Physio sutherland


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.

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What is an over-active pelvic floor? Women's Health Wednesday

Pelvic floor post.jpg

This week charlotte, our women's health physio in sutherland, explains AN OVER-ACTIVE PELVIC FLOOR?

Like any muscle in the body it is important that the pelvic floor can both contract and relax.

If you think of your bicep muscle this needs to be able to contract to pick something up and relax to put something down. Imagine if the bicep was contracted all day long, it would be really hard to use your arm functionally and your bicep muscle would not work efficiently. Especially when strength is needed, the pelvic floor is the same.

Some women have pelvic floor muscles which have difficulty relaxing and remain constantly contracted. This however does NOT mean they are strong, imagine how tired they would be when you need them! 



What are the symptoms of an over-active pelvic floor?

Symptoms will vary from person to person, but often include:

  • Pain with sex

  • Pain with using tampons

  • Pain with pap-smears

  • Pelvic or back pain

  • Difficulty emptying bladder or bowel (constipation)

  • Incontinence

  • Increased sensation of needing to urinate


Who is at risk of an over-active pelvic floor? 

People who tend to have a higher risk for an over-active pelvic floor include:

  • People with an overactive bladder, this is due to always needing to squeeze their pelvic floor to minimise leaking

  • Strong athletic women with strong outer core muscles

  • People with anxiety

  • Sedentary work/life style (poor posture can shorten the pelvic floor muscles)

  • Mouth/chest breathers


What is the treatment for an over-active pelvic floor?

Our initial treatment will always look at the way you breathe!

If you imagine your core and trunk muscles as a box, your pelvic floor is the base of your core with your transverse abdominus being the walls and your diaphragm muscle (breathing muscle) being the ceiling.

It is really important that all aspects of your core are working efficiently. If you are always breathing through your mouth, with a chest pattern of breathing the pelvic floor does not have a chance to relax.

Diaphragmatic breathing or “belly” breathing is essential as this allows the pelvic floor to descend and relax. 



Can I still do pilates with an over-active pelvic floor?

Yes! However more focus should be on the strength of your muscles (not including your pelvic floor initially) therefore you should not actively contract your pelvic floor during initial pilates sessions. 

As symptoms decrease, we start to add in a graded strengthening program for you pelvic floor



DID YOU KNOW THAT Physical inactivity is now identified as the fourth leading risk factor for global mortality?

That's right, the fourth leading risk factor of global deaths is NOT moving enough. Sounds bizarre I know, but as a population, we have become well adapted to the conveniences of the modern world. Whether it's commuting, working, leisure time, home time etc. It is all based around more convenience and less movement, less labour, less physical activity and less exercise.

The World Health Organisation recommends that all healthy adults aged 18–64, without a specific medical reason not to, should participate in;

  • at least 150 minutes of moderate-intensity aerobic physical activity each week or; 
  • at least 75 minutes of vigorous-intensity physical activity throughout the week or;
  • an equivalent combination of moderate- and vigorous-intensity activity, and;
  • muscle-strengthening activities which should be done involving major muscle groups on 2 or more days a week.
Adults aged 18–64 should do at least 150 minutes of moderate-intensity physical activity each week
— World Health Organisation

So while 150 minutes might sound like a lot of time across the week, it's not.

Simply, it's 30 minutes across 5-days. Throw in a couple of strength sessions and you have a recipe (with strong evidence) to:

1. Improve brain health

Physical activity has been shown to increase brain size, improve memory and decrease dementia risk. In Australia between 2006 to 2015, dementia has moved from the fourth to the second leading cause of death. 

2. Improve heart and lung health

Ischaemic heart disease,  a condition that affects the supply of blood to the heart, has remained Australia's leading cause of death over the past decade.

Exercise and physical activity improves heart and lung function and decreases your cardiovascular disease risk.

3. Improve mental health and wellbeing

In Australia in 2014-15, around one in twenty Australians reported having both an anxiety-related condition and a mood (affective) disorder, such as depression.
Physical activity and exercises has been shown to be effective in decreasing the risk of depression and helps improve mental wellbeing.

4. Improve musculoskeletal health

Physical activity and exercise helps increase bone mineral density, decreases the risk of osteoporosis and fracture and improves muscular strength and fitness.

The take home message is really just to move. Find ways in your day, things that you like and things that you will want to do to get the body moving. 

If you like pilates, do pilates.

If you're more a yogi, do yoga.

If you like the gym, get to the gym.

If you're a hiker, a rock-climber, a surfer, a sprinter, tai-chi'er or a jiu jitsu practitioner - then do that!

Just make sure you're moving your body, it thrives on it. It allows your brain to light up it's synapses, to move or stabilise joints and use its strength to lift and carry things, to accomplish a difficult task or to simply have fun.  

Over time, with some capacity building, some strength progressions, some time in the game, you will see the benefits. 

Get moving!


Did you know? Australia has launched the FIND YOUR 30 campaign that encourages Australians to find their 30 minutes of physical activity each day to lead a healthier and happier life. 



  1. World Health Organisation
  2. Australian Bureau of Statistics - Dementia
  3. Australian Bureau of Statistics - Mental and Behavioural Conditions
  4. Find your 30 

Lisfranc Injuries


What does a French surgeon and gynaecologist have to do with this week's Flow Knows?

Well you would have heard his name thrown around a fair bit since Collingwood's Daniel Wells, sustained a left Lisfranc injury that required surgery in round 12.

The Lisfranc joint refers to the joints at the base of the five metatarsals and the articulations with the tarsal bones in the foot.

Injuries can range from ligament sprains to complete tears with differing degrees of separation and displacement. 

The 2 main mechanisms of injury are a direct crush force to the midfoot, or an indirect force.

The indirect mechanisms usually occurs from a fall backward with the foot trapped, a longitudinal compression or a fall on the point of the toes. 

Clients typically present with difficulty weight-bearing, running and walking on toes after an acute mechanism or injury.

It's important to note, that while Lisfranc injuries are uncommon in the general population, they are the second most common foot injury in athletes and require a high amount of clinical suspiscion in presentations where midfoot pain lasts greater than 5 days. This is due to the disastrous consequences if left untreated. 

Treatment will depend on the severity and amount of instability present. In lower grade injuries, with no separation, conservative management with a period of non-weightbearing in a CAM boot can be recommended. For higher grade injuries with instability and separation, a surgical approach is usually favoured.




Although a lot of women are keen to get back their pre baby routine it is really important to make this return as safe as possible.  

Whether you have had a caesarian or vaginal delivery we recommend you starting your pelvic floor exercises along with light walking as soon as you feel comfortable.

6 week check with your Women's Health Physio

At 6 weeks you will have a follow up appointment with your Obstetrician or GP, after this we recommend having a 6 week check up with a Women's Health Physiotherapist who will check the integrity of your pelvic floor. This is to make sure you can get a contraction, as some women's pelvic floor can be inhibited after birth and they can struggle to contact their pelvic floor muscles. It will also involve assessing the position of your pelvic organs to make sure there is no prolapse, checking for a abdominal separation and deep core contraction. Following this we will be able to safely prescribe a postnatal exercise program for you to begin. 

What about returning to running or high intensity exercise?

Although every woman’s body recovers differently, we still recommend waiting a minimum of 12 weeks, as well as having no incontinence issues, no pain or no prolapse symptoms before participating in any outer abdominal exercises such as sit ups or any high intensity core work that increases your intra abdominal pressure. This intra abdominal pressures directly puts strain on your pelvic floor.



Running is another hight impact exercise that places strain through these muscles and we recommend before beginning to run that your have your pelvic floor assessed and pass a pelvic floor stress test.