Seeing him walk into the dojo hurt me to watch. His uniform was still crisp but his face showed the true story: pain. This LEO is a highly dedicated veteran officer that works both patrol and SWAT; when it’s time to go he can and will get it done. This LEO also has a black belt in Kempo and that brings us back to the story. I watched him attempt to warm up, stretch and do some drills hoping that he could work it out. How many of you have been in this exact situation?
True to his internal drive he pushed through class doing rolls, falls and advanced kicks plus some new techniques which of course all ended in take downs and controls. After class was over I knew that he would never ask for help so I offered it knowing that at oh-dark-early the next day he would be back in the car for another busy shift.
“I have this weird pain running down my leg stopping just behind my knee. My back feels stiff but not a lot of pain”.
After 23 years of sports medicine, physical therapy, manual therapy and coaching experience it’s not a big stretch to know that this dedicated LEO is on a slippery slope. He has “had this pain before but it always went away.” The more your body gives you symptoms, and pain is a symptom, the more it is being damaged. Every day that you sit in the car, every day that you wear your vest, each shift you don’t stretch before and after and each shift that you do not stay mobile your body is being set up to eventually fail.
Lower Crossed Syndrome: We have known since the 40’s with the research of Vladimier Janda (see end note*) that a syndrome of muscle imbalances in the hips and pelvis, lower cross syndrome, causes the muscles that should protect our back and knees to function improperly. If you have ever been in one of my classes you already know this; if not you need to know this.
Over time, because we sit too much and because we have done or do improper exercises like crunches and leg raises, our hip flexors become tight. As they become tight they pull the pelvis forward and as the pelvis is pulled forward some interesting things happen:
1. The abdominal wall lengthens; this is bad. We have all been taught that strong abs equals a strong back BUT long muscles - the abs in this case - do not fire well or at all. As an example, when you go hands on with a perp, instead of your abs firing to support the back they are silent. This means that you have to ‘buy’ the stability the abs should have provided from another muscle group - your back.
2. As the pelvis is pulled forward and your center of gravity shifts away from neutral your body naturally wants to ‘fix’ the problem. Your hamstrings (a hip extensor) wake up and begin to get tighter essentially trying to pull the pelvis back into place. There is a reason why most people with back pain have tight hamstrings yet the hamstring tightness in almost all cases is a symptom, not the cause of the problem.
3. As the hip flexor pulls forward and the hamstrings pull back, essentially a tug of war that your job reinforces, the trifecta occurs. The most powerful muscle group in your body, the muscle group that is supposed to protect your back, the muscle group where all your lifting power comes from is so confused that it does not do its job. The term in the literature is “gluteal amnesia.” That’s right: your butt forgot what to do and in most cases of low back pain and injury it’s the imbalance in the glutes that causes you to use your back to move and not your legs.
If you came to me in the Physical Therapy clinic with LBP one of the first things I would do is get both your glutes to fire properly and together. Just doing this would reduce the pain and improve mobility in almost all our patients. So In a nutshell without the ability to fire your glutes on any lift or transfer, you are essentially placing the load on your back.
4. A final issue we see is tightness in the calf and ankle. Tight boots, hard floors and sitting will all make your calf and ankle tight.
The first thing we did was to get the glute and piriformis to calm down; a foam roller or tennis ball can easily achieve this goal. Once the piriformis was calm, most of the pain in the leg stopped. From there we rolled and then stretched the hip flexors and inner thighs to allow the hips and piriformis to fire properly and not get tight again. At this point our dedicated LEO reported that “almost 50% of the pain was completely gone.” I know that over the next few days with some focus on staying mobile and then getting the glutes to fire properly again he will back in fighting shape which also means I need to watch that nasty round kick he likes to do to my head.
*Vladimir Janda, MD, DSc Tribute to a Master of Rehabilitation. Craig E. Morris, DC, FACCRS,* Philip E. Greenman, DO, FAAOSPINE Volume 31, Number 9, pp 1060–1064 ©2006, Lippincott Williams & Wilkins, Inc.
Bryan Fass
is a leading expert on public safety injury prevention. As the president and founder of Fit Responder Bryan’s company works nationally with departments, corporations; state and local governments to design and run targeted injury prevention and wellness programs. He is frequently contacted for expert opinion and content contribution for all aspects of public safety fitness, ergonomics and wellness. Bryan authored the Fit Responder book used by departments and schools plus writes for numerous web and peer-reviewed journals including the NSCA-Tactical Strength & Conditioning journal, officer.com, ems-1.com & best practices in EMS. Bryan holds a bachelors’ degree in sports medicine with over 17 years of clinical practice, was a paramedic for over 8 years, and is certified as an Athletic Trainer (ATC, LAT), Strength Coach (CSCS) and the Functional Movement Screen (FMS). Fit Responder developed the nation’s first validated pre-hire Physical Abilities Test for EMS. Bryan is a sought-after speaker on a variety of topics including risk reduction, employee self-care, real world wellness and How to Eat on the street. www.fitresponder.com
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