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3 ways to reduce, prevent EMS-related back pain

Pain while running EMS calls or sitting around the station is not normal and it can be treated with strength and flexibility exercises

Pain when working out or training for fitness is OK, in fact it means you are pushing your body to improve. Pain while running EMS calls or sitting around the station is neither normal nor good.

Maybe my perspective is different (actually, I know it is) since I came into EMS after 15 years of clinical physical therapy, athletic training, spine rehab, pain management and sports performance.

Almost nine years in a very busy urban EMS system and another 10 years training first responders to not get hurt my experience tells me we are missing some vital yet simple sports medicine techniques. These techniques can help you manage the pain of the job and even prevent your next injury.

Pain without a specific injury is a warning sign that cannot be ignored. Back pain is far too common in first responders. If your back hurts without the presence of an injury, then there are some very simple steps to take to ensure that the symptom does not cause an injury.

1. Ice

We seem to forget that ice helps our patients and can also help us. Applying ice for 15 minutes on the affected area is akin to taking an over-the-counter pain reliever and putting 100 percent of it where it hurts.

Plus, you can apply ice every few hours since it has both anti-inflammatory and anti-pain effects with no side effects.

2. Mobilize the agonist

Just like in pharmacology, the musculoskeletal system has both agonists and antagonists. The hip flexor group becomes very tight because we have become a sedentary society and the job has us sitting and leaning forward so much. Strangely these tight muscles rarely generate a pain signal so we do not realize the need to treat them.

Foam roll the hip flexors, inner thighs and then the glutes.




Long duration stretch the hip flexor by holding the stretch for at least 90 seconds. This works even better if you rolled them first.


3. Strengthen lower back muscles

Now that we have calmed the painful area with cryotherapy and mobility, the final step is to fix it. The only way to fix the lower back pain is to keep it mobile as described above and then get the hips and mid-back strong enough to stop using the lower back as a lifting device. Two days a week of some basic yet powerful strength and stability exercise will do the trick.


3 X 15 with a 3 second hold at the top.


3 sets of 5 reps with a 5 sec hold at the top of each rep. DO NOT bend your arms and only raise the leg far enough that the back does not twist. Imagine balancing a tray on your knee.


5 sets of 5 reps with a challenging weight. Keep the sternum up at all times and back flat. Film yourself if unsure of your form. This can be done with a dumbbell, kettlebell, bar or gear.

By following these three simple sports medicine based steps for any part of the body you can invest in yourself and manage anything the job throws at you.

Bryan Fass, ATC, LAT, CSCS, EMT-P (ret.), dedicated over a decade to changing the culture of EMS from one of pain, injury and disease, to one of ergonomic excellence and provider wellness. He leveraged his 15-year career in sports medicine, athletic training, spine rehabilitation, strength and conditioning and as a paramedic to become an expert on prehospital patient handling/equipment handling and fire-EMS fitness. His company, Fit Responder, works nationally with departments to reduce injuries and improve fitness for first responders.

Bryan passed away in September, 2019, leaving a legacy of contributions to EMS health and fitness, safety and readiness.