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Injury Prevention
Background
Injuries in the fire service account for $100,000’s per year in medical and disability costs and many hours in time loss. Many of these injuries can be prevented with a proactive approach by:
- understanding the risk factors common to many of these injuries
- implementing behaviors and strategies to mitigate these risk factors
Injury statistics
Low back
Shoulder
Cost - money/time off
Injury Factors
The following are factors that can contribute a firefighter’s risk of injury
Trauma
Trauma can include falls, impact, environmental hazards (explosions, etc). Trauma can't always be avoided but how we tolerate trauma can be. If you look at contact sports, athletes can withstand high levels of trauma and continue to perform. They also are able to recover from injury faster. This ability comes from high levels of fitness and training, not only strength and endurance but balance, agility, flexibility.
Previous Injury
Many firefighters have incurred previous injuries, many of these may have occurred years ago. Even minor aches and pains can alter one’s range of motion (ROM) or ability to use a body part. If this continues for even a relatively short period of time it can result in a change in movement patterns or muscular balance. These changes cause us to alter the stresses placed on our bodies, creating potential for chronic injuries (tendonitis, new pains in other joints). This in-turn increases the risk of acute injury. Our bodies will find a way to cheat around these issues as long as they aren’t too severe. The longer this situation persists the greater the risk of either the chronic pain becoming severe enough to prevent a FF from performing his/her job or a severe acute injury occurring. It is critical to completely rehabilitate and retrain after an injury to minimize the risk of re-injury.
Body mechanics/ Fitness
In previous injury prevention programs, and many texts, body mechanics have been addressed as the proper way of lifting. In this program we are going to address the human body as a machine and the mechanics of it as the parts that are required to make that machine work and how they must work together to perform efficiently.
Reasons that can affect performance efficiency can be either inactivity or over-activity. The human body is an amazing thing It adapts itself to what we do to it. If we were to stop moving we would eventually lose the ability to move altogether. If we stop exercising, within weeks, we would begin to lose strength, muscle mass, endurance and ROM all relative to the level of activity we expose our bodies to. If you never do anything more than sit at a job for 6-8 hours a day, do daily house chores and walk a few miles a day, you cannot expect your body to perform at a high level (running 10 miles). If one were to try to perform at a high level of activity (in the example) it could be done for a short period of time but the negative effects would be significant and possible injurious.
Over activity or incorrect training can lead to issues as well. If you look at a bodybuilder, marathon runner, swimmer or cyclist they are 4 very different body types. Each good at what they trained for. For each of them to cross over to another sport would be difficult (for most) and they wouldn’t be very good at the new sport. Why is that? They have spent long hours training either very specific skills, or muscle groups in specific positions. Their bodies have adapted themselves to the stimulus that has been applied to it.
In many cases, the type of training can create issues as well. As an example, many times a person’s understanding of exercise comes from books or magazines, the majority of which are focused on the sport of bodybuilding. Many of these workouts that are either body part specific or partial workouts more focused on increasing muscle size while causing a decrease in ROM, agility or coordination. It is up to the individual to utilize these at the risk of either performing exercises beyond their capability or creating functional deficiencies. The lack of understanding in training can create a limited athlete and not the most overall efficient human machine.
Like any machine the body needs all of its parts to work together as one efficient unit. Any part that does not work at it’s optimum level, or is over developed, will decrease the overall machine’s efficiency and in turn place more stress on other parts as we compensate to perform the task at hand. This inefficiency can be caused by both inactivity as well as over activity (as described above). The key to a healthy and efficient body is to address all the performance components into your workouts.
Here are the components needed for the optimum human performance
- Muscular Balance/posture
- we have a postural blue print, shoulders & hips should be level, all the joints should be vertically aligned. This is the platform our muscles need as a base to work off of.
- posture is dictated by muscular balance, posture can be changed if there are muscles that are weak or overly developed
- any weakness will be compensated for by other body parts causing excessive wear and an increased risk of injury
- ROM (range of motion)
- Each joint has a predetermined mechanical ROM
- For the a joint to perform, the muscles surrounding it must coordinate together to allow for efficient/full ROM movement
- There must also be proper stabilization of other joints
- i.e: as you lift an object overhead, the shoulders must both move and stabilize themselves through the ROM as well as the lower body and spine stabilize through the lift
- any lack of ROM will cause us to compensate in other areas
- we will perform but the risk of injury is higher
- Strength
- strength can be misconstrued as muscle size, absolute strength is more about training the neuromuscular recruitment and pathways, training the body to recruit the maximum amount of muscle groups in the correct sequences
- many weight lifting routines come from body building paradigms where the idea is to isolate muscle groups to gain size. Functional training is more about training the body to lift as a unit, training proper ROM with stabilizing and move the appropriate joints. This distributes stresses evenly throughout the body
- training “mirror muscles” will create muscular imbalances
- any lack of strength will cause us to compensate in other areas
- we will perform but the risk of injury is higher
- Endurance
Muscular
o The ability to perform repeated or prolonged muscular contraction over a relatively long periods of time
- Muscular strength is important but many fire ground tasks requires longer periods of exertion where muscular endurance is required
- as our endurance decreases our movement efficiency decreases/ compensation increases and risk of injury increases
Cardiorespiratory
o The ability for you body to intake and provide the needed oxygen for the level of exertion needed and for the body to use the oxygen while removing waste products. The more efficient this system is the longer and greater the time the level of exertion can be maintained. The efficiency of this system also results in faster recovery times.
o This involves both the anaerobic and aerobic energy systems
o This includes the intensity and duration of the exertion but most importantly how fast a FF recovers and can return to the task (FF goes up 10 floors and then has to fight fire, can he get up the stairs and then recover fast enough to then begin fire ops?)
- Balance/Coordination/Agility
- Balance and coordination are needed to move the body through space and react to environmental forces while providing a solid base of support to perform
- On the fire ground we are required to do many tasks on uneven terrain, in low light conditions, changing surfaces, moving heavy equipment
- Muscular strength, endurance and the ability to react to changes in balance are required
Functional Anatomy- we need to think in terms of performance efficiency
- Low back/hip/knee complex
- To maintain the proper spine alignment there needs to be proper muscular balance and ROM of the spine, hips and knees during any movement
- The traditional strategy of tightening abs & arching the back are valid but hip and knee ROM are required to get into good lifting position and perform the lift.
- Shoulder/back/hip complex
- The shoulder is the joint consists of the humerus, scapula, clavicle as well as the relationship between the scapula and the rib cage.
- The shoulder joint is the joint with the most ROM but it is also the most unstable joint in the body. This results in a higher risk of injury
- It’s stability comes from tendons, ligaments and muscle.
- It’s movement requires 27 muscles to both move and stabilize the joint components.
- For proper shoulder function it takes proper positioning of the joint and the coordination of all 27 muscles to both stabilize and move the shoulder components to complete a task. Any limitation (muscular weakness or tightness, decreased ROM) will cause compensation and place more stress on other body parts and an increase in the risk of injury (elbow tendonitis, shoulder tendonitis)
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- Use examples to show how a limitation affects performance: straight leg lift/ scap retracted arm lift
Lifting Technique
· Think of a power lifter’s position
o Head up
o Pelvis in neutral (practice obtaining pelvic neutral) and spine elongated
o Shoulders back
o Feet hip width or slightly wider
o Bend at the hips and knees, hips back
Strategies
· Increase your ability to handle demand
· Increase fitness
· Plan & Communicate when you can
· Proper equipment
· Proper man power
Injury and return to work
· Redmond handout
· Talk about the importance of complete rehab/training
· Consequences of only rehabbing and not training prior to returning to work
· Role of PFT
Fire Tasks
· Tarp
· Hose
· Fans
· Overhaul
o Pike pole
o Trash buckets
o Moving heavy appliances
Station Prep Routine
· Prepares the body
· Can be done at any time during the day
· Recommend 2-3x/day
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