Patient Case Study – Full Rotator Cuff Avulsion Rehabilitation

Patient details: 65yr old male, Obese, Hypertension, no other comorbidities

Occupation: Heavy haulage truck driver

Injury Details: Fell between two truck trailers onto the right arm causing major rotator cuff tearing. Right shoulder arthroscopic subacromial decompression, excision of the AC joint and open repair of a massive avulsion of the entire rotator cuff on the 24/08/2020.

Critical Physical Demands of the job role: Ingress/Egress from large trucks and heavy machinery requiring 3 points of contact and ladder climbing. Lifting to 30kg from floor to shoulder height, forceful manoeuvring of items weighing up to 30kg at chest height, occasional heavy lifting above head height up to 30kg, repetitive upper limb use when tying downloads. Physical tasks can be completed for periods of up to 4 hours on a repetitive basis.

Rehab Timeline: The patient commenced physiotherapy immediately post-op and completed this for the first 6-weeks, he then transitioned to an exercise rehabilitation programme under my supervision at the request of the surgeon. From weeks 6-12 post-operatively, the focus of the exercise rehabilitation programme was to restore pain-free shoulder passive and then active ROM and begin isometric rotator cuff activation exercises and basic Theraband exercises in preparation for moving into the strengthening phase of the programme after week 12.

On review with the treating surgeon at 12-weeks post-operatively, the surgeon was happy with progress given the complexity of the injury, and clearance was provided to commence gentle strengthening exercises. From week 12 onwards, strengthening exercises were gradually introduced whilst also keeping focused on further building and maintaining the patient’s active ROM and rotator cuff function. Overhead exercises were not introduced until 5-months post-operatively when the patient was able to demonstrate good scapulothoracic control into overhead positions. The patient made steady progress over a period of 3-months (see graph below), with weekly reviews to ensure he remained on track with his exercises and they were appropriate for his presentation and abilities.

At the 6-month post-operative review, the patient was able to demonstrate normal pain-free shoulder range of motion (symmetrical to his non-injured arm), excellent power and strength with all rotator cuff integrity testing, and had reached the appropriate milestones to facilitate a graduated return to work programme. Using the evidence from the supervised exercise programme, the surgeon was able to provide clearance for the patient to return to modified duties with a 15kg lifting restriction below shoulder height only.

The patient is due to review with the surgeon again at the 9-month post-operative mark, the goal prior to this review is to further build the patient’s strength and tolerance for work-specific physical tasks and gradually build strength and capacity for overhead movements. The exercise programme will be suitably modified to begin to replicate the critical physical demands of the job role to ensure the patient is exposed to these tasks in a controlled environment, where a focus on correct manual handling and sound technique can we implemented. The ideal scenario would be for the patient to return to his full pre-injury duties at the 9-month mark, with some possible permanent restrictions in places for overhead lifting, due to the nature of the injury and surgery completed.

Keep an eye out for further updates on the patient’s journey over the coming months!

Alixe Marion (BSc – Exercise Physiology)

Workers Compensation Specialist

Senior Accredited Exercise Physiologist

Patient Interview

Patient Interview: Phulpreet was referred to us following a lower back injury he had obtained at work. Given Phulpreet’s pre-injury job role was quite heavy and labour intensive, I recommended he commence a gym-based program to ensure we had adequate equipment so he was able to demonstrate lifting capacity in order to return to full pre-injury duties. Phulpreet, however, was not 100% confident with attending the gym on his own given he had no previous gym experience. Fast forward to now, just five short weeks into his program, Phulpreet is averaging 4 weekly visits to the gym (one of these being supervised) and has gone from being certified fit to complete supervisory duties, to close to full capacity whilst also reporting a significant improvement in lower back symptoms.

I asked Phulpreet a few questions at our most recent consultation to understand how he (and I assume quite a few others) feel when we recommend a gym membership and they have not stepped foot in a gym before. I also wanted to address how he has gone from feeling quite anxious in a gym environment, to attending 4 times per week and more importantly how he feels as a result.

Prior to your injury, what is your exercise history?

“Absolutely nothing, it was all just work-related. I felt because I lifted heavy things at work, I did not really need to attend the gym because I was doing enough”.

What was your view around the gym prior to starting this program?

“I was nervous about what other people thought of me. Was I doing exercises with the right technique? What if I was doing it wrong?”

What did you expect when getting referred to us at Absolute Balance?

“I thought you were going to push me too hard I was going to be so sore and wouldn’t want to come back.”

2-3 sessions in, how did this change?

“Was such a big improvement, I started with mat work which was good to start and once you had taught me to breathe properly and release the tightness throughout my back my pain improved almost immediately. Because you taught me the technique, I didn’t even think about other people watching me at the gym. Because I felt so much better it made me want to come to the gym to get better.”

How has your perception around pain changed?

“Significantly, I don’t have to rely on other people for my daily activities and I’m no longer in pain throughout the day. It also helped me get my health back on track, I feel a lot better after coming here.”

What advice would you give to someone else who has been recommended to attend the gym but has no previous experience like yourself?

“Do not compare yourself and do not look at others for comparison, pay really good attention to your instructor as they are there for you to help you.”

 At our initial assessment, Phulpreet was able to lift 5kg from floor to waist and waist to shoulder, he struggled to complete full range squats or multiple cable rotations due to on-going pain throughout his back. Phulpreet’s average pain score was 6/10 following prolonged sitting or standing and was very guarded when asked to move into lumbar flexion and extension. The photos below were taken just five weeks into his program and his average pain score has decreased to an intermittent 1/10 pain.

Given Phulpreet was quite reluctant to attend the gym given the minimal prior experience, I spent additional time throughout our sessions on teaching him correct technique, how to adjust machines, gave him a few key points on what to focus on throughout each movement and tried to limit the exercises I prescribed to one area of the gym. From speaking with Phulpreet, it was these little changes that reportedly made him feel much more confident with attending the gym as he felt no one was staring at him for doing something with wrong technique or not being able to adjust the machines.

By identifying these barriers early, it ensured that I could address these and make sure there was not going to be any push back when it came to Phulpreet’s progress and compliance to the program. This has helped immensely when proving functional capacity within the gym and making sure he was comfortable within the gym environment. Phulpreet also mentioned to me at our last meeting that he was planning on continuing his gym membership even after our supervised sessions have ceased.

Please feel free to contact our team at info@absolutebalance.com.au if you have any queries regarding how best we can help.

Channai Graham (B.Sc-Ex.Sp.Sci,Post.Grad.Dip.(Clin.Ex.Phys))

Senior Accredited Exercise Physiologist (AEP) (AES) (ESSAM)

Meet the Team – Leigh Ashmore

Hi everyone, my name is Leigh Ashmore and I have recently joined the Absolute Balance family as a Senior Accredited Exercise Physiologist in the Workers’ Compensation team. Although new to Absolute Balance, I cannot say I am a ‘newbie’ to the industry having worked as an AEP in Occupational Health for almost 15 years…my how time flies!

 

Over this period, I have seen tremendous growth in (and recognition of) the Exercise Physiology profession, particularly with the strong evidence for active-based treatment modalities proving so pivotal in improving injury recovery times. Over the years of my career, I have had the pleasure of helping many different people with a wide range of complex and challenging injuries achieve their recovery goals.

 

Winding back – my childhood years were somewhat unique. I spent time growing up in the Central Wheatbelt of Western Australia on a Wheat and Sheep Farm which was approximately 6500 acres, give or take! As you could imagine, this environment enabled fantastic opportunities to develop my love of outdoors and living an active lifestyle.

 

Since I was young, I always had a keen interest in sport, regularly playing for the local footy and basketball teams. Due to the geographical isolation of our farm, it would not be unusual for our family to travel more than 3 hours for training and games, particularly when I was lucky enough to gain a WAIS scholarship as a teenager. Due to my interest in exercise, I naturally gravitated towards completing an Exercise and Sports Science degree, ultimately specialising in Exercise Rehabilitation.

 

Jumping forward to the present, my beautiful wife Nikki and I have three wonderful kids, Caleb (8), Aidan (6) and Chelsea (3) who are such a blessing in our lives but they definitely ensure life is busy and there’s never a dull moment. Now things have come full circle and it is me driving my kids to their respective sports continuing the encouragement of an active lifestyle for optimal health and wellbeing.

Leigh Ashmore BSc(Sports Science) PGradDip (Exercise Rehabilitation)

Senior Accredited Exercise Physiologist

 

 

My Recovery Journey (Part 1)

I am currently six weeks post my ACL reconstruction, meniscal repair, and lateral release. It has been very odd being on the opposite side of the fence, now being a patient instead of an exercise rehabilitation specialist, so I really wanted to give a bit of an insight into my recovery so far. I am hoping this blog serves to give a virtual hug to those going through an injury or recovery now, and a reminder that you are not alone! I am really trying to utilise this journey to become a better practitioner and human. Below are 4 of the biggest things I have learnt so far from weeks 1-6 post op.

BE KIND TO YOURSELF

To go from being able to work full time, go to the gym every day, go for a hike on the weekend, to struggling to get up out of bed (literally) is hard. Having surgery, or a significant injury affects EVERY PART of your life. Before having this operation, I made a promise to myself that I would be kind to myself and reassure myself that it is OKAY to not be okay sometimes. I gave myself a few days post-surgery to feel sorry for myself, have a cry, let people fuss over me and process the road ahead. Even when I started moving again, I was consciously making it a priority to tell myself it is OKAY that I cannot clean my entire house in an hour like I used to, it is OKAY to let someone carry my bag for me and instead of feeling frustrated about what I couldn’t do right now, take the situation for what it was and feel grateful at the amount of support I have.

KEEP STRUCTURED

Overall, I had two weeks off work but during that time off l still set an alarm Monday to Friday to get up, do my exercises, have a shower and get ready for the day (even if that was getting into some fresh trackies). I had my coffee outside with my dog and looked at my “schedule” for the day. I also made sure that I have set reminders in my phone to complete my exercises again at mid-day and then again before dinner, to ice three times a day, to continue to eat breakfast, lunch and dinner at similar times every day and set reminders of when to take my medications. This meant that I was up and about every hour doing something.

SET GOALS EVERYDAY

At around day 4 post op when the pain was becoming more tolerable and I was becoming more comfortable with my brace and crutches, I started to set mini goals for myself. With the schedule I mentioned above, I started adding in tasks, whether that be take the bin bag out (I have stairs in my house so this was a nightmare for me), unpack the dishwasher, do a load of washing, whatever. Over the days, I gradually increased the number of tasks I was completing each day. I am not saying every day was perfect. I  had one or two days where I lapsed in motivation because it more was comfortable to stay on the couch and watch an extra episode of Suits instead of completing my rehab, but this is where accountability and playing tricks on your brain come in. My personal favourite was telling myself I would get up to complete one or two easy stretches, and voila! Once I was up, I completed my entire programme. I found ticking off my goals each day helped keep my sanity in check, boosted my mood and helped with returning to work.

GET OUT OF THE DAMN HOUSE

During the period I was at home, I made sure to let my friends and family know that I needed them to help me get out of the house. If you are feeling anxious about leaving the house, keep your social outings brief (starting with 1-2 hours) or do something close to home so you can leave easily if you need too. Obviously, I had to miss out on some things, however I have made sure if there was a way I could attend a social outing, I would. For example, I really did not want to miss out on going to the pub with my friends to watch the Western Derby (although being a Fremantle supporter I kind of wish I did miss the game…) so I made sure I planned in advance to reserve a table at a venue that was easily accessible for me and comfortable for me to prop my leg up and also secured a lift there and home given I was unable to drive. Another thing I did for some stimulation was going and staying with my parents and friends for a day or two just to give myself a change of scenery. It is so important to have some sort of mental outlet and distraction, even if it is for a short period.

Stay tuned for part 2 of my recovery journey and the next phase of my rehab!

Tayla O’Halloran (B.Sc. – Exercise Physiology)

Workers Compensation Specialist

Exercise Rehabilitation Team Leader (AEP) (ESSAM)

 

 

Chronic Pain – Rewiring the Brain

The latest developments and research studies in neuroscience are revealing significant discoveries about pain. They are showing that chronic pain changes both the structure and function of our brain and nervous system.

It is no longer just about the body with the saying “no brain, no pain” never being more accurate.

Anatomy 101 – Throughout the body there are nerve endings that convey information up to your brain. The amount of nerve endings in a part of your body determines how much information is delivered to your brain.

How Chronic Pain Rewires the Brain
Chronic pain, over time, can cause changes in the way the brain is wired. Every time you feel pain the same pathways are stimulated in the brain. As a result, this pathway becomes more embedded in the brain. These changes are observable in the homunculus. The brain signals more neurons to “pay attention” to the painful stimulus. This is the beginning of an over-sensitised nervous system often termed, central sensitization.

3 approaches that can help!

  1. Cognitive Behavioural Therapy- CBT

CBT helps to identify and develop skills to change negative thoughts and behaviours. These tools can assist people in creating their own experiences and by changing their negative thoughts and behaviours. These strategies involve changing the awareness of pain and allow the development of better coping skills.

  1. Graded Motor Imagery- GMI

This involves using imagined movement and mirror-imagery to develop neuroplastic changes in the brain. This should be combined with exercise and movement of joints. One of the many ways this works is by decreasing fear associated with movement.

  1. Pain Education.

As previously discussed, chronic pain is often less about what is happening in the body and more about what is occurring in the brain. Learning about pain is proven to alleviate it. Depending on the circumstance, when you understand that if it is not about the body sending signals – then you can start to make the connection that often times it doesn’t mean you are damaged. Here is a great video to watch to better understand this concept created by Professor Lorimer Moseley – https://www.tamethebeast.org/

 

In this process it is also important to incorporate active management, rather than passive coping strategies.

  • Active management– ways to influence pain or to function despite pain – Exercise, activity pacing or support groups.
  • Passive coping – withdrawing and surrendering control to your pain eg. medication, surgery, or injections.

As with any condition, treatment for Chronic Pain should be comprehensive and specific to each case. If you would like more information on managing your chronic pain contact Absolute Balance by mail info@absolutebalance.com.au or view our website www.absolutebalance.com.au

Michael Buswell (B.Sc. – Exercise Physiology)

Senior Accredited Exercise Physiologist (AEP) (ESSAM)

 

Crofford LJ. Chronic Pain: Where the Body Meets the Brain. Trans Am Clin Climatol Assoc. 2015;126:167-183.

Ahmad AH, Abdul Aziz CB. The brain in pain. Malays J Med Sci. 2014;21(Spec Issue):46-54.

Ditch the scales and focus on how exercise makes you feel

Many people start their fitness journey with only a weight loss goal in mind. Have you ever stepped on the scales after cleaning up your diet and increasing your physical activity levels to have them say exactly what they did last week? Whilst this can be disappointing, it is completely normal to have weeks where nothing changes (on the scales). Therefore, it is so important to focus on alternate goals and how exercise makes you feel.

Below are just a few things you may realise whilst the scales are not budging that means you are most definitely still making progress:

  • Your body measurements are dropping (such as waist and hip circumference)
  • Your clothes are now too big for you or you have to go down a notch on your belt
  • You feel more energetic!
  • Improvements in your health (reduced blood pressure, cholesterol, a reduction in blood glucose levels, reduction in the use of medications)
  • Reduction in anxiety and stress levels
  • You can get to the top of the stairs without losing your breath
  • Reduction in joint pain (such as knees, back, shoulders)
  • No longer craving chocolate and junk food and have cleaned up your diet eating more whole foods
  • Sleeping better at night and waking up feeling refreshed
  • An overall improvement in mental health and wellbeing

Having a weight loss goal is okay, although it helps to have other goals to work towards to ensure you don’t lose motivation and the healthy habits you’ve tried so hard to keep are maintained. Weight loss is just one bonus in the pool full of health benefits you gain from being physically active.

For further assistance or if you have any questions around how best to incorporate exercise into your weekly routine, please contact the team of Accredited Exercise Physiologists at Absolute Balance today on info@absolutebalance.com.au

 

Channai Graham

Senior Accredited Exercise Physiologist (AEP) (ESSAM)

 

References:

Agarwal, S. (2012). Cardiovascular benefits of exercise. International Journal of General Medicine, 551. Doi: 10.2147.

 

Groin Injury and Prescribed Exercise Rehabilitation

A groin injury is a strain or tear of the inner aspect of the thigh, known as the adductor muscles. This kind of injury is usually caused by sudden movements such as kicking, twisting and sudden change of direction. Groin injuries are commonly sustained in elite and recreational sporting activities such as soccer, ice hockey, gymnastics and football. Management , diagnosis and treatment of groin injuries has been identified as complex. This is mainly due to the many anatomical structures surrounding the hip and groin area that are prone to injury.

There are some other risk factors that can increase the likelihood of an athlete sustaining a groin injury. These include weakness and imbalance of muscles in the Hip region, previous injury to the area, and level of experience within the sport. There are many sport specific training techniques that can contribute to a groin injury which can lack core strength and stability.

Usually conservative treatment is recommended, however on rare occasions surgery may be indicated in chronic cases or full tears of the muscle tendon. Implementation of prevention programs, stretching, exercise therapy and increasing range of motion of the hip joint has shown to be effective in reducing the risk of injury and positive rehabilitation outcomes. Other studies have proven that implementing an exercise program involving resistance, stability and mobility exercises is more beneficial than conventional physiotherapy treatment. An Accredited Exercise Physiologist can assist by prescribing a tailored program to the individual with the main focus of reducing the risk of potential injury, strengthening the groin area and correcting muscle imbalances. Through exercise we can minimise and prevent further risks associated to any injury.

 

Katie Lintott 

Accredited Exercise Physiologist (AEP) (ESSAM)

References:

  1. Nicholas SJ, Tyler TF. Adductor muscle strains in sport. Sports Med. 2002;32(5):339-344. doi:10.2165/00007256-200232050-00005
  2. Sherman B, Chahla J, Hutchinson W, Gerhardt M. Hip and Core Muscle Injuries in Soccer. Am J Orthop (Belle Mead NJ). 2018;47(10):10.12788/ajo.2018.0094. doi:10.12788/ajo.2018.0094
  3. Tyler TF, Nicholas SJ, Campbell RJ, Donellan S, McHugh MP. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. Am J Sports Med. 2002;30(5):680-683. doi:10.1177/03635465020300050801

 

Treatment of Patellar Tendinitis

Patellar tendinitis is an injury to the tendon connecting your kneecap (patella) to your shinbone. The patellar tendon works with the muscles at the front of your thigh to extend your knee so that you can kick, run and jump. For most people, treatment of patellar tendinitis can begin with some anti-inflammatory medication (if necessary), with physical therapy to stretch and strengthen the muscles around the knee.

There are a few different methods to treating someone with symptoms of patellar tendinitis, including:

Exercise Therapy:

  • Stretching exercisesRegular, steady stretching exercises can reduce muscle spasm and help lengthen the muscle-tendon unit.
  • Strengthening exercisesWeak thigh muscles contribute to the strain on your patellar tendon. Exercises that involve lowering your leg very slowly after extending it can be particularly helpful, as can exercises that strengthen all of the leg muscles in combination, such as a leg press.

Other Therapy options:

The following treatments can also be useful for pain relief, however this will provide results in the short term, without actually addressing the problem that is causing the knee injury.

  • Patellar tendon strapA strap that applies pressure to your patellar tendon.
  • IontophoresisThis therapy involves corticosteroid medicine.

 

All the options of treatment above would be considered conservative methods of treatment. If these do not help your patella tendinitis issue, a Doctor may recommend other procedures such as:

  • Corticosteroid injection
  • Platelet rich plasma injection
  • Surgery

 

Lifestyle Management Tips!

  • Note any recent injuries that may have damaged your knee joint.
  • Log your typical daily activity, sports/exercise and intensity/volume, change in activity, equipment used.
  • Avoid activity that causes pain as working through pain can further damage your patellar tendon.
  • Apply ice after an activity that causes pain.

 

Ronan Power (B. Ex Phys)

Senior Accredited Exercise Physiologist.

References

  1. Kasper DL, et al., eds. Periarticular disorders of the extremities. In: Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed Jan. 25, 2018.
  2. Patellar tendon tear. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases–conditions/patellar-tendon-tear. Accessed Jan. 23, 2018.
  3. Tintinalli JE, et al. Knee injuries. In: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, N.Y.: The McGraw Hill Companies; 2016. http://accessmedicine.mhmedical.com. Accessed Jan. 25, 2018.
  4. Malliaras P, et al. Patellar tendinopathy: Clinical diagnosis, load management, and advice for challenging case presentations. Journal of Orthopaedic & Sports Physical Therapy. 2015;45:887.

Maitin IB, et al. Sports rehabilitation. In: Current Diagnosis & Treatment: Physical Medicine & Rehabilitation. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed Jan.

Frozen Shoulder

Frozen shoulder, also referred to as adhesive capsulitis is a condition indicated by pain and stiffness in the shoulder joint. There is no known answer to exactly why frozen shoulder may occur, however, people who experience extended periods of shoulder immobility generally are at a higher risk of developing frozen shoulder. Immobility of the shoulder joint may occur because of a rotator cuff injury, broken arm, direct impact to the shoulder joint or during the recovery from surgery. Typically, associated symptoms will worsen over time and can take up to one to three years to fully recover.  Although, each individual case of frozen shoulder may differ and time periods to make a full recovery can change dramatically.

Symptoms

The common symptoms of frozen shoulder are categorised into three main stages over the recovery period.

Freezing: Freezing is the first stage of frozen shoulder and is generally the stage whereby pain increases gradually over time, making movement through the shoulder joint harder and harder. During this stage it is noted that pain may be more prominent during night-time. On average this stage can last anywhere from 6 weeks to 9 months.

Frozen: During the second stage pain generally dose not increase however the shoulder remains stiff and movement may be restricted for 4 to 6 months.

Thawing: During the final stage movement begins to ease, the shoulder starts to return to normal and pain begins to fade. This stage can take anywhere between 6 months and 2 years.

Treatment

The main goal during the treatment of frozen shoulder is to preserve as much range as possible whilst keeping pain to a minimum. Although there is no gold standard when it comes to frozen shoulder there are several methods for treatment. Typically, steroid injections will be administered in the early stages to help maintain mobility and decrease pain however, there is the option of shoulder manipulation or surgery should it be necessary.

Benefit of Exercise Therapy

In 90% of cases frozen shoulder will improve with non-surgical treatment such as physical therapy. The main aim of physical therapy is to increase or restore range of movement to the affected shoulder joint. A series of simple exercises can be completed in your own home which can drastically improve the overall function of the shoulder. Exercise and movements should be conducted within the limits of a person’s pain threshold and can be completed multiple times per day. The key to a full recovery from a frozen shoulder is patience and persistence.

Cameron Galati

Accredited Exercise Physiologist (AEP, AES) (ESSAM)

Lateral Epicondylitis – Why can it linger, and what is the best rehab for it?

Lateral Epicondylitis, commonly known as Tennis Elbow, is a very common chronic inflammatory condition of the elbow that is normally placed into the category of an ‘Occupational Overuse Syndrome’ (OOS). Lateral Epicondylitis is caused by repetitive loading with twisting activities of the forearm and wrist, it can also be caused by activities such as repetitive typing, keyboard, and mouse usage. The lateral epicondyle is the Common Extensor Tendon Origin (CETO); there are five key tendons that attached at this point including the Extensor Carpi Radialis Brevis (ECRB) and Longus (ECRL), Extensor Digitorum (ED), Extensor Digiti Minimi (EDM) and Extensor Carpi Ulnaris (ECU); all of which form the Common Extensor Tendon (CET).  The ECRB is frequently the main cause of symptoms and makes up the largest component of the CET, and often becomes the main focus of a rehabilitation programme, however, the smaller tendons may often be overlooked and may become the underlying culprits causing an extended recovery from the injury. We quite often hear from our patients that they have had multiple failed attempts at conservative rehabilitation with the focus being solely on the ECRB, and when provided rehabilitation exercises that target the smaller muscles and tendons we regularly see a great response and significant improvements in their symptoms.

When assessing function of the hand wrist and forearm for a client with LE, it is important to assess ALL functions of the fingers, hand, wrist, and forearm which are associated with the CET. I also find it helpful to assess functions including pronation and supination of the forearm with the elbow in a fixed position to determine if there are any biomechanical discrepancies outside of the normal range and function of the elbow. Covering all your bases in the assessment will assist in finding any functional gaps that can be worked on throughout the rehabilitation programme. It is promoted and supported by the literature that LE is treated conservatively, with interventions including activity modification and exercise (Bisset, 2006). A good exercise rehabilitation should combine range of motion and stretching exercises, concentric and eccentric strengthening exercises, and fine/gross motor control and grip strengthening exercises. A systematic review conducted by Menta et. Al, 2015, concluded that clinic-based strengthening exercises were effective for short-term improvements in pain reduction and have a better longer-term outcome for patients with persistent LE.

If you or a patient are struggling with an ongoing and painful elbow injury, a referral to an Accredited Exercise Physiologist may be the appropriate next step in the treatment timeline to attain a positive outcome. Absolute Balance have a caring team of skilled Accredited Exercise Physiologists’ that can help get your rehabilitation back on track, with comprehensive assessments and exercise programming designed with the goal of attaining full pain-free function front of mind. If you would like further information on this topic, or would like to contact the team you can email info@absolutebalance.com.au or visit our website www.absolutebalance.com.au

Alixe Marion (B.Sc. Exercise Physiology)

Senior Accredited Exercise Physiologist – Complex Claims Specialist

 

References:

Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B BMJ 2006 Nov 4;333(7575):939

Menta R, Randhawa K, Côté P, Wong JJ, Yu H, Sutton D, Varatharajan S, Southerst D, D’Angelo K, Cox J, Brown C, Dion S, Mior S, Stupar M, Shearer HM, Lindsay GM, Jacobs C, Taylor-Vaisey A J Manipulative Physiol Ther 2015 Sep;38(7):507-20