BACK INJURY

JUST DON’T

INTRODUCTION (Adventure Story)It’s 0330 on a blustery November morning and you’re pulling another all nighter on the meat at 27’s. You’re just about back asleep after your 5th run after midnight when the tones hit again. This time, you are being called to the assistance of A21 in order to help move a “heavy”. Upon your arrival, you gear up and get ready for battle and look in horror as you make your approach, realizing the pt is on the 3rd floor of the Casa Juanita Apartments…and the elevators have been offline for over a week because of overzealous Inspector violation reports. As you reach the pt, you realize even with 6 firefighters, each of you will be carrying up to 100 lbs down 3 flights of stairs. After putting the pt in the Mega Mover(s), you proceed to pick your side up. Since there are 6 firefighters plus a large patron in a tight hallway, movement will be very awkward. Back posture will not be “prime”. As you manage to shimmy your self down the hallway, the transition to the stairs looms over you like the dark clouds of Moridor. You make your move to the first step, the force of the impact from the load you are carrying shaking you to your very being. One step, two steps. Your officer who happens to be holding the feet and a total of about 20 lbs is chanting soothing haikus towards the rest of you, gently coaxing you to watch your feet. You are now tilted precariously to the side, off balance, and off center, your spine curvature more closely resembling a backwards “C” than the steel I-beam of a column that all firefighters by nature have. Three steps. Four. Now to the landing. Turn to your left. Step. Shuffle. Twist……..And then it happens. The loud cracker jack like sound every battle hardened pt assist soldier dreads. POP! You go down. The pt goes down. Everything goes black…you wake up from a coma after 18 years only to see that your children have grown up and your spouse has moved on…Well, that’s not what really happened unless you are Steven Segal, but you get the point. You actually just pony up and pick up your end of the mover and drag the heavy down to the cot where they are transported to Evergreen and released 30 minutes later for an ankle sprain. You just hobble back to 27 where you take a couple Advil and run 4 more calls before your shift change. You blow off the injury as a “tweaked” muscle, take the next set off and leave it to bother you for the next 15 years. Is this something that could have been prevented? Maybe, maybe not. We are going to take a look at the “maybe” scenario and hopefully make you more “maybe” proof.

Why am I even reading this?

1) First off, because it’s quarterly training, so you have to.

2) Secondly, because we have all probably been there and done that in some form or another. Whether or not it has been a super heavyweight Blackhawk down extraction operation or helping frail Ms. Smith on the ground level of Mad House, we have all picked people of various shapes and sizes up and moved them as awkwardly as humanly possible. How about on the fire ground. Ever lifted a charged deuce and a half or strained for dear life in an attempt to reposition a precariously placed 5”? Tied your shoes lately? Washed your feet? Chances are if you’ve done any of these things, you have put yourself in less than optimal positions to accomplish such daring feats.

3) Your career depends on you keeping your back and adjoining structures healthy. Duh. Not only that, but you also want to be able to enjoy life with your family and friends doing the things you love without pain or restriction. Duh.

4) Lastly, because it’s quarterly training, so you have to.

So what am I talking about?

Primary Structures•Spine and Pelvis

Core•Everything from your shoulders to your legs

Back Anatomy7 vertebrae Cervical

• Very Flexible• Thinnest and most delicate vertebrae• Functions to allow skull movement up and down (C1) and left to right (C2)

12 VertebraeThoracic• Less flexible than Cervical• Forms connection with ribs

5 VertebraeLumbar• Largest vertebrae in spine• More flexible than Thoracic due to lack of ribs• All of upper body’s weight bears down on this section

1 bone made of 5 bones fused during adolescenceSacrum• Wedged in between the 2 hip bones• Connection point for SI Joint

Single bone made of 3-5 vertebrae fused at adolescenceCoccyx• Attachment point for gluteal muscles• Bears weight of body when sitting

Pelvis AnatomySacroiliac Joint (SI)• Bilateral joints that transmit

force produced by lower body to spine

• Small tolerance for movement, several mm forward and backwards, independent of one another

• Prevalent cause of lower back px

Sacrum• Joins Pelvis to spine• Major force

transmission point

This is as far as we will go into spinal and pelvic anatomy as far as this presentation is concerned. For all intensive purposes, from here on out, the “Back” is the force transmitting structure that the “Core” supports and the vital component we are trying to protect.

Core Anatomy

This is the area we are concerned with in this presentation. Everything From the shoulders to the Legs is what we are going to call the “Core”. Encompasses everything around your spine.

Pecs

Obliques/Serratus

Rectus Abdominus“Abs”

Psoas

Hip Flexors

Rhomboids

Lats

Quadratus Lomborum“QL”

Glutes

Spinal Erectors

Core Anatomy

What does all this anatomy jargon mean to me?...

Probably NOTHING

Just realize that all those little muscles you take for granted make up the entirety of your core and there is a lot going on when you do even the simplest of tasks. If you remove just one piece of the building, the entire structure can come down.

Core Anatomy

Core Function

Stabilize Primary Structures

Transmit force from lower to upper extremities

Create neurological connection

The Core has several 3 primary functions we are concerned with in this presentation

Stabilization• Probably the most important function of your core

is to stabilize and support your critical structures, i.e. your spine and pelvis.

• Your spine contains all your important wiring; when the wiring gets messed up, impinged, or improperly tensioned, bad things happen.

• The spine is strongest in a NEUTRAL and FIXED position. IT CAN AND DOES FLEX/ EXTEND, BUT MOVEMENT UNDER LOAD IS DEFINITELY NOT IDEAL.

• Has relatively good resistance (to an extent) to flexion and extension forces.

• The spine does not handle torsional forces very well. It is designed to lever, not twist.

• If your spine is in a bad position, neuromuscular impulses and firing sequences can be disrupted and affected, usually in BAD ways.

Stabilization cont’dConsider the large concrete columns to the right. They support a tremendous load vertically and transfer the force downward to the ground. They are extremely strong vertically but when a lateral force is applied, the strength of the column can be compromised. If you were to weaken the middle of the column, the load capacity and stability of said column would be significantly decreased. Unless the ENTIRE column is rigid and strong, the potential for catastrophic failure is likely. So, if the column is struck by a large truck, its integrity might be compromised. Fortunately, these columns are reinforced and very durable even to such a traumatic force. Obviously this is not ideal, but it will survive. This is how we want our cores to function. Our spines can withstand significant vertical pressure, but a shift in applied force can expose us to injury. We want to over-engineer the core, per se. If the column is weak, the whole structure is weak

Stabilization cont’d

Imagine you are lifting a Pt on a backboard over a railing at a house. Which one of these do you want to represent your spine when under heavy load?

Force Transfer• Another primary function of your core/ trunk is to

affect the transfer of force from your lower body to your upper body and visa versa.

• When you lift something off the ground, whether to a standing position or an overhead position, you are transferring the weight of an object in space. This requires the production of force and the transmission of force. When lifting an object from the ground, the force is applied to the ground by the lower body, transferred to the upper through the CORE and applied to the weight. Without the ability of the applied force to go somewhere, all you will have is a bunch of singular upper and lower body movement with no load movement.

• Without a stable centerpiece, the risk of injury goes up because often the force producing pieces of the body are strong enough to create some movement force (i.e. legs can press a lot of weight into the floor during the deadlift but the lower back hyperextends due to lack of stiffness). If the weak link is the midsection, all that force is applied to an unprotected nervous system, which is bad….very bad.

Force Transfer cont’d

Take the legendary pogo stick for example. The weight of the user compresses the spring at the bottom and reverses the force upward through the shaft of the pogo stick to the user. Getting airborne is possible because the shaft acts as a stiff column, transferring the energy upward. If the center were made up of a tube of rubber or some other non rigid material, all the upward force would be lost at the rubber and all sorts of weird, bad vector and sheering forces would be exerted into the shaft, or in our case, your spine.

Force Transfer cont’d

A more realistic illustration for what we are dealing with would be the clean and jerk. Notice how this athlete maintains a rigid core the entire time. If at any time during the lift his trunk were compromised, the weight would shift and he would miss the lift, or worse.

The line of force is produced vertically from the base against the floor, up through the trunk and out through the arms. Any midline deviation would result in a greatly decreased end result.

FORCE

FORCEPRODUCTION

MIDLINETRANSFER

LINE OF FORCE

END RESULT

Force Transfer cont’d

Now that this has been drilled into your head, you should realize how important your midsection truly is in being more efficient at strength related tasks and getting the desired results when applying force in a particular direction, which might apply somewhat to our profession. Hint hint!

Neuro Connection• The last component of midline function we will cover is the

neuromuscular connection. While not as frequently brought up as stabilization, it is none the less very important.

• Creates circuit continuity between motherboard (brain) and interface (limbs).

• Improves strength output and muscle function• Creates safer “tunnel” for nerves and connective tissue to travel

through.• Facilitates greater muscular proprioception and awareness.

Neuro ConnectionWhen it comes to your nerve tunnels and spinal column, it’s pretty straight forward.

This ThisNot as Good As

Neuro Connection

Obviously this is preferable to the former. Keeping a strong, neutral spine maximizes, well, EVERYTHING.

Can be caused by repeated loaded hyperextension, hyperflexion of spine. Nerve impingement, entrapment, reduced “signal”.

Neuro Connection

Neutral spine allows the body to expend less energy maintaining a desired position. We’re all about being energy efficient. Also allows for the proper firing sequences and activation of muscle groups for specific movements.

INJURIESC

ommonality

Types

Causes

So how and whey are we hurting ourselves anyway?

Commonality

I. In 2014, there were 3 officially reported back injuries for KFD. These are on-duty injuries reported to the City.

II. The number of reported injuries for the past years have been essentially the same.

III. In 2014, there were no less than 14 on the job back injuries that were not officially reported. These for the most part were not time loss injuries. Most were minor tweaks and sprains. Several became ongoing, chronic issues. Of the 14 back issues, the majority were received during calls while lifting patients. The majority of our work includes lifting people. Many of those people are large.

Types

Strain Sprain Spasm Trauma

Types

Strain• Strains are a muscle/ tendon injury

• Caused by overuse, acute over contraction, excessive movement beyond a learned range of motion

• Can be very mild micro trauma such as weight lifting to severe Grade 3 strains that cause complete muscle or tendon ruptures

• Muscle flexibility comes from the belly of the muscle (and “learned” by the nervous system) and if the muscle is pushed beyond it’s maximum range of motion suddenly, an injury can occur

• If suddenly contracted beyond it’s max ROM, and if the muscle is very tight, a stretch or tear can actually occur at the tendon itself, or worse, tear away from the bone

• Tendon injuries are the worst form of strain because they receive the least amount of blood flow and heal much slower

Sprain

• Sprains are ligament injuries• Caused by overuse and excessive movement beyond the

max ROM of a certain joint• Since ligaments limit the range of motion of a particular joint,

if the ROM is suddenly exceeded, a resulting injury can leave the joint unstable and “wobbly”

• Bad sprains can actually tear off patches of bone where the ligaments connect

• FYI- your spine and pelvis have LOTS of ligaments• Slow to heal• Common sprains are rolled ankles and jammed fingers

Types

• Spasms occur when a particular muscle is involuntarily contracted for a certain amount of time

• Can be caused from trauma, repetitive poor posture, electrolyte imbalances, protective mechanisms

• If a muscle is stressed beyond the body’s perceived ability of that muscle to function, it can go into a protective muscle spasm reflex, which basically locks and contracts the muscle in place in order to tell you to stop using it; this can last anywhere from hours to years

• Many people develop muscle spasms that persist for years due to poor mechanics and overuse of certain muscles, these can result in trigger points or progress to muscle dysfunction and inhibition

Spasm

Types

• If you get hit, stabbed, gouged, shanked or pummeled, your muscles might get jacked up

• The biggest problem with these types of injuries, along with others initially is the bleeding into the surrounding tissue space that can occur

• Swelling is a natural process for muscle trauma and shouldn’t be inhibited after the initial injury settles down as it brings vital nutrients and oxygen to the area; the initial injury is a good case for swelling reduction as the bleeding can cause pressure build up and secondary tissue death of the surrounding tissues

• Mechanical injury of structures can often have other far reaching implications for nerve function

Trauma

Types

Causes

Based on what we just said about the types of injuries we are seeing, we are going to talk about why we are seeing more and more people hurting their backs at work. Besides the inevitable step off a high ledge and mess up your hips situations and the ol trip over the box of cat litter in the middle of the 2” wide hallway carrying a person in a mega mover hoarder house scenario, we can only do so much to prevent ourselves from becoming injury statistics. We will go over a few things that we do that expose us to these injuries.

Causes

MusclesNo, muscles aren’t the problem per se. The main function of our muscles are to produce force, which we already covered and also to create stiffness at joints. The problem comes when our muscles produce more force than they are capable of stabilizing. In fact, the failure to properly stiffen joints is the biggest cause of joint injuries. When your legs are so strong you can squat 400 lbs but you have a weak midsection, you jam all that force into an unstable spinal column, causing all sorts of bad juju. Same goes for the knees, elbows and the infamous shoulder. If the joint isn’t stiff, the joint just sort of flops around in it’s socket or connection point. That is BAD.

CausesOverextension

Notice how both of these people are super overextended in an overhead position. This arching of the back creates a huge compression force on your vertebrae. Instead of the force going in a straight line, it forces the vertebrae in your back to pinch and compress on themselves. Huge amounts of pinching force occur at the lower joints of the spine. Now imagine trying to ram a hook through the ceiling and hitting a rafter with full force. What do you think that is going to do to your low back? Same goes for lifting something heavy off the ground.

CausesExcessive Flexion

Excess flexion is also a huge cause ofback problems. It can compress the spineand cause a large amount of shear on the vertebrae. This position is very common especially on the fire ground where ROM is greatly reduced by our gear. We’ve all seen people get lazy when picking stuff off the ground and get into this position, especially with patients. I don’t even have to talk about what this can do to your muscles and joints when those same muscles pull in this position. The biggest danger is when the spine is under load and then movement is created in the spine. Lifting in a semi flexed position can be acceptable assuming there is no spine motion during the lift. Repeated flexion in the spine can cause bulging and herniation over time.

CausesTwisting

Twisting can be another major back killer. The old adage says to never lift and twist. This is mostly true. The spine is very durable and able to take a beating with repetitive duty cycles, but eventually with enough bad cycles, something will fail. The act of spinal torsion creates a large twisting shear force on the vertebrae and can lead to degeneration and other nasty injuries. When we twist, we want to twist AROUND the spine, not THROUGH it. We will cover this later but suffice it to say that if your upper body is going one way and your lower body is stationary, you’re doing it wrong. Knock it off! Transferring a patient from our cots to the hospital bed is a prime example of this. Sometimes it can’t be helped, but don’t make it a habit.

CausesHere it is folks! The Destroyer of backs. SITTING! Whether you’re the day to day desk athlete working furiously to finish your quarterly training and get that box green or chillin on your couch for the Hawks game, you’ve probably been guilty of ALL of the photos below. Ever wonder why your back hurts when you stand up and your hips feel so tight along with your low back feeling like somebody just shanked you with a dagger? Sitting for long periods literally trains your hip flexors to become short and weak and your back to be in a constant flexed position. When you stand to stretch and everything aches, it’s because your short hip flexors and flexed abdomen are pulling on your pelvis, tilting it forward, which in turn cranks on your low back, creating a nice pendulum effect of gouging out of your insides. Bad posture in standing is no better. Your body will learn the positions you are in most regularly and carry those over to the rest of your movement patterns. If you sit bad, you probably do everything bad.

What gets us?Any combination of the previous 3 types of injury primers can cause any number of the previous injury types. Specifically, there are 3 big issues we see in our job due to the nature of what we do.

Bulged Disc

Herniated Disc SI Joint Sprain

What gets us?

The bulged disc is a condition where the nucleus of the disc becomes inflamed and irritated and pushes against the inside of the annulus of the disc. Think of it like a jelly doughnut. If you smash the doughnut a little bit, the delicious jelly filling starts to push against the doughnut itself. You end up with a small bulge in the outside of the doughnut but no leakage yet. This can be caused by repeated micro trauma, sprains, strains and compression forces.

What gets us?

Oh no, you’ve done it! You’ve just completed your 10,000th kettlebell swing and now you can’t even move your legs. Too bad you hyperextended your back on every single one of those reps. Now you have a herniation. Your doughnut has no sprung a leak and the jelly filling has burst out through the side of the doughnut. That once delicious jelly filling is now smashing itself against your vertebral column causing you a world of pain and regret. Much more serious than a bulge, these usually require surgical intervention. Oopsie.

What gets us?Probably the biggest digger of all that we see in our job is the elusive Sacroiliac Joint. Remember this little fella from the earlier slides? Of course you don’t. This particular joint is a huge load hinge transfer point from the lower body to the upper body. All spacial body movement requires the SI joint to work properly. Walking, running, lifting, sitting, bending, and standing transfers force through this little joint. What often happens is when a load is lifted awkwardly or improperly, the nervous system freaks out and shuts down the correlating Quadratus Lomborum with spasm. This in turns cranks on the ilium of the pelvis and pulls it out of alignment. One side naturally twists and voila! You now have an unstable pelvis and a shortened leg to go with that back pain. This can last weeks to years if undiagnosed. Lack of mobility and bad mechanics are primary antagonists for this sucker. Ever had a painful left or right side just above your pelvis? Yup, you probably have.

So Now What?

Now that you have just stared blankly at the screen for 38 slides, you are finally at the practical application part. There are 3 things we really need in order to help keep our backs safe.

Proper

Sequencing Flexibility Strength

Sequencing

First things first, we need to learn how to properly stabilize our core in order to carry any sort of load. In order to stabilize it properly, we must also learn how to engage the proper muscles, aka EVERYTHING AT ONCE. There are 3 primary ways we will go over to do just that.

Intra-abdominal pressure

Squeeze Butt

Maintain Good Posture

SequencingThe most important piece of core preparation is Intra-abdominal pressure. This concept boils down to filling the diaphragm with air and forcefully bearing down while holding your breath. For example: Go ask Jason Pierce to whip kick you in the gut and see how you brace yourself for the kick. I’ll bet you don’t try to “flex” your abs or suck your stomach in as is commonly advised in the gym world. My money is on the probability that you will take a huge breath and squeeze for all your worth. Don’t think about trying to push your stomach “out” either. Think of holding your breath and bearing down for a bowel movement. You should feel your stomach and surrounding muscles tighten down and your diaphragm should feel like it is being pressed into your abdominal cavity. This is proper midline bracing. The amount of bracing you need is dependent on your task. Picking up a piece of paper; moderate. Picking up a heavy: TONS of bracing. We should always have our core engaged to some extent.

Notice how he looks like his face is going to explode. You don’t need to look like that but this illustrates just how hard he is bracing himself and “crushing” his diaphragm down.

SequencingA great exercise for getting a feel for how this to simply lay supine on the ground and extend your hands overhead and lift your legs off the ground. If you are not tight, there will be a gap between your lower back and the ground. To make that gap go away, bear down and push your back flat against the ground. This is a good queue to help recognize what muscles need to do what for proper bracing. Note: We don’t squat or deadlift in a hollow position, we maintain “neutral” with a natural spine curvature. This just helps to learn how to feel core engagement and train stability.

SequencingSimultaneous with creating abdominal pressure, the glutes need to be activated. This will tighten up the surrounding joints (hips, SI) and musculature. This along with tightening up your gut will create the pillar effect we are looking for in maintaining rigid spinal alignment. The glutes are, or should be the strongest muscles in the body and thus support huge loads through the pelvis and femurs. Because of underdevelopment and improper sequencing, many people have weak glutes that lead to back issues. We don’t want that. When you lift something, squeeze the butt. When you bend down to tie your shoe, squeeze your butt. When you push something overhead, squeeze your butt. Get it?

The last part of proper sequencing we need to be conscious of is good posture. It is pretty simple. Keep your head neutral and in line with your spine. Don’t arch your head up or down. Don’t let your back round during a lift and definitely don’t let it hyperextend. Keep EVERYTHING nice and linear. Think of pushing your heels through the floor. This will activate your butt, hammies and quads correctly and help you engage your core.

Sequencing

Good Bad

PS- When pushing with your feet, keep your big toe on the ground. It creates a neuro connection with the hamstrings and allows them to be turned on.

FlexibilityIn order to safely lift patients, hose, tools and perform basic tasks, we need to have enough joint and muscle mobility to give us a “buffer” inside which we can safely operate do perform our routine tasks. The extreme demands will come and there is nothing we can do about that, but we can prepare ourselves so that when we do have to lift a really heavy person in an awkward low position, we have the capacity, durability and ability to do so. We should all be able to touch our toes with little to no rounding of the back and enough reserve mobility that in case we do arch or overextend, it’s not going to kill us. This is a length topic on top of an already lengthy topic so I will just put links to articles and videos on how to achieve good mobility.

FlexibilityBack/ Spine• https://www.youtube.com/watch?v=SO2UvHDxGU8• https://www.youtube.com/watch?v=z2G4J0ujp0s

Hips• https://www.youtube.com/watch?v=_

713h6iug30• https://

www.youtube.com/watch?v=jsUISMcXeCM• https://

www.youtube.com/watch?v=ZkzFT6rRMhQ• https://

www.youtube.com/watch?v=SE-yVP691SA• https://

www.youtube.com/watch?v=yzHcIzIVRKw• https://

www.youtube.com/watch?v=SaeAvGh6gkg• https://

www.youtube.com/watch?v=IioW8A3fgW0

Hamstrings/ Glutes• https://

www.youtube.com/watch?v=Ol0r8lUqB-Q• https://

www.youtube.com/watch?v=CcIaR2IFmAE• https://

www.youtube.com/watch?v=wu4zAsskzCQ• https://

www.youtube.com/watch?v=swytqZLmdao• https://

www.youtube.com/watch?v=SfGV-65GaPg

SI Joint• https://

www.youtube.com/watch?v=BaePO6wQBtk

Shoulder girdle• https://

www.youtube.com/watch?v=eveYJP1indI• https://

www.youtube.com/watch?v=q0Elx93duAA• https://

www.youtube.com/watch?v=RmGgYuMWf1A• https://

www.youtube.com/watch?v=RXCyNiSGrEs• https://

www.youtube.com/watch?v=H8xds0f922I• https://

www.youtube.com/watch?v=8WQsQRoeZxs• https://

www.youtube.com/watch?v=uzWOECAhsAM

Strength

The last part of the module for gaining the upper hand on back injuries is the strength component. Since you should have an idea on how to tighten everything up and understand how flexibility carries over into stability, you need some tools to work with.

StrengthWhen designing a program to positively affect your strength and conditioning, one first needs to decide what they want to train for. Here are a couple of my thoughts. Take them with a grain of salt.1. The program should incorporate some sort of mobility and coordination work in order for

your nervous system to most efficiently work.2. Decide what you want to train for. Not everyone needs to be able to deadlift 400# as well

as not everyone needs to be able to run 13 miles at one time. Everyone has different goals and methods. Choose whatever best suits you but realize that our job requires both strength and some endurance.

3. Exercises are tools to get specific jobs done. The way an exercise is performed depends on the rationale for choosing that exercise.

4. Failure to train in all 3 planes of motion leads to imbalances and suboptimal real life performance. (Sagittal- forward and backwards, Frontal- side to side, and Transverse- rotational are the 3 planes. Most programs are only Sagittal planar and neglect 2 huge components of real life human movement)

5. Train to be strong and stable in unstable positions, i.e. overhead, side loaded, bent over, etc.

6. Train for longevity and overall health. Don’t burn yourself out, mentally or physically.7. Try new and challenging exercises you might not normally do. You might find weak points

you need to address.8. Make good decisions.

Strength

Turkish Get Up

Great exercise for muscle group coordination, balance and emphasis on core rigidity.

https://www.youtube.com/watch?v=05XkK3UbRhY

Strength

Kettlebell Windmill

Great for overhead shoulder stability, hip flexibility, balance, core bracing. Start off light and w/ lesser range of motion for beginners.

https://www.youtube.com/watch?v=6651sjanpxI

Strength

Kettlebell Goblet Squat

Huge emphasis on keeping torso upright and bracing in low position of relative instability, works hip flexibility to great extent.

https://www.youtube.com/watch?v=QrVgpDOLlgM

Strength

Suitcase Deadlift

Teaches unilateral loading patterns while training bilateral movement, forces extreme midline bracing and abdominal pressurization, works same side glutes and opposite side QL and stabilizers to high degree

https://www.youtube.com/watch?v=qE9b5faHEZ4

Strength

1 arm Bulgarian Split Squat

Single side loading forces opposing side to resist leaning and rotation, excellent movement for glute activation and anti-rotational stability. Focus on keeping core tight and resisting forward lean. Squeeze the butt!

https://www.youtube.com/watch?v=LA5K2SXmsUc

Strength

1 Arm Single Let Deadlift

Big focus on balance and unilateral stability. Forces one to resist rotation forces and keep midline straight. Focus on NOT reaching with loaded arm. The following article has an excellent description.http://tonygentilcore.com/2011/06/perfecting-the-1legged-rdl/

https://www.youtube.com/watch?v=sAqkGppE72U

Strength

Full Contact Twist

Huge emphasis on anti-rotation. Forces the body to work as a single unit and creating global tension. Works obliques, hips and glutes to large degree. Really focus on rotating through the hips. We do NOT want to twist through the spine. Rotation should be around the spine and controlled by the hip movement.

https://www.youtube.com/watch?v=vrgYO-9d7OA

https://www.youtube.com/watch?v=vPCsgI_MmJc

https://www.youtube.com/watch?v=hgbYpGOFbe0

Strength

Sledgehammer Strikes

Great practical exercise for overall power and core development. Don’t overextend!!

https://www.youtube.com/watch?v=HX6WExJA2iU

Strength

Rotational Med Ball Throws

Again, don’t twist THROUGH spine. Use hips to drive rotation. Same action as side sledge swings. Massive rotational force development.

https://www.youtube.com/watch?v=fi26fgPgcBg

Strength

Planks

Basic bodyweight isometric exercise that trains stability in unstable position. Squeeze the butt and don’t let the back sag or round too much. Think of the hollow position upside down.

Strength

Farmer’s Carry

One of the best all around conditioning/ strength movements there is. Works EVERYTHING. Huge demand on core and pelvis stability. Works both QLs heavily at the same time. Keep the ribcage down and take quick, choppy steps.

https://www.youtube.com/watch?v=g3quf2TWCYg

Wrap UpThanks for grinding through all 60 slides. I know it is a lot to take in, some very redundant but the goal here is to ingrain in your dome how important our backs are. Without a healthy back, you can kick your career goodbye, and since we aren’t LEOFF 1, we can’t just go out on disability and get free $$$$ ;) Please take care of yourselves and think about how you can make yourself less susceptible to injury and more effective on the fire ground and in life in general.

A few additional articles for those of you that care to learn a bit more about back pain and stability tactics. Thanks.

http://www.t-nation.com/training/interview-with-dr-stuart-mcgill-part-1

http://www.ericcressey.com/fixing-the-flaws-a-look-at-the-ten-most-common-biomechanical-weak-links-in-athletes

http://www.ericcressey.com/tag/core-stability

http://www.performbetter.com/webapp/wcs/stores/servlet/PBOnePieceView?storeId=10151&catalogId=10751&pagename=438