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Rotator Cuff Repair and Exercise Rehabilitation Programme

Jan 04, 2021

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.

22 Mar, 2024
Does your spine look like the picture on the left or does it look more like the one on the right? As Exercise Physiologists, we often see all sorts of presentations of the spine and in this blog, we will be covering a condition known as ‘lordosis’. More specifically, we will be focusing on the lower or ‘lumbar’ aspect of the spine, which is where we see this condition commonly. What is Lordosis? Normally, the spine is naturally curved forward a little bit which helps with shock absorption and supports optimum posture but in lordosis there is an inward exaggeration of the spinal curve which can be felt on the outside as a deep dip in the lower back. Who does it affect? Simply put, anyone of any age group can develop lordosis and it is most seen in people who are pregnant, as a hereditary condition in children and adults with obesity or reduced bone density are at a higher risk of development of this condition. What is the cause? A common cause for lordosis includes poor posture as a result of weak core muscles and muscular imbalances which can be attributed to the modern-day lifestyle where we are sitting more than ever. Other causes include conditions such as osteoporosis, spondylolisthesis, kyphosis and as previously mentioned, obesity. What are the symptoms? An obvious symptom of lordosis is lower back pain. As you can see in the photos above, there is a higher risk of complication involving entrapment of a nerve when there is excessive spinal curvature leading to increased compression of the spinal vertebrae. Although sometimes lordosis can be asymptomatic and a person can go about their daily lives without too much of an issue, in more serious cases, those affected can potentially experience lumbar radiculopathy or sciatica, where there is compression of the exiting lumbar nerve roots and lead to symptoms which can be described as burning, tingling, radiating pain, paraesthesia and numbness in one or more uncommonly, both legs. How is it treated by an Exercise Physiologist? As they say, prevention is better than cure and to reduce the risk of potential future development of lordosis, maintenance of a healthy weight and engaging in core-strengthening exercises will assist with reducing the pressure placed on the spine as well as maintaining proper posture. However, if you are somebody who is already experiencing back pain as a result of lordosis, it is never too late to engage in physical therapy to improve pain-free range of movement, flexibility and mobility of the spine. Posture can also be improved significantly with strengthening of the appropriate musculature in the trunk, hips and lower limbs and addressing compensatory patterns that may have developed over time. For example, when a person spends a significant amount of time in a seated position, the muscles in the lower or lumbar aspect of the back can become excessively tight from trying to support and stabilise the spine. Additionally, muscle groups such as the hamstrings, glutes and abdominals become weak and inhibited, contributing to poor biomechanics. Physical therapy has been proven to be highly effective by taking a conservative approach to manage symptoms and improve function. With adherence to an appropriate rehabilitation programme an injured worker will have a higher chance of returning to work as well as a return to normal activities. Chris Chen Workers Compensation Specialist ‑ Innovation Team Leader (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
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Rhythm is one of the most important elements of music across all its forms. Rhythm gives structure to music. It assists tone, it influences tempo and can control cadence, just for a quick snapshot. What I’ve found over my time playing music as hobby, is that rhythm is ever important and ever consistent. It’s something we can create, maintain, tweak, and develop but ultimately it remains consistent in providing structure. It’s also something we all have in our day-to-day life and in relation to our overall health, a rhythm can provide a positive impact on our overall health and wellbeing. So, you’re probably wondering where I’m going with this and how does it relate to exercise or health? Over time, or maybe just through personal growth and more awareness I have found that there are certain structures or constants that are frequent in my day and when performed consistently over a period time, provide the opportunity for me to perform at the best I can be and have a positive impact on my health and wellbeing. That being said, when these structures aren’t followed through or forgotten, it can then create the opposite effect; whereby we may feel stress, fatigue, unmotivated and not on the right track. For me I have found that I have a general rhythm that I try to maintain, the hard part is consistency (which is the challenge for most things!). Think of this another way. It could be your routine, your non-negotiable’s, the one-percenter’s, your daily habits or even just the beat of your day. Things that you do daily, that create structure, consistency, and the mainstay standards you have for yourself that help you be the best version of yourself. For some it can involve a variety of things and as you’re reading this, I am sure you are already thinking about some of these items. Okay, what are these constants? They can be as specific as you like or as general as possible, they could incorporate activity and exercise (I hope so!) or involve silence and stillness. It could include reading, journalling, meditation, the way you sleep or eat, the rules, restrictions, or freedoms you have put in place. There is no right or wrong way. If it works for you and you can be consistent, then ultimately this is your rhythm and as such your guide to maintaining your health! Coming into a new year, dealing with significant change, or working through a new challenge, there’s always a chance you can be thrown a curveball and then get stuck trying to work through it, whereby there are usually sacrifices made with our day-to-day rhythm, which then impact our health and wellbeing in a negative manner. It’s important in these moments to reflect to our rhythm or routine (whatever name you have for it) and make sure we don’t make those sacrifices, and we strive to maintain our peak health and well-being. Afiq Jackson Workers Compensation Specialist ‑ Team Leader North West (AEP, ESSAM)
01 Mar, 2024
Hey guys, Mike Andrews here. I am the Business Development Manager at Absolute Balance, a role I have filled for just over 18 months. This exciting role has allowed me to learn an immense amount about myself and the team that makes up our business. The team of exercise physiologists, the corporate team, and injury prevention, have phenomenal positive outcomes and back to work results, proving their elite level of work. The team is changing lives on the daily, however I often notice how they overlook their own impact, and just shrug it off as “just doing my job”. I agree, they are doing their job, but the impact and effect is way more than that and there is importance in knowing your impact. Now this is where I come in, and I love my role, without a doubt, I consider it an absolute privilege. I spend quality face to face time with our team, assisting and coaching them on their mindset around their impact of “just doing my job”. As a result of my role and my interaction with the team believe “BDM” should stand for Building & Developing Mindset. Each team member has a different approach to their work, comes from a different mindset, background, and has their own strengths, and or weakness, an aspect which makes the time spent with them so rewarding. Everyone will find their sweet spot with their mindset at different stages which is great! With that being said, the real goal for the business is combining the individual strengths into a highly functioning team. In my view, the simpler and more straight forward the goals/attributes the better. I’ve stated three that I believe will result in a highly functioning team, which are: 1. Clear vision. 2. Clear roles for each team member. 3. Celebrating the process. As important as each attribute is, I believe the last one outweighs the rest. When you combine the energy and passion our team have with an improved mindset, each day will be more rewarding and enjoyable. My role is to help assist the team members to use their attributes and strengths to find their sweet spot or ultimate mindset. That’s why I believe my role is so enjoyable and ultimately should stand for Building & Developing Mindset. Michael Andrews Business Development Manager 
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