Preventing Back and Knee Injuries This Winter

Winter brings snow, ice, wind and frigid temperatures, and with the cold weather comes the arrival of knee and back injuries across the northeast. The most frequent injuries that we see in our physical therapy practice over the winter months are low back pain from shoveling, anterior cruciate ligament (ACL) tears and patellofemoral pain syndrome in knees from winter sports.

Lower back injuries are very prevalent once the snow begins to fall. Shoveling and snow blowing can both put a lot of strain on the muscles of the lumbar region, especially if some easy precautions are not taken. Shoveling snow tends to require people to lean over for prolonged periods of time, while lifting potentially heavy weights that are far from the center of their body. While doing this for a few minutes may not be problematic, shoveling snow for 30 minutes may lead to muscular or potentially disc-related issues.

Generally speaking, the muscles of the lumbar spine are not trained to perform repetitive heavy lifting. They are endurance muscles designed to maintain our upright posture all day. By constantly leaning over while carrying additional weight, undue stress is placed upon the lumbar musculature, which can cause them to fail, resulting in a strain. When a muscle is strained, it can become spastic, which is an involuntary contraction of the muscle. Muscle spasm can be quite painful, especially in a central region of the body, such as the lumbar spine. To alleviate a muscle spasm, various stretching and soft tissue techniques are performed and typically symptoms resolve within a few weeks.

Snow shoveling can also lead to posterior disc herniation, which may cause sciatic nerve aggravation. If a disc does begin to press against one of the nerve roots in the lumbar spine, often times a tingling or numbness is felt throughout the leg, typically in the gluts, hamstrings or foot. As a preventative measure, it is recommended to perform standing lumbar extensions before, during and after shoveling snow, as this movement helps to counteract leaning forward. To perform a standing lumbar extension, simply place your hands on your hips and lean backwards, trying to create a large arch in your low back, hold for a few seconds and repeat 10 times.

Skiing is the cause of a significant number of winter injuries, including ACL tears. The ACL can tear by being struck from the front, forcing the knee into hyper-extension, or it can be torn when a rotational force is applied to the knee when it is planted on the ground. Generally in skiing, the tear occurs when a ski boot does not dislodge from a ski during a fall, causing the rotational force. Unfortunately, there isn’t anything that can be done to ensure that a boot will disconnect properly other than wearing proper footwear. In general terms, the likelihood of having an ACL tear can be lessened if a person has strong hip musculature and good stability through the knee. This can be achieved by performing strengthening exercises targeting the gluts, as well as doing exercises on unstable surfaces, such as on balance boards, BOSU balls and physioballs. If an ACL tear does occur, the recovery time following surgery is typically 9-12 months, assuming full return to sport participation, including skiing, is the goal.

Lastly, most winter sports, including skiing, snowboarding, hockey and ice-skating, put a lot of pressure on the knees, as these sports require the participant to maintain mini-squat positions for extended periods of time. This can be an issue if the participant has weakness in the hip and/or thigh musculature. Hip weakness typically manifests itself with knee genu valgum, also known as knocked knees. Genu valgum is an issue, as it places a lot of stress on the medial structures of the knee, especially the medial collateral ligament (MCL). The iliotibial band (ITB) can also become very aggravated, because this position can increase friction between the ITB and the lateral femoral condyle, causing pain along the lateral side of the knee. These issues can both be addressed with strengthening of the gluts and quadriceps, as well as stretching of the ITB and gluts.

Not all winter injuries are preventable, but there are some simple strengthening exercises, as mentioned above, that can help assist in building up areas in the knee and back which can avert or lesson injuries that might otherwise slow you down this winter.

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