Prevention and Tips

Back Safety for Yard Clean-up

The spring and fall lawn clean-up activities generate a tremendous number of back and shoulder injuries. Proper mechanics and a little preparation can limit injuries and make for a more enjoyable outdoor experience. Here are a few tips to help you get through annual battle with nature in preparation for winter.

Be careful when moving large branches or other debris. Approach the lifting of these items just as you would any other heavy object...try to square your body to the load and keep it in close. Do not twist you trunk to throw something like a branch. Use your legs to lift not your back when possible.
When cleaning out the flower beds, keep your arms and hands in front of you. Do not twist to reach in or around objects.
When cleaning gutters, try to limit extreme reaching to the sides. It is better to do small areas and move the ladder frequently. If you have trouble on the ladder due to balance or strength, please get someone to help you.
When raking, try to minimize the amount of twisting in your trunk/lower back. It is better to use your arms to pull the rake toward you while keeping your hips and back square.
Do not overfill yard waste bags.
Change your activity every 20 minutes. Rake for twenty minutes and then change to flower beds or moving outdoor furniture, then return to raking.
Stretch your legs, shoulders, and back after you have finished for the day.
If you have pain during or immediately following these activities use ice for 15-20 minutes over the painful area to reduce the impact of minor injuries.

Maintenance Care for Chronic Back Pain

I have always been very cautious about recommending monthly treatments for chronic low back pain patients because of a lack of evidence. I usually tell them to wait until it hurts again. This prospective single blinded placebo controlled study, published in the prestigious Spine journal, strongly supports regular manipulation following the initial month of intensive therapy for chronic low back pain. Regular spinal manipulation and chronic back pain

Snow Shoveling Safety

It is that time of year again so it seems appropriate to talk about how to protect yourself while shoveling snow. The good news is that when done safely, shoveling is an excellent form of exercise in the winter months. The three major health concerns with shoveling are heart attacks, falls, and back strain.

The most serious of these concerns is obviously cardiac issues. Shoveling for as little as two minutes has been shown to increase a sedentary male’s heart rate beyond the recommended levels for aerobic exercise. That is a quick increase in demands on the heart and can be even more exaggerated by the cold, which makes it harder to breath.

- You should not shovel without asking your physician if you have a previously diagnosed heart condition, high blood pressure, or high cholesterol.
- Take frequent breaks to catch your breath and hydrate.
- Avoid caffeine or nicotine before shoveling, as these increase your heart rate.
- Dress in layers to avoid overheating.

The major problems seen from falls are head injuries, broken bones, and back strains.

- Wear proper shoes and stay aware of slick areas and “black ice”.
- Be sure someone knows you have gone outside to shovel. If you fall and are seriously injured you do not want to be outside without anyone realizing you need help.
- Consider taking a cell phone out with you so you can call for help if needed.

Back strains are the most common shoveling related injuries and, thankfully, the least serious. There are several things you can do to protect yourself from these types of injuries.

- Warm up. Unfortunately many times we have to shovel in the morning before leaving for work. When you first get up in the morning your muscles are at their tightest. Take a few extra minutes to make sure your muscles have had a chance to loosen. Stretch your legs and back. Do slow and gentle side bending and twisting movements of your lower back.
- Pick a shovel that fits your height. Make sure it is not too wide. The wider the blade, the more snow you are dealing with and the heavier the load.
- Use proper posture, keeping your feet about shoulder width apart and keeping the shovel directly in front and close to your body. Do not twist at your back or waist to throw the snow…turn your entire body and have your feet facing the direction you are throwing the snow.
- Take a 10-minute break when you start to feel any back strain or pain. Do not sit – keep moving and perform a few gentle stretches. Use this time to hydrate.
- Warm down. The worst thing you can do is get in your car or go inside and sit down immediately after shoveling. Spend a few minutes walking around, keeping your muscles loose while they recover.
- If you strain or injure your muscles, apply ice immediately for 20 minutes. Try to continue moving and gently stretch the area. If the pain does not resolve with ice and stretching, call for an appointment.

Winter Running

Now that winter is upon us, I thought it appropriate to share some tips on cold weather running. Many of my patients run through the winter and are quite experienced. This information is probably more helpful for those who have decided to continue into the winter months for the first time.

Unless you have a specific training goal in mind (i.e. Boston Marathon) that requires an increase in mileage or speed through the winter months, it is recommended that you set a goal of maintaining your present levels as opposed to increasing them. Cold weather and the possibility of slippery conditions are already an added physical stress. By adding speed and/or distance during this time of year you are putting yourself at greater risk of injury.

Warm up and stretch indoors before running. Cold makes muscles less elastic and more susceptible to injury. Even if warm it is advisable to shorten your stride and slow your pace until you have adapted to the environment and feel loose. If there is a chance of slippery conditions you should definitely shorten the stride.

Proper clothing is critical for outdoor activities this time of year. Running gloves work great on mild days and mittens are recommended for colder days. Keeping moisture off of your skin helps your body maintain a more constant temperature. Use polypropylene or any of the newer, high-tech under layers to wick moisture away from the skin. Synthetic sock liners are also important for this reason. Avoid cotton, it holds moisture and will keep you wet. A middle layer of fleece is great for the really cold days. Wear an outer layer that will block the wind and protect you from precipitation. Wear a hat that covers your ears and for really cold weather (approaching zero F) cover your mouth and nose to conserve heat and warm the air before it is inhaled. With all of this said, it is important not to overdress. The rule of thumb is to dress as if it were 20 degrees warmer outside than it is.

Be aware of the temperature AND the wind chill. If the temperature is below 0 F or the wind chill below -20 F, move your workout inside. Running into the wind can speed the loss of body heat by disrupting the layer of warm air trapped in clothing. Plan your route with this in mind. Be prepared to increase your protection just before turning into the wind by zipping or replacing layers. It can be difficult to warm back up after getting cold. Finally, for very cold days, consider altering your route so that you are never more than 10 minutes from protection from the weather.

Don’t forget why you are running. Enjoy and be safe.