By David Freidson | Posted: Monday, January 27, 2014 12:00 am
"The highest function of a specialty is to prevent
that which it treats."
- Jan Jirout, MD, 1956
I have been treating a lot of winter-related injuries this year: Car accidents, slips, falls and injuries from shoveling snow. I'm going to discuss ways to prevent injuries from shoveling snow.
Shoveling snow may seem like a benign enough task, but it can cause great harm to the musculoskeletal system.
In 2001, a study published in the American Journal of Emergency Medicine found that an average of 11,500 shoveling injuries occurred each year from 1990-2006.
The most common injury type that was diagnosed was soft tissue (strains/sprains) injuries, which accounted for 55 percent of the reported injuries. Lacerations were second at 16 percent; fractures at 7 percent and cardiovascular events at 7 percent.
The most common injured region of the body is the low back at 34 percent. Next were the arms and hands at 16 percent.
While cardiac events accounted for only 7 percent of the total number of cases, they were the most serious, accounting for more than half of the hospitalizations and 100 percent of the 1,647 fatalities associated with shoveling of snow.
I am not a cardiologist, but I am going to tell you something that can eliminate cardiac events from the snow removal process. This tip will also eliminate all injuries from the snow removal process.
That is to not remove snow and have a plow service do it. When studying for a chiropractic diplomate in applied ergonomics and occupational health, we learned on day one that the best way to avoid injuries is to have a machine do the work that a human was doing.
I have yet to hear of a plow service causing the home-owner to have a heart attack. I know that a good professional plow service may be cost prohibitive, but if it isn't and you have any cardiac or orthopedic issues, please consider doing this.
I want to discuss a free plow service that is much underutilized: That free service is your child. I'm not talking about the elementary school child, I'm talking about the junior high and high-school children living under your roof.
I often see adult patients who injure themselves shoveling and I know that they have a 17-year-old football-playing child. I ask these patients why they don't have their kid shovel. They often say that they don't want their child to get up early.
To that I say that raising kids is hard work and involves a lot of sacrifice, at least they can enjoy a big benefit of having a child, which is having a live-in shoveling service.
If you can't afford a plow service, don't like the idea of waiting for someone else to come to your house, and don't have a teenage child at home, then the next best thing to prevent snow removal injuries is to use a snow blower. If having your own snow blower isn't an option for you, maybe you could use your neighbor's.
Now, let's assume you have to shovel, which most people have to do. Even those who don't shovel their driveway often have to shovel the walk.
The first thing in any task is to get the right equipment for the job. A modified shovel design with two perpendicular shafts was studied by Delgani et al in 1993, and was shown to reduce the force of the low back muscles. You can call this the ergonomic shovel and this would be the best shovel to use.
The worst thing you can do when you're shoveling is to not have your nose aligned with your toes. You don't want to rotate your body while throwing the snow, or with picking the snow up. Just think, nose lined with the toes.
When you are shoveling, you want to ideally push the snow instead of picking it up and throwing it over your shoulder.
Plan ahead. If you know that you need to shovel before you get to work, then get up at least 30 minutes early. You want to make sure you warm up your muscles with some active stretching before you go out to shovel.
Also, make sure you are appropriately layered so that you can try to stay warm when you're shoveling (especially important in the current "polar vortex" we're having).
The colder your muscles are, the more likely they are to get injured. Muscles are like taffy, they are more pliable in warmer conditions.
Shoveling is often done in the morning, and the morning is the most vulnerable time for the low back. In the first 30 minutes after arising, the spinal discs have about 54 percent less fluid and the spinal ligaments are 300 percent more taught. Combine that with shoveling and it's a recipe for disaster.
Wise strategy to prevent low back injuries in the morning is to avoid standing lumbar flexion (bending forward). To avoid lumbar flexion with shoveling, it is important that you maintain the natural curve in your low back, which is helped by bending with your knees, and keeping your chest up.
Take breaks when you shovel. Every five minutes do a microbreak stretch for 10 seconds. For the low back you want to put your hands on either side of your lumbar spine and gently arch backwards.
If you have some slight pain after shoveling, I advise icing the area. If the pain doesn't go away in a few days, then you should see a doctor.
David Freidson is a licensed chiropractor and works out of the Synergy Health & Rehabilitation office in Minnetonka. To learn more, visit www.synergyhealthmn.com or call 952-475-4080.