Originally published in The Armory, Volume 1:Issue 2
With huge physical and psychological cost associated with injury, injury prevention has become a buzz word in the health and wellness community. As we knew, not all injuries can be prevented. However, as a healthcare provider who has spent most of my career trying to treat injuries after they have happened, I have realized the importance of an upstream focus of care and management – meaning are there small steps we can take to prepare ourselves more for the stressors placed on our bodies on a daily basis, in order to decrease our risk of injury and illness? How can we become more proactive in our daily habits, rather than reactive after something is injured? Often following injury, there is an inevitable decline in movement, exercise and load. I don’t want to mislead you to thinking that no rest is required – some rest, recovery and modifications are always warranted. However, there are times when we doing too little following an injury actually sets us up for future injury when we return to the high physical demands of our jobs or other activities.
Decreasing injury risk is actually NOT about decreasing load. In order for our body to heal and be prepared to withstand more stress, we need to continually challenge it in safe and foundational ways. An example of this can be seen in the way we treat certain injuries. Ankle sprains used to be casted, with the joint immobilized and the patient non-weight bearing for a period of time. This led to terrible healing and outcomes, as there was no stress being placed on the bones, muscles, and tendons to encourage healing. Now, ankle sprains are often treated with a brace, and immediate rehabilitation exercises.
A key to prevention is load management- how much load are you placing on your muscles, bones, heart? Rather than a mindset of total rest during a period of injury, can you add in some safe exercise and movement to facilitate healing and promote fewer future injuries? The answer is yes.
Depending on the extent of your injury and/or recommendations from your healthcare providers, my few go-to exercises may not be appropriate for everyone. However, when I recommend rehabilitation exercises or prevention exercises, they almost always involve similar foundational movements that act to strengthen the base for everything else we need to do. Similar to a house – if our body does not have a strong foundation, things will start to wear down and fall apart. For the purpose of these exercises, our foundation includes our feet, our core/pillar, and our breathing. All of our power and stability starts proximally (or close to our midline) at our torso. Our arms and legs translate the force that our core generates, so we must have proximal stability (core strength) for distal mobility (arm and leg movement and function). Injury will inevitably occur when we try to press something overhead if we only strengthen our shoulders, rather than also focusing on our hips and core. Regardless of your injury, I would recommend the following tips to improve your capacity and prevent future injury: move well and move often, include foundational movements in your training (hinge, squat, lunge, push, pull, carry), and build consistency in maintaining load on your body.
My foundational exercises to build your base and prevent future injury:
- Foot core strengthening (think 6 pack abs at your foot!)
This can be done seated, no equipment required! Over time, our feet can lose strength and sensory feedback from wearing shoes all the time. The small muscles in your feet play a huge role not only at your feet with dealing with injuries such as plantar fasciitis and Achilles tendonitis, but up the entire chain of your lower leg (knee pain, hip pain). Start seated, barefoot, with both feet on the ground. While keeping your big toe and your heel in contact with the ground, draw your ach together and up – as if you were raising it and creating more of a “dome.” Hold this for three seconds, relax, repeat. Start at 3×10, and work up to 3×30. Common mistakes: your toes curl. Try to achieve this movement from just the arch- don’t curl the toes, and keep the ball of the foot pressed into the ground.
- Lateral band walking – glute medius strengthening
A foundational part of the O2x methodology, glute activation is a daily practice we should instill, as we often sit for long periods of time, creating weakness and length in the posterior chain (glute and hamstring) muscles. The most optimal position for you to complete this exercise is with a mini band around your feet. While keeping toes, hips, shoulders pointed forward, take small lateral side steps while maintaining tension on the band the whole time.
- Bear crawl
A foundational movement and excellent way to strengthen your pillar and also mimic functional tasks. Keeping your knees right under your hips and your hands right under your shoulders, take small opposite hand and foot steps forward, backward, right, and left, maintaining the starting crawl posture at all times.
- Diaphragmatic breathing
While lying on your back or seated in a chair, place one hand on your chest and one hand on your stomach. When you inhale, the hand on your stomach should rise, with minimal movement occurring and the hand on your chest. On the next inhalation, in addition to the bottom hand rising, try to draw the rib cage down away from your head and expanding it out to the right and left. This encourages the diaphragm to strengthen, and help increase your breathing capacity. Try this for a few minutes at a time, slowly building the time that you do it each day. Common mistakes: tensing any part of your head/neck/upper body, the upper hand rising on the inhale, therefore using other muscles before your diaphragm to encourage breath.
About Adrian Wright-Fitzgerald, O2X On-Site Specialist with Boston Fire Department
Being an athletic trainer my whole career, I have focused on evaluating and treating injury and illness when and sometimes after they occur. The more I learn about the things we need to be
healthy (not just get healthy after injury), I have become passionate about building an upstream culture of whole person health promotion, to decrease the high rates of preventable injuries that occur in tactical athlete populations.
Top notch sports medicine access is available for intercollegiate and professional athletes, but there is meager and suboptimal access to similar providers for tactical athletes. Embedding healthcare professionals and human performance specialists into operational organizations will help ensure they understand the mission, culture, and most importantly the needs of the end users. This helps bridge gaps in care in order to prevent injuries, manage “nagging” injuries while athletes are still on duty, and promote whole person health and wellness.
My role is to be accessible to the 1500 firefighters in Boston and build relationships with each house. I deliver exercise, expertise, and am an extension of the O2X program so that members stay healthy for their entire careers, and are able to return to performance stronger than when they may have had to leave due to injury. What I love about the opportunity to be embedded with both O2X and BFD is the squad of experts I have access to in order to address any facet of health and performance that tactical athletes need. Injuries cannot be prevented through only movement and rehab, and I have the ability to be a direct liaison and resource to the athletes by delivering expertise from our specialists in the areas of strength and conditioning, nutrition, sleep, mental resilience, etc.
Some of our initial anticipated impacts associated with this position are increased fire ground performance, decreased injury rates, implementation of screenings to detect and mitigate risk, and cost savings associated with fewer injury and wellness-related leave. My long-term hope as an O2X human performance specialist is to foster a continued emphasis on a lifelong “athlete mentality” and focus on building a culture that promotes comprehensive health and wellness.
As with all of O2X’s programs, my goal is to encourage the department to optimize performance by focusing on getting 1% better every day.