Exercise Physiologist
Richard is an Exercise Physiologist for an in-home, workplace compensation recovery service. He drives to clients houses to educate and empower them with advice and exercises to build movement habits that support their recovery.
“[It’s] about educating and empowering people to be able to independently recover and self-manage their condition…If they’re not doing anything, their quality of life is going down because they’re not engaging in activities of daily living.”
What an Exercise Physiologist (EP) does
The main thing is educating and empowering people to be able to independently recover and self-manage their condition. I mostly work with clients on the workers compensation scheme which means 1) managing the client’s physical condition through exercise prescription and 2) managing their psychological, mental and social issues because as the client’s injuries are chronic, they’ve now reduced their physical activity levels, they’re not socialising, going outside, engaging with the community or maintaining a social life. They’re not completing any domestic tasks and are pretty much dependent on loved ones or carers. They’re not going back to work so they’re financially, emotionally and physically stressed and feel like they’re not doing anything right. If they’re not doing anything, their quality of life is going down because they’re not engaging in activities of daily living. If they can barely eat breakfast by themselves, they can’t be happy like that. They end up getting anxiety and depression, so I’m part-psychologist as well.
If someone for example, falls off a ladder at work and breaks their arm, they would get surgery and all the medical procedures required to fix it. They’d inform their employer and when they’re at a stage to be able to work at some level again, their doctor writes up a certificate of capacity detailing how much they can lift and how many hours they should be working. They then get referred to me and we book an initial assessment which is where I ask about the mechanism of the injury, how everything happened and past medical history. It’s also where I detail mental issues I notice during the assessment. A lot of the time they’re very mentally weak so I make very subtle, casual conversation.
I like to bunch clients who live in the same area together so I don’t waste time doing extra driving. The maximum number of clients I’ll see in a day is five and I’ll give myself about thirty minutes between each appointment. I have my face-to-face session with my client where I get updated on and take notes on their progress, for example, if they’ve seen a specialist recently, how the pain is or if there have been any aggravations or flare ups in the past week. We then do exercises and stretches, I give them education on self-management and how to manage when they’re at home by themselves. I then put everything in the central information system and bill for an hour to the insurance company.
Between sessions, I still have to make phone calls with each client’s insurance company, case manager, rehab provider and nominated treatment doctor. I have to communicate with all of those parties as well as the client. When I touch base with them, I tell them I’ve completed the initial assessment, describe my findings and make suggestions on how we can work together in helping the client. The goal is to ensure everyone is on the same page, otherwise, the client gets nowhere.
I also get CTP (comprehensive third party) claims, people who have been injured in car accidents. There’s also the NDIS (National Disability Insurance Scheme) which is for people with disabilities. That’s mostly solutions around socialising because they’re typically lifetime disabled and aren’t going to get any better so I help increase their strength and function for them to have an increased of quality of life and standard of living.
Being able to do his own thing
As I’m on the road by myself with no boss watching over my shoulder, he can see how much work I’m getting done as I log it onto the information systems. I like it that way because it’s independent and I often feel pressured having a boss looking over my shoulder, I just want to do my own thing. It’s like when you’re in class and the teacher is staring at you and you’re freaking out in your head like, “I don’t know the answer.” It’s flexible, I like that.
The administrative side of the job
My least favourite part is the paperwork. I get so sick of report writing. We have offices across Sydney where I can pop by to fill in paperwork but I’ve got a work laptop so most of the time I work in my car before or after an appointment. I like the flexibility.
I like to do paperwork while everything is fresh in my mind so right after the session but it gets tiring and I’m not perfect. At the moment, I’m stressed because I’ve got three reports I have to do over the weekend which I don’t want to do because it’s the weekend but then if I do it next week, I’m going to forget everything. I’ve only got two hands and one brain though.
The difference between Exercise Physiology and Physiotherapy
EP’s deal with more chronic injuries, whereas Physiotherapists deal with acute injuries, for example, an EP wouldn’t meet someone shortly after they had injured themselves. We see people who may have had lower back injury for the past eight months.
Exercise Physiology is an active treatment where I teach clients what to do so they’re actively doing the exercises regularly to become stronger. Physiotherapy is a more passive so a Physiotherapist might give someone a massage and education regarding why they’re hurting. Apart from traumatic injuries where something’s fallen on you or you’ve fallen onto something, a lot of the time injuries occur because of poor lifting techniques, for example, putting all the weight on your back when lifting a box instead of using the right muscles. To meet the demands of someone’s work duties, we have to mimic that with exercises or physical activity so people do all those tasks using the right body parts.
“[I tell] them what they can do rather than what they can’t. They keep focusing on the fact that they can’t go to work or complete a myriad of other tasks, so I show them how to change their perception.”
Building rapport with clients
The clients I see lack confidence and are reluctant to open up especially because I’m a stranger. I’m a carefree and humorous person so I use jokes to get to them otherwise they’ll never tell me anything and I can’t do a proper initial assessment. I write a report, send it off to an insurance company and they approve it. The next step depends on the client because I meet some who define exercise as walking around the block, so there’s no point getting them a gym membership because they’re not going to use it if they feel intimidated. However, if it’s someone whose job involves repetitively lifting hundreds of kilograms everyday with prolonged standing, sitting, bending squatting, twisting etc., the gym would be effective for them. For others I might arrange for them to participate in a program so they become more engaged with the community.
On managing a client’s mental health
That’s the education aspect coming in again and telling them what they can do rather than what they can’t. They keep focusing on the fact that they can’t go to work or complete a myriad of other tasks, so I show them how to change their perception. Yes, they might not be able to go to work but they can practice walking up the stairs and if they keep doing that with consistency, they have the potential to become stronger and they’re going be able to do that task in the future. Consistency is key. It’s about framing it positively and changing their mindset because they’re so negatively focused on the injury and dwelling on the issue that they’re not focusing on how to get better.
It wasn’t a linear path
I studied a Bachelor of Sport Science and Master of Exercise Physiology.
I actually started off doing a year of Bachelor of Product Design though. The only reason was because I came first in graphics in Year 12 and I was like, I love this, I love drawing, this is a passion of mine. Straight up, that’s what I thought I was passionate about.
I did introductory design subjects like design thinking and got turned off straightaway because I always had to find stories behind ideas. I just wanted to draw what I wanted, but it didn’t matter if I thought it looked great and was happy with it, what mattered was whether the customer liked it. It’s so subjective. I might think it’s a hectic idea but the people who are going to manufacture it might think it’s rubbish and I’d have to re-design it. I might design something creative but I have to ask myself, is it functional? It’s got to have that balance but, I just enjoyed drawing so I told myself it was just a hobby.
Existential crises
I struggled, I remember the time when I had three life crises. I was going to drop out of design and had no backup plan. I ended up transferring to Sport Science. Then, after graduating, I was trying to find a job in sport sciences and there was literally nothing in the field. I thought I’d just wasted three years of my life. I knew I had to upskill from there, but didn’t know what I was going to do.
It’s different in the real world
I did an EP subject during undergrad and I was so disruptive in the class, I just couldn’t pay attention. I passed but hated it so much. I was like I’m never doing this again and then ironically, I went into EP because it was either that or Physiotherapy and I chose EP because I thought it’d be more rewarding in terms of helping clients become independent. I also did a workers’ compensation subject during postgrad and hated it. I thought it was so boring but then now I’m in workers’ compensation. It’s ironic but I enjoy the job at the moment. That’s what they mean when people tell you this isn’t what it’s like in the real world. It’s so much more practical which suits me. I hate theory. I can’t sit there with a book in my face.