During this class there are two main Q’s we are going to answer.
Is pain normal? NO, pain is a symptom and it’s a symptom that must not be ignored-it must be treated.
The second half of the class is all patient and equipment handling.
The focus of this class is simple. We cannot teach you to lift-push-pull-carry or move if you do not have the basic mobility and physical ability to get into a safe lift position.
When we started this program we stepped back and took a look at the biomechanics of the job. We realized that as emt’s you are medical power lifters and movers.
Did you know EMS is the only profession where its acceptable to lift incredible heavy loads from the floor. Every shift you load your body with torque and compressive loads that will cause injury.
The only way we can combat that it to move well and move patients well and that starts with you moving well first!
We also realized that until now you have never had a tool box to pull from to keep your body primed, pain-free and moving well……because movement matters.
With a profession like EMS/Fire that has some of the highest injury rates of any job we must “invest” in ourselves through self-care.
This class will teach you a tool box approach to moving well and feeling well.
2 tools for stretching
2 tools for mobility and pain management
Talk about how as a profession we do a poor job of sharing the data on injuries in the field.
The study that bothers us the most is #1……
Ask the Question:………..Who thinks that # is LOW??????
It is…we are seeing a 70% injury rate in EMS.
The only profession with a 100% acceptable injury rate is the NFL and they get paid a LOT more then us.
The only profession we can be compared to on a biomechanical level are labor and municipal employees. We get hurt 83% MORE then people who labor for a living!
This study broke down the biomechanics of the jobs. Kneeling, bending, leaning, reaching, lifting etc.
People who labor for a living get hurt 83% less then we do!
The primary cause of disability is injury to the back-knees-hips-shoulders……..preventable injury
Look at the IAFF fire-ems data and HALF of all injuries are soft tissue….and these are preventable.
Because we do not “invest” in proper training BEFORE new responders hit the street over ¼ of all EMT’s entering the profession will get hurt in the first 4 years…..we must do a better job investing in ourselves and our training.
Use a story about cumulative traumas here…..someone that got hurt doing a seemingly normal task.
Use a story about someone who was pain-free after using the tool box.
SLIDE #11: no notes
Green = Areas of the body that MUST be mobile.
Blue = Areas of the body that must be stable with little movement
The problem is that we have the exact opposite relationship in the body.
The data Is clear…..we can break the body down into 4 predictable parts. If they are predictable then they are preventable.
Calf and ankle: not if but when you lose mobility you will have knee, Hip and LBP…the pain goes UP the kinetic chain.
Glutes: tight glutes, especially imbalanced glutes will cause low back pain…..Demonstrate the hip stretch on the table.
A 20% tightness = a 60% greater chance of injury on the tight side.
Hip flexor: causes knee and LBP
Mid-back aka. Thoracic spine causes most of our upper body injury.
We have spent our entire life in this position…most posture is repetitive and that will cause injury.
“School example and how a career in public safety sets up this bad posture.
Cause is anterior (chest and neck) and the symptoms are posterior…your tool box will loosen up the front and calm down the back.
Computers, phones, charting, driving….how you are sitting RIGHT NOW is causing your next injury.
This is usually our guts and butts posture or the grand pa butt…where it looks like they stole your butt….either way it’s an imbalance in the pelvis.
Hip flexor gets tight = inhibits the abs = no support for the back (strong abs/strong back)
As the hip flexors pull the pelvis forward the hamstrings wake up to pull the pelvis back.
The glutes…where all your power comes from weaken
End result = you lift with your back and not your legs
*****Use the example of a bed to bed transfer….the ab’s do not fire to co-support the back = you use your back as a prime mover instead of your hips.
The top picture is line backer stance = hip hinge-broomstick/neutral spine-head up.
There is load(weight) applied to the shoulders. In LB stance the load is managed and the tissue does not reach it’s failure point.
Bottom picture the knees are locked, back is rounded, head is down. The load is NOT managed by the tissue and the “gap”/,margin of safety is almost gone. This is how injury occurs.
**Ask the class what can increase their risk of injury that they can control…………(hydration, healthy foods, fitness, fatigue)
The tool box…backwards.
Show the slides and START with the glute stretch
Give disclaimer about not getting hurt, only do what you can or feel comfortable with.
***Tell them what each stretch will do for them!!!!!!!
Sternum points out (not into your body) and the head is always up. Do not look at the floor.
These stretches help to keep you loose & remind your body to have better biomechanics.
**big teach point…..a 20% tightness in one hip (when the opposite side lays flat on the table) = a 60% greater chance of injury!
This is a LBP and knee pain stretch
IF someone cannot get the knee flat STOP the stretch
This stretch can reduce back pain.
Step away…further than you think you have to
Squat slightly and sit back…try to get your heel and glute to touch
Feel the stretch in the front of the leg (quad/hip flexor)
The stretch height does not need to be very high….the step is ideal.
Both knees locked, feet straight and head up
Broom stick on the back and HINGE at the hip.
The all important calf stretch…..keep this muscle group loose and mobile.
The one heel hangs off the truck is the most effective stretch
This is what allows you to squat-walk-climb safely.
If you can’t squat well you will have back pain
Turn the feet, chest up, look up and away.
“thumb up, palm flat”
This is a head ache, neck pain, back pain stretch
Knees bent and slightly forward of the hips
Get long, low and lazy
ASK…….How do you feel?……MOST PARTICIPANTS WILL BE SURPRISED THAT THEY FEEL BETTER.
Everything we have done so far has led up to this point…the 4 functional / active stretches to get you ready for working injury free.
Demonstrate arm circles as a BAD active stretch.
ASK….?why are we the only high-risk profession that does not embrace beginning of the shift warm-up’s???
Go slow, let the body open itself up. Do not force it. These feel weird, look weird and will make you feel better and move better.
The key to all of these is focusing on your movements….don’t just go through the motions….make them work for you.
No bouncing, go slow but consistent.
SLIDE #30: no notes
Video =Full video…you can skip the next slides into the break before ergonomics or go through the videos individually.
SLIDE #32: Calf and ankle glide
SLIDE # 33: no notes
Emphasize blocking the elevated leg so that it does not move
Emphasize the reach UNDER & AWAY from the hip…..like someone is pulling your arm.
SLIDE #36: Intro to the Tennis ball
ASK…….How do you feel?
The next tool if for at home….remember pain is a sx…do not ignore it…treat it. Watch TV while you go after the trigger points.
Play the video on what a TP is and how to treat it
We believe that many programs fall short of their goals b/c they fail to address the underlying cause of pain and movement dysfunction… the trigger point.
**If you felt pain or tightness with the active stretches the best tool to deal with that symptom is the tennis ball.
**You can not stretch a trigger point, it has to be broken up.
This is a great TV technique…..stop ignoring your symptoms…treat them BEFORE they become your next injury.
TP’s can form anywhere
In this class we will be going after what we call the usual suspects….the TP’s that cause most of your problems.
More examples of the TP that we will target with the TB and the foam roller
Emphasize NOT using anything firmer then a tennis ball and the places to NOT put the ball.
Healthy / normal tissue does not hurt to press on…..unhealthy / damaged tissue is very painful
1.Lateral 1/3 of the hip. Walk the feet out and turn the feet toward the side that has the ball.
*this is a LBP and knee pain area
IT band is a cause of non-traumatic knee pain. 6 inches above the joint line and roughly 1 inch forward toward the quad.
T12-L1 junction. Below the floating rib in the soft spot between the rib and the Para spinals aka. The flank
*This is a pure LBP point
2. On the border of the scapula…trace the ‘C’ shape of the scapula all the way from the top of the shoulder to the bottom.
*This is a headache, neck pain and shoulder pain point
Final 2 points are anterior….they do not generate a pain signal so we forget them BUT,,,they cause the majority of the pain and injury we deal with.
Pect minor: Above the breast tissue in females, Tends to be very sharp and refers pain down the arm
*headaches, neck/shoulder issues all stem from this point.
2. Subscapularis: the point is at the angle of the scapula slightly back from the lat.
*headaches, elbow pain, neck pain all step from this point
Have them re-treat the tight hip for 45 seconds.
Who felt a difference in their movement?
How do you feel now?
Did we do a lot to get you moving and feeling better??
SOOOO we have a conundrum…..this is the best tool I can give you BUT if you have never used it before it hurts so much that many of you will not come back to it.
Now that you understand that a little pain makes you feel and move better then a lot of pain is even better.
The FR is where much of the science is now. It’s quick, very effective and serves as a warm-up and stretch at the same time.
**take away: if million $ athletes use it before they do anything what will it do for us?
The FR is your stretch, tennis ball and warm-up in one tool.
People like the FR better because it’s usually faster, you have to move the whole time and your feel instantly better.
**Get on the floor and demonstrate prior to having the students try the techniques.
To save time have them do these 4 areas. 1 minute per area.
Explain the specificity of rolling ALL the muscle, relieving pressure as needed, breathing and how we have not deviated form the 4 areas of the body that cause injury.
Part two of the class
We spent the first half getting you mobile so we can safely lift properly.
This class will challenge your convictions and “hold the mirror” to EMS as a profession that we have all been taught wrong.
Remember it’s all about reducing tissue load.
These are the two stances that you will learn in this class. The stances are designed to “trick” your body into firing properly.
1.Injury occurs from 3 primary factors:
the load is too heavy
2.These stances are designed to reduce the forces placed on your body by “Primally firing” the core and hips to dampen the load.
3.Give the bariatric vs. frail patient on the floor…..which one elicits the primal response to get ready / fight.
4.That’s why the unsuspecting load often injures us.
1.Demonstrate the stance and clearly explain that you are moving around the hip NOT the back.
2.Designed to trick your abs and glutes to fire thus “sparing/protecting your back”
3.This stance is used for frontal loads (LSB, Lat. Transfer, cot lift etc.)
A = Spine board/scoop/tarp to cot
B = Lift from a chair, floor and bed to bed
*It engages the hips to stop you from using your back
1.Can we all agree the system is broken?
2.EMS needs a “stop behavior” for ergonomics….give the defib. Tie in as a stop behavior
3.We need to SLOW DOWN
4.We need to become responsible for each others ergonomics and use a built-in safety stop.
Embellish the steps
1.NIOSH lifting equation for healthcare workers says……So what does a 300lb patient add to your spine??
2.We know injury can occur at roughly 800-1000 lbs. of compressive force in the untrained (not strong) responder.
3.Pre-sell the lateral transfer and tarp lift…foreshadow what’s to come in the class.
4.We NEED to do it BETTER! And we CAN
5.*****If 51lbs takes us up to the safe lifting limit do we need to rethink our definition of bariatric???
The folks at FEMA thought it important to let us know that we should stop lifting below the knees……thanks!
So it only makes sense to focus on the most dangerous lifts first.
Here is what we are dealing with that ultimately breaks us.
Injury occurs from overload aka. Tissue failure or more common cumulative traumas
Compressive load is the most damaging…..this is why we must learn to move from the hips and not the back
Shear forces occur when you bend from the back with no hip engagement
Moments are those instances when you get pulled or twisted (lift from the floor-pulled forward, scoop to cot twist)
Play the video. Explain why we hinge at the hip and not at the back. This is why we have the linebacker stance and the Warrior.
Tie this back into what is supposed to be mobile vs. stable.
Use the tool don’t be the tool
NO MORE lifting from the floor because we can, change the lift height
No more dangerous patient handling techniques like this one
1.Leaning at the back not the hips
2.Hands are in the wrong position
3.What exactly is the person on the other side doing?
Briefly explain the rules surrounding this transfer
Must secure the opposite side with a person, wall, cabinet/immovable object.
Both responders at the head and hip pulling together