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Winter Safety Tips – November Newsletter

Winter Safety Tips to Reduce Falls and Injuries

John Fiore, PT

Winter weather has arrived in Montana along with endless winter recreational opportunities. Although skiing and snowboarding have inherent risks, shoveling your driveway or crossing the street are hazardous in the winter. A 2010 retrospective research study looking at the incidence of snow shoveling related injuries between 1990-2006 looked at snow shoveling injury statistics.1 An estimated 195,000 individuals were treated in US hospital emergency departments for snow shovel-related injuries between 1990-2006. The study showed 67.5% of these injuries occurred among males and 21.8% occurred in adults 55 years of age and older. The most common causes of shoveling-related injuries were soft tissue injury (54.7%), low back strain (34.3%), musculoskeletal exertion (53.9%), slips and falls (20%), and being struck by a snow shovel (15%).

Examples of shovels that will help keep you safe while shoveling snow.A few simple steps will greatly reduce your risk of injury related to snow shoveling. Avoid simultaneous lifting and twisting and lift the weighted shovel with your legs. Utilize a squat while maintaining a neutral spine posture to decease lumbar strain. Maintain a strong core and pace yourself, especially when the snow is wet and heavy. Proper footwear with adequate traction will reduce fall risk, and choosing the right shovel will improve your shoveling mechanics (photo: consumerreports.org).

While most snow shovel-related injuries (95.6%) occur around the home, work-related falls due to ice and snow in Montana are common. Montana tops the nation in incidence of work-related injuries due to falls on ice and snow (12.2 falls per 10,000 workers in 2014).2 In 2014, there were 42,480 work-related injuries involving ice, sleet, or snow that required at least one day away from work to recover. Injuries were the result of falls, slips, overexertion, transportation incidents, and contact with objects and equipment. The national average for ice, sleet, or snow related falls was 3.2 per 10,000 workers in 2014. Several states, however, had incidence rates at least two-and-a-half times greater than the national average. Among them were Montana (12.2), Maine (11.2), Wyoming (10.6), and Alaska (9.5).
Incident rates for occupational injuries and illnesses from same-level falls related to ice, sleet or snow - 2014

Here are some recommendations to stay safe when walking on ice and snow at work and at home:

  • Choose footwear with lots of surface area and adequate lugged traction. Utilize traction devices such as Kahtoola Micro Spikes (Kahtoola.com) to add extra grip on icy terrain.
  • Walk slowly and avoid abrupt changes in direction. When walking quickly the body has more momentum, which means it will take more effort to slow down, safely turn, or stop.
  • Take small steps. Small steps will enable you to maintain your center of gravity more securely above your feet and avoid exaggerated heel striking or forceful push off where falls are more likely to occur.
  • Keep your knees bent to keep your center of gravity low.
  • Avoid carrying heavy loads over ice and snow. Carrying heavy objects can make it harder to maintain balance.
  • Walk around, not over, snow berms left by snow plows as they are often solid ice.
  • Use caution getting in and out of vehicles. Use the doorframe to stabilize yourself when possible, and watch for low points in parking lots where water and ice may accumulate.

Muscle of the Month: Flexor Hallicus Longus

John Fiore, PT

diagram of the Flexor Hallicus LongusLike most muscles in the human body, the flexor hallicus longus is Latin for its location, appearance, and purpose. The flexor hallicus longus flexes (bends downward) the big toe (hallicus) and is a surprisingly long muscle associated with its important function.

The flexor hallicus longus (FHL) originates on the posterior 2/3 surface of the distal fibula bone and inserts on the base of the distal portion of the big toe. The tibial nerve (branch of the sciatic nerve) supplies the FHL muscle (L5, S1, S2 nerve roots), and its action is to flex the big toe downward towards the ground.

Technically, the FHL sounds like just another obscure muscle in the foot and lower leg. Functionally, however, the FHL is a key muscle in efficient, functional, walking and running. Without a strong functioning FHL, overuse injuries of the foot and lower leg are more likely to occur. Upon inspection of the vast tendon traveling from the lower portion of the FHL muscle to the base of the great toe, one should ask: “Why is the flexor hallicus longus tendon so long and why is the muscle so far away from the big toe if it flexes the big toe?” The answer, as it usually does in the human body, lies in its function.

diagram of FHL & FDL in the ootThe big toe is by far the strongest toe in our foot. The action of the big toe pressing against the ground during the late stance phase of walking or running is crucial for foot stability. Working diligently with the tibialis posterior (TP) and flexor digitorum longus (FDL), the FHL propels us forward over a stable foot. Pushing off with a stable, supported foot reduces pronation of the foot-ankle and valgus (inward collapse) of the knee.

Pain associated with weakness, overuse, or trauma to the FHL muscle and its expansive tendon may be felt in the bottom of the foot, the medial ankle (where it travels over the sustentaculum tali of the talus bone), or deep within the calf muscle. Walking or running over uneven, soft, slick surfaces may result in overuse of the FHL to “grip” the trail, thereby resulting in pain along the tendon or muscle belly. Releasing muscle tension and treating inflammation are both effective treatments. Strengthening the FHL and its associated lower leg musculature (tibialis posterior, flexor digitorum brevis, gastroc-soleus, fibularis longus-brevis) collectively protect the foot and ankle from injury to allow you to run, jump, hip, and skip without incidence. Functional strengthening isolating the FHL is necessary to reduce injury during weight bearing, repetitive sports. “Toe yoga,” towel “scrunches,” arch raises, and band resisted ankle inversion are three examples of exercises to improve the strength and function of your foot and ankle for pain-free walking and running.

Image of foot exercises called toe raisesimage of exercises with a yoga towelimage of exercise called arch raises

1 Am J Emerg Med. 2011 Jan;29(1):11-7. doi: 10.1016/j.ajem.2009.07.003. Epub 2010 Mar 25.
2 Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, 42,480 work injuries involved ice, sleet, or snow in 2014 on the Internet at https://www.bls.gov/opub/ted/2016/42480-work-injuries-involved-ice-sleet-or-snow-in-2014.htm (visited November 10, 2018).