Snow Shoveling and Back Pain: What You Need to Know to Stay Safe This Winter

The recent snowstorm in the DC area was different than what we usually see. Not only did we get a much larger volume of snow, but the sleet that followed packed everything down, making the snow significantly heavier than expected. For many people, that meant long hours of shoveling driveways and sidewalks under cold, challenging conditions.

Unfortunately, events like this often lead to a spike in injuries and back pain is one of the most common reasons people seek physical therapy after heavy snowfall.

Why Snow Shoveling Is a Common Cause of Back Pain

Snow shoveling places a unique and often underestimated load on the body. Snow can weigh two to three times more than most people expect, especially when it’s wet or compacted by sleet. Combine that with cold temperatures and repetitive movements, and the risk of injury rises quickly.

Cold weather causes muscles, tendons, and joints to feel stiffer and less responsive. Unlike a typical workout, most people don’t warm up before shoveling. That means the body is suddenly asked to lift, bend, and twist repeatedly while tissues are at their least prepared state.

From a biomechanics standpoint, shoveling is especially demanding on the spine. The weight of the snow is held far out in front of the body, increasing stress on the lower back. Unlike lifting a weight close to your body, something we coach regularly in back pain physical therapy. Shoveling often involves reaching forward, rounding, and then twisting to throw the snow. Repeating this pattern over and over can overload the spine and surrounding muscles.

Cardiac Risks During Heavy Snowfall

While back pain is the most common complaint we see after snowstorms, it’s also important to acknowledge the cardiovascular risks. Many cardiac events occur during snow shoveling due to the combination of cold temperatures and sudden, intense physical exertion.

If you are over the age of 45 or have risk factors such as high blood pressure, high cholesterol, or diabetes, it’s especially important to pace yourself, take breaks, and avoid overexertion during heavy snowfall.

How to Reduce Back Pain Risk When Shoveling Snow

The best way to approach snow shoveling is to think of it like a workout rather than a household chore.

Before heading outside, take a few minutes to warm up with light, dynamic movements. The goal is to get your body warm enough that you’re almost sweating before you start lifting heavy snow. This can significantly reduce strain on the lower back and shoulders.

Staying hydrated is also important. Cold, dry air increases fluid loss, even if you don’t feel thirsty. Proper hydration supports muscle function and recovery and can help reduce stiffness.

During shoveling, try to minimize excessive twisting and avoid lifting more snow than necessary at once. Smaller loads and frequent breaks go a long way in protecting your back.

What to Do If You’re Feeling Back Pain After Shoveling

It’s very common to feel sore or stiff after shoveling, especially in the lower back, shoulders, and neck. Gentle movement, relaxed breathing, and light mobility exercises can help calm irritated tissues and reduce next-day soreness.

However, if your back pain lingers, worsens, or limits your ability to move normally, it may be time to seek back pain physical therapy. Many snow-shoveling injuries are very treatable with the right approach, and addressing them early can prevent the issue from becoming chronic.

How Back Pain Physical Therapy Can Help

Back pain physical therapy focuses on more than just pain relief. The goal is to identify why your back was overloaded in the first place, whether that’s poor movement mechanics, limited mobility, or insufficient strength and address those factors directly.

Through targeted mobility work, strength training, and education, physical therapy can help you recover faster, move more confidently, and reduce your risk of future injuries, whether from snow shoveling or everyday activities.

Back Pain Got You Regretting Yesterday’s Workout?

Back pain is one of the most common reasons active adults seek out physical therapy in Bethesda and McLean. A pattern we hear repeatedly sounds like this:

“My back feels great while I’m working out, but the next day it’s killing me.”

For many people, this is confusing and frustrating. If you felt strong and pain-free during the workout, why does your back feel stiff, sore, or even painful the following day? More importantly, does this mean you hurt yourself?

In most cases, the answer is no. What you’re experiencing is usually not an injury. It is a capacity and load tolerance issue, and understanding this distinction is critical to managing back pain effectively.

How Adrenaline Masks Back Pain During Exercise

During exercise, your body is flooded with adrenaline and other stress hormones. These chemicals temporarily increase pain tolerance, improve performance, and blunt symptoms. That is why you can lift heavy weights, move explosively, or push through intense workouts feeling strong and capable.

In the short term, your nervous system essentially turns down the volume on pain signals.

The problem shows up later.

Once the workout is over and those chemicals wear off, the tissues that were stressed beyond their current tolerance start to respond. This often happens hours later or the next morning, when you suddenly notice stiffness, soreness, or pain with simple movements like bending over or putting on socks.

This delayed response is one of the most misunderstood aspects of back pain physical therapy.

Why Next-Day Back Pain Does Not Automatically Mean Injury

Many active adults assume that pain equals damage. This belief leads people to panic, stop exercising, or avoid movements they enjoy. In reality, pain after activity is often your body’s way of signaling that the demand exceeded your current capacity, not that something was torn or broken.

Think of it like sun exposure. You might feel fine while you’re outside, but later that evening you realize you stayed out longer than your skin could tolerate. The solution is not to avoid the sun forever. It is to build tolerance gradually and dose exposure more intelligently.

Your back works the same way.

Load Tolerance and Why It Matters in Back Pain Physical Therapy

Load tolerance refers to how much stress your tissues can handle before symptoms appear. Your spine and surrounding muscles adapt positively to load when it is introduced progressively. Problems arise when demand increases faster than adaptation.

This is especially common when people:

Increase workout intensity too quickly
Add more weight or volume without adequate progression
Increase training frequency without adjusting recovery
Combine hard training with high life stress and poor sleep

High-intensity training performed for long durations can amplify this effect. Even if your technique is solid, your back may not yet be prepared to tolerate the cumulative stress.

Back pain physical therapy focuses on identifying these mismatches and correcting them, not simply chasing symptoms.

Why Avoiding the Gym Is Usually the Wrong Answer

After experiencing next-day back pain, many people respond by avoiding the gym altogether. While rest can calm symptoms temporarily, prolonged avoidance often leads to decreased strength, reduced tissue tolerance, and greater sensitivity to future stress.

This creates a cycle where the back becomes less resilient over time.

The goal of effective back pain physical therapy is not to remove load, but to apply the right load at the right time in the right amount. That is how long-term improvements happen.

Training Smarter Instead of Training Less

If your back pain consistently shows up after workouts but settles within a day or two, that is often a sign that your program needs refinement, not elimination.

Smarter training may involve:

Adjusting exercise selection
Modifying volume or intensity
Improving recovery strategies
Progressively loading the spine and surrounding musculature

A well-designed plan gradually increases your back’s ability to tolerate stress so that the same workouts no longer trigger symptoms.

This is one of the core principles of back pain physical therapy for active adults.

How Back Pain Physical Therapy Helps Active Adults

A comprehensive back pain physical therapy approach looks beyond where you feel pain and examines:

Strength and endurance of the trunk and hips
Movement strategies during loaded tasks
Training history and recent changes
Recovery capacity and overall workload

Rather than telling you to stop doing what you love, the goal is to help you return to lifting, training, skiing, snowboarding, and daily life with confidence and consistency.

If your back feels great during workouts but hurts the next day, that does not mean you are broken or that you should stop being active. In most cases, it means your current capacity does not yet match the demands of your training.

With the right progression, guidance, and strategy, your back can become more resilient over time.

That is exactly what high-quality back pain physical therapy is designed to do.

Having a 6-Pack Is Overrated?!

When it comes to fitness, the six-pack — those visible abs known as the rectus abdominis — gets all the glory. But from a physical therapy and spine health standpoint, it’s time we set the record straight: having a 6-pack is overrated.

At Cohen Health and Performance, we frequently work with active adults and athletes who want to prevent or recover from back pain, improve their core stability, and get more out of their workouts. A key misconception many bring in is the belief that the rectus abdominis is the holy grail of core strength.

Let’s break that myth down.

What the Rectus Abdominis Really Does

The rectus abdominis runs from your ribcage to your pelvis, right down the front of your abdomen. It’s the most superficial abdominal muscle — meaning it’s closest to the surface — which is why it’s the one you see in the mirror. But it’s not the most functional when it comes to spinal support or back pain prevention.

Its attachment points on the ribcage and pelvis are small and weak compared to deeper abdominal muscles. This means it doesn’t do a great job controlling how your ribcage and pelvis align — a key part of keeping your spine supported during movement.

The Real Core Stabilizers: What Actually Helps with Back Pain

At Cohen Health and Performance, where we provide sports physical therapy in McLean and Bethesda, we focus heavily on training the deeper core muscles that make a real difference:

-Transverse abdominis: The deepest abdominal muscle, wraps around your torso like a corset.
-Obliques: Help with rotation, side bending, and crucially, stabilizing your ribcage and pelvis.
-Diaphragm and pelvic floor: Work in sync with your core to manage internal pressure and support the spine.

These deeper muscles have stronger connections to your ribcage and pelvis and play a much greater role in controlling spinal position — making them essential for back pain relief and injury prevention.

How We Teach Patients to Engage the Right Muscles

Many people struggle to “find” or activate these deeper muscles because they’ve been trained — often unknowingly — to only rely on superficial muscles like the 6-pack.

One of the first drills we teach many of our physical therapy patients in Bethesda and McLean is something you can try at home:

1. Lie on your back with knees bent and feet flat.
2. Breathe in through your nose.
3. Exhale slowly through your mouth — as long as you possibly can.
4. As you exhale fully, you should feel your ribs draw down and in — and your deeper abs engage.
5. Hold that feeling for 5 seconds at the end of the exhale.
6. Try to quietly breathe in without losing that muscle engagement and repeat this cycle 5 times

This is often the first step toward building true core control — and a key part of our rehab process for those dealing with chronic or recurrent low back pain.

How This Applies to Movement and Exercise

Once you learn how to activate those deeper muscles, we help you bring that control into movement:

-Lifting one leg at a time while lying down
-Overhead arm motions while continuing to feel your deep abdominals
-Transitioning to standing drills like squats or deadlifts
-Returning to sport or high-level athletic performance

This progressive, intelligent approach is what sets our physical therapy practice in Bethesda and McLean apart — and what helps our patients get long-term results, not just temporary relief.

Struggling with Back Pain? Want Smarter Core Training?

If you’ve been dealing with low back pain, poor posture, or feel like your workouts just aren’t translating to improved performance or comfort, it may be time to train your core smarter, not harder.

Our Doctors of Physical Therapy in Bethesda and McLean can help you:

-Eliminate chronic or nagging back pain
-Improve core strength and stability
-Optimize your breathing and movement patterns
-Return to sport, the gym, or simply a pain-free life

Ready to Get Started?

If you are looking to move and feel better, don’t waste time chasing six-pack abs. Schedule an appointment with our team at Cohen Health and Performance in Bethesda or McLean, VA and start building a strong, functional core that actually protects your back and enhances your performance. Click here to get started!

You Don’t Just Have a “Bad Back”

At Cohen Health and Performance, I’ve had the privilege of helping countless individuals overcome chronic back pain—pain that’s persisted for months, years, or even decades. One thing I hear often is:
“I just have a bad back.”

But what does that really mean?

Rethinking the “Bad Back” Mindset

Many people are told by well-meaning professionals—or after seeing a concerning X-ray or MRI—that they’ll just have to “live with” back discomfort. But here’s the truth: imaging findings don’t always match up with pain levels.
You can have a “perfect” MRI and still feel miserable. Or, your imaging might show disc herniations or degeneration, yet you feel completely fine. So if structure alone doesn’t explain back pain, what does?

Pain is more than a picture. It’s a response. And in the case of chronic back pain, your body may be responding by stiffening up the spine to protect it—like putting a cast on a broken arm. The problem? That constant “splinting” or bracing over time can cause its own set of issues.

Why Movement Matters in Back Pain Physical Therapy

Your spine isn’t one long, fragile bone—it’s a series of small vertebrae stacked like building blocks, designed to move segmentally, much like a slithering snake. When your back stiffens due to prolonged discomfort or fear of movement, you lose that segmental motion. This not only limits function but also reduces the nutrition your joints and discs receive through movement.

One of the first things we focus on in back pain physical therapy and back pain rehab is restoring this movement. I often teach clients a drill called spinal segmentation, where the goal is to regain control by moving one segment of the spine at a time. It doesn’t need to be perfect—it just needs to reconnect your brain to your body’s natural movement capacity.

Stability: Learning to Support Your Spine (Without Leaning on It)

Alongside restoring movement, spinal stability is just as important. Many people with long-term back pain unknowingly rely on their spine for support—even during basic daily activities—rather than using their core muscles.

A favorite exercise of ours to teach spinal stability is the bear position hold. In this position, the goal is to support your body using your abdominal muscles rather than “hanging” on your spine. We coach patients to keep their belly button from dropping and to create tension through their core—retraining them to stabilize without compressing or bracing their spine unnecessarily.

Once this is mastered, we integrate that same feeling of stability into more functional movements like squats or weightlifting, encouraging patients to “feel their abs” supporting them rather than overusing their back.

Breaking the Chronic Pain Cycle

If you’ve been dealing with back pain for a long time, you may have started to believe that nothing will change—that this is just how it is. But that belief is part of what holds people back.

At Cohen Health and Performance, we’ve found that the most effective approach to chronic back pain is an active one—helping you learn how to move better, build control, and load your body in a way that restores trust and function.

Back pain physical therapy and back pain rehab in McLean isn’t about avoiding movement. It’s about restoring movement—and giving you the tools to do the things that matter to you, without fear or limitation.

Ready to Reclaim Your Life from Chronic Back Pain?

If you’re tired of being told you have a “bad back” and want to explore what’s really possible with the right plan, we’re here to help. Reach out to schedule an evaluation or check out more of our educational content on our YouTube page, where we demonstrate exercises and share strategies that have helped countless people just like you.

Let’s stop managing your pain—and start changing your story.

Extension Related Back Pain with Hypermobility

If you’re an active adult or athlete with hypermobility, recovering from back pain can be especially frustrating. What works for most people—like stretching or simply “moving more”—can actually make things worse if your joints already move too much.

At Cohen Health and Performance, we often help hypermobile individuals recover from extension-related back injuries, which typically result from excessive compression of the spine during movement. You may have heard some of the more technical terms for these injuries—like spondylosis, spondylolisthesis, pars defects, or even stress fractures.

These types of injuries are common in athletes who spend a lot of time arching or extending through the low back—think gymnastics, dance, overhead lifting, and even running.

Why Hypermobility Needs a Different Approach

Hypermobility means your joints exceed normal range. While that can be an advantage in sports requiring flexibility, it places a higher demand on your muscles to create stability. This is especially important when it comes to the spine, where poor control can lead to repeated irritation or injury.

If you’re recovering from an extension-based back injury—one where backward bending has caused too much load through the joints in the spoine—your recovery needs to be just as specific as your condition.

How Physical Therapy Can Help

At Cohen Health and Performance, our physical therapists work directly with hypermobile patients to restore safe movement and prevent re-injury. Our approach focuses on:

Stabilizing the spine by improving deep core work
Distributing movement across the hips, shoulders, and thoracic spine rather than dumping into the low back
Progressively retraining lumbar extension, so it’s controlled and not reliant on end-range joint motion
Building strength to support hypermobile joints through all phases of movement

We don’t just chase flexibility or range—we build the foundation for controlled, purposeful movement that leads to long-term results.

Recovering Extension the Right Way

Extension is a normal and necessary part of athletic movement—but when it happens excessively or without control, it can lead to spinal compression and pain. Here’s how we approach it in the clinic:

Train Core Control First
Your core muscles are your spine’s best defense against compression. We teach you how to activate and coordinate these muscles—especially in positions of extension—so that your spine is protected, not overloaded.
Use the Hips and Shoulders
Movement should be shared—not isolated. Our physical therapists help you restore mobility and coordination in the hips and shoulders so that the lumbar spine isn’t forced to do all the work.
Control Mid-Range Before Deep Range
Hypermobility often comes with a tendency to hang out in end-range. We train you to control movement through more mid-range positions first, before carefully progressing to deeper extension with purpose and strength.
Build Strategic Strength
Strength is one of the most important tools in hypermobility rehab. We customize strength programs to support your spine and joints so you can move powerfully without pain.

Our Goal: Help You Stay Active, Pain-Free, and Performing

Whether you’re a gymnast, a weightlifter, or simply someone who likes to push yourself physically, we understand how important your activity is to you. At Cohen Health and Performance, we don’t just help you get out of pain—we help you move with confidence and longevity.

Back Squats & Back Pain: What Your Physical Therapist Wants You to Know

If You’re Dealing with Back Pain, Not All Squats Are Created Equal

In my physical therapy practice, I work with a wide range of athletes and active individuals dealing with back pain. Earlier today, I had a conversation with a local personal trainer who is about to start working with one of my patients—a patient currently in physical therapy for back pain.

We were collaborating on how to design a training program that supports their recovery. Naturally, the topic of squatting came up. It’s a staple in most fitness routines, but when you’re dealing with low back pain, the type of squat you choose can make a big difference.

Why Back Squats Might Not Be Ideal for Back Pain

Let’s get one thing clear: I’m not saying back squats are inherently bad. But when it comes to physical therapy for back pain, we have to weigh the risk-to-reward ratio of every exercise.

In a traditional back squat, the barbell rests behind the head. This positioning shifts the center of mass forward and often leads to excessive lumbar extension—or over-arching of the lower back. That posture increases spinal compression, limits hip mobility, and can aggravate existing pain.

For patients going through physical therapy for their back, this added pressure on the spine is something we want to avoid—not just for comfort, but for long-term recovery and performance.

Better Squat Alternatives for Back Pain Relief

In my work with patients, I often recommend squat variations that are more compatible with spine-friendly movement mechanics. Examples include:

Goblet Squats
Safety Bar Squats

These exercises shift the load in front of the body, promoting a more back-friendly spine position, stronger abdominal engagement, more open hips, and reduced stress on the lumbar spine.

In fact, many patients find that these alternatives not only feel better but allow their legs to work harder—because their back is no longer overcompensating for poor positioning.

What This Means for Back Pain Rehab

One of the most important principles in physical therapy for back pain is knowing what to modify and when. You don’t need to stop training—you just need to train smarter.

If you’ve struggled with low back pain in the past or are currently recovering from an injury, making small changes like adjusting your squat style can protect your spine while still building strength, muscle, and endurance.

Need Help with Your Training Program?

At our Bethesda and McLean clinic, we specialize in physical therapy for back pain and helping people return to high-level performance without re-injury. Whether you’re a weekend warrior, a competitive athlete, or someone simply trying to move pain-free, we’re here to help.

Simple contact us and we will take things from there.