Safety & Health

Reducing Spinal Injuries

Issue 5 and Volume 15.

The six-pack abs have been deemed the “gold standard” for abdominal “core strength” since the rise of steroid use, social media marketing, and photoshopping images. The “core” in general has become a trendy concept the fitness industry has been able to reinvent the wheel with. I do agree that six-pack abdominals look amazing on the beach. The truth is, however, the rectus abdominus has no attachments to the lumbar spine and therefore, offers no true stabilization or support. The rectus abdominus originates at the pubic bone and inserts at the bottom of the sternum. Its main purpose is to flex the trunk (think sit-up motion). Functionally, this is important for motions like getting out of bed and leaning forward. When it contracts, it offers no support to the low back. Firefighting, lifting patients, and carrying heavy loads of equipment put all firefighters at high risk for back injuries. If you have been focusing on sit-ups and crunches to strengthen your core, prevent back injury, and maintain your active-duty status, you are not actually preventing injury in the slightest.

Underneath the rectus abdominus is a deep stabilizing abdominal muscle called the transverse abdominus. This muscle is not quite as popular, is not easily photoshopped, and offers less visible aesthetic advantage. It does, however, cinch in the waist visibly and stabilize the spine to prevent injury (think internal back brace). Preventing injury also offers the aesthetic advantage of avoiding hunched-over posture from pain, facial wrinkles induced by wincing, and back brace clothing debacles. More importantly, injury prevention keeps you working for your livelihood, medical bills, and psychological distress.

The transverse abdominus wraps all the way around the core, attaching to the lumbar fascia, in parallel fibers. It compresses the abdomen and provides thoracic, lumbar, and pelvic stability when properly contracted. This internal back brace can be activated during all firefighter-related movement, lifts, and tasks. Without proper stability and TA contraction, the nervous system cannot coordinate the muscles of your extremities efficiently. You are literally only as strong as your core–specifically, your transverse abdominus and the other lumbar stabilizers it co-contracts with. Imagine that–your squat max and bicep curl can actually be improved with the proper transverse abdominus activation. The trouble is most people are unaware of this deep stabilizing muscle or chronic pain issues have caused the brain to shut this muscle off in an effort to stop you from continuing to injury yourself.

So how do you improve your “core” the right way? A simple way to see if you can properly activate this muscle is to find your hipbones, dig your fingers in just inside those bones, and contract. Think about bracing for a punch in the gut while drawing in your belly button in and up. Do not forget to breathe! You need this muscle working during everyday movement and job-related tasks, which requires breathing! Most injuries occur when this muscle is not properly firing during the aggravating motion. If the muscle is not engaged before you lift the patient or equipment, you are at risk for injury. Practice engaging this muscle throughout your daily movements and with your work required tasks: forward bending, getting up out of a chair, lifting, pushing, pulling, reaching, climbing, carrying, getting in/out of the car, getting in/out of bed, etc.

As trivial as any movement seems, activate before it! This muscle’s job is to work all day long to stabilize, so the more the merrier. It is different from a movement muscle and does not fatigue in the way 100 bicep curls or 100 sit-ups would stop you from continuing. The more you practice, the more the brain learns a new motor pattern and is more apt to contract when you aren’t thinking about it during a situation that may have caused injury. Below are exercises for further strengthening this muscle.

Preventive Exercises

Here are a few exercise ideas to incorporate in your fitness regimen that can help reduce injury.
1. Transverse Abdominus Activation
• Start by sitting or lying down, find your hipbones, dig your fingers in just inside those bones, and contract. Think about bracing for a punch in the gut while drawing in your belly button in and up. Do not forget to breathe! You need this muscle working during everyday movement and job-related tasks, which requires breathing!
• Perform before any lift, with all strength exercises, and throughout the day during functional movements. You can practice this anywhere! • Practice 10-second holds throughout your work day with various movements.

2. Planks
• Begin on your stomach and lift up onto elbows and toes, maintaining a neutral low back and body in a straight line.
• Keep your head in a neutral position. Activate your core muscles and hold position for 30 seconds to 2 minutes. Stop when you lose form. Be sure to maintain core activation.
• If unable to maintain proper form for 30 seconds, begin on your elbows and knees. 

3. Bicycles
• Lie on your back; activate transverse abdominus, keeping your back flat against the ground. Lift both feet up into a 90-degree hip and 90-degree knee angle. Maintaining core activation and a flat back, perform bicycle motion for 3 sets of 20 repetitions. Stop before the recommended amount if you lose flat back posture.

4. Banded Side Steps
• Place a resistance band above your knees. Slightly bend the knees and begin side stepping while maintaining core activation. Keep your toes pointed straight ahead. You should feel this in your hips/glutes! Perform 3 set of 20 steps heading both left and right.

5. Supermans
• Lie on your stomach and extend your arms out in front of you. Lift your arms and legs while maintaining core activation and squeezing your glutes. You should feel your back extensor muscles and glutes working. Perform 3 sets of 20 repetitions.
• Variation: Lift one arm and the opposite leg at the same time, alternating sides.
• If this causes shoulder pain, perform with legs only.

As with any exercise, consult a physician if you have any concerns and stop any exercise that causes pain.

Common Postural and Lifting Mistakes

Standing Up Straight: The most common mistake people make when correcting posture is they overcorrect. Upright posture must remain relaxed and natural. Walking around like a robot is not conducive to posture improvement. Think about elongating your spine, standing tall, and someone pulling you up from a string on the top of your head. This aligns your head over your spine to avoid forward head and rounded shoulder posture. The amount of forces through the cervical spine are doubled if your head is one inch forward.

Lift with Your Knees: Most people have been taught to “lift with your knees” to avoid injury. The problem with this cue is you can still have poor lumbar, thoracic, shoulder, and neck position with bent knees. You must maintain a neutral neck position, chest up, shoulders back, and avoid a rounded back posture. Your spine should stay straight as you bend from the hips and stick your bottom back to achieve a “squat position.” Prior to lifting the weighted object or patient, you must activate the transverse abdominus. This is all assuming the object is easily accessed. Patients are often in awkward positions, other objects become obstacles, and in a life or death situation speed is always critical. The best suggestion is to maintain neutral lumbar position as best as possible and activate transverse abdominus prior to lifting.

Holding Your Breath: Some people instinctively hold their breath when they are asked to activate their abdominals. This is the body’s way of cheating. It is more beneficial and functional to learn how to activate the transverse abdominus with normal breathing during lifting. If you depend on holding your breath to maintain stability, the second you start breathing while transporting the patient you lose your internal back brace.

Using Brute Strength: Training strict motions is great for increasing strength. However, using momentum and hip drive is an effective way to lighten loads while maintaining proper mechanics during real-life firefighting tasks–for example, to lift a heavy piece of equipment.

 

Dr. Jeanna LeClaire Hill, PT, DPT, ATC, CSCS, USAW-L1SP, graduated magna cum laude from Towson University with a bachelor of science degree in athletic training and then earned her doctorate in physical therapy from the University of Maryland School of Medicine. She is also a certified strength and conditioning specialist and a USA Weightlifting Level 1 sport performance coach. She specializes in perioperative spine care, degenerative spine conditions, postural syndromes, and high-performance training. She owns and operates Hill Physical Therapy, LLC. She has experience owning, operating, and coaching in a CrossFit affiliate where she helped individuals of all ages and fitness levels safely maximize their fitness potential.