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A day in trade with Mr Daniel Meyerkort – Orthopaedic surgeon

Jan 04, 2021

As an Exercise Physiologist we normally see our patients in the sub-acute to chronic stages of post-operative rehabilitation. I recently had the pleasure of observing Mr Daniel Meyerkort from Perth Orthopaedic and Sports Medicine Centre in theatre at Hollywood Hospital in Perth. I was lucky enough to witness three procedures during the afternoon observations, two of which will assist with understanding the process of post-operative exercise prescription for my patients in the workers compensation system who have undergone these surgeries. I was able to witness a lateral ankle ligament and tendon repair, chronic exercise-induced compartment syndrome fasciotomy and an ACL reconstruction with meniscal root repair.

It was humbling to see the professionalism of the team in the room from wheeling the patient in and going through pre-op procedures to wheeling the patient out for post-operative recovery. The team run like clockwork whilst still taking the time to ensure every patient is safe. It was amazing to see the differences in skills required from delicate stitching through to pulling through new ACL grafts that are required with some force! It is easier to appreciate why some patients pull up with more pain than others due to the invasiveness and force of some of these procedures. I have quickly learnt over my time that two patients will not recover from the same surgery in the same way. I also learnt that a lot of the patients will present quite sore not only from the surgery but also the tourniquet applied above the surgical site.

Mr Meyerkort explained that despite patients presenting with the same injuries, advice will change depending on the patient themselves. Not only the amount of injury sustained is taken into account but their age, associated risks and comorbidities, the occupation of the person as well as their standpoint on having surgery. This is always why I encourage my patients not to “Dr Google” as the advice is never going to be the same for every person. Every person’s rehab journey post-surgery is never going to be the same either. It was also great to hear the amount of education that is given to the patient’s surrounding their surgery.

It was surprising to see that even with viewing the imaging of the patient’s knee prior to surgery it is sometimes never fully clear to see the extent of what is going on until you are in the surgery. Mr Meyerkort kindly talked through each of the surgeries whilst able to repair on the go. During the ACL reconstruction he was able to go through the knee and find out the exact parts of the meniscus that needed repairing and his team where able to demonstrate and explain the thread work required and the importance of positioning and precise drilling required through the tibia and femur. The ACL procedure was the longest and most technical of the three with the aim of restoring stability to the knee. Mr Meyerkort demonstrated the extraction of the hamstring graft first using a long instrument to take the semitendinosus and gracilis to use for the graft. Careful inspections of the tendons is a must to make sure the thickness is of exact amount to provide stability. While Mr Meyerkort was repairing the meniscal damage and clearing the fat pad of the knee, the hamstring graft was being meticulously prepared. Throughout the surgery the knee was regularly tested through flexion and extension to ensure everything was on track. This is something that as an exercise physiologist I can draw on, as functional testing should be intermittently performed on the patient to ensure treatment is effective. Through fine and technical threadwork along with some brute strength, the ACL graft was pulled through the knee and secured in a tight position to restore the patient’s stability with the entire surgery lasting approximately two hours.

It was fabulous to see the acute stages of injury repair and the start of a patient’s rehab journey. I was able to draw comparisons in Mr Meyerkort’s work which rings true in the exercise physiology world.

1. You always have to consider the patient as an individual and no one treatment will have the same effect on that patient.

2. No person will have the exact same outcome and it is important to consistently test and check along the way

3. To always have respect and care for the patient and listen to their needs and concerns and be able to adapt in your approach where possible.

It is important to empower the patient through their recovery. If you have a question surrounding pre or post-operative rehabilitation, you can contact an Accredited Exercise Physiologist.

Taylor Downes

Accredited Exercise Physiologist

BSc/GradDipClinExPhys | B.Ed. Human Movement | (ESSAM, AEP)

22 Mar, 2024
Does your spine look like the picture on the left or does it look more like the one on the right? As Exercise Physiologists, we often see all sorts of presentations of the spine and in this blog, we will be covering a condition known as ‘lordosis’. More specifically, we will be focusing on the lower or ‘lumbar’ aspect of the spine, which is where we see this condition commonly. What is Lordosis? Normally, the spine is naturally curved forward a little bit which helps with shock absorption and supports optimum posture but in lordosis there is an inward exaggeration of the spinal curve which can be felt on the outside as a deep dip in the lower back. Who does it affect? Simply put, anyone of any age group can develop lordosis and it is most seen in people who are pregnant, as a hereditary condition in children and adults with obesity or reduced bone density are at a higher risk of development of this condition. What is the cause? A common cause for lordosis includes poor posture as a result of weak core muscles and muscular imbalances which can be attributed to the modern-day lifestyle where we are sitting more than ever. Other causes include conditions such as osteoporosis, spondylolisthesis, kyphosis and as previously mentioned, obesity. What are the symptoms? An obvious symptom of lordosis is lower back pain. As you can see in the photos above, there is a higher risk of complication involving entrapment of a nerve when there is excessive spinal curvature leading to increased compression of the spinal vertebrae. Although sometimes lordosis can be asymptomatic and a person can go about their daily lives without too much of an issue, in more serious cases, those affected can potentially experience lumbar radiculopathy or sciatica, where there is compression of the exiting lumbar nerve roots and lead to symptoms which can be described as burning, tingling, radiating pain, paraesthesia and numbness in one or more uncommonly, both legs. How is it treated by an Exercise Physiologist? As they say, prevention is better than cure and to reduce the risk of potential future development of lordosis, maintenance of a healthy weight and engaging in core-strengthening exercises will assist with reducing the pressure placed on the spine as well as maintaining proper posture. However, if you are somebody who is already experiencing back pain as a result of lordosis, it is never too late to engage in physical therapy to improve pain-free range of movement, flexibility and mobility of the spine. Posture can also be improved significantly with strengthening of the appropriate musculature in the trunk, hips and lower limbs and addressing compensatory patterns that may have developed over time. For example, when a person spends a significant amount of time in a seated position, the muscles in the lower or lumbar aspect of the back can become excessively tight from trying to support and stabilise the spine. Additionally, muscle groups such as the hamstrings, glutes and abdominals become weak and inhibited, contributing to poor biomechanics. Physical therapy has been proven to be highly effective by taking a conservative approach to manage symptoms and improve function. With adherence to an appropriate rehabilitation programme an injured worker will have a higher chance of returning to work as well as a return to normal activities. Chris Chen Workers Compensation Specialist ‑ Innovation Team Leader (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
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Rhythm is one of the most important elements of music across all its forms. Rhythm gives structure to music. It assists tone, it influences tempo and can control cadence, just for a quick snapshot. What I’ve found over my time playing music as hobby, is that rhythm is ever important and ever consistent. It’s something we can create, maintain, tweak, and develop but ultimately it remains consistent in providing structure. It’s also something we all have in our day-to-day life and in relation to our overall health, a rhythm can provide a positive impact on our overall health and wellbeing. So, you’re probably wondering where I’m going with this and how does it relate to exercise or health? Over time, or maybe just through personal growth and more awareness I have found that there are certain structures or constants that are frequent in my day and when performed consistently over a period time, provide the opportunity for me to perform at the best I can be and have a positive impact on my health and wellbeing. That being said, when these structures aren’t followed through or forgotten, it can then create the opposite effect; whereby we may feel stress, fatigue, unmotivated and not on the right track. For me I have found that I have a general rhythm that I try to maintain, the hard part is consistency (which is the challenge for most things!). Think of this another way. It could be your routine, your non-negotiable’s, the one-percenter’s, your daily habits or even just the beat of your day. Things that you do daily, that create structure, consistency, and the mainstay standards you have for yourself that help you be the best version of yourself. For some it can involve a variety of things and as you’re reading this, I am sure you are already thinking about some of these items. Okay, what are these constants? They can be as specific as you like or as general as possible, they could incorporate activity and exercise (I hope so!) or involve silence and stillness. It could include reading, journalling, meditation, the way you sleep or eat, the rules, restrictions, or freedoms you have put in place. There is no right or wrong way. If it works for you and you can be consistent, then ultimately this is your rhythm and as such your guide to maintaining your health! Coming into a new year, dealing with significant change, or working through a new challenge, there’s always a chance you can be thrown a curveball and then get stuck trying to work through it, whereby there are usually sacrifices made with our day-to-day rhythm, which then impact our health and wellbeing in a negative manner. It’s important in these moments to reflect to our rhythm or routine (whatever name you have for it) and make sure we don’t make those sacrifices, and we strive to maintain our peak health and well-being. Afiq Jackson Workers Compensation Specialist ‑ Team Leader North West (AEP, ESSAM)
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Hey guys, Mike Andrews here. I am the Business Development Manager at Absolute Balance, a role I have filled for just over 18 months. This exciting role has allowed me to learn an immense amount about myself and the team that makes up our business. The team of exercise physiologists, the corporate team, and injury prevention, have phenomenal positive outcomes and back to work results, proving their elite level of work. The team is changing lives on the daily, however I often notice how they overlook their own impact, and just shrug it off as “just doing my job”. I agree, they are doing their job, but the impact and effect is way more than that and there is importance in knowing your impact. Now this is where I come in, and I love my role, without a doubt, I consider it an absolute privilege. I spend quality face to face time with our team, assisting and coaching them on their mindset around their impact of “just doing my job”. As a result of my role and my interaction with the team believe “BDM” should stand for Building & Developing Mindset. Each team member has a different approach to their work, comes from a different mindset, background, and has their own strengths, and or weakness, an aspect which makes the time spent with them so rewarding. Everyone will find their sweet spot with their mindset at different stages which is great! With that being said, the real goal for the business is combining the individual strengths into a highly functioning team. In my view, the simpler and more straight forward the goals/attributes the better. I’ve stated three that I believe will result in a highly functioning team, which are: 1. Clear vision. 2. Clear roles for each team member. 3. Celebrating the process. As important as each attribute is, I believe the last one outweighs the rest. When you combine the energy and passion our team have with an improved mindset, each day will be more rewarding and enjoyable. My role is to help assist the team members to use their attributes and strengths to find their sweet spot or ultimate mindset. That’s why I believe my role is so enjoyable and ultimately should stand for Building & Developing Mindset. Michael Andrews Business Development Manager 
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