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Applying the "principles of training" to an injured worker.

June 20, 2023

The principles of training are a fundamental aspect that go into the planning and progression of athletes in all stages of their sporting career. They are similarly critical to the way in which we manage the rehabilitation of an injured worker. As Exercise Physiologists at Absolute Balance, we apply these principles daily to ensure our clients best progress their functional rehabilitation. It is also important that these principles are educated thoroughly to the client to ensure they can apply them in an independent manner and seek longevity away from supervised treatment.


Specificity:

When we make a programme for an injured client, it is important to understand the goal/s you are working towards with respect to the injury and the job role they are physically required to fulfil. Specificity outlines the need to programme towards aspects of the client’s job role to ensure they are conditioned to return to their pre-injury status. This will also provide the client with more confidence in their return to work. As workers compensation specialists, Absolute Balance specifically programmes work specific exercises for our clients to track their return-to-work progress.


Frequency:

When programming frequency it is important to consider the wide range of variables which can impact the rehabilitation of a client. This can include the stage the client is at in the rehabilitation, the type of exercise they are required to complete, how much they are currently working and their overall rate of recovery. We want to ensure the client sits comfortably between ‘overdoing it’ and ‘underdoing it’. In saying this, it is a constant learning process between the client and clinician which develops overtime through more experience working cooperatively.


Intensity:

Is another principle that is dependent upon a wide range of variables, particularly the stage in which the client is at in their rehabilitation and the requirements of their job role. Intensity is typically a subjective measure which a clinician can gather through tools such as RPE or rate of perceived exertion. Intensity can generally increase in the later stages of rehabilitation and more so for workers in physically demanding job roles such as in trades or mining.


Duration:

Typically, under the workers compensation scheme we allocate a certain timeframe to undertake an appointment. With this comes the need to identify how much of this time is utilised for work i.e., completing the exercise, rest, and other aspects such as education and general discussion. As clinicians we can modify the duration a client needs to spend completing their exercise per session and collectively in a week, and the size of their rest periods. Rest periods can be effectively tailored to best mimic the job demands which can be progressively changed depending on the stage in the client’s rehabilitation.


Progressive overload:

Is the principle of gradually increasing the stress placed on a specific muscle or muscle groups, joints, and collective structures in the body. This can be implemented through increases in weight, repetitions, duration, frequency etc. The overarching goal is to progressively increase the capacity of the individual by careful modifying a programme in line with their functional improvements. An easy way to identify the need for this is reported reduction in symptom presentation and rate of perceived exertion on a previously difficult programmed exercise.


Reversibility:

Commonly associated with the phrase ‘use it or lose it’, reversibility outlines a reduced functional capacity due to decreases or termination in exercise participation. It is important as clinicians we educate clients to progress them into an independent form of management where they continue their exercise habits far beyond the programme, effectively following the clinical framework.


References:

- Lambert, M.I., Viljoen, W., Bosch, A., Pearce, A.J. and Sayers, M., 2008. General principles of training. Olympic Textbook of Medicine in Sport. Chichester, UK: Blackwell Publishing, pp.1-48.

- Kraemer, W.J. and Ratamess, N.A., 2004. Fundamentals of resistance training: progression and exercise prescription. Medicine & science in sports & exercise, 36(4), pp.674-688.


Daine Richards

Workers Compensation Specialist (AEP, ESSAM)

Exercise Rehabilitation Services – WA

     

The Role of Load Management in Rehabilitation

By Michael Andrews • February 20, 2025
The Role of Load Management in Rehabilitation: A Framework for Returning to Function, and Injury Prevention. Load management is often associated with high performance sport, but its principles are just as critical in rehabilitation. Whether guiding injured workers back to work, older adults to independent living, or patients recovering from injuries, progressively and systematically managing load is essential for recovery, injury prevention, and long-term function. A major challenge in rehabilitation is balancing workload progression to optimise adaptation without overloading healing tissues. Sudden spikes in training load or returning to full activity too soon significantly increase the risk of re-injury. Exercise physiologists can use load monitoring, periodisation, and predictive planning to ensure a structured and safe return to work, life, or recreational activity. Understanding Load and How to Monitor It In rehabilitation, load refers to the total amount of mechanical and physiological stress placed on the body. This includes external load; the measurable work performed (e.g., weight lifted, steps taken, distance covered, time spent in physical activity), and internal load; the body’s physiological and perceptual response to that work (e.g., heart rate, rate of perceived exertion (RPE), pain, fatigue). Both external and internal load must be monitored to ensure that rehabilitation is progressive yet not excessive. One of the most useful frameworks for load management is the Acute: Chronic Workload Ratio (ACWR), which helps determine whether a patient is progressing at a safe rate or at risk of overload. A sudden spike in acute load (ACWR >1.5) increases injury risk by 2-4 times in the following week. Therefore, a gradual increase in chronic load (≤10% per week) is essential to build resilience and capacity. - Acute Load = The total workload over the past week. - Chronic Load = The rolling 4-week average of workload. - ACWR = Acute Load ÷ Chronic Load. Patients often underestimate how small spikes in activity (e.g., resuming full work shifts after time off, or inconsistent engagement in their self-management plan) can lead to flare-ups or re-injury, and by tracking ACWR, we can educate the patient accordingly and prevent excessive acute spikes while ensuring a steady increase in chronic workload, reducing the likelihood of setbacks and ensuring a progressive return to function. To apply these principles effectively, we need accurate and practical ways to measure and track load in real world rehabilitation settings. Unlike athletic settings, maximal strength testing (1RM) is often inappropriate in rehabilitation. Alternative methods include volume-based and time-based load tracking, perceived exertion and fatigue monitoring, and functional testing. - Monitoring total weight lifted per session (sets × reps × resistance). - Measuring time under tension for endurance-based activities. - Using exercise RPE and session RPE to gauge effort. - Reassessing movement capacity, endurance, and strength progression over time. Using subjective feedback alongside objective load tracking allows for better exercise prescription and progression. Asking the right questions can guide real-time modifications: External Load Questions: - How much activity did you complete this week? - How does this compare to last week? - Did you struggle with any tasks or exercises? Internal Load Questions: - How fatigued do you feel after sessions? - How long does it take you to recover? - Are you experiencing pain or discomfort, and how does it change with activity? Structuring Load Progression for Long-Term Success Periodisation is the planned progression of training load over time, ensuring continued adaptation without excessive strain. While typically used in athletic settings, structured periodisation is just as valuable in rehabilitation, helping prevent stagnation by adjusting workload over time, ensuring progressive overload while respecting tissue healing and recovery rates, and guiding return-to-work planning by matching rehabilitation loads with real-world demands. A structured approach allows us to compare a patient’s current workload tolerance to their end goal and reverse-engineer a safe progression plan. If a patient needs to tolerate X hours of work or Y level of activity, we can use their current capacity and reverse-calculate a safe, gradual progression timeline and by maintaining consistent, small increases in chronic workload, we minimise setbacks and ensure safe long-term recovery. Linear Periodisation is best suited for straightforward recovery cases with minimal variability in symptoms. While, nonlinear periodisation may be more practical for rehabilitation, as symptoms and capacity can vary day-to-day. - Linear Periodisation: Steady, predictable increases in intensity, volume, or duration over time. - Nonlinear (Undulating) Periodisation: Load fluctuates based on recovery, pain, and function. Applying Periodisation to Rehabilitation Planning Step 1: Establish a Baseline Identify current weekly workload (e.g., hours of tolerated activity, steps, resistance training volume) and functional deficits (e.g., strength, endurance, movement capacity). Step 2: Define the End Goal What workload is required to return to work, sport, or daily function? This could mean sustaining an 8-hour work shift, lifting a certain weight, or tolerating daily activities without pain. Step 3: Plan a Safe Progression Gradually increase chronic workload by ≤10% per week. Avoiding acute spikes (ACWR >1.5) to prevent setbacks. Monitor pain, fatigue, and function to guide daily and weekly adjustments. By integrating load monitoring, periodisation, and predictive planning, exercise physiologists can create safe, structured rehabilitation programs that optimise recovery, prevent re-injury, and guide patients back to work, sport, or daily life with confidence. Key Takeaways for Exercise Physiologists - Load management is essential in rehabilitation, not just in sports. - Acute vs. chronic load balance is key. Avoiding acute spikes prevents injury, while gradual increases build resilience. - Tracking external and internal load ensures a data-driven approach to exercise prescription. - Periodisation structures rehabilitation progression, ensuring steady gains without excessive strain. - Patient education on workload progression improves compliance and reduces re-injury risk. References Impellizzeri, F. M., Menaspà, P., Coutts, A. J., Kalkhoven, J., & Menaspà, M. J. (2020). Training load and its role in injury prevention, part I: back to the future. Journal of athletic training, 55(9), 885-892. Gabbett, T. J., Kennelly, S., Sheehan, J., Hawkins, R., Milsom, J., King, E., ... & Ekstrand, J. (2016). If overuse injury is a ‘training load error’, should undertraining be viewed the same way?. British Journal of Sports Medicine, 50(17), 1017-1018. Windt, J., & Gabbett, T. J. (2017). How do training and competition workloads relate to injury? The workload—injury aetiology model. British journal of sports medicine, 51(5), 428-435. Jildeh, T. R. (2024). Editorial commentary: load management is essential to prevent season-ending injuries in the National Basketball Association. Arthroscopy, 40(9), 2474-2476. Bache-Mathiesen, L. K., Andersen, T. E., Dalen-Lorentsen, T., Tabben, M., Chamari, K., Clarsen, B., & Fagerland, M. W. (2023). A new statistical approach to training load and injury risk: separating the acute from the chronic load. Biology of sport, 41(1), 119-134. Williams, S., West, S., Cross, M. J., & Stokes, K. A. (2017). Better way to determine the acute: chronic workload ratio?. British journal of sports medicine, 51(3), 209-210. Carey, D. L., Ong, K., Whiteley, R., Crossley, K. M., Crow, J., & Morris, M. E. (2018). Predictive modelling of training loads and injury in Australian football. International Journal of Computer Science in Sport, 17(1), 49-66. Impellizzeri, F. M., Shrier, I., McLaren, S. J., Coutts, A. J., McCall, A., Slattery, K., ... & Kalkhoven, J. T. (2023). Understanding training load as exposure and dose. Sports Medicine, 53(9), 1667-1679. Lorenz, D. S., Reiman, M. P., & Walker, J. C. (2010). Periodization: current review and suggested implementation for athletic rehabilitation. Sports Health, 2(6), 509-518. April Hawser Exercise Physiologist Exercise Rehabilitation Services – NSW

Rehab a wrist Injury, from an Exercise Physiology perspective

February 7, 2025
How would I rehabilitate a wrist, hand or finger injury? Rehabilitating a hand injury is challenging due to the hand's essential role in daily tasks, including heavy lifting and precise movements. So, what are some key focuses to prioritise with rehabilitation of the hand and wrist? Understanding hand anatomy is essential. The hand consists of 27 bones: 8 carpal bones (wrist base), 5 metacarpals (palm), and 14 phalanges (fingers), all connected by ligaments and serving as tendon attachments. When an upper limb injury occurs, immobilization is necessary for recovery. This leads to reduced upper limb use, resulting in muscle atrophy, decreased strength and feelings of tightness or stiffness, along with discomfort. Not every movement requires a 'power' grip for strength and endurance restoration. Rehabilitation stages may involve using various objects to challenge the grip, facilitating a transition to dynamic everyday strength. The hand, as the most proximal structure of the upper limb, is crucial for daily tasks and fine motor control. A little tip that can help improve someone’s rehabilitation is implementing exercises that can incorporate a ball, broomstick or even different types of stationary! Rehabilitation for fingers, hands, and wrists varies for each individual.  A tailored approach, sometimes requiring minimal intervention or creative solutions, can lead to optimal outcomes. Afiq Jackson Workers Compensation Specialist ‑ Team Leader North West (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA

The Role of Sports and Exercise in Fostering Relationships and Instilling Purpose

January 31, 2025
Joining a sports club or team provides an opportunity to integrate into a community where you can forge lasting relationships. This experience can offer a sense of purpose and belonging. Below are three separate occasions that illustrate how joining a rugby club and a squash club positively influenced my life: Occasion 1: I began my university journey in a new city, knowing only a few friends from school. After taking a gap year in New Zealand, my school friends had already formed new connections at university, having started a year before me. One sunny morning at the beach, I was invited to join a touch rugby game with people I had never met. Fast forward three years, and the new acquaintances I made that day had become lifelong friends through my involvement at the local rugby club they played for. Participating in that touch rugby game allowed me to connect with like-minded individuals, which led to me joining the rugby club and giving me a sense of purpose and direction during my early university years. Occasion 2: After graduating from university, I relocated to a new city to embark on my first real job. Drawing from my past experiences, I sought out the nearest squash club, having given up rugby due to an injury. Just like before, within two days of becoming a member of the local squash club, I received invitations to lunch and social gatherings at the homes of fellow players. Along with connecting with a wonderful group of individuals, the regular exercise and my commitment to a team that I had to show up for each week provided me with a similar sense of purpose I had experienced during my rugby club days. This experience was essential in helping me become the best version of myself. Occasion 3: The final and perhaps the most significant moment to reflect on was when I relocated to a larger, busier city to advance my career. During this transition, I reconnected with an old friend from a previous club who had taken up running. Naturally, I joined him for a few runs, quickly bonding with the running group. After a year, I became involved in this running community, which ultimately resulted in my moving into a new home and meeting my now-wife! To sum up, the potential that sports and exercise offer is limitless. In any setting filled with like-minded individuals, the possibilities are endless! I hope this blog inspires you to finally join that gym or sport you've been interested in for all these years! Michael Andrews Business Development Manager
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