As leaders none of us discounts the importance of fitness and wellness programs for first responders. However from my personal experience I have not seen many leader let alone a coach / personal trainer at the departments I teach at across the country. Instead I see fitness minded first responders, cross fit™ coaches or more often than not a PT academy instructor that gets pushed into the position of coach. This often leads departments with a struggle to design, implementation and buy gain in from crews.

The misdirected pursuit of strength and fitness

What I have seen more times than I can count are that these ‘instructors’ who mean well are pulling from a tool box of outdated and often dangerous exercises hoping to improve employee fitness. There is often no scientifically accurate planning as they do not have the knowledge base to pull from, instead we see ineffective warm up’s, a complete lack of self-care and mobility training coupled with exercises that harm more than they heal.
On top of that we also see departments building a “box” because it’s cost effective and popular. Just my opinion here but I often wonder if the lack of buy in, follow through and behavior change stems from a litany of psychological junk stemming from high school PE through the academy. Are we demotivating responders from exercising by programming them that fitness always has to be hard to be effective?

The unreported prevalence of Pain

“When anomalously surveyed over a 6 month period 57% of EMT’s and paramedics have sustained some type of soft tissue injury that they did not report.” (1) I have repeated this study (unscientifically) in every class I teach and I am seeing this number edging close to 70% of the class, every class. If we have an unreported injury rate above 50% that leads me to believe that pain is a serious demotivator to participation in and follow through with wellness and fitness programs.

Shift work and Stress

The literature is full of studies about the dangers of shift work, chronic stress activation, hormone disruption and the effects on the body. (3,4) As a former Paramedic I can clearly recall the sleep disturbances, stress responses and fatigue so profound that the last thing I wanted to do was train. This is where we often see the drop off; chronic fatigue, stress and pain acting as a demotivating factor to even the most fit of responders. No one wants to train hard after their 4th 12 hour shift in a row, and if you have been on the street those 12’s often turn into 14’s by the time you clock out.
Add to that stress eating, fatigue eating, (2) substance abuse including alcohol (the dirty little secret that no one will talk about) and coaches we have the perfect recipe for exactly what departments are dealing with; a total lack of participation and buy in.

Remove the Barrier

One of the tools that have worked extremely well is the use of a simple practice (pressure less) tennis ball. We spend time teaching responders not only on the how but the why of trigger point massage. Instead of just telling them to massage and trigger point the piriformis we teach them that a tight Piriformis can cause knee pain and it can also cause low back pain. A tight pectoralis minor can contribute to upper crossed pattern which can lead to headaches, neck pain and even rotator cuff disorders. Focus on the calves, hip flexor, lats as well as the afore mentioned. By following this approach we can empower responders to not only treat their symptoms but to apply self-care techniques that can benefit them throughout their career, pain is not normal it’s a symptom so treat it. A final benefit is that this is a very easy and inexpensive home technique that responders can do pre or post shift without the fear of being razzed by their peers; which is a rite of passage and coping mechanism in first responders.

KISS

Movement matters and as the saying goes move well and move often. However in fire and EMS how do you teach responders to lift a 400 lb. patient out of a bath tub, that’s wet, naked and has stopped breathing? As coaches we know that strength will reduce the rate and severity of overexertion soft tissue injury but in many cases the spinal loads responders sustain are more than 5x the NIOSH recommended limit. (5) One PEARL that I personally like because it’s simple, effective and ties into a safety culture is to follow theses 4 steps.

1. Feet flat: To ensure proper balance, firing patterns and stability make sure the feet are always flat and when possible shoulder width apart.
2. Hips hinged: Make sure the hips are hinged to spare the spine; ensure that your crews know the difference between a squat and a hinge.
3. Sternum up: Keeping a neutral spine is of the utmost importance, I like to teach the crews that “if your sternum points into your body you lose, keep your chest up!”
4. Head up: Always lift, move, push, pull and carry with the head up. This holds especially true for confined spaces and awkward lift situations.

Its human nature to make things overly complicated and to fall prey to fads, gimmicks and crowd think; as leaders we need to keep one eye on the science and the other eye on the crews. Fatigue, stress, dehydration, repetitive motion disorders and disease are sadly the norm in most departments; with many responders surviving on overtime shifts to make ends meet further compounding the issue. Keep is simple, actionable and just help them to feel better as it’s all possible from there.

(1) FEASIBILITY FOR AN EMS WORKFORCE SAFETY AND HEALTH SURVEILLANCE SYSTEM,
DEPARTMENT OF TRANSPORTATION NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, TECHNICAL SUMMARY, CONTRACTOR Bedford Research; The Pacific Institute for Research and Evaluation REPORT DATE February 2007
(2) http://www.health.harvard.edu/newsletter_article/why-stress-causes-people-to-overeat
(3) Stress hormones may increase cardiovascular risks for shift workers
October 3, 2011, The Endocrine Society. Appl Ergon. 1996 Feb;27(1):9-16.Costa G.
(4) http://www.ncbi.nlm.nih.gov/pubmed?term=MartinGill%20C%5BAuthor%5D&cauthor=true&cauthor_uid=22023164
(5) Efficacy of the revised NIOSH lifting equation to predict risk of low-back pain associated with manual lifting: a one-year prospective study.Hum Factors 2014 Feb;56(1):73-85 Ming-Lun Lu, Thomas R Waters, Edward Krieg, Dwight Werren