A muscle, tendon, ligament, nerve or bone becomes injured when it isn’t prepared for the demand that’s placed on it. By improving strength, flexibility and endurance, you better prepare your musculoskeletal system and, thus, protect yourself from future injury.
The fire service suffers some 60,000 injuries per year. Fifty-nine percent of them are classified as sprains, strains and muscular pain. They usually occur during lifting, pushing or pulling. (Keep in mind, these are only reported injuries. This doesn’t account for firefighters who, for example, complain of back pain that they chalk up to “part of the job.”)
In 2018, the Orlando, FL, Fire Department suffered 172 injuries, 30 percent of which resulted in lost duty days. Even with gross underestimates of only one lost duty day per injury, such a scenario results in more than 52 days lost per year. What implications does having one member out of commission one day every week have for your department? Do you have the ability to drop to a three-member crew from a four-member? How many workers’ compensation claims is this?
Not only is mandatory overtime fiscally detrimental to department budgets, but it also carries negative morale consequences when utilized frequently.
Then there’s cardiovascular disease. True, it’s beyond the scope of this article, but because of its prevalence and dire consequences when poorly managed, some words are necessary.
Cardiovascular disease is the leading cause (45 percent) of on-duty deaths among firefighters. Twenty-seven percent of all injuries are classified as overexertion (heat exhaustion and dehydration). Firefighters who died of cardiac arrest were more likely to suffer from atherosclerotic and hypertensive disease, and more than 70 percent of all firefighters are obese.
Obesity increases the likelihood of sustaining a musculoskeletal injury and is a direct contributor to cardiovascular disease. Some risk factors, such as genetics, can’t be changed. However, many risk factors and the health of your heart is something that can be directly influenced. The heart is a muscle. It can be trained.
How to minimize common injuries
This isn’t specific or individualized medical advice. This is a general guide to point you in the right direction for improved comprehensive health and performance.
Before diving in, a few misconceptions: All back pain is the same. All back pain results in surgery or is related to a disc. Because you have back and leg pain, you have sciatica.
Back injuries comprise 30 percent of all musculoskeletal injuries. Improved back strength and endurance were shown to reduce back-related lost duty days by 74 percent over two years. Although this statistic might not correlate precisely for each body part, outcomes will be similar. The stronger that you are and the more endurance that you have, the less likely you are to get hurt.
Possible movements that might contribute to back pain include buddy carries, equipment carries, ladder throws, pulling ceiling, hose drags, forcing doors and wearing PPE.
Knee injuries encompass 26 percent of all musculoskeletal injuries. Knees are inherently stable joints that don’t do much more than flex and extend. However, the hip and ankle are meant to be very mobile. When they aren’t mobile enough, the knee gets caught in the middle, which results in pain or injury.
Possible movements that might contribute to knee pain include kneeling, climbing into the apparatus, crawling for search and rescue, wearing PPE, forcing doors and climbing stairs.
Sixty percent of all musculoskeletal injuries occur in these two areas: the back or knee. Within these two major body sections, there are hundreds of possible sources for pain or dysfunction.
Nerves, muscles, tendons, ligaments and bones that are in either location can result in any number of possible presentations. No two knee or back injuries are the same. Thankfully, the multitude of possible sources leaves multiple areas to address for prevention.
Mobility vs. flexibility
Low back and knee pain prevention are related and interconnecting. Spinal and hip mobility, core and hip strength, endurance and lower extremity flexibility are crucial for low back pain prevention. (Note: Core strength doesn’t mean just abdominal strength. Having a six-pack is irrelevant if you can’t dead lift or hold a proper plank.)
Mobility and flexibility often are used interchangeably, but their differences are important in physical performance. Mobility is the ability to actively control a joint through its full range of motion. Mobility is being able to lift your leg to place your foot on top of your 24-inch bumper without using your hands to assist and without pain or other deviations. Flexibility is the passive stretch of a muscle through its full range of motion. Flexibility is being able to lie on your back, passively pull your knee to your chest using both hands and hold a stretch. Mobility is functional; flexibility alone isn’t. You need both but train them differently.
Knee pain prevention requires strength, hip mobility/endurance, ankle mobility, muscular flexibility and motor control. Motor control is similar to coordination: the ability to control your arm or leg in space. Think about how a baby giraffe walks: It’s cute but not coordinated. It hasn’t learned how to control its long limbs.
My husband is another example: He is as strong as an ox but falls all over the place when I have him do a single leg exercise. He can out deadlift me by two-fold, but when we single-leg deadlift, I outperform him on quality every time.
Training single arm and leg movements is crucial and vastly underutilized. Motor control is a necessity when preventing knee pain.
Part of injury prevention and overall training is understanding what you’re working on and how to optimize your performance. Strength, power, hypertrophy and muscular endurance are different and require diverse training tactics. Building strength—the ability to pick up a heavy object and successfully put it down—requires working at least six repetitions per set at least 85 percent of your one-repetition maximum.
If every exercise involves three sets of 10 repetitions of moderate weight, you aren’t getting stronger or improving endurance. That set/repetition scheme builds muscle bulk (hypertrophy) and is a waste of time in the fire service, because it doesn’t equate to strength.
Your time, particularly on duty, is incredibly valuable. Don’t waste training time by working at a volume or intensity that’s asynchronous to your goals. As firefighters, you need strength, power and muscular endurance, but you must know how to target them individually. You wouldn’t go to pump operations to learn how to repel off a building. Tactical training is specific. Physical training should be, too.
For example, operating a charged hoseline requires a multitude of physical characteristics: appropriate spinal rotation and flexion mobility to reach across your body to grab the line as well as the core strength and endurance to return yourself to a neutral position to safely and easily carry the hose. You operate the hose, not the other way around. Whether you drag the hose forward or kneel to operate it, you need the hip mobility and strength to get into the required position and the endurance to maintain your chosen position. Ankle mobility is one of the most overlooked areas of improvement for optimizing body mechanics throughout a variety of activities.
Own it: hurting vs. injury
Feeling hurt isn’t the same as being injured. Being hurt might be something new or old: There is no time limit on feeling pain. Don’t let misconceptions about pain prevent you from addressing it. Pain isn’t part of the job nor part of getting older. Your pain might be permanent, but it just as easily might be temporary and can be changed.
Conversely, an injury is new—typically less than 30 days. An injury can result from a single accident or a slow onset from repetitive activities. Don’t let your new injury become a chronic hurt by not reporting it. Injuries aren’t a weakness nor something to hide. Nor are they permanent.
Train like you fight
Tactical training drills and scenarios are tackled by departments daily. You all read books, listen to presentations and attend seminars to learn how to do your job better. You simulate tactical scenarios to the best of your ability, so when the day comes, there is no guess work.
Physical training should be no different. Simulating the physical demands of the fireground in physical training is most easily accomplished via circuit training. Circuit training is high-intensity, low-rest endurance and resistance training that’s performed in a circuit with or without intervals.
Do you perform CPR for two minutes and take a break because you’re winded? Do you run five miles without stopping? No? Then why train like that? Fireground activities vary vastly in intensity and duration job-to-job. Training must reflect this to adequately challenge each individual energy system. A ladder-raise takes less than 10 seconds; a victim-drag takes 30–120 seconds; climbing stairs can take upward of 120 seconds. Circuit training allows you to work this variability into your exercise routine.
Donning PPE adds a minimum of 45 lbs. to your person, increases heart rate by 44 percent at baseline, and contributes to back and knee injuries. Utilization of PPE in physical training not only helps to condition your back and knees to this increased load but also your heart. Remember, your heart is a muscle and can be trained. Circuit training with and without the use of PPE aids in reducing cardiovascular morbidity and mortality.
Circuit training applications and benefits to the fire service are endless. It allows infinite training diversity, builds camaraderie, adapts to any fitness level, requires minimal equipment and addresses cardiovascular risks. Nothing bothers me more than to visit my husband at his station and see guys doing bicep curls or bench five days per week and never have a leg day. No one cares what your biceps look like if you can’t pull ceiling for 45 minutes or pick a fallen beam off of your buddy.
One glaringly obvious fact about the fire service that isn’t given appropriate recognition is that if you fail to physically perform your job, someone might die. An adequate amount of physical fitness is your duty. You owe it to yourself, your family and your community to take care of yourself to the best of your ability. Train like you fight. Your life depends on it.
Longevity: Life after the fire
Who has time for fitness? We’re all just trying to make it to the end of the shift, the end of the year, to retirement. Right? Wrong. If on-the-job motivation isn’t enough, what about life after the fire? You’re a firefighter, but who else are you? Do you have a second job? Are you a parent, a grandparent, a spouse? When you retire, how do you want to function? Reducing your risk for injury via prevention will aid in maximizing your quality of life in retirement.
Jessica Gutschick
Dr. Jessica (Jessy) Gutschick, PT, DPT, OCS, MTC, CSCS, attained her Bachelor of Science from the University of South Florida, and she holds a doctorate in physical therapy, which she attained at the University of Florida (UF). During her last clinical rotation at UF, Gutschick worked at Fort Bragg Army Base, where she treated Special Forces students who were going through the Q-course to become Green Berets. In 2019, Gutschick completed her orthopedic residency and attained her Orthopedic Certified Specialist title. Prior to residency, Gutschick married into a firefighter legacy family, giving her insight into the daily shift and off-shift lifestyle. This relationship helped guide her professional expertise to start a first-responder-specific physical therapy program. Currently, Gutschick manages an outpatient clinic for CORA Physical Therapy in central Florida, as she continues to work on building the program.
