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0:03
- [Stephanie] Hello and welcome to today's WorkSafe Month webinar Exercise Physiology-Task specific exercise programmes in the Workers' Compensation Arena. I'm Stephanie Moraski from WorkSafe Tasmania, and I will be your moderator. Before we start please take a moment to read the following slide about information received today.
0:28
I'll now go over housekeeping. Here is a screenshot of the attendee Control Panel, you should see something that looks like this on the right hand of your screen. You're likely listening in using your computer speaker system by default, if you would prefer to listen over the phone, just select Telephone in the audio pane, and the dial-in information will be displayed. Webcams and audience microphones will not be used in today's presentation. Questions will be taken at the end of this webinar,
0:59
please use your Control Panel to type and submit your questions. Finally, today's webinar is being recorded.
1:07
I would now like to introduce your presenter Justin Ockerby, Senior Consultant Exercise Physiologist from IPAR Rehabilitation.
1:18
Justin is an accredited Exercise Physiologist with over six years experience in both clinical and occupational rehabilitation settings. Joining the IPAR Tasmania team in early 2020, Justin has been facilitating exercise physiology programmes aimed at returning injured workers back into the workplace, by tailoring specific exercise programmes that replicate the tasks and duties of the client. By doing this, Justin believes that mirroring the physical demands of the work duties,
1:53
helps promote human movement patterns that will allow for the most successful and efficient rehabilitation of musculoskeletal conditions. Welcome Justin.
2:06
- [Justin] Thanks Stephanie, and welcome everyone.
2:11
So first of all, task specific exercise programmes in the Workers' Compensation Arena.
2:18
So what we will cover today, is what is an exercise programme, what it might look like? Why are exercise programmes is used in Workers' Compensation Arena, specifically for musculoskeletal conditions and injuries, physiotherapists and exercise physiologists, the similarities and differences, dependent versus independent programmes, is it important to be tasks specific, and conditioning at work, fact or fiction, and can exercise programmes only be used for physical injuries?
2:51
So first of all, what is an exercise programme? Exercise programmes usually involve a prescribed volume and amount of sets repetitions, wait, rest time, times for wake so the frequency, all of these variables are able to be altered depending on the needs, goals,
3:09
and current capacity of the individual. They're usually completed a prescribed amount of tones per weight, but this can also be varied of course, and they can be completed in the gym, at home, at work, in public parks, et cetera, it's a personal preference and they do not need to be brutally hard either, which is a common misconception and why potentially
3:33
take out, writes up potentially quite lot of sometimes.
3:40
Oops sorry.
3:44
So why are exercise programmes used in the Workers' Compensation Arena? So an injury occurs at work, it can be mild, moderate, or severe, sometimes somebody can stay at work on light duties, but oftentimes they can require some time off work, and even request surgery. A large majority if not all, will benefit from an exercise programme regardless of the severity of injury or whether surgical intervention is required. Exercise rehab helps regain the functional capacity
4:14
that has been compromised by the injury, and can assist in getting an individual back to a level of functional capacity required to perform their role. Some roles are of course more physically demanding than others, the more physical role, the most specific and exercise programme that will require, and often for a longer period of time will be required to return for work capacity, with a more graduated return to work plan in stages as functional goals are achieved.
4:40
I'm sure most people are familiar with return to work plans and how they work in stages. So having a professional who can plan this out and update everyone when certain goals have been achieved so certain duties are safe, is a really good way to make sure that they are set in an appropriate manner. Once the exercise rehab programme has been completed, the worker will be able to physically complete all components of their pre-injury role, in most cases depending on the injury of course,
5:12
and the workers' compensation client can then come to an end. Ideally, even once the climb has ended and a return to work has been achieved, the programme can continue in some capacity to prevent future injuries, so that the individual will be able to carry that on independently. Exercise programmes are one of the best ways to prevent future injuries not just to recover from them, so they can be used as a preventative measure as well as a recovery measure.
5:40
Recent ISA sustained very strong evidence to support active rehabilitation for nearly all musculoskeletal conditions and injuries, due to the long-term health, recovery, and injury prevention benefits, moving away from more passive therapies that can be used for a short term symptom modifiers, but do not assist in allowing
6:00
physiological adaptation to enhance function. These include treatments such as massage, tans enabling, et cetera. If these are used they should be used in conjunction with exercise, and then gradually transitioned as of towards getting somebody active to return the function.
6:19
So I did notice a couple of questions on what is an exercise physiologist. So the definition from Exercise and Sports Science Australia which is the professional body that accredits, that will registers professional such as myself, is a university qualified allied health professional equipped with the knowledge, skills, and competencies to design, deliver, and evaluate safe and effective exercise interventions for people with acute, subacute,
6:49
or chronic medical conditions, injuries or disabilities. APS and physios are very similar in some ways, so these two circles only have a small overlap, but there is actually much, much, much more than that.
7:04
Physios do hands-on work, so the massage manipulation that a lot of people are familiar with, and oftentimes focus more on early stage and acute recovery in pain management, and regaining range of motion such as after surgery somebody who's been in the sling and they're quite stiff 'cause they haven't been able to move their arm for four to six weeks, whereas APS, which will say AP for short, are more about strength and conditioning to regained function and that longer term rehabilitation.
7:43
As there is a lot of overlap, best practise would be to involve both physio and AP along the path to recovery, and many practises now have both professions working together.
7:56
From personal experience I worked in one, this would often involve the physio seeing someone for example the first month to get symptoms under control, and then handing over to the AP to build an exercise programme for return to work, or sports, or hobbies, that will most likely focus on their overall function and not just the site of injury. So it's looking at the global function in addition to the function of the area where they were injured.
8:24
so dependent versus independent programmes and how that changes along the path of rehab. When starting rehab the exercise programme is going to be more dependent, more one-on-one sessions will be required as more supervision is needed to look at technique, monitor symptoms, and modify the programme as required to ensure it's appropriate to progress without flaring up symptoms causing more pain, et cetera setting them back. Sessions can be gradually reduced
8:53
once technique is good and some has been restored, and the individual is confident performing it at home, or in the gym alone on a regular basis whichever their preferences, and obviously this individual differences is to who and how quick somebody might be confident in being able to perform that alone, and how high risk their injuries is as well or severe. Towards the end of rehabilitation sessions should only be required when increasing the programme or modifying it,
9:22
as the workers should be Self-sufficient. The aim of rehab should always be to create independent programmes, the goal of any trader is to make themselves redundant towards the end of recovery, by giving their client the tools, skills, and knowledge to be able to perform a self-sustained programme when they're discharged.
9:42
So on to the main topic, is it important to be task specific? Would you create the same exercise programme for an office worker as you would for Scaffolder? Most people would say no because there's a lot of contrast between the two, but obviously there's subtleties in there between two very physical top roles, and would exercise such as a bicep curl assist with the rehab of a knee injury?
10:10
So you can see how these are two starkly contrasted examples.
10:15
So specificity is one of the principles of exercise prescription, the adaptations to the exercise are specific to the joint angles, the muscles used, the speed of the muscle contractions, the time under load and the repetitiveness, a one big effort versus multiple frequent efforts, and various other factors. For example if you want to be a good runner, running should maybe part of your programme, there's only some crossover. Say if you did cycling, it's also an endurance activity
10:47
but it requires different demands of the muscles,
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although the cardiovascular benefits are maintained between both. And the same goes for musculoskeletal conditions as well,
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if somebody is spending a lot of time on their hands and knees, the physical requirements for them they gotta be very different to somebody who spends more time say climbing or reaching overhead for long periods like a mechanic standing under a car for example, the two are very different, so you would approach how you would prescribe their programme in a different way.
11:22
Going back to that first example at the top,
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if an office worker and a scaffolder both had lower back injuries for example,
11:32
for the scaffolder you will need to ensure they have enough law body and shoulder strength to return them to full function, whereas the office worker would not particularly need any upper body exercises specific for work per say, just for general strength and conditioning to offset the sedentary time. And the programme would lock the focus on just being more active in general, as inactivity a risk factor for back pain and various other injuries.
11:56
The scaffolder would require good whole body strength for lifting and moving objects, as well as good control due to the dynamic nature of lifting in the role, and the large objects they need to move in addition to having to climb up ladders, et cetera. It's not always possible to have things close to the body in a nice little package the way we're normally taught to lift, so we need to help them adapt and prepare to be able to do those different tasks that require movement and control.
12:26
An example of why task specific exercises can be important for the scaffolder is that, if they're consistently lifting say 10 kilogramme objects just for a nice easy round number, but we were to train them to perform efforts of 15 to 20 kilogrammes, then their body adapts to that higher loading, making the lower amount that's actually required at work well within their capacity and capabilities, reducing the injury risk because they're less likely to overload what their body is capable of.
12:57
The same rule applies for the rehab from injury, the aim is to get them to a point where their strength exceeds the capacity of their role to prevent reaggravation or reinjury.
13:08
And recent research in this area has brought about a change in thinking regarding pain conditions and injuries in the work place. It sometimes might not actually be doing too much that's cause an issue, it may actually be not doing enough and not being accustomed or prepared for it. For example, if somebody just walks regularly for exercise and then gets up one day and decides to run 10 kilometres without training, they're not gonna be accustomed to it,
13:35
so the same sort of thinking and rules apply in terms of preparing somebody for that activity. General programmes with whole body large multi-joint exercises for whole body conditioning, are going to play an important role in adaptation and should form the basis of the programme, and then the tasks specific aspects assigned to lie on top for the specific requirements or areas of focus such as shoulders or lifting from the ground and overhead for the scaffolder.
14:09
So an example of programme we have here is for a Concreter, Obviously they spend a lot of time in a bent-over position on their hands and knees. So listed here we've got a number of exercises that are performed in similar positions to this such as bent-over Dumbbell row or barbell row, deadlifts, low row on a cable machine, sled push and pull to simulate wheelbarrows and a focus on low weight/high repetitions for prolonged periods. So to emphasise exercises within the range of motion
14:43
and body positions that are required for work, these would be done in addition to more general exercises that aren't in these to build the foundation strength, and then you'd put these ones on top to help prepare for the time they spend in these positions which cannot be avoided.
15:03
You'd also focused on endurance because they're gonna be doing it for long periods of time, and low-rep heavier strength efforts to build up tissue capacity so that their muscles can take that loading as well as their other soft tissues. And to have a posterior try and focus to hamstrings, glutes, and back muscles because they work hard in these positions to hold the body positioning for a long period of time.
15:31
So conditioning at work, fact or fiction?
15:35
That quote at the top is something we hear a lot, is that work is the exercise so we don't need to do anything else.
15:44
But by performing work tasks only, it means there'll be no buffer between the physiological capacity of the individual, and the physical requirements of their work, increasing the potential for an injury, so the work tasks will essentially be 100% of the maximum potential, so any increase in loading will be unaccustomed.
16:05
If they were to combine work tasks with an exercise programme to build up their capacity, then the worker's body will be conditioned beyond the point of their work tasks, meaning less likelihood of injuring themselves if the work tasks up only say 75% of the maximum potential. This is why athletes often train at a higher intensity during play season then they would play just to prepare them for that, and make sure that anything they're exposed to
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in the actual event itself, whether that's a sport or work is able to be coped with by their bodies.
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Further, strength training improves tissue strength, but not just muscles but also tendons, ligaments, and bones due to the forces they adapt to, therefore increasing their ability to tolerate load and decrease in injury risk. Say you've got less risk of fractures, tendon or ligament tears, as well as muscle strains and sprains which are some of the most common especially with lifting activities.
17:11
An idea for how to incorporate this is some companies often find a couple of physio sessions for workers, a lot of large staffs have one common on site, in addition to that it might be an idea to fund a couple of sessions with an AP to build an independent programme to improve strength and conditioning, and work with the individual on how they would like to do that, what their goals are et cetera, with the aim being long-term health improvement and injury prevention.
17:40
They can be self-directed with a clean start and end point and no need for ongoing sessions, it would be to make that person able to then modify their own programme, educate them enough to be able to do that themselves.
17:59
So can an exercise programme only be used for physical injuries?
18:05
Some of these improvements listed here, most people will be familiar with increased muscular strength, better coordination and agility, increased energy levels. So increased energy levels is similar to the one of the previous examples about preparing your body for the strength and loading requirements, in order to increase your energy levels.
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You need to adapt to activities well above
18:37
the usual requirements of your activities of daily living, so your daily tasks, and so the chances of experiencing fatigue are lower because your normal tasks are well within your ability. And improve balance and spatial awareness, less likely to have avoidable accidents such as trips, falls, et cetera. But the main point highlighted down the bottom is psychological wellbeing, so we know a lot of the physical benefits of exercise. Now that's well-established and known by most people,
19:08
but there is very strong evidence that exercise can be as effective in managing all symptoms of depression and anxiety as commonly prescribed medications, and it is certainly now recommended as part of the therapy by a psychologist due to the well known effects of endorphins in boasting mood, plus the added benefit of improved physical health, something that also suffers with mental illness.
19:31
And more intense exercise is also linked to deeper and more restful sleep which also allows mental and physical recovery. So there's a multitude of benefits there that help both from a work perspective but also a general health and life perspective as well. And one final point I would add is that exercise programmes can also help avoid the need for surgery.
19:58
So it has been a lot of research in say knee injuries for example where maybe an arthroscope has been recommended, but it's been delayed by a month or two, and so during that time somebody will see a physiotherapist or an exercise physiologist, do a good intense exercise programme, and the increase in function and reduction in symptoms I get from that means that the surgery is actually not performed in the end because the function is good enough without needing that.
20:33
Obviously that depends on the injury, but that's something to keep in mind as well and personally, I would try that first before going for surgery, I would surgery as the last resort. And even if the surgery is then still required,
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we call it prehab, so prehabilitation, pre-surgery rehab. And evidence also shows that by doing that, the individual can actually come out of the surgery better because they have more function when they go into the surgery, and therefore the mountain to climb for recovery afterwards is much lower.
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So whether or not the surgery goes ahead, the benefits are pretty good I think and worth a try.
21:21
Any questions, thanks for your time.
21:25
- [Stephanie] Thank you Justin. So if anyone does have any questions for today's presenter Justin Ockerby from IPAR Rehabilitation, please use your Control Panel to type and submit your questions.
22:04
A reminder as well that today's webinar has been recorded and will be made available on WorkSafe Tasmania's YouTube channel in the coming days.
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Don't have any questions coming through Justin. So on that note, I'll begin to close the presentation. - [Justin] Yep, sure. - [Stephanie] So thank you Justin Ockerby senior consultant exercise physiologists from IPAR Rehabilitation. And thank you everyone for joining us for today's webinar exercise physiology, task specific exercise programmes in the Workers' Compensation Arena. At the cause of this webinar you will receive a survey to complete, we do appreciate
23:42
you providing us with your feedback. Today's webinar has been recorded and will be made available on WorkSafe Tasmania's YouTube channel. On behalf of WorkSafe Tasmania and the workCover Tasmania Board, thank you for joining us and thank you Justin.
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