On-Site Manual Therapy for Firefighters in Seoul: Six-Month Utilization and Outcome from a Retrospective Service Analysis

Can on-site manual therapy reduce musculoskeletal pain for firefighters? A six-month pilot program in Seoul fire stations suggests that bringing manual therapy directly to firefighters at their workplace is a feasible approach to addressing the chronic musculoskeletal disorders common in fire service — and it raises a broader question about how emergency services worldwide handle the physical toll of the job.

TL;DR

• Seoul's fire service piloted on-site manual therapy at fire stations over six months — the first known feasibility report of this kind of intervention in a fire station setting.
• Musculoskeletal disorders remain one of the most undertreated occupational hazards in fire and EMS, often addressed only after the damage is advanced.
• Bringing treatment to the station removes the most common barrier to care: time away from shift and crew.
• Fire and EMS agencies should evaluate whether on-site physical health interventions — not just gym access — belong in their wellness programs.

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Firefighters break down. Not dramatically, not all at once — but steadily, over years of lifting, pulling, carrying, and absorbing impact in environments no ergonomics committee ever designed for. The conversation around first responder health has shifted heavily toward mental health and behavioral wellness over the last decade. That shift matters. But it has also left a gap: the physical damage that accumulates shift after shift rarely gets the same institutional attention. Musculoskeletal disorders are treated as an inevitability rather than something that can be managed upstream. A pilot program in Seoul, South Korea, attempted to address that gap directly — by placing manual therapy providers inside fire stations. The results, published in Chiropractic & Manual Therapies in April 2026, represent the first known feasibility report of this kind of intervention delivered at fire stations. The study design was retrospective service analysis combined with a web-based survey of firefighters who participated.

What Did the Seoul Fire Service Actually Do?

In 2023, firefighters in Seoul responded to over two million emergency calls. The Seoul Metropolitan Fire & Disaster Headquarters (SMFDH) recognized that this call volume — combined with the physical demands of firefighting, rescue operations, and emergency medical response — placed firefighters at elevated risk for musculoskeletal disorders and occupational stress. Rather than relying on off-site referrals or generic wellness programming, SMFDH piloted an on-site manual therapy program. Providers delivered treatment directly at fire stations. The program ran for six months, and researchers evaluated both utilization patterns and outcomes through a retrospective analysis of service records and a web-based survey of participating firefighters. This is significant not because manual therapy is new, but because the delivery model is. The intervention went to where firefighters work, rather than requiring firefighters to seek care on their own time.

Why Do Musculoskeletal Injuries Get Ignored in Fire and EMS?

Musculoskeletal disorders are among the most common occupational injuries in fire and EMS. Back injuries, shoulder dysfunction, knee deterioration, chronic neck pain — these are not edge cases. These are baseline conditions for many providers with more than a few years on the job. The problem is not that providers are unaware of their pain. The problem is structural. Most fire and EMS agencies address musculoskeletal health reactively. A provider gets injured, files a workers' compensation claim, and enters a treatment pipeline that is slow, bureaucratic, and often disconnected from the realities of shift work. Preventive care — the kind that could reduce injury severity or delay onset — rarely fits into the operational model. Barriers include: - Time: Off-site appointments require time away from shift. In 24-hour or 48-hour shift environments, that means sacrificing rest periods or personal time. - Access: Many stations are in areas without convenient access to physical therapy, chiropractic, or manual therapy providers. - Culture: Seeking treatment for pain that is not yet disabling often gets categorized — explicitly or implicitly — as weakness. - Cost: Without clear organizational support, providers absorb costs individually, which suppresses utilization. A review of Korean firefighter health interventions published in Frontiers in Public Health found that the vast majority of programs (85.7%) relied on face-to-face delivery methods, with most being workplace-based. However, the same review noted limited follow-up and a need for more diverse intervention formats. The Seoul manual therapy pilot fits within this landscape as one of the few programs specifically targeting musculoskeletal health through hands-on, station-based care. Education on topics like this is part of the broader work being developed through the nonprofit  Emergency Services Outreach.

How Does On-Site Treatment Change Utilization?

The core insight from the Seoul program is not about manual therapy specifically. It is about access architecture. When treatment is available at the station — during or between operational periods — the barriers listed above shrink significantly. Providers do not need to schedule around shifts. They do not need to drive to an appointment. They do not need to explain to a crew why they are leaving. A typical case might involve: a firefighter with chronic low back pain from years of patient lifting and equipment carries who has never sought treatment because no single episode was severe enough to justify a workers' comp claim. On-site availability changes the calculation. Treatment becomes a low-friction option rather than a logistical project. This model is not theoretical. The Seoul program ran for six months in active fire stations with active firefighters responding to real call volumes. The feasibility question — can this work operationally? — appears to have been answered.

What Does This Mean for U.S. Fire and EMS Agencies?

Direct translation from a Seoul pilot to a U.S. fire department is not automatic. Healthcare delivery systems, labor structures, and cultural norms differ. But the underlying problem is identical: firefighters and EMS providers accumulate musculoskeletal damage, and most systems wait until that damage becomes disabling before intervening. Several operational considerations are worth evaluating: 1. Assess current MSD burden honestly. Most agencies know their injury rates. Fewer have mapped the chronic, sub-clinical pain that reduces performance and accelerates burnout without generating formal injury reports. 2. Evaluate on-site delivery models. This does not require hiring full-time clinicians. Contract arrangements with licensed manual therapy, chiropractic, or physical therapy providers — scheduled for regular station visits — can replicate the access model tested in Seoul. 3. Integrate physical health into existing wellness programs. Many agencies have invested in behavioral health, peer support, or fitness initiatives. Musculoskeletal care should sit alongside those programs, not compete with them for funding or attention. 4. Track utilization, not just outcomes. The Seoul study examined both. Utilization data reveals whether providers will actually use what is offered. High availability with low utilization signals a cultural or structural barrier that needs separate attention. 5. Remove stigma through normalization. When manual therapy is available at the station and used visibly by senior members, it stops being a sign of injury and starts being maintenance. The framing matters. Resources for long-term physical and psychological resilience are being developed through initiatives like Ranchito de la Redencion, designed to create space for recovery and sustained well-being for first responders, healthcare workers, and veterans.

Reactive Systems and Preventable Damage: The Broader Pattern

The Seoul pilot is one data point. But it fits a pattern that is observable across EMS systems internationally: occupational health programs for first responders tend to activate after damage is done, not before. A common situation in EMS: A 15-year paramedic with bilateral shoulder impingement and lumbar disc disease has never received a single employer-supported manual therapy session. The agency has a gym. It has an EAP. It may even have a peer support team. But the physical deterioration that will eventually end this provider's career has not been addressed by any organizational resource. That gap is not accidental. It reflects how fire and EMS agencies have historically defined "wellness" — as either fitness or mental health, with little space for the musculoskeletal maintenance that directly affects both operational readiness and career longevity. The Seoul program suggests that addressing this gap does not require a massive infrastructure investment. It requires a delivery model that meets providers where they are — at the station, on shift, without friction.

Bottom Line

Agencies that treat musculoskeletal health as an afterthought will continue losing experienced providers to preventable physical deterioration — and the Seoul pilot suggests that a station-based delivery model is feasible enough to test anywhere.

References

1. Park, S., & Jang, B.-H. (2026). On-site manual therapy for firefighters in Seoul: six-month utilization and outcome from a retrospective service analysis and web-based survey. Chiropractic & Manual Therapies. https://pubmed.ncbi.nlm.nih.gov/41998652/
2. Organizational health culture in the Korean firefighter intervention landscape. Frontiers in Public Health. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1537976/full

Emergency Services Outreach, Inc. is a non-profit dedicated to education, awareness, and long-term support for first responders, healthcare workers, and veterans. ESO operates Ranchito de la Redencion.