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A day in trade with Mr Daniel Meyerkort – Orthopaedic surgeon

Jan 04, 2021

As an Exercise Physiologist we normally see our patients in the sub-acute to chronic stages of post-operative rehabilitation. I recently had the pleasure of observing Mr Daniel Meyerkort from Perth Orthopaedic and Sports Medicine Centre in theatre at Hollywood Hospital in Perth. I was lucky enough to witness three procedures during the afternoon observations, two of which will assist with understanding the process of post-operative exercise prescription for my patients in the workers compensation system who have undergone these surgeries. I was able to witness a lateral ankle ligament and tendon repair, chronic exercise-induced compartment syndrome fasciotomy and an ACL reconstruction with meniscal root repair.

It was humbling to see the professionalism of the team in the room from wheeling the patient in and going through pre-op procedures to wheeling the patient out for post-operative recovery. The team run like clockwork whilst still taking the time to ensure every patient is safe. It was amazing to see the differences in skills required from delicate stitching through to pulling through new ACL grafts that are required with some force! It is easier to appreciate why some patients pull up with more pain than others due to the invasiveness and force of some of these procedures. I have quickly learnt over my time that two patients will not recover from the same surgery in the same way. I also learnt that a lot of the patients will present quite sore not only from the surgery but also the tourniquet applied above the surgical site.

Mr Meyerkort explained that despite patients presenting with the same injuries, advice will change depending on the patient themselves. Not only the amount of injury sustained is taken into account but their age, associated risks and comorbidities, the occupation of the person as well as their standpoint on having surgery. This is always why I encourage my patients not to “Dr Google” as the advice is never going to be the same for every person. Every person’s rehab journey post-surgery is never going to be the same either. It was also great to hear the amount of education that is given to the patient’s surrounding their surgery.

It was surprising to see that even with viewing the imaging of the patient’s knee prior to surgery it is sometimes never fully clear to see the extent of what is going on until you are in the surgery. Mr Meyerkort kindly talked through each of the surgeries whilst able to repair on the go. During the ACL reconstruction he was able to go through the knee and find out the exact parts of the meniscus that needed repairing and his team where able to demonstrate and explain the thread work required and the importance of positioning and precise drilling required through the tibia and femur. The ACL procedure was the longest and most technical of the three with the aim of restoring stability to the knee. Mr Meyerkort demonstrated the extraction of the hamstring graft first using a long instrument to take the semitendinosus and gracilis to use for the graft. Careful inspections of the tendons is a must to make sure the thickness is of exact amount to provide stability. While Mr Meyerkort was repairing the meniscal damage and clearing the fat pad of the knee, the hamstring graft was being meticulously prepared. Throughout the surgery the knee was regularly tested through flexion and extension to ensure everything was on track. This is something that as an exercise physiologist I can draw on, as functional testing should be intermittently performed on the patient to ensure treatment is effective. Through fine and technical threadwork along with some brute strength, the ACL graft was pulled through the knee and secured in a tight position to restore the patient’s stability with the entire surgery lasting approximately two hours.

It was fabulous to see the acute stages of injury repair and the start of a patient’s rehab journey. I was able to draw comparisons in Mr Meyerkort’s work which rings true in the exercise physiology world.

1. You always have to consider the patient as an individual and no one treatment will have the same effect on that patient.

2. No person will have the exact same outcome and it is important to consistently test and check along the way

3. To always have respect and care for the patient and listen to their needs and concerns and be able to adapt in your approach where possible.

It is important to empower the patient through their recovery. If you have a question surrounding pre or post-operative rehabilitation, you can contact an Accredited Exercise Physiologist.

Taylor Downes

Accredited Exercise Physiologist

BSc/GradDipClinExPhys | B.Ed. Human Movement | (ESSAM, AEP)

We live in a 3D world, it's time to start training that way!

By Alison Absolute Balance • 24 Apr, 2024
The human body is designed to move in a three-dimensional plane divided into the following segments: Sagittal Plane: Cuts the body into left and right halves. Forward and backward movements. Frontal Plane: Cuts the body into front and back halves. Side to side movements. Transverse Plane: Cuts the body into top and bottom halves. Twisting/rotational movements. Too often we get caught training mostly in a sagittal plane, think running, squats, bicep curls etc. While these are all good exercises, in day-to-day life we don’t only move along a sagittal plane. What happens when you need to quickly get out of the way of the e-scooter flying towards you on the foot path or make a quick sidestep to avoid a pothole – these movements are along the frontal plane. While movements such as turning to check your blind spot while driving or turning to talk to the person next to us are in the transverse plane. When it comes to injury prevention and movement efficiency it is important to incorporate exercises from all planes of movement into training programs. Sagittal If a line ran down the middle of the body splitting it from left to right, movements parallel to this line are within the sagittal plane of movement. The sagittal plane is the most common plane of movement and is trained overwhelming more than the frontal and transverse planes of movement. Movements/exercises considered to be in the sagittal plane include running, squats, deadlifts and bicep curls. Now while all these exercises are good, with the way our lives having evolved into many desk sitting roles, driving from place to place etc, to then go to the gym and focus heavily on movements that are predominantly up – down, and forwards – backwards we can end up reinforcing these pathways and becoming somewhat robotic, heavily limiting our natural movements. Frontal If a line ran down the middle of the body splitting it into front and back, movements parallel to this line would be within the frontal plane of movement – essentially any movement that involves moving away from or towards the midline. Often neglected in strength programs, frontal plane exercises include Cossack squats, lateral lunges, and side raises. Transverse If a line split the body in half separating it into top and bottom with the pelvis being the point of division, any movement parallel to this line would be considered to be in the transverse plane of movement. Movement along/through a transverse plane is generally more rotational such as a Russian twist or trunk twist. By focussing largely on sagittal plane movements, we are risking developing muscle imbalances, limited mobility and uncoordinated movements in the neglected planes. Our body is designed to move on a 3-dimensional plane so make sure to train in a way that will allow it to move the way it’s supposed to. Katie McGrath Injury Prevention Specialist Injury Prevention Services

Stretching and mobility benefits

18 Apr, 2024
Stretching and mobility exercises are indispensable components of both injury prevention and recovery strategies. Incorporating dynamic stretches before physical activity can help prepare the body for movement by increasing blood flow to muscles and enhancing joint flexibility. This dynamic warm-up routine primes the muscles and connective tissues, reducing the risk of injury during subsequent activity. Furthermore, static stretches, performed after physical activity, helps alleviate muscle tension and improve flexibility, thereby minimizing the likelihood of strains and tears. In the realm of injury recovery, stretching and mobility exercises play a crucial role in rehabilitation protocols for individuals recuperating from various musculoskeletal injuries. Following an injury, muscles can become tight and weakened due to disuse or trauma. Gentle stretching exercises aid in maintaining or restoring flexibility, preventing muscle atrophy and contractures. Additionally, targeted mobility exercises assist in restoring range of motion and functional movement patterns, allowing individuals to gradually regain strength and flexibility while reducing the risk of re-injury. Moreover, stretching and mobility exercises promote tissue healing by improving circulation to the injured area. Increased blood flow delivers essential nutrients and oxygen to damaged tissues, facilitating the repair process and reducing inflammation. By incorporating a comprehensive stretching and mobility routine into their regimen, individuals not only safeguard themselves against future injuries but also expedite their recovery journey, enabling them to return to their activities with greater resilience and confidence. Mariah Adolphus Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA

Meet a Team Leader at AB

05 Apr, 2024
Hey, my name is Blake, and I am an Exercise Physiologist, Workers Compensation Specialist and Clinical Team Leader at Absolute Balance. I graduated from Edith Cowan University in 2015 after completed my Bachelor of Science (Exercise Science and Rehabilitation). I grew up on a farm Northeast of Perth past Gingin with my parents and two brothers, both of which are back working on the farm, which has been in our family for generations. My love for sport and interest in the human body initially prompted me to complete my Bachelors in Exercise and Sports Science, and my initial thoughts on a career were either Physiotherapy or Phys Ed Teacher. However, this quickly changed when I commenced my first Exercise Physiology unit in my Sports Science degree as it opened my eyes to exercise rehabilitation, and how important it was to individuals with injuries. Having experienced multiple injuries personally playing football (AFL), basketball and tennis, I can fully empathise with how much injuries can impact your life. Being an EP and being in a role where I can make a positive and meaningful impact on individual’s lives who have sustained an injury is extremely important to me. This doesn’t only extend to the patients I see, but also the team members I lead within Absolute Balance. I guide a team of five in the Northeast region at Absolute Balance, assisting them with their own patients and leading them to grow as Exercise Physiologists and individuals. Although it has its challenges, leadership is extremely rewarding and has helped me grow both personally and professionally. Whilst I am not at work, I am spending my time at the gym, at football training and games during February-September (or in the car travelling to and from comes with the gig of country football), spending time with my wife and our dog Otis. I spend the other half of my weekend manicuring my lawn and watching good shows and sports. Blake Cocking Workers Compensation Specialist ‑ Team Leader North East (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
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