Winter musculoskeletal injuries: what primary care clinicians need to know

Primary care is often the best place to treat common muscle, bone, and joint problems, and winter makes that role especially clear. As colder temperatures, seasonal storms, and disrupted routines affect how people move and work, musculoskeletal (MSK) complaints become a frequent reason for primary care and urgent care visits. 

During the current Arctic blast, for example, many nurse practitioners and other advanced practice providers are likely seeing how slippery surfaces, heavy lifting, cold-related stiffness, deconditioning, and winter sports contribute to predictable injury patterns. 

Following are common winter MSK injury patterns, how they typically present, and practical insights intended to support primary care clinicians in delivering confident, nonsurgical care.

---

Falls on ice and wet surfaces seen in primary care

In regions with snow, ice, or freezing rain, falls remain a leading cause of winter MSK injury, especially among older adults.

Common presentations

• Wrist fractures from falls on an outstretched hand
• Ankle sprains or fractures
• Hip fractures or contusions
• Shoulder contusions, dislocations, or rotator cuff injuries

Primary care approach

• Pay close attention to mechanism, particularly in older patients
• Obtain plain radiographs when fracture is suspected
• Manage stable injuries with immobilization, analgesia, and early physical therapy
• Use winter visits to address fall risk, footwear, balance, and home safety

Even seemingly minor winter falls can result in significant injury, especially in patients with osteoporosis or balance issues. Careful history, exam, and first-line imaging often determine whether these patients can be managed safely in primary care or require escalation.

Image: Truveta

🚩 Red flags: when winter MSK injuries need urgent evaluation
While most winter MSK injuries are appropriate for conservative management, certain presentations require urgent escalation. Prompt referral or emergency evaluation is warranted when patients present with:

• Inability to bear weight after a fall or injury
• Obvious deformity or suspected displaced fracture
• Rapidly increasing pain or swelling
• Neurovascular compromise (numbness, weakness, cool or pale extremity)
• New bowel or bladder dysfunction or saddle anesthesia
• Progressive neurologic deficits following trauma

Early recognition of these red flags helps prevent complications and ensures timely and appropriate escalation of care.

Snow shoveling and heavy lifting injuries

Snow shoveling or any seasonal heavy lifting frequently leads to acute MSK complaints.

Common presentations

• Acute low back strain
• Cervical or thoracic paraspinal muscle strain
• Shoulder and rotator cuff flares
  

Primary care approach

• Screen for neurologic deficits or red flags
• Avoid early imaging unless trauma or neurologic symptoms are present
• Emphasize conservative care:
  • Activity modification
  • NSAIDs or acetaminophen
  • Early mobility and gradual return to activity

These injuries often result from poor biomechanics combined with sudden, unaccustomed load, and are frequently seen in patients who are otherwise inactive for much of the year.

Learn more about shoulder injuries in our Online Mini Course The Painful Shoulder (10 hours)

---

Winter sports injuries commonly seen in primary care

Winter sports contribute a steady stream of MSK injuries, many of which can be managed nonsurgically.

Common presentations

• Knee ligament injuries (ACL, MCL)
  
• Shoulder dislocations or AC joint injuries
• “Skier’s thumb” (ulnar collateral ligament injury)
• Wrist sprains or occult fractures
  

Primary care approach

• Start with X-rays to rule out fracture
  
• Use bracing and activity modification early
• Reserve MRI for suspected significant ligament or meniscal injury when results will change management
• Most patients improve with structured rehabilitation rather than surgery

Only a small proportion of winter sports injuries ultimately require operative care.

For many patients, reassurance and a clear recovery plan are just as important as imaging. Setting expectations early around healing time, activity modification, and rehabilitation can reduce unnecessary follow-up visits and referrals.

❄️ Cold weather and injury risk: what to watch for
Cold temperatures affect more than comfort, they also influence injury risk.

• Muscles and tendons are less elastic in colder conditions
• Inadequate warm-up increases strain and tear risk
• Cold-related stiffness may worsen chronic joint pain

Encouraging gradual warm-up, layered clothing, and paced activity can reduce winter-related MSK injuries, particularly in patients returning to activity after a period of inactivity

Cold-weather muscle, tendon, and overuse injuries

Even without snow or ice, winter increases MSK injury risk due to colder temperatures and changes in activity patterns.

Common presentations

• Hamstring, calf, or quadriceps strains
• Achilles or patellar tendinopathy flares
• Plantar fasciitis
• Shin splints or early stress reactions

Primary care approach

• Recognize sudden changes in activity, footwear, or training surface
• Emphasize warm-up, load management, and gradual progression
• Imaging is usually unnecessary early unless stress fracture is suspected

Cold muscles and tendons are less compliant, increasing injury risk without adequate preparation. These presentations often test diagnostic confidence, especially when deciding whether imaging is necessary or conservative care is appropriate.

Learn more about lower extremity conditions in our Online Lower Extremity and Inflammatory Conditions Course (65 hours)

Falls prevention still matters, even without ice
Even in regions without snow or ice, winter increases fall risk due to:

• Reduced daylight
• Footwear changes
• Deconditioning
• Vision or balance challenges

Winter visits can be a timely opportunity to address fall risk proactively, rather than waiting for an injury to occur.

Image: Truveta

Indoor exercise and home-related injuries

Indoor exercise and home-related injuries
As more people move workouts indoors during winter, injury patterns shift.

Common presentations

• Shoulder impingement or rotator cuff irritation
• Wrist and elbow overuse injuries
• Low back strain from poor ergonomics or floor exercises

Primary care approach

• Ask where and how patients are exercising
• Address technique, volume, and recovery rather than default imaging
• Early physical therapy can prevent progression to chronic pain
• Simple questions about equipment, technique, and recent changes in routine often reveal the underlying cause.

---

Arthritis and chronic pain flairs

Winter often worsens symptoms of chronic MSK conditions, even in the absence of injury.

Common presentations

• Knee, hip, hand, and spine osteoarthritis flares
• Increased stiffness and reduced morning mobility

Primary care approach

• Encourage movement rather than prolonged rest
• Adjust analgesic strategies seasonally
• Reinforce strengthening and joint-protective activity

Clear guidance on movement and pain management can help prevent unnecessary imaging or escalation during seasonal symptom flares.

🩺 Conservative care works for most winter MSK injuries
Most winter musculoskeletal injuries can be managed effectively without surgery, and many do not require specialist referral when appropriately assessed in primary care.

Core components of conservative care include:

• Activity modification rather than complete rest
• Appropriate use of bracing or support
• Analgesia tailored to patient risk factors
• Early referral to physical therapy when indicated

Reassurance, education, and follow-up are often just as important as imaging or intervention, as well as reducing unnecessary referrals, improving patient flow, and keeping care closer to home.

When to refer, and when to reassure

Primary care is often the best place to treat common muscle, bone, and joint problems. Urgent referral is warranted for:

• Inability to bear weight
• Neurovascular compromise
• Obvious deformity or unstable fracture
• Red-flag spine symptoms

Most winter MSK injuries, however, can be managed confidently in primary care with conservative treatment and close follow-up. Clear referral thresholds help clinicians reassure patients while ensuring timely escalation when it truly matters.

---

Tell us how you're doing

Winter looks different depending on where you practice, and the musculoskeletal patterns you see may vary by region and patient population. If you’re noticing winter-related MSK patterns in your clinic – whether tied to cold weather, activity changes, or recovery challenges – we’d love to hear what you’re seeing.

Feel free to join the conversation on our social channels and share what winter looks like in your practice.

---

Sources and further reading

• https://www.truveta.com/blog/research/winter-falls-and-injuries
• https://www.sportsmed.org/membership/sports-medicine-update/winter-2024/safe-slopes-preventing-winter-sports-injuries
• https://pmc.ncbi.nlm.nih.gov/articles/PMC7093636/
• https://pubmed.ncbi.nlm.nih.gov/37651272/