Back Pain and How to Prevent It

I want to address a fitness concern for fire/paramedic personnel, back pain and injuries associated with work-related activities. Back injuries account for more than 20 percent of all workplace injuries in the United States and are a particular problem in EMS, where at any given time nearly 10 percent of the workforce is out of work from injury. As a result, nearly 25 percent of all EMS workers experience career-ending back injuries within the first four years of their career.


Proper body mechanics is one of the most important things to prevent injury. This requires ongoing training that addresses procedures and plans for high-risk lifting and maneuvers. However, I will not address this since it is a part of ongoing education/evaluation for all fire/paramedic personnel.

Instead, I want to address two factors that if not addressed will increase the chance of injury, especially in those situations where body mechanics are compromised.

Abdominal Obesity

Added weight can and does cause back pain in patients. The excess weight, especially in your belly, strains your back muscles and ligaments, contributing to back pain. One of the first solutions to back pain that doctors advise is to lose weight. Unfortunately this profile has become the normal in our society. If your current abdominal measurement taken at the belly button is 40 inches or larger for a man and 35 inches or larger for a woman, it is time to start exercising and to make dietary changes. Focus on daily exercise and replacing high fat, high calorie meals with lean protein and more fruits and vegetables.

Muscular Strength
and Endurance

Using the U.S. Code of Federal Regulations categories for lifting, Very Heavy Work is lifting objects over 100 pounds and regular lifting of objects over 50 pounds. Not only do fire/paramedics need to be able to lift this weight they need to repeat it multiple times during a shift. Therefore a fitness program should encourage both safe lifting practices and focusing on both muscular strength and muscular endurance. It is important that this is done under supervision of a trainer initially so proper body mechanics are performed while lifting. When they understand this and feel the difference, the awareness of good body mechanics will carry over when lifting at work.

An example of a workout program would include core, upper body and lower body.

Beginners need to focus on developing strength to maintain good body mechanics while performing the exercise.

  • Core exercises such as Sit-ups and Planks
  • Upper Body Exercises such as Push-ups, Bicep Curls, Shoulder Presses
  • Dumbbell Rows
  • Lower Body Exercises such as Air Squats and Walking Lunges

Once these can be performed with proficiency focus should be on more dynamic movements that are multi-joint and more functional to job requirements. Some examples are:

  • Dead-lifts
  • Farmer Carries on level and climbing stairs
  • Weighted Squats
  • Abdominal twists with weight or ball both on floor and standing
  • Sled Push and Sled Pulls
Karen Leatherman is president/owner of Fitness Forum Occupational Testing Services. She started the first hospital-based fitness center in South Carolina where she started cardiac and pulmonary rehab programs. She has over 30 years performing exercise stress testing and has been testing firefighters for over 20 years. In addition, she was on the American College of Sports Medicine (ACSM), Health and Fitness Certification Committee where she travelled with a team from the U.S. to India and Hong Kong to teach and administer ACSM exams.Email Leatherman at and share your workout routines.

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