Carol, 44, had a nag–ging problem with her right knee. It was not enough to keep her from running and playing tennis — if she took painkillers and applied ice — but the problem was always there.

As Carol found out when she finally sought help, there are many options available for those who have nagging joint injuries — from sports medicine clinics to fitness centres with a rehabilitation focus. The trend these days is not toward just fixing the local problem but also training people to exercise properly and in a way that prevents recurrence.

Health-care professionals such as kinesiologists and physical therapy experts are increasingly focussing on the prevention of injuries.

“One premise is prevention and the other is preparation for any activity or sport,” says Ken Phu, a biomechanics expert at Core Strength personal training and wellness centre in Toronto. He and colleagues design programs for individuals based on their particular strengths, weaknesses and goals — whether the goal is to lose 10 pounds or run a marathon.

John McCordic, owner of the North Shore Orthopaedic & Sports Clinic in North Vancouver, also believes that rehabilitation of joint problems is inseparable from the idea of preventing further injury. McCordic oversees a multidisciplinary staff that includes physiotherapists, massage therapists, personal trainers and yoga and Pilates instructors, all working toward educating clients about their own bodies and how to prevent problems.

“Today, physiotherapists view the concept of rehabilitation and prevention as an interactive program of care,” McCordic says, “carried out by a team of practitioners who employ both traditional and nontraditional approaches.”

The trend in treatment, he says, emphasizes both “hands on” and “hands off” streams. Hands-on treatment by a physiotherapist might include assessing the injury and then focusing on optimizing conditions under which the body can begin healing. Joint problems — especially overuse injuries — can have more than one cause, McCordic says, so assessments must be detailed. His team uses high-tech laser systems, sonic systems and hyperbaric chambers to achieve healing.

McCordic uses a technology called “dynamic pressure analysis” to measure the pressure distribution along the bottom of a person’s foot while he or she walks. The digital report may indicate a need for orthotics to reduce pressure points and improve balance and function in the joints.

Hands-off treatment at the clinic includes conditioning and training that is customized to the clients, given their previous injuries and the activities they prefer.

Carol asked around and a friend told her about Phu’s Core Strength clinic.

Phu is one of about 20 biomechanics specialists in Canada who have been trained in a new form of therapy called muscle activation techniques, or MAT. MAT was developed by Greg Roskopf, an exercise physiologist and former biomechanics consultant to the Denver Broncos football team and basketball’s Utah Jazz.

When Carol arrived, Phu took a detailed history of her previous injuries — there were quite a few of them — and did some manual testing to check for muscle symmetry between the left and right sides of her body.

“There are many layers to injuries,” Phu says. “It’s like peeling an onion.”

Within an hour, he had determined that the source of Carol’s problem was a right ankle injury that had occurred two years ago. When a person sprains an ankle, he explains, he or she tends to hobble on the strong leg, and when the injury is better, the strong leg still takes more of the pressure. Because the person is no longer in pain, he or she returns to regular activities without dealing with the imbalance.

“We assume everything’s 100% and take on any activity,” Phu says. “We can be overloading or stressing our bodies and getting injured.”

If an activity is supposed to involve 10 muscles and five are taking a break, the other five compensate, he says, which leads to more pain.

The pain in Carol’s knee was a symptom but not the cause of her injury. The real problem, Phu says, was muscular inhibition on the left side, which was causing instability and decreased range of motion. Once Phu figured this out, he palpated the affected muscles on Carol’s left side to loosen them up, retested her range of motion, palpated again, retested and then developed a series of exercises for Carol to do at home and at the clinic to bring her body back into alignment.

@page_break@The body is a complex piece of machinery, Phu says. It needs to be balanced, like a car: “If a tire is deflated, the rest of the car eventually goes out of whack.” IE