The weak knees of an Exercise Physiologist.

April 4, 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

Prehabilitation in Workers Compensation: Enhancing Function, Reducing Downtime

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As the global population ages and the prevalence of musculoskeletal conditions continues to rise, the demand for orthopaedic surgeries has surged dramatically. With this increase comes a growing emphasis on not just the surgical intervention itself, but also on the preoperative phase as a critical window of opportunity to enhance patient outcomes. One of the most promising strategies emerging in this space is prehabilitation—a proactive, personalized approach to preparing patients physically and mentally for surgery. Prehabilitation can be broadly defined as a personalized exercise program designed to improve physical function and optimize recovery outcomes for any upcoming surgical intervention. In the context of workers compensation, prehabilitation offers additional value. By maintaining or even improving a patient’s physical function prior to surgery, individuals are often able to remain engaged in modified or light-duty work roles. This not only supports their psychological well-being and financial stability but also contributes to faster and more sustainable return-to-work outcomes post-surgery. A recent meta-analysis by Punnoose et al. 2023, found that a targeted prehabilitation program increased muscle strength, improved joint function and led to a higher health-related quality of life (HRQOL) scores. These findings were consistent with patients undergoing Total Knee Replacements (TKR), Total Hip Replacements (THR) and lumbar spine surgery. Some clinical applications are listed below: Targeted approach of 4-6 weeks, with 2 sessions per week. This aligns with physiological evidence suggesting that a minimum of 4–6 weeks of strength training is needed for neuromuscular adaptations. Mixture of supervised and unsupervised intervention Multimodal programs (e.g. combining exercise with education or psychological support) may enhance outcomes By improving outcomes and reducing recovery timeframes, prehabilitation stands out as a cost-effective, proactive approach to treatment.  James Chandler Workers Compensation Specialist ‑ Team Leader South (AEP, ESSAM) Exercise Rehabilitation Services – WA

How to Fit Exercise into Your Lifestyle

September 1, 2025
As Exercise Physiologists, a large part of our role is to empower an injured worker to integrate exercise into their lifestyle – something that is easier said than done for everyone! A common misconception about exercise, is that, for an effective workout, it must be a gruelling 1-hour session in a gym or a 10km stomach churning run, however this is not the case! Here are some alternatives and strategies to gradually make positive changes to your life: One easy way is to add movement to tasks you already do. Walking or biking instead of driving short distances, taking the stairs instead of the elevator, holding your newborn as you perform a few quick (and safe!) squats or completing short exercises during TV commercials are simple ways to stay active without setting aside extra time. Another is to schedule ‘mini’ workouts like any other appointment. Set aside just 20 to 30 minutes a few times a week—whether in the morning, during lunch, or in the evening. Utilising exercise equipment that we give you during our initial assessment and picking a handful of exercises that you may particularly enjoy, is a great shorter alternative. Treating these moments as important and ‘you’ time can help build a consistent habit. Exercising with others can make it more fun. Invite a friend for a walk, join a fitness class, or play a sport with family. When you combine social time with physical activity, it feels less like a task and more like enjoyment. The same goes for a sport or hobby that you may like, whether it’s swimming, yoga, hiking or dancing! Experimenting with the introduction of one of these strategies can be an easier first step to making a positive lifestyle change. With a little planning and creativity, exercise can become a natural part of your lifestyle, helping you stay healthy and energized without adding stress to your day. Alexander Gerry Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services – WA

The Beauty of a program: Couch to 5k

June 19, 2025
If you have doom scrolled through Instagram/Facebook or YouTube recently you may have been bombarded with advertisements for a slew of different exercise programs. These all usually have something to do with what you value and target you with a preamble on how to get it, how did I shrink my waist size, how do I build muscle or how I rehabbed my knee pain. As an exercise physiologist it's my job to write these programs! Now although I don’t always enjoy interruptions to my news feed of cat videos and rugby highlights, I do actually think a lot of these programmes have merit! I love anything with a bit of structure that can help you progress yourself towards what you care about so today I wanted to write about one of my favourite programs of all time and that is the “Couch to 5km Running Programme” Why Running? I love running as an exercise choice, it gets you outdoors, it has increasing social connections via run clubs/park runs and is completely free! However, it’s hard to jump in to, I see a lot of people getting tripped up by some of the barriers that come with it. A lot of the people I see starting running don’t know about the many choices that come with exercise and in the exercise physiology business we call this the FITT principle! - Frequency – How often are you doing your running? - Intensity – How fast or slow are you running? - Time – How long should I run for? - Type – Why run over biking or rowing? A dedicated programme takes care of these for you, and I think the Couch to 5k programme does a fantastic job of introducing you to all these different ideas. Language! The first thing I love about the “Couch to 5k” is its language. The use of simple and direct language leaves a bit of room for interpretation. You can see clear above on your first Tuesday run you will run for 1 minute and walk for 1 minute. In this small interval that speed is utterly and entirely up to you. Go as slow as you like or as fast as you like however I want you to run for the entire minute! Keeping things simple is so important and this guidance is exactly where I would want you to start off as a beginner runner, have some fun and run! Progression! From week to week the running times can be seen to get bigger and bigger! Slowly but surely these intervals only increase by 1 or 2 minutes at a time. Between each session you will be able to notice small increases, but your fitness catches up with that! The whole point of a programme is that it starts small and works up, no single day itself should feel like an insurmountable workout but by the end you’re able to run a whole 5k! Rest! This program builds in rest days and rest periods so well. Each day is spaced out giving some time for you two recovers but not so much so you can get some fitness in! Within the workouts as well these intervals leave you working for the right amount of time each workout. Goals Too often when working out our goals are too big and lofty. Being able to make big changes start with small actions and goals. You can’t change yourself image in one day so I like the time frame of 6 weeks (in some programmes 6-12 weeks) because by the end we have a set definable goal of what we want to achieve, and we can really feel thar progression of fitness! Mathew Walker Exercise Physiologist Exercise Rehabilitation Services ‑ WA
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