KATIE SELL, PHD, CSCS,*D, TSAC-F AND MARK PLONSKI, NSCA-CPT
CONSIDERATIONS FOR DECREASING INJURY RISK
DURING PHYSICAL TRAINING
Several initiatives have been released over the last 15 years
to target health- and fitness-related concerns in wildland and
structural firefighters (10,17,18,20,24). However, the improper
implementation of physical conditioning programs may
detrimentally affect work capacity, as well as increase the
likelihood of injury, which may also lead to financial ramifications
related to absenteeism and worker’s compensation costs (26).
Between 2004 and 2009, one third of the injuries to structural
firefighters occurred during physical fitness or exercise-related
training (21). The purpose of this article is to provide suggestions
for professional practices that will decrease the risk of injury
during physical conditioning and promote a safe and productive
training environment. The information presented in this article
is aimed at the exercise professional conducting physical
conditioning programs with fire departments, as well as the
individual firefighter either currently or planning to implement a
self-directed training program, but may also have implications for
military and law enforcement programs.
PRE-SCREENING AND PHYSICIAN CLEARANCE
The purpose of a pre-screening is to identify any areas of possible
contraindication to exercise that would necessitate a medical
evaluation and the safe and appropriate modification to the
training program. A comprehensive physical activity readiness
pre-screening should be conducted when initiating a new
training program (or making significant changes to a pre-existing
approach), or if returning from a period of time away from training
(such as an injury or illness).
The Canadian Society of Exercise Physiology (CSEP) suggests a
physical activity clearance should be reviewed on an annual basis
(1). However, a pre-screening may also be necessary before a
physical training session if a given tactical athlete has experienced
a high degree of job-related physiological stress. For example, a
firefighter who has been exposed to smoke and particulates in an
earlier call-out may exhibit residual compromised work capacity.
This would suggest that an additional physical training session
that same day could be contraindicative, especially if they have
not yet completed the entire shift. Each fire department may have
their own pre-screening requirements, so trainers and trainees
should check the legal requirements for an exercise program or
test-related pre-screening with the allied health professionals
affiliated with their respective department. Pre-screening
typically involves the completion of a Physical Activity Readiness
Questionnaire (PAR-Q), health history or appraisal questionnaire,
medical evaluation, and informed consent or waiver form, if
necessary (1,15). The standard PAR-Q can be obtained through the
CSEP, but some fire departments may use a modified PAR-Q (e.g.,
USDA Forest Service Health Screening Questionnaire).
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WARM-UP AND COOL-DOWN
Include a thorough warm-up and cool-down with each training
session. A warm-up will help prepare the body for the impending
increase in physiological demand by increasing body temperature
(muscle and core especially), redirecting blood flow, and
decreasing connective tissue tightness (14). A thorough warm-up
should consist of light aerobic activity (e.g., brisk walking, jogging,
light cycling) for 5 – 10 min, followed by dynamic stretches similar
to the movements to be engaged in during the subsequent
training (e.g., butt kicks, high knees, etc.). These stretches may
be preceded by other preparatory approaches such as myofascial
release (e.g., foam rolling) or prehabilitation exercises. The
duration of the cool-down may depend on the type and duration
of the exercise conducted, but generally should include light-
intensity aerobic activity followed by static stretching (2).
PREPARE APPROPRIATELY FOR PHYSICAL TRAINING
To optimize physical performance (and recovery) it is imperative
to wear the correct training attire (clothing and shoes), adequately
hydrate before, during, and after training, and consume sufficient
nutrients. Clothing provides a layer of insulation for the body, with
thicker, darker-colored clothing presenting a greater insulating
effect and thus increasing body temperature to a greater extent
(9). The addition of equipment or firefighter-specific clothing
may further magnify this effect. When choosing the appropriate
clothing for a given training situation, consider the environmental
conditions (e.g., heat, humidity, wind flow, air pollutants, etc.) in
which the training will take place, the participants’ state of fatigue
at the beginning of the planned workout, and the volume and
intensity of the planned training session (7,25). When exercising,
wear comfortable shoes that are the appropriate size and that are
designed for optimal support. Take the time to select shoes that
fulfill these criteria, and replace shoes that have become loose or
worn down.
Fluid, fuel, and caloric consumption should reflect the metabolic
demands of the firefighter given their daily energy expenditure
and individual energy needs. This may often be challenging due to
the unpredictability of job-related responsibilities. Implementing
strategies such as carrying a water bottle during the day, pre-
packing healthy, nutritional snacks for consumption throughout
the day or post-exercise, and monitoring intake of caffeine and
supplements (particularly any ergogenic aids), will help facilitate
optimal hydration and decrease risk of dehydration or heat-related
injury, as well as increase physical training preparedness (2,7,23).
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 CONSIDERATIONS FOR DECREASING INJURY
RISK DURING PHYSICAL TRAINING
PROFESSIONALISM IN THE TRAINING ENVIRONMENT
Awareness, acknowledgement, and subsequent management
of factors that may detrimentally affect work capacity or risk of
illness, or injury, is imperative. This may include management of
medical (e.g., clearance protocols, AEDs), external (e.g., equipment
safety), and environmental (e.g., adequate air conditioning, or
access to drinking water) risk factors. Professional and responsible
behavior in the physical training environment may help decrease
the potential for injury. Supervision by a certified professional
may not always be possible, but working out with a partner or
informing others of your intention to exercise may decrease the
likelihood of injury due to unforeseen accidents. Correctly racking
free weights and plates when finished will decrease the likelihood
of weights falling and causing injury; and using barbell collars
or clips and a proficient spotter when lifting will help facilitate
proper form. Regular safety checks of equipment in the training
room should be conducted and documented. Furthermore, the
recognition of signs and symptoms of overtraining, excessive
fatigue, and exertional heat illness (e.g., rhabdomyolysis) is
imperative. This is the responsibility of certified strength and
conditioning professionals, but is highly recommended for all
individuals engaged in physical training who may experience
residual physiological and psychological stress related to his or her
job demands.
CORRECT FORM
Correct form during aerobic, stretching, and resistance-based
exercise is imperative for optimizing physiological training and
adaptation, as well as avoiding compensatory muscle action
that may increase the likelihood of injury and discontinuation of
training. Correct technique includes appropriate breathing form—
exhaling on the exertion or more strenuous phase of the exercise—
and the use of spotters to provide feedback on form (2,16). It is
important to remember that form may be affected when weight is
added to a lift, or when the stability or complexity of a movement
is altered. Correct form should be demonstrated for every exercise
before additional stress (e.g., weight, multidirectional movements)
is added. Video analysis and commentary for a variety of exercises
are available through the NSCA’s Exercise Technique Manual for
Resistance Training (2nd edition) (19).
FOLLOW GUIDELINES CONCERNING PREREQUISITE
COMPETENCIES FOR TRAINING
The development of a foundation of muscular strength and
endurance is recommended before engaging in intermediate or
advanced resistance training approaches (e.g., sandbag training).
Resistance exercise machines provide a modality that allows the
user to go through a guided range of motion (ROM) and allows
for controlled movement, which may be attractive for beginner
lifters. Free weights (e.g., dumbbells, kettlebells, sandbags, and
“strongman” implements) (Figure 1) usually allow for movement
through a greater ROM, and greater diversity for program
progression. The transfer from machine-based exercises to free
NSCA’S TSAC REPORT | ISSUE 29
weights, and from more to less stable modalities (e.g., dumbbells
vs. sandbags) requires a greater degree of strength, experience,
and supervision while the lifter adapts to the unfamiliar dynamic
resistance (2). This guideline also applies to conditioning
approaches commonly used to target a variety of metabolic
systems or physiological goals. Prerequisite guidelines for exercise
intensity based on health-related factors, such as accumulation of
coronary artery disease risk factors, should be addressed in a pre-
screening medical clearance protocol; this should be utilized for
any and all conditioning programs. However, a recent consensus
statement suggested that additional variables including recovery
time after strenuous activity, safety of movement patterns
involved, resistance to fatigue, and physical fitness levels should
significantly affect the decision to engage in a given training
approach at a given point in time (3). Furthermore, the impact of
introducing a “competitive” physical conditioning environment
on a group of trainees with a variety of physical capabilities is an
important consideration, especially if the individual needs within
the group are not adequately addressed using one universal,
blanket conditioning approach.
APPLY PROGRESSIVE OVERLOAD IN A GRADUAL MANNER
Progressive overload of the musculoskeletal system is necessary
for achieving continued adaptations towards specific training
goals (12). The progression of a resistance training program can
occur through the manipulation of sets, repetitions, and exercise
frequency. Programs can also be progressed by decreasing the
stability of the exercise, adding multi-joint and closed-chain
exercises, and by altering the exercise selection, execution, or
modality (12,22). However, to decrease the likelihood of injury,
the manipulation of the volume or complexity of the program
should be gradual and dictated by the fulfillment of prerequisite
requirements. For example, these requirements may include
lifting a designated volume of sets and repetitions at a lighter
weight (as determined by pre-defined resistance training goals),
or demonstrating competent exercise form. However, increases in
weight should be gradual, with smaller increases for upper-body
and isolated lower-body exercises.
Although the principle of progressive overload tends to be
applied more frequently to resistance-based programs, aerobic-
based training should also be progressed in an appropriate and
safe manner. When progressing a program, consider work and
training schedule to avoid overloading the body in a way that
may interfere with occupational performance (i.e., unduly increase
fatigue).
TRAIN FOR MUSCLE BALANCE, MOBILITY, AND STABILITY
Muscle imbalances detrimentally impact the reciprocal interaction
between opposing muscle groups, and may predispose individuals
to movement inefficiencies and compensatory movement patterns
(6,13). For example, tight hip flexors may limit hip mobility
resulting in low back muscles being overworked, and increasing
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 CONSIDERATIONS FOR DECREASING INJURY
RISK DURING PHYSICAL TRAINING
the potential for overuse injury and/or pain. Resistance training
that demands activation of the stabilizing muscles of the trunk,
shoulders, and ankles, may help reduce the risk of injury, especially
if the exercise is conducted through movement patterns reflective
of occupational tasks. Typically, free weights and multi-directional
exercises will facilitate activation of the stabilizing muscles to a
greater extent than machines. Additional pieces of equipment such
as BOSU trainers and balance discs can be used to manipulate
the stability variable of an exercise and challenge stability of the
joints, balance, and proprioceptive control (4). It is important to
be evaluated by a professional before making decisions to work on
movement deficiencies.
DO NOT IGNORE PAIN
Delayed onset muscle soreness (DOMS) is one of the most
common sport-related injuries (5). Training while in pain and
ignoring prolonged muscle aches, or signs and symptoms of
injury, is not recommended. This includes aches and pains
following physically exhaustive job demands or following physical
conditioning. Adequate recovery between high-intensity activities
is highly recommended (5). Seek advice and possible treatment
from a physician, or appropriate allied health professional, if pain
continues, especially if it is associated with a pre-existing injury.
Always obtain the appropriate and/or necessary clearance before
returning to a physical conditioning program (1).
SEEK ADVICE ON PROGRAM IMPLEMENTATION
If possible, working with a certified strength and conditioning
professional who has knowledge about the population-specific
needs of firefighters may help develop a personalized, optimal
conditioning program. If a certified professional is not available, it
is important to utilize professional, evidence-supported resources
to assist with program development. Professional organizations
that specialize in exercise testing, prescription, and program
development include, but are not limited to, the National Strength
and Conditioning Association (NSCA), specifically the Tactical
Strength and Conditioning (TSAC) branch, and the American
College of Sports Medicine (ACSM).
Safety during job-related tasks is a major priority for structural
and wildland firefighters (4,8,11). This should also be a priority
in the physical training environment. The approaches suggested
in this article are important preparatory measures that may help
reduce the risk of illness or injury during training, and allow the
conditioning to elicit the desired adaptations.
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FIGURE 1. COMMON ALTERNATIVE FREE WEIGHT TRAINING
EQUIPMENT
Supervision may be necessary when using this equipment. Care
should be taken with beginner lifters and those returning to
training following an injury.
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RISK DURING PHYSICAL TRAINING

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36(6): 926–934, 2004. ABOUT THE AUTHOR
Katie Sell is an Associate Professor in the Department of Health
14. McArdle, WD, Katch, FI, and Katch, VI. Exercise physiology:
Professions and Kinesiology at Hofstra University. She currently
Energy, nutrition and human performance. (6th ed.) Baltimore, MD:
teaches undergraduate and graduate courses in exercise
Lippincott, Williams and Wilkins; 2007.
physiology, physical fitness assessment, and exercise programming.
15. McNeely, E. Pre-screening for the personal trainer. Strength Her primary research interests lie in the area of physical fitness
and Conditioning Journal 30(5): 68-69, 2008. assessment and exercise programming for wildland firefighters
16. Myer, GD, Quatman, C, Khoury, J, Wall, E, and Hewett, T. and law enforcement personnel. She is currently on the National
Youth versus adult “weightlifting” injuries presenting to United Strength and Conditioning Association (NSCA) Tactical Strength
States emergency rooms: Accidental versus non-accidental injury and Conditioning Special Interest Group (SIG) Executive Council.
mechanisms. Journal of Strength and Conditioning Research 23(7):
Mark Plonski is an undergraduate student pursuing a Bachelor’s
2054-2060, 2009.
degree in Exercise Science at Hofstra University. In addition, he
17. National Fire Protection Association (NFPA). NFPA 1583: works as a performance coach for high school athletes and tactical
Standard on health-related fitness programs for fire fighters. professionals at Body in Balance Performance Enhancement Center.
Quincy, MA: National Fire Protection Association; 2000. His future plans include pursuing a Doctorate in Physical Therapy,
18. National Fire Protection Association (NFPA). NFPA 1582: as well as a career in both the fields of physical therapy and
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