By John Hofman
Over the years, I have worked with many of our firefighters assigned to light duty. Most suffered from low back pain or shoulder problems, and I began to realize something: Even though their symptoms were different, many of their problems were caused by the same reason–THEIR POSTURE! Many firefighters suffer from posterior pelvic tilt or “flat back,” which could be associated with many of their musculoskeletal injuries. Posterior pelvic tilt involves the reduction of the natural lumbar curvature. This will increase your risk of lumbar disk herniations and upper extremity or shoulder problems.
Why is their posture so bad? Easy: THE JOB! Let’s just look at one example: if we place a self-contained breathing apparatus (SCBA) on your back, you roll your shoulder forward so that you do not fall backwards (for some it actually looks like an abdominal crunch). Have you ever heard a firefighter complain about “his hamstrings are always tight?” From the front wall, the abdominals and external obliques are pulling up on the pelvis, and the backside, the glutes, and the hamstrings pull down on the pelvis. This leads to a series of issues.
1. Because there is no lumbar curve, firefighters tend to move into lumbar flexion. Our bodies do not really want to be in lumbar flexion, especially under load. So when we prescribe bi-lateral squats or deadlifts, we may be doing more harm than good because you are at higher risk of a disk herniation. In fact, many firefighters over time lose the ability to control their pelvis so that when they perform bilateral movements, their pelvis rolls under, placing pressure on the lumbar.
SOLUTION: Prescribe more unilateral exercises such as split squats, lunges, lateral squats, lateral step up, and crossover steps. Unilateral training activates deep core muscles to help keep you balanced. When you do a movement with only one side of the body, different muscles will need to engage to compensate to stabilize the spine and pelvis. Besides, you generally work on one leg vs. two (i.e., walking, climbing, running, and so on).
To help make the exercise even more specific, our firefighters train with one dumbbell or kettlebell only while performing these exercises. This will allow the body to be unequally loaded, thereby creating more stability strength and reducing the chance of injury.
2. If the lumbar spine is flat, it could lead to increased kyphosis (or slouched upper back) and head forward posture. Excessive kyphosis isn’t a good thing if you value your rotator cuff health, and head forward posture puts you at increased risk for neck pain as well as cervical disc herniations. Sound familiar? How many firefighters do you know who are suffering from shoulder problems?
SOLUTION: Follow the table below
(sound familiar? You probably stretch these muscles all the time because you feel tight.)
tensor fasciae latae
One type of screening that can be incorporated into any fire program is the Functional Movement Screen (FMS). This screening is not a diagnostic tool but rather a simple method to assess basic movement. Over they years I had come to hypothesize that shoulder mobility and rotary stability would be good predictors for reduction of injuries. After screening hundreds of firefighters, it started to become clear: All of them had strong front abdominal walls (many do crunches, planks, and bilateral squats), yet those same firefighters had minimal strength in their rotary muscles. Why? Most low back injuries occur during twisting under load. Does this sound familiar: “I was just going for my jacket and my back gave out“? If you include poor shoulder mobility, it is safe to say that firefighters will probably incur some type of injury.
Recently, we had the opportunity to work with Dr. Butler of Duke University, who helped analyze our statistics so we could gain a better picture of some of the muscular imbalances associated with our firefighters. The results only confirmed my hypothesis.
One study published in the Journal of Occupational Medicine and Toxicology (April 2007) focused on the FMS as a new model for injury prediction and prevention. There results showed a reduction of lost time due to injuries by 62 percent and the number of injuries by 42 percent over a 12-month period. The study published by the North American Journal of Physical Therapy (August 2007) established a FMS score of 14 or less was positive to predict serious injury with professional football players.
Based off firefighter FMS Scores, we were able to identify the following:
1. A score of 14 was the appropriate cut point for elevated injury risk. Every firefighter we have ever had on light duty has always scored 11. So our goal is to establish a return-to-duty policy based on these numbers. (We are currently working on how much you will actually cost the department if you score 11, 12, and 13, respectively).
2. As mentioned above, many firefighters suffer from posterior tilt and lack pelvic control during bilateral movement. The deep squat was a strong predictor of injury. A score of 2 reduced the injury risk
3. Other tests related to injury risk were shoulder mobility and rotary stability. A score of 2 or above had a reduced injury risk.
4. A score of 16 was the appropriate cut off point for elevated injury risk during af fire academy.
The results were based on fire recruits, not career firefighters. Many career firefighters will generally have a strong front wall simple because of the job and physical tasks placed on them, whereas many recruits have not been exposed to the job and it could be assumed that their front wall is weaker because of it.
Overall, this type of assessment is invaluable to a comprehensive health-and-wellness program. By having a more preventive system, we are able to identify and properly prescribe better corrective strategies that will help reduce the chances of injury. Fitness is important, but knowing what exercises to prescribe or not prescribe only enhances the program and makes it specific to the needs of the department and the individual.
John Hofman is the strength and conditioning coach for the Sacramento Fire Department, John oversees the Wellness Centre, coordinates the department’s medical and fitness assessments; develops recruit fitness training, pre-employment medical and fitness evaluations; and assists the department’s 20-certified Peer Fitness Trainers. In addition, John also works as the strength and conditioning coach for the California Regional Fire Academy, Sierra Fire Technology Program, Rocklin Fire Department, and South Placer Fire District. He also consults with the Fire Agency Self Insurance System of California.
Peate, W.F., Bates, G., Lunda, K., Francis, S., & Bellamy, K., (April, 2007). Core Strength: A new model for injury prediction and prevention. Journal of Occupational Medicine and Toxicology.
Kiesel, K., Plisky, P., Voight, M., (August, 2007). Can Serious Injury In Professional Football Be Predicted By A Preseason Functional Movement Screen? Volume 2, Number 3
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