Shouldering the Load

It's the end of a long three days of 12-hour shifts, your shoulders are tired and sore, and you are probably wondering why the call volume just keeps going up. As you have progressed in your career, you may have noticed that at the end of the day, your head protrudes a little farther forward than it did earlier, and your shoulders round a bit more. Occasionally your jaw pops, your upper back and neck are really beginning to get stiff, and those headaches are becoming more frequent.

The relentless sitting, driving, leaning forward, documenting and couch-surfing are taking a toll on your postural integrity. The chronic postural patterns of school and now career have caused some nasty postural distortions to occur in your upper back and shoulders. Vests, radios and other protective gear contribute to the load as well.

Responders, I do not have to tell you how difficult our careers are, both mentally and physically. The majority of injuries we sustain on duty occur mostly from chronic muscular fatigue and postural distortion that cause altered mechanics. Data indicates that very few injuries occur from specific events. Most of us get hurt doing everyday tasks, which for us is running calls and dealing with/treating the public. This is the classic case of the straw that broke the responder's back! Over time, as our posture deteriorates, our body tries, unsuccessfully, to mitigate the negative effects of chronic postural distortion. It does this by reflexively tightening the muscles to create stability and maintain proper position. Unfortunately gravity is constant, so the strain is continuous, and over time those muscles become weak and begin to scar down. As an example, please reference Figure 1, which depicts an upper-crossed syndrome (UCS)-a very common postural distortion. The problem with an upper-crossed syndrome is what has to occur to get there. Like a myocardial infarction, the problem has slowly been growing for years, and the result is a lot of trouble. What you may know as neck pain, sore and tight shoulders, shoulder pain/injury and possibly numbness/tingling in the arms is a long-term effect of UCS. UCS will also contribute to bone spurs in the neck and shoulders.

The average weight of a human head is roughly 12 lbs., and for every inch the head leans forward, the weight effectively doubles because of gravity. The cervical spine and supporting tendons, ligaments and muscles must now support and hold up more than they were intended to. To combat this excessive strain, the muscles in the back of the neck and shoulders tighten to essentially stop your head from falling off-but since gravity is constant, the fight is already lost. To compound this issue, the shoulders have rounded forward because we, as a population, spend way too much time sedentary and seated. Rounded shoulders do not allow the shoulder joint to move normally, which will lead to rotator cuff injury from chronic shearing of the tendon. Couple this with improper exercise to exacerbate this distortion, and the head gets pulled farther away from the body.

So now that your head is going to fall off, what is a responder to do? Let's explore the cause-and-effect relationship to find a simple fix you can do while on duty. The muscles in the front of your neck (the scalenus group) have become overactive and shortened, effectively pulling the neck forward and down. The chest muscles (specifically the pectoralis minor) have shortened and tightened, pulling the shoulders forward. To correct the UCS, we must stretch the overactive and shortened muscles, and then strengthen the reflexively tight and painful ones. This ensures that we are not just addressing the symptoms, but the cause as well. After a few weeks of stretching, we can begin to strengthen the muscles in the shoulders and work on stability exercises for the neck.

Try the stretches illustrated here (Figures 2-4). All these stretches need to be done two times per side and held for a full 60 seconds. Do them 2-3 times a day.

Bryan Fass is the author of "Fit Responder," a comprehensive wellness plan for the first responder (www.fitresponder.com) and the Fit Responder Blog (www.fitresponder.wordpress.com). Bryan has a Bachelor's Degree in Sports Medicine and is certified as a licensed athletic trainer and a strength and conditioning specialist. He was a paramedic for over eight years, and has authored four books regarding fitness, wellness and human performance. Bryan is available for consulting and speaking on Public Safety Fitness Testing along with Fitness, Wellness and Injury Prevention Programs. Contact him at bryan@firepoliceemsfitness.net