Clay Shoveler's Fracture Risk and Treatment

Clay shoveler's fracture is an avulsion fracture, with avulsion referring to a sudden pulling or tearing away of something. Avulsion fractures typically result from excessive, sudden contracture of muscles that are attached to the spinous processes. (An example of such a muscle is the trapezius.) This unique, forceful, contraction can occur in certain shoveling activities; hence, the name.

A patient talking to his spine doctor
Cecilie_Arcurs / Getty Images

When a clay shoveler's fracture occurs, a break which results in the detachment of the spinous process of one (or more) vertebrae in the upper spine takes place. Typically, it is the C6, C7, and/or T1 levels that are affected, but this injury can happen in other areas of the cervical or upper thoracic spine, as well. Clay shoveler's fractures can occur at more than one spinal level, although this is rare.

Who's at Risk

In modern industrialized countries, fracture of the cervical spinous processes is usually the result of direct impact or trauma to the affected spinous process(es), while the person is hyper-flexing their neck. For this reason, there are no risk factors to speak of (except for being in situations that make you vulnerable to this type of impact).​

That said, at the beginning of the 20th century, clay shoveler's fracture was common among workers and well known among healthcare providers. This is because back in the day (of the Industrial Age) it was a common occupational injury that mainly affected laborers whose responsibilities consisted of shoveling heavy loads repeatedly.

But now that we are in the age of technology, machines, software, and algorithms have, for the most part in Western society, replaced much of the heavy work. So healthcare providers and other spine experts have likely all but forgotten about clay shoveler's fracture. Because of this, the possibility of a clay shoveler's fracture is the cause of your neck pain that may be overlooked during the diagnosis process. If you happen to garden or shovel snow and you see your healthcare provider for neck pain, it's probably a good idea to mention these activities to her. Doing so may alert her to the possibility of clay shoveler's fracture, as well as save you time and expense trying to figure out what's going on with your neck.

What to Do for Pain

Wearing a cervical collar and restricting your neck movements for a few months will likely help with the pain. Generally, there are no nerve symptoms (i.e. pins and needles, electrical shock, burning and/or pain that goes down one arm only) associated with clay shoveler's fracture.

Regardless of how it happens, if you experience any kind of trauma or impact to your neck, you should see your healthcare provider as soon as you can.

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  • Akhaddar A1, Mandour C2. Multiple contiguous cervicothoracic Clay-shoveler's fractures (from C6 to T9 spinal vertebrae). Pan Afr Med J. 2013 Dec 2;16:128. doi: 10.11604/pamj.2013.16.128.3531. eCollection 2013.
  • Dellestable F1, Gaucher A. Clay-shoveler's fracture. Stress fracture of the lower cervical and upper thoracic spinous processes. Rev Rhum Engl Ed. 1998 Oct;65(10):575-82.

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.