When Professor Julie Hides graduated as a physiotherapist from the University of Queensland some 35 years ago, she had no idea her career would see her working with astronauts.

‘I went to work at the Mater Hospital straight from university and that was great because I had clinical rotations in a whole lot of different areas across the hospital.

'And I absolutely fell in love with paediatric physiotherapy and the neonatal nursery, which is quite far removed from what I do these days, but that was what I was passionate about initially,’ Julie says.

A few years later she did a course in musculoskeletal physiotherapy and then enrolled to do a master’s degree in this area, where she started the research that would set the foundation for her career.

‘We had a research component in the master’s program and I was quite interested in studying low back pain.

'I started a project using ultrasound imaging to look at back muscles.

'I realised that in addition to being able to measure muscle size, you could also use ultrasound imaging as a biofeedback tool.

'It intrigued me that it was “living anatomy” and that you could actually see muscles contracting in real time.

'It’s often quite difficult for people to learn how to control their back muscles as they can’t see them and it seemed to be a really novel and previously unused way to actually re-educate control of these muscles,’ she says.

Her master’s project completed, Julie went back to work at the Mater Hospital, but she continued her work on using ultrasound imaging to look at the lower back.

‘And then I decided I’d enrol in a PhD in that area because I was so interested in it.

'It was a clinically focused PhD, undertaken while I was working at the hospital.

'I recruited patients from the emergency department at the hospital, assessed them and gave one group an exercise program.

'All of the patients were measured at the hospital,’ Julie says.

Having that clinical support network at the hospital helped a lot, says Julie.

‘It was a very clinically oriented project and it was linked with the other departments at the hospital—radiology, the emergency department and the physiotherapy department.

'Linda Blackwell, who was the director of physiotherapy then, gave me amazing support.

'It gave me the confidence [to believe] I could actually do it.

'Having that support network for a clinically focused PhD was really important,’ she says.

Equally as important was the validation and financial support she received from the Physiotherapy Research Foundation, which awarded her a grant in support of the project.

‘It allowed the purchase of equipment I used in the hospital to image the muscles.

'But apart from that, it was instilling the belief that I could actually do this,’ Julie says.

After completing her PhD, Julie went back to clinical work at Mater and took a part-time academic position.

She has been combining research with clinical work and teaching ever since and became a Fellow of the Australian College of Physiotherapists by Original Contribution in 2005.

‘I’ve been really fortunate in my career; I have had a real mix of jobs.

'It’s always been research and clinic and teaching as well as at times undertaking leadership positions.

'I think it’s valuable to have that mix,’ says Julie.

Julie still works in the Back Stability Clinic at the Mater every couple of weeks, seeing patients.

She also teaches students in Griffith University’s Bachelor of Physiotherapy program, which she helped to establish at its Brisbane campus.

But her main focus these days is research.

Julie’s research spans three main areas: low back pain; sports injuries, including both musculoskeletal injuries and concussion; and the microgravity/prolonged bed rest studies that have led her to work with astronauts and space agencies.

Across these three research areas, she focuses on motor control training, ultrasound imaging and prediction and prevention of injuries.

Julie Hides's research spans low back pain, sports injuries and microgravity/prolonged bed rest studies. 

In her low back pain research, based at the Mater Back Stability Clinic, where she is the clinical director, she is focused on self-management and exercise approaches to chronic low back pain and predicting which patients with low back pain will have better outcomes from motor control training.

‘Self-management and exercise have good evidence for their effectiveness in low back pain and physiotherapists have used that research and that approach for a very long time.

'It’s an effective approach,’ Julie says.

Julie’s second area of research is sports-focused and grew out of the low back pain research, she says.

Cricket Australia approached her to look at why fast bowlers were more susceptible to low back pain.

‘They wanted to know if there was a modifiable factor we could target to try to help with back pain, so that led to a series of studies where we looked at cricketers and at their abdominal and back muscles to see if we could train the fast bowlers to help decrease pain,’ Julie says.

The results of those studies, which did indeed show that by changing and controlling the way they used their trunk muscles, bowlers could decrease the incidence of low back pain, led to a series of studies with the AFL investigating whether better control of the abdominal and back muscles reduced lower limb injuries.

More recently, Julie and some of her students have been investigating concussion in rugby, both league and union, and in combat sports.

The third arm of Julie’s research examines the effects of prolonged bed rest and microgravity on the musculoskeletal system.

Prolonged bed rest studies are used to simulate the effects of space flight, allowing researchers to look at different interventions to mitigate the effects on the musculoskeletal and other systems.

Initially invited to join the Berlin BedRest Study as one of the physiotherapists rehabilitating the participants, she has continued to work with the European Space Agency and on projects funded by the UK Space Agency, which have ranged from bed rest studies to developing exercise programs for astronauts spending time on the International Space Station to keep their musculoskeletal systems as healthy as possible and rehabilitate them when they return to Earth.

‘What they’re talking about in space research at the moment is long-duration missions to Mars.

'Now, the effects on the human body could potentially be drastic in long-duration missions.

'How are we going to keep our human musculoskeletal system healthy on these long-duration missions in spacecraft with fairly limited room for exercise equipment?’ Julie says.

In 2020, Julie was admitted to the Women in Space Hall of Fame’s ‘Space Doctors’.

Her research is also featured in the current Questacon exhibit Australia in Space.

Julie notes that the space studies are not just relevant to planning space missions.

There are plenty of people with Earthbound conditions who can benefit from her research findings, including patients with chronic low back pain or muscle wasting diseases, those on prolonged bed rest and patients undergoing intensive care.

More recently, this group has included Long COVID-19 patients and COVID-19 patients who have undergone prolonged ventilation as a result of severe illness.

‘Sometimes people think that space research is a bit left field, but it does directly translate to many conditions.

'The thing that makes it a really nice research paradigm is that astronauts are fit, healthy, conditioned individuals and when they go into microgravity, you can predict what’s going to happen to them,’ she says.

Julie says it has been great to be involved in these large studies, working with international teams and with people from so many disciplines.

‘It’s an amazing opportunity for a physiotherapist.

'I think physiotherapists have a lot to offer research teams.

'We think differently from other professionals and sometimes it’s the simplest things that you can propose that make a huge difference to these studies.

'We should be confident that we can make a sound contribution,’ she says.

‘Generally speaking, we’re pretty practical people.

'With your patients you’re often trying to think of a workaround if they can’t do something.

'And that can be quite useful in a research setting as well.

'A lot of physiotherapists are very good at thinking on their feet.’

It’s that practicality that has given Julie a fulfilling career in physiotherapy research.

‘I didn’t ever think I would be a researcher.

'I really wanted to work with patients and help them in the clinical environment.

'The thing about research that did interest me was that you could make a real difference to people’s lives.

'All of my research has been clinical research; I really enjoy that.

'I think it’s so important that it has translation and impact and it’s useful for people,’ she says.

>> Tune in to Julie’s episode of the APA podcast series Researchers on the Record here.

Main image: Julie uses ultrasound imaging to teach a participant in the Berlin BedRest Study to contract his abdominal muscles after 56 days of bed rest (photo supplied by Julie Hides).