The Effect of Load Carriage on Spinal Health in Firefighters

Written By Eric Haskins

By Eric Haskins, CSCS, TSAC-F
Founder – Firehouse Strength & Conditioning

Abstract

Firefighting requires the carriage of heavy external loads, most notably structural turnout gear and self-contained breathing apparatus (SCBA). These ensembles can weigh between 20–25 kg, significantly increasing biomechanical stress on the spine and surrounding musculature. Firefighters experience elevated rates of low back injury, with the NFPA reporting that strains, sprains, and muscular pain remain the most common line-of-duty injuries. This article examines the biomechanical effects of load carriage on spinal health in firefighters, summarizes relevant research from tactical populations, and provides evidence-based recommendations for prevention through targeted training, recovery, and organizational policy.

Introduction

Low back pain is the single most prevalent musculoskeletal disorder in the fire service, accounting for thousands of lost workdays and medical claims annually (Karter & Molis, 2019). Firefighters are required to wear PPE and SCBA that impose additional load, often exceeding 20 kg. During tasks like hose advancement, ladder raises, and victim drags, the cumulative load increases compressive forces on the lumbar spine.

Research in tactical populations (military, law enforcement, and firefighters) shows that repetitive load carriage is strongly associated with increased risk of spinal injuries and chronic back pain (Orr et al., 2020). For firefighters, the combination of high external load, awkward postures, and unpredictable operational environments creates a unique injury risk profile.

Literature Review

Biomechanical Effects of Load Carriage

  • Spinal Compression: PPE + SCBA increases spinal compression by up to 50% compared to unloaded conditions (Park et al., 2015).
  • Postural Adaptations: Firefighters demonstrate greater forward trunk lean and reduced hip mobility under load (Orr et al., 2014).
  • Fatigue Factor: Load carriage accelerates trunk muscle fatigue, reducing spinal stability.

Injury Epidemiology

  • The U.S. Fire Administration reports that musculoskeletal disorders account for ~50% of all non-fatal firefighter injuries annually.
  • Low back pain is the most frequently reported site of chronic pain among career firefighters (Punnett et al., 2007).

Comparative Research

  • Military research highlights increased intervertebral disc degeneration in load-carriers compared to age-matched controls (Rayson, 1998).
  • Similar biomechanical mechanisms apply to firefighters, suggesting that long-term spinal health risks may be underestimated.

Methods / Program Design Principles

1. Strength Training for Spinal Resilience

  • Prioritize posterior chain development: deadlifts, hip hinges, glute bridges.
  • Incorporate anti-rotation core training (Pallof press, farmer’s carries).
  • Train with moderate external load (vests/sandbags) to simulate PPE/SCBA conditions.

2. Mobility and Posture Optimization

  • Daily hip flexor and thoracic spine mobility drills.
  • Firehouse warm-ups should include dynamic stretching targeting lumbar and hip regions.

3. Load Management & Ergonomics

  • Rotate personnel for high-load tasks.
  • Use mechanical aids (carts, stair chairs) where possible.
  • Encourage pre-shift warm-up routines to prepare lumbar musculature.

Application to the Fire Service

Structural Fire Operations

  • Hose advancement and victim drags: emphasize team-based execution to distribute load.
  • Ladder raises: train trunk bracing strategies under load.

Wildland Firefighting

  • Extended pack loads (15–25 kg): integrate rucking and loaded conditioning in training.

Training Environments

  • Simulate PPE/SCBA loads in the gym 1–2x per week to build specific tolerance.
  • Integrate unilateral load training to reduce asymmetry risk.

Limitations & Future Research

  • Fire-specific studies are limited compared to military research on load carriage.
  • More longitudinal research is needed on cumulative disc degeneration in career firefighters.
  • Future research should compare injury prevalence between departments using structured strength programs vs. those without.

Conclusion

Load carriage is non-negotiable in firefighting. PPE and SCBA are lifesaving, but they impose significant spinal strain and elevate injury risk. Firefighters who develop spinal resilience through targeted strength, mobility, and ergonomic strategies will reduce injuries and extend career longevity.

Capacity > Demand. Train like a firefighter.

References

Orr, R., Johnston, V., & Coyle, J. (2020). Load carriage and musculoskeletal injury in tactical populations: Implications for firefighters. Applied Ergonomics, 82, 102944. https://doi.org/10.1016/j.apergo.2019.102944

Orr, R., Pope, R., Johnston, V., & Coyle, J. (2014). Load carriage and its force impact. Applied Ergonomics, 45(6), 1463–1471. https://doi.org/10.1016/j.apergo.2013.08.003

Park, K., Hur, P., Rosengren, K. S., Horn, G. P., & Hsiao-Wecksler, E. T. (2015). Effects of load carriage on gait and postural stability in firefighters. Safety and Health at Work, 6(3), 234–239. https://doi.org/10.1016/j.shaw.2015.04.001

Punnett, L., Pruss-Ustun, A., Nelson, D. I., Fingerhut, M. A., Leigh, J., Tak, S. W., & Phillips, S. (2007). Estimating the global burden of low back pain. International Journal of Occupational and Environmental Health, 13(4), 429–438. https://doi.org/10.1179/oeh.2007.13.4.429

Rayson, M. (1998). The physiological assessment of load carriage. Ergonomics, 41(1), 1345–1358. https://doi.org/10.1080/001401398186084

Eric Haskins
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