1. Sprain and Strain Prevention
A quantitative approach to functional movement improvement
Central Pierce Fire and Rescue
Wellness and Fitness

2. A Typical Preventative Maintenance Program
What is your fire department’s most valuable asset?
Rigs, Stations, Equipment, Firefighters
How do you maintain that asset?
Fire Apparatus
Firefighter
Maintenance
70% 3%
Repair
30%
97%
Total
100%
#2 How do we take care of our athletes, and how do they take care of themselves?
Most Valuable Asset:
Firefighter
Put out fires, perform CPR, Mitigate the hazard. All departments have different pieces of equipment to assist in accomplishing the job, but the firefighter is the one who makes the right decisions and puts the equipment to work in a manner that accomplishes the task.
Also greatest Cost
Salary, Health Insurance, Pension, Training
Preventative Maintenance for the apparatus
Daily, weekly, Monthly, PM
Cost less in the long run to maintain our equipment
Take the same approach to our personnel.
The healthier your personnel remain, (mentally, physically, medically, financially, relationship) the further the taxpayers $ goes
Remember injured FF’s are expensive

3. If you believe its important to maintain your equipment…
Stations, Engine, Ladder, Medic, Gurney, Monitor, Generators, etc…
Rig checks (daily, weekly, monthly)
Preventative maintenance

4. You must maintain your firefighters!
Rig check for the body (Daily, Weekly, Monthly, Annual)
Do you need an alignment?
Will you be forced to retire, or go out on your own terms?

5. Optimum Performance Pyramid
If the base of your pyramid is not sufficient to support the layers above it, issues with performance and injuries will arise.
Combining the FMS with Functional Fitness
The performance pyramid illustrates the importance of achieving functional movement. It forms the foundation for everything we do. If you don’t have a large enough base of functional movement you can not optimally achieve functional performance and will always have limitations to the optimal achievement of functional skill.
Injury risk also increases if you are trying to achieve a functional performance base without the pre-requisite movement base. This would be a case of adding fitness on top of dysfunction.
In order to achieve functional skill as a firefighter in all aspects of our job, we need to have a base of fitness (performance) that will hold up to the demands we are put under. In order to do this we must have a non-dysfunctional movement base to operate from. Without this, its not a question of if we will get injured, but how long until we get injured?

6. Movement Quality
Please don’t let me to grow up and think I can’t do this anymore.
We all developed functional movement at one point in our lives.
Developmental Kinesiology Approach to movement looks at how we learn to move and how the whole movement pattern is greater than just the sum of its parts.
We were born with the mobility to put our feet in our mouths, and gradually developed the stability to lift our heads, then roll over, then crawl, then squat, then stand.
Everyone in this room used to be able to do a perfect squat.
What happened?

7. Use it or Lose it
Contrary to popular opinion, quality movement is not limited by age.
Movement is limited by habitual lack of use. Our habits create poor movement.
Squatting with full range of motion is clearly not limited by your age.
This is how we sit most often. How would we sit if we didn’t have chairs?
Use the movement or lose the movement.

8. Predict and Prevent Injury?
What if we had a way to predict who would be injured?
What if we could prevent them from being injured?

9. Injury Prediction and Prevention Model
The sports performance and fitness industry have been using an injury prediction and prevention model for several years called
THE FUNCTIONAL MOVEMENT SCREEN
(FMS)

10. What is the FMS?
The Functional Movement Screen (FMS) is the product of an exercise philosophy known as Functional Movement Systems. This exercise philosophy and corresponding set of resources is based on sound science, years of innovation, and current research.

11. How does it work?
The FMS is a ranking and grading system that documents movement patterns that are key to normal function. The FMS identifies functional limitations and asymmetries. These issues can reduce the effects of physical conditioning and distort body awareness.
The FMS generates the Functional Movement Screen Score, which is used to target problems and track progress.
The scoring system will assist in identifying corrective exercises that will be most effective to restore proper movement and build strength in each individual.

12. What does it do?
The FMS simplifies the concept of movement and its impact on the body.
Evaluation - Easily identifies movement asymmetries and limitations.
Standardization – Establishes a functional baseline to mark progress and provides a means to measure performance.
Safety - Identifies dangerous movement patterns so that they can be addressed, and identifies an individual’s readiness to perform exercise so that realistic goals can be set and achieved.
Corrective Strategies - Can be applied at any fitness level, simplifying corrective strategies for a wide array of movement issues.

13. FMS Components
The FMS is designed to measure both MOBILITY and STABILITY.
The FMS is able to quantify a person’s ability to maintain control (STABILITY) within the presence of change (MOBILITY).
Proper stability and proper mobility combine to create proper movement patterns

14. FMS Components
Mobility – The ability of a joint to achieve full range of functional movement
The priority of corrective exercise Rx is to make sure that you can achieve a functional ROM within your joints.
Don’t confuse flexibility with mobility. Flexibility is focused on tissue length (which is a function of mobility), you can be flexible and have poor mobility (CNS issue, previous injury, joint capsule problem, etc…)
Specifically, we want to ensure we have functional mobility at our ankles, hips, t-spine, and shoulders.

15. FMS Components
Stability – The ability of a joint system to maintain control in the presence of movement
Once we improve mobility, we want to focus on creating stability.
Specifically we want to focus on stability in the foot, knee, lumbar spine, and scapula region.
In a nutshell, do we have the ability to move our extremities and maintain a neutral spine regardless of the activity and external demand.
This is generally done by performing the Rx’d mobility drill with the addition of gravity, which will now force you to stabilize your body to a certain degree.

16. FMS Components
Movement Pattern – Incorporates fundamental mobility, while maintaining stability to reinforce coordination and timing within functional movement
Once improvements (no matter how minor) have been achieved to mobility and stability, corrective then focus on cementing those improvements into a movement pattern.
A single leg kick to the head is the ultimate example of achieving mobility, while maintaining stability through the core and transferring power though a movement pattern.
For a firefighter this would be displayed in any number of ways:
Throwing ladders
Rescuing victims
Pulling hose
Overhaul
Etc…

17. FMS Components Consists of 7 movements 1. Deep Squat 2. Hurdle Step
3. In-Line Lunge
4. Shoulder Mobility
5. Active Straight Leg Raise
6. Trunk Stability Push Up
7. Rotary Stability

18. FMS Components
Each movement is scored based on how well it is performed
3 = Able to complete the movement without compensation (Perfect)
2 = Able to complete the movement with compensation (Adequate)
1 = Unable to complete the movement even with compensation (Poor)
0 = Pain is experienced while attempting to perform the movement pattern

19. 1. Deep Squat
Fire fighters should be able to perform a “full range of motion” squat.
Measures the ability to integrate the body into a full range, full body, functional movement.
MOBILITY: ankles, hips and T-Spine
STABILITY: knees, lumbar spine and scapulae
1st Movement in the screen is a Deep Squat.
This movement is used universally as an assessment of movement by therapists, trainers and coaches, to look at how well someone moves from a gross motor perspective. Can you tie movement in your lower extremities to stability in your core.
This looks at mobility in your ankles, hips, and T-spine, while at the same time evaluating how well you can stabilize your knees, spine, and core as a whole.
Clearly, everyone in the fire service should be able to achieve a full ROM squat based on the activities that are demanded of us.

20. #1 Deep Squat Score = 3 Torso is toward vertical
Femur is below horizontal
Knees are aligned over feet
Dowel is aligned over feet

21. Deep Squat Score = 1 Score = 2
Perform movement perfectly by raising heels on a board
Score = 1
Unable to perform correctly even with heels raised

22. 2. Hurdle Step
A firefighter is routinely required to step over objects, climb stairs, and ladders
Measures the ability to stand on one leg
MOBILITY: hip
STABILITY: opposite hip and core
2nd movement Hurdle Step
This is a movement to illustrate how well you can stand on one leg.
Functionally, we do this everyday, walking, running, going up an down stairs, climbing ladders.
This movement pattern gives us a look into how well we can stabilize one side of our body, while achieving mobility through the hips on the other side of the body.
This is the first movement where we can to compare the right side to the left side to see if we are symmetrical, or if we have glaring differences bilaterally.

23. 2. Hurdle Step Score = 3 Hip, knee and ankle remain in a straight line
Minimal movement in lumbar spine is noted
Minimal weight shift occurs in single leg stance
Dowel remains parallel to the floor

24. Hurdle Step
Score = 2 Able to step over the hurdle but unable to maintain alignment
Score = 1 Unable to step over the hurdle without loosing balance or touches the hurdle

25. 3. In-Line Lunge Firefighters work in a kneeling position
Measures ability to balance with a narrow base of support
MOBILITY: ankle, hip, and shoulder
STABILITY: opposite hip and core.
3rd movement In-Line Lunge
This is a basic lunging pattern, that is used in all locomotion (walking, running, etc…), or a split squat anytime we want to drop to one knee.
Functionally, as firefighters, this is a safer position to use, as opposed to kneeling on both knees because it allows us to move and react to our surroundings faster a full kneeling position. This is especially critical when operating around unstable objects such as during auto extrications.
The in-line lunge allows us to evaluate our stability with a narrow base of support, ankle, mobility, hip mobility (simultaneous hip flexion and extension), core stabilization, t-spine mobility, and shoulder range of motion.
This test is also used to compare differences between the right and left sides.

26. 3. In-Line Lunge Score = 3 Maintain 3 points of contact with the dowel
Torso remains vertical
Dowel and feet remain perpendicular to the board
Knee touches board and front heel remains down

27. In-Line Lunge Score = 2 Able to perform the lunge with compensations
Score = 1 Unable to perform the lunge without losing balance

28. 4. Shoulder Mobility Firefighter must be able to perform work overhead
Measures the ability to move through the upper extremities
MOBILITY: shoulder and Thoracic Spine
STABILITY: scapular and lumbar stability
4th Shoulder Mobility
This shows us how well we can move through our shoulders.
Functionally, this is necessary when reaching overhead with a saw, breaching ceiling with a pike pole, or reaching behind your back to turn on you SCBA.
This test can help identify core and shoulder stability issues, as well as, possible t-spine and shoulder mobility limitations.
Comparing the right and left sides to each other can be beneficial, and frequently there are significant differences based on your hand dominance.

29. Shoulder Mobility
Score = 3
Fists are within 1 hand length

30. Shoulder Mobility Score = 2 Fists are within 1.5 hand lengths
Score = 1 Fists are more than 1.5 hand lengths apart

31. 5. Active Straight Leg Raise
Firefighters need to have the ability to reach down to the ground and pick stuff up.
Measures the ability to touch your toes
MOBILITY: hamstring, calve and hip
STABILITY: core and lumbar spine
5th ASLR
This movement is used to evaluate any hinging activity.
Functionally, this movement is used any time you lift something off the ground (deadlift), reach down in a toe touch position, or a squatting pattern.
Areas of evaluation are core stability and hip mobility (simultaneous flexion and extension).

32. Active Straight Leg Raise
Score = 3
Able to maintain a straight leg and raise it past mid thigh while keeping the down leg straight and in contact with the board

33. Active Straight Leg Raise
Score = 2 Unable to maintain a straight leg and raise it to mid thigh
Score = 1 Unable to maintain a straight leg and raise it past the knee

34. 6. Trunk Stability Push Up
A firefighter needs to be able to maintain a stable core in the presence of extremity movement.
Measures the ability to perform a plank push up
Mobility: Shoulders
Stability: Core, scapulae, hips
6th TSPU
Effectively, this screen measures a persons ability to maintain a plank position in the presence of movement.
Functionally, this is a push up, but it is evaluating the ability of the person to stabilize their core (prevent extension and flexion) while creating movement with the extremities.
This is the pure definition on stability. The ability to maintain a neutral spine in the presence of change.
It is also a measure of upper body strength.

35. Trunk Stability Push Up
Score = 3
Able to perform a push up with the thumbs aligned with the forehead.
Maintain straight line from ears – shoulders – hips – knee – ankle throughout the push up.
Chest and hips are one unit

36. Trunk Stability Push Up
Score = 2 Maintain chest and hips in line with thumbs aligned with chin
Score = 1 Unable to maintain chest and hips in line with thumbs aligned with chin

37. 7. Rotary Stability
Firefighters are routinely required to crawl and to generate power through rotation of the core for things like ax swings
Measures the ability to stabilize the core rotationally
Mobility: Shoulder and hip
7th Rotary Stability
This is a basic crawling pattern that is used to measure how well someone is able to stabilize their core rotationally.
Functionally, as firefighters we are required to be on our hands and knees and crawl.
This test will identify right and left asymmetries, and highlights the ability, or lack thereof, for a person to recruit their inner core stabilizers properly and not rely on the prime movers to stabilize the core.

38. Rotary Stability Score = 3
Able to extend the arm and leg together on the same side while maintaining the hips and chest parallel to the floor
Able to touch same side elbow to knee and re-extend arm and leg without losing balance.

39. Rotary Stability
Score = 2 Ability to extend opposite arm and leg and touch elbow to knee
Score = 2 Unable to extend opposite arm and leg and touch elbow to knee

40. FMS and the NFL 2005 Study done on one NFL team
46 athletes screened
Players with a FMS score < 14
6 times greater risk of injury than players scoring > 14
Players with score < 14, given 7 week program focused on improving individual deficits as identified by the FMS
FMS score improved by 2 points
2008 FMS was instituted in the NFL Combine

41. FMS and the NCAA 2010 Study of female college athletes
38 athletes screened
Players with a FMS score < 14
4 times greater risk of injury than players scoring > 14

42. FMS and Firefighters 2007 Tucson Fire Department
433 firefighters screened
Implemented an 8 week basic strengthening program
Results year over year
44% reduction in injuries
62% reduction in time lost due to injury

43. FMS and Firefighters Orange County Fire Authority
Over a 3 year period
113 Recruits screened from academies 33 – 36
Firefighters with FMS score = < 15
6 times greater cost of injury

44. FMS and Firefighters
Average cost per injury for recruit academy over 3 years
Not only are those who score <15 more frequently injured, but according to OCFA their injuries were also more costly on an individual level.
FF’s with a score of <15 who sustained an injury, cost the department 2.5 times as much as a FF who sustained an injury with a score of >14.
This, once again, suggests that the severity of an injury is lessens as the FMS score improves.

45. FMS and Alliant Energy Public Utility
Implemented FMS and an innovative ergonomics program 2008 as part of injury reduction program
3 state area
1500 employees
Average age 51
2008 average FMS score = 9.5
2011 average FMS = 13.5
In 2011, 77% of all strain and sprain injuries, occurred to employees with an FMS score of < 15
Alliant Energy is a private utility company that has instituted the FMS into their injury prevention program and seen dramatic results.
Since implementing the FMS in 2008 they have improved their employees scores by 3 points.
In % of all strains and sprains, were sustained by individuals with an FMS score of <15.

46. FMS and Alliant Energy Public Utility
Total # of injuries has declined by almost 50% over the span of 4 years.

47. FMS and Alliant Energy Public Utility
This has resulted in substantial savings over the course of the last 4 years.
Keep in mind, the FMS is not the only thing they do in regards to injury prevention.
They have 3 classes a year for all their employees that focus on some kind of injury prevention, movement based correction, lifting and exercise instruction.
The hurdles they faced implementing this program were far more substantial than a fire department would face. They are spread over 3 states and have an older work force, but they were able to create a culture of movement prep and exercise every morning before their shift started.
They have also focused on training ergonomic movement for the repetitive tasks that their lineman perform.

48. CPFR and the FMS? How did CPFR implement the FMS?
Trained ACE Peer Fitness Trainers (ACE PFT) in the FMS concepts by Deb Reed with ErgoFit Consulting
Each ACE PFT completed the FMS Home Study Course through Functional Movement Systems
ACE PFT screened A, B, and C shifts at a department wide battalion level drill

49. CPFR and the FMS
Additional battalion level drill for A, B, and C shift where each firefighter received a personalized movement assessment by a physical therapist.
Done in cooperation with:
Physical therapy students from University of Puget Sound
3D Physical Therapy in Tacoma, WA

50. CPFR and the FMS
Results of the FMS and physical therapist screening were recorded, analyzed and organized into a personalized corrective exercise program for each firefighter.
Personalized exercise programs were ed to each participating firefighter.

51. CPFR and the FMS
Each ACE PFT was assigned a group of firefighters to follow up with and answer questions about the exercise program and encourage program compliance.
Special attention is given to following up with all firefighters with a movement score < 14.

52. CPFR and the FMS
ACE PFT’s will be performing a follow up FMS screen later in 2013 to track potential improvements.
Re-screen each firefighter annually over 3 year time frame to monitor improvements.
Compare historical “strain and sprain” injury numbers to “strain and sprain” injury numbers to track program effectiveness.

53. How to create a personalized exercise program
ACE PFT’s digitally recorded dozens of exercises that were used to create the exercise program.
Each video provided a description of how TO and how NOT to perform each recommended exercise.
All videos were posted on YouTube

54. How to create a personalized exercise program
Each exercise was hyperlinked to the corresponding video that was posted on YouTube.
Each program was created and then ed to each individual.

55. Sample Corrective Exercises
Level 1 (Mobility)
Supine OHDS
Level 2 (Stability)
Wall Sit with Shoulder Press Progression
Level 3 (Movement Pattern)
Goblet Squat with Press

56. Sample Exercise Program
The following is a link to a sample corrective exercise program and how to follow the program.

57. Questions?
If you have questions about this program or would like to discuss how it might work for your department contact
Cpt. Adam Jackson
FF/EMT Jeff Krekling

58. “Combat operations are teaching us a lesson about the individual Marine, a lesson we already knew, but are coming to understand better and that is, our best investment as a service, is in our people.”
James F. Amos Lt. Gen. Deputy Commandant for Combat Development and Integration
This a quote from a document produced by the USMC 2006 entitled “A Concept for Functional Fitness” in which they detailed how to approach improving their fitness standards and preparing their troops for the physical realities of battle.
The best investment we can make in our department and in ourselves is in us, the firefighter.