How exercise prescription is individualised to the patient and their job role

I would like to share one of my success stories of my recent patient who sustained a lower back injury at work and returned to pre-injury duties after her exercise rehabilitation with Absolute Balance. The challenge with this patient was that she commenced a new administrative role with the same employer during her treatment.   That meant I had to make adjustments to her exercise programme, along with completing an ergonomics assessment on her new workstation.

The client is a 33-year-old early childhood teacher who sustained a lower back injury at her workplace while lifting a child approximately 5kg from the floor in an outreached posture. She felt pain progressively worsen over a week. The MRI scans indicated mild disc degeneration at L3/4 and L4/5. At the initial assessment, the client had a full range of movement through her lumbar spine with reports of 3 of 10 pain on the visual analogue scale (VAS) in extension and lateral flexion. The client reported experiencing nerve pain through to her right glute. The client demonstrated slight bracing behaviours and rigid spine while performing functional exercises including loaded squats, lunges and push/pull movements. The client was following a return to work plan and was currently completing 8hrs per day 4 days per week. She had a lifting restriction up of 10kg, sit stand and walk up to 1hr.

Job Specific Programme

The client’s work tasks involve working with children between 0-2 years old, weighing up to 10kg. She works with 12 children per day and 28 children throughout the week. She is required to lift children in and out of cots, up onto benches to change their nappies, transfer children, bottle feeding and playing with children. The physical critical demands of the client’s job role are to lift from floor to shoulder height weighing up to 10kg, frequently in forward and flexed postures while carrying a child in and out of the cot. Sustained kneeling postures, and frequently getting down and up from the ground with children. The exercise rehabilitation programme initially focused on increasing her lumbar spine mobility promoting correct muscular recruitment patterns implementing relaxation strategies and dynamic neuromuscular stabilisation (DNS) exercises. The client quickly progressed to lumbopelvic stability, functional lower body strengthening and correct manual handling techniques for her work duties, focussing on carrying load away from the midline of her body. During her exercise rehabilitation programme, the client commenced a new administrative job role with the same employer, as such a slight adjustment was made to her exercise programme. The client reported of localised lumbar pain with increased prolonged seated postures. Absolute Balance traveled out to her workplace to complete an ergonomic assessment and made some changes including increasing chair and monitor height and implementing a temporary footrest to improve her seated position to reduce stress on her lumbar spine and to provide sufficient lumbar support. A recommendation of workstation equipment for the client was sent to her employer.

Outcome of Exercise Rehabilitation

The client is now at 100% functional capacity, completing one supervised session along with two independent sessions per week. The client showed significant improvements in her mobility through her lumbar spine with no reports of pain, combined with lumbopelvic stability, with less bracing through her trunk and increased strength through her lower limbs to perform safe manual handling techniques. The client was provided with all the tools to effectively self-manage her programme and educated on the importance of taking regular postural breaks with stretching and myofascial release to relieve her soreness. The client has reached all outcome measures set by Absolute Balance. As a result, the client obtained a final medical certificate following three months of exercise rehabilitation.

 

Daniel Nguyen (B.Sc. Exercise Physiology)

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