Mark: Hi, it’s Mark from TLR. I’m here with Dana Ranahan. She’s the owner of Body Works Physiotherapy in North Vancouver. And we’re going to talk about back strain from Shovelling snow. How are you doing Dana?
Dana: Hi, Mark. Welcome. Yeah, I’m doing well.
Mark: So, I shovel snow all the time. I don’t get any back strain. What are you talking about?
Dana: Wow. That’s pretty good. Lucky for you. Well, back strain, I think that’s probably one of the most common things that we see when we have a big snowfall, is that people kind of go out and just go for it and shovel. They clear their sidewalk or driveway or whatever, and it can definitely overload your back, especially because it’s something that we don’t do that often in the Vancouver area.
Mark: Yeah, with that Sierra cement that you guys get down there, there was a little tongue and cheek, we’re used to the light snow here. So it is not that big a deal. But I lived in Vancouver for a long time. I mean, I know what the snow is like down there and you get four or five inches and it’s wet. It’s heavy.
Dana: It’s like a brick almost. And I think for here in the lower mainland, this Christmas, we had some very cold weather and it was really fluffy snow, and it was kind of a treat relative to what we’re used to, but we do generally get that heavy, wet snow, which is really where people are more at risk.
And then when you try to shovel, like even trying to push it, the pushing action is quite hard. And then you’re trying to lift now this big brick of weight, which again, we’re not used to. So I think that’s really key is just really checking the snow conditions. And how much are you trying to push and move at one time. And really watching your back mechanics.
Mark: Yeah. I imagine it weighs probably fairly close to what a gallon of water weighs, which is 10 pounds. So, I mean, that’s going to be, you know, 10 to 20 pounds out on the end of a shovel is a lot of leverage for your back to lift.
Dana: And then that’s where your body mechanics come into play. So one we want to look at what’s the snow like. Try not to lift too much at once. Try to pace yourself a bit. Don’t do the whole thing at once, depending on you know, how much you have to shovel. But also body mechanics, because if you’re lifting that amount and you’re a stooped over, it kind of bent over with your shovel and now you’re trying to lift it. That’s really where you put your back at huge risk is in that sort of stooped posture or forward bent posture with a shovel. So that’s where if we can use our legs as much as we can and our core muscles, we try to take some of the stress off of the lower back. So it would be a combination of things that will help.
Mark: Okay, so someone’s hurt their back and they come in to see you, what’s the typical, how do you diagnose that? How do you go about diagnosing that?
Dana: Well, the question is we need to sort of figure out what exactly have they done, you know, did they overload a muscle? So it could be overused or maybe too heavy. And they strain a muscle. Probably one of the easier things to fix relatively, but not necessarily easy, but in terms of severity, not that bad. So if someone has had a muscle strain, we would work to identify what muscles they’ve pulled and to try to help loosen those muscles and strengthen them so they can regain function.
And sometimes it takes a little bit of time for the pain to settle down, because if you’ve injured the muscle or you’ve overused, the muscle, it’s like you’ve sort of partially torn the muscle. And so it does need to heal and it will take probably a couple of weeks to start feeling a little bit better.
And then you can start building a strength back up again, because the research shows us if you’ve had a muscle strain or a back injury before, if you don’t get your strength back again, you’re more vulnerable to reinjury. So we’d have to then look at, you know, is if it’s not muscular, what is it? Is it that you’ve sprained a joint in the lower back kind of like spraining your wrist or your knee, in which case it’d be similar, but we treated a little bit differently.
We need to restore mobility in the joint and to try to keep you from overloading the joint. And thirdly would be, you know, is it a disc injury or something which can happen. Sometimes people will blow, you know, herniate a disc. That could be a troubling injury and could have a range of consequences. So that would be our first thing is trying to identify what structures do we think that they’ve injured. And then what is the course of treatment to address those issues and helping people to understand, you know, how to manage it.
Mark: So, is this something where you’re going to want to get people moving a little bit as quickly as possible again, even within the limits of their pain threshold, et cetera?
Dana: Definitely. I think with a lot of injuries, we try to get people moving as quickly as we can. And it depends on the severity of the injury. If they’ve got, you know, a large degree of swelling and pain, then some of it they need to rest, especially in the beginning to settle things down a little bit. But not rest too long.
So then it’s introducing, well, what can they do? And sometimes it might be even, you know, lying down maybe you’d do some core exercises or some easy mobility exercises was first. We’re not going to start you doing like weight-bearing squats or something, if you’re having pain with those kinds of things.
But the early, early stages definitely is very important to try to encourage muscle activation. Because when you have an injury, the muscles going to get shut off, it’s like they go into, oh, I’m afraid to work mode and they become inhibited. So if we can start to get the muscles acting and working even gently early on, it usually helps the recovery to be faster.
Mark: So when you say core work, I guess it can do a lot of crunches. Is that it?
Dana: Well sometimes, but you know, some people, like if you have a disc injury, you don’t necessarily want to be doing flection like setups or flection. So it might be just activating your abdominals. And trying to do some leg movements, or it could be plank exercises or different things, depending on, you know, what it is that we need to strengthen.
And in the limits of what you’re able to do. Sometimes like a plank might be too much compressive force on your back. So maybe you can’t tolerate that. You know, maybe we’d have to do it in a different posture, but it’s sort of figuring those things out, but then empowering people to know what they can do safely and is going to help them and not hinder them. Because if you try to just go back to doing too much, you can make it worse and then prolong your recovery in the end.
Mark: It becomes, it seems to me, that it becomes very important then to know, within that range of kind of minor to extreme. Having expert diagnosis to know where you are and then expert help in, okay, here’s the next thing you need to do? Okay. You need to be start moving in the minimum kind of area. And then with you’ve heard a disc or something. Okay. We’re referring you to a doctor because you need medical help at this point.
Dana: Even with the disc type injury, is helping them to understand what they need to do. And there’s a certain sort of assessment of different exercises we can do to help reduce disc injuries a lot of times and not exacerbate them. So those are really important for people to understand. If someone has acute disc injury, we can teach them what they can do to move and to try to strengthen and restore the disc health as best we can.
And in some cases they refer on for investigations and surgery or whatnot, but nowadays the surgery for those types of injuries is usually much less common and they try to do more conservative type approaches. So if you can get on that right away and understand what you need to do and not keep overloading the disc and irritating it and aggravating it, then your recovery will be longer. So I think that’s really important for people to understand what they can do and should be doing to try to recover that injury.
Mark: In the scope of things that you see in your clinic with Shovelling snow, back strain, what’s a typical recovery process look like. And how long does it take.
Dana: Well, usually when we look at the stages of healing, it’s sort of you know, within the first couple of weeks, the body sends all the inflammatory cells to try to heal the injured tissue. And with a disc injury, but let’s say like, you think you just sprained a joint or your muscle’s aggravated.
And so in the first couple of weeks, it’s usually that inflammatory response in which case the body is sending all the tissue to repair the damage. And so those would be really easy. And then the first couple of weeks usually, you slow exercises, core activation, stretching maybe, and then we start to build things up.
So once we get past the three week, mark is when we start to lay down the new tissue, that’s going to actually heal things. So in that three to six week window is when we can start increasing what you can do. And then of course, depending on the severity of injury, when I feel to go a little quicker, a little slower depending on how you’re responding to it. So most people start to feel better in that four to six week window.
And if it’s a little bit more severe of a strain, it could be, you know, like a six to 10 weeks or six to eight week window to start to feel a bit better. So we kind of gauge it depending on how the person presents, but usually that first two to three weeks is really critical for the healing process and laying down just to start the healing in the tissue that’s been damaged.
Mark: And then after they’re starting to feel better, you’ve got them strengthened up. What’s the outcome after all this?
Dana: Most people can return to pretty much all their activities again. And, you know, they might be a little bit nervous about, say a Shovelling accident again, or Shovelling kind of injury or certain activities. So usually we would increase strength and then try to increase functional strength, meaning getting them back to function. So if you’re a skier or snowboarder, you know, you like to hike or whatever, we slowly would start to integrate the functional activities that you need to do to try to get your muscles in your body ready for it.
And also like, you know, so you’re not so nervous about introducing it, but most people are able to return back to largely all the activities that they did previously, unless they have a more serious strain.
Mark: If you have any kind of back pain from Shovelling or just back pain period in North Vancouver, the people to see our Body Works Physiotherapy. You can reach them at 604-983-6616 to book your appointment. Or check out the website body-works.ca. You can find all kinds of information. There’s tons of data and videos and articles and all kinds of great information there that will help you get feeling better. But even more important, get in there, get help so that you have expert advice on how to start moving better and feel better, frankly. Body Works Physiotherapy. Thanks Dana.
Dana: Thanks a lot, Mark.