Snow shoveling strain

Also called: Shoveling back injury; winter driveway back pain; snow shoveling heart risk

Relief and prevention Strength Stretch Massage

Lifting and throwing wet snow hundreds of times, bent forward and twisting, in the cold, first thing, by people who sat all week. The back takes the twist under load - and the heart takes a sudden near-maximal effort in air that has narrowed the arteries.

How common: About 11,500 US emergency visits a year, a third of them for the lower back, and about 100 deaths a year, nearly all cardiac

Open the Physical Work & Lifting routine All problems

What it is

Snow shovelling is one of the few everyday activities that produces genuine cardiac events in significant numbers. It combines sustained isometric arm work, a large sudden increase in effort, cold air which constricts coronary arteries, and a time of day when cardiac events are most common anyway.

The musculoskeletal side is the more common problem and the cardiac side is the more serious one. Emergency departments see clusters of both after every heavy snowfall, and the population doing it - middle-aged and older people who are otherwise sedentary - is precisely the one at risk.

What it feels like

Low back pain during or after shovelling, sometimes acute and disabling
Aching shoulders and forearms from the sustained gripping and lifting
Breathlessness and a pounding heart out of proportion to the effort
Chest tightness, jaw or arm discomfort - which is a stop-immediately signal
Exhaustion far beyond what the task seemed to warrant

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Lifting and throwing under flexion and rotation: Wet snow weighs five to ten kilograms a shovelful, lifted from the ground and thrown to the side. Flexion with rotation under load is the most provocative combination there is for the spine, repeated hundreds of times.
Sustained isometric arm work: Holding a loaded shovel out in front is an isometric effort, which raises blood pressure sharply and puts a particular kind of demand on the heart - different from and less well tolerated than rhythmic exercise.
Cold air narrowing the coronary arteries: Cold causes vasoconstriction, including in the coronary arteries, at exactly the moment the heart's oxygen demand is rising steeply. It is the specific combination that makes this activity dangerous.
A sudden near-maximal effort: Shovelling frequently pushes people to a high percentage of their maximum heart rate within minutes, with no warm-up, in people who do nothing else strenuous all year.
Being sedentary the rest of the time: The population doing this is largely untrained. A sudden near-maximal effort in an untrained middle-aged body is the setting for both the back injury and the cardiac event.
Time of day: Most shovelling happens first thing in the morning, which is when cardiac events peak anyway, and on cold, stiff tissue that has been still all night.
Wet snow: Wet snow is several times heavier than dry snow. A snowfall of wet snow produces a substantially higher load per shovelful, and the injuries cluster accordingly.
Throwing rather than pushing: Lifting and throwing generates far more spinal load than pushing snow along the ground, and it adds the rotation.
Not stopping: The urge to clear the whole drive in one go removes the breaks that would allow recovery, both for the back and for the heart.
Existing cardiac risk: Known heart disease, high blood pressure, diabetes, smoking or a family history all raise the risk of the cardiac event substantially, and many people do not know they have it.

Who tends to get it

Middle-aged and older adults who are otherwise sedentary
Anyone with known heart disease, high blood pressure, diabetes or a smoking history
Men over forty-five and women over fifty-five
Anyone with a history of low back problems
People clearing heavy wet snow first thing in the morning

What makes it worse, and what settles it

Makes it worse

Lifting and throwing rather than pushing
Doing the whole drive without stopping
Starting cold with no warm-up, first thing in the morning
Heavy wet snow, which multiplies the load per shovelful
Ignoring chest tightness, breathlessness or arm and jaw discomfort, which is the emergency

Settles it

Pushing the snow rather than lifting and throwing it, which removes most of the load and the rotation
A shovel with an ergonomic bent handle, which reduces the bending required
Working in short bursts with breaks rather than continuously
Warming up with a few minutes of walking first
Getting someone else to do it, or using a snow blower, if you have cardiac risk factors

What actually helps

The short version: Lifting and throwing 5-10 kg of wet snow, hundreds of times, bent forward and twisting, in the cold, first thing in the morning, by people who sat all week. The back takes the twist under load; the heart takes a sudden near-maximal effort in cold air that narrows the arteries, which is why cardiac events cluster here

Strength work: Back: Spinal Erectors; Glutes: Max; Legs: Quads; Abs: Obliques; Abs: Transverse Abdominis; Hands, Fingers, Grip; Posterior Chain; Full Body - hip hinge, squat and loaded-carry strength built through the year, not the week before the storm

Stretching: Hips: Flexors; Legs: Hamstrings; Back: Lower Back; Trunk: Rotation & Side Bend; Chest - a five-minute warm-up indoors before going out

Massage: Back: Quadratus Lumborum (QL); Glutes; Back - afterwards

Also worth doing: Push snow rather than lift it; small loads, bend the knees, never throw over the shoulder; shovel early and often while it is light; take breaks every 15 minutes; if you are over 55, sedentary, or have heart disease or high blood pressure, get someone else to do it

What the evidence says: Acute musculoskeletal exertion caused 54% of the shoveling injuries in the national study; people over 55 were four times more likely to have a cardiac event while shoveling, and men over 55 twice as likely as women. Conditioning the hinge and carry through the year, a warm-up, and pushing rather than lifting are the prevention.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

The qFIT routine for this

Ready-made routinePhysical Work & Lifting

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Open this routine in my Checklist

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Chest pressure, pain spreading to the arm or jaw, breathlessness, sweating or faintness while shoveling - stop and call emergency services; back pain with leg numbness or weakness afterwards - see the low back pain red flags

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Back strains from shovelling settle over one to three weeks like any other. The cardiac risk is the reason this page is stricter than most: chest tightness, pressure or pain, breathlessness out of proportion, pain in the jaw, neck or arm, nausea or cold sweating during or after shovelling is a possible heart attack and needs an emergency call immediately - not a rest and a wait to see. Anyone with cardiac risk factors should consider not doing it at all.

Prevalence basis: 17-year national study of snow shovel-related injuries treated in US emergency departments (Nationwide Children's Hospital); American Heart Association statements

Others the same routine covers

These share the Physical Work & Lifting routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

← All 267 problems 🪯 Muscle Guide