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The weak knees of an Exercise Physiologist.

Apr 04, 2023

Sweaty palms, heavy arms, spaghetti (mum’s), but mainly weak knees.


At one stage it seemed like almost a pre-requisite for joining the team at Absolute Balance, but I, like several of my colleagues, fell victim to the dreaded ACL injury. Unfortunately, not once but twice; a right knee ACL rupture in 2017, followed by a left knee ACL rupture and medial and lateral meniscus tears in 2020. In 2017 I underwent an ACL reconstruction with hamstring graft, after which I returned to competitive sport comfortably at 18 months. In 2020 I decided not to undergo surgery, instead attempting a non-operative approach. I made major progress but ultimately due to my knee still “giving way” I would not be able to return to competitive sport unless I underwent surgery. Since then, my ongoing strength program has allowed me to return to running comfortably, engage in recreational activities, and significantly reduce occurrences of my knee giving way. From my journey I was able to experience first-hand some key factors in managing ACL tear rehabilitation successfully.


  • An experienced and knowledgeable support team.

In 2017 I did not have a strong support network of professionals to guide me through my post-operative rehabilitation. The surgery outcome itself was a success but my rehabilitation was disjointed. I lagged in my rehab stages, still not having full range of knee flexion at 12 months post-operation. I experienced poor mental health, and ultimately had a delayed return to competitive sport at 18 months.


In 2020 I was able to navigate my recovery with the right guidance and support from a physiotherapist experienced in non-operative ACL rehabilitation, an experienced and honest surgeon (who told me impartially a return to competition would not be likely without surgery), and an exercise programme (self-prescribed as an AEP) guided by their recommendations. This allowed me to achieve strength and fitness levels greater than I had before the injury.


  • Prehab = low risk, high reward.

A positive of my training post ACL rupture is I can’t make it worse as it’s gone and it’s not growing back (although recent studies have shown in some lucky people, it can do just that). The caveat is being mindful not to get carried away and cause damage to everything else, now that I can do most activities I enjoy. The improvements in muscle strength from the non-operative approach should hold me in good stead leading into my eventual ACL reconstruction.


A meta-analysis by Poulsen et al (2019) identified that the risk of developing osteoarthritis after a significant knee injury was 4-6 times higher than a non-injured knee, however this risk was similar regardless of operative or non-operative approaches. Studies also support the completion of preoperative rehabilitation consisting of progressive strengthening and neuromuscular training prior to surgery, as patients were shown to have greater functional and subjective outcomes (Failla et al (2016), Rejiman et al (2021)).


  • Make an educated decision.

Ultimately the choice comes down to the patient, but it is important that they are presented with the research, risks, and benefits, to make an informed decision. As allied health professionals, it is important for us to provide up to date information on their injury, recovery timeframes, and support them in their journey. Lifestyle, demands, age, and comorbidities should be factored into the decision making; however, a positive outcome is more likely when a patient is provided the right support, and surrounded by a team of professionals who are looking out for their best interest.


References.

Failla, M. J., Logerstedt, D. S., Grindem, H., Axe, M. J., Risberg, M. A., Engebretsen, L., . . . Snyder-Mackler, L. (2016). Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts. Am J Sports Med, 44(10), 2608-2614. doi:10.1177/0363546516652594.

Poulsen, E., Goncalves, G. H., Bricca, A., Roos, E. M., Thorlund, J. B., & Juhl, C. B. (2019). Knee osteoarthritis risk is increased 4-6 fold after knee injury - a systematic review and meta-analysis. Br J Sports Med. doi:10.1136/bjsports-2018-100022.

Reijman, M. et al. (2021) “Early surgical reconstruction versus rehabilitation with elective delayed reconstruction for patients with anterior cruciate ligament rupture: Compare randomised controlled trial,” BMJ [Preprint]. Available at: https://doi.org/10.1136/bmj.n375.


Bastien Auna

Workers Compensation Specialist (AEP, ESSAM)

Exercise Rehabilitation Services ‑ WA

The Effects of Fatigue on Workplace Injury Risk: Identifying and Reducing Risk Factors

29 Oct, 2024
Fatigue is a significant concern throughout many work environments, affecting workers across various industries. Fatigue can be a by-product of long hours, demanding tasks, inadequate rest, and stress. While fatigue is often overlooked, its implications for injury risk are often profound. Understanding Fatigue in the Workplace Fatigue in the workplace can manifest as physical exhaustion, mental tiredness, or a combination of both. Physical fatigue results from prolonged exertion, while mental fatigue arises from extended periods of concentration and decision-making. Both forms can impair a worker's ability to perform tasks safely and efficiently, which can lead to a higher risk of accidents and injuries. Other factors such as sleep loss, and environmental conditions can significantly impact a workers’ fatigue levels. Individual factors such as age, hydration, fitness level, diet, smoking and alcohol intake are also just as important to consider. Mechanisms Linking Fatigue to Injury Risk Decreased Coordination and Balance Altered Perception and Reaction Time Increased Muscle Strain Compromised Judgment Neglect of Safety Protocols It is important to highlight that industries requiring workers to complete extended periods of manual labour are more likely to be involved in workplace incidents. The risks become elevated as fatigue is mixed into already high-risk environments. Mitigating the Risks of Fatigue There are several ways to help mitigate the risks of fatigue. These can be but are not limited to: Implementing Fatigue Management Programs Adequate Rest and Recovery Monitoring Workloads Providing Ergonomic Support Encouraging Healthy Lifestyle Choices Creating a Supportive Work Environment Fatigue is a critical factor influencing injury risk in the workplace. Understanding the mechanisms linking fatigue to injuries can help organisations implement effective strategies to mitigate these risks. By prioritising rest, monitoring workloads, and fostering a culture of safety and support, employers can enhance worker well-being and significantly reduce the likelihood of accidents. Addressing fatigue is not just a matter of improving productivity; it is essential for ensuring the health and safety of all workers.  Daine Richards Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services – WA

Meet 50% of our new starters in QLD

25 Oct, 2024
Meet Rowan 50% of our new QLD AB squad. Hello everybody, I’m Rowan, Accredited Exercise Physiologist at Absolute Balance. I studied in sunny Townsville at James Cook University, graduating in 2014. Shortly after, I landed a position at a local chiropractic clinic as the sole Exercise Physiologist among chiropractors, physiotherapists, and massage therapists. After a year, I transitioned to Max Employment as a Health Services Officer, covering Townsville, Ingham, Ayr, and Charters Towers. In this role, I helped job seekers secure suitable employment, an unexpected shift from my previous experience but one that ignited my passion for the role of exercise in mental health. After a few years, I decided to move to Brisbane, where I ventured into the occupational rehabilitation field. However, I soon realized that vocational rehabilitation wasn’t the right fit for me. This realisation led me to focus on pre-employment medical assessments, including functional capacity evaluations, drug testing, and lifting capacity assessments. Fun fact: I encountered every drug in the tests except cocaine—it's puzzling why people would use methamphetamines the weekend before their employment screenings! Eventually, I traded in corporate attire for shorts and joggers as I embraced a role in the gym environment. I enjoyed working directly with Medicare, DVA, NDIS, and private patients, so much so that I decided to start my own business (2021) with Meagan, the other 50% of the new Queensland team. As we launched our company, I found myself asking, "What the hell do I do now?" That's when I reached out to ol’ Derek Knox to be our business mentor. My experiences with Derek likely echoed those of many others: he was constantly emphasising my "why" and the "red brain-green brain" concept, all while sharing his extensive industry knowledge, and taking time out of his busy schedule just to hear me say things like, ‘nothings really going on this month’, and ‘red brain is bad right?’. Now, I find myself back in the WorkCover space—though this time, I'm not involved in vocational work—and I'm thoroughly enjoying it. If you’ve made it this far, thank you very much for your time, but let’s finish up with 2 truths and a lie, feel free to email me your answers: I hid on a plane, causing a lot of problems, when I was 5yrs and travelling alone from Sydney to Hobart. I was shipped off to military boarding school in Sydney for 9 years. I caused $40,000 worth of damage to a hotel because I left the kitchen sink tap on. Rowan Dicks Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services ‑ QLD

The Story of a Fork and a New Beginning

14 Oct, 2024
At Absolute Balance, we have a rather unique tradition: every new team member receives an engraved fork upon joining the company. Now, you might wonder—why a fork? Well, it all started in our old office, where forks seemed to vanish mysteriously. No one could ever figure out where they went, and instead of solving the mystery, we decided to turn it into a fun tradition. To make new staff feel welcome (and to ensure they always had their own cutlery!), we started gifting everyone a personalised fork. When I officially joined the team (and decided to move from Perth to Sydney), I was entrusted with a special mission: delivering the engraved fork to another new team member in Sydney. This fork, however, was no ordinary utensil—it had already racked up some serious miles. Initially flown from Perth to Sydney, it missed its delivery and was flown back to Perth. Now, I was tasked with bringing it back to Sydney by car—making it the most well-travelled fork in Australia! After completing my university practicum placement with the Perth team as part of my exercise physiology degree, I was eager to take on a new challenge and grow within the company, so I applied for a role with the New South Wales team. I was thrilled when I got the position. This move marked a significant step in my career—transitioning from a student to a fully-fledged exercise physiologist, ready to make a positive impact on the health and wellbeing of my clients. The long journey from Perth to Sydney, with the engraved fork in tow, became symbolic of this exciting new chapter in my life. Day one took us from Perth to Norseman, and it began with a flat tire—maybe not the ideal start, but we were determined! Feeling a mix of excitement and hope about my new career, I was ready to tackle the journey. And honestly, by the time we hit the road, this fork had more travel points than most people.  The drive across the Nullarbor Plain was a test of patience, but it also highlighted the vastness and beauty of the Australian landscape. Somewhere along the 90 Mile Straight, the clutch on the car started acting up—because every epic journey needs a bit of drama, right? We nursed the car all the way to Border Village, a roadhouse just over the South Australian side where the roadhouse staff were amused by the story of the well-travelled fork. As we continued, we stopped in Kimba, a charming little town in the heart of Australia. It was here that the fork got its own ‘midway point’ photo-op, with Kimba’s beautiful silo art providing the perfect backdrop. The town’s community vibe and warm welcome were exactly what I needed as I adjusted to the idea of leaving my old life in Perth behind and embracing this new adventure. After a quick pit stop in Port Augusta to fix the clutch (thankfully, the car made it!), we continued our journey through vineyard country along the Murray River and into Victoria. Having coffee by the river, watching the sun rise and set, and knowing that I was getting closer to my new home was a beautiful experience. The last night on the road was spent in Wagga Wagga, where the rain finally caught up with us. As we camped out in the wet and chilly weather, I laughed at the thought of the fork enduring all these adventures, from the outback to the vineyards and now to a rainy campsite. Despite the weather, we stayed cozy in our swag, and the fork was safe and dry, ready for its final destination. Arriving in Sydney felt like a milestone—not just for me but for the fork, too. It had travelled thousands of kilometres and was finally ready to meet its new owner. It was an exciting moment to hand it over, symbolizing the beginning of a new chapter for both of us. Starting my new role as an exercise physiologist with Absolute Balance has been an incredible experience. After meeting the Sydney team, I felt a strong sense of belonging and support. Having spent time with the Perth team during my practicum, I knew I was joining a company that valued honesty, integrity, teamwork, and empathy—values that I hold close to my heart as I embark on this new journey to make a positive impact in the lives of my clients. This journey was more than just a road trip; it was a personal and professional adventure that taught me the value of resilience, adaptability, and finding humour in unexpected situations. As I settle into my new role, I’m excited to apply these lessons in my work, supporting my clients and helping them reach their health and fitness goals. So, next time you see someone in our team with an engraved fork, you’ll know the story behind it—and you’ll know about the one fork that travelled further than any other. April Hawser Exercise Physiologist Exercise Rehabilitation Services – NSW
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