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Would Santa have back pain?

Is Santa at Risk for Back Pain?

Just for fun, I started to think about whether or not Santa Clause would be at risk for back pain.  Based on my experience as a Chiropractor and Athletic Therapist, as well as my experience of treating back pain these are my thoughts.

First let’s look at Santa’s job description. Throughout the year he is responsible for the logistics and production of toys for girls and boys throughout the world. He needs to monitor kids to make sure if they are being naughty or nice and place them in the appropriate list. He needs to check all of his lists at least twice. Then on Christmas eve he is the driver of a sleigh which is pulled by 9 reindeer, including Rudolph. That’s a lot of horse … reindeer power that he has to control through the entire trip. Then he needs to lift up his heavy sac and carry it up and down a chimney.

Thankfully, Santa has his elves helping him make all the toys for the boys and girls.  It was smart of him to delegate some of the work.  If he had to do all the work himself he would likely experience repetitive strain injuries in his wrists, elbows, shoulders, neck in addition to his lower back.

Sadly though, in the case for lower back pain, the odds are against Santa. Approximately 80% of people will have suffered from back pain at least once in their life.  The occurrence rate is also high among those who have had a previous back injury.

Here are some of the risk factors for back pain that Santa possesses.


Years ago Santa was a smoker. Smoking is a risk factor for back pain.  People who smoke tend to experience an increased occurrence of degenerative disc disease of the spine.

Smoking tends to reduced the anabolic activity of cells within the discs. This shifts the balance, between repair and break down, towards breaking down.

Santa may not be smoking (or he is hiding it because it is less socially acceptable) now but the damage to his spine has already been done. The effectiveness of quitting smoking on the regeneration of a degenerated disc has been shown to have limited benefit on the health of the disc.

On a positive note, the presence of disc degeneration does not necessarily mean that back pain is present. One study found the following

  • 37% of pain-free 20-year-olds have disc degeneration
  • 96% of pain-free 80-year-olds have disc degeneration

In addition, smoking is associated with chronic pain which is often experienced by those who have had a back injury. The current theory is that chronic smoke exposure may decrease pain tolerance and therefore increase pain awareness.


It is rather evident that Santa is overweight. Every time he laughs his belly jiggles like a bowl of Jello.  The extra weight he carries places added strain onto all of his weight bearing joints, including his spine and the intervertebral discs between his vertebrae. This added strain can lead to an intervertebral disc derangement/herniation  and possibly lead to sciatica down his leg. With his extra weight in his belly his spine needs to extend backwards so he can stay upright.  This can cause abnormal compression onto the joints between the vertebra causing what is known as facet syndrome. It also means the lower back muscles are having to work.

There is a positive association between obesity and back pain especially for those who who have back pain for more than 30 days.

If Santa were to work on changing his body composition by increasing his activity levels and changing his calorie consumption there is good evidence that his lower back would improve or even disappear.

In addition, with Santa being overweight he may be suffering from Metabolic syndrome which has also been associated with lower back pain. In one study the prevalence of metabolic syndrome among chronic lower back pain patients was 36.2%.

  Metabolic syndrome is linked to Type II diabetes. Considering all of the cookies that Santa consumes on Christmas Eve he likely has Type II Diabetes (He may want to learn how exercise can help with diabetes).  Santa may also want to consider better eating habits and read this great weight loss success story by my friend Kymberley (She has now lost 80lbs!).


Typically disc herniations occur around 25 and 45 years of age.  Santa has been around for a long time.  His origins begin back to the 4th Century.  That would make him very old.  One might assume that he is from a lineage of Santa Clauses and if that is the case, the white beard likely places him in his 60s or later.  At this age we are more concerned about arthritis of the joints or even stenosis of the intervertebral foreamen where the nerves exit the spine. 

Arthritis of the spine has sometimes been called “grey hair of the spine”.  It is a natural process and thus it is highly expected to be found in Santa’s X-rays . And, sometimes arthritis of the spine can cause back pain.


It is quite evident that for most of the year Santa is inactive.  I am going to assume he has not performed any core exercises to aid in protecting his back and he likely doesn’t have the muscular strength or endurance to perform his job. You would think that he needs considerable strength to hold the reins of his flying reindeer, carry his Santa sac and to climb up the chimney after leaving from a house.

Inadequate core endurance and fatigue results in poor technique and can increase the chance of hurting your back.  The problem with having to work only once a year is similar to the weekend warriors who only play on the weekend and do not exercise any other time of the week.  Weekend warriors are often the ones who get injured.

I recommend to Santa to work on building up his core endurance, his general physical conditioning (which should involve pushing, pulling, squatting, deadlift exercises and carrying exercises or even simply work on a walking program.

Uneven lifting

Santa has to carry a heavy sac of toys.   Carrying a sac over one shoulder (likely the same shoulder all the time because of our tendency to be one side dominant) places excessive strain on one said. This would likely result in muscular imbalance and the possibility of back pain due to over use. He should follow the advice of a Chiropractor and use a backpack to evenly distribute the weight across both shoulders but more importantly prepare his body for the yearly one day event

Long sitting followed by heavy lifting

Truck drivers are often at risk for back pain one of the reason is due to the long sitting. The intervertebral discs are at even more risk of injury if long sitting is followed by lifting activities.

It is quite evident that Santa has a job that requires him to sit for long periods of time. He has to make his list and check it twice to see see who is naughty or nice. He has to sit for long hours listening to children’s Christmas wishes. Lastly, on Christmas Eve he flies in his sleigh on a 24 hour tour of the world. Sitting in his sleigh is followed by lifting his heavy Santa’s bag filled with toys for girls and boys.

I highly recommend to Santa that he takes a few minutes between sitting and lifting. He could take some time to do some repeated back bends.

I often recommend people get out of their chairs at least every 20 minutes and do something active for at least one minute. Remember, our body is meant to move.

Stressful job

Stress is another risk factor for back pain.  Santa likely gets very stressed with his job. He has billions of letters to read and he has to watch over every child making sure they are naughty or nice.  The naughty kids must make him want to pull his hair out (I wonder if that is why he wears that hat all the time). For most of the year his job must be pretty thankless.  As Christmas Eve gets closer he has to make sure everything is perfect. In addition, he has a deadline that can’t be extended. He has to get presents to all the boys and girls before they wake up.  If he doesn’t they won’t be very happy. He should try mindfulness meditation to help with his stress.


As you can see the odds of Santa having back pain are high.  Thankfully a number of these risk factors can be controllable while others are completely out of his control.  I highly suggest to Santa that he should seek out some help in managing his weight, developing his core, and developing his strength and endurance.  There are great Chiropractors, Athletic Therapists, Personal Trainers and Physiotherapists out there who can help. In addition he may want to try massage, fascial manipulation, Active Release Techniques, or acupuncture to help manage the back pain.  With a good team of healthcare providers you can manage your back pain more effectively.

Do you have any of these risk factors for back pain and do you have back pain? If so you may want to become proactive in your health seek out a health care professional that you can trust and start your New Year on the road to recovery.
I hope you all enjoyed this fun blog. Have a Merry Christmas!

Dr Notley

P.S. Hey Santa, if your back is hurting on Christmas Eve and you need to see a Chiropractor or Athletic Therapist in Winnipeg I have a table at home.  You know where I live.

originally written in 2010. Updated 2021


Originally posted on May 17, 2022 @ 4:39 pm