By, Dr. Austin Pack PT, DPT, CSCS, SFMA – O2X Injury Prevention Specialist
Tactical athletes, such as firefighters, law enforcement, military personnel, and emergency medical responders perform in high-stress, physically intense environments where the risk of injury is constant.These roles often require lifting heavy loads, sudden bursts of movement, working in unpredictable environments, and long hours under physical strain.
Injury prevention isn’t just about safety, it’s about operational readiness, career longevity, and overall quality of life.
The good news is that our bodies are designed to adapt and manage physical stress. While complex in design, the human body is simple in the way structures work together to allow us to walk, run, lift and carry. Here is a quick anatomy run down for familiarization on the major joints we will cover in this article.
Anatomy 101:
Low Back (Lumbar Spine)
Bones: 5 lumbar vertebrae (L1–L5) form the lower spine.
Discs: Soft cushions (intervertebral discs) sit between each vertebra to absorb shock.
Muscles: Core muscles (like the multifidus and erector spinae) stabilize the spine.
Nerves: Major nerves, like the sciatic nerve, exit the spine here.
Key point:
The low back must be both strong and flexible to handle lifting, twisting, and load bearing without injury.
Knee Joint
Bones: Femur (thigh bone), tibia (shin bone), and patella (kneecap).
Cartilage: Menisci act as shock absorbers between femur and tibia.
Ligaments: ACL (anterior cruciate ligament), PCL, MCL, and LCL provide knee stability.
Tendons: Connect muscles like the quadriceps to bones.
Key point:
The knee needs strong muscles around it and good alignment during movement to avoid damage.
3. Shoulder Complex
Bones: Humerus (upper arm), scapula (shoulder blade), and clavicle (collarbone).
Muscles: Rotator cuff group (supraspinatus, infraspinatus, teres minor, subscapularis) stabilize the shoulder.
Joints: Ball-and-socket joint allows 360 degrees range of motion.
Tendons: Attach muscles to bones — very prone to wear and tear.
Key point:
The shoulder is the most mobile joint, but that makes it susceptible to injury if muscles aren’t balanced.
4. Ankle and Foot
Bones: Tibia and fibula (the two lower leg bones) connect to the talus (ankle bone).
Ligaments: Lateral ligaments (outside of ankle) are often sprained.
Tendons: Achilles tendon connects calf muscles to the heel.
Muscles: Small foot and lower leg muscles stabilize movements.
Key point:
The ankles need to be stable/strong, while the foot remains mobile yet rigid for force absorption and production.
5. General Overuse Areas
Bones: Tibia (shin bone) often experience stress injuries
Tendons: Connect muscles to bones and can get inflamed with repetitive use.
Muscles: Constant activity without rest can cause breakdown at muscle the muscle belly or attachment sites.
Key point:
Recovery and progressive overload are essential to reduce overuse injuries.
Now, let’s define what a musculoskeletal (MSK) injury is: an injury that affects the muscle, bone, tendon, ligament, nerve, cartilage or other soft tissue structures in the body. These injuries can be brought on by direct trauma or overuse. Below are 5 of the most common MSK injuries affecting tactical athletes, along with practical, proven strategies to prevent or minimize them.
1. Low Back Injuries
Common Types:
Lumbar strain/sprain
Herniated or bulging discs
Sciatica (nerve impingement)
How:
Low back injuries are often caused by lifting patients, gear, or equipment improperly. Long hours of sitting (in patrol cars or vehicles), wearing heavy vests/plate carriers, and poor posture during tasks all add stress to the spine. Over time, this leads to mechanical dysfunction. Our spines are meant to be agile but strong. With high work and physical demands, there is a need for strengthening and recovery. Strength is found in proper programming outside of duty. Recovery is achieved by following an effective mobility routine, stretching or utilizing tools to help with tissue recovery
Prevention:
Strengthen the Core: Core stabilization exercises like planks, side planks, crunches, chops, and even heavier lifts like squats or deadlifts, build support for the spine.
Practice Safe Lifting: Use proper mechanics, hip hinge, knees bent, spine neutral, using glutes to assist the lumbar extensors.
Mobility Work: Stretching hip flexors, tight hamstrings, hip internal/external rotation, thoracic rotation and extension.
Minimize Prolonged Sitting: Intermittently adjust posture when seated, switch positions when possible (even if subtle changes).
2. Knee Injuries
Common Types:
Meniscus tears
Patellar tendinitis (jumper’s knee)
ACL/MCL sprains
How:
Knee injuries are common from sprinting, jumping, or sudden changes in direction, especially during pursuits, tactical training, or emergency responses. Repeated kneeling during field operations can also cause stress at the knee complex.
Prevention:
Build Lower-Body Strength: Focus on glutes, quads, adductors and hamstrings to stabilize the knee.
Use Proper Landing Mechanics: Practice controlled landings with knees tracking over toes.
Agility and Balance Drills: Incorporate lateral movements with or without cones, or other agility equipment.
Protect Knees During Groundwork: Use knee pads when tasks require extended kneeling.
3. Shoulder Injuries
Common Types:
Rotator cuff tears or tendinitis
Shoulder impingement
AC joint sprains
How:
Whether lifting overhead, climbing, breaching, or hauling gear, the shoulder joint is highly vulnerable. Repetitive strain, poor mobility, or traumatic falls can lead to chronic pain or functional loss.
Prevention:
Strengthen Stabilizers: Include rotator cuff and scapular stability work (e.g., resistance band external rotations, rows).
Improve Mobility: Stretch pectoralis group, thoracic extension and strengthen the mid-back to allow proper shoulder motion.
Avoid Overuse: Don’t overload shoulders with overhead presses if form isn’t solid.
Train Symmetry: Ensure both shoulders are balanced in strength and flexibility.
4. Ankle Injuries
Common Types:
Lateral ankle sprains
Achilles tendinitis
Peroneal strain or instability
How:
Tactical athletes often sprint, change direction quickly, or operate on uneven terrain — all of which increase the risk of rolling an ankle. Bulky footwear, limited foot space ,and muscle imbalances further increase the odds.
Prevention:
Balance and Proprioception Training: Use single-leg drills, balance boards, and BOSU balls to build stability.
Strengthen Ankles and Calves: Include heel raises, eccentric calf drops, and band work.
Strengthen Foot and Arch: Practice toe curling, extension and intrinsic doming exercises.
Upgrade Footwear: Ensure boots and shoes are in good condition, provide ankle support, yet not too constricting.
5. Overuse Injuries
Common Types:
Medial Tibial Stress Syndrome (Shin splints)
Stress fractures
Tendinitis (Achilles, patellar, shoulder, or elbow)
How:
Overuse injuries result from doing too much, too fast, without adequate recovery. This is especially common during training phases, selection courses, or repeated high-intensity shifts. Small repetitive motions — even without heavy loads — can cause tissue breakdown over time.
Prevention:
Use Periodized Training: Alternate between high, moderate, and low-intensity phases to allow recovery.
Incorporate Cross-Training: Vary activities (swim, cycle, pilates, yoga, row) to reduce repetitive strain.
Watch Volume and Load: Increase activity gradually — avoid sudden jumps in mileage or intensity.
Prioritize Recovery: Sufficient sleep, proper hydration & nutrition, stress management, and stretch or foam roll regularly.
A General Guideline for Tissue Healing Timelines:
*These are general timelines, as ranges can vary depending on a person’s current health and past medical history. Always consult with your rehab professional or medical provider.
Key points to remember:
Muscles heal faster because of better blood supply.
Tendons and ligaments heal slower because of less blood flow.
Bones generally heal steadily but need stabilization (casts, braces) during the early weeks.
Debrief:
Injuries among tactical athletes don’t just impact the individual — they can also affect entire teams, missions, and operations. By identifying common injury patterns and implementing smart, proactive strategies, tactical personnel can stay mission-ready and extend their operational careers.
It all begins with the correct education and awareness. Within this lies the main pillars of injury prevention: strength, mobility, proper technique, and recovery. Integrating these elements into regular training routines and on-the-job habits can make the difference between a thriving career and one sidelined by injury/re-injury.
STAY PRIMED.
References:
American Academy of Orthopaedic Surgeons (AAOS). (2021). OrthoInfo: Injury Prevention.
Retrieved from https://orthoinfo.aaos.orgAnderson, M. K., Hall, S. J., & Martin, M. (2014). Foundations of Athletic Training: Prevention, Assessment, and Management. Lippincott Williams & Wilkins.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 5th ed. McGraw Hill; 2020.
Houglum, P. A., Harrelson, G. L., & Leaver-Dunn, D. (2018). Principles of Athletic Training: A Guide to Evidence-Based Clinical Practice. McGraw-Hill Education.
Knapik, J. J., & Reynolds, K. L. (2002). Load carriage in military operations: A review of historical, physiological, biomechanical, and medical aspects. Military Medicine, 167(1), 11-16.
National Institute for Occupational Safety and Health (NIOSH). (2019). Preventing Injuries in Tactical Operations.
Retrieved from https://www.cdc.gov/nioshPeate, W. F., Lundgren, K., & Johnson, J. J. (2007). Fitness for duty: The need for medical fitness programs for first responders. Occupational Medicine, 57(5), 336–341.
About O2X Injury Prevention Specialist Dr. Austin Pack:
Dr. Austin K. Pack is a Physical Therapist based out of Greenville, South Carolina. He graduated this past year from Philadelphia College of Osteopathic Medicine with his Doctorate in Physical Therapy. Prior to his education, he served 4 years in the Marine Corps as an Infantry Team Leader. He served overseas in several countries during his time. He grew up loving the outdoors, playing sports, being active and helping others. Austin loves to understand human movement, whole body wellness and training for longevity and performance; He implements this through the way he treats his patients/clients. He has worked with athletes of all levels, military, active population, etc. He enjoys giving back to the military/veteran community and to people who invest in their health. Austin is also a certified strength and conditioning coach through the NSCA. He also owns his own performance based physical therapy business, All Prime PT.
About O2X Human Performance:
O2X Human Performance provides comprehensive, science-backed programs to hundreds of public safety departments, federal agencies, and the military. O2X works with clients to elevate culture, improve mental and physical wellbeing, support healthy lifestyles, and reduce healthcare costs associated with injuries and illnesses. Driven by results and cutting edge research, O2X programs are designed and delivered by a team of Special Operations veterans, high level athletes, and hundreds of leading experts in their respective fields of human performance.
