's true
of another commonplace evil, as well:
Blisters
Friction blisters, that is. (Don't confuse these with the blisters
caused by plant poisons and burns.) But while blisters and chafe share a
common cause — friction — they're not the same thing at all. Chafe
favors the neck, trunk, inner thighs, and bum, while blisters pop up in
places where taut skin lies close over bone. Feet and hands are the usual
victims. Here's where the wonderfully intricate structure of our skin becomes
its…er…Achilles' heel. Friction tugs at the skin, but the bone
anchors it firmly in place. Guess what happens next. The skin starts to
delaminate, that's what. The layers pull apart. Then fluid fills the gap, and
a blister is born. Chafe and blisters have a few more things in common than
friction, however. Both thrive on damp, heat, and pressure. Once again, it's
active folks who suffer most: outdoor workers, paddlers, runners, hikers, and
cyclists. Still, like I said earlier, it's easier to prevent blisters than it
is to treat them. So let's begin by looking at ways of…
Stopping Blisters Cold
The stratum corneum of hard-working skin thickens into a protective
callus. Though a callus that's grown too thick can cause trouble on
its own, tender feet and soft hands invite blisters. (Not for nothing were
novice cowboys called "tenderfeet.") The lesson for canoeists and kayakers is
obvious. Build your paddling time gradually. The same goes for other sports.
Walk (or run or cycle) a little further each day than the day before. Your
calluses will grow apace, and when you reach the put-in for the start of your
Big Trip your skin will be as hard as your muscles. Some paddlers (and many
cyclists) try to hurry the process along by rubbing their feet and palms with
alcohol or immersing them repeatedly in cold water. Unfortunately, it doesn't
work. At least it doesn't work for me. Hikers — and all paddlers
are hikers, at least some of the time — who dread blistered toes and
heels sometimes soak new leather boots in water and then walk them dry,
believing this will break them in. But such drastic treatment is usually
neither necessary nor helpful. It's a relic of the days when military
contractors skimped on material, cutting the uppers of marching shoes too
small. Soaking the tight footwear gave the hapless infantryman a fighting
chance of stretching his boots to size. Durability suffered, but that wasn't
a primary consideration. Modern fabric
and leather boots don't need this sort of kill-or-cure approach, however.
If they're going to fit, they'll fit right out of the box. (If they don't,
exchange them for a pair that does.) And what about the increasingly rare
all-leather boot? As cyclists wedded to leather Brooks saddles have long
known, there's just no substitute for a gradual break-in. You get a bonus,
too: your feet get tougher at the same time. It's a win-win scenario.
A few things make the process less trying. Taping blister-prone areas can
help — some old woodsmen sing the praises of adhesive-backed felts like
moleskin — and liberal dustings of talcum powder can reduce friction. It
also helps if your socks are free from lumps and seams. Keep them clean, too,
and change out of wet socks as soon as possible. Gloves
provide comparable protection for the hands. And if a hot spot develops, act
immediately. Find the cause and correct it. If you haven't taped the area,
now is the time to do so, before a blister forms.
But what if all your efforts come too late? It happens. Then it's…
Off to the Surgery
Before venturing further, however, please read and heed this timely
WARNING: I'm not a doctor, and while I've drained blisters many
times without untoward incident, you may be less lucky. Diabetics, in
particular, must exercise extreme caution in caring for any injury to their
feet. They should consult a doctor before attempting self-treatment. In fact,
that's very good advice for everyone!
Always try to preserve the blister's "roof," the dome of skin across the
top. If this roof tears away, healing will be delayed and the risk of
infection increased. Happily, if you catch a blister early, before much fluid
has collected, it may be enough to compress the dome, forcing the roof back
into contact with the living skin beneath. A tight, nonadherent bandage
should do the trick. On the other hand, if a blister is already swollen and
painful, elementary field surgery may be the only way to preserve the roof
more or less intact. Opening the blister and draining the accumulated fluid
won't just lessen the pain, it will also permit the roof to collapse. With a
little luck, and a well-placed pressure dressing, the roof may even reattach,
greatly speeding the healing process.
This operation — and it is an operation, however minor it may
seem — requires great care. The resulting opening can easily allow
infectious organisms to gain a foothold in a favorable environment. To make
sure the odds are in your favor, do your best to keep things clean. I scrub
the blister and surrounding skin with an alcohol prep pad, and use the tip of
a prepackaged sterile surgical blade from my medical kit
to do the cutting. (On several occasions, I've even used a needle from my
ditty bag or a sharp
penknife, but since alcohol can't be relied upon to sterilize a blade,
and flame sterilization may destroy the temper of good steel, I do not
recommend this.) When the alcohol has dried, I carefully pierce the roof
of the blister near its base, allowing the fluid to drain away. Once the
drainage is complete — gentle pressure with a sterile gauze pad may be
necessary here — I bandage with a snug, nonadherent dressing. I then
take great pains to keep the area clean and dry.
And what if you've left it too late? What if the roof of the blister is
torn away? All you can do then is clean the wound, protect it with a sterile,
nonadherent dressing — Spenco Second Skin® is a favorite — and
hope for the best. So far, I've been fortunate. I've never had an infected
blister. If, however, despite all your care, any of the classic signs of
infection appear (redness, swelling, pain, or fever), seek competent
medical assistance immediately. In a remote area, of course, you may be
on your own. That's when you'll be glad you sought your physician's advice
before you left for the put-in. You'll also be thankful that you have a good medical
handbook in your pack.
Where's the rub? Where the action is, of course. Chafe and blisters may
only be skin deep, but they bedevil outdoor workers and recreational paddlers
alike. And they can ruin a trip in a hurry. Don't let this happen. There's
truth in the old saw. Prevention really is better than cure — and it's a
lot simpler, as well!
Copyright © 2006 by Verloren Hoop Productions. All rights
reserved.