Cold Weather Injuries

Community Health
Written By Aaron Masters

Introduction

Living near the Great Lakes presents distinct seasonal challenges. Our region experiences subzero temperatures and substantial snowfall throughout winter; conditions that test both our resilience and our preparation. Yet as C.S. Lewis observed in That Hideous Strength, childhood teaches us something adults often forget: snow is made for wonder and fun!

"Everyone begins as a child by liking Weather. You learn the art of disliking it as you grow up. Noticed it on a snowy day? The grown-ups are all going about with long faces, but look at the children—and the dogs? They know what snow's made for." — C.S. Lewis

But, it also creates genuine health hazards if we remain unprepared. This post explores the most common winter injuries, their prevention, and how to safeguard both our bodies and our neighbors.

Winter Injuries: Beyond Frostbite and Hypothermia

When most people think of winter health risks, frostbite and hypothermia come to mind immediately. However, cold weather injuries extend far beyond these dramatic conditions. A comprehensive examination of winter-related trauma reveals a broader spectrum of injury mechanisms.

The True Injury Landscape

A 2011 study examining injuries sustained during an ice storm in Oklahoma provides illuminating data. Among 6,047 injured persons treated, the distribution of injuries was striking:

  • Falls: 74%

  • Motor vehicle collisions: 13%

  • Sledding injuries: 8%

These findings underscore that mechanical trauma, not cold exposure alone, accounts for the vast majority of winter-related emergency department visits (Piercefield et al., 2011).

Snow Shoveling: A Deceptively Dangerous Activity

Snow shoveling, often viewed as routine outdoor maintenance, represents a significant cause of injury and medical emergency. Between 1990 and 2006, an estimated 11,500 snow shoveling–related injuries were treated annually in U.S. emergency departments (Watson et al., 2010). The injury spectrum includes:

  • Soft tissue injuries: 54.7%

  • Lower back injuries: 34.3%

  • Cardiac-related events: 6.7% (including all snow shoveling–associated deaths)

Critically, these injuries are not confined to elderly populations. In one clinical example, a woman in her 40s presented to urgent care with hip pain following a fall on ice. Radiographic evaluation, ordered primarily to rule out fracture in a middle-aged patient, revealed an unexpected hip fracture; a reminder that osteoporosis and injury risk affect younger individuals far more frequently than clinicians initially suspect.

Prevention Strategy: A Two-Part Framework

Preventing winter injuries requires a comprehensive approach addressing both injury occurrence and injury resilience. Effective prevention operates on two complementary levels: avoiding injury entirely, and ensuring our bodies can withstand trauma when injury does occur.

Part One: Avoiding Injury

Protecting Your Community
Prevention begins with neighborly responsibility. Keeping sidewalks, driveways, and porches clear of snow and ice protects not only your household but also mail carriers, delivery personnel, and emergency responders who may visit your property. These individuals face occupational exposure to slip-and-fall hazards they cannot control.

Safe Shoveling Practices
When removing snow, implement evidence-based biomechanical strategies:

  • Use a bent-shaft shovel if available (Lewinson et al., 2014). The bent design reduces lumbar spine loading and compressive forces during lifting.

  • Maintain optimal posture: Keep your back relatively straight, engage your core, and lift with your legs rather than your back.

  • Avoid overexertion: Pace yourself across multiple sessions rather than attempting to clear large areas in one bout.

  • Know your limits: Individuals with known cardiovascular disease, significant deconditioning, or orthopedic limitations should consider hiring professionals or using mechanical removal methods rather than shoveling manually.

Safe Winter Driving
Winter driving requires adjusted expectations and spacing:

  • Maintain a greater following distance than normal driving conditions require.

  • Recognize that vehicles require longer stopping distances on ice and snow.

  • Reduce speed commensurate with road conditions.

  • Avoid sudden acceleration, braking, or sharp turns.

Frostbite and Hypothermia Prevention
While less common in our region than mechanical injuries, cold-induced tissue injury remains a genuine risk, particularly for individuals engaged in winter recreation. The following evidence-based preventive measures significantly reduce frostbite risk (OpenEvidence.com):

  • Avoid extreme wind-chill exposure: Wind-chill temperatures below −27°C (−18°F) create substantial frostbite risk over short exposure periods.

  • Wear mittens over gloves: Mittens provide superior insulation by keeping fingers grouped together.

  • Use chemical or electric warmers: Hand and foot warmers pre-warmed to body temperature before activation maintain extremity warmth.

  • Change socks and gloves frequently: In cold-wet conditions, moisture dramatically reduces insulation and accelerates heat loss. Frequent changes maintain dry extremities.

  • Avoid restrictive footwear: Tight-fitting boots and socks impede peripheral blood circulation and increase frostbite risk.

  • Respond immediately to early warning signs: Numbness or paresthesia (pins-and-needles sensation) warrant immediate rewarming using adjacent body heat from the axilla (armpit) or abdomen.

Part Two: Preparing Your Body

Beyond external prevention, we can improve physiological resilience to trauma when injuries do occur. This requires a proactive, multi-system approach to health optimization.

Bone Health Assessment
Osteoporosis screening should be a standard component of winter preparation, particularly for individuals over age 50, postmenopausal women, or those with risk factors for bone loss. Early identification of decreased bone density allows targeted intervention before fracture occurs.

Nutritional Optimization
Vitamin D supplementation enhances bone health and may improve balance, fall avoidance, and overall musculoskeletal function during winter months when sun exposure diminishes.

Balance and Fall Prevention
Progressive balance training—including tai chi, yoga, or simple single-leg stance exercises—reduces fall risk in older adults and those with vestibular impairment. These exercises should be incorporated into regular routines beginning in autumn, before winter conditions arrive.

Cardiovascular Health Screening
For individuals planning strenuous snow removal, cardiovascular assessment is prudent. This screening identifies silent ischemia, undiagnosed hypertension, and arrhythmias that might precipitate cardiac events during physical exertion. If shoveling is deemed unsafe, alternative strategies should be identified in advance.

Core and Spinal Stability
Targeted exercises strengthening the core musculature and lower back substantially reduce shoveling-related injuries. Programs emphasizing lumbar stabilization, gluteal activation, and postural control should be established before winter arrives.

Conclusion

Winter need not be a season of injury and misfortune. Through thoughtful prevention strategies, both at the level of injury avoidance and physiological resilience, we can embrace winter's beauty while minimizing its hazards. By combining environmental modifications, safe practices, and personal health optimization, we honor both ourselves and our community in the months ahead.

For as the rain and the snow come down from heaven,
And do not return there without watering the earth
And making it bear and sprout,
And giving seed to the sower and bread to the eater,

So will My word be which goes forth from My mouth;
It will not return to Me empty,
Without accomplishing what pleases Me,
And without succeeding in the matter for which I sent it.

Isaiah 55:10-11

References

American Academy of Family Physicians. (2020). Frostbite: Recommendations for prevention and treatment from the Wilderness Medical Society. Retrieved from https://www.aafp.org/pubs/afp/issues/2020/0401/p440.html

Castellani, J. W., Eglin, C. M., Ikäheimo, T. M., et al. (2021). ACSM expert consensus statement: Injury prevention and exercise performance during cold-weather exercise. Current Sports Medicine Reports, 20(11), 594–607. https://doi.org/10.1249/JSR.0000000000000907

Castellani, J. W., Young, A. J., Ducharme, M. B., et al. (2006). American College of Sports Medicine position stand: Prevention of cold injuries during exercise. Medicine and Science in Sports and Exercise, 38(11), 2012–2029. https://doi.org/10.1249/01.mss.0000241641.75101.64

Lewinson, R. T., Rouhi, G., & Robertson, D. G. (2014). Influence of snow shovel shaft configuration on lumbosacral biomechanics during a load-lifting task. Applied Ergonomics, 45(1), 1–7. https://doi.org/10.1016/j.apergo.2013.05.009

McIntosh, S. E., Freer, L., Grissom, C. K., et al. (2024). Wilderness Medical Society clinical practice guidelines for the prevention and treatment of frostbite: 2024 update. Wilderness & Environmental Medicine, 35(2), 183–197. https://doi.org/10.1177/10806032231222359

OpenEvidence.com. (n.d.). Frostbite prevention evidence summary. Retrieved from https://www.openevidence.com

Piercefield, E., Wendling, T., Archer, P., & Mallonee, S. (2011). Winter storm-related injuries in Oklahoma, January 2007. Journal of Safety Research, 42(2), 147–152. https://doi.org/10.1016/j.jsr.2011.02.006

Watson, D., Shields, C. J., & Smith, J. (2010). Snow shovel-related injuries and medical emergencies treated in US EDs, 1990 to 2006. American Journal of Emergency Medicine, 28(7), 757–765. https://doi.org/10.1016/j.ajem.2009.03.018

Aaron Masters https://buffalofamilynp.com
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