OOPS
FUNCTIONAL
RE-TRAINING

WORK HARDENING

When you are able to perform the strong exercises, begin work activities at 25% of the normal level ie only 25 % of the usual amount of time at activity per day and 25% of the heaviness of the most weight usually carried in hand. See  the main examples below. 

If you are an employee, you will need to discuss your return to work with your employer to begin at the correct level. If your employee doesn't have the correct work for you to return, as these instructions, then you should create the correct level of actions in home jobs.

For other specific tasks, make an estimation e.g. if the maximal single weight carried at a time in one hand is a full bucket of water then start with 1/4 (25%) bucket of water. If this level of activity increases the pain beyond 4/10 (See the Pain Score), cease work for a few more days, continue the exercise program, and then try to work at 25% again.

So long as the level of activity does not worsen the pain beyond 4/10, increase the level of activity by 25% every 3 days to one week. If any increase in activity increases the pain score more than 4/10, reduce the activity level back to the previous level. Keep progressing in this way until you achieve full return of function. If unable to advance for three weeks, see a doctor or physiotherapist.

FUNCTION &
RE-TRAINING ADVICE

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SITTING - OFFICE WORK

When returning to office work, check that your seating is correct for reducing stress on the back, shoulders and neck.

You should be able to sit comfortable with good back support from the chair, adjust the chair height so the hands are able to rest easily on the desk with elbows a little more open than right angles, feet flat on the floor.
If you are short for the equipment you have, adjust by using a foot stool.

Return to Office Work Training
Use a standing desk where possible. You can alternate between sitting and standing every half an hour.
Week 1. Take a short break every half an hour. Stand up and perform these exercises.
Week 2. Take a short break every hour and repeat exercises and continue to do these as a routine. 

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REPETITIVE REACHING AND HAND ACTIVITY

The diagram shows the low risk range for reaching work and activities. It presumes an even upright stance or sitting without bending forward.

Return to Work Schedule
Returning to work from an upper limb injury or repetitive use injury requires an incremental return to work program. Only commence return to work program when symptoms and functional assessments have returned to at least 75%.
Here are the guiding principles for a return to work program:
1. Return to work for two hours per day for one week. If possible to an activity that was not implicated in the injury.
2. If after one week, there is no worsening of symptoms then return to usual activity for 2 hours per day.
3. After one week, if no worsening of symptoms, increase working activities to 4 hours per day.
4. After one week, if no worsening of symptoms, increase working activities to 6 hours per day.
5. After a further week, if no worsening of symptoms, return to full time activities.
6. At any weekly review that symptoms have increased, reduce to previous weeks activity level for an additional week. 

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LIFTING OVERHEAD 
Medium Size & Weight Objects

Only attempt to lift objects above shoulder height that are easy to lift to waist height.
To lift overhead, begin in a slight lunge position.
As you prepare to lift, provide a small bend to the knees and then thrust up and forward on feet as lifting the object.

Likewise when bring an object down from above shoulder height, take the weight of the object through slightly bent knees in a lung position.

Return to Work Schedule
Return to work to activities which pain is less than 4/10 on the pain scale and avoid lifting above head.

Return to above head lifting when clinical testing demonstrates that you can lift the work weight above head 10 times without provoking pain more than 4/10 on the pain scale.

On return to lifting above shoulder height at work, if pain of 5/10 or more is provoked, report to the supervisor and cease the activity for that shift. Only return to lifting above shoulder height the next shift if your pain is no more than 4/10 and there is no restricted movement. If shoulder function is markedly reduced then review shoulder assessment again and follow the guidelines accordingly.

Following these guidelines will minimise your risk of re-injury and optimise your return to work recovery. 

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WALKING I 
FLAT GROUND.

Walk for five minutes every hour for the first few days after you are off crutches.

Then, every few days, providing pain is no more than 4/10 on the pain scale, add 5 minutes walking per hour.

When up to 15 minutes, reduce to every two hours. Commence Balance I exercises as below

At 20 minutes, walk every 3 hours.

At 25 minutes walk twice per day.

At 30 minutes, increase walking speed to as quickly as you can while keeping an even gait. Continue with this twice per day until you have regained your normal walking speed.

Then progress to uneven ground as next.

Return to Work Schedule
If your job is in sitting, return to work when your resting pain in sitting is no more than 4/10. Elevate your effected leg on another chair, to manage swelling, if necessary.

If you job requires some standing, return to work only to perform the sitting aspects of work when your resting pain is no more than 4/10.

If your job is mainly standing and walking, when you can walk without pain of more than 4/10 for 30 minutes you can consider commencing a return to work program.




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WALKING II 
FULL PERFORMANCE

RETURN TO FULL DUTIES
Because most standing work requires working with a load, also train all the balance components here, and any of the relevant lifting, squatting, stairs, and manual work components, below, as you need for your job. In this way you will have tested yourself for capability, pain levels, and safety before returning to those components of work.
Then only perform your standing component of work as long as the pain is no more than 5/10 on the pain scale. 

UNEVEN GROUND
When you can walk 30 minutes on the flat surface at normal speed with pain less than 4/ 10 on the pain scale, insert in each session a walk of 5 minutes on uneven ground such as the grassy surface of a park.

Every few days to one week increase the park walk by 5 minutes until you are walking 15 minutes on uneven ground and 15 minutes on flat ground.

Then commence Slope and Stairs Training below. 

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BALANCE I
ONE LEG STAND EYES OPEN

Set a stopwatch or watch a clock.
Stand on an even surface, on the injury effected leg, lifting the non effected leg, for as long as you can. When you loose balance and need to bring the other foot down for balance, note the time you were on one foot. Stand on the non-effected leg for 10 seconds.
Repeat alternately in this fashion for 5 minutes.
Repeat twice daily until you can stand easily on the effected leg for 30 seconds.
Then progress to EYES CLOSED. 

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BALANCE II
ONE LEG STAND EYES CLOSED

Set a stopwatch or have a friend watch a clock.
Stand on an even surface, on the injury effected leg, lifting the non effected leg, for as long as you can. Close your eyes.
When you loose balance and need to bring the other foot down for balance, open eyes, regain balance and note the time you were on one foot.
Stand on the non-effected leg with eyes closed for 10 seconds.
Repeat alternately in this fashion for 5 minutes.
Repeat daily until you can stand easily on the effected leg for 10 seconds.
 

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BALANCE III Dynamic

Walking on the spot while turning your head to the right and left.

i) Turning head slowly to one side over a few steps. Then turn the other side for a few steps. Repeat 20 x daily for a few days or until easy.

Then
ii) Turning head to each side with each step. Try both step and turn to the same side; and then step and turn to opposite sides. Repeat 20 x daily until easy each way.

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SQUATTING

When your physical assessment is better than 75% begin squatting retraining.

Holding on to a stable bar, squat evenly until any mild stiffness or pain. Then rise. Repeat 10 x. daily.

Without creating more that 5/10 pain, continue until you can squat with bottom to heels without resistance or until you have completed the exercise for 2 months.

If you cannot fully squat after two months, have a doctor or physiotherapy review.

Return to Work
Squatting is important if your work or activities require that you lift objects e.g parcels from the ground or floor. When you can fully squat, you can then train for lifting from the ground as below. 

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WALKING III
TRAINING ON SLOPES & STAIRS


Commence training on slopes when you can walk on the flat for 30 minutes with only mild pain.
Begin by walking on gentle slopes e.g. 10 degrees. Only walk with mild pain. It is often more difficult to walk downhill than uphill. Begin with a 5 minute walk on the slope period in your walking program.

Increase the walking on slope by 5 minutes per week until you're walking on a gentle slope for 30 minutes.
 
Then find a moderate slope e.g 20 degrees.

Add walking on stairs when it is only mildly painful. Also begin with 5 - 10 stairs per day. Add an extra set of stairs into your walking / running program each week until doing 3 sets of 10 stairs per walking session. 


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WALKING IV
FULL STAIRS DUTIES


Return to Work Schedule.

If you have to walk stairs to enter your work, use support e.g stair railing until you can walk up the stairs with mild pain only.

If your work includes walking up and down stairs routinely, only return to this work when you are able to walk up and downstairs with mild stiffness and pain no more than 4/10 for 30 minutes.


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RUNNING I 
FLAT SURFACES


Only commence a running program if you were able to run prior to the injury or pain, and especially if you were running for sport.

Only commence jogging (slow running) when you are able to walk for 15 minutes on uneven ground (as in in the walking program).

You will begin walking for 30 minutes and divide your walking program into:
i) 5 minutes walking on flat surface (footpath);
ii) 5 minutes walking on uneven surface (grass area);
iii) repeat walking even and uneven surfaces for 20 minutes;
iv) then add jogging for five minutes on the flat surface.
v) finally complete the session by walking 5 minutes on the flat surface.
Repeat daily for one week.

Each few days to one week add an additional 5 minutes of jogging until performing 25 minutes of walking and 20 minutes of jogging. You can intersperse 5 minutes of jogging after 5 minutes of walking. Complete the session with 5 minutes walking to cool down for a total of 45 minutes. 

Then progress to advanced running retraining below

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RUNNING II ADVANCED
for Returning to High Performance


Once you are comfortable with 45 minutes of intermittent walking and jogging, continue with the series in a forested park area so that the ground is more uneven and there are obstacles such as trees or rocks. 

Train with the following instructions 3 days per week

1. Walk and run in a meandering manner around obstacles for the 45 minutes,  

2. Then replace one 5 minute block of walking with jogging.

3. Repeat replacing a 5 minute walk block with jogging, every week until you are jogging in uneven terrain for 45 minutes. 

4. Once you can comfortably jog in uneven terrain for 45 minutes, increase the performance training by running on a combination of even grassed, uneven park, and sloping terrain. Use the following combination and you can alter this to ensure variability in the performance. 
a) 5 minutes jog warm up on even grass
b) 5 minutes jog on slope and uneven park
c) 5 minutes of intermittently 1/2 speed and jogging on even grass
d) repeat b) & c) intermittently 3 more times
e) 5 minutes jog cool down. 
Note: heart rate should be back to resting level within 5 minutes of completion of the set, before advancing to set 5. below. 

You can now return to formal sport training  

5. Once you are comfortable and have an easy stamina with the series of 4. begin introducing sets of faster speed on slopes, uneven and even ground. Gradually increase speed on even field until you are interspersing 10 seconds of sprinting. Do not attempt sprinting components unless you were sprinting immediately before the injury

If these performance retraining sets do not fulfil your ability to return to work and sport training, you can get additional customised advice from a physiotherapist. You can schedule an online appointment here. In that case, make sure you also complete a self assessment form. 

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