FASIS

Firefighter Fitness: Shoulder Pain - Is it impinging on your life?

Thu, 26 Apr 2012 08:00:00 GMT

Shoulder Pain: Is it impinging on your life?

It is well documented that firefighting is a physically demanding job and throughout their career a firefighter will deal with some type of injury (ie. low back, knee, shoulder). Low back injuries are ranked as the highest among musculoskeletal injuries followed by knees and shoulders. Shoulder problems are starting to become more apparent with firefighters due to a number of factors such as a reduction in thoracic spine mobility, rotator cuff endurance, and scapula stability. These attributes develop over time because of the physical demands required during normal fire ground operations. If we include poor exercise selection and technique within their fitness program we will only begin to see an increase of shoulder injuries.

Many new types of training modalities are being exposed to the fire service, everything from high intensity training to multi planar, metabolic conditioning are being implemented so firefighters may improve on their fitness. Still one third of all injuries in the fire service resulted in physical exercise activities (1). Exercise like push ups and pull ups are very common within these types of modalities due to the simplicity and effectiveness, yet performed incorrectly with repetitive motion will eventually cause pain or discomfort within the shoulder.

The shoulder is a unit composed of the shoulder joint and shoulder girdle which requires a great amount of dynamic stability. The glenohumeral joint is a mobile system that is mostly controlled by the deltoid and the rotator cuff. The scapula is the anchor for the rotator cuff and creates stability within the joint. The main priority when using the shoulder is to have glenohumeral and scapula rhythm. When there is a muscular imbalance between them along with high repetition and high intensity exercises, injuries will occur.

The rotator cuff’s (RTC) primary job is to stabilize or center the humeral head within the socket when the arm is moving. When it no longer works properly the deltoid will over power it and force the humeral head to hit the ceiling of the joint socket creating an impingement (which leads to a tear). It is recommended that you limit or eliminate and deltoid side raises and shoulder fly work if you currently have shoulder pain - your only going to make things worse. Remember the RTC works as a whole, every time you raise your arm all four muscles work, and it has a low load threshold, so if you use to much you will injure it. When a tear occurs the injured firefighter will not be able to stabilize their shoulder forcing their scapula up creating a shrug motion. Most RTC injuries do not just happen it is generally a progressive pathology that goes from irritation - inflammation - fraying - tearing.

Exercise such as kipping pull ups, overhead press, or hand stand push up should not be recommended for firefighters dealing with shoulder pain. Kipping pull-ups are a method of jerking and swinging your way through a pull-up vs. using the actual strength and power of your muscles to get your chin over the bar. It requires strength and stability within the shoulder girdle, and can be seriously exhausting to the muscles, joints and connective tissue. Common injuries that have occurred from kipping pull ups (high repetitive / high intensity movements) are superior labrum from anterior to posterior tears (SLAP) and rotator cuff problems. SLAP tears occurs within your labrum when it is subject to sudden stress, such as kicking out of the bottom of a pull up. Pain will generally occur when you move your arm overhead (ie. pulling ceiling), or throw (ie. pulling hose).

Age and poor posture are two other contributing factors to shoulder pain. One third of all firefighter injuries occur between the ages of 30-39. This is a significant in the prevention of injuries because during this time period most males begin to lose their flexibility, see a reduction in aerobic capacity and gain weight. Overtime firefighters will also develop poor posture that can be attributed to the job. It is not uncommon to see a firefighter with their scapula protracted and anterior tilted due to their SCBA. This position will decrease strength in the serratus and low traps and create tightness in the pectoral minor and upper traps.

Some of the more common injuries in the fire service are either related to pain in the acromioclavicular (AC) or glenohumeral joint. To help assess the shoulder raise your arm above your head. If the pain is painful at the top it will probably be an AC joint problem (impingement), if the occurs while lifting your arm but goes away when you reach the top it will probably be a glenohumeral joint (rotator cuff) problem. Always refer to your medical professional for further evaluation.

Most firefighter will suffer from external impingement because of the constant overhead work found in firefighting. The pain is general caused by the following

- direct pressure on the AC joint
- horizontal adduction (pull your arm across your chest) overhead motion
- horizontal pressing (ie bench press, push up)
- periods of inactivity
- internal rotation

If external impingement is the issue the firefighter needs to modify their exercise programs accordingly.

- overhead activities
- modify / eliminate horizontal pressing (perform isometric hold push ups with feet elevated or floor presses)
- incorporate more horizontal rows (TRX Low Row)
- incorporate more scapula stabilization exercises (heavy farmers walk)
- soft tissue work and stretch the pectoral minor, teres minor, and lats.
- increase thoracic spine mobility (quadruped external rotation)

Rotator Cuff problems are also very common in the fire service. They range from minor to severe. Specific pathologies associated with RTC problems are internal impingement, RTC tensile overload, partial or full thickness tears. Most RTC injuries occur because of

- high rep with high intensity
- high velocity
- repetition and fatigue (arm fatigue and injury patterns)

To help reduce the chances of a shoulder injury occurring firefighters should focus on creating rotator cuff balance by utilizing a 2:1 ratio of posterior to anterior exercises. External rotation should be used more so that the low trap and serratus begin to work together when you raise your arm, increasing scapula stability so that it will anchor the rotator cuff reducing any impingements, develop dynamic stability, and never work the rotator to failure.

Sample Program:

Foam Roller: Lats, Pec Minor, Teres Minor
Static Stretch: Pectoral Minor, Lat, and Neck Flexors
Activation: Isometric hold push ups with rhythmic stabilization (have some one gently push your body side to side, front and back while you maintain control - you should really feel your RTC working), Heavy Farmers Walk
Scapula Stabilization: W exercise (hands by your side and externally rotate your hands out so your elbows go down creating a W - you will feel it in your mid back), Prone Y exercise.
External Rotation: Side Lying shoulder rotation (with a towel between your arm and torso)

Shoulder Rehab WITH PROGRESSION - Level 1

Shoulder Rehab WITH PROGRESSION - Level 2

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Category: Firefighter Fitness from Coach Hofman

Firefighter Fitness: Heart Disease and Firefighters - How and Why?

Tue, 24 Apr 2012 08:00:00 GMT

Heart Disease and Firefighters: How and Why?
John Hofman, CSCS, MS

It has been well documented that the number 1 killer of firefighters is heart disease. Intervention strategies within a comprehensive health and wellness program have helped to reduce these numbers over the years, but there is still an alarming rate of firefighters who suffer from heat attacks each year.

Researchers at Iowa State University discovered that 86% of volunteer firefighters did not know their blood lipid and 47% did not know their blood pressure(1). Within the U.S. alone over 1 million people will suffer a heart attack within the next year and it does not just affect the elderly. We are now seeing individuals as young as 21 suffer from heart disease. So why are firefighters at an increased risk more versus the average population?

Simple: Its the job! But let’s take a closer look at some of the things that lead to an increase in heart attacks.

Sleep plays an important role helping our bodies recover from stress, illness, and fatigue. If we do not get quality sleep our resting metabolic rate will decrease causing weight gain. A firefighters “internal biological clock” is often disrupted throughout a shift affecting the bodies ability to regulate the sleep-wake system. Researchers at the Bringham and Women’s hospital showed that prolonged sleep restriction with simultaneous circadian disruption decreased the individuals metabolic rate. Thereby increasing over time the risk for diabetes (2).

The Univeristy of Chicago went even further and showed there a direct link between sleeping and an increased risk of stroke, heart attack and congestive heart failure (3). Their findings showed how an individual who sleeps more than eight hours and less than six had a significantly higher chance of chest pain or angina and coronary heart disease. Therefore it is important to control the duration of restful sleep in a completely dark room to help reduce the chances of heart disease and other related illnesses.

Abdominal fat, also known as visceral fat, is generally associated with diabetes. However, there have been links to an increase of strokes through the hardening of the arteries. Increased visceral fat could lead to diabetes which creates a change in blood vessels which reduce blood flow to the brian. Based on the findings at Iowa State University 41% of volunteer firefighters were classified as obese, and 35% classified as overweight. Therefore is is recommended that a firefighter participate in physical activity and proper nutrition program to reverse the side affects associated with belly fat.

Firefighters are often exposed to traumatic stress. Over a 30 year career things tend to affect them both mentally and physically. According to researchers at the University of California - San Francisco these exposures over a lifetime or career will boost inflammation in the body, even if they do not lead to post traumatic stress disorder (4). It was discovered that the greater the traumatic stress the higher levels of inflammation within the body. Individuals with higher levels of inflammation within their body tend to have an increased risk of having a heart attack. Even if the firefighter adjusted to these traumatic events the inflammation remained constant over a period of time. So the stress of the job can impact your health even if you don’t have certain mental of physical symptoms. Intervention strategies to help combat stress such as exercise, yoga, and other health related activities should be integrated at the start of a firefighters career.

Firefighting itself is physical demanding and will eventually break the body down. According to a study performed at the Illinois Fire Service Institute (5), 3 hours of prolonged firefighting stiffens arteries and impairs heart function in young healthy male firefighters. The same is seen within heavy powerlifters and ultra marathon runners.
This could affect those firefighters who do not value the important of fitness and therefore exhibit several of the risk factors for cardiovascular disease, including being overweight and having elevated blood pressure and/or cholesterol.
Finally your lungs. Breathing in toxic fumes and particles during overhaul, exhaust pollution from the app bay, and exposures during most regular calls can adversely affect lung function. Lung function and obstructive airway diseases are strongly and independently associated with increased risk of heart failure. These results were not primarily confounded by just smokers, but also non-smokers.

So what can you do?

1. Get an annual physical with a complete blood panel. In addition to the normal blood work ask your physician to include the following:

a. C-Reactive Protein: is elevated in the blood when there is widespread inflammation somewhere in the body. The evidence now available indicates that inflammation and molecules such as C-reactive protein associated with inflammation may be as important as cholesterol in determining the development of atherosclerosis ("hardening of the arteries") and heart disease.

i. You are at low risk of developing cardiovascular disease if your hs-CRP level is lower than 1.0mg/L
ii. You are at average risk of developing cardiovascular disease if your levels are between 1.0 and 3.0 mg/L
iii. You are at high risk for cardiovascular disease if your hs-CRP level is higher than 3.0 mg/L

2. Testosterone: Lower testosterone levels have been shown to be an independent risk factor for worse outcomes among men and women with heart failure. It also has been have been associated with decreased survival for men with coronary artery disease.
3. FORGET ABOUT DIETS AND LOW FAT! EAT HEALTHIER...There is no MAGIC PILL! Although there are some benefits to taking omega -3 and fish oils some studies have suggested otherwise. In an analysis of past studies there was no difference in the number of heart attacks, strokes or deaths among more than 20,000 people with heart disease who were randomly assigned to take either fish oil supplements or fish oil-free placebo pills. So EAT BETTER.

• Eat more fruits and vegetables high in antioxidants. Good heart health depends on open, flexible arteries that can deliver blood efficiently throughout the body. Dark chocolate and cocoa, as well as plant-based compounds found in red wine and green tea, are high in antioxidants, which help fight cell damage from free radicals in the bloodstream that can cause fatty plaque to build up on artery walls
• EAT MORE FIBER: Aim for 35 to 40 grams of dietary fiber per day. Fiber helps to lower cholesterol by binding with it and pulling it out of the system.
• SPICE IT UP: Numerous studies have shown that spices can help improve cardiovascular health. Cayenne pepper is known to strengthen the heart, arteries and capillaries and lower cholesterol level. Garlic is known to help lower blood cholesterol and ginger is a natural blood thinner and anti-inflammatory agent.

4. EXERCISE, EXERCISE, EXERCISE. 30 minutes of aerobic activity is associated with a 70% reduction in heart attack risk over a year. Researchers from the Mayo clinic than analyzed their data and noticed that a brisk 10 minute walk a day would results in nearly 50% reduction of heart attacks versus those who did nothing (7).

5. STAY HAPPY, BE OPTIMISTIC: It could save your life. A Duke University study of 255 doctors from several years ago found that 14% of those rated above average for hostility based on a personality test had died 25 years later--most from heart disease--compared with 2% of those who tested below the average (8)

References
(1) Yoo, HL, Franke, WD. Prevalence of cardiovascular disease risk factors in volunteer firefighters. Department of Kinesiology, Iowa State University.J Occup Environ Med. Aug 2009;51(8):958-62.
(2) O. M. Buxton, S. W. Cain, S. P. O'Connor, J. H. Porter, J. F. Duffy, W. Wang, C. A. Czeisler, S. A. Shea. Adverse Metabolic Consequences in Humans of Prolonged Sleep Restriction Combined with Circadian Disruption. Science Translational Medicine, 2012; 4 (129):
(3) American College of Cardiology (2012, March 26). Sleeping too much or too little can be bad for your heart. ScienceDaily. Retrieved April 21, 2012
(4) O'Donovan A, Neylan TC, Metzler T, Cohen BE.Lifetime exposure to traumatic psychological stress is associated with elevated inflammation in the Heart and Soul Study.Brain Behav Immun. 2012 May;26(4):642-9. Epub 2012 Feb 15.
(5) Fahs, Christopher A ,Huimin Yan, Ranadive, Sushant , Rossow, et al. Acute effects of firefighting on arterial stiffness and blood flow. Vasc Med April 2011 16: 113-118
(6) Grace Rattue. "Lower Lung Function And Airflow Obstruction Raise Heart Failure Risk." Medical News Today. MediLexicon, Intl., 26 Feb. 2012. Web. 21 Apr. 2012.
(7) MayoClinic.com: Walking for Fitness: How to Trim Your Waistline, Improve Your Health
(8) Barefoot JC, Brummett BH, Williams RB, et al. Recovery expectations and long-term prognosis of patients with coronary heart disease. Arch Intern Med 2011; DOI:10.1001/archinternmed.2011.41

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Category: Firefighter Fitness from Coach Hofman

Firefighter Fitness: Sick Time!?

Wed, 21 Mar 2012 08:00:00 GMT

How much does Obesity Cost Your Department?
John Hofman, MS, CSCS

Sick time, modified duty, and on-line injuries are consistent staple in the fire service. Let’s face it firefighting is a very physically demanding job so injuries will occur. So it would only make sense to have a health & wellness program to help reduce the chances of these things from occurring. Yet many fire departments may not have the resource to incorporate one, or worse yet still not see the benefits of having one. During these hard economic times it becomes difficult to justify such a program, especially when there are layoffs, cut backs, and brown outs occurring all across the nation. So what do you do?

Most departments will spend time a lot of time developing a comprehensive wellness program that focuses on everything from policies for workout time at the station to medical screenings at the local medical center. Yet one important thing usually goes unanswered. Who will oversee the program? This is an important question to answer because it will be the foundation of your program. In my experience many departments have started programs but within one year were unsuccessful in maintaining it. There are usually two approaches that are most common when fire departments try and answer this question. 1 Place a Chief, Captain, or Firefighter into a position to oversee the program or 2. Create a team of Peer Fitness trainers to collectively run the program. Both strategies have shown that a majority of programs effects did not remain past one year; however the long-term pattern of behaviors suggested these worksites as a whole were healthier more than 3 years following the interventions (1) this should then tell us that most health and wellness programs are not meeting their full potential. Worse yet departments may not be getting any type of return on investment.

So do we assume that firefighters do not want to get healthier? NO, in fact they want to know corrective strategies to help improve their health and wellness. In a study performed by the New York College of Osteopathic Medicine of New York Institute of Technology, a total of 730 surveys were returned among a potential study population of 20,590 volunteer firefighters. More than three-quarters of respondents met the criteria for being overweight or obese, and nearly 40% reported having high blood pressure, high cholesterol, or both. Most respondents expressed at least some interest in attending a fire department-sponsored health lecture and participating in a fitness program.(2) This just proves to us that firefighters have a desire to learn more about risk factor modifications and have fire departments take a more active role in helping them improve their health.

A comprehensive wellness program is a complex thing. It is more than just providing information to firefighters in regards to heart disease and exercise. To truly make a successful program their needs to be an individual the firefighters can identify with. This individual gives the program focus and a personality which allows them to change the culture. Researchers at Kent State University showed that physical fitness is an intricate, cultural construct, based on functional capacity and management expectations. Coronary heart disease is not a culturally relevant reason for workplace fitness program adherence (3). They concluded that Fitness interventions must culturally adapt to the unique nature of the fire service, emphasizing functional capacity, crew dependability, and fitness/well-being strategies. With that being said, would it make more sense to hire a certified coach to oversee the program for the long term? Maybe this idea should be approached as an investment rather than an expense? Let’s take a closer look at how much an out of shape firefighter would actually cost the fire department We know based off certain studies that .there is a consistent relationship between obesity and absenteeism in the workplace. However, most studies have focused on primarily sedentary occupational groups and not firefighters. Researchers at the Institute for Biobehavioral Health Research examined the cross-sectional association between BMI and obesity and injury-related absenteeism.

BMI, body fat percentage, waist circumference; injury, and injury-related absenteeism were assessed in 478 career male firefighters. One hundred and fifteen firefighters reported an injury in the previous year and the number of days absent from work due to their injury. BMI was an independent predictor of absenteeism due to injury. Firefighters meeting the definition of class II and III obesity had nearly five the number missed work days due to injury when compared to firefighters with class I obesity or those who were overweight. The attributable per capita costs of class II and III obesity-related absenteeism over the last year were $1,682.90 per firefighter, $254.00 per firefighter for class I obesity, and $74.41 per firefighter for overweight (4). This suggest that’s those listed in class II and II are costing your fire department thousands even hundreds of thousands of dollars per year. (4)

Let’s just say for the sake of argument you were to pay a coach $10,000 to assist with your program. All he would need to do is impact 38 employees in one year to justify the cost. Now multiply that by a 30 year career. That’s a savings of $1,917,480.

So do you still think it’s an expense?

(1) Long-term effects of a worksite health promotion program for firefighters. J Occup Environ Hyg. 2010 Aug;7(8):477-82.

(2) Scanlon P, Ablah E. Self-reported cardiac risks and interest in risk modification among volunteer firefighters: a survey-based study. New York College of Osteopathic Medicine of New York Institute of Technology, Old Westbury, USA

(3) Firefighter fitness, coronary heart disease, and sudden cardiac death risk. Eur J Appl Physiol. 2011 Oct 29.

(4) Obesity and injury-related absenteeism in a population-based firefighter cohort. Biol Psychol. 2011 Apr;87(1):152-60. Epub 2011 Mar 5

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Category: Firefighter Fitness from Coach Hofman

Firefighter Fitness: Body Weight Curcuit

Mon, 19 Mar 2012 08:00:00 GMT

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Category: Firefighter Fitness from Coach Hofman

Firefighter Fitness: Workouts & Shifts - Part 2 of 2

Wed, 29 Feb 2012 08:00:00 GMT

Last posting we discussed the idea of shift schedules and exercise programs. This posting we will show you how to put it together. We will apply it to 3 different schedules: 48/96, Modified Kelly, and the Kelly. Click here for the full article.

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Category: Firefighter Fitness from Coach Hofman

Firefighter Fitness: Workouts & Shifts - Part 1 of 2

Mon, 27 Feb 2012 08:00:00 GMT

Many firefighters often feel overwhelmed or confused when it comes to exercise prescription. Let’s face it there so much information out there it can be somewhat confusing. When should exercise? What type of exercise should I perform? How long? How hard? Etc….. We all can agree that it firefighting is a physically demanding job and that multi-plane & multi-joint exercise would be the best selection of exercises. Read More >>

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Category: Firefighter Fitness from Coach Hofman

Firefighter Fitness: Hip Hinge and KB Swing

Wed, 22 Feb 2012 08:00:00 GMT

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Category: Firefighter Fitness from Coach Hofman

Firefighter Fitness: 5 Things to Help You Achieve Your Goals

Thu, 26 Jan 2012 08:00:00 GMT

It’s the New Year and most people have started their new years resolutions. But how many actually succeed at them? Most people believe that if they simply write down their goals for 2012 it will become a reality. I wish it were that simple, but it is not. Most people will have a difficult time trying to achieve their goals because making a wish list is not enough. So what goes wrong?

1. TOO MANY, TOO MUCH

Studies have shown that if you want to make one change in your life, you have an 85% chance of success. However if you try to change two thing at once, your chances of success drop to around 35%. Three things at once? Almost zero. Many people actually develop certain poor habits over 10, 20, 30, or even for 40 years. So trying to establish a new habit while breaking an old one can be challenging in itself. Now include a number of other goals and you will not achieve any of them.

2. TOO TOUGH, TOO SOON

Typical goals for the new year are weight loss and/or exercise. Its not uncommon to hear “I want to lose 50lbs” or “I want to run a marathon”. Both of these goal are great but they are also very challenging, and it will take a some time to achieve either one. For example, most people will lose up to 2-3 lbs. per week if they change their diet - that means they will have to achieve 2 separate goals (see above) 1. Change their poor eating habits, and 2. start with a healthier one. Not only that, they will also have to do this over a 5 -6 month period. The same goes for the marathon, assuming you never ran one - on average it will take 6 months of preparation to run a marathon.

But let’s be realistic, most people do not want to wait that long. In regards to weight loss, people will change everything right from the start. They will go to the “All natural” food store and purchase everything that is gluten free, whole wheat, and sugar free right from the start. Unfortunately, this is only setting them up to fail because everything will taste like crap and within 2-3 weeks and they will stop (once the food runs out).

The same goes for the marathon. People will start a running program and within the first week and run so hard that their bodies will be so stiff and sore that by the 2nd-3rd week they will not be able to move without some type of discomfort creating a negative effect in regards to exercise. By starting out to hard most people will set themselves up to fail right from the start.

3. TOO HARDCORE

Is there really such a thing as “too disciplined?” YES, especially if I want to enjoy life. In the beginning most people will be so focused that it eventually takes it toll on your emotions and psyche, which over time could lead to a meltdown. Your willpower is only so strong and it will eventually give out. You can’t hold your breather forever, neither can your willpower - so don’t forget to breathe. It is important to remember life is about balance, so make sure you don’t miss out on all the great things in life. Let your body recover from the long runs, give yourself a cheat day when starting a new diet, and try and laugh once in while. It will make things less of a chore and more fun. I will admit, this is an area I need to work on.

4. TOO RIGID

Benjamin Franklin once said ““Do not fear mistakes. You will know failure. Continue to reach out.” Allow yourself some room for error. Life happens and mistake occur. If you want to learn about success, talk to a successful person. If you want to learn about failure, talk to a very successful person. Tavis Smiley calls l this failing up - “See failure as a friend. ... Understand that failure is not fatal. Failure is not final.”

5.TOO VAGUE

Goals need to be specific or quantified. For example, one personal goal I set this year is to perform 50,000 push ups. That means I have to average the following:

Per month: 4110 push ups
Per Week: 1027 push up
Per Day: 137 push ups per day (at least 2012 is a new year)

If I miss a day then the next day its doubled, and again, and again. So if I miss a whole week I may be spending one day doing 1027 push ups (can you say injury).The same can be applied to any goal. You want to read 4 books in a year. How many pages are there in each book? How long will it take you to read a chapter per month, per week, per day?

Goal setting is a practiced skill and to help make your new years resolutions become a reality try some of these simple tricks.

List 5 or 6 behaviors you need to improve or change to help you achieve your goals. Ask yourself “What do I need to be doing that I am not already doing?” “What bad habits do I need to get rid of?” What good habits do i need instill?”
List your goals from easiest to hards, as well as your habits.
“Maintain” all your other goals and focus your attention on the first thing on your list (the easiest one.) Try and spend 2-3 weeks just focusing on achieving that one goal so it becomes a habit. On average it takes 21 consecutive days to establish new habits or break old one’s.
Once you have achieved that goal or habit, move to the next one on your list and focus your efforts their.
Be patient, realistic, and honest with yourself and one by one your will establish new habits and achieve all your goals, which in essence will create a “snowball” effect creating a bigger overall effect with long-term success instead of trying to do it all at once.

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Category: Firefighter Fitness from Coach Hofman

Firefighter Fitness: SL RDL (Hip-hinge)

Mon, 23 Jan 2012 08:00:00 GMT

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Category: Firefighter Fitness from Coach Hofman

Firefighter Fitness: Kettleball Complex

Mon, 16 Jan 2012 08:00:00 GMT

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Category: Firefighter Fitness from Coach Hofman