Pilates for

!FIREFIGHTERS

!Keeping Emergency Workers safe and prepared for action

!Jacquelyn De Longe

September 2017

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Pilates for Firefighters !

!“We, the members of the Santa Barbara City Fire Department, are committed to ensuring the safety and

protection of our community through the preservation of life, property and the environment.” - Pat McElroy, Fire Chief !!!Call of Duty

!! When the call for help comes into the station, firefighters must be ready in a moments notice. As first responders to an emergency, they are the expected to be prepared to give assistance however it may be needed. From attending to an unconscious patient, who has fallen down a flight of stairs in their home, cutting open cars with the jaws of life to rescue a stranded driver on the freeway, or battling a brush fire on uneven terrain as it threatens to consume a neighborhood, core strength, balance and flexibility are key to a firefighter’s injury prevention, because for them, when the alarm rings, it’s go time.

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Firefighters are only on the streets helping the public for a small amount of time, in fact, much of their shift is spend training for potential emergency situations with rigorous drills and challenging simulations. There are intense physical demands, such as, maneuvering narrow and unsafe passages at precarious heights, or managing heavy cumbersome equipment, all while wearing an addition fifty pounds of bulky fire retardant equipment. By conditioning the body with the positive movement patterns of Pilates, firefighters can decreased their risk of falling, and minimize back/shoulder injuries, the leading causes of injury on the job, not to mention, practicing Pilates increases mental focus and control that is needed to manage unpredictable situations. Pilates training, and the mind body connectionist requires, is a wonderful tool to help process the stress and adrenalin that the body naturally produces in an emergency. “Research shows the basis for most muscle imbalances is our predictable response to stressful environmental demands”, Rael Isacowitz (Pg 67 Comprehensive Course Study Guide).

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Table of Contents !!!!Title Page p. 1 !Call of Duty p. 2 !Table of Contents p. 4 !Case Study p. 5 !Anatomical Guide p. 6 !Prescribed Training Program p. 8 !Conclusion p. 9 !Bibliography p. 10 !

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Case Study: Jesse Grimes

!! A firefighter for over twenty years at the Santa Maria and Santa Barbara Department, Jesse Grimes has suffered numerous injuries on the job. Most recently a dislocated shoulder and rotator cuff tear both of which required surgery to repair. He is an avid surfer on his off-days, charging waves three times a week, year round, which requires heavy back extention, core engagement, balance, and proper shoulders mobility. Also, as an active forty year old father of three under ten years old, he is on the move constantly, keeping up with his busy children.

Grimes is in good cardio vascular shape overall with a strong back but has deviant movement patterns through the shoulders, either from unsuccessful rehabilitation/physical therapy from his earlier dislocation or long term muscle memory patterns from surfing, which leaves him susceptible to repeat injury both at work and at play. He has intermittent pain in his previously injured shoulder and lower back, both of which seem to be from tightness in his muscles.

He strength trains on his own once or twice a week with free weights and classic gym equipment while on his shift at the firehouse (each station is equipped with standard exercise equipment) but does not stretch. While practicing drills at the firehouse, he is expected to lift and maneuver over 100 pounds, wearing bulky equipment (which weights up to 75 pounds itself).

A greater range of mobility in his upper body, less pain in his shoulder and lower back are the goals for Grimes. With a well-planned routine focussing on his individual needs, I believe Pilates will be able to deliver the results he is looking for.

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Anatomical Guide of the Trunk

!Front

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!Back

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!Prescribed Training Program

! Balance and strength are increased with strong stomach and back muscles, which is precisely what rescue workers need to maintain their safety and preform their duties. A firefighter’s training program should focus on trunk stability using the spine extensors and deep abdominals, increasing the range of lateral flexion and rotation with addition training through the shoulders and upper girdle to support the various movements required by the job. For Grimes focus will be on stretching and lengthening, and rehabilitative scapular stabilization. Isometric core work, back extension with lateral flexion and rotation will be integral. Like most of us, Grimes neglects to stretch and lengthen his muscles. Tightness in his pectorals causes his shoulders to slightly wrap forward and deepening the pitch forward of his head when sitting or standing. To prevent greater Kyphoisis later in life, back extension exercises will focus on the cervical and thoracic spine elongation, as well as, strengthening the upper back and stabilizing the scapula to support a neutral upper girdle. After his rotator cuff repair surgery, where doctors reattached his severed supraspinaus and shortened the tendon, he was left with a smaller range of motion when moving his left arm in circular motions (particulary when passing from 9 o’clock to 11 o’clock). Repeating scapular stabilization repertoire on the equipment as well as exercises that incorporate shoulder stretches, we should be able to bring more secure mobility back to his upper body. With such a dominant upper body, strengthening his hips and legs will create improved stability and agility for a better balanced body.

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The Warm-Up:

The fundamental mat warm up was selected for Grimes to activate his core and bring his awareness to the muscles of his trunk. The spinal articulation initially stretches his lumbar spine which holds a lot of his tightness, while the supine abdominal work support his lower back.

!The Repetoire:

(Mat - fundamental)Pelvic Curl 5 rep spinal articulation; engaging abdominals and

hamstrings

Spine twist supine 5 sets spinal rotation; abdominals with oblique focus,

Chest Lift 5 reps deeper engagement of abdominals maintaining pelvic stability; create depth with breath pattern

Chest Lift w/ rotation 5 sets building on the chest lift, deepen oblique work rotating through waist and maintaining trunk flexion while avoiding lateral flexion

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FOOTWORK (Cadillac)

Parallel Heels 10 rep 1B 1R stretch and strengthen hamstrings, strengthen quadriceps: reach heels to ceiling on extension, bend knees as much as possible while keeping sacrum down

Parallel Toes 10 sets 1B 1R strengthen hamstrings, maintain foot and ankle alignment in plantar flexion, pelvic stability

V Position Toes 10 reps 1B 1R continued engagement of hamstrings maintaining lumbar stability; engage hip adductors on extension and create deeper knee flexion on return

Calf Raises 10 reps 1B 1R stretch legs in dorsi flexion. strengthen in plantar flexion, keeping legs straight

Prances 10 reps 1B 1R distribute weight through feet while actively moving from dorsi to plantar flexion; maintain pelvic lumbar stability (avoid lateral flexion)

Because of the orientation or the PT Bar and the distribution of the spring tension (1R 1B), Grimes is able to get a deeper stretch throughout his legs while lying supine and supporting his lumbar spine. Also, unlike the shoulder blocks on the reformer, there is no additional pressure baring down on his injured shoulder while he works.

These classic Pilates abdominal repertoire connects deep to the core without creating strain to the lower back. There is little pressure on the recovering shoulder and the range of movement of the arms support the rehabilitation of the shoulder injury. We did modify his legs to be slightly bent to alleviate low back discomfort.

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ABDOMINAL WORK (Reformer)

Hundred Prep 3 rep 1R 1B strengthen abdominals while controlling shoulder movements, maintain straight arms and tabletop legs throughout

Hundred 100 count

1R 1B strengthen abdominals, maintain deep core contraction; pace pump or arms with controlled breath (5 in / 5 out x 10)

HIP WORK (Reformer)

Frog 5 rep 1R 1B stretch and strengthen legs; in external rotation reach heels forward and up on extension, bend knees as much as possible keeping sacrum down

Circles Down 5 rep 1R 1B hamstrings focus, in external rotation maintain foot and ankle alignment in plantar flexion, pelvic stability

Circles Up 5 rep 1R 1B hip adductors focus, in external rotation maintain foot and ankle alignment in plantar flexion, pelvic stability

Openings 5 rep 1R 1B maintain external rotation of legs as adductors and abductors open and close legs, pelvic stability

Lying supine on the carriage, Grimes can practice anchoring the movements of his legs to his core during this hip work series. He also strengthens the spine and legs in eccentric engagement.

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!(Surprisingly, weight on the back of Grimes’ shoulder did not cause discomfort.) Long and Short Spine was selected for Spinal Articulation as it creates an incredible about of space along the spine, as well as, increasing balance and control.

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!Side Splits create an opportunity to improve balance on a moving unstable surface and bring awareness to the deeper internal core muscles and his adductors for increased agility.

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Stretches (Reformer)

Side Split 5 rep 1R stretch and strengthen hip adductors: reach head to ceiling and maintain neutral pelvis, gather inner thighs on return, pause before changing directions in and out

SPINAL ARTICULATION (Reformer)

Short Spine 5 rep 1R 1B abdominals lift pelvis, carriage finds stoppers as legs bend, feet over eyes as spine articulates down

Long Spine 5 rep 1R 1B abdominals and spine extensors work together, lengthen hamstrings on decent, still carriage during roll up/down

!The Stomach Massage series will increase Grimes heart rate and challenge his core connection. Training his body to move dynamically while being able to anchor to a stable foundation will assist him when he is out in the field.

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FULL BODY INTEGRATION (F/I) (Reformer)

Stomach Massage Round Back

5 rep 2R abdominals deepen as legs extend, dorsi/plantar flex feet; maintain c-curve of spine

Stomach Massage Flat Back

5 rep 2R abdominals deepen as legs extend, dorsi/plantar flex feet, spine extensors lengthen as legs bend; maintain straight spine

Stomach Massage Reaching

5 rep 2R abdominals deepen as legs extend, dorsi/plantar flex feet, spine extensors lengthen as legs bend; maintain straight spine, stable trunk

ARM WORK (Tower) *bar set slightly above shoulderChest Expansion 10 rep pressing back engage muscles on the side of the

ribcage and back of the upper arm minimizing scapulae movement; arms reach long

Hug-A-Tree 5 rep engage pecs as arms draw forward at shoulder height; keep trunk and scapulae stable, back broad

Circles Up 5 rep rotate arms forward to lift overhead, arms stay shoulder height at they pull across chest

Circles Down 5 rep rotate arms to open wide, minting scapulae stability as arms lift overhead

Punches 5 rep arms shoulder height, elbows high and wide

Biceps 10 rep arms extend and flex behind body, trunk stable

Butterfly 5 rep rotate upper body, stable through pelvis and legs; maintain spring tension

The Tower creates the resistance useful to strengthen and stretch the upper girdle while also challenging the body with instability. Because of the independent springs, the true ability of each side can be more easily noticed and imbalances addressed quickly to retrain positive movement patterns. Working with his injured shoulder, we adjusted the movement for each side. Additionally, work on the Tower requires lower body stabilization and constant engagement from legs and gluteals. !

By utilizing the Push Through Bar during the Full Body Integration, Grimes must learn to stabilize his scapula with his lats and serratus anterior as he twists on Side Reach, as well as, while passing from articulation to extension on Kneeling Cat Stretch. As he progresses, the more advanced repertoire, Saw, will be introduced as it requires rotation on a longitudinal axis, a frequent movement required in his profession.

Having strong legs, I increased the spring tension by a half spring and reduced his speed on extension and return. Skating strengthens the larger muscles of Grimes’ legs, while challenging his balance as he works on the narrow reformer platform and the moving carriage.

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LEG WORK (Reformer)

Skating 5 rep 1R 1B strengthen quadriceps, hamstrings of stationary leg, and gluteals of moving leg; maintain neutral pelvis; improve balance

FULL BODY INTEGRATION (F/I) (Cadillac)

Side Reach 5 rep 1B stretch and strengthen abdominals, increase lumbar mobility; reach through feet to increase stretch of legs

Kneeling Cat Stretch 5 rep 1R strengthen deep abdominal, improve spine flexibility and balance; keep pelvis over knees

!Grimes can learn how to move and connect to his lateral flexors, both the intercostal muscle and the obliques separately, slowing down the actions increase the challenge and improve flexibility/ROM.

!!!Utilizing his own body weight, there is little risk of injury as Grimes strengthens and lengthens his back. Also, having his arms free from apparatus reduces any stress on his shoulders until the become more flexible.

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LATERAL FLEXION/ROTATION (Ladder Barrel)

Side Over Prep 3 rep stretch and strengthen lateral flexors; inhale arc over, exhale contract to diagonal line, maintain narrow position, feet on bottom rung

Side Overs 5 rep stabilize trunk, stretch and strengthen lateral flexors; inhale arc over, exhale contract to diagonal line, push through heel of externally rotated top leg

BACK EXTENSION (Ladder Barrel)

Swan Prep 5 rep strengthen spine extensors

Swan 5 rep strengthen spine extensors, increase lumbar flexion; engage hip extensors and maintain deep abdominals to protect low back in flexion

Conclusion ! After the first few sessions there was a noticeable difference in Grimes’ posture. His head was resting back closer to alignment over his spine. His shoulders softened down away from his ears and his neck appeared longer. He stood taller and leaner and noticed more mobility in his rehabilitating shoulder. Lower back pain minimized as he learned to connect to deeper abdominals and he found his modified leg positions on supine reformer exercises like the hundred and hip work. By opening up and stretching his quadratus lumborum, lower trapezius, and obliques, we brought more movement and length into his body.

Overall, Grimes’ posture is improved, his pain decreased and his mobility increased. He has more awareness of how he lives and moves in his own body. With continued practice, Grimes will develop more positive movement patterns through his shoulders. He will be able to tap into his deeper core for heavy lifting at a moment’s notice and he will have more balance on uneven terrain, making his hours as a firefighter safer with less risk of work-related injury.

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Bibliography !Websites !Call of Duty quote (pg 2) https://www.santabarbaraca.gov/gov/depts/fire/default.asp !http://www.fireengineering.com/training/drills.html !Anatomical Guide Front (pg 6) https://s-media-cache-ak0.pinimg.com/564x/3b/12/0f/3b120f4f3c99814e7cd1aae9edeab463.jpg !Anatomical Guide Back (pg 7) http://medicine.academic.ru/pictures/medicine/989.jpg !Kyphosis (pg 8) https://www.verywell.com/forward-head-posture-297078 !!Books BASI Study Guide, Comprehensive Course BASI, Cadillac, Movement Analysis Workbooks BASI, Mat, Movement Analysis Workbooks BASI, Reformer, Movement Analysis Workbooks BASI, Wundachair - Ladder Barrel, Movement Analysis Workbooks !Anatomy of Movement, Blandine Calais-Germain, 2007 !Anatomy & 100 Essential Stretching Exercises, Barron’s Educational Series, 2015

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