Wednesday, January 14, 2015

Shoveling and Low Back Pain

It’s that time of year again here in the Northeast. Temperatures have dropped, snow has started falling in sheets, and it seems like every other day we’re outside bundled up in our winter gear trying to clear that snow out of the driveway and off the front steps. It’s an inevitable part of living in Massachusetts. Injuring yourself while making sure you can get out of your house and off to work, however, doesn’t have to be. As a chiropractor in Boston and a resident of this very cold state, I can tell you it is this time of year that brings more people into the office with household-related injuries than any other season. The ‘simple’ (read: rarely simple, usually exhausting, and hardly ever fun!) act of shoveling snow ends up injuring more people each year than even I can believe!

A recent study published in the American Journal of Emergency Medicine reported an average of 11,500 shovel-related injuries in the ER each year. While fractures, cardiac events, and cuts or bruises were all identified as reasons for seeking medical attention, not surprisingly low back injuries were among the most common. Approximately one third of the injuries reported in the ER were low back in nature! Those low back patients are the very same patients walking through our doors, wondering how they managed to hurt themselves shoveling. Let’s take a look at the most common injuries we’re seeing, and how to prevent them!

How many times have you come in from shoveling and thought, “Wow. I’m going to be sore tomorrow”? No matter how you slice it, shoveling is a form of exercise, and a unique one at that. Like any other form of exercise, if it’s new to you (or perhaps, it’s the first snow of the winter) your muscles are not accustomed to what you’re about to put them through. Let’s start with some general biomechanics:

Each time you bend forward to scoop snow, the muscles of the low back and the hamstrings have to stretch and lengthen to get you closer to the load you’re about to lift. If you continued this forward movement, though, you’d end up face-planting! In order to prevent that, those same muscles have to quickly contract and shorten to stop you after a few inches of forward bending. Now you’ve got snow (ie. weight) loaded on the end of the shovel, a few feet away from your body. Not only do your core muscles have to stabilize you, but those same low back and hamstring muscles have to continue to contract even more forcefully to lift you and the snow upright. Lastly, you’re probably twisting to one side to toss the shoveled snow out of the way. Repeat this stretch, contract, and twist combination another 900 times along the length of a driveway, and you’ve got yourself a workout! (Incidentally, this is probably the WORST way to approach shoveling, but also the most common. We’ll make sure to address good technique shortly J.) This repetition of movement resembles most exercises at the gym, and as a result the muscle fibers of the low back and legs react the same way. Each time the small individual muscle fibers that make up a muscle are stressed during exercise, they are subjected to damage on a microscopic level, aka micro tears. The body recognizes the damage and sends extra blood, nutrients, and waste clean-up to the area to help heal, rebuild the muscle, and make it stronger. A by-product of this is inflammation. Now, inflammation tends to get a bad rap, but (when under control in the right circumstances) it’s actually a very normal and healthy part of healing. Inflammation helps to heal those muscle fibers, but is also perceived by us as tenderness or pain. So, you shovel for the first time this year, or the snow is exceptionally heavy, or you’re out there every hour because it’s falling THAT fast, and you end up sore because it’s new to your muscles in one way or another.

Some muscle soreness is generally not the end of the world, but severe tightness or pain definitely isn’t normal. What you should really be aware of is the potential to cause a true sprain/strain injury of the low back by overdoing it. Remember how we talked about a muscle’s ability to shorten and lengthen? Well, sometimes if we stretch too far or too quickly, the muscle tendons or ligaments of the low back can be over-stretched or torn past the point of the normal micro tearing we just talked about. We end up with a sprain or strain. Both injuries result in lots of muscle spasm, excess inflammation, and pain. Lift more snow than you’re used to, or twist to toss the snow aside before your body stabilizes itself, and the next thing you know you’re really injured!

Another potential injury commonly associated with shoveling is a disc injury. Intervertebral discs are the cushions between each bone (vertebra) of the spine, responsible for shock absorption. Think of a disc as the body’s equivalent of a jelly donut; squishy jelly inside, dense dough outside. The jelly inside the donut has room to move around within the confines of the dough as it’s squeezed (loaded) and pressure changes. When we bend one way, the jelly naturally moves in the other direction to relieve pressure. Sometimes, however, if the pressure pushing the jelly around as we move is great enough, that jelly can start to seep into the dough and get pretty messy. In our bodies, when the gelatinous inner substance of the disc (normally contained by the tougher outer layers) starts to push outward, the disc ends up injured and inflamed as it bulges. Less commonly, it can even push through those outer layers resulting in a herniated disc. Despite the amazing ability of these discs to withstand forces, there are circumstances in which they are more vulnerable. For instance, sitting increases the pressure in the disc far more than standing does. The same is true for forward bending. Bend forward with a load, or bend and twist, and you’ve now put your discs in the most stressful positions possible. Sound familiar? Bending forward with your shovel, loading it with heavy snow, and then lifting it and twisting to toss it aside is the trifecta of movements that put the discs at the greatest risk of injury. Injuring the outer layers of the disc can cause immense pain, inflammation, and spasm in the low back. Herniating a disc, however, means nearby spinal nerves or the spinal cord may be affected. Injury to these structures can result in all of the discomfort we just mentioned, plus pain, numbness, and/or tingling into the legs. It’s a much more severe injury to sustain.

Now that we’ve covered all of the big, bad stuff that COULD happen, let’s try to prevent it! Here are some tips for tackling the snow safely:
·      Avoid Shoveling: If you have a snow blower, you’re one of the lucky ones! Use it! If not, please continue reading…
·      Warm Up: We’ve already established that shoveling is a form of exercise. Just like we get our bodies warm before lifting weights, we should be doing the same before shoveling. Take a couple of laps up and down the driveway to get the muscles warm and prepped for activity.
·      Salt/Sand: Use it to make sure you have good footing and balance, allowing your muscles to activate normally. Slippery surfaces make you unsteady and can catch your muscles off guard, leading to injury.
·      Ergonomic Shovels: They make shovels with curved handles and adjustable lengths for people of all heights so you’re not bending as much. While you’re at it, chose a lightweight shovel. The snow is heavy enough!
·      PUSH the Snow: Pushing the snow out of the way instead of lifting it is a lot easier and requires much less bending and stress on the low back. When you have to lift it, try a little less snow.
·      Technique: Start by squaring your body off to the load, keeping it in front of you. Use one hand closer to the blade and one hand near the handle. Keep the low back as straight as possible. Brace your core (imagine someone is about to punch you in the stomach and tighten your abs for protection), bend at the hips and lift with the legs to minimize the amount of pressure on the low back and in the discs. Keep the load as close to you as possible for more control and less strain on the muscles. Instead of twisting and tossing the snow, pivot to where the snow will be discarded and deposit it. This helps reduce the added pressure on the discs created by forward bending combined with twisting.
·      Pace/Rest: Sometimes taking a break makes all the difference. Give your body a chance to regroup, and head back out. Also, instead of trying to lift 12in of snow at once, take a few off the top each time to make it lighter and more manageable.
·      Remember: Heart issues have been reported in association with shoveling and the cold weather. If you have a history of cardiac issues, check with your doctor for clearance. If you notice any cardiac symptoms while shoveling, seek medical attention immediately.

Now, if somehow you still find yourself injured or uncomfortable, there are ways to heal more quickly. Your chiropractor has the ability to evaluate the severity of your injury and treat appropriately. Muscle spasms can be reduced, mobility can be restored, sprains/strains can be healed, and even minor disc injuries can be addressed with various techniques. More importantly he or she should be able to give you the appropriate strengthening exercises once healed, to prevent further injury. After all, it’s a long winter with plenty more snow on the way, and your driveway isn’t going to shovel itself! Stay safe out there!

-Dr. Doscher