Winter is coming and many parts of the country have already been walloped with serious snow storms. But shoveling your driveway can be more than just a chore — it can be hazardous and even lethal if you’re not careful.

Snow removal led to about 100 deaths and 11,500 injuries that required a trip to the emergency room each year between 1990 and 2006, a study published in the peer-reviewed American Journal of Emergency Medicine found. The most common injuries were soft tissue damage, the lower back was the most frequently damaged part of the body, and cardiac-related injuries were responsible for all of the 1,647 fatalities.

The true total of injuries and deaths may be much higher, according to Barry Franklin, director of preventative cardiology and cardiac rehabilitation at William Beaumont Health in Royal Oak, Michigan. Franklin begin researching the issue because two of his friends died suddenly after clearing snow.

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