Surgical Prescription – A Day In Trade

Recently I had the pleasure of observing Mr David Colvin from Western Orthopaedic Clinic in theatre at St John of God Subiaco Hospital. Mr Colvin specialises specifically in shoulder and knee surgery and I was fortunate enough to witness a range of simple and complex procedures that have already helped me tremendously, in my exercise prescription for clients who have previously undergone these surgeries, and in general the rehabilitation of shoulder and knee injuries.

The very first thing that became clear to me was just how invasive surgery can be. As someone who thankfully has not required surgery in the past, I certainly have a better appreciation for just how tender our clients can be in the early stages of rehabilitation. Some of these procedures involve a real hammering!

I was also surprised at how plans could change on the fly once Mr Colvin and his team were operating. Even with all the imaging pre-operation, you never really know what’s going on until you are actually in there taking a look at the anatomy itself. For instance, when performing a knee arthroscope on one of his patients, Mr Colvin found a synovial plica (a piece of connective tissue that rubs over the epicondyle subsequently causing degradation of the cartilaginous surface). This was quickly rectified but could have quite easily gone undetected, causing the cartilage damage, had the arthroscope not been performed. This is a skill that I believe highly correlates between our two fields. The ability to draw upon previous experience and evidence-based knowledge to make a diligent, informed decision for the benefit of the client – be that the removal of synovial plica on top of the knee arthroscope or swapping out certain exercises that you know are hindering the rehabilitation process in favour of a different programme.

The biggest thing I took away from my time in theatre was something Mr Colvin said; “You can not afford to be dogmatic as a surgeon”

I believe this quote can quite easily be applied to many topics, but it especially rings true to me as an Accredited Exercise Physiologist. Any good Exercise Physiologist, any good health professional in general, MUST take an individualised approach to each client or patient they see. Mr Colvin performed two knee arthroscopes, one of the procedures was relatively routine and took roughly 15 minutes. The second knee arthroscopy persisted for an hour as Mr Colvin had some difficulty accessing an irregular bone growth in the posterior knee. This required multiple surgical entries and the shaving away of a sizable amount of cartilage. As exercise physiologists, it is extremely important for us to understand that both clients, although undergoing the same operation, will likely present differently throughout the rehabilitation process. We cannot afford to be dogmatic in our approach, by simply saying when you have (X) procedure you can commence rehabilitation at (Y) weeks post operation with (Z) exercises. This approach will lead to poor patient outcomes.

We want to empower our clients through personalised exercise programmes where they can return to previous physical function and their lives as soon as possible. If you have any further questions or are looking for a pre-op or post-op rehabilitation programme, please contact Absolute Balance at

Callan Smith 

Accredited Exercise Physiologist (AEP) (ESSAM)