There is a new phrase in Cape Town's lexicon: Day Zero injuries.
Most of them are caused by lugging buckets of grey water from showers and washing machines to recycle in the loo or garden.
Some of them are minor and heal with a bit of rest. Others are more serious and need physiotherapy, or in a few cases, surgery.
Local physiotherapists say they have seen a spike in these injuries, while one Pilates instructor has given classes on how to carry loaded buckets without doing yourself harm.
Ian Meder, a physiotherapist at the Sports Science Institute in Newlands, said he had seen an increase in neck, shoulder, elbow and wrist injuries since the water restrictions started.
"Most of these were from carrying buckets of water and emptying them into toilets, in an awkward position. Most of my clients' injuries were linked to the repetitive movements of doing this over time," Meder said.
"And it is generally the ones who are less active who get injuries. If you are not exercising properly, something is going to give, and it is usually the tendons."
The problem began back in January when the City council said the drought was so severe that Cape Town's taps could run dry. To avoid Day Zero, Capetonians were told they had to live on just 50l of water a person a day.
The sale of buckets went up and people across the city started collecting water from showers and washing machines to flush toilets, water gardens and clean floors.
While millions of people around the world - and in this country - have no running water and have to collect it from rivers or communal taps far from their homes, most middle-class South Africans have little experience of lugging heavy buckets around day after day.
Although the City council said in March that Day Zero was unlikely to happen this year, the water restrictions remain just as severe, so in many households the bucket regime continues.
Physiotherapist Gary Louis from Tokai said one reason why people injured themselves was that, instead of using smaller buckets, or filling them only halfway, many used big buckets and filled them up.
When they poured these heavy buckets into toilets, they were often in awkward positions and injured themselves.
"We've seen an increase in lower back injuries and injuries to the dominant arm - hand, elbow, shoulder and neck," Louis said.
He had also seen two clients with knee injuries from carrying buckets up and down staircases and several people with injuries to the rotator cuff, the muscles and tendons surrounding the shoulder. Some of them had to have surgery.
"One guy drilled into his arm when he was drilling to put in water pipes and had to have surgery. A woman slipped on the wet floor when she was putting water into the toilet and she hit her face on the bowl and cracked her jawbone," Louis said.
Rashaad Jakoet, also from the Sports Science Institute, said another way people had injured themselves was from loading heavy water containers into vehicles.
"You'll get moms coming back from the school run and quickly stopping to fill containers at a spring, for instance, and then lifting them into the back of the SUV. Some people don't realise that 20l of water weigh 20kg, and doing that when you are not used to it can cause injuries," he said.
Lizanne Tucker, a physiotherapist in Bellville, said she had seen plenty of lower back and shoulder injuries from carrying buckets.
"We don't keep stats, but a lot more of our clients have injuries related to Day Zero activities. A lot of clients with top-loader washing machines collect the water from the first load and then put it back for a second load. A top-loader takes a lot of litres and it is heavy to pick up and put it back," Tucker said.
Pilates trainer Leonie Dyamond from Durbanville said she had decided to start classes to train people how to carry buckets without injuring themselves. She began this last year when water restrictions outlawed using hoses on gardens, and people began carrying buckets.
"I bought 16 buckets for the eight people in the class and I filled them with stones or weights, and taught them to bend their knees when they picked up loads, and keep the load close to the body. Also, not to round the spine or twist when they are carrying them," Dyamond said.
She said the class was already prepared by the time Day Zero came and none of the people from her studio had incurred Day Zero injuries.
"We are now experiencing in the middle classes what poorer people all over the world have to do. I read that females do 80% of the water carrying in the world. Some women from cultures that carry water on their heads get compression of the neck by the time they are 40.
"Whether we are middle-class or poor, women are generally not strong in the shoulders and have to be careful," Dyamond said.
bend the knees when lifting loads;
keep the load close to the body when lifting;
to avoid spilling and slipping, do not rush;
make a few trips with half-full buckets rather than one trip with a full bucket;
use good quality buckets with handles that don't come loose;
and invest in a trolley that folds flat and fits into the boot to carry heavy containers from springs.