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Hey there, you with the shovel. Headed outside to shovel some snow? When's the last time you had a physical? Have you considered warming up, maybe doing a little stretching?

It might sound funny, but if you are not thinking about shoveling snow in the same way you would think about working out, preparing before jumping in and seriously considering your cardiovascular health before beginning, you might be headed for a serious injury, or even worse, according to area physicians.

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"Snow shoveling, especially first snow of the year, we definitely see a true risk of heart attacks happening in that setting and part of the issue is people do think of it as a regular household task, 'I shovel the snow the same way I sweep the floor,'" said Dr. Radhika Kuna, a cardiologist with Carroll Health Group. "If you are not used to exercising regularly, shoveling heavy, wet snow can really raise you blood pressure and your heart rate much more than the body is used to and in a very short period of time."

Shoveling snow is a triple threat, Kuna said, because in addition to the sheer effort and exertion, the cold weather itself can tighten the arteries of the heart, creating a hazard for someone who might not otherwise have any symptoms of heart disease, while heart attacks are more common in the morning hours any time of the year.

"If you have risk factors for heart disease and you are generally an inactive person not used to doing strenuous activity, putting yourself in that setting of sudden heavy lifting in the cold air first thing in the morning — it's sort of a recipe for a heart attack, unfortunately," Kuna said.

Blood pressure issues or mild plaque accumulation, a family history of heart disease, smoking and general inactivity are risk factors for heart attack, Kuna said, and it is often those with no symptoms, or mild symptoms, who find themselves in trouble.

"Unfortunately, it's the 50-year-old male who might just have a little bit of blood pressure or cholesterol [problems], but isn't necessarily the most active person — those are the people that have the heart attacks happen to them in this kind of weather," she said.

Even for those whose hearts can handle the load, joints, muscles and tendons are not always so lucky, especially because people tend to perpetually underestimate just how physically demanding snow removal can be, according to Dr. Brian Polsky, a sports medicine surgeon who practices in Eldersburg.

"These winter storms definitely keep me busy ... I get a lot of shoulder injuries, neck and back problems and even hips and knees," Polsky said. "It's a very demanding, athletic thing, shoveling a lot of snow. I would compare it to just waking up and doing a couple of hours of lifting weights; if that's not something you normally do, it's going to be a problem."

Shoveling snow is quite literally the same as squatting down to pick up a 3- to 15-pound weight — it depends on the size of your snow shovel, and they can come quite large nowadays — and throwing it, according to Polsky, and the results can range from mild soreness to damage that requires surgical intervention.

"You range all the way from strain — which is usually what I call good pain, kind of an ache, mild discomfort but no significant function loss — all the way up to a rupture, which is when either a ligament, or in this case, a tendon detaches from where it belongs," he said. "If you do not warm up, if you don't stretch and take your time and ease into it; that's a very good way to cause strains and sprains, or even worse, tears or ruptures."

While a strain is a "good pain," a result of a muscle being pushed to the limit, a sprain results in some loss of function and microscopic damage to the muscle, even some bruising, according to Polsky. Beyond sprains are tears and ruptures, where muscle fibers tear or where a tendon or ligament becomes detached.

Almost the entire range of snow shoveling-related injuries can be treated with rest, stretching and anti-inflammatories, but ruptures can sometimes require surgery, according to Polsky. And while a sprain may receive very similar treatment to a strain, the recovery time is longer; Polsky recommends trying to mitigate damage in the first place.

"If you're shoveling snow and you are feeling some discomfort in your shoulder or your hip or your back, the first thing you should do is stop, because it's probably going to get worse. You don't want to fight through it and keep going," he said. "If you catch a strain early enough, you can just treat it very conservatively with activity modification, anti-inflammatories, and it will get better. A strain turns into a sprain if you ignore it and keep going."

It's also important to keep in mind that the cold itself is problematic, according to Polsky — snow shoveling is a heavy gym workout done in freezing temperatures.

"You need to stretch and warm your muscle up because you are going into an even colder environment than in your house obviously, and your muscles and tendons and ligaments are kind of like rubber bands: If they are warm, they will stretch really nicely and not have a problem," he said. "If they are really, really cold, they don't stretch as well and if they're freezing, they can break."

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Taking shoveling seriously as a serious exercise, warming up, paying attention to your body and guarding against the cold are great tips for protecting your heart while tackling the snow as well, according to Kuna.

"Dress in layers, protect your body from the cold ... using a scarf over your head and mouth so you are inhaling less cold air, that can actually make a difference," she said. "Not doing this activity right after a large meal has actually been shown to probably be beneficial, so you are not draining the blood away from the parts of your body that need it and to your stomach instead, and then doing things like pushing the snow or lifting only small amounts at a time, which may take you longer, but at least you are putting less stress on the body."

It's also important to keep in mind that heart troubles do not always present as sudden, extremely painful event, according to Kuna.

"People expect themselves to be having a sharp pain in their chest, or even the worst pain of their life in their chest when they have a heart attack and that is often not the case," she said. "It's usually, frequently is, something more subtle, kind of a dull aching. An annoying, nagging in the chest, pressure or tightness."

Of course, some of those symptoms can occur just with exposure to cold air, Kuna said, which is why she recommends simply taking it easy; move less snow at a time, go a little slower and do not be afraid to take breaks — the snow will wait.

"If you notice those symptoms, definitely stop: Take a break from what your are doing and go into the warmth," she said. "If it's shortness of breath more than you would expect, that would be a sign to go in, take a break and try again at a slower pace once you have recovered."

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