I have recently completed a work hardening program for Kylie, a 49-year-old female who sustained a right-side calf injury at work. Kylie was referred to Absolute Balance just 3 weeks after the initial injury. When we received the referral, Kylie was completing full pre-injury hours, although her restrictions were lift to 5kg, no prolonged walking or standing, and avoid pushing wheelchairs. She also experienced a 5/10 pain throughout her right foot and lower limb and showed high fear avoidant behaviours associated with exercise. Kylie was highly motivated to return to work although had never stepped foot in a gym and was quite intimidated by the thought.
General Information – Kylie:
Client: 49-year-old female
Injury Details: Right side calf injury
Pre-Injury Job Role: Education Assistant – Special Needs
Medical Restriction: PIH – no lifting more than 5kg, avoid prolonged walking, standing, no running/jogging, avoid pushing wheelchairs.
Rehabilitation Goals: Reduce pain symptoms and fear avoidant behaviours associated with exercise, increase tolerance and confidence with performing all work-related tasks and educate on the importance of self-management strategies for long term injury management.
We assessed Kylie, obtained her injury history and completed appropriate physical testing. The key findings were; mild limitations in ankle and lower limb range of motion and reduced lower limb strength and endurance with resistance-based exercise. Kylie reported a 5/10 pain throughout her calf when asked to perform functional movement tasks and whilst walking downstairs.
Kylie also presented with generalized lower body deconditioning and demonstrated high fear avoidance behaviours, admitting she was quite concerned about the risk of re-injury given her symptoms at the time. Kylie also mentioned she avoided descending stairs and walking long distances as she believed this would result in re-injury.
In order to return Kylie to her full pre-injury job role, she needed to demonstrate that she could:
- Lift 20kg from floor to waist
- Lift 10kg from waist to shoulder
- Push / pull loads up to 30kg (such as wheelchairs)
- Prolonged standing, sitting and walking (up to 1 hour each repetitively throughout the day)
- Assist with sport classes and classroom tasks
Kylie’s exercise program was prescribed based on her physical presentation in the initial assessment and the critical physical demands required for her job role outlined above. As Kylie had no prior gym experience and was quite skeptical about the thought of attending independently, I accompanied her to the supervised sessions once per week to ensure she was confident in her ability to complete the prescribed exercises and I could answer any questions she had regarding technique or machine set-ups.
We then set her up with a phone exercise app called TrackActive, allowing us to upload her exercise programs electronically and being able to access pictures and videos of exercise technique with instructions as well as individualised sets and repetitions. Kylie was also advised she was more than welcome to contact me throughout the week at any time regarding any questions or queries she has regarding her exercise program.
Just 4 weeks into her exercise program, Kylie had gained the confidence to attend the gym independently and could demonstrate all her exercises with correct technique. At this point in time, Kylie was attending the gym close to 4 times per week. We also challenged unhelpful injury beliefs by providing education surrounding pathology, injury causation and the evidence behind the importance of a graded exercise routine. Throughout the claim, Kylie also reported other external changes such as weight loss, Kylie also admitted to feeling much happier within herself and expressed how much her confidence in her abilities had improved.
After completing a ten-week exercise program with Absolute Balance, Kylie had returned to full pre-injury duties and hours achieving 100% capacity in the physical critical demands outlined in the initial assessment. Kylie was then issued a final medical certificate. 4 weeks on Kylie is still completing her exercise program within the gym up to 4 times per week with a gym membership she has now continued herself and understands the importance of self-managing her exercise program going forward to avoid the risk of re-injury.
Kylie has also noted a significant improvement in her mood, body confidence and energy levels since commencing the exercise program. Often some factors that go un-noticed. Awesome job Kylie!
For more information on return to work exercise rehabilitation programmes contact Absolute Balance on 9244 5580 or email us at email@example.com.
Channai Graham (B.Sc-Ex.Sp.Sci,Post.Grad.Dip.(Clin.Ex.Phys))
Accredited Exercise Physiologist (AEP) (AES) (ESSAM)