Recently, I covered the Evel Knievel Days event in uptown Butte, Mont., for A-1 Ambulance. This event has become a popular celebration for folks in Montana and across the country. People come to see freestyle motorcycle jumping, distance jumping and other stunts, such as the "Wall of Death" and the "Ball of Steel."
My co-worker Arch had a little trouble getting into his "leathers" in preparation for riding the loop. "Stiff hips," he blamed. After the loop, we watched as several of the middle-aged bikers struggled a bit to raise their legs and dismount the motorcycles.
I considered talking to one biker about a hip-flexibility program and shared this idea with my partner, Dave. He chuckled and said, "Yeah, then duck."
We were both amused by the thought of randomly educating your average biker on the importance of developing and maintaining musculoskeletal flexibility. Although this important component of health may not be a part of every biker's fitness plan, flexibility training should definitely be a consideration for EMS professionals.
Flexibility can be defined as the range of motion of a joint or group of joints, and various factors determine joint range of motion. The first factor affecting range of motion is the architecture of the joint. The specific design of the bones that meet in the joint have an enormous impact on the direction and range of motion at that joint. For example, the hinge joint of the elbow allows for relatively modest movement when compared to the ball-and-socket joint of the shoulder because of their respective architecture.
Age and sex also play a role: Younger people tend to be more flexible than older people, and females tend to be more flexible than malesƒespecially in the hips. Also, active people tend to be more flexible than inactive people. Connective tissue, such as tendons, ligaments, fascial sheaths, joint capsules, and skin also determine joint range of motion.
Benefits of Stretching
Simply because of the nature of the job, EMS has an athletic component to it. As the strength and conditioning coordinator for Montana Tech's basketball teams, I've seen firsthand how flexibility affects athletes. Some research supports this conclusion.
In one study, researchers assessed the lower body flexibility in 146 male soccer players prior to the 1999Ï2000 season. All of the examined players were monitored throughout the season to determine the presence and severity of injury. Players who suffered a hamstring (N = 31) or quadriceps (N = 13) muscle injury during the season were found to have significantly lower flexibility in these muscles before their injury compared with the uninjured group. No significant differences in muscle flexibility were found, however, between players who sustained an adductor muscle injury (N = 13) or a calf muscle injury (N = 10) and the uninjured group.
Researchers concluded that these results indicate that soccer players with an increased tightness of the hamstring or quadriceps muscles have a higher risk for a subsequent musculoskeletal injury to those areas, but not necessarily to the groin or calf areas.
Most experts agree that there appears to be an ideal range of flexibility that will help prevent injury and that flexibility may be one factor in the development of an injury. So how does this research relate to your average EMS field provider?
Injuries are often the result of both intrinsic and extrinsic factors. Intrinsic causes may include the age, weight and overall physical fitness of the EMT. Extrinsic factors include rescue methods, surface and terrain during rescue operations, footwear and other protective wear and such environmental factors as weather.
You don't have to be a college-level athlete to reap the benefits of a flexibility training program. In my opinion, this component needs to be a regular part of EMS professionals' physical training sessions. Along with the possibility of reducing the occurrence of injury, properly performed stretching exercises may help relieve lower back pain, muscular cramps, muscular soreness and stress.
There are two general approaches to stretching: static and dynamic. Static stretching involves moving toward the body's range-of-motion limit in a slow and gentle manner, and holding the stretched position. Dynamic stretching involves actively moving the limb toward the limits of its range of motion. One type of dynamic stretching is called "ballistic."
As the name implies, ballistic stretching involves bouncing a limb toward the edge of its range of motion. The American College of Sports Medicine (ACSM) recommends participating in a balanced static stretching program to maintain and/or improve flexibility. Static and dynamic stretching may improve flexibility, but avoid ballistic stretching because it has a higher chance of excessive muscle soreness and injury.
When should you stretch? The body's temperature is usually higher at the end of a workout session compared with the beginning of the session, and it may be safer and more effective to stretch at this time. ACSM recommends that a flexibility program adhere to the following guidelines:
Type: A general stretching routine that exercises the major muscle and/or tendon groups
Frequency: A minimum of three days per week
Intensity: Moving the body segment to a position of a comfortable stretch
Duration: 15Ï30 seconds
Repetitions: Three to four per stretch
Here are a few important notes specifically for EMS professionals:
- Some stretching exercises may not be appropriate for some participants because of prior injuries or other conditions, or because the exercises have been identified as unsafe. Avoid contraindicated exercises shown on p. 36.
- Stretch to the point where you feel a comfortable stretch in the target muscle group, NOT pain. NO BOUNCING!
- Focus on deep breathing and avoid holding your breath. The recommended time, 10Ï30 seconds, should be spent concentrating on deep breathing and relaxing the muscle group being stretched.
If you want to make the most effective use of your stretching time, make sure to target the common tight spots: hamstrings, hips and lower back. Keep in mind, research indicates that maintaining a healthy range of motion in all the joints/major muscle groups is important for preventing musculoskeletal injuries. This is true for EMS professionals as well as stunt bikers. JEMS
Parts of the Muscle
Tendons: Connect muscle to bone.
Ligaments: Connect bone to bone.
Fascia: Aids in maintaining integrity to the individual components (muscle fibers) of the muscle.
Capsule: Surrounds the joint and secretes synovial fluid, which helps to lubricate the joint.
- 1. Alter M: Science of Flexibility, Second Edition. Human Kinetics Publishers: Champaign, Ill., 1996. p. 2.
- 2. Witvrouw E, Danneels L, Asselman P, et al: "Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players: a prospective study." The American Journal of Sports Medicine. 31(1):41Ï46, 2003.
- 3. Hackney R: "Nature, prevention, and management of injury in sport." British Medical Journal. 308(6940):1356Ï1359, 1994.
- 4. American College of Sports Medicine. ACSM_s Guidelines for Exercise Testing and Prescription, Sixth Edition. Lippincott Williams & Wilkins. Philadelphia. 158Ï160, 2000.
John Amtmann,EdD, NREMT-B, is a professor of Applied Health Science at Montana Tech of the University of Montana in Butte. He_s an EMT with A-1 Ambulance in Butte, an ACSM certified preventive and rehabilitative exercise specialist and an NSCA certified strength and conditioning specialist. Contact him at JAmtmann@mtech.edu.