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
-Dr. Doscher
http://ergo.human.cornell.edu/ErgoPROJECTS/97projects/coffiner.htm
