The Power of Early Exercise Intervention in Acute Musculoskeletal Injuries

August 9, 2023

As allied health professionals, our primary goal is to ensure the best possible outcomes for patients recovering from musculoskeletal injuries and surgeries. Traditional approaches to rehabilitation have often emphasized rest and immobilization during the initial stages of recovery. However, emerging research suggests that early exercise intervention can play a pivotal role in enhancing recovery and restoring function. In this blog, we will explore the significant benefits of early exercise intervention in acute musculoskeletal injuries and surgeries, shedding light on the advantages it offers to patients' overall rehabilitation process.

 

1. Accelerated Healing and Tissue Remodelling.

 

One of the most compelling reasons for incorporating early exercise intervention is its ability to promote accelerated healing and tissue remodelling. Controlled, gentle movements can enhance blood flow to the injured area, facilitating the delivery of oxygen and nutrients to support tissue repair. A study by Ferreira-Valente et al. (2018) reported that early exercise following musculoskeletal injuries promotes angiogenesis and collagen synthesis, essential for tissue healing and remodelling.

 

2. Preservation of Muscular Strength and Joint Function.

 

During the early stages of recovery, patients often experience muscle atrophy due to disuse. Early exercise intervention can counteract this muscle loss, preserving and even enhancing muscular strength. A systematic review by Hultman et al. (2019) highlighted that early mobilization and targeted strengthening exercises positively influence muscle preservation during post-surgical rehabilitation.

 

3. Pain Management and Neurological Adaptations.

 

Pain is a common challenge in musculoskeletal injuries and surgeries. Contrary to conventional wisdom, early exercise intervention can be a powerful tool for pain management. Low-impact exercises and movements can activate the body's natural pain-relieving mechanisms, such as the release of endorphins. A study by Smith et al. (2017) demonstrated that early exercise interventions positively influence pain thresholds and reduce pain perception.

 

4. Psychological Benefits and Patient Empowerment.

 

Injuries and surgeries can be emotionally challenging for patients, leading to anxiety and feelings of helplessness. Early exercise intervention allows patients to actively participate in their recovery process, promoting a sense of empowerment and control over their healing journey. A meta-analysis by Turner et al. (2020) found that early exercise interventions in orthopaedic rehabilitation improve patient motivation, confidence, and overall psychological well-being.

 

 

5. Reduction in Rehabilitation Duration and Healthcare Costs.

 

By kickstarting rehabilitation early on, the overall duration of the recovery process can be significantly reduced. Early exercise intervention can expedite functional recovery, allowing patients to return to their daily activities and work sooner. A study by Aamot et al. (2019) reported that early exercise interventions in post-surgical rehabilitation led to shorter recovery periods and reduced healthcare costs.

 

The benefits of early exercise intervention in acute musculoskeletal injuries are evident, making it an essential component of modern rehabilitation protocols. By incorporating appropriate exercises at the right time, we can promote accelerated healing, preserve joint function, manage pain, and empower patients on their road to recovery. Embracing this evidence-based approach and collaborating to optimize patient outcomes will improve the overall quality of care in our field.

 

References:

 

- Ferreira-Valente, M. A., Pais-Ribeiro, J. L., & Jensen, M. P. (2018). Physical therapy and exercise in pain management. Pain Reports, 3(5), e674.

- Hultman, J., Sääf, M., & Halvorsen, K. (2019). Early active mobilization after flexor tendon repair in zone II. JBJS Reviews, 7(2), e4.

- Smith, L., Louw, Q. A., Crous, L. C., & Grimmer-Somers, K. (2017). Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay, and quality of life in patients with cancer. British Journal of Sports Medicine, 51(10), 792-797.

- Turner, R. R., Beckenkamp, P. R., Griffiths, L. R., & Hughes, D. L. (2020). Psychological aspects of anterior cruciate ligament injuries. Journal of Orthopaedic Surgery and Research, 15(1), 22.

- Aamot, I. L., Forbord, S. H., Gustavsen, M. T., Nordvik, H., Stensvold, D., Ugelstad, I., ... & Dalen, H. (2019). Home‐based versus hospital‐based high‐intensity interval training in cardiac rehabilitation: A randomized study. European Journal of Preventive Cardiology, 26(2_suppl), 17-25.


Cameron McRae

Workers Compensation Specialist ‑ Team Leader East (AEP, ESSAM)

Exercise Rehabilitation Services ‑ WA

5 Simple Steps to Stay Consistent with Exercise

April 28, 2025
1. Time of Day Identify, if you haven’t already, if you are a morning person or a night owl. Now I don’t necessary mean whether you struggle to wake up before 8am or find it impossible to fall asleep until the clocks strikes 12. I mean, identify when the BEST time is for YOU to complete 45-60 minutes of uninterrupted regular structured exercise (RSE). This can take time, but once you do find the ideal time of day for your RSE, stick to it, make plans AROUND your RSE time and make that time for yourself. Be firm but also be fair to yourself when life inevitably creeps back in to dismantle your routines. Find ways to work around it, and make it work for you. 2. Buddy System Call on a partner, friend, family member, colleague, or your furry loved ones. This person should ideally be someone who you can hold accountable, and who you know will hold you accountable. In no way do you have to train together, bonus points if you do, but they are there to encourage, support, and empower you to get to your fitness destination. 3. Goal Setting Like a lot of aspects in our lives a way to maintain consistency throughout your fitness journey is goal setting. Goal setting is a very powerful way to turn a dream or a thought into an actionable and achievable task. The simplest way to set a goal is to follow the SMART goal process. Specificity: What is it you are looking to target? Improve strength – okay, stronger in what exactly? Lose weight – absolutely, how much weight? Measurable: Can the above specific goal be measured if so, how? Achievable: Is the goal realistic or is it far-fetched. It's okay to have big goals, but it's more important to break your big goals down into smaller, more achievable goals. Relevant: Apply the goal to your life, a goal becomes reality before you know it if the goal has relevance to you. i.e. a running race coming up, would require you to train more, or maybe your wedding is on the horizon and you want to be in the best shape of your life. Time bound: The final element of any excellent goal is setting a time-based deadline. Now this doesn’t mean it’s the end, far from it, this is where you will evaluate your goal against your performance, and in turn, set another goal. 4. Have a Spot This can mean a lot of different things for a lot of different people, and can greatly depend upon your goals (yes, a call back). For many people obtaining a gym membership is the ideal way to train and maintain consistency, for others, a home-based gym with the necessities is all they need, for some a good pair of running shoes and their favourite running loop. Having a dedicated space is very important however, can be different for everyone, find what works the BEST for you. 5. Practice Like many aspects of our life, the more we do any one thing, the better we get. The same applies to behavioural changes like consistency. The first weeks can be easy because its new and exciting, or it can be daunting because its new and terrifying. However, in a roundabout sort of way, the key to consistency specifically with exercise, is finding the BEST form of exercise for YOU. Find the one where you get the most enjoyment from and run with it (pun intended). Lachlan Simpson Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services ‑ QLD

Exercise for Mental Health: A Vital Component for Busy Individuals

March 7, 2025
Exercise for Mental Health: A Vital Component for Busy Individuals In the hustle and bustle of modern life, juggling work, family, and social obligations can leave little room for self-care. However, prioritizing regular physical activity is crucial for maintaining not just physical health but also mental well-being. While the demands of a busy schedule might make it challenging to incorporate exercise into daily routines, the profound benefits it offers for mental health make it a non-negotiable element of a balanced and fulfilling life. The Connection Between Exercise and Mental Health Exercise has long been celebrated for its physical health benefits, including weight management, cardiovascular health, and increased strength and endurance. However, its impact on mental health is equally significant and often overlooked. Research has shown that physical activity can alleviate symptoms of anxiety and depression, improve mood, enhance cognitive function, and reduce stress levels. Some of the benefits of exercise on mental health include: Mood Enhancement: Engaging in physical activity stimulates the release of endorphins, often referred to as the "feel-good" hormones. These chemicals act as natural mood lifters, helping to combat feelings of sadness and anxiety. Stress Reduction: Exercise provides a healthy outlet for stress relief. Physical activity increases the production of norepinephrine, a chemical that moderates the brain's response to stress. Additionally, the repetitive nature of many forms of exercise can have a calming effect, akin to meditation, helping individuals feel more relaxed and centred. Improved Sleep: Regular exercise has been shown to improve sleep quality, which is closely linked to mental health. A good night's sleep is essential for cognitive function, emotional regulation, and overall well-being. Cognitive Benefits: Exercise has been found to boost brain function and protect against cognitive decline. Physical activity increases blood flow to the brain, promoting the growth of new neurons and enhancing synaptic plasticity. This can lead to improved memory, concentration, and overall cognitive performance, which are particularly beneficial for busy individuals juggling multiple responsibilities. Social Interaction: Many forms of exercise, such as team sports or group fitness classes, provide opportunities for social interaction and connection. Building relationships and engaging with others in a positive, supportive environment can have a significant impact on mental health, reducing feelings of isolation and loneliness. Exercise is an Antidote to Burnout When work and personal life pile up, burnout becomes a real concern. The feeling of being constantly “on” with no time to recharge can negatively impact both your mental and physical health. Exercise provides a much-needed escape. It helps you disconnect from work pressures and reconnect with yourself. Taking the time to move your body is a form of self-care that signals to your brain that you are prioritizing your well-being. As you engage in physical activity, your body releases tension, clears your mind, and gives you space to breathe—important factors in preventing burnout. Overcoming Barriers to Exercise for Busy Individuals For those with hectic schedules, finding time for exercise can be challenging. However, integrating physical activity into daily routines is possible with some strategic planning and creativity. Here are some tips to help busy individuals make exercise a priority: Schedule It In: Treat exercise as a non-negotiable appointment, just like any other important meeting or commitment. Block off time in your calendar for physical activity and stick to it. Consistency is key to reaping the mental health benefits of exercise. Incorporate Short Bursts: If long workout sessions are not feasible, aim for shorter bursts of activity throughout the day. Even ten minutes of exercise, such as a quick walk, stretching, or a mini workout, can contribute to overall mental well-being. Combine Activities: Look for opportunities to combine exercise with other tasks. For example, take a walking meeting, use a standing desk, or do bodyweight exercises while watching TV. These small changes can add up and help you stay active. Find Activities You Enjoy: Choose forms of exercise that you genuinely enjoy, as this will make it easier to stick with them. Whether it's dancing, hiking, swimming, or playing a sport, finding an activity that brings joy will increase the likelihood of making it a regular part of your routine. Set Realistic Goals: Set achievable fitness goals that align with your schedule and lifestyle. Start with manageable targets and gradually increase the intensity and duration of your workouts as you build confidence and stamina. Make It a Social Event: Involve friends, family, or colleagues in your fitness journey. Exercising with others can provide motivation, accountability, and an opportunity to bond over a shared activity. Conclusion Incorporating exercise into the lives of busy individuals is essential for maintaining mental health and overall well-being. The positive impact of physical activity on mood, stress reduction, sleep quality, cognitive function, social interaction, and burnout prevention makes it a valuable tool for anyone seeking to navigate the demands of a hectic lifestyle. By prioritizing exercise and finding creative ways to integrate it into daily routines, busy individuals can enjoy the mental health benefits that come with an active lifestyle. Remember, a healthier mind is a step towards a happier, more balanced life.  Blake Cocking Workers Compensation Specialist ‑ WA Team Lead (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA

The Role of Load Management in Rehabilitation

By Michael Andrews • February 20, 2025
The Role of Load Management in Rehabilitation: A Framework for Returning to Function, and Injury Prevention. Load management is often associated with high performance sport, but its principles are just as critical in rehabilitation. Whether guiding injured workers back to work, older adults to independent living, or patients recovering from injuries, progressively and systematically managing load is essential for recovery, injury prevention, and long-term function. A major challenge in rehabilitation is balancing workload progression to optimise adaptation without overloading healing tissues. Sudden spikes in training load or returning to full activity too soon significantly increase the risk of re-injury. Exercise physiologists can use load monitoring, periodisation, and predictive planning to ensure a structured and safe return to work, life, or recreational activity. Understanding Load and How to Monitor It In rehabilitation, load refers to the total amount of mechanical and physiological stress placed on the body. This includes external load; the measurable work performed (e.g., weight lifted, steps taken, distance covered, time spent in physical activity), and internal load; the body’s physiological and perceptual response to that work (e.g., heart rate, rate of perceived exertion (RPE), pain, fatigue). Both external and internal load must be monitored to ensure that rehabilitation is progressive yet not excessive. One of the most useful frameworks for load management is the Acute: Chronic Workload Ratio (ACWR), which helps determine whether a patient is progressing at a safe rate or at risk of overload. A sudden spike in acute load (ACWR >1.5) increases injury risk by 2-4 times in the following week. Therefore, a gradual increase in chronic load (≤10% per week) is essential to build resilience and capacity. - Acute Load = The total workload over the past week. - Chronic Load = The rolling 4-week average of workload. - ACWR = Acute Load ÷ Chronic Load. Patients often underestimate how small spikes in activity (e.g., resuming full work shifts after time off, or inconsistent engagement in their self-management plan) can lead to flare-ups or re-injury, and by tracking ACWR, we can educate the patient accordingly and prevent excessive acute spikes while ensuring a steady increase in chronic workload, reducing the likelihood of setbacks and ensuring a progressive return to function. To apply these principles effectively, we need accurate and practical ways to measure and track load in real world rehabilitation settings. Unlike athletic settings, maximal strength testing (1RM) is often inappropriate in rehabilitation. Alternative methods include volume-based and time-based load tracking, perceived exertion and fatigue monitoring, and functional testing. - Monitoring total weight lifted per session (sets × reps × resistance). - Measuring time under tension for endurance-based activities. - Using exercise RPE and session RPE to gauge effort. - Reassessing movement capacity, endurance, and strength progression over time. Using subjective feedback alongside objective load tracking allows for better exercise prescription and progression. Asking the right questions can guide real-time modifications: External Load Questions: - How much activity did you complete this week? - How does this compare to last week? - Did you struggle with any tasks or exercises? Internal Load Questions: - How fatigued do you feel after sessions? - How long does it take you to recover? - Are you experiencing pain or discomfort, and how does it change with activity? Structuring Load Progression for Long-Term Success Periodisation is the planned progression of training load over time, ensuring continued adaptation without excessive strain. While typically used in athletic settings, structured periodisation is just as valuable in rehabilitation, helping prevent stagnation by adjusting workload over time, ensuring progressive overload while respecting tissue healing and recovery rates, and guiding return-to-work planning by matching rehabilitation loads with real-world demands. A structured approach allows us to compare a patient’s current workload tolerance to their end goal and reverse-engineer a safe progression plan. If a patient needs to tolerate X hours of work or Y level of activity, we can use their current capacity and reverse-calculate a safe, gradual progression timeline and by maintaining consistent, small increases in chronic workload, we minimise setbacks and ensure safe long-term recovery. Linear Periodisation is best suited for straightforward recovery cases with minimal variability in symptoms. While, nonlinear periodisation may be more practical for rehabilitation, as symptoms and capacity can vary day-to-day. - Linear Periodisation: Steady, predictable increases in intensity, volume, or duration over time. - Nonlinear (Undulating) Periodisation: Load fluctuates based on recovery, pain, and function. Applying Periodisation to Rehabilitation Planning Step 1: Establish a Baseline Identify current weekly workload (e.g., hours of tolerated activity, steps, resistance training volume) and functional deficits (e.g., strength, endurance, movement capacity). Step 2: Define the End Goal What workload is required to return to work, sport, or daily function? This could mean sustaining an 8-hour work shift, lifting a certain weight, or tolerating daily activities without pain. Step 3: Plan a Safe Progression Gradually increase chronic workload by ≤10% per week. Avoiding acute spikes (ACWR >1.5) to prevent setbacks. Monitor pain, fatigue, and function to guide daily and weekly adjustments. By integrating load monitoring, periodisation, and predictive planning, exercise physiologists can create safe, structured rehabilitation programs that optimise recovery, prevent re-injury, and guide patients back to work, sport, or daily life with confidence. Key Takeaways for Exercise Physiologists - Load management is essential in rehabilitation, not just in sports. - Acute vs. chronic load balance is key. Avoiding acute spikes prevents injury, while gradual increases build resilience. - Tracking external and internal load ensures a data-driven approach to exercise prescription. - Periodisation structures rehabilitation progression, ensuring steady gains without excessive strain. - Patient education on workload progression improves compliance and reduces re-injury risk. References Impellizzeri, F. M., Menaspà, P., Coutts, A. J., Kalkhoven, J., & Menaspà, M. J. (2020). Training load and its role in injury prevention, part I: back to the future. Journal of athletic training, 55(9), 885-892. Gabbett, T. J., Kennelly, S., Sheehan, J., Hawkins, R., Milsom, J., King, E., ... & Ekstrand, J. (2016). If overuse injury is a ‘training load error’, should undertraining be viewed the same way?. British Journal of Sports Medicine, 50(17), 1017-1018. Windt, J., & Gabbett, T. J. (2017). How do training and competition workloads relate to injury? The workload—injury aetiology model. British journal of sports medicine, 51(5), 428-435. Jildeh, T. R. (2024). Editorial commentary: load management is essential to prevent season-ending injuries in the National Basketball Association. Arthroscopy, 40(9), 2474-2476. Bache-Mathiesen, L. K., Andersen, T. E., Dalen-Lorentsen, T., Tabben, M., Chamari, K., Clarsen, B., & Fagerland, M. W. (2023). A new statistical approach to training load and injury risk: separating the acute from the chronic load. Biology of sport, 41(1), 119-134. Williams, S., West, S., Cross, M. J., & Stokes, K. A. (2017). Better way to determine the acute: chronic workload ratio?. British journal of sports medicine, 51(3), 209-210. Carey, D. L., Ong, K., Whiteley, R., Crossley, K. M., Crow, J., & Morris, M. E. (2018). Predictive modelling of training loads and injury in Australian football. International Journal of Computer Science in Sport, 17(1), 49-66. Impellizzeri, F. M., Shrier, I., McLaren, S. J., Coutts, A. J., McCall, A., Slattery, K., ... & Kalkhoven, J. T. (2023). Understanding training load as exposure and dose. Sports Medicine, 53(9), 1667-1679. Lorenz, D. S., Reiman, M. P., & Walker, J. C. (2010). Periodization: current review and suggested implementation for athletic rehabilitation. Sports Health, 2(6), 509-518. April Hawser Exercise Physiologist Exercise Rehabilitation Services – NSW
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