Leadership

Firefighting & Injury Prevention

The fireground and other emergency scenes may be the most difficult arenas in which to prevent injuries. As firefighters, we know firsthand the challenges we face responding to and mitigating an emergency. Critical fireground factors, such as threats to exposures, victims trapped, water supply issues, etc., constantly challenge the incident action plan as well as the firefighters executing that plan. So to lessen the risk of injuries and increase our effectiveness on calls, we exercise. But sometimes the workouts intended to help us decrease injuries can be the very thing that causes the injuries in the first place.

Firefighters vs. Athletes
Because of the physicality of our job, firefighters have often been compared to professional athletes. Although this is an admirable comparison, I don’t think we’re comparing apples to apples. Professional athletes usually possess some God-given talent that, coupled with the proper training, often leads to a prosperous career. While the fire service consists of highly motivated and conditioned people, our jobs differ from those of professional athletes in many ways.

First, firefighting doesn’t require a person to have some superhuman talent, such as running fast, throwing far or jumping high, before they can become a member of the service. Second, firefighters don’t have game schedules; we don’t know when we’ll be called to perform. Third, our conditioning and preparation must be constant. The idea of off-season versus seasonal training does not apply to our fitness regiments. I believe this is a major reason why we experience so many injuries.

Consider this hypothetical situation: Let’s say that as firefighters, we do know ahead of time when we’ll get dispatched. Assume that during your next shift at 1000 HRS, you’ll be dispatched to a multi-vehicle accident in which a vehicle rolled over several times and came to rest on its top, requiring the extrication of two patients. Knowing this information beforehand, you could prepare yourself physically and mentally to be as effective as possible for that specific type of call.

Now let’s assume that your shift continues throughout the day and concludes with a working house fire at 0200 HRS with a report of two people trapped. There’s little doubt that you’ll wake up an hour or so ahead of time to physically and mentally prepare for this intense situation. You’d be like a thoroughbred horse at the gate, ready to start the race.

My point: Because of the physicality of our job, coupled with its unpredictable schedule, the potential for injuries is high. That potential becomes even higher for those with decreased fitness levels. But while it’s an absolute must for us to be fit for duty, we must also be intelligent in how we accomplish that. So how do we minimize injuries given all the odds stacked against us? By preparing ourselves while off-duty and not injuring ourselves in the process.

Injury During Exercise?
Injuries are going to occur on the fireground. Even the most prepared firefighter will face things that will cause trauma to their body, and the body can only take so much. However, the more fit and prepared the body is, the less pain and/or damage it will incur when the incident that causes the injury occurs. A sensible and properly tailored fitness and injury prevention regimen will greatly reduce the number and severity of injuries incurred by firefighters. The key words are “sensible and properly tailored.”

After examining the number and nature of injuries our firefighters incurred for the year, our department formed a Physical Fitness Injury Task Force. The goal of this task force is to more closely examine the number and nature of injuries and provide recommendations on how to reduce our on-duty injuries that are incurred during workouts or exercise. Needless to say, the number of exercise-related injuries was a concern for us.

Although we’ve seen a steady increase in our department’s fitness levels, we’ve also seen a steady rate of exercise-related injuries, the highest number of which occurred during lifting-related exercises. Although some of these injuries were related to “non-traditional” lifts that involve tires and other different props, most were sustained in the gym. This was somewhat of a revelation to me, because we allow a variety of different types of physical training that, in my opinion, had a greater potential for injury. I assumed that the gym was a fairly benign and “controlled” environment compared to the basketball court or training academy grinder.

The first matter of business was to figure out why there were such a high number of lifting-related injuries. The evidence, in my opinion, pointed to 1) ego, 2) improper form and 3) improper or lack of preparation as the major culprits.

Ego
Let’s start with the ego portion of the equation, and I’ll keep it simple: Injuries occur when people lift too much, too quickly and too errantly. You would never expect a professional sprinter to run a couple of laps and then try for a personal best in the 100 meters. Yet we see people go into the gym, do a couple of stretches or shoulder rolls and then “max out” on the bench press.

This “maxing out” idea not only applies to the amount in which a person lifts, but also the number of reps a person attempts. There comes a point when technique and form degrade as repetitions increase, the point where risk outweighs the benefit. I’m not saying that our workouts should never be difficult or push us to new levels. In fact, we need to challenge our fitness levels in order to improve our overall job performance. But a sensible training program would recognize the point where maximal effort and minimal risk meet.

Improper Form
Form involves not only the path of movement within an exercise, but also the range of motion. To explore this concept further, let’s examine one of the best free-weight exercises for building strength and stamina: the squat.

For reference, I interviewed Al Escobar, a physical therapist and owner of Aris Physical Therapy. Escobar is also a former professional bodybuilding and power-lifting competitor, and a subject matter expert in the field of exercise and injuries. Escobar has worked with our department, creating injury-prevention programs, lecturing and rehabilitating many of our injured firefighters. To gain a better understanding of our job, he has gone through various skills and tasks at our training academy while wearing bunker gear and SCBA. “The squat is one of the best exercises you can do, because its mechanics are foundational to many other exercises and daily movements,” he says. “It is great for increasing core, lumbar and pelvic strength, in addition to building power in the lower extremities. The squat can also help you recruit some of the strongest and underused muscles in the body: the glutes.” The glutes are responsible for hip extension and are critical for acceleration and speed. All these benefits are contingent on a properly performed squat. An improperly performed squat can wreak havoc on the lower back and knees.

Performing the Squat
A properly executed squat should start with a shoulder-width stance. Too narrow of stance will result in the thigh touching the hip, causing the loss of a neutral spine, lumbar flexion and the possibility of lower back strain or a herniated disk. Next, the thigh and second toe need to face the same direction, in the same plane. The wider the stance, the more rotated the knees and hips need to be, followed by the foot.

Regarding the range of motion or depth of a squat, Escobar says, “The depth of squat depends on the flexibility of the hips and ankles, coupled with the ability to maintain a neutral spine. Hip flexibility is contingent upon hamstring flexibility, but ideally, the femur should end parallel to the ground.” He also to states that deep squats, (those where the femur goes beyond parallel) are OK as long as the spine maintains its neutral alignment.

One of the most common mistakes in performing the squat is allowing the knees to extend past the toes. This increases tension on the knees and can result in tendonitis and accelerated wear and tear on the knee. The usual cause of this is a straight-down descent, as opposed to a rearward descent where the hips actually reach back as they descend. This serves to counter-balance the weight of the upper body, which is especially important when doing barbell squats.

Performing the Bench Press
Another exercise responsible for many injuries in the gym is the bench press. “The main reason people injure themselves while performing the bench press is because they try to lift too much weight,” Escobar says. “In addition, their range of motion is far too great, thus increasing stress on the shoulders and chest, which causes pectoral and rotator cuff tears.”

“The elbows should not go below the depth of the body,” Escobar continues. “That means that for most of us, touching the bar to our chest is too deep and puts unnecessary stress on the pectorals and shoulders. It also increases joint compression, which leads to accelerated wear and tear on the cartilage.”

The safest way to bench press is with a grip that’s slightly wider than shoulder-width apart. The elbows should extend approximately 40–45 degrees away from the body, and the descent should not dip below the plane of the body. The amount of weight loaded on the bar will determine whether this form can be adhered to or not.

“Everyone has a different tissue resilience, which factors into the potential for injuries,” Escobar notes. “Genetics and nutrition play a big role in this as well.”

Improper Preparation: Stretching vs. Warm-Up
Stretching before activity does not prevent injuries. Recent studies not only support this idea, but some data suggests that static stretching prior to activity may actually lead to injury and a decrease in performance. I realize this seems counterintuitive to the way we learned to do things back in school, but if you want to prevent injuries, you need to be thinking about warming up rather than stretching.

Static stretching means holding a target muscle in a stretched state without movement for a period of time, usually around 15–30 seconds, which is what we used to do at the start of PE class in high school. A couple of the most recognizable static stretches are the sitting toe reach and the standing quadriceps stretch, in which you pull your ankle behind your leg.

I’m not saying that static stretching has no benefit. It feels good to stretch and, if done correctly, you can gain flexibility. For example, if you lack the flexibility in the hips and ankles to perform a squat correctly, then a daily stretching routine after a workout or proper warm-up would help you gain flexibility in these areas. But the key is to perform this stretching after a workout or proper warm-up.

Conversely, a dynamic warm-up has been shown to not only increase performance, but also decrease injuries. Essentially, a dynamic warm-up is a series of low-intensity activities that target the muscles and joints involved in the given activity or exercise. They’re also usually activity specific, meaning that a warm-up for a soccer player will be different than that of a baseball player.

The goal of the warm-up is to increase the body’s temperature, heart rate and blood flow to the muscles and tendons. It also serves to increase the elasticity of the muscles. In addition, the dynamic warm-up increases the mind-muscle connection, contributing to better coordination and reflex time.

As previously stated, the dynamic warm-up is activity specific, but there are a few common aspects to all warm-up programs: First, you should start at a low intensity and progress to a higher intensity. You should include all planes of motion, and work in multiple directions. You should feel your core temperature elevate, and the components in the warm-up should mimic the activity that you’re about to perform. For example, if you’re going to play basketball, your warm-up might include jumping jacks, a high knee jog, a lateral shuffle, calf raises and arm circles, to name a few. The warm-up may take about 15–20 minutes, which is one major reason why people skip it and dive right into their exercise or activity.

Conclusion
Although there’s no guarantee that we’ll have an injury-free career, there are things we can and should do to give ourselves the best possible chance of achieving that. Injuring yourself in a controlled setting like the gym is preventable. If you’re injuring yourself while exercising, self-evaluate to see if it’s a matter of ego, improper form or lack of preparation. (It could also just be a matter of TMB—too many birthdays.)

And keep in mind that a proper warm-up can dramatically reduce the number and severity of injuries incurred while exercising, which will lead to more effective gym time and a greater fitness level.