Fit to Waist away: A workplace exercise program to improve health benefits of employees.

As we have been told for many years implementing exercise into your daily routine has many potential health benefits, however, despite knowing the benefits, most of the population do not meet the recommended guidelines. Sedentary jobs are common in employed adults with approximately half of all waking hours spent at their workplace, therefore, the implementation of exercise programs during this period is known to be an effective strategy to reduce sedentarism and improve overall health (Conn et al., 2009). Incorporating a workplace program can also promote group cohesion, build friendships and improve the overall social climate (Jakobsen et al., 2017; Berry, Mirabito & Baun, 2010).

Over a 12-week period, consisting of two 6-week blocks, Absolute Balance undertook a workplace exercise program at the Shire of Mundaring. The aim of the “Fit to waist away” program was to improve physical fitness while also increasing the social interaction of the participating employees. Prior to the group sessions, all participants completed an initial assessment which included baseline (heart rate, blood pressure, body mass, body fat percentage, circumference measurements etc) and functional assessments (push-ups, squats, step up test, flexibility). These assessments allowed the Absolute Balance consultants to address any physical discrepancies that presented themselves, while also allowing for goals to be set. Whether it be for body composition, functional improvements or both, the Absolute Balance team worked alongside the participants to provide a comprehensive approach to exercise. The assessments were then re-taken after each 6-week block and to track progression.

The group exercise sessions that were run by the Absolute Balance team, included a variety of exercise formats which included; boxing, circuit classes, bodyweight movement, and mobility. This allowed all participants to be introduced to a range of different training styles, which in turn provided for a uniquely physical and mentally stimulating environment. Over the 12 weeks, all participants had positive increases in their functional assessments, with both upper and lower limbs increasing in overall muscular strength and endurance. A large proportion of participants also had changes in body composition over both 6-week periods. Specifically, one participant lost 5 kgs off their total body mass, with a reduction in both waist and hip circumferences. This program conducted by Absolute Balance identified that by implementing workplace programs directly into the daily routine of employers leads to improvements in both physical and psychosocial factors. This is supported by several academic research articles that have all concluded that; through the implementation of structured workplace exercise programs, improvements in physical, mental, and social health of employees can be seen (Conn et al., 2009; Jakobsen et al., 2017; Berry et al., 2010).

On completion of the structured 12-week program, all employees involved responded positively and stated how ‘they had thoroughly enjoyed the workplace program’. This program has clearly identified the importance of implementing exercise into daily working routines, with both body composition and functional changes seen throughout all participants.

If you think that your workplace would benefit from this program please contact us on 9244 5580 and or email at us

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



Berry, L., Mirabito, A. M., & Baun, W. (2010). What’s the hard return on employee wellness programs?. Harvard Business Review, December, 2012-68.

Conn, V. S., Hafdahl, A. R., Cooper, P. S., Brown, L. M., & Lusk, S. L. (2009). Meta-analysis of workplace physical activity interventions. American Journal of Preventive Medicine37(4), 330-339.

Jakobsen, M. D., Sundstrup, E., Brandt, M., & Andersen, L. L. (2017). Psychosocial benefits of workplace physical exercise: cluster randomized controlled trial. BMC Public Health17(1), 798.


Injured at work, who can help me???

In the unfortunate event that an accident occurred at work and you become injured, it can often be a stressful time in your life. Not only have you sustained an injury, but it can often raise many questions such as how long will I be off work? How am I going to pay bills? Will this injury affect my normal routine? How am I going to get better? Who is going to help me get better?

The last two questions how am I going to get better and who is going to help me are the two questions health professionals most often come across. Recently, I had the opportunity to shadow a general practitioner (GP) for an afternoon. In that time, I was able to sit in on several initial assessments for workplace injuries. These two questions come up without fail throughout the assessments, with most workers unsure of the system and who can provide them with the help to get better. The answer to these two questions varies from case to case however the process to get to those answers follows the same process.

The answers are largely based on how the injured worker presents in the initial assessment. The treating GP will carry out their testing based on the information given by the worker on the incident. They will then determine if there are any other investigations needed or what treatment options are appropriate at the time to get the best possible outcome for you and your condition. When determining who will be suited to help you get better, the GP will work through the Workcover clinical framework and determine who will provide you with the most effective treatment, address any biopsychosocial factors (if any are present), empower you to manage your injury, implement goals that optimise function and participation in your return to work plan and base treatment on evidence-based research. Often the GP will refer you to an allied health professional such as an Accredited Exercise Physiologist (AEP) to assist you in your recovery.

Once a referral has been made by the GP and has the appropriate allied health professionals involved, they will also follow the Workcover clinical framework to assist in achieving the best possible outcome for you and your injury. When treated by an AEP they will assess you and take baseline measures related to your role and assist the GP in determining your capacity for work. A comprehensive treatment plan with effective management strategies is then put in place to help you get back to work. These measures are also reviewed and re-assessed over the course of the treatment to determine the effectiveness of the treatment and that it is relevant to improving your condition. Regular reviews also give you as the worker regular feedback on your progress recovery and your independence. This feedback often empowers you as the injured worker to begin managing the condition and implement the management strategies given to you by your health provider.

Ultimately having the right health team on board, they will do their best to assist you in improving your condition, doing what they can in their scope of practice to help get better.

If you have any questions on how an Accredited Exercise Physiologist can help you improve your workplace injury and get you back to work contact us at

Claire Hills

( B.EXSpSc,Grad.Dip.(Clin.Ex.Phys))
Accredited Exercise Physiologist (AEP) (ESSAM)



Clinical Framework. (2016, January 28). Retrieved July 7, 2019, from

Rio Tinto – ICARE Body Movement class: The importance of mobility and stability exercises in sedentary workplaces

Over several weeks, Rio Tinto conducted an ICARE movement program for their employees focusing on the role of mobility, stability and strength for risk mitigation and overall joint health. The classes focused on body parts that research has indicated to be of high importance for postural imbalances and musculoskeletal pain in sedentary workplaces. The 4-week exercise program conducted once a week involved various mobility and stability exercises for the hip, spine (cervical, thoracic, lumbar), and shoulder to allow for the optimal function for work-related tasks and other performance measurements (Okada, Huxel & Nesser, 2011; Parry et al., 2017).

Over the weeks, the team at Absolute Balance provided educational information on the importance of mobility and stability. Identifying how it relates to improvements in strength and reductions in workplace musculoskeletal discomfort.  We implemented mobility exercises into the sessions allowing the employees to perform several movements through their full active range of motion
(AROM), whilst reducing any restrictions of the adjacent tissue around the joints. In addition, Absolute Balance implemented stability exercises that challenged the employees to control their joint position and movement by coordinating surrounding tissues and their neuromuscular system (Okada, Huxel & Nesser, 2011).

Mobility relates to movement while stability relates to control”

The primary role of why Absolute Balance implemented these movements of mobility and stability into the program was to improve any postural imbalances, while reducing the impact of musculoskeletal pain/discomfort. Recently, several systemic reviews conducted by Parry et al (2017) and Van Eerd et al (2016) identified that musculoskeletal symptoms such as pain and discomfort in the upper extremities, lower back, and neck are present in more than 90% of sedentary workers. The reviews identified that specific range of motion exercises can have a positive effect on consistent workplace musculoskeletal problems and overall work capacity (Parry et al., 2017; Van Eerd et al., 2016). Therefore, we completed this 4 – week program to increase awareness of the importance of movement while providing them with the tools to complete the exercises in the future.

Overall, each of the employees that undertook the ICARE program thoroughly enjoyed the sessions, identifying the importance of each exercise. Several staff members of Rio Tinto identified that numerous movements that were conducted have been implemented into their daily routines resulting in reductions of musculoskeletal symptoms.

If you are interested in implementing a program like this into your workplace or feel as if your body would benefit from mobility/stability exercises, please contact Absolute Balance on 9244 5580 or email to speak with an Accredited Exercise Physiologist.

David McClung

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


Okada, T., Huxel, K. C., & Nesser, T. W. (2011). Relationship between core stability, functional movement, and performance. The Journal of Strength & Conditioning Research, 25(1), 252-261.

Parry, S. P., Coenen, P., O’Sullivan, P. B., Maher, C. G., & Straker, L. M. (2017). Workplace interventions for increasing standing or walking for preventing musculoskeletal symptoms in sedentary workers. Cochrane Database of Systematic Reviews, (1).

Van Eerd, D., Munhall, C., Irvin, E., Rempel, D., Brewer, S., Van Der Beek, A. J., … & Amick, B. (2016). Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occup Environ Med, 73(1), 62-70.

What is Proprioception?

Proprioception in the body’s ability to know the positioning and movement of all parts of the body in space without having to look at them. Proprioception is referred to as one of our internal senses and is so critical to our everyday functioning as human beings that it’s generally not until we sustain an injury that we become aware of how important it really is. Proprioception allows us to do things like run on uneven ground and kick a ball without having to look at what we are doing.

In basic terms, our muscles, joints, skin and ligaments all contain sensory receptors that contribute to proprioceptive input. These receptors sense things like tension, contraction and stretch and send this information to our brains. The brain responds by sending signals back telling muscles to contract or relax to achieve the desired movement. This system is subconscious and often movement correction or adjustment happens so quickly it’s almost reflexive.

Proprioception can be interrupted by musculoskeletal injury where the sensory receptors get damaged which in turn affects the feedforward feedback loop. Interruptions to this system can inhibit neuromuscular control, coordination and increase reaction time external stimulus this subsequently increases the risk of sustaining further injury.

How is proprioception improved?

Proprioception can be improved with challenging exercises such as those that challenge positional awareness, throwing and catching, working on uneven surfaces, working with uneven or unpredictable loads, jumping landing and balance exercises to name a few.

Proprioception exercises should be integrated into a rehabilitation programme as soon as clinically appropriate. An Accredited Exercise Physiologist can provide further advice on this.

Below are examples of some more advanced shoulder proprioception exercises that I have recently used in the later stages of a rehabilitation programme with a client who sustained a shoulder injury at work.

Prone Ball Bounces


Lying prone on a bench with arms and head extended over the end of the bench, bounce the bosu ball and catch again, repeat for the required repetitions.

Bosu Ball Modified Push Up


Lean forward and lower body to bosu ball (unstable surface), absorb force through arms and then push back to start position, repeat for the required repetitions.

Prone Ball Walk Out


The above proprioception exercises that I implemented with my client were useful in improving movement co-ordination and building confidence to complete dynamic upper body tasks required in his pre-injury job role. For more information, speak to an Accredited Exercise Physiologist at Absolute Balance.


Lisa Wallbutton (BSR, MClinicalExPhysiol(Rehab))

Accredited Exercise Physiologist (AEP) (ESSAM)



José Inácio Salles, B. V. (2015). Strength Training and Shoulder Proprioception. Journal of Athletic Training, 277-280.



Exercise physiologist: How we can help you with chronic disease

Exercise is considered a relatively new treatment option for chronic disease prevention and management. Many doctors and patients are unaware of how exercise can help, and what kind of exercise is right for them or their patients. This is where exercise physiologists (AEP’S) come in. We are the experts in exercise prescription. Often AEP’s are confused with physiotherapists and although they are similar, they are not the same thing. Physios address and diagnose acute musculoskeletal injuries and restore initial function; where as AEP’s use evidence based exercise intervention for chronic disease prevention and management. Although different, physios and AEP’s often work together to ensure the best results for patients.

Exercise as a treatment option has only gained traction in the 21th century, however it was widely regarded as one of the best disease prevention options over two thousand years ago. Hippocrates wrote “In a word, all parts of the body which are made for active use, if moderately used and exercise at the labour to which they are habituated become healthy, increase bulk, and bear their age well, but when left without exercise they become diseased, their growth is arrested and they soon become old”.

As AEP’s we use exercise as medicine. Each individual is prescribed a dose of exercise for their particular pathology. The prescription is given similar to any other medication. For example, exercise A, for B times a day, for C amount of time; whether that is for days/weeks/months or years. The dose and type of exercises are chosen for each individual person based on their needs and ability. They are then progressed based on their individual goals and functional need to perform physical tasks. This is designed for long term management, lifestyle and behavioural changes to effectively manage chronic conditions.

Exercise can be used to manage and prevents a number of chronic diseases which include cardiovascular disease, metabolic diseases such as diabetes, neuromuscular diseases such as Parkinson’s; as well as musculoskeletal conditions such as arthritis, osteoporosis and other acute and chronic musculoskeletal disorders.

At Absolute Balance we empower our clients, provide education and encourage positive behaviour changes through the use of evidence based therapies to help out clients achieve their health goals. For more information contact us today


Claire Hills ( B.EXSpSc,Grad.Dip.(Clin.Ex.Phys))
Accredited Exercise Physiologist (AEP) (ESSAM)


What is an Accredited Exercise Physiologist? (n.d.). Retrieved March 18, 2019

Moore, G. E. (2004). The role of exercise prescription in chronic disease. British Journal of Sports Medicine, 38(1), 6-7. doi:10.1136/bjsm.2003.010314

Durstine, J. L., Moore, G. E., & Painter, P. L. (2016). ACSMs exercise management for persons with chronic diseases and disabilities. Champaign, IL: Human Kinetics.

Hamstring Injury

Last week I injured my hamstring whilst decelerating from a sprint at soccer training.  Fortunately, it’s not a serious injury, however I will still miss 3 games.  This injury is a wake-up call as two of the main factors were in my control.  In the preceding nights, my sleep quality was poor, causing a state of fatigue, and henceforth an elevated injury risk.  The second factor was my level of conditioning, which was good, but I know it could have been higher, especially for repeated sprints.  So as part of my rehabilitation (and long-term goals) I will focus on maintaining a regular sleep pattern and increasing repeated sprint capacity, in addition to restoring hamstring function.

As with any injury, it is important to understand the mechanism of injury to devise an optimal plan of action.  A key role of the hamstring muscle group is to decelerate the thigh and leg during the late swing phase of sprinting.  During this phase, the hamstrings are working eccentrically.  There is a large body of evidence indicating reduced eccentric hamstring force due to fatigue is associated with an augmented injury risk.  My injury occurred whilst decelerating from a sprint, and during the latter stages of training when hamstring force capacity was reduced due to fatigue.  Therefore, a key part of my rehabilitation will be to increase eccentric hamstring strength and fatiguability (as well as other factors).  I have included the Nordic hamstring lower in my rehabilitation programme to target eccentric strength as it is reported to be an effective intervention for preventing hamstring injury.  The world governing body of soccer/football, FIFA, has included the Nordic hamstring exercise in their injury prevention programme.  Whilst a primary focus will be on restoring hamstring function, I will also increase my lumbo-pelvic stability and maintain aerobic fitness through cycling.  As I return to running, I will progressively increase my repeated sprint capacity to facilitate my return to playing soccer.

Whilst the physical elements are vital for any rehabilitation programme, one of the most important factors for me is my mindset.  I have a strong drive to return to both soccer and running as these are two of my hobbies.  This mindset will facilitate my progress over the next 3 weeks by motivating me to complete my exercises each day.  Additionally, a clear mindset will also lighten the burden of any potential setbacks, which I have experienced with past injuries.

Whilst watching from the sideline is not ideal, I have learnt the importance of having a clear goal and a plan in place to achieve that.  I’m also aware that I need to take responsibility to reduce my future risk of injury and keep me on the playing field.

Please note hamstring injuries can be multi-factorial and those listed above are not an exhaustive list.  If you would like more information on exercise rehabilitation programmes that Absolute Balance can provide, please don’t hesitate to contact us at


Daniel D’Avoine (B.Sc.Ex.Phys)

Senior Exercise Physiologist (AEP, AES) (ESSAM)



Al Attar, W.S.A., Soomro, N., Sinclar, P.J., Pappas, E., & Sanders, R.H. (2017). Effect of injury prevention programs that include the Nordic hamstring exercise on hamstring injury rates in soccer players: a systematic review and meta-analysis. Sports Medicine 47(5), 907-916.

doi: 10.1007/s40279-016-0638-2.

Freckleton, G., & Pizzari, T. (2013). Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-anaylsis. British Journal of Sports Medicine, 47(6), 351-358.


Small, K., McNaughton, L., Greig, M., & Lovell, R. (2010). The effects of multidirectional soccer-specific fatigue on markers of hamstring injury risk. Journal of Science and Medicine in Sport, 13(1), 120-125.


Smoking and its effect on your health

It has been highlighted by medical professionals that most smokers have heard it is harmful to their bodies, but they continue to smoke. It’s important for clients to know exactly the impacts of the choices they are making to their bodies so they can make an informed decision about their health and seek the correct help.

Every year approximately 6 million people world-wide die prematurely from preventable smoking related diseases, mainly cardiovascular diseases like coronary heart disease and respiratory diseases such as chronic obstructive pulmonary disease. This might be a shocking number to some as the prevalence of smoking has declined over the years.  Smokers are four times as likely than non-smokers to suffer from cardiac related deaths and is the cause of around 20% of all cancer deaths and 80% of all lung cancers. Smoking is a preventable lifestyle choice that leads to premature deaths and illnesses worldwide.

What are cigarettes actually made up of?

You might be surprised to know that cigarettes contain more than 4000 chemicals! A large amount of these chemicals has been identified as cancer causing, a few examples of these toxins include:

  • Nicotine – the addictive agent in tobacco smoke.
  • Formaldehyde – used in preservation of laboratory specimens.
  • Ammonia – used in toilet cleaner.
  • Hydrogen Cyanide – used in rat poison.
  • Acetone – used in nail polish remover.
  • Carbon monoxide – found in car exhaust.
  • Tar – particulate matter in cigarette smoke.
  • Toluene – found in paint thinners.
  • Phenol – used in fertilisers.

Some common health impacts:

  • Smoking reduces fertility in both men and women.
  • Declines in lung function and airway inflammation, which is why many smokers get out of breath quickly.
  • Aggravation of asthma and becoming resistant to inhaled corticosteroids.
  • Increased risk of miscarriage and underdevelopment of foetus.
  • Increased risk of bacterial and viral infections in the respiratory tracts.
  • Increased risk of cancers
  • Increased risk of cardiovascular diseases
  • Increased risk of strokes
  • Increased risk of blindness
  • Increased risk of deafness
  • Increased risk of osteoporosis
  • Increased risk of peripheral vascular disease
  • Increased risk of back pain.

What happens when you stop smoking?

When you take the step to stop smoking it can lead to different reductions in risks of smoking related diseases. 12 months post discontinuing smoking it is shown that the excess risk of having a heart attack due to smoking reduces by 50%! Giving up smoking recovers approximately 2-3 months of healthy life expectancy for every year smoking is stopped, around 4-6 hours every day. It is also shown to reduce breathing difficulties and return your lungs to a normal age-related decline, this will help with completing activities of daily life and being able to efficiently transport oxygen around the body.

For help:

Visit Absolute Balance consultants to discuss your health and fitness or call Quitline on 131 848

Dominique Mitchell

(B.Sc. Exercise, Sports, & Rehab Science; Grad Dip. Exercise Rehabilitation)



Godtfredsen, N. and Prescott, E. (2011). Benefits of smoking cessation with focus on cardiovascular and respiratory comorbidities. The Clinical Respiratory Journal, 5(4), pp.187-194.

West, R. (2017). Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychology & Health, 32(8), pp.1018-1036. (2019). quitnow – Cigarettes and poison. [online] Available at: [Accessed 14 Feb. 2019].


Success Story – Paul Hudston

Paul sustained a knee injury at his workplace when he slipped stepping down from a step and slipped into mud and twisted his right knee. Paul was referred to Absolute Balance for exercise rehabilitation by his employer and insurer 2 weeks post-operative right knee arthroscopy and removal of loose bodies and chondroplasty.  At the initial assessment, Paul presented with slight swelling around the anterior-lateral aspect of his right knee and reported of ‘clicking’ during squatting movements. Paul had slightly restricted range of movement through his right knee specifically in knee flexion approximately 120o in weight bearing postures and approximately 10o in extension. Paul demonstrated loading approximately 40% through his right knee while performing functional movements including squats and step ups, and it was identified Paul had weak gluteal and hamstring musculature. Paul’s restrictions were lifting up 5kg, stand up to 15 minutes, walk up to 200 metres, drive 30 minutes twice day.


Job Specific Program

Pauls’ pre-injury duties included construction of scaffolds, working on platforms on average 3 metres in height, working on narrow and in confined spaces, operating cranes, load/unload tools and equipment, carry equipment on even surfaces and climbing up to 10 flights of stairs while carrying tools up to 20kg. The physical critical demands of his job role include lifting from floor to waist up to 25kg, lifting waist to shoulder height up to 20kg and lifting overhead up to 10kg. Majority of Paul’s work tasks are performed in a repetitive forward flexed and outreaches postures combined with push/pull style movements.


Paul’s exercise rehabilitation program initially focussed on improving pain-free range of movement through his right knee using a series of stretching and active range of movement exercises. The program progressed to correct muscular recruitment patterns of his right knee particularly his posterior chain and improved proprioception during work-based tasks. The final stage of his program was to increase strength of his supporting knee and hip musculature with the focus on correct biomechanics and safe manual handling technique for his job role to reduce the risk of re-injury. Paul was having concurrent physiotherapy and exercise rehabilitation treatment three times per week. Paul was able to return back on site with some restrictions including lifting up to 15kg and climbing 3 flights of stairs, after 3 months of exercise rehabilitation. Paul completed a few swings with those restrictions and his capacity was upgraded to pre-injury duties after a month.


Outcome of Exercise Rehabilitation

Paul is now at 100% functional capacity and has showed significant improvements in range of movement through his right knee with slight restriction at end ranges, he demonstrated improved stability and overall lower limb strength. Paul was able to perform repetitive floor to waist lifts with 25kg load, step ups with 20kg load and farmer’s carry with 20kg load on uneven surfaces. These functional movements matched up with the physical critical demands of his job role. Paul performed pre-injury pain-free as a rigger/scaffolder for a month, as a result he obtained a final medical certificate following a graded exercise rehabilitation program. Along the process, Paul started a strict eating plan along with the exercise program and he was able to lose 15kg in weight. Well done Paul!


More some insight on Paul’s exercise rehabilitation program, click on the links below!




Daniel Nguyen (B.Sc. Exercise Physiology)

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


Time Frames for Rehabilitation following Stem-Cell Injection Therapy

Stem cell injections have been increasingly used in the treatment of tendon and meniscus injuries, with varying degrees of success depending on the initial injury, the type of cells injected and the rehabilitation protocol following treatment. Any surgical intervention comes with an element of downtime, but just how much down time is suitable is a common misconception amongst patients following stem cell injections.

Recommendations for rest following stem-cell injections vary from 4 weeks rest up to 12 weeks rest, however the additional effect of deconditioning can inhibit the rehabilitation of injuries whilst time is set aside allowing the stem cells to take. Research suggests that moderate exercise combined with stem cell therapy provides the optimal outcome for conditions such as meniscus repairs with improved regeneration, reduced inflammation and reduced need for prescription-based medications. Further to this, rehabilitation protocols have been identified as most effective when commencing four weeks post-treatment.

Initial stage rehabilitation incorporating Exercise Physiology for lower limb injuries should incorporate two sessions of hydrotherapy per week using only the patients body weight. The second month of rehabilitation should continue to build incorporating hydrotherapy with additional load, progressing towards body weight only land-based exercise with three sessions completed per week. The final phase of rehabilitation should incorporate four sessions of exercise per week for months three and four with two hydrotherapy sessions completed per week and two land-based sessions completed per week.

Delays in the commencement of such rehabilitation protocols can negatively impact the outcomes of stem-cell surgery. Each patient’s injury and previous experience with exercise is different. Treatment from an Exercise Physiologist incorporating the above protocol can ensure the best possible outcome.


Ingrid Hand

BSc – ExHealthSc, GraddipSc – ExRehab, MSc – HumMvt

Exercise Rehabilitation Manager – Accredited Exercise Physiologist (ESSA)


Gibbs, N., Diamond, R., O Sekyere, E., & Thomas, WD. (2015). Management of knee osteoarthritis by combined stromal vascular fraction cell therapy, platelet-rich plasma, and musculoskeletal exercises: a case study. Journal of Pain Research, 8, 799-806.


Total Knee Replacement and Exercise Rehabilitation

The knee, also known as the tibiofemoral joint, is a highly complex joint that when healthy, has a significant function in gait and weight bearing activities. In a perfect world, the articular cartilage and meniscus that allows smooth mobility and shock absorption throughout the joint would remain undamaged. Unfortunately, damage is extremely common through aging and trauma and this kind of impairment is essentially the definition of osteoarthritis. Given the consistent forces the joint experiences in flexion and extension, it is no wonder that this degenerative disease can result in chronic knee pain – and is the leading cause for 98% of knee replacement surgery in Australia.

There is a lot to consider before going under the knife. Your GP and specialist may try several non-invasive options including pharmacological pain management, walking aids and weight loss/ muscle strengthening through exercise. If these options are deemed inadequate, a total knee replacement (or total knee arthroplasty), may be the best choice. It is a significant yet common procedure where the tibia and femur are cut, diseased bone removed and a prosthetic knee joint is applied – essentially resurfacing the joint. This of course is a very simplified description and the complexity of such surgery should not be underestimated.

In Australia, we have seen significant growth in the popularity of the procedure. According to the Australian Commission on Safety and Quality in Health Care, between 2003 and 2014 the number of knee replacement procedures undertaken per year increased by 88%. They indicate that “the increase is partly due to population ageing but also to the growing use of this intervention for people at earlier ages, as a result of rising levels of obesity, which have increased the need for knee replacements.”

So, let’s assume knee replacement surgery is in your best interest – one can expect to experience impairment to range of motion, muscle flexibility, strength, endurance, balance and muscular recruitment patterns. Whilst all muscles around the knee joint are important, atrophy of the quadriceps is the significant contributor to these listed impairments. Quite positively however, exercise intervention can address all of these implications. A study completed by Mizner, Patterson and Snyder-Mackler (2005), showed that “following 6 weeks of rehabilitation, quadriceps strength improved significantly at each following assessment (2, 3, and 6 months postsurgery).” In addition, functional performance enhanced significantly at each assessment, correlating with that of increased quadricep strength. This study and a wealth of others show that muscle impairment and functional limitations can be reversed following a total knee replacement.

Each individual is unique in their recovery after surgery and this remains true throughout the whole rehab process. Common practise will have you moving very shortly after the procedure and in this stage treatment from a physiotherapist may have the best outcome. Up to 3 months post-surgery however, concurrent or sole treatment with the services of an exercise physiologist would be most suitable. The EP’s at Absolute Balance are experts in knee rehabilitation and use only the most up to date, evidence based research when providing exercise therapies. For the best outcomes in your recover, contact us today!

Ed Daccache

B.Ex.SpSc, Grad.Dip.Ex.Sc (AEP, AES) (ESSAM)
Accredited Exercise Physiologist





Australian Commission on Safety and Quality in Health Care. (2017). The Second Australian Atlas of Health Care Variation (Knee replacement hospitalisations 18 years and over). 243-255. Retrieved from

Meir, W., Mizner, R., Marcus, R., Dibble, L., Peters, C., Lastayo, P. (2008) Total Knee Arthroplasty: Muscle Impairment, Functional Limitations, and Recommended Rehabilitation Approaches. Journal of Orthopaedic & Sports Physical Therapy. 38(5), 246-256. Retrieved from

Mizner, R., Petterson, S., Snyder-Mackler, L. (2005). Quadricep Strength and the Time Course of Functional Recovery After Total Knee Arthroplasty. Journal of Orthopaedic & Sports Physical Therapy. 35(7), 424-436. Retrieved from