The Mummers Parade is a heavy lift. These marchers take steps to avoid injury.

Joe Trafficante marched in the Christmas parade in West Cape May this year with one of the heftier instruments on the musical spectrum: a 45-pound bass saxophone. For a guy who just learned to play the big horn in the last year or so, he did great — but for one rookie mistake.

He left his back support at home.

“It’s basically like taking a little 7-year-old kid, and putting a little hook on his belt loop and holding him that way,” said Trafficante, a Mummer who plays with the Greater Overbrook String Band. “When I was done with that parade, I basically lay on the ground to get my back back into shape."

Spectators may focus on the routines, the music, and the clever costumes of the Mummers at the New Year’s Day parade and other events throughout the year. But beneath the feathers and sparkle, many marchers have another issue in mind: aching joints.

Spines and shoulders are at risk of injury, and physicians at the Rothman Orthopaedic Institute say they have treated Mummers for hand and wrist ailments, as well.

Try lugging a bass sax or a tuba for miles in the icy cold. Or the hulking string bass, which weighs 50 pounds even at the scaled-down, three-quarter size carried by band members.

Then there are the elaborate feathered costumes with steel-framed back pieces. The largest ones measure close to 10 feet in diameter, mounted on a wide metal “blade” strapped to the parader’s back. The stout leather straps are padded but -- ouch!

Joe Bongard, a member of the Golden Sunrise club, felt the strain after the 2018 New Year’s Day parade, when he wore a Statue of Liberty costume that he estimated weighed 75 pounds.

“My back and shoulders were killing me for a couple of days,” he said.

The trick to a pain-free march is conditioning and proper weight distribution, longtime Mummers say.

Patrick Donahue, a string-bass player for the Durning String Band, carries his instrument with a wide strap like the ones movers use to lift a refrigerator. This year, he is thinking of adding a back brace to distribute the weight better -- likely to be useful when the big wooden instrument catches a gust of wind from a side street. And because his string-plucking fingers have not developed heavy calluses, he protects them with layers of medical tape “to keep from taking the skin off.”

Bass players have even been known to cut pieces of wood out of the instrument’s body to make it lighter -- a move Donahue rejects because of the impact on sound quality.

Mummers may be more likely to sustain injury if they are not in good shape, said Asif M. Ilyas, a hand and wrist surgeon at the Rothman Institute.

“It’s just like an athlete vs. a weekend warrior -- if you’re not used to carrying around a 30-pound drum every day, and suddenly you do it for four hours,” he said.

With overuse, tendons in the wrist, hand, and fingers can become inflamed and painfully swollen, said Ilyas, a professor of orthopedic surgery at Thomas Jefferson University. Treatment can include rest or splinting in milder cases, possibly with anti-inflammatory medicine. More serious cases may require cortisone injections or even surgery, he said.

On parade day, the emergency room also can get a few revelers with broken bones -- from falls or alcohol-fueled altercations, he said.

“Mummers parades are very festive,” Ilyas said.

One of the more commonsense measures to prevent injury is used with a costume called a frame suit -- a parade float that generally weighs more than 100 pounds, pushed from inside by one or two people. They simply put wheels on the bottom. Decades ago, before someone had the idea to mount the steel-and-wood frames on wheels, marchers would pick them up to march between performance stations, said Jack Cohen, president of Golden Sunrise.

“It was insane,” he said.

Bongard, the club member who wore the Statue of Liberty costume, is all about innovation for the 2019 parade. A technician at Faulkner Collision Center in South Philadelphia, he has devised a new costume harness that puts the weight on the wearer’s hips, like a hiker’s frame backpack, instead of the shoulders.

And instead of the classic steel frame, his Philadelphia Eagles-themed costume for Jan. 1 is made from lighter aluminum.

The Mummers are a tradition-loving crowd, and Bongard acknowledged that such changes may draw some pushback from the purists. But he predicts that his new rig will win converts.

“I think once people see it," he said, "they will want one.”