When firefighters arrive on a scene, they’re typically wearing between 50 and 75 pounds of gear.
While working in bulky pants and jackets, helmets, air tanks, masks, and heavy rubber or leather boots, they could also be dragging hoses, carrying heavy tools, or pulling people out of burning buildings. And it’s safe to say that many of these tasks are performed with incorrect posture.
The potential for injury is high, to say the least.
In 2014, there were more than 27,000 firefighter injuries reported at the scenes of fires, and nearly 14,600 injuries reported at non-fire scenes. Strains, sprains, and muscular pain accounted for 53 percent of the fire- related injuries and 60 percent of the non-fire-related injuries.1
Firefighters, police officers, and rescue personnel all face challenging work environments with a high potential for injury—and often not a result of the extreme scenarios we tend to associate with them.
There’s no question that a good number of these injuries could be prevented with chiropractic care, including functional orthotics.
Thank them for their service
People often struggle with how to thank first responders for the services they provide and the risks they take to ensure our safety. One way to show appreciation could be to help them do their jobs safely.
A number of chiropractors do regularly provide services to first responders, often at a reduced rate. Steven Shirley, DC, with a practice in Spokane Valley, Washington, decided to set up a massage table in the woods when he heard how fatigued firefighters were from battling a wildfire in 2015. After contacting the public information officer for the fire, he was set up in the firefighter camp the next night. Many firefighters, he said, had upper-back, neck, and shoulder issues from working 16-hour days for two weeks straight and sleeping in tents.
Most situations aren’t that extreme. Injuries can also occur from repetitive use over long periods or from a single incident. DCs can provide support to their local communities by reaching out to police, fire, and rescue organizations to offer their skills and expertise.
Brett Richey, owner of Richey & Co. Shoes in McLean, Virginia, created the Charlottesville/Albemarle Fire-Police Orthotic Clinic, where first responders can receive custom orthotics for a small fee. The providers who participate in the clinic subsidize the cost.
First responders might not be aware that chiropractic care could be subsidized by their insurance plans.
Encourage them to explore what options their plans include for adjustments and orthotics. Even plans that do include chiropractic care might come up short, however, because first responders often require different footwear for different scenarios. Firefighters, for example, wear a certain type of boot in the station and change into different ones for either structure fires or wildfires. If you provide them with orthotics for each set of footwear, you can increase their personal safety and effectiveness as well as increase awareness about the utility of orthotics in different situations.
Feet are the foundation
The spine and lower extremities represent a closed kinetic chain, with the feet as the foundation. As such, the feet have great potential to influence the performance of the entire kinetic chain.
All first responders must be ready to perform their jobs in environments where the demands on musculoskeletal health are high, meaning that their feet need to be supported so the rest of their kinetic chain can function safely and effectively.
Like athletes, first responders must be able to perform physically demanding tasks, but while wearing cumbersome clothing and using heavy tools, too.
One study found athletes who wore custom-made flexible orthotics experienced improved proprioception and reduced fatigue.2 In another study, custom-made functional orthotics were found to help golfers increase relative club-head velocity.3
That might not seem like a big deal, until you realize that a more efficient swing could translate into saved lives and property when firefighters use axes and other tools to stop the spread of a fire and rescue victims.
Another study found the type of boot had a significant effect on gait changes: “The increases in the time when both feet were in contact with the floor suggest greater energy cost and a longer time was needed for the body to reestablish stability from one step to another.”
In addition, the sagittal range of motion at ankles was significantly reduced, and hip internal and knee external angles were increased when subjects wore heavy boots. As the weight of boots increased, ankle ranges of motion decreased.4
The study demonstrated that boot types affect gait characteristics and lower extremity kinematics. Ideally, redesigned boots for first responders could reduce biomechanical stresses of the lower extremity and improve gait performance. However, the process for redesigning and approving first-responder gear can be long and involved.
For example, firefighting gear design is regulated by the National Fire Protection Association, which revises its standards every three to five years. The current standard for firefighter boots states, “Footwear shall consist of at least the following assembled components: a sole with a heel, an upper with lining, a puncture resistant device, an insole, a ladder shank or whole sole equivalent, and an impact- or compression-resistant toe cap.” The only stated requirement for the insole is that “the insole surface in contact with the foot shall not exceed 44 degrees C (111 degrees F).”5
While the boots that first responders need to wear must meet specific guidelines, the orthotics within those boots offer more freedom and could mitigate negative effects on performance.
Chiropractors can help meet this important need by advocating for proper chiropractic care, including custom- made functional orthotics appropriate for the patient’s situation. For first responders, I always recommend an extra durable orthotic designed to hold up to moisture and extreme conditions, while supporting the medial longitudinal, lateral longitudinal, and anterior transverse (metatarsal) arches.
Orthotics support feet and provide a stable foundation for the kinetic chain under extreme conditions. But just as with firefighting gear, the right orthotic needs to be chosen for the job.
Kevin Wong , DC, is an expert on foot analysis, walking and standing postures, and orthotics. He discusses spinal and extremity adjusting at speaking engagements. He can be contacted through orindachiropractic.com.
References
1 Haynes HJ, Molis JL. U.S. firefighter injuries—2015. National Fire Protection Association. Oct. 2016.2 Stude DE, Brink DK. Effects of nine holes of simulated golf and orthotic intervention on balance and proprioception in experienced golfers. JMPT. 1997;20(9):590-601.
3 Stude DE, Gullickson J. The effects of orthotic intervention and 9 holes of simulated golf on gait in experienced golfers. JMPT. 2001;24(4):279-287.
4 Chiou S, Turner N, Zwiener J, et al. Effect of boot weight and material on gait characteristics of men and women fire fighters. NOIRS 2008-Abstracts of the National Occupational Injury Research Symposium: October 21-23, 2008. National Institute for Occupational Safety and Health. 2008:34.
5 National Fire Protection Association. “NFPA 1971: Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting.” http://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of- codes-and-standards?mode=code&code=1971. Updated March 2017.Accessed March 2017.
