Knee pain and strain is a common ailment that affects a large (and growing) number of firefighters. As first responders, we constantly subject our knees to dynamic and static forces, resulting in increased knee complaints and a higher relative risk of osteoarthrosis and tears. You do not need to look at research and data to confirm this statistic—just walk into any firehouse and survey the crew.
In the following video, I provide three stretches and three exercises that will strengthen the knees and help manage firefighter knee pain.
Causes of Firefighter Knee Pain
Firefighters are at a higher risk osteoarthritis and knee problems because we perform a job that requires a lot of squatting and kneeling. We are constantly stepping on and off large vehicles, climbing stairs, assessing patients and carrying heavy gear. All these movements can create trauma and inflammation within the knee and can lead to more serious injuries like ACL/MCL and meniscus tears.
There are, however, other causes than just the job itself. Excess weight or being overweight increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage. And a lack of strength and flexibility can increase the risk of knee injuries. Strong muscles help to stabilize and protect your joints and muscle flexibility can help you achieve full range of motion.
Although it is not always possible to prevent knee pain, the following suggestions and exercises may help alleviate it by strengthening the muscles around the knee and improving flexibility. First, it is important to keep extra pounds off. Maintaining a healthy weight is one of the best things you can do for your knees. Every extra pound puts additional strain on your joints, increasing the risk of injuries and osteoarthritis.
You also need to prepare your muscles for the demands of the job. A consistent fitness program and plan will not only help keep the weight off, it will also condition your muscles to better meet the physical demands we face. And, because weak muscles are a leading cause of knee injuries, you will benefit from building up your quadriceps and hamstrings, which support your knees. Tight muscles also can contribute to injury, so stretching is important.
Here are three great strengthening exercises and three stretches you can incorporate into your fitness plan to prevent firefighter knee pain.
Warm Up First
Before performing any stretches or strengthening exercise, you should warm up your target muscles. This can be a brisk, 2-minute walk while pumping your arms, or do a few wall push-ups followed by the same number of calf raises. Try to get the blood moving through your muscles; this will help you get more out of the exercises and stretches. I personally incorporate these strengthening exercises in each one of my workouts. And then make sure to finish with the stretches. You should try to perform these exercises at least three times per week.
The Glute Bridge
One of the best ways to prevent knee pain is by strengthening the muscles that support the knee joint. Bridge and marching bridge exercises can help you strengthen the hamstring, quads and glute muscles.
Perform the bridge by lying on your back with knees bent. Keeping your abdominals tight, raise your hips and lower back from the floor. Hold this “bridge” position for 5 seconds before lowering your body down to the floor. Repeat the bridge 10–15 times, working up to two sets.
The wall sit is an isometric, quad- and glute-strengthening exercise. It is safer for the knees because the body is in a fixed position with added support from the wall.
Stand with your back against a wall, your feet about shoulder-width apart. Slowly bend your knees and keep your back and pelvis against the wall. Hold for 20–40 seconds. Do not bend too deeply. If you feel pressure or discomfort in your knees, change your position. Repeat the exercise for three to five sets, working to hold the sit position a few seconds longer each time.
Quadruped Fire Hydrants
I could not resist adding this exercise to the list. The first reason is obvious—it has a great name! Second, this exercise is great for strengthening the muscles of the glutes, hips and core, which will help stabilize your hips and reduce strain on the knees.
Get on your hands and knees. Draw your belly button in toward your spine to engage your abdominal muscles. Keeping your knee bent, lift one leg out to the side. Keep your hips facing down to prevent rotation at your spine. Pause, then slowly lower your knee back down to the start position. Perform 10 repetitions of this exercise on each leg, for two to three sets.
After completing the strengthening exercises, the next step is to improve the flexibility and mobility of the exercises around the knee. Be mindful of your form and posture as you perform each exercise. Your goal is to hold each stretch for at least 20–30 seconds and perform them at least three times per week. Do not hold your breath as you stretch and make sure you do not stretch through sharp pain.
Standing Hamstring Stretch
Your hamstrings help support your hips and knees. Knee injuries can be caused by hamstring strains, so it is important to guard against them by keeping your hamstrings flexible.
Stand on your right foot with your left foot in front of you, heel on the floor, toes up. Hinge forward at your hips and bend your right knee as you sit back a bit. As you bend your right leg, keep your left leg completely straight with your weight on the edge of your heel. You should feel this stretch in the hamstring (back of leg) of the straightened leg. Hold for 20–30 seconds. Switch sides and repeat for two to three sets each leg.
Heel and Calf Stretch
This stretch targets the muscles in your lower leg, specifically your calf muscles. Like the hamstring, the calf muscles are attached to the back of your knee. If your calf is tight, it can pull on the knee joint and cause pain.
Place your hands on the wall and move one foot back as far as you can comfortably. Make sure the toes on both feet are facing forward with your heels flat and a slight bend in your knees. Lean into the stretch and hold for 30 seconds. You should feel the stretch in your back leg. Change legs and repeat. Do two to three sets for each leg.
Standing Quads Stretch
This stretch specifically targets your quadriceps, the muscles at the front of your thighs. Performing this move can help improve the flexibility in your hip flexors and quadricep muscles.
Stand on your left leg, one knee touching the other. You can hold a chair or the wall to keep you steady if needed. Using your right hand, grab your right foot and pull it towards your butt. Make sure to push your chest up and hips forward. Do not worry about pushing your foot too close to your backside; your focus should be on feeling the stretch in your quad muscle and pushing your hips forward to get a good hip flexor stretch. Hold the position for 20–30 seconds, then repeat on the other leg. Do this stretch two to three sets for each leg.
Not all knee pain is serious, but if your knee pain persists after a few weeks and does not improve, consider seeing an orthopedic specialist. And if you have sharp pain in your knee accompanied by significant swelling, and/or tenderness and warmth around the joint, see a physician right away.
Be smart about exercise. If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you exercise. Make sure you are working functionally by incorporating mobility, core, and balance exercises. If your knees are hurting, limit the high-impact activities.
- Frost DM, Beach TA, Crosby I, McGill SM. Firefighter injuries are not just a fireground problem. Work. 2015;52(4):835-42. Retrieved 5/28/21 from https://pubmed.ncbi.nlm.nih.gov/26409354/
- Reichelt P, Conrad K. Musculoskeletal injury: ergonomics and physical fitness in firefighters. Occup Med. 1995;10(4):735–746. Retrieved 5/28/21 from https://pubmed.ncbi.nlm.nih.gov/8903746.
- U.S. Fire Administration. (2014) Fire-related firefighter injuries reported to National Fire Incident Reporting System (2010-2012). Topical Fire Report Series. 2012. Retrieved 5/28/21 from https://pubmed.ncbi.nlm.nih.gov/8903746/