Fitness Training Sterling Heights Fire Department

1. Fitness Training Sterling Heights Fire Department HealthQuest Physical Therapy & Wellness Centers

2. CONTENTS Strength, Flexibility and Stabilization Exercises for: • Upper Extremities • Strength • Flexibility • ROM • Lower Extremities • Strength • Flexibility & ROM Trunk and LE’s • Core/Spine • Strength and Stabilization

3. SUGGESTED EQUIPMENT • Exercise Mat • Free Weights • Swiss Ball • Theraband (optional) • Varying Surface Heights • Step Box • Weighted Balls (optional) • Grid for Floor (create with masking tape)

4. TERMINOLOGY & ABBREVIATIONS • UE=Upper Extremities • LE=Lower Extremities • ROM=Range of Motion • IR=Internal Rotation • ER=External Rotation • EXS=Exercise • SLS=Single Leg Stance • TB=Theraband (Colors least tension to greatest: yellow, red, green, blue, black, grey) • 90/90=90˚ position of bend at the hip and knee joints. • Keep joint “soft”=slight bend, joint not locked or fully extended. • Prone=Position on stomach. • Supine=Position on back.

5. TERMINOLOGY & ABBREVIATIONS • RTC=Rotator cuff, group of endurance muscles around the scapular and shoulder joints. • Hip Hinge=Squat position with neutral spine, bend occurs through hips and knees; knees behind toes. • APT=Anterior Pelvic Tilt; forward tilt of the pelvis which increases the low back curvature. • PPT=Posterior Pelvic Tilt; backward tilt of pelvis which decreases/flattens the low back curve. • BOS=Base of support, position of LE and foot contact with ground. • “Set the scapula”=Prior to the exercise movement, stabilize the shoulder blades by pulling inward/together and slightly down.

6. GENERAL EXERCISE GUIDELINES • NOTE: • If you experience pain, question technique, need help with program development, design or progression, seek help from a Peer Fitness Trainer in your department. For further assessment of pain or to clarify exercise, contact a physical therapist at HQ (see contact list). • If at any time while performing the exercises you experience atypical musculoskeletal pain or discomfort, chest pain, lightheadedness, confusion, clamminess or any other abnormal symptom please immediately stop the exercise and seek professional help. • TRAINING RECOMMENDATIONS: • Exercise most days of the week. • Include all training components for a balanced program: cardiovascular (aerobic and anaerobic), strength training and flexibility/ROM. • If you participated in the fitness testing program, spend more time in the areas which showed deficit or were rated average or below. • OPTIMIZE in 45:You have a 45 minute window post workout where your body uses food and nutrients optimally, refuel your body with 4:1 ratio of good carbohydrates to protein (good carbs=fruit, vegetables, etc.).

7. GENERAL EXERCISE GUIDELINES • CARDIOVASCULAR: • Research shows that fire fighters must be able to work at a VO2max ≥ 42 ml/kg/min. See the Gerkin protocol and VO2max conversion table in the reference section of the manual. • Work at MET levels 11+ (See reference section for MET information). • Do an adequate warm up and cool down (i.e. warm up with lighter version of activity plan to partake in); at least 5-10 minutes recommended. • Perform cardiovascular training for 30+ minutes/day. • Due to the physical demands of fire fighting, train at 70-100% of your Maximal Heart Rate (220-AGE). (Target Heart Rate=MAX HR x desired % work at). • Use variety with aerobic training to challenge the cardiovascular system. Incorporate both aerobic and anaerobic training. Examples of anaerobic exs: biking with frequent hills, basketball, circuit training with high intensity spurts. • Your anaerobic threshold may change each exercise session. To determine this, take 10-15 minutes to increase your HR and reach the point where you must breath through your mouth, drop jaw, and speak short word sentences. Use this HR or feeling to guide training that day. If you exercise within 30 BPM below this level, you will burn fat and some sugar, if you exercise above this level you will burn mostly sugar.

8. GENERAL EXERCISE GUIDELINES • STRENGTH: • Choose at least one exercise for each major muscle group. • Consider the speed of the exercise, lifting at a slower pace requires a more even application of muscle force throughout the ROM. • Consider the type of muscle contraction you are performing (most difficult to least: Eccentric>Isometric>Concentric). Start with 3 sets of 8-12 reps, adjust the weight based on goals of the muscle group or 70-80% of maximum resistance. Increase the weight when the muscles adapt or the exercise is not fatiguing by the last rep. For endurance muscles (i.e. RTC) do increased reps with less weight, for strength (i.e. chest) do fewer reps with heavier weights. • Be sure to use proper technique. You may need to decrease weight in order to perform the exercise properly and minimize momentum or use of uninvolved body parts. • Schedule strength workouts to avoid working the same muscle groups on consecutive days.

9. GENERAL EXERCISE GUIDELINES • FLEXIBILITY: • Perform a moderate stretch, hold ~30 sec., do 2-3 reps on each major muscle group post workouts. • Focus more time on muscle groups which had greater deficits with testing to create balance around joints and avoid injury. • For tight muscles requiring an increase in ROM at a joint, do a prolonged stretch, hold 3-5 + minutes. • Stretches can be both static (those shown in manual, nonmoving) and dynamic (moving/active). Determine the muscle to stretch, its functional use and use the appropriate type of stretch. • If you are short on time, use stretches which incorporate multiple muscle groups (i.e. triangle, down dog, etc.).

10. Sidelying ER Pushouts Theraband IR/ER Empty Can Hand in Pocket Standing Rows Serratus Modified Push-Ups Scapular T’s and Y’s Sidelying Horizontal Abduction Shoulder Diagonals Wrist Flexion and Extension MUSCULAR STRENGTH UPPER EXTREMITIES

11. Target Muscles: Rotator Cuff (Infraspinatus, Teres Minor) Start Position: Lying on side with knees bent, shoulder hip and elbow in straight line, elbow bent 90˚, forearm parallel to floor, wrist neutral, towel roll between upper arm and trunk. Movement: Set the scapula, keep arm at side, rotate shoulder by bringing hand toward ceiling maintaining the 90˚ elbow bend. Progression: Increase weight, increase ROM (< 90˚). SIDELYING EXTERNAL ROTATION

12. Target Muscles: RTC (Supraspinatus), Middle Deltoid Start Position: Standing, arms in front of thighs, palms facing body, wrists neutral, holding TB or free weight. Movement: Set the scapula, push arms to side 3-5 inches. Progression: Increase weight or resistance of TB. PUSH-OUTS

13. Target Muscles: Rotator Cuff (Supraspinatus) Start Position: Standing, arms by side holding weights with thumbs facing downward. Movement: Set the scapula, lift the arms at 45˚ angle to ≤ shoulder height parallel to floor; avoid elevating/shrugging the shoulders. Progression: Increase weight. EMPTY CAN

14. Target Muscles: Rotator Cuff (Infraspinatus, Teres Minor) Start Position: Standing, upper arm by side, towel roll between UE and trunk, elbow bent 90˚, wrist neutral, holding TB (attached to wall on opposite side of exs arm). Movement: Set the scapula, maintain 90˚ elbow bend, rotate hand outward away from body<90˚. Progression: Increase ROM (≤90˚), increase TB resistance. THERABAND- EXTERNAL ROTATION

15. Target Muscles: Rotator Cuff (Subscapularis) Start Position: Standing, upper arm by side, towel roll between UE and trunk, elbow bent 90˚, wrist neutral, body at 45˚ angle from wall holding TB (attached to wall on same side as exs arm). Movement: Set the scapula, maintain 90˚ elbow bend, rotate hand inward toward the body. Progression: Increase TB resistance. THERABAND-INTERNAL ROTATION

16. Target Muscles: Shoulder Internal Rotators (Subscapularis) Start Position: Standing, hand placed in small of back, set the scapula, forearm parallel to floor, elbow bent to 90˚. Movement: Lift hand off small of back maintaining 90˚ bend at elbow. Hold 5 seconds, repeat 10 times. HAND IN POCKET

17. Target Muscles: Rhomboids, Middle Trapezius Start Position: Feet and hands shoulder width apart, grasp bar or other resistive equipment, hinge at hips, neutral spine, draw abdominals in, set the scapula. Movement: Draw the arms back until elbows in line with trunk, maintain set scapula, squeeze blades together; avoid elevating/shrugging shoulders. Progression: Increase weight, change hand hold (widen or narrow). STANDING ROWS

18. Target Muscles: Serratus Anterior Start Position: Push-up position, hands shoulder width apart, body on incline, flat back/neutral spine. Movement: Draw in abdominals, drop chest in and allow shoulder blades to come together, press back up and separate shoulder blades. Progression: Use lower surface height, progress to floor. SERRATUS MODIFIED PUSHUPS

19. Target Muscles: Rhomboids, Middle and Lower Trapezius Start Position: Lie prone over ball, tuck chin, lift chest, arms extended, down at floor, thumbs up. Movement: Set the scapula, lift the arms straight up at 45˚ angle until in line with trunk. Progression: Add weight, balance single leg. SCAPULAR Y’S

20. Target Muscles: Rhomboids, Middle Trapezius Start Position: Lie prone over ball, tuck chin, lift chest, arms extended and down at floor, thumbs up. Movement:Set the scapula, lift the arms out to side at 90˚ angle until in line with trunk. Progression: Add weight, balance on one leg. SCAPULAR T’S

21. Target Muscles: Rhomboids, Posterior Deltoid Start Position: Lying on side, knees bent, neutral trunk, hips in line with shoulders, arm straight out 90˚and parallel to floor. Movement: Set the scapula, lift arm up toward ceiling until perpendicular to floor. Progression: Increase weight. SIDELYING HORIZONTAL ABDUCTION

22. Target Muscles: Shoulder and UE rotators Start Position: Sitting on ball, feet shoulder width apart, arm near straight, soft elbow, arm across body, thumb down holding weight. Movement: Set the scapula, keep arm near straight, lift arm on a diagonal up across body to the opposite side and overhead turning thumb up. Progression: Increase weight, balance on single leg. SHOULDER DIAGONALS

23. Target Muscles: Shoulder and UE rotators Start Position: Sitting on ball, feet shoulder width apart, arm at side 45˚angle, near straight, elbow soft, thumb facing out to side holding weight. Movement: Set the scapula, keep arm near straight, lift arm on a diagonal up across body to the opposite side and overhead turning thumb up, palm facing body. Progression: Add weight, balance on single leg. SHOULDER DIAGONALS

24. Target Muscles: Wrist Flexors (Flexor Carpi Ulnaris and Radialis) Start Position: Standing, arm by side, elbow bent 90˚, wrist neutral, palm facing up, holding weight, scapula set. Movement: Bend wrist and bring hand toward ceiling, maintain UE position. Progression: Increase weight, stand on one leg or uneven surface. WRIST FLEXION

25. Target Muscles: Wrist Extensors (Extensor Carpi Ulnaris and Radialis) Start Position: Standing, arm by side, elbow bent 90˚, wrist neutral, palm facing down, holding weight, scapula set. Movement:Bend wrist and bring hand toward ceiling, maintain UE position. Progression:Increase weight, stand on one leg or uneven surface. WRIST EXTENSION

26. FLEXIBILITY UPPER EXTREMITIES • IR Stretch • Pectoral Stretch Doorway or Corner • Doorway Stretch Shoulder Elevation-Flexion and Abduction • Latissimus Stretch

27. Target Area: Shoulder Joint, External Rotator Muscles Start Position: Lie on side of stretch arm, body at ¾ turn, trunk neutral, arm at 45-70˚ angle from trunk, elbow bent 90˚, top hand on wrist/forearm. Movement: Gently pushup UE downward until feel moderate stretch in shoulder, maintain 90˚ elbow bend; hold 30 sec., do 2-3 reps. Progression: Bring stretch arm to 90˚/shoulder height. SHOULDER INTERNAL ROTATION STRETCH

28. Target Muscles: Pectoralis Major/Chest Start Position: Arms on both sides of wall at entrance to door, staggered stance lunge position, neutral spine. Movement: Move body forward through doorway by distributing weight to front leg until feel moderate stretch in chest; hold 30 sec., do 3 reps. Progression: Raise or lower arm position. PECTORAL STRETCH-DOORWAY

29. Target Area: Shoulder Joint, Extensor and Rotator Muscles Start Position: Stretch arm overhead on side or top of door frame, LE staggered stance. Movement: Move body forward through doorway by distributing weight to front leg until feel moderate stretch in shoulder or reach end range; hold 30 sec., do 3 reps. Progression: Raise arm position until perpendicular to floor. SHOULDER OVERHEAD STRETCH -DOORWAY

30. Target Muscles: Shoulder Extensors, Upper Back Start Position: Hands and knees, neutral spine. Movement: Push bottom back toward heels, stretch arms overhead and slightly to side until feel moderate stretch in shoulder and upper back; hold 30 sec., do 3 reps. Progression: Vary UE position by moving arms closer or further away to increase stretch. LATISSIMUS STRETCH

31. RANGE OF MOTIONUPPER EXTREMITIES • Pendulum • Pulleys • Cane (Supine and Stand)

32. Target Area: Shoulder Joint Start Position: Bend trunk forward, support body weight with UE on wall, let exercise arm hang, keep it relaxed. Movement: Shift body to create small circles with the exercise arm; this allows shoulder distraction and increased blood flow to joint; do 25 reps or as needed for symptom relief. PENDULUM

33. Target Area: Shoulder Joint and Surrounding Muscles Start Position: Seated, back against wall, hands on pulley handles, involved arm straight with thumb up resting on knee. Movement: Use opposite arm to elevate arm in front of body and overhead until feel moderate stretch or reach end range; hold 10 seconds, repeat 10 times. ROM-PULLEY FLEXION

34. Target Area:Shoulder Joint and Surrounding Muscles Start Position: Seated, back against wall, hands on pulley handles, involved arm straight with thumb up resting on knee. Movement: Use opposite arm to elevate exs arm at 45˚ angle from body overhead until feel moderate stretch or reach end range; hold 10 seconds, repeat 10 times. Progression: Move arm out toward side, continue until hand is close to wall through-out the ROM. ROM-PULLEY SCAPTION

35. Target Area:Shoulder Joint and Surrounding Muscles- Focus-Rotators Start Position: Standing, hands on pulley handles (or ends of towel), involved arm in small of back, opposite arm in front of body. Movement: Use opposite arm to lift hand behind back upward until feel moderate stretch or reach end range; hold 10 seconds, repeat 10 times. ROM-PULLEY INTERNAL ROTATION

36. Target Area: Shoulder Joint and Surrounding Muscles Start Position: Lie on back, hold cane/pole with hands slightly wider than shoulder width, arms extended, palms facing one another, thumbs facing up to ceiling. Movement: Lift arms overhead toward ears, keeping them straight, until feel moderate stretch in shoulder or reach end range (~180˚); hold 5 sec., repeat 15 times. Progression: Perform in standing. CANE RANGE OF MOTION-FLEXION

37. Target Area: Shoulder Joint and Surrounding Muscles-Focus Rotators Start Position: Lie on back, hold cane/pole with hands, the exercise arm at 45˚ angle from trunk, elbow bent to 90˚, palm facing inward, thumb up. Movement: Maintain the 90˚ elbow bend, rotate the exs arm back and down until feel moderate stretch in the shoulder or reach end range (≤90˚); hold 5 sec., repeat 15 times. Progression: Perform in standing. CANE RANGE OF MOTION-EXTERNAL ROTATION

38. Target Muscles: Shoulder Joint and Surrounding Muscles Start Position: Lie on back, hold cane/pole with hands slightly wider than shoulder width, exs arm extended, hand at end of cane with thumb facing up toward ceiling. Movement: Keep exs arm straight, lift up and overhead at 45˚ angle until feel moderate stretch in shoulder or reach position parallel to floor; hold 5 sec., repeat 15 times. Progression: Perform in standing. CANE RANGE OF MOTION-SCAPTION

39. Wall Slide-Abduction 90/90 Wall Bridge 90/90 Heel Tap 90/90 Pistoning Sidelying Hip ER Sidelying Knee-to-Knee Sidelying Hip Adduction Hip Hinge Box Step Downs Side Stepping Squats-Swiss Ball Multi-directional Lunges Single Leg Balance-Multidirectional Reach Hip Extension Heel Raises MUSCULAR STRENGTHLOWER EXTREMITIES

40. Target Muscles: Gluteus Medius Start Position: On side with hips and shoulders square against wall, bottom knee bent, top knee straight, toes facing down. Movement: Lean top hip slightly forward and slide heel up wall ~45˚, be sure movement occurs at hip vs. torso. Progression:Add cuff weight or TB resistance. WALL SLIDE

41. Target Muscles: Hamstring Start Position: Lie on back, feet on wall, hips and knees 90˚/90˚. Movement: Squeeze bottom to create slight PPT, pull down with back of thigh/hamstring and feet to lift bottom 1 inch off surface. Hold 10 seconds, do 10 reps., 2-3 sets. 90/90 WALL BRIDGE

42. Target Muscles: Hamstring Start Position:Lie on back, feet on wall, hip and knee of one LE 90˚ bend, other LE knee straight, pelvis level, heel on wall. Movement: Squeeze bottom to create slight PPT, pull down with back of thigh/hamstring and feet to lift bottom 1 inch off surface, tap the heel of the straight leg on the wall then lift away ~6 inches, maintain a level pelvis; repeat 10 times, do 3 sets. 90/90 HEEL TAP

43. Target Area: Pelvic and hip ROM Start Position: Lie on back, feet on wall, hips and knees 90˚/90˚. Movement: Squeeze bottom to create slight PPT, pull down with back of thigh/hamstring and feet to lift bottom 1 inch off surface, shift left hip down toward surface; repeat 10 times, do 2-3 sets both LE’s. 90/90 PISTONING

44. Target Muscles: Hip External Rotators (Piriformis, Obturator Internus) Start Position: Lie on side, hips and knees bent to 90˚, feet on wall, shoulders and hips in line, roll top hip slightly forward. Movement: Draw the abdominals in, keep the pelvis and trunk stable, lift the top knee up toward the ceiling keeping feet together and on wall. Progression: Add weight to top leg or TB resistance. SIDELYING HIP EXTERNAL ROTATION

45. Target Muscles: Inner Thigh, Hip Internal Rotators and Adductors Start Position: Lie on side, hips and knees bent to 90˚, feet together, shoulders and hips in line, roll top hip slightly forward. Movement:Draw the abdominals in, keep the pelvis and trunk stable, top hip slightly forward, lift the top knee and hold this position, lift the bottom knee up to the top keeping feet together. Progression: Add cuff weight to bottom leg. SIDELYING KNEE-TO-KNEE

46. Target Muscles:Inner Thigh-Hip Adductors Start Position:Lie on side, hips and knees straight, top foot resting on elevated surface (i.e. chair), other LE on floor, shoulders and hips in line. Movement:Draw the abdominals in, keep the pelvis and trunk stable, lift the bottom leg up to the top; hold 5 seconds, repeat 10 times, 2-3 sets. Progression:Lift the pelvis and hips off the surface prior to lifting the bottom leg, maintain hip position thoughout exs. SIDELYING HIP ADDUCTION

47. Target Area: Spine and Pelvis Start Position: Standing, neutral spine. Movement: Perform a mini squat, bend through hips and knees, maintain neutral spine. Progression: Increase ROM with squat, add UE weight. HIP HINGE

48. Target Muscles: Quadriceps Start Position: Standing, one foot on step box, other hanging to side. Movement: Bend the knee of foot on the step box, lower the other leg bringing it forward, to the side, then back (3 directions = 1 rep), keep knees behind toes. Progression: Use higher step box, perform deeper squat/step down. STEP BOX- 3 WAY STEP DOWNS

49. Target Muscles: Buttocks, Hip Abductors (Gluteus Medius) Start Position: Standing hip hinge/mini squat, TB around ankles. Movement: Step to side against resistance maintaining squat position, maintain tension in TB. Progression: Take larger steps; increase TB resistance; stand on one leg with TB around ankles, perform repeated reps on one side. SIDE STEPPING WITH RESISTANCE

50. Target muscles: Quads, Gluts Start position: Standing with feet shoulder width apart and ~4 ft. from wall, ball positioned comfortably in the low back curve. Movement: Keep a neutral spine/anterior tilt and abdominals drawn in, perform a squat by bending the hips and knees to ≤ 90°, keep knees behind toes. Progression: Perform single leg squat. SQUATS-SWISS BALL