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Patient Case Study – Full Rotator Cuff Avulsion Rehabilitation

Mar 29, 2021

Patient details: 65yr old male, Obese, Hypertension, no other comorbidities

Occupation: Heavy haulage truck driver

Injury Details: Fell between two truck trailers onto the right arm causing major rotator cuff tearing. Right shoulder arthroscopic subacromial decompression, excision of the AC joint and open repair of a massive avulsion of the entire rotator cuff on the 24/08/2020.

Critical Physical Demands of the job role: Ingress/Egress from large trucks and heavy machinery requiring 3 points of contact and ladder climbing. Lifting to 30kg from floor to shoulder height, forceful manoeuvring of items weighing up to 30kg at chest height, occasional heavy lifting above head height up to 30kg, repetitive upper limb use when tying downloads. Physical tasks can be completed for periods of up to 4 hours on a repetitive basis.

Rehab Timeline: The patient commenced physiotherapy immediately post-op and completed this for the first 6-weeks, he then transitioned to an exercise rehabilitation programme under my supervision at the request of the surgeon. From weeks 6-12 post-operatively, the focus of the exercise rehabilitation programme was to restore pain-free shoulder passive and then active ROM and begin isometric rotator cuff activation exercises and basic Theraband exercises in preparation for moving into the strengthening phase of the programme after week 12.

On review with the treating surgeon at 12-weeks post-operatively, the surgeon was happy with progress given the complexity of the injury, and clearance was provided to commence gentle strengthening exercises. From week 12 onwards, strengthening exercises were gradually introduced whilst also keeping focused on further building and maintaining the patient’s active ROM and rotator cuff function. Overhead exercises were not introduced until 5-months post-operatively when the patient was able to demonstrate good scapulothoracic control into overhead positions. The patient made steady progress over a period of 3-months (see graph below), with weekly reviews to ensure he remained on track with his exercises and they were appropriate for his presentation and abilities.

At the 6-month post-operative review, the patient was able to demonstrate normal pain-free shoulder range of motion (symmetrical to his non-injured arm), excellent power and strength with all rotator cuff integrity testing, and had reached the appropriate milestones to facilitate a graduated return to work programme. Using the evidence from the supervised exercise programme, the surgeon was able to provide clearance for the patient to return to modified duties with a 15kg lifting restriction below shoulder height only.

The patient is due to review with the surgeon again at the 9-month post-operative mark, the goal prior to this review is to further build the patient’s strength and tolerance for work-specific physical tasks and gradually build strength and capacity for overhead movements. The exercise programme will be suitably modified to begin to replicate the critical physical demands of the job role to ensure the patient is exposed to these tasks in a controlled environment, where a focus on correct manual handling and sound technique can we implemented. The ideal scenario would be for the patient to return to his full pre-injury duties at the 9-month mark, with some possible permanent restrictions in places for overhead lifting, due to the nature of the injury and surgery completed.

Keep an eye out for further updates on the patient’s journey over the coming months!

Alixe Marion (BSc – Exercise Physiology)

Workers Compensation Specialist

Senior Accredited Exercise Physiologist

Walking for health and longevity

16 May, 2024
A recent study investigated how the number of steps we walk each day affects our chances of living longer. Researchers completed a meta-analysis (collecting many studies and looking at the combined results), that measured step counts and compared it to people's all-cause mortality (risk of dying from any cause). They looked at seven trials with over 28,000 individuals and discovered that for every 1,000 extra steps completed each day, the all-cause mortality rate fell by around 12%. They also investigated if factors such as the location of the research or the age of the participants affected the results, they found no statistically significant differences. Taking more steps generally reduces your chance of death. Walking 16,000 steps per day was associated with a 66% lower risk of all-cause mortality when compared to walking only 2,700 steps. To put it another way, walking only 2,700 steps per day was linked to a 3x increased risk of death compared to walking 16,000 steps. Before leaping to conclusions, keep in mind that just because those who walk more tend to live longer doesn't mean that walking directly makes you live longer. It's possible that healthy people are naturally more active. However, some other studies have shown that even moderate walking programs can benefit a variety of health indicators, once again implying that walking more may help you live longer. In the meta they also compared some well-known causes of all-cause mortality, smoking and obesity against walking. It was surprising to see that walking only 2,700 steps a day had a greater effect on mortality with a 200% increased risk, than smoking or even obesity at 70-80% increased risk and 74% increased risk at a 40 BMI respectively. So, while going to the gym, lifting weights and doing classes to staying healthy is defiantly beneficial, this study emphasises the value of simply moving more in your daily life. Even if you have a busy schedule or live in an area that is not conducive to walking, finding strategies to increase your daily steps could lead to a longer, healthier life. References: Leuphρων, R. (2014, August 11). How many steps/day are enough? For adults. PubMed (original PMID: 21798015, PMCID: PMC3197470, DOI: 10.1186/1479-5868-8-79)

A 3-Minute Snapshot of a Move Across the Country

10 May, 2024
“Failure is a bend in the road, not the end of the road. Learn from failure and keep moving forward.” Roy T. Bennett Hypothetically, if I asked you to move to the other side of the country, to a new landscape, new work environment, and to the unknown, what would your answer be? In August 2023, I answered “F**k, yes”, and I want to take you through a journey of learnings, maturity, and growth that only saying “yes” can get you. Fast forward to the 15 th of October 2023, after packing a sea container with belongings, selling my car, and booking a one-way flight to Brisbane, Queensland, I was set. With all the back-end tasks out of the way, I was taking off to what was about to become the most uncomfortable (and horrifying) period of my life. Different city, different lifestyle unfamiliar people, even more unfamiliar landscapes, more responsibility, more opportunities. These were the thoughts rushing through my head while on a one-way trip to my next chapter. And it didn’t take long before the wheels were turning, and I was finding my feet, well, only as quickly as one can after venturing into their uncomfortable. I was thrusted into a new and exciting work environment, with an opportunity to build brand and self-awareness in a new state and legislation. I very quickly realised that I was so far out of my comfort zone, that I wasn’t even sure what zone I was in anymore. “Where do I start? What do I do? Who do I speak to?” Are all rationale thoughts to have, and looking back now, I can safely say that I felt out of my depth, lost, and overwhelmed with the road ahead. Through the motion of failure, and my not so successful trials, I have become far more resilient, confident, mature, I have learnt not to fear rejection but embrace it, I have adopted a mindset where “no” is a conversation starter, not a finisher. Through all this my ability to treat clinically, build relationships, and produce positive outcomes has improved. The journey has been challenging, but so incredibly worth it. I am becoming more comfortable with the uncomfortable and I wouldn’t have changed a thing. Lachlan Simpson Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services ‑ QLD

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
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