Absolute Balance Exercise Physiology are specialists in prescription Exercise Rehabilitation in the compensable sysytem.

Lower back pain

Why is Early Intervention so important for the Treatment of Acute Lower Back Injuries?

As most of us know and have heard early intervention is always best when it comes to the rehabilitation for acute injuries. But why is this so important and what can we improve to ensure the best outcome for an injured individual?

As an exercise physiologist specialising in the workers compensation system, it is very common to be referred an injured worker months after their injury. This could mean that the worker has had no active treatment, may have poor coping strategies, a lack of education about their injury and the recovery timeframes, have had little assistance navigating the workers compensation system, and could have commenced no return to work to assist with a return to function.

Studies have shown that with acute lower back injuries early intervention is more effective in the short term than advice on staying active, leading to more rapid involvement in function, mood, quality of life, and general health. An additional and highly important point found was that the timing of intervention affects the development of psychosocial features, which are very common in the workers compensation system. If treatment is provided later, the same psychosocial benefits are not achieved. Therefore, early intervention is a necessity for improving an individual’s function, mood, quality of life, general health and decreasing the development of biopsychosocial features that can hinder an injured workers engagement in a return-to-work plan, treatment compliance, and their return to pre-injury function.

At Absolute Balance we understand that during the initial assessment with an individual it is crucial to focus on explaining the cause of pain and instructions to stay active, which studies show can promote long-lasting physical and mental health in individuals with acute lower back pain. Returning to work is a part of returning to function and research indicates that not implementing early intervention for acute work-related back pain can lead to high pain and disability, low recovery expectations, and fears that work may increase pain or cause harm which are risk factors for chronic work disability.

If you would like more information on individualised client-focused goal setting and how to build stronger rapport with your clients, please do not hesitate to contact us at info@absolutebalance.com.au.

Jason

Jason Peschke

Accredited Exercise Physiologist (AEP) (ESSAM)

 

References

Turner, Judith A. Et al. Worker Recovery Expectations and Fear-Avoidance Predict Work Disability in a Population-Based Workers’ Compensation Back Pain Sample, Spine: March 15, 2006 – Volume 31 – Issue 6 – p 682-689.

Wand, M Benedict et al. Early Intervention for the Management of Acute Low Back Pain, Spine: November 1, 2004 – Volume 29 – Issue 21 – p 2350-2356.

Whitfill, T., Haggard, R., Bierner, S.M. et al. Early Intervention Options for Acute Low Back Pain Patients: A Randomized Clinical Trial with One-Year Follow-Up O

Collagen

Collagen and its role in Rehabilitation from an Injury

The recommendations for diet, exercise, supplementation, and our health are changing on a regular basis, with new research and scientific studies delving deeper than ever before into how to best sustain the health of the human body. An up-and-coming area of research, specifically for athletic populations and rehabilitation, is the use of Collagen supplementation to treat injuries to muscles, tendons, ligaments, cartilage, and connective tissues.

To start with, I will answer the question ‘What is Collagen?’

Collagen is an abundant protein within the human body, found in all connective tissues, the skin, muscles, and bones, and is often referred to as the scaffold or glue that provides strength and structure to these tissues. Collagen is comprised of amino acids, once ingested Collagen is broken down to its amino acid form, transported through the blood and to the tissues where the amino acids are used to synthesise new tissue and rebuild damaged tissues.

So, what does this mean for rehabilitation from an injury?

The evidence suggests that supplementation of Hydrolysed Collagen is useful in the treatment of all injuries to the connective tissues or cartilage, with most current research being conducted specifically with tendinous injuries. The most recent research suggests that when collagen is supplemented into the diet while recovering from an injury, collagen synthesis can be increased up to 20%, particularly when taken 1 hour prior to completing exercises (Lis and Baar, 2019), this has a positive impact on the body’s ability to heal, repair and build Collagen containing tissues. The consensus of the available research supports that Collagen supplementation could very likely reduce the time it takes to recover from an injury, which is an amazing concept!

Although the research demonstrates supplementation of Hydrolysed Collagen to have the most promising responses, it is possible to consume high amounts of good quality Collagen in our diets to also assist with the recovery process. The good news – Collagen is easily found in animal products, with the highest bioavailable amounts found in cartilage, bone marrow, tendons, and gristle. If you are the adventurous type, the best sources of Collagen are in chicken feet and pig skin, and marine collagen including fish skin, scales, and bones! If none of these foods sound appealing, the good news is that Collagen can be easily added into your diet through consuming bone broth and gelatin.

The only downside to dietary consumption of Collagen is that you cannot specifically measure and predict accurate dosages for yourself or others, however the health benefits of consuming Collagen rich foods in your diet still far exceed other types of supplementation when recovering from an injury. The only other factor to consider is that your Collagen needs to be consumed with Vitamin C as this is vital for Collagen Synthesis. The specific dosages for Vitamin C vary, however the RDI of 45mg/day combined with 15-25g of Hydrolysed Collagen or Gelatin seems to be a winning combination.

The information above is of course evidence-based and supported by the latest scientific research, however, each injury is different, and each patient should speak to their treating medial practitioner regarding what would benefit them the most with their recovery. If you are interested in knowing more on the topic, get in touch with the team at Absolute Balance through the website www.absolutebalance.com.au or email info@absolutebalance.com.au.

 

Alixe Marion

Alixe Marion (BSc – Exercise Physiology)

Workers Compensation Specialist

Senior Accredited Exercise Physiologist

 

 

References

Lis, D. and Baar, K., 2019. Effects of Different Vitamin C–Enriched Collagen Derivatives on Collagen Synthesis. International Journal of Sport Nutrition and Exercise Metabolism, 29(5), pp.526-531.

 

Tend to Your Forearm Tendonitis!

Have you ever experienced a burning sensation in the small tendons and muscles in your forearms? Do you encounter this feeling after strain, overuse or too much exercising involving your forearms? You may be suffering from forearm tendonitis.

Forearm tendinopathy and tendonitis are some of the most frequent encountered disorders of the upper extremity. With forearm tendonitis individuals present with progressively increased pain in their forearms over a subacute or chronic period. Although forearm tendonitis can be caused by a sudden injury, such as a motor vehicle accident, it most commonly occurs through repetition of a particular movement over time. The importance of proper technique in work duties and hobbies is crucial to reduce the stress put on the forearm tendons and musculature. Other infrequent causes include nerve entrapment in the forearm or arthritis.

The main symptom of forearm tendonitis is inflammation of the forearm tendons. This can cause pain, redness, and swelling around the elbow, wrist, and hand. Secondary symptoms of inflammation including warmth, weakness, throbbing, burning, stiffness, numbness, or the development of a lump on the forearm. Compromised forearm tendons and musculature intrinsically effects range of everyday arm or hand movements.

R.I.C.E:

Rest – Although it can be difficult to stop using your forearm muscles in everyday tasks, constricting movement in a brace or splint will reduce the overall healing time of the inflamed tendons.

Ice – Applying ice to the affected area for 10-minutes a day is an immediate effective treatment after the forearm has been heavily used or inactive for a long period of time. Applying ice to the area will temporarily reduce blood flow and significantly reduce inflammation, swelling and pain.

Compression – Different sleeves and wraps are designed to compress either the full area or segments of it. Applying pressure will also reduce swelling by restricting the flow of blood and other fluids.

Elevation – Keep the forearm raised at a level above the heart to reduce the blood flow to the affected area. This intern will reduce swelling and other symptoms.

Exercise Rehabilitation:

Stretching and strengthening exercises of the forearm and surrounding musculature have been shown to assist in reducing the symptoms of inflamed and injured tendons. Targeted forearm stretching exercises including wrist extension, elbow extension and wrist rotations will help rehabilitation and strengthen the forearm slowly, as well as improve blood circulation through the forearm and into the wrist. Localised strengthening exercises including wrist curls, reverse curls and forearm pronation/supination can help build lost forearm strength and help prevent forearm pain from reoccurring.

Ergonomic Assessments:

By using biomechanical principles, adjustments can be made to your workstation to reduce the risk of overuse/repetitive movements that increase the risk of developing forearm tendonitis. This includes observing force, repetition, volume, and exertion on certain muscle groups to complete daily work tasks. Simple adaptations including using an ergonomic keyboard and adjusting your desk to an appropriate height can reduce the repetitive strain on your forearms.

James McNally

James McNally (BSc – GradDipClin Exercise Physiology)

Workers’ Compensation Specialist (AEP ESSAM)

 

References:

Eric Wagner, Michael Gottschalk. (2019). Tendinopathies of the Forearm, Wrist and Hand. Clinics in Plastic Surgery, 46 (3), 317-327.

What Is Forearm Tendonitis, and How’s It Treated? (2021) Healthline. Retrieved from: https://www.healthline.com/health/forearm-tendonitis#home-remedies

What are the causes of forearm pain? (2018) Medical News Today. Retrieved from: https://www.medicalnewstoday.com/articles/320782

 

Trigger Finger

Trigger Finger

Trigger finger is a mechanical condition that often causes the finger or thumb to get stuck in a bent position, sudden locking and releasing of the finger or thumb during flexion and extension. Trigger finger can also be known as trigger thumb and stenosing tenosynovitis. The tendons of the finger or thumb become inflamed and can no longer easily slide through their sheath as normal, in some cases a nodule can also form on the tendon. Symptoms can include stiffness when bending the finger or thumb, snapping or popping sensation when moving the digit and pain or soreness at the base of the thumb and palm. The most common digit effected is reported to be the thumb.

The cause of trigger finger is believed to be multi-factorial including exposure to shear forces, biomechanical factors, anatomical difference in the pulley system and performing unfamiliar activities. Most cases are caused by secondary thickening of the flexor pollicus longus tendon, however other joints and the carpal tunnel can also be involved. Other possible contributing causes include diabetes mellitus, carpal tunnel syndrome and repetitive finger movements. Diagnosis is mainly based on presentation and clinical symptoms. Trigger finger can occur in anyone; however, the most common reported population is middle-aged women. It frequently occurs in people in people who have hobbies or jobs that include repetitive motions, strong grasping and gripping such as farmers, musicians and construction workers.

First-line treatment for trigger finger is usually conservative treatment. Conservative treatment includes NSAIDs, splinting, corticosteroid injections and physical therapies. Another treatment option can include surgical intervention. As Exercise Physiologists we can assist with physical rehabilitation by providing an individualised exercise programme, monitoring symptoms and adjusting the exercise rehabilitation programme accordingly. Recommended exercises include passive and active joint range of motion, stretching, digit blocking and tendon gliding exercises. Through exercise we can improve and maintain pain free range of motion, improve strength of the surrounding musculature and assist to prevent the risk of recurrence.

 Katie Lintott

Katie Lintott 

Accredited Exercise Physiologist (AEP) (ESSAM)

 

References

Howitt, S., Wong, J., & Zabukovec, S. (2006). The conservative treatment of Trigger thumb using Graston Techniques and Active Release Techniques. The Journal of the Canadian Chiropractic Association50(4), 249–254.

Vasiliadis AV, Itsiopoulos I. Trigger Finger: An Atraumatic Medical Phenomenon. J Hand Surg Asian Pac Vol. 2017 Jun;22(2):188-193. doi: 10.1142/S021881041750023X. PMID: 28506168.

Ferrara, P. E., Codazza, S., Maccauro, G., Zirio, G., Ferriero, G., & Ronconi, G. (2020). Physical therapies for the conservative treatment of the trigger finger: a narrative review. Orthopedic reviews12(Suppl 1), 8680. https://doi.org/10.4081/or.2020.8680

Trigger Finger. (2020, December 18). Physiopedia, . Retrieved 07:03, January 8, 2021 from https://www.physio-pedia.com/index.php?title=Trigger_Finger&oldid=262566.

 

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

Rib Fractures

Rib Fractures

Rib fractures are often caused by trauma to the chest region. Due to the structure of the ribs (long thin bones), they are prone to breaking because of direct trauma or repetitive trauma. Some common causes include a fall, motor vehicle accident, coughing, some sports or an assault. Symptoms of a rib fracture include pain with deep breathing, coughing or with touch. Rib fractures can occur at any age; however, the elderly are at higher risk due to the decrease in bone density. Often rib fractures or the trauma endured can lead to other illnesses or injuries such as pneumonia, bruising of the lungs, pneumothorax, and a collapsed lung.

Treatment of patients with rib fractures may include a team of professionals such as a pain specialist, surgeon, and physical therapist. Depending on the risk of complications, some patients may be hospitalised or require surgery. Symptoms can also be managed with anti-inflammatory drugs, however the key to successful treatment of rib fractures is physical therapy. This would generally begin with controlled breathing exercises; this ensures the lungs are being fully inflated and reduces the risk of developing pneumonia. Studies have shown thoracic stretching and mobility exercises, breathing exercises, have a positive impact on patients who have sustained chest injuries, specifically regarding chest wall expansion and physical function. Rib fracture treatment is considered complete once the patient can breathe and cough normally without discomfort, walk and complete activities of daily living with no aggravation. This can take up to 3 months to fully heal depending on the severity of the fracture.

An Exercise Physiologist can assist with putting together an individualised exercise programme including breathing exercises, thoracic mobility and stretching as well as progressing to more functional exercises to get you back to your regular daily activities.

 

Katie Lintott 

Accredited Exercise Physiologist (AEP) (ESSAM)

References

Baiu, I., & Spain, D. (2019). Rib Fractures. Jama321(18), 1836-1836.

Julie A. Ekstrum, Lisa L. Black & Karen A. Paschal (2009) Effects of a Thoracic Mobility and Respiratory Exercise Program on Pulmonary Function and Functional Capacity in Older Adults, Physical & Occupational Therapy In Geriatrics, 27:4, 310-327, DOI: 10.1080/02703180902803895

 

Carpel Tunnel Syndrome: What is it?

The carpel tunnel is a narrow, rigid passageway of ligament and bone that is found at the base of the hand. It houses the median nerve, which is a mixed sensory and motor nerve that runs from the end of the brachial plexus (located at the root of your neck) through the forearm to provide sensation and feedback to the thumb and first three fingers. Carpel tunnel syndrome is one of the most common peripheral nerve entrapment disorders in the upper limb and occurs when the median nerve becomes compressed or squeezed at the wrist. This kind of injury is most commonly caused by sudden trauma to the wrist, such as a sprain or fracture, that causes swelling. Other common causes include an overactive pituitary glad, an underactive thyroid gland or rheumatoid arthritis. This compression on the median nerve leads to symptoms including feelings of pain, numbness and tingling in the hand and arm.

When treating carpal tunnel syndrome, it is important to begin as early as possible once symptoms start. Non-surgical treatments can assist in making the problem go away if you’ve only experienced mild to moderate symptoms that come and go for less than 10 months.

Exercise Rehabilitation:

Range of motion and nerve gliding exercises have been shown to be the most effective in improving pain, pressure pain threshold, and overall function in patients with carpel tunnel syndrome.  Nerve gliding (also referred to as nerve flossing or neural gliding) is a stretching technique that takes areas of the body through specific ranges to help target and free up injured nerves and improve mobility.

Evidence shows that symptoms should begin to improve within two weeks of consistent daily nerve gliding exercises. After six to eight weeks, it is expected to feel no tightness or pain within your affected wrist.

 

Carpel Tunnel

Other Non-Surgical Therapy:

  • Splinting: Most common initial treatment is to wear a splint at night. A splint will stabilize the wrist and minimise pressure on the median nerve allowing a period of relative rest from movements that may increase symptoms.
  • Prescription medication: Corticosteroids or the drug Lidocaine can be prescribed and injected directly into the wrist or taken orally to relieve pressure on the median nerve.
  • Alternative therapies: Yoga has been shown to reduce pain and improve grip strength in people with carpel tunnel syndrome. Better joint posture may decrease intermittent compression, and blood flow may be improved to decrease ischemic effects on the median nerve.

 

James McNally

James McNally (BSc – GradDipClin Exercise Physiology)

Workers’ Compensation Specialist

References:

Ruth Ballestero-Perez, Gustavo Plana-Manzano, Alicia Urraca-Gesto, Flor Romo-Romo, Maria de Los Angeles Atin-Arratibel, Daniel Pecos-Martin, Tomas Gallego-Izquierdo, Natalia Romero-Franco. (2016). Effectiveness of Nerve Gliding Exercises on Carpel Tunnel Syndrome: A Systematic Review. Journal of Manipulative and Physiological Therapeutics, 40 (1), 50-59.

NK Visweswaraiah. (2013). Yoga for Occupational Health and Rehabilitation. Indian Journal of Physiology and Pharmacology, 57 (5), 20-21.

National Institute of Neurological Disorders and Stroke. (2020). Carpel Tunnel Syndrome Fact Sheet. Retrieved from: https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/carpal-tunnel-syndrome-fact-sheet

 

Rotator Cuff Repair and Exercise Rehabilitation Programme

I would like to share one of my success stories of my recent patient who sustained a left shoulder injury at work in February 2020. An MRI showed a full-thickness tear of the supraspinatus tendon, moderate subscapularis tendinopathy and complete long head of biceps tendon tear. My patient had a left shoulder arthroscopy and open rotator cuff repair March 2020 and commended his exercise rehabilitation programme in July 2020. The individualised exercise rehabilitation programme was implemented to facilitate a return to pre-injury duties as a Groundsmen.

 

Job Specific Programme

The patient was completing pre-injury hours with a lifting restriction of 5kg and working below shoulder height. The patient’s pre-injury duties involved maintenance of irrigation around the school grounds including digging, repair and replacement of sprinklers and checking underground electronics. The physical critical demands of the patient’s job role are sustained bent over postures, combined with predominately repetitive hand-arm movements between waist and shoulder height. He is required to lift and carry 20L buckets of sand.

The exercise rehabilitation programme initially focused on increasing pain-free range of movement, joint mobility and stability through his left shoulder. The patient’s programme quickly progressed to addressing recruitment patterns of the left shoulder and supporting musculature with a focus on a variety of positions and postures. The final stage of his programme was to increase upper limb strength in a variety of postures with a focus on correct manual handling and repetitive movements with lifting load away from the midline of his body. The programme included eccentric strengthening exercises for the rotator cuff, concentric and eccentric strengthening for the scapular stabilisers. The focus was external rotator cuff strengthening due to an imbalance between the over strengthen internal rotators and weakened external rotators.

 

Outcome of Exercise Rehabilitation

The patient is now at 100% functional capacity in the gym for his pre-injury role. The patient was compliant to his exercise rehabilitation programme and return to work plan. He initially completed one supervised session per week for the first eight weeks combined with two to three unsupervised sessions per week. The supervised session was reduced to once per fortnight, which allowed the patient to progress to self-management. At the end of the exercise programme, the patient showed significant improvements in his range of movements and mobility through his left shoulder. The patient has gained strength with lifting load away from the midline of his body and lifting load in various postures necessary for his pre-injury duties, which allowed for job hardening, giving him the confidence to perform his work duties pain-free. As a result, the patient was certified fit for pre-injury duties and due to obtain a final medical certificate at his next specialist review.

 

 

Daniel Nguyen (B.Sc. Exercise Physiology)

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

 

 

Reference

Byram IR. American Orthopaedic Society for Sports Medicine (AOSSM) 35th Annual Meeting Abstract 8363. Presented July 10, 2009.

A day in trade with Mr Daniel Meyerkort – Orthopaedic surgeon

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)

Mirror Box Therapy

Mirror box therapy is derived from the use of a mirror to reflect the use of a normal functioning limb to trick the brain to reinforce movement without pain. It involves placing the affected limb inside a box or covered with the reflective side displaying the “working limb” back to the person. From their perspective, they see two fully functional limbs. This type of therapy has been widely used for people with amputated limbs who experience phantom limb pain, complex regional pain syndrome and people recovering from stroke.

Phantom limb pain is where a person feels painful sensations from a limb that is no longer there. The mechanisms of phantom limb pain are not widely understood; however it is thought to be due to peripheral mechanisms due to the injury-causing disrupted input from afferent nerves back to the spinal cord and changed in central neural mechanisms. Mirror box therapy can assist people with phantom limb pain by using the mirror to assist with visual feedback making it real for the patient to see movement and move the “phantom limb”. They receive feedback through vision and proprioception which assist the person to see real movement and that this can occur without pain. The idea is to trick the brain to remodel the cortical systems that may provide relief through visual dominance of the motor-sensory process and activation of mirror neurons through visual movement.

There are some limitations to the use of mirror therapy in rehabilitation with restrictions to the location of injury as well as the extent of injury and the variety of pathologies that induce pain. Mirror box therapy can be easily added into exercise-based routines using active or passive range of motion movements and other exercises for patients based on their level of ability. It is best to consult an accredited exercise physiologist prior to undertaking treatment.

Taylor Downes |B. HM. | GradDipClinExPhys|

Accredited Exercise Physiologist (AEP) (ESSAM)

 

Najiha, A., Alagesan, J., Rathod, VJ., Paranthaman, P. Mirror Therapy: A review of evidences. IntJ Physiother Res 2015;3(3):1086-1090. DOI: 10.16965/ijpr.2015.148

Subedi, B., & Grossberg, G. T. (2011). Phantom limb pain: mechanisms and treatment approaches. Pain research and treatment, 2011, 864605. https://doi.org/10.1155/2011/864605

O’Connell  NE, Wand  BM, McAuley  JH, Marston  L, Moseley  GL. Interventions for treating pain and disability in adults with complex regional pain syndrome‐ an overview of systematic reviews. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD009416. DOI: 10.1002/14651858.CD009416.pub2.