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First in Fitness
by Bryan Fass

3 exercises to help medics avoid back injury

These techniques can and should be done on duty, and will help you manage those aches and pains before they become an injury

By Bryan Fass

Your lower back has been aching for a few weeks now. Sure, some days are better than others, but overall it’s been downright cranky.

Last shift, you and your partner were picking up a frail old patient off the floor, and instead of taking an extra second to grab the flexible stretcher or the Reeves you just decided to "get it done." While awkwardly lifting this patient, you felt a pop in your back and the pain was immediate.

Back injuries consistently rank as the leading cause of disability, lost work and early retirement in the country — especially in EMS. The good news is there are a lot of great new products hitting the market that make lifting and moving patients much easier.

Prevention is key

That flexible stretcher or megaMover is not just for bariatric; use them with all patient contacts to provide better lifting height, distributed load and reduced friction during lateral transfers.

The same holds true for what we consider the post injury responders. You had an injury, it’s “mostly” better but let’s be honest — your back still lets you know that it’s there. One wrong lift and that familiar pain will be back. 

Prevention is obviously the key to having a healthy back. Studies and data clearly show that stretching daily, consistent exercise, good nutrition and hydration will all help to prevent on-the-job injury.

Let’s take it a step further. Current best practices from the sports, therapy and public safety clearly show that using tissue mobilization tools like foam rollers, massage balls and massage sticks all have a clear benefit to helping your tissue be more mobile.

These techniques are all uniform and station friendly so they can and should be done on duty. Plus you will feel better, and you can manage those aches and pains before they become an injury.

So what are the three exercises you need to be doing to protect your back?

1. Bird dog: Contralateral extension focuses on the poster chain muscles. But what it really does is begin to stabilize the fine-motor spine while simultaneously engaging the muscles in the core and hips. Do two sets of 15 to 30 repetitions every other day. 

Start on your hands and knees and imagine you have a broom stick on your back. Extend your opposite arm and leg until fully extended. Slowly draw imaginary boxes in the air for 15 to 30 reps each side. Keep your body still and in broom stick posture as your arm and leg do the work.

2: Bowlers squat: Named such because it looks like a bowler releasing the ball. In the beginning go slow and focus on your form. As you get better speed it up, but technique is key. This is a gluteal integration technique; its purpose is to strengthen your hips and legs so when you lift, these muscles fire properly and provide a spine sparing effect. Do three sets of 10 to 15 repetitions.

3. Kettle bell swing: Having the ability to hinge the hips when performing a physical task like lifting, or reaching over a bed to transfer a patient, is very important. This is why you were taught to lift with your legs and not your back, but as we have seen in the field almost every one of you still initiates and finishes your lift with your back. We need an exercise that trains your body to hinge the hips rapidly while maintaining a safe neutral spine angle (flat back/broom stick posture).

So yes, you need a kettle bell for this but it does not need to be heavy. Proper technique is of the utmost importance at all times. This is not an arm exercise; it’s a leg and core exercise.

Use your hips to explode the kettle bell from under your body, thinking of your arms as simply an attachment for the kettle bell. Think broom stick on the back at all times. Do three sets of 15 repetitions.

As with all exercise always warm up first. Foam roll, actively stretch and then do a few light reps of the exercise before you jump into your sets. These three movements are my go-to exercises because they are effective, quick and can be done in uniform.

One word of caution: there is a learning curve with the kettle bell swing. If you have a trainers or coaches who can critique you please use them, and if not, a mirror will give you great feedback on technique as well.

None of these exercises are complicated or flashy but they are job specific, and will help you to keep your back strong and mobile.

About the author

Bryan Fass is a leading expert on public safety injury prevention. As the president and founder of Fit Responder, Bryan’s company works nationally with departments, corporations, and state and local governments to design and run targeted injury prevention and wellness programs. He is frequently contacted for expert opinion and content contribution for all aspects of public safety fitness, ergonomics and wellness. He authored the Fit Responder book used by departments and schools, and writes for numerous web and peer-reviewed journals including the NSCA-TSAC journal,, JEMS, & best practices in EMS.

Bryan holds a bachelors’ degree in sports medicine with more than 17 years of clinical practice, was a paramedic for more than 8 years, and is certified as an Athletic Trainer (ATC, LAT), Strength Coach (CSCS) and the Functional Movement Screen (FMS). Fit Responder developed the nation’s first validated pre-hire Physical Abilities Test for EMS. Bryan is a sought-after speaker on a variety of topics including risk reduction, employee self-care, real world wellness and How to Eat on the street. Fit Responder also offers a mobile app and program for Fire-Rescue fitness. Contact Bryan at
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Brent Driscoll Brent Driscoll Sunday, April 06, 2014 6:03:02 PM How about a video? Would have saved a thousand words!
Don Sharpe Don Sharpe Friday, April 18, 2014 2:28:54 PM These exercises are great, pics help. You can look 'em all up on the 'net.... Then shut off the computer and do 'em!!
Brett Polan Brett Polan Wednesday, October 29, 2014 6:10:52 AM Can't forget about the mighty planks
Thom Swan Thom Swan Wednesday, October 29, 2014 7:12:31 AM YouTube is your friend. Search for each of the exercises by name and you'll find video. Russian swings with the kettle bell are my personal favorite, BTW.
AS Walczak AS Walczak Wednesday, October 29, 2014 11:53:10 AM zobaczmy...
Mike Kopowski Mike Kopowski Thursday, October 30, 2014 5:31:49 AM My back used to be on fire by the end of the shift, it was all I could do to stand and do the dishes at the firehouse. I started doing kettle bell swings and my back problems were gone almost over night! I can praise them enough.

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