Craig from Flow Physio Co Sutherland talks to us about a recent study that looked at the effects of strength training on injury risk. Read on for more.

Strength training programs as a whole reduced the likelihood of injury by 66% (Lauersen et al 2018)

A recent meta-analysis of 6 studies with a combined total of 7739 participants aged from 12-40 published in the BJSM looked at strengthening intervention on injury risk.

It was found that strength training programs as a whole reduced the likelihood of injury by 66% with 95% certainty!

It was also found that the longer programs provided the most favourable results.

The programs had an average of 8 months with zero adverse effects reported.

Strength training appears to have a direct preventative effect for injuries of the hamstrings, ACL and anterior knee pain.

Take Home Messages:

  • This study obviously indicates the benefits of implementing a strengthening program for all athletes and weekend warriors regardless of age or sport

  • Consistency over time provides the greatest benefits

  • Strength training is safe

  • Appropriate dosage and progression is important

Reference: Lauersen JB, Andersen TE, Andersen LB. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis Br J Sports Med 2018;52:1557-1563.

Full Text

2019 Guidelines for Physical Activity in Pregnancy - Flow Physio Co Sutherland - Women's Health Physio

Guidelines for Physical Activity in Pregnancy

2019 Canadian Consensus Statement

The 2019 Canadian Guideline for Physical Activity in Pregnancy  provide guidance for pregnant women, obstetric care and exercise professionals on prenatal exercise.

The guidelines provide evidence based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, foetal and neonatal health. 

The Benefits of Being Active through Pregnancy

In the absence of contraindication, following these guidelines is associated with fewer newborn complications and maternal health benefits such as:

  • Decreased risk of gestational diabetes and preecplamsia

  • Less risk of Instrumented-assisted delivery; and

  • Decreased risk urinary incontinence post birth

What is Recommended?

The guidelines make 4 strong recommendations and 2 weak recommendations:

  1. All women without contraindications should be physically active throughout pregnancy (Strong recommendation, moderate-quality evidence)

  2. Pregnant women should accumulate at least 150 of moderately intense physical activity each week to achieve clinically meaningful health benefits and reduction in pregnancy complications (Strong recommendation, moderate-quality evidence)

  3. Physical activity should be accumulated over a minimum of 3 days per week, however being active everyday is encouraged (Strong recommendation, moderate-quality evidence)

  4. Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits (Strong recommendation, high-quality evidence)

  5. Pelvic floor muscle training may be performed on a daily basis to reduce the risk of urinary incontinence - instruction on proper technique is recommended (Weak recommendation, low-quality evidence)

  6. Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position (Weak recommendation, very-low quality evidence)

Enhancing maternal health and reducing pregnancy complications

In conclusion prenatal exercise should be therefore considered the front line therapy for reducing the risk of pregnancy complications and enhancing maternal physical and mental health. 

What should you do?

You should check with your obstetric care provider or Women’s Health Physio to make sure you don’t have any contraindications to exercise and enjoy the wonderful benefits of being active through pregnancy.

Back pain (Part 1) - Myths and Misconceptions - Sutherland Shire Physio


Back Pain:

Myths & Misconceptions


Back pain is one of the most common presentations to physiotherapy and were estimated to effect 1 in 6 Australians in 2014-15.

The Australian Institute of Health and Welfare report that;

In 2008–09, around $1.2 billion of total health-care expenditure in Australia was attributed to back problems. In 2011, ‘back pain and problems’ were the third leading cause of disease burden in Australia, accounting for 3.6% of the total burden across all diseases and injuries.

Below we take a look at some of the common myths and misconceptions about back pain. Let us know what you think!

I have been told that I should rest until my back pain settles…

An acute back pain event can be significantly painful and debilitating and unfortunately some movements can be very painful and uncomfortable. However, gradually returning to movement, normal activities and work as able is shown to be better for recovery and preventing recurrence than bed rest (1-3).

I should not exercise as it will make my pain worse…

Exercise has time and time again proven to be effective medicine for both acute and chronic low back issues (4). The issue arises when people take the wrong dosage. Ie. they do too much causing aggravation and overload, or they do too little so that no adaptations can occur. Multiple forms of exercise have been beneficial for low back pain, even heavy resistance training (1,4-8) Essentially any form of movement is better than none so find what you enjoy and progressively build it up (9).

I need a scan of my back to find out what structure is damaged…

There is an abundance of research that indicates that the results of scans correlate poorly with symptoms in people with low back pain (10-12). It is also interesting to note that most people without low back issues have changes on scans that do not cause any symptoms at all (12-14). What this means is that just because there are changes present on scans does not mean there will be pain. This does not mean that scans are irrelevant but it means they are only required in the presence of certain signs and symptoms that require further investigation and not all presentations of back pain.

Because it is so painful something must be damaged…

The amount of pain experienced does not equal the amount of damage.

I have arthritis so nothing can be done…

Some form of change as we age is normal on scans, it is similar to wrinkles, but on the inside. Studies of individuals with and without back pain have shown that just because changes are present does not mean there will be pain present. Even in severe cases of arthritis positive outcomes can be achieved with appropriate management (12-14).

My back pain is due to something being out of place/out of alignment and needs to be “manipulated back in”...

No matter what you have been told in the past there is zero evidence to show that low back pain is caused by something in the back being “out of place” or “out of alignment”. This also applies to discs “slipping” out of place, sure there can be disc bulges present on scans which can be shown to shrink and resolve over time. Furthermore, as things don’t actually slip out of place or get put out of alignment there is no evidence at all to demonstrate spinal manipulations or similar techniques can actually put anything back into place (15). This is not to say it will not feel as if something is out of place or alignment. Or that you cannot get relief from some of these techniques but it is important to know from a long term point of view that a structure isn’t out of place.

I have been told I should never lift more than 10kg…

Unfortunately what this leads to is diminished capacity long term. Once the back issue settles it means that it will no longer be as strong and is often guarded and protected particularly with lifting. This leads to diminished capacity, so that in the future it is in fact less strong and resilient and therefore more likely to become reaggravated. We take the approach of rebuilding capacity and the greater we extend that capacity the more robust things become and the less likely things are to go wrong.

Take Home Messages

  • Stay as mobile and active as possible in the presence of back pain and gradually build things up.

  • Scans can be helpful but are not always necessary and it is not unusual for changes to be present.

  • The amount of pain does not equal the amount of damage.

  • Arthritis being present does not mean that pain will always be present.

  • It is not necessary to have ongoing manipulations to keep things in alignment.

  • It is important rebuild capacity to reduce the likelihood of recurrence and ongoing issues.



  2. Balagu, F. et al., 2012. Non-specific low back pain. The Lancet, 379(9814), pp.482–491.

  3. Wynne-Jones, G. et al., 2014. Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine, 71(6), pp.448–56.

  4. Searle et al (2015) Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials; Clinical Rehabilitation 2015, Vol. 29(12) 1155 –1167.

  5. Steele et al (2015) A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain; American Academy of Physical Medicine and Rehabilitation Volume 7, Issue 2, Pages 169–187.

  6. Bjorn et al (2015) Individualized Low-Load Motor Control Exercises and Education Versus a High-Load Lifting Exercise and Education to Improve Activity, Pain Intensity, and Physical Performance in Patients With Low Back Pain: A Randomized Controlled Trial; Journal of Orthopaedic & Sports Physical Therapy, Volume:45 Issue:2 Pages:77-85.

  7. Pieber et al (2014) Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain; Eur Spine J 23:779–785.

  8. Vincent et al (2014) Resistance Exercise, Disability, and Pain Catastrophizing in Obese Adults with Back Pain; Med Sci Sports Exerc. 46(9): 1693–170.

  9. Smith et al (2014) An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders 15:416 DOI: 10.1186/1471-2474-15-416.

  10. Videman et al, (2003) Associations Between Back Pain History and Lumbar MRI Findings

  11. Endcan et al, (2011) Potential of MRI findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review.

  12. Brinjikji et al, (2015) MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis

  13. Teraguchi et al, (2013) Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study.

  14. Cheung et al, (2009) Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three Individuals.


Returning to sport after ACL surgery - When are you ready?

What is guiding your return to sport after your Anterior Cruciate Ligament (ACL) surgery?


What makes you confident in your decision to return to sport?

We too often see clients who have no clear pathway to return to sport. Here is a brief snapshot of what we assess to make sure we are helping our clients decrease their risk of re-injury when returning to sport:

  1. >90% on lower limb strength testing comparative to uninjured side

  2. >90% on hop testing comparative to uninjured side (single leg hop, single leg triple hop, single leg crossover hop, timed 6m hop, lateral hop)

  3. >9 months post surgery

  4. Implementation of an ongoing prevention program

  5. Confidence to return to sport as assessed through questionnaires

We know that returning to cutting sports like AFL, soccer, rugby, netball after an ACL surgery means around a 4 times greater risk of re-injury. Making sure you meet these criteria before return to sport has been shown to reduce injury rates by up to 84%.

What guiding your decision to return to sport after ACL reconstruction? We’d love to know!

Exercise for Low Back and Neck Pain


Exercise is Medicine - Low Back and Neck Pain

Exercise is not only the key to a healthy life but also leads to a comfortable life. The old saying “move it or lose it” was correct! We have previously discussed the importance of movement for general health and well being purposes HERE.

Move it, or lose it

Today we will talk about the benefits of movement for reducing the incidence of neck and back pain, which, unfortunately is becoming far too common in society today.

In 2014-15, 1 in 6 Australians reported back and neck problems which equates to approximately 3.7 million people.

1 in 6 Australians Reported back and neck problems in 2014-15.

The AIHW reports that neck and back troubles were the 3rd leading cause of disease burden in Australia in 2011 (1).


What does the research say?

As these levels are very high, there is a growing field of research to identify what we can do to prevent these issues. The recurrent stand out is exercise! Exercise has time and time again shown to be medicine for a variety of conditions (2-3).

Exercise programs have been shown to substantially reduce the risk of a new episode of neck pain (4) and the same just happens to be true for low back pain. Evidence suggests that exercise as a stand alone intervention or in combination with education is effective in the prevention of low back pain (5).

The Cherry on top

To really add the cherry on top, if this is combined with some strengthening exercise, then the risk of not only neck and back issues but all sports injuries is reduced to less than one third and the rate of overuse injuries is halved (6).

What does this mean?

Exercise is one of the best things that can be done to not only live a healthy life but also to feel good whilst doing so. All of the research suggests that it doesn’t necessarily matter what you are doing as long as you are moving. So don’t over analyse things just do what you enjoy!


In case you’re wondering how much?

  • It is advised that for adults aged 18-64 years, 150-300 minutes of moderate intensity physical activity or 75-150 minutes of vigorous physical activity, or an equivalent combination of both, per week is recommended.

  • Strengthening activities should be performed at least twice per week.

  • For adults 65+ at least 30 mins of moderate intensity exercise is advised daily(3).

Take Home Message

  • Exercise is meant to be a long term drug, consistently taking it over time leads to the greatest benefits.

  • Do what you enjoy and do it often.

  • Add some variety and gradually progress.

  • If you fall off the bandwagon don’t stress, life happens, just get back on.





  4. de Campos, T. F., Maher, C., Steffens, D., Fuller, J., & Hancock, M. (2018). Exercise programs may be effective in preventing a new episode of neck pain: a systematic review. Journal of Physiotherapy, 64(3), 159-165. DOI: 10.1016/j.jphys.2018.05.003-

  5. Steffens D, Maher CG, Pereira LSM, et al. Prevention of Low Back PainA Systematic Review and Meta-analysis. JAMA Intern Med. 2016;176(2):199–208. doi:10.1001/jamainternmed.2015.7431-

  6. Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials Br J Sports Med Published Online First: 07 October 2013. doi: 10.1136/bjsports-2013-092538-