Few life choices are fraught with more peril than the decision to shovel snow.

Yes, shoveling is a killer workout — except, of course, when it actually kills. And then there are the legal ramifications. Many municipalities require residents to clear walks and driveways. But some homeowners refuse because someone at some time said shoveling actually increases a homeowner’s liability in slip-and-fall accidents. It’s an enduring and convenient excuse, only it’s not true … most of the time.

But first things first. Before deciding to shovel, are you even able? Shoveling snow is excellent exercise, burning about 400 calories per hour. But the cold constricts blood vessels, and shoveling spikes your heart rate. That could lead to a heart attack. Barnes-Jewish Hospital cardiologist Edward Geltman recommends folks in questionable health work slowly and take breaks.

“Don’t do anything that makes you breathe hard and prevents you from speaking in full sentences,” Geltman said. “But if you can, shoveling is a total-body workout, like cross-country skiing. You’re using your shoulders, your arms, your back.”

Even if you can shovel, must you? Most municipalities say yes.

In Columbia, a city ordinance on clearing sidewalks says all residents must keep sidewalks in front of or adjacent to property they own or occupy clear of snow and ice. Failure to do so is considered a misdemeanor offense.

What does Missouri law say on the question? The state does not explicitly require homeowners to clear their drives, but St. Louis University law Professor Peter Salsich says Missouri common law suggests otherwise. He calls the shoveling-lawsuit link an urban myth.

“I guess some people think, ‘If I do nothing, then it’s someone else’s problem. They see it’s icy, and it’s their responsibility to be careful,’ ” Salsich said. “But it’s clear that you cannot allow your property to pose a danger.”

But what if you clear your walk and a litigious neighbor still slips? It depends on what conditions are like in the surrounding areas. Say, for instance, you wake up to falling snow. The law does not demand you skip breakfast and clear snow as it falls.

“They don’t call that an act of God, but it is the same concept. No person is responsible for general natural accumulation,” said Evans & Dixon attorney John Michener, who defends property owners against personal injury cases.

But once the condition starts to change — say repeated trips walking back and forth has turned the snow into uneven patches of ice — then the homeowner is liable for the walk’s altered condition.

“That may take three hours or three days, but the snow is no longer in that natural state,” Michener said. “Then there is the duty to clear it. The standard is what would a prudent person do. You don’t have to wave a wand and get to the concrete. You don’t have to do an extraordinary job, just what a reasonable person would do. Of course, 12 jurors may argue about what that means.”

For instance, in one landmark Missouri case, a plaintiff successfully sued a restaurant after slipping on a lot the day after it was cleared. Personal injury attorney K. Lindsay Rakers of the Cagle Law Firm explains the condition of the property was more dangerous than surrounding areas.

“A thorough investigation of the facts leading up to the fall is absolutely crucial in these fall cases,” Rakers said.

Clearly, these cases are complicated. But Michener can think of one example when, yes, you should leave the shovel in the garage: ice topped with snow.

“At that point, you have the natural accumulation and no legal duty. But if you do go out there and expose a sheet of ice under 3 inches of snow, then you’ve made it worse,” Michener said. “Good intent doesn’t matter in cases of negligence.”

It’s enough to give your brain frostbite. You could keep a legal and medical team on retainer. Or you could just shovel the darn snow. That’s what Jim Camoriano, a spokesman for State Farm Insurance Cos., does. The insurance company does not track snow-related slip-and-falls, but Camoriano said the region hasn’t faced a rash of claims. He recommends policyholders do what they can to keep their walks safe. After all, it’s the neighborly thing to do.

“I’ve heard that too, that once you maintain” your walk “then your liability increases,” Camoriano said. “But don’t you want to do what you can to make things as safe as possible for your neighbors and your mail carrier, not to mention yourself? To me, it seems like common sense.”

Much of the country enjoyed a white Christmas and post-Christmas. Digging out from a heavy snow is not only a tiring chore, it can be downright dangerous. And the danger can be greater than just aching backs and frozen fingers.

“Each year thousands of people are treated in emergency departments across the United States for heart attacks, broken bones and other injuries related to snow shoveling,” said Dr. Thomas Esposito, chief of the Division of Trauma, Surgical Critical Care and Burns, Department of Surgery, Loyola University Chicago Stritch School of Medicine.

Esposito recommends people with a history of back or heart problems ask someone else to do the heavy shoveling. If you have to do it yourself, know your limits and don’t overdo it.
Pumping snow

Shoveling is a very physical activity that is comparable to lifting heavy weights repeatedly and quickly. Unless you pump iron regularly at the gym, you might not be up to the task.

If you decide you’re fit enough to do your own shoveling, health experts suggest doing some warm up exercises first, as though you were preparing for a vigorous workout. At the very least, start with a brief walk or marching in place to get your body ready for the physical strain. Also, try adding arm movements and stretching your back to warm up the upper body.

Here are a few more tips to help you stay healthy during shoveling season:

* Dress appropriately. Wearing layers allows you to adjust to the temperature outside. When you are going to be outside for a long time, cover your skin to prevent frostbite.
* Use a small shovel that has a curved handle. A shovel with wet snow can weigh up to 15 pounds. A small shovel ensures you have a lighter load, which can prevent injury.
* Separate your hands on the shovel. By creating space between your hands, you can increase your leverage on the shovel.
* Lift with your legs, not your back. Make sure your knees are bending and straightening to lift the shovel instead of leaning forward and straightening with the back.
* Shovel frequently. Don’t wait till the snow piles up. Shovel intermittently, about every two inches.
* Push the snow. It is easier and better for your back to push the snow rather than lift it. Also, never throw snow over your shoulders.
* Pace yourself. Take breaks and gently stretch your back, arms and legs before returning to work.
* Stay hydrated. Drinking plenty of water is important when exercising regardless of the outside temperature.
* Avoid caffeine and nicotine. These stimulants increase the heart rate and constrict blood vessels, putting strain on your heart.
* Avoid alcoholic beverages. Alcohol can dull your senses and make you vulnerable to hypothermia and frostbite.

“Each season has its own particular set of risks, but winter with its snowstorms, plunging temperatures and wind chills can be especially daunting when it comes to safety,” said Esposito.

If you have any doubts, hire a youngster in the neighborhood to clear your walk, or seek your health care provider’s advice.

The American Physical Therapy Association (APTA) is pointing to a new study on low back pain in Medicare patients in its efforts to encourage the newly established Center for Medicare and Medicaid Innovation to promptly launch a demonstration project on direct access to physical therapist services that was recommended in the recent health reform law.

The study, published in the journal Spine, showed Medicare patients who received physical therapy in the acute phase following an episode of low back pain were less likely to receive epidural steroid injections, lumbar surgery, or frequent physician office visits in the year following their initial physician visit as compared with patients who received physical therapist treatment later.

“This study has demonstrated a decreased usage of medical services in patients who receive physical therapy early after an acute low back pain episode,” remarked APTA President R. Scott Ward, PT, PhD. “Therefore, we encourage the Center for Medicare and Medicaid Innovation to swiftly undertake the direct access for physical therapy demonstration project recommended by the health care reform law. The results of this project could significantly change the way physical therapy services are delivered to our nation’s seniors—putting them on a path to recovery sooner and decreasing future costs.”

Researchers examined a nationally representative, 20% sample of physician outpatient billing claims from the Centers for Medicare and Medicaid Services. The 431,195 enrollees were categorized into acute (having received physical therapy in less than 4 weeks after an episode); sub-acute (having received physical therapy between 4 weeks and 3 months after an episode), and chronic (receiving physical therapy between 3 and 12 months after an episode) treatment groups. There was also a category of patients who did not receive physical therapist treatment.

Researchers also found that patients who were initially evaluated by a generalist specialist (internal medicine
, family practice, emergency medicine, and general practice) were least likely to receive physical therapy within a year as compared with patients who were evaluated by physiatrists (physical medicine and rehabilitation), whose patients were most likely to receive physical therapy in the acute phase and also within 1 year of their initial evaluation.

“The study has also shown us that treatment practices among those who are utilizing less physical therapy, namely generalist specialties, may need to be modified since these providers also are responsible for evaluating the largest proportion of patients with acute low back pain,” said Ward.

The most common condition experienced by the patients was nonspecific backache (63.6%), followed by sciatica (14.5%), degenerative disc disease (10.5%), and spinal stenosis (6.2%).

In November, the Centers for Medicare and Medicaid Services formally established the Center for Medicare and Medicaid Innovation, which will examine new ways of delivering health care and paying health care providers who can save money on behalf of Medicare and Medicaid while improving the quality of care. Included in the Innovation Center’s initiatives is a demonstration project on direct access to physical therapists that was outlined in Section 3201 of the new health reform law, the Affordable Care Act, but no deadline was established regarding its implementation.

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While every case is different, you will need (at a minimum) the following:

* photos of the scene, ideally photos depicting the condition
* as many witnesses to the incident, or the dangerous condition, as you can find (remember, you yourself are also a witness)
* the “incident report” (if it occurred in a business establishment)
* proof of your injuries and damages; and
* reports of prior incidents (if they exist).

Many cases will also require bringing in an expert witness, especially if the dangerous or hazardous condition is not apparent (as in a slick surface), who can evaluate the condition and testify as to what caused you to fall, based on his/her technical education, training or experience. If you work with an injury attorney, he or she will have the necessary resources at hand to prove your case.

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