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Meet the Team – Channai Graham

My name is Channai Graham and I have been working at Absolute Balance for over a year and as an Accredited Exercise Physiologist for just over three years.

I grew up in a small country town called Kondinin, 3 hours south east of Perth and loved every second. Despite the fact I had just 2 others in my year at primary school and the whole town knew everything about everyone it was a great environment to grow up in. As usual for a kid growing up in a small country town, sport and exercise was a big part of my life, from playing netball on weekends to learning to water ski and everything in between.

Unfortunately, whilst I was still quite young my Dad was diagnosed with Multiple Sclerosis. This affected his life and the people surrounding him quite significantly and I believe this was the point I knew what career path I wanted to take. Both my parents still currently reside in Kondinin and I have a little brother completing his apprenticeship up here in Perth.

I made the big move to Perth in year 8, boarding at a private all girl school which was where my love of sport grew further. Before and after school was packed with training, whether it be athletics, cross country, netball or volleyball, I just had to be involved. I graduated high school in 2012, and despite others in my class still unaware of what path they wanted to take from there, I was quite the opposite.

After seeing my Dad go through countless Physiotherapy sessions and seeing how much it helped him both physically and mentally, when it came to deciding what to study at University, I went with a degree in Sport Science at Curtin University. It was over these first three years at university that I realised the impact exercise can have on so many different individuals through all walks of life, although always knew my passion was around helping people like my dad get back on track and I knew exercise could do that. From here, I opted to study for an additional year and complete my Post Graduate Diploma in Exercise Physiology at Notre Dame.

Outside of work I love going for walks with my dog (of whom I talk about way too much about), keeping active and hanging out with friends and family. I also have a serious weakness for Italian food. I have been travelling to the typical Australian holiday destinations such as Bali and Vietnam, although I am planning a trip to Europe as we speak for mid-June.

Over the past 3 years I have had the privilege of meeting and working with so many people from all walks of life and have been involved with so many great outcomes. At the end of the day, nothing is more satisfying to me than someone saying I have changed their life for the better and that is what motivates me every day to continue with this career and industry.

 

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

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

Bumping into a rehabilitation patient after 20 years

I was lucky enough to re-engage with an old rehabilitation client (and friend). Some of you may have remembered the accident of Brad Ness who lost his leg whilst working on the Rottnest Ferries twelve days before Christmas about 20 odd years ago.

Funnily enough, Brad and I reacquainted recently twice in two weeks. The first was on a flight returning to our home-town Perth and the second was at an Awards night where unknowingly to me he was the Master of Ceremonies at the Australian Rehabilitation Providers Association. At the Awards night, it was quite a humble experience that he spoke about his workplace injury and his rehabilitation programme that he completed. Needless to say, I didn’t realise how much of an influence I had on his recovery, his return to normal living and returning to work within 12 weeks back at preinjury work within 6 months after losing his leg from the knee down.

Following the awards night Brad agreed to tell his story about his injury, subsequent recovery and the implementation of exercise rehabilitation. Our business development manager Alison had the privilege of interviewing Brad. Recently having the opportunity to listen to the recording, I again was left quite inspired by the impact we as Exercise Physiologists have on people’s lives after sustaining such a debilitating injury.

Brad mentions in his interview that it was the small steps gained session by session, our “can do” attitude and thinking outside the box to implement appropriate exercise strategies. One particular that comes to mind was managing the swelling and the atrophy of Brad’s leg during his exercise and recovery during the fitting of the prosthesis. This certainly created challenges as we had blistering from the new weight driven through into the prosthesis coupled with sweat from exercising, as well as restabilising neuromuscular pathways and associated proprioception.

Since his accident and through his tenacious drive, Brad has been extremely successful as a Paralympian representing Australia, winning a gold medal at the 2008 Beijing Paralympics, and silver medals at the 2004 Athens and 2012 London Paralympics. He was also the flag bearer at the Opening Ceremony for the 2016 Rio Paralympics. Brad these days now coaches and mentors young AIS and WAIS para-athletes, amongst other things is expecting his second child very soon.

Listening to the interview, it was evident that exercise physiology has a critical and pivotal part of the return to work process no matter what the extent of the injury but more so, it provides the foundations to establish a return to a meaningful life.

It was a pleasure to be a part of Brad’s journey.

Derek Knox |B.Sc. – Sports | MBA|

Director – Accredited Exercise Physiologist (AEP) (ESSAM)

Stuart Downey – Cervical Radiculopathy

What has been the best part of your exercise rehab program?

“The accountability, the communication  and how quickly improvements have come in his strength”

 

Has the program benefited you in other areas of your life?

“Able to do more around the house without pain”

 

Accredited Exercise Physiologist: Michael Buswell

PREHAB: Posture, Pain and Function

Muscles, tendons, joints and nerves are extremely susceptible to injury, when under stressful situations or traumatised over an extended period. Regardless of the occupation, most of the working population are involved in completing repetitive movements and maintaining postures for long periods of time. Based on current literature the most common injuries in the workplace are the lower back, neck and shoulders. These affected areas then cause a reduction in the productivity of companies, therefore implementing health and safety strategies may reduce the likelihood of workplace injuries.

At the end of August, Absolute Balance conducted an initiative for Iluka Resources to address pre-existing injuries and/or physical goals of the current employees; this program was called “PREHAB”. The program involved conducting an initial assessment for 30 minutes, which included a health and lifestyle questionnaire and a functional assessment (Range of motion, special tests and manual muscle testing). This allowed the Absolute Balance team to construct a comprehensive exercise program to address physical discrepancies or imbalances of each of the employees. Each employee was provided with an exercise program addressing sets, repetitions and rest periods, accompanied by self-managing equipment (foam rollers, spikey balls and resistance bands). This provided the employees with the tools to tackle any pre-existing injuries they may have.

Most injuries that were assessed by Absolute Balance included lower back pain, bursitis, tennis or golfers’ elbow, carpal tunnel syndrome, general tightness/soreness, postural imbalances and many more. The main goal of the initiative was to empower the employees with exercises that would provide symptomatic relief of the area of concern, while strengthening the surrounding musculature. When completing the functional assessments, a common re-occurrence of the employees were postural imbalances of the upper and lower limbs e.g rounded shoulders. This may be caused either from poor ergonomics and or repetitive movements in sustained postures under load (Wang, 2016).

Corporate wellness programs have received a rejuvenating jolt in the past several years whether it be group classes, nutritional advice and or health checks. Another area that should not be overlooked is the employees’ physical posture. Like physical activity, good posture is linked with a range of health and well-being benefits. Several studies have concluded that implementing exercises such as resistance-based and or stretching has a positive effect on postural imbalances, reducing the impact of workplace musculoskeletal pain (Kim & lee, 2004; Kim et al., 2015). The main goal of PREHAB was to empower employees with exercise programs to address underlying musculoskeletal injuries, that cause discomfort in working tasks or other activities. The program received good feedback from the employees as it provided education and the tools to complete the exercises at home or at work.

If you believe that your company would benefit from a program such as “PREHAB”, get in contact with us today either by emailing info@absolutebalance.com.au or calling us on 9244 5580.

 

David McClung, B.Sc. Exercise Science and Rehabilitation (AEP, AES) (ESSAM)
Accredited Exercise Physiologist

References:

Kim, J. K., & Lee, S. J. (2004). Effect of stretching exercise as work-related musculoskeletal pain of neck and shoulder. J Kor Alliance Health Phys Edu43(43), 655-62.

Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of Physical Therapy Science27(6), 1791-1794.

Wang, C. (2016). Good Posture and its Wealth of Benefits to the Workplace. Lumo Bodytech.

 

 

A NEGATIVE Lift Has POSITIVE Results

Resistance training consists of two main movements, concentric and eccentric. Concentric movement is when the muscle shortens whilst producing force, an example of this is the pushing phase of a bench press. Eccentric movement is the lengthening of a muscle whilst under tension, this occurs on the lowering of a bench press. More often than not a resistance training program will focus on the concentric portion of the lift as this is known to be the ‘best’ way to increase muscle size and strength. However, recent studies have shown that if your main goal is to increase overall muscle size and strength, then eccentric training may be more beneficial. There are several ways a program can implement eccentric training, the most common and widely used variation is tempo.

Tempo is used to alter the speed in which a movement is performed putting particular focus into the eccentric portion, resulting in a greater time under tension (TUT). Along with other variables, TUT is important for promoting a greater stimulus which increases both muscle strength and size. Depending on experience level and current training phase, the tempo used will change accordingly. When focusing on muscular endurance the eccentric phase of exercise is ideally between 2-6 seconds (s). However, if your goal is more focused toward hypertrophy or strength the eccentric portion is between 2-4s and 1-2s respectively (P.Mcall, 2019).

Interpreting tempo is very simple, more often than not it will be written in a four-figure configuration. The first number of the sequence represents the first movement pattern of the exercise. For example: 3/2/X/1 in a squat will be a 3s lowering phase, 2s pause, X (explosive) upward phase and a 1s reset before the next repetition. However, if this same tempo was to be implemented into a deadlift due to the different starting movement the tempo will be interpreted slightly differently. For example: 3/2/2/1 where 3s is the upward phase, 2s pause, 2s lowering phase, and a 1s reset.

Implementing tempo into your training program is an effective way to progressively overload a muscle fibre without having to add extra weight. Next time you hit a plateau try giving tempo a go, alternatively, you can contact us at info@absolutebalance.com.au for more information.

Cameron Galati 

Accredited Exercise Physiologist

B.Sc. Exercise and Rehabilitation, B.Sc. Exercise and Sport Science, (AEP,AES) (ESSAM)

References:

 G, Dudley., P, Tesch., B, Miller., & P, Buchanan. 2016. Importance of eccentric actions in performance adaptations to resistance training. Journal of European Medicine, 62(6).

Brandenbrug, J., & Docherty, D. (2002). The effects of accentuated eccentric loading on strength, muscle hypertrophy, and neural adaptations in trained individuals. Journal of Strength and Conditioning Research, 16(1), 25-32.

Vogt, M., & Hoppeler, H. (2014). Eccentric exercise: mechanics and effects when used as training regime. Journal of Applied Physiology.

McCall, P. (2014). Weightlifting tempo and amp: sets: how to select the right tempo counts. American Council on Exercise.

 

Losing our right arm!

Eight weeks ago our Business Manager Viki suffered a distal radius fracture whilst playing with her children. These injuries can be quite complex in adults.

Besides the frustration about the injury Viki’s primary concern was how to cope with two young kids (2 & 5), work and the myriad of daily duties that a mum and a professional have.

Wrist fractures, in particular, are notoriously difficult to heal due to the potential for malunion. The goal of treatment is to restore mobility, reduce pain, and improve functional outcomes following rehabilitation.

Treatment initially was, immobilisation/splinting (cast) for 6 weeks followed by mobilisation and finally strengthening through progressive rehab.

It was interesting having the full rehab process that our clients go through front and centre with one of our own (albeit not a worker’s compensation injury). As employers, we value ALL our team members and Viki was no different, given that she is an accountant and handles all our financials (amongst other duties) not being able to use her right hand made life difficult.

What we did:

  • Consulted with her treating specialist to individualise the program, ascertain any contraindications present (if any)
  • Conducted an ‘in-house’ ergonomic assessment both at work and at home looking at non-dominant hand mouse use as well as support for the injured limb as well as the other factors relevant
  • Flexibility for Viki to work from home when she saw fit e.g. when the pain was too severe or it was easier to manage in the comfort of her own home
  • An exercise rehabilitation program and an individual Accredited Exercise Physiologist (AEP) to assist Viki’s rehab and recovery
  • Main focus; keep the swelling down and keep pain at a minimum; Rest, Ice, Compression, Elevation. Range of Motion exercises for improved mobility followed by strengthening exercises to increase function
  • Equipment for Viki’s strengthening and function; hand putty, theraband and tubigrip compression garment for at night
  • Ongoing reassurance, assistance, and encouragement

Whilst we never like to see anyone injured, having one of our own certainly ensured we practice what we preach with regards to appropriate rest, recovery and rehabilitation. Our business was also tested with regards to flexibility for our workers and I think Viki would say we passed with flying colours!

If you wish to know more about our services or people please visit absolutebalance.com.au or email info@absolutebalance.com.au

Ryan O’Connor

Director – Accredited Exercise Physiologist (AEP) (ESSAM)

 

Reference

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098688/

 

Achilles Tendon Rupture – The Different Rehabilitation Phases

For those who followed the NBA finals between the Toronto Raptors and Golden State Warriors, you would have seen Kevin Durant go down in Game 5 with an Achilles rupture injury. It is a horrific injury and it will be a long road to recovery for him. The optimal individualised treatment for patients with an Achilles tendon rupture still requires further research. Many of the current research explores the impact of the calf muscle recovery at different time intervals after an Achilles tendon rupture.

The latest evidence-based research suggests the rehabilitation for an Achilles tendon rupture can be divided into four phases. The progression of a patient is based on both the recovery of the patient and the time since the injury occurred. Pain after an Achilles tendon rupture is mostly not an issue; however, the dosage of activities must be closely monitored in order to avoid over-use injuries.

  1. Controlled mobilisation phase (0-8 weeks)

The injured foot is mobilised in a plantar flexed position for 6-8 weeks after injury. 2 weeks after injury, non-weightbearing plantarflexion exercises are introduced. Both active and passive ankle dorsiflexion will be limited to prevent tendon elongation.  Gradual progress to full weight-bearing within the first 6 weeks along with accelerated rehabilitation has been proven beneficial.

  1. Early mobilisation phase (6-12 weeks)

Patients are ready to commence a supervised exercise programme; close monitoring is required when loading the ankle as the risk of re-rupture of the Achilles tendon is at its greatest during this stage. The orthosis is worn during all weight-bearing activities for 6 to 8 weeks after injury. Partial weight-bearing without an orthosis is slowly introduced in this phase, however wearing regular shoes with bilateral heel lifts to decrease ground reaction force during functional activities is required. Stretching the tendon in dorsiflexion is not recommended in order to prevent elongation of the tendon. Introduction of active non-weight bearing ankle dorsiflexion that stretches the gastrocnemius and soleus muscle group with the knee extended and flexed.

  1. Late mobilisation phase (10-15 weeks)

The goal of this phase is to improve the strength and proprioception of the lower limbs. Initiate open- and close-chain, low-intensity resistance exercises at 8-10 weeks. Open-chain resistance exercises include the implementation of a resistance band. Bilateral progressing to unilateral close-chain exercises such as sitting heel raises with external load (25-50% of body weight) and standing heel-raises with the variation of concentric, eccentric and isometric contractions. A milestone during this phase is to perform at least 20 seated heel-raises with a load of 50% of body weight. Proprioception training and balance exercises are incorporated, progressing from bilateral to unilateral stance and from stable to unstable surfaces.

  1. Return to sport/work phase (3-12months)

The final phase of rehabilitation is directed towards returning the patient to pre-injury work function and demands of recreational and sporting activities, which begins around 12- 16 weeks. A more intensive resistance programme including dynamic proprioceptive exercises combined with eccentric resistance exercises of the gastrocnemius-soleus muscle group in weight-bearing positions and gradually progressing to plyometric exercises. Patients are able to gradually return to work or sport 5 to 6 months if the strength of the injured limb is relatively comparable to that of the contralateral limb.

Tendon elongation after an Achilles tendon rupture affects heel-raise height during a standing single-leg heel-raise. The current recommended treatment protocol suggest calf muscle performance is not restored completely in most patients, but some evidence indicates that regaining calf muscle performance within the first year after the injury is beneficial. However, calf muscle recovery takes a long time and improvements in heel-raise height in the injured limb are found up to 7 years after the injury. Early intervention such as a supervised exercise programme is vital for the recovery of an Achilles rupture injury. Contact the team of experienced Accredited Exercise Physiologists at Absolute Balance on 9244 5580 or email info@absolutebalance.com.au

Daniel Nguyen (B.Sc. Exercise Physiology)

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

 

Reference

Caroyln Kisner & Lynn Allen Colby. (2007). Therapeutic Exercsie 5th Edition. Foundations and Techniques, 782-786.

Brorsson, D. A. (n.d.). Calf muscle rehabilitation post Achilles tendon rupture. Physio Network.

 

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 info@absolutebalance.com.au.

Callan Smith 

Accredited Exercise Physiologist (AEP) (ESSAM)

 

The Role of Muscle Mass in Type 2 Diabetes Mellitus

Diabetes is classified broadly into type 1 and type 2 diabetes. Type 1 accounts for approximately 5-10% of cases with Type 2 diabetes accounting for 90-95%. Type 2 is diagnosed normally during adulthood and is generally associated with insulin resistance and eventually loss of insulin secretion. This means the glucose in our blood is no longer being adequately controlled by insulin which can lead to heart, eye, kidney and nerve problems.

Exercise is imperative for the prevention and treatment of type 2 diabetes and the role of resistance training plays an integral part. When partaking in resistance exercises, we create an energy need within the muscle which allows blood glucose to enter the muscle and leave the bloodstream which reduces our blood glucose levels. More importantly, it also allows us to build up GLUT 4 receptors. These are transporters that are located in muscles that are activated during exercise. They are responsible for up taking glucose into the muscles to be used for energy. By building up muscle mass and GLUT 4 receptors through exercise, diabetics will have a better ability to reduce their blood glucose levels. This leads to better long-term control and improves insulin resistance, blood pressure, reduces fat mass and increases strength. Resistance training can also reduce the stress hormone cortisol which has also been linked to insulin resistance.

The exercise recommendations for type 2 diabetics are at least 150 minutes per week of aerobic and resistance training. It is recommended that exercise is performed daily due to enhanced insulin action. Performing resistance training before aerobic exercise, when combined in one session, will also reduce the likelihood of postexercise hypoglycemia.

Lifestyle changes that focus on exercise and dietary interventions are recommended for weight loss in the prevention and management of type 2 diabetes. If you are looking for an individualised programme, contact an accredited exercise physiologist.

Taylor Downes

Exercise Physiologist (Student)

B.Sc. Sport & Exercise, B.Ed. Human Movement (ESSAM)

References

Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., et al. (2016). Physical Activity/Exercise and diabetes: A position statement of the American diabetes association. Diabetes Care, 39(11), 2065-2079. doi:10.2337/dc16-1728

Ahlqvist, E., Storm, P., Käräjämäki, A., Martinell, M., Dorkhan, M., Carlsson, A, et al. (2018). Novel subgroups of adult-onset diabetes and their association with outcomes: A data-driven cluster analysis of six variables. The Lancet. Diabetes & Endocrinology, 6(5), 361. doi: 10.1016/S2213-8587(18)30051-2

Greater Trochanteric Hip Bursitis.

Is it becoming a common occurrence to feel a burning sensation down the side of your hip? This could occur in the mornings when you wake up, after a session at the gym or even as simple as a brisk walk around the supermarket. You could be experiencing the symptoms of Greater Trochanteric bursitis (hip bursitis). Bursitis refers to the inflammation to the sac of fluid (bursa) which reduces the friction between bone, tendon or muscle.

Previously hip bursitis was commonly found in aged populations, however, there is an increasing number of young to middle-aged adults who are also experiencing the same symptoms. There are a few forms of hip bursitis however, Greater Trochanteric (GT) being the most commonly diagnosed. Those who have been sedentary for a lengthy period of time are at a greater risk to have an over-use injury. The attempt to complete activities that the muscles supporting the hip have not yet adapted to creates an overload. Inadequate rest time between sets or active periods can cause this. Tightness will begin to occur in the muscle and tendon creating friction on the bursa which will elicit that pain response.

Athletic populations are not ruled out from this injury. Without the appropriate amount of rest and flexibility training, bursitis pain can arise. The repetitive movements within the hip especially in endurance sports such as running, AFL and combat sports are the most likely candidates to experience this.

A great way of restoring function and reducing pain is through a range of specific exercises. In the case of GT bursitis, there are 3 main muscles we should aim to target. Those being the gluteus medius, minimus and maximus which are responsible for abduction and stabilisation of the hip. Exercises are likely to have a positive effect if the individual begins with isometric contractions before any movement is added.

Below are some examples of isometric strength exercises and their progressions noting that resistance bands can be added to increase the intensity of each exercise.

1. Seated isometric bilateral hip abductions with resistance bands

  • Crab walks

2. Standing isometric unilateral hip abduction against a wall

  • Clamshells

3. Isometric glute-bridge hold using resistance band

  • Pulsing glute bridges

The team at Absolute Balance are experts in chronic, acute and overuse injuries. We understand the importance of working to restore you back to a functional capacity. For more information or to arrange a more tailored programme to your injury, get in touch with the team here at Absolute Balance.

Emily Longmuir

Exercise Physiologist

Tyler, T. F., Fukunaga, T., & Gellert, J. (2014). Rehabilitation of soft tissue injuries of the hip and pelvis. International journal of sports physical therapy9(6), 785-97.