EMS injury prevention: Start with 3 stability, core endurance exercises

Pre-shift stretching is known to reduce injury and can easily be added to a medic's routine

Patients are not getting any lighter, patient-handling gear is not either, and the call volume is ever increasing. When we add these three variables together it’s easy to see why injury rates in EMS and fire-rescue personnel are increasing, which is odd because we have some of the best technology possible to help us move patients.

This begs two questions.

  1. Why are our injury rates so high in EMS
  2. Why do we, as a profession, keep getting hurt?

As a profession, we must first look at our fitness and underlying physical ability. I frequently write and teach that EMS is in the moving business, everything we do is physical; in the process we provide awesome medical care. Yet we spend little to no time preparing our bodies to survive this job. 

I also work with industrial businesses to develop injury-reduction programs. I am struck that most of those companies mandate pre-shift stretching because they know it reduces injury.

What do we do in EMS at the start of the work day? We drink a second cup of coffee. 

Obviously comparing EMS to the manufacturing or packing industry is not precise, but when we dial down to the biomechanics, it’s more similar than we want to admit. 

Get loose and mobile, then get strong

Stretching and mobility reduce injury. The data is clear. Step one for every EMS provider is to get loose and get mobile. No one can teach you to be fit and strong or lift patients if your body does not possess the underlying ability to move properly. Think squat or lunge; can you do these critical motions with perfect form?

Step two is to get strong and here is where the big disconnect lies. We go off the rails with the misdirected notion that exercise must be nasty, painful, exhausting and puke inducing to be beneficial. Sadly that’s exactly what we do not want from exercise to get strong. 

EMS is NOT a high-intensity profession. If you are a dual role, fire and EMS provider, I have a completely different argument, but this column is focused on EMS. 

EMS providers need body control and stability

Body control and stability are what matter most for EMS providers. Specifically medics need the ability to control movements or motions while maintaining proper posture.

Building stability, core control and core endurance are decidedly simple. There is nothing fancy or flashing in this exercise routine, but I know from teaching it to thousands of EMS providers that it will absolutely fire you up. To get started all you need is a resistance band that you can find at sport goods store or online, like this one on Amazon.

A resistance band tied to the truck is an instant gym. I just got rid of your first excuse for not exercising. Now let's get started with two simple rules. 

  1. Control, not speed is key and posture throughout the movement is paramount. Speed is not your friend and you must maintain a neutral spine with your pelvis in line.
  2. Numbers are irrelevant. Your goal is 15 repetitions for 3-4 sets but as soon as your technique goes bad or you lose the ability to control your body, stop the movement. 

Exercise 1: Bridge progression
Bridging is a fantastic exercise to activate the glutes. Weak glutes can cause back pain and injury. The glutes get weak from sitting so bridging is a great go-to exercise for both back pain and injury prevention.

Start lying on your back with your heels under your knees and lift your toes off the floor. Driving through your heels, bridge up to the top position, where your back is flat. Hold at the top for 5 seconds. Come down from the top position slowly, tap the floor and repeat for 15 reps. Do 3-4 sets.

Exercise 2: Tall kneeling progression
Tall kneeling row and press movements are like bridges, but now you must engage your core, hips, abs and chest and back. These are technically counter-rotation exercises that build fantastic trunk/core endurance. Keep the glutes tight, kneel tall, head up and control your motions.

Perform 3-4 sets of 15-20 reps. Which side of your body is weaker? Over time our goal is to create balanced strength and stability.

As the name says, kneel tall with your spine neutral and glutes engaged. Press the band out, pause and slowly return to the start position. Both of these exercises work the abs, core, hips and chest on the press and back on the row. This total body engagement is EMS specific and has an added benefit of upping the calorie burn.

The tall kneeling row is the same as the press only this time you are facing the band and pulling to the side of your body.

Exercise 3: Squat progression
In EMS squatting is a job-specific task yet I see so many responders struggle to squat properly. Tight calves cause your heels to rise when you squat. Because your hips are tight you turn your feet outward and trunk flex. Since your back is tight you trunk flex, which is using your back when you think you are using your legs.

To build a better squat, perform three sets of 15-25 with perfect form. If you cannot achieve the points mentioned above go back and work on your mobility and the bridge progression.

Start building body control and stability

Perform these exercises, in the order listed, two to three times per week for about 30 days with a day of no resistance training in-between. On the days you are not resistance training, I recommend 45 minutes of cardio as a great way to burn fat and boost your cardiovascular endurance. Once you have built up a good cardio base, I strongly recommend one day of sprint work followed by 48 hours of rest. A great starting sprint workout is a 20 second running sprint followed by 40 seconds of rest. Repeat that cycle nine times.

Find more fitness tips and exercises in the First in Fitness archives. 

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