The evidence is clear that as the duration of work absence increases, the likelihood of returning to work decreases. Safe Work Australia’s 2024 report makes the bold statement; “after 24 months of prolonged worklessness, very few people will ever make a successful return to paid work” (1). In our role as Exercise Physiologists, we see this play out not only in deconditioning and in the loss of physical capacity, but also in a loss of confidence for movement and reduced cognitive capacity.
Sophia (name changed for confidentiality) had been deemed unfit for work since her lumbar disc prolapse injury in 2024; 19 months off work and counting. Before her injury, Sophia worked more than 40 hours per week as a palliative care Support Worker. Her role was physically demanding, requiring her to perform household cleaning, shower and dress clients, assist with mobility and transferring in and out of cars, beds and more.
Sophia started feeling some left-sided low back pain which then progressed to a radiating pain heading towards her knee with numbness and pins and needles in her left foot. She started to struggle to bend over, lift anything moderately heavy and also couldn’t maintain a sitting or standing position for long – all movements frequently required in her role.
Despite lacking significant confidence in her ability to complete many aspects of her role, Sophia was determined to get back to work. Enter, Exercise Physiology.
Understanding the Starting Point
When Sophia met with Cara, one of our NZ based EPs, in April 2026, the impact of her injury was evident. For the past 19 months, she had been avoiding and restricting so many of her movements due to the pain they were causing. With guarded movement often comes a loss of flexibility, and her range of movement scores showed this; with lower back mobility well below normal for extension, lateral flexion and rotation.
Cara went on to test her ability to complete various functional activities to see how she was managing to complete her various day to day tasks at the start of the program. During her six-minute walk test, Sophia needed a break after 3.5 minutes due to pain. Lifting and carrying 5kg weights also resulted in pain scores of 6/10 and she explained that she struggled to complete many everyday activities, as reflected in her PSFS score (Patient-Specific Functional Scale) of 18.5/50 for tasks such as walking, gardening, grocery shopping, vacuuming and work.
Her Orebro score was 124, indicating a moderate risk of delayed recovery and prolonged absence from work. For Cara, this result reinforced the importance of addressing not only work capacity, but also Sophia’s confidence, beliefs around pain, and ability to return to meaningful activities.
Making Exercise Relevant to Work
To get Sophia back on the right track, Cara built a program which combined mobility, core stabilisation, gradual loading and movement retraining. Sophia needed to rebuild her confidence in movement and once this was done, her exercises needed to be progressively matched to the physical demands of her Support Worker role if she were to translate this confidence into a belief that she could manage the demands of her work again.
Some key aspects of Cara’s program included:
- Walking was gradually increased and later progressed to weighted walking to improve her tolerance for moving around clients’ homes while carrying equipment.
- Core exercises such as the “deadbug” were used to improve lumbar control during contralateral (across the body) movements, such as would be required when dressing clients, cleaning bathrooms and vacuuming.
- Wall push-ups were progressed to improve upper-limb endurance for client transfers, pushing beds and cleaning tasks.
- Dynamic core strength drills were used to prepare Sophia for repeated bending, lifting, twisting, and diagonal reaching.
This workplace-specific approach gave each exercise a clear purpose: building the physical capacity and confidence required to return to her job.
Meaningful Progress Towards Work Readiness
After only four weeks, Sophia was already noticing changes. Her pain had reduced when mowing the lawn, she felt more confident doing the grocery shopping and was sitting for longer periods during social gatherings. She was also able to carry a full washing basket independently, something she had previously relied on her husband to do. While these improvements were noted in Sophia’s everyday life, they also quietly built a foundation of confidence for her ability to return to her role as a Support Worker. Sophia worked diligently at her exercises and the progress continued to flow.
Towards the end of the program, Cara visited Sophia’s worksite to watch her completing the tasks she would encounter in her role, including bed making, vacuuming, laundry, bathroom cleaning, dressing clients, bending forward to put on someone’s socks and client transfers. The review demonstrated how Sophia’s improved strength, endurance and movement tolerance translated into the practical requirements of her role, while also helping identify any further support required for her return to work.
The Outcome
At the time of reassessment, only 12 weeks after starting her Exercise Physiology plan, the results spoke for themselves.
- Her walking tolerance had increased from 3.5 minutes to 30 minutes.
- Her driving tolerance had increased from 20 minutes to 60 minutes.
- Lumbar mobility returned to normal ranges for extension (12° improvement), lateral flexion (5° to the left, 7° to the right) and a significant improvement in rotation (7° to the left).
- Her ability to squat (60 second sit-to-stand test) improved from 9 repetitions with 5/10 pain, to 12 repetitions with only 1/10 pain.
- Her postural endurance (wall sit) improved from 58 seconds with 5/10 pain, to 2 minutes with 0/10 pain.
- Her upper body endurance (wall push-ups) increased from 20 repetitions with 4/10 pain to 30 repetitions with 0/10 pain
- Her cross-body core control (deadbug exercise) increased from 6 to 16 repetitions
As her confidence for movement increased (PSFS score 32/50), her Orebro score also improved – from 124 (moderate risk) to 79 (low risk of long-term disability).
A Pathway Back to Work
After more than 19 months away from work, and only 12 weeks of Exercise Physiology input, Sophia had built the capacity to commence a graded return of 15–20 hours per week. With a GP appointment booked to gain work capacity certification, Sophia had a plan in place to progress towards her full-time hours over a 6-8 week period.
Sophia’s journey demonstrates the value of a targeted Exercise Physiology approach following prolonged work absence. As with most pain-based conditions, progress is not simply about reducing pain. It is about rebuilding physical capacity, restoring confidence and demonstrating that the improvements achieved in rehabilitation can translate into the real demands of the workplace.
Through graded exercise and a workplace-specific approach, Cara helped Sophia move from being fully unfit for work to having a clear and realistic pathway back to the role she valued.
References:
Safe Work Australia. (2024). Early intervention in the workers’ compensation process: Final report. Safe Work Australia. https://www.safeworkaustralia.gov.au/sites/default/files/2024-04/early_intervention_in_the_workers_compensation_process_-_final_report.pdf
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