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Lower Back Injury Prevention

 

When it comes to exercise in the fire service, the varying theories are no less unique than the individual firefighters themselves.  The necessity for individuality in strength and conditioning programs creates a unique challenge for fire apartments who are trying to come up with standardized methods for ensuring health, wellness, and fitness among their ranks.  It can be difficult to convince anyone, especially a firefighter, that what they are doing, or not doing, is at best inefficient and possibly counterproductive; it is even more challenging to get an entire station, battalion, or department to get on the same page. I believe that the department’s big picture view of this issue has to start with the selection of candidates and continue with education and performance testing through the academy and probation, and finally foster a healthy environment for the firefighter’s entire career. But since we are not starting a brand new fire department with a massive budget and forward thinking managers I will begin here and now with a few ideas of how to approach exercise from the injury prevention perspective. In my experience attacking fitness in this way helps to straighten out a few of the “individual needs” issues and will give you your best chance at a long, injury free, career and post-retirement golfing for years to come.

 

What are the most common injuries in the fire service? You guessed it; lower back, knee, and shoulder. Any idea how much money departments spend on workman’s compensation for these three body parts alone? Somewhere around $800 million dollars annually, so lets start with the lower back.

 

Without needlessly delving into an anatomy and physiology article I want to cover a few basics of human movement that will be critical as we move forward. For starters every joint in the body has a set of muscles and connective tissue that dictate what speed, how powerfully, and how far the joint will flex or extend; generally this coordinated flexion and extension is the basis for all movement. The balance of strength and flexibility in the tissues surrounding the joint will dictate the movement pattern of the bones on either side of joint which will either be correct or not. – A common injury among runners and firefighters a like is patellar tendonitis or “runner’s knee” which is generally considered to be a “overuse injury” but really stems from a strength and flexibility imbalance between the quads and hamstrings.– Imbalances like the one described above are at the root of the most common fire service injuries.

 

The two main joint structures in the body are the hips and shoulders, every physical task we perform involves movement in one or both of these structures and there is one very complex and very important series of joints that connects the two. Enter the spine. I cannot stress enough how important it is to grasp the idea that the spine is the ”bone” that connects your shoulders to your hips and in doing so transfers all of the power generated by the legs from the ground all the way out to your finger tips. When acting in this “backbone” capacity it is essential that the spine is in its natural, neutral position; this means that we have to actively use all of the muscles that surround our spine to keep it locked securely in position. This is often referred to as midline stability. Can I use that in a sentence? Sure. The ability to maintain midline stability during a full depth squat requires glute, hamstring, and hip capsule flexibility. Why is that important? Mostly because the spine is strongest in compression, meaning that it can support a tremendous load on the shoulders when in its neutral anatomical position versus the load it can manage when used like a lever arm, as in the deadlift. If midline stability is lost before or during a lift, whether it’s a patient on a backboard or a barbell, it creates a weak link in the chain and leads to a shear force being placed on the spine; that shear force is often what causes the injury, either by damaging a disk or straining a muscle in an effort to regain neutral position.  The muscles surrounding the spine are designed to hold it in a rigid column not to flex or extend it in an effort to generate power.

 

So if the goal is to prevent back injury there are a few areas that need to be addressed. First and foremost it is important to develop a “core to extremity” movement pattern. We have already established that the spine is responsible for transferring power from the ground up so this should come as no surprise. It is difficult to regain a neutral spine once that position is lost under load so it makes sense that the first move is to stabilize the core. If movement is generated first by contracting the spinal stabilizers and then initiating the rest of the movement you stand a much better chance of maintaining midline stability. Start in the middle and work your way out.

Next on the list is flexibility or mobility. If a muscle group lacks flexibility it affects the mobility of the joints above and below and in the case of the hip capsule it directly affects the safety of the lower back; developing enough flexibility in the glutes and hamstrings to squat below parallel is critical, without it you will compromise your lower back when picking something up off the ground.

The final piece of the puzzle is shoring up the stabilizing muscles the surround the spine and sacroiliac joint where it connects to the hip. The best way I have found to strengthen these muscles is to use them in the fashion they were designed, as stabilizers; think planks and bridges not crunches and side bends.

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