Case Studies

 Rehabilitation of a Custodial Officer

45-year-old male Custodial Officer referred for rehabilitation following non-specific lower back strain from restraining a detainee. Referred to Agility Rehabilitation 3 weeks' post-injury for exercise therapy. Non-responsive to physiotherapy treatment and on regular Panadeine Forte for symptom management.

Initial presentation/assessment: Significant irritable lower back pain (rated up to "10/10" pain intensity on VAS) with moderately restricted lumbar range of motion, guarded movement patterns and poor tolerance for load-bearing activity. Patient-recorded moderate lower back disability (39% Oswestry Lower Back Pain & Disability Questionnaire) and certified for restricted work hours and duties.

Treatment provided: 3 weeks of hydrotherapy to unload and progressively reload spinal structures and musculature, reduce symptom irritability and improve tolerance for movement. Progressed to two months of gym-based exercise targeting multiplane trunk strength, spinal movement control and graduated return to high-impact, high intensity activity.

Outcome: Full recovery with resolved back pain. Minimal ongoing functional disability (4% score on Oswestry). Final functional testing included replicated rapid rise from floor, replicated detainee tackle, and 50m sprint. Return to full capacity as a Custodial Officer achieved.

 Diabetes, obesity and hypertension

63-year-old office worker recently diagnosed with T2DM. Previously physically active in younger years but minimal regular physical activity for at least 15 years. Hypertensive, controlled with medication.

Initial presentation/assessment: Weight of 123kg equalling BMI of 37.8 (Obese class 2). Normal resting heart rate and rhythm but elevated resting (164/82 mmHg) and exercising blood pressure. Reluctance for recommencing regular exercise routine.

Treatment provided: Five sessions of one-on-one exercise consultations over two months incorporating combination resistance and aerobic exercise. Guidance and advice provided for daily home exercises, nutrition, and goal setting.

Outcome: Discharge - Weight at discharge (2 months) had reduced to 111.4kg. Resting blood pressure had reduced to 150/74 mmHg, and blood glucose levels were stable. 3 months post-discharge – Patient had lost a further 13kg and was no longer diabetic. He continued to exercise regularly and committed to long-term lifestyle changes.

Testimonial: "I'd just like to say thanks for your help and encouragement and in all honesty I feel much better and healthier than I have for years" - Gerry

 Athlete with persistent lower back pain

38-year-old female amateur athlete self-referred for advice on exercise for persistent lower back pain.

Initial presentation/assessment: Long history of non-specific lower back pain for most of her adult life. Pain up to 8/10 intensity exacerbated with some abdominal exercises, lifting and twisting movements, awkward bending, and stress. Currently participating in long distance running, sprint training, high intensity circuit training and stretching. Good range of motion but guarded and stiff movement patterns.

Treatment provided: Two sessions involving lumbar and hip mobility exercises, running and sprint technique modification, cognitive functional therapy and relaxation techniques.

Outcome: Significant reduction in lower back pain after two sessions including self-reported "pain-free" mornings. Effective management of lower back pain whilst continuing active exercise regime.

Testimonial: "Just a thank you to Agility Rehab - Jonny for the prompt accurate and thoughtful service. I feel more confident exercising knowing I have stretching strengthening and endurance training specific to my condition and really appreciate Jonny going above and beyond by providing advice on the impact of tension depression and anxiety on the body physically and how this can impact on other body systems. Thank you very much, so grateful for your professional support." – Vanessa

 Quadriceps tendon rupture – rehab

70-year-old truck driver sustained a quadriceps tendon rupture after falling awkwardly at work. Surgical repair one week later and referred for hydrotherapy 5 weeks' post op.

Initial presentation/assessment: Patient presented for exercise rehabilitation 5 weeks' post op wearing a hinge brace locked at 0-60° flexion and ambulating on two crutches. Significant quad and calf muscle atrophy with minimal capacity for squatting, walking and stair climbing.

Treatment provided: 6 weeks' hydrotherapy incorporating progressive weight bearing training and range of motion exercises. Gym-based exercise commenced 12 weeks' post-op incorporating quadriceps and calf strengthening, and functional weight bearing exercise. Restricted knee flexion and weight bearing protocol was appropriately implemented.

Outcome: Patient discharged from supervised exercise rehabilitation 20 weeks' post op. Knee flexion range was restored to 116°, squat depth to 90° knee flexion, and stair-climbing, walking and sit-to-stand capacity was normal on discharge. Patient was able to return to full, unrestricted work duties as a truck driver and continues to attend the gym independently.

Testimonial: "I was involved with both Jonny and Belinda and found both very helpful and very good at understanding my needs." – Lysle

 Upper limb rehabilitation

42-year-old female Teachers Assistant referred following a student restraint incident resulting in right lateral epicondylitis, left shoulder pain and cervical pain. Initial treatment consisted of 6 weeks right forearm immobilisation via splint followed by passive physiotherapy treatment for cervical and shoulder pain. Referred to Agility Rehabilitation 3 months' post injury for a physical reconditioning program.

Initial presentation/assessment: Patient reported mild to moderate pain in her right upper trapezius and scapular area as well as lateral forearm tenderness. Reported overall feeling of 'weakness' and loss of confidence in her ability to physically restrain students when required. Poor tolerance for tasks involving grip strength and forearm pronation.

Treatment provided: 8 weeks of gym-based exercises to improve upper limb strength and shoulder mechanics, cervical mobility and overall physical conditioning. High intensity cardiovascular exercise was also included for pain and stress management.

Outcome: Full recovery with no ongoing disability. Shoulder and cervical pain resolved within the first 4 weeks of program. Upper body strength improved considerably over 8 weeks giving her confidence to return to full, unrestricted duties at work. Patient reported considerable improvement in overall wellbeing and was motivated to continue with the program self-paced.

 Post-operative lumbar rehabilitation

50 year old Installation Technician referred for rehabilitation 5 months post L5/S1 decompression, micro-discectomy and rhizolysis.

Initial presentation/assessment: Constant numbness and pain in his left leg and foot and occasional sharp pain in his lower back (rated up to "5/10" pain intensity on VAS). Patient-recorded moderate lower back disability (34% Oswestry Lower Back Pain & Disability Questionnaire). Reasonable trunk range of motion, however guarded movement patterns and poor squat capacity. Completing light duties with a 5kg lifting restriction.

Treatment provided: 4 weeks of hydrotherapy to improve movement patterns and exercise tolerance. 6 months of gym-based strengthening exercises to build trunk strength, restore normal movement patterns and improving lifting capacity.

Outcome: Complete resolution of referred leg and foot symptoms with minimal ongoing lower back pain. Reduced lower back disability rating (26% Oswestry Lower Back Pain & Disability Questionnaire). Improved lifting capacity to 15kg. Comfortably completing a work trial as an electrician with possibility of permanent employment.

Testimonial: "With Belinda's expertise I have come a long way from the initial consultation to where I am now. Belinda's programme gave me the confidence to progress slowly but surely to endeavour to take on my normal daily life where possible. Without her help I am positive I would not be anywhere near the stage of ability that I am today" … "Thank you for all your help it's much appreciated as I have come a long way since the first consultation. With Belinda's advice I can hopefully keep advancing to the best of my abilities. Basically, I would highly recommend Agility Rehabilitation from my experience. As you may understand any improvement in a person with an injury is like winning the lotto to them. I can never thank you enough for your advice and concern in my wellbeing." - Gerry

 ACL reconstruction & return to sport

33-year-old female referred 8 weeks’ post ACL reconstruction, medial meniscus repair and patella chondroplasty. Referred for exercise rehabilitation following a period of physiotherapy.

Initial Assessment: Stable ACL graft with occasional calf and sub-patella pain with increased activity (‘4/10” pain intensity). Other symptoms include occasional knee and ankle swelling, patella-femoral crepitus and pain restricted knee range of motion. Poor tolerance for prolonged walking, standing and driving. Poor capacity for squatting past 90° knee flexion and unable to kneel. Non-reciprocal stepping when descending stairs, and slight limp, more pronounced post testing.

Treatment provided: 3 months of gym-based exercise programming to restore knee mobility, improve muscle strength, protect repair, develop dynamic knee stability, and develop confidence in agility tasks with a goal of resuming recreational sporting pursuits.

Outcome: Full recovery with average Limb Symmetry Index of 94.94% per hop testing. Complete restoration of pain-free left knee range of motion with minimal functional disability and normal tolerance for prolonged tasks such as walking, standing and driving. Returned to unrestricted work duties as a Hygiene Technician and cleared for gradual return to high intensity sport.

 Customised climbing program for an Arborist

34-year-old male arborist referred 8 weeks post bilateral umbilical hernia repair surgery. Injury sustained during prolonged heavy lifting, initial surgery 2 months following injury, follow up surgery 1 month later. No physio or regular medication.

Initial assessment: Minimal pain with palpation at surgery site (1-2/10), minimal discomfort with normal adl’s, symptoms include pins and needles. Full range of motion with early fatigue in exercises requiring core control. Certified unfit for work for 1 month.

Intervention: 4 weeks of hydrotherapy followed by 2 months of gym-based rehabilitation for dynamic abdominal control and endurance. In order to safely return to work, 3 weeks of replicated climbing activities were prescribed and assessed at an indoor rock-climbing facility. Tasks included replicated Prusik climb, ladder climb and suspension from harness.

Outcome: Full recovery from surgery with no specific pain at surgical site. Successful return to pre-injury duties following customised climbing evaluation.

 Sub-acromial bursitis rehabilitation

27-year-old Electrician referred for rehabilitation for bilateral sub-acromial bursitis. Moderate relief from cortisone injections, anti-inflammatories and physiotherapy. Referred 6 weeks’ post-injury.

Initial presentation/assessment: Constant right shoulder pain and occasional left shoulder pain. Pain level rated “4-6/10”. Shoulder Pain and Disability Index (SPADI) score of 50.7% (interpreted as “severe” disability). Significant right scapular winging evident. Completing light duties with a 5kg and no overhead lifting restriction.

Treatment provided: 8 weeks of gym-based strengthening exercises focusing on scapulothoracic and rotator cuff control and upper body reconditioning.

Outcome: Near full recovery, with further improvements in function expected with continued exercise. Reports being mostly pain free. Improved sustained overhead reaching capacity from 34 seconds to 1 min 40sec. SPADI score reduced to 8.75% (“minimal” disability). Significant reduction in right scapular winging. Returned to full work duties without difficulty.

 Conservative management of PCL rupture

24-year-old labourer and social rugby player sustained a full PCL rupture from an impact incident at work. Reviewed by an orthopaedic specialist and recommended to trial non-operative management. Referred to Agility Rehabilitation 2 months’ post injury.

Initial presentation/assessment: Positive posterior tibial sag upon passive assessment and functional testing. Mild knee pain at rest that increases in intensity with exercise. 77% function as per Knee Outcomes Survey (KOS), 3cm thigh girth deficit, difficulty with squatting, running and heavy lifting, and inability to kneel or hop.

Treatment provided: 5 weeks of progressive strengthening exercises focussing on restoring quadriceps and hamstring strength, improving proprioceptive control, and minimising posterior tibial translation during active exercise.

Outcome: Patient discharged from all treatment 15 weeks’ post injury. Minimal ongoing pain or symptoms of tibial sag with activity. Restored quadriceps muscle mass. 94% knee function (KOS) with restored lower limb symmetry per hop testing. Full capacity for kneeling, running and hopping and return to rugby training (non-contact) with no difficulty. Advised to avoid contact sport for a further 6 months.

 Group exercise for acquired brain injury (ABI) residents

Agility Rehabilitation were engaged to provide group exercise classes for residents with Acquired Brain Injury as part of a healthy living program at several residential care facilities. Focus of the program was to improve resident fitness and function to assist with daily living, improve health and mental wellbeing, improve engagement and motivation to exercise, and ultimately improve quality of life.

Initial Assessment: Prior to program commencement, every participant underwent a pre-exercise functional assessment. Due to the nature of brain injury, individuals presented with varied levels of mobility and physical function including those relying on electric wheelchairs, self-propelled wheelchairs, walkers, support sticks or independent mobility. Some with degrees of paralysis, tremor or contractures. Mental health conditions common as well as cognitive dysfunction including anxiety/depression, poor problem solving and concentration, impaired short term memory and low motivation. High levels of comorbidities such as obesity, type II diabetes, dysphagia, chronic pain, asthma, joint pain or non-specific pain.

Exercise Intervention: The group exercise classes were run once weekly for 12-18 weeks onsite at three different homecare facilities. Group size was limited to 6 participants per 60-minute session. Sessions consisted of varied circuit based exercise programming with aspects of muscular strengthening, cardiovascular fitness, coordination, balance and problem solving. High focus on creating a supportive and fun environment to assist with motivation and engagement.

Outcome: General improvements in strength and cardiovascular fitness assisting activities of daily living such as independent transfers and mobility. Noted development of coordination, control and balance resulting in improved mobility confidence and reduced falls risk. Most notably an improvement in enjoyment and appreciation of exercise resulting in improved mood, confidence, motivation and hopefully developing long-term exercise habits in the participants.

Testimonial: Zoe has been a fantastic facilitator, who understands the strengths and limitations of each of our clients and is able to modify and grade exercise intensity to meet their specific requirements. She has established great rapport with our groups and has been highly professional in all her communication and planning. Due to the specific concerns that arise when working with people with ABI – who often have a number of neurological, physiological and medication interactions going on which cause extreme fatigue and problems with balance, planning, sequencing, etc - we have found that the exercise physiologist skill set is well suited to working with this group in the community. - Health & Wellbeing Coordinator, Brightwater Care Group