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Justin Vanderleest

Health Advisor is a regular column where contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Follow us @Globe_Health.

Most people seek physiotherapy treatment only when they're really hurt. At that point, the physiotherapist determines what risk factors might have contributed to the injury. But what if you could gaze into a crystal ball that could predict your injuries before they happen? A physiotherapy assessment may be the next best thing.

The same risk factors are seen time and again for injuries such as runner's knee, shoulder impingement and lower back injuries, among others. These injuries are common, but they are preventable. If you can identify the risk factors in advance, treatment can begin to correct them before an injury occurs.

The concept that prevention is the best medicine is not new. People undergo medical and dental check-ups routinely to maintain their health. But people have been slower to take the same approach to their orthopedic health. The term "prehabilitation" has been coined to describe the identification and treatment of orthopedic risk factors. Increasingly, it's gaining traction in sports and pre-employment screening. But anyone can benefit from this approach.

Here are the seven things physiotherapists may have on their checklist:


Postural faults are at the root of almost every injury – so this is where we start. Slouched sitting can contribute to everything from tension headaches to spinal disc herniations. In contrast, lazy standing postures place too much stress on the joints and ligaments of the back, hips, knees and feet. Every body part has an optimal posture in various different positions, from the neck to the feet. Posture correction is fundamental to injury prevention.

Movement screening

After identifying obvious postural faults, watching how a person moves during specific tests can expose key muscle weaknesses, inflexibilities and faulty movement patterns. A simple example is watching knee alignment during squatting. If the knees are too close together, it causes excessive pressure under the knee cap, leading to the most common knee condition, called patellofemoral syndrome or runner's knee. This movement could be a learned behaviour. Or it could be the result of weakness of hip stabilizers, the quadriceps or the foot muscles. Or the shape of the foot – fallen arches, or a forefoot varus, in which, unfortunately, the foot has best ground contact in the wrong knee position. Orthotics may help reposition the feet, putting the knee in a better position. Or maybe strengthening certain muscles is most important.

Muscle weakness

From the core muscles that stabilize the spine to the muscles of the feet, there are numerous key ones that are commonly weak. The physiotherapist can assess them and give strengthening exercises when necessary. The rotator cuff, for instance, is a group of four muscles that stabilize the shoulder. When they're weak, they can tear more easily. If they're not strong enough to stabilize the shoulder effectively, their tendons get impinged between two hard surfaces, which can cause a rotator cuff tear during heavy or overhead tasks.

Muscle inflexibility

Tight muscles can be more susceptible to tearing. Additionally, they can place undue stress on other structures. If your hamstrings aren't flexible enough and you bend forward, this can force your lower back to bend more. If you push ahead, you run the risk of straining a back muscle, damaging your sacroiliac joint or even herniating a disc in your lower back. When people suffer these injuries, not infrequently hamstring stretching is a major part of the rehabilitation. Posture is a factor with muscle tightness too: By correcting posture and teaching a few stretching exercises, the likelihood of many injuries can be diminished.

Joint mobility

Along with flexibility, maintaining joint mobility is fundamental for optimal function. When joints don't get a chance to move through their full range of motion on a regular basis, they tend to get tight. It's a case of use it or lose it. Sustained postures such as sitting, combined with the aging process, allow the ligamentous tissue around the back and hip joints to tighten. Corrective exercises and manual therapy, in which a physiotherapist mobilizes joints for a patient, can maintain or improve joint mobility.

Faulty movement patterns

For every action, there are better and worse ways to move. Certain movement patterns underlie the most prevalent orthopedic conditions. For a faulty movement pattern identified during the movement screen, if it isn't attributable to one of the aforementioned causes, it could be just a flawed technique. The valgus knee alignment that leads to runner's knee could be a technique adopted at random during childhood. If so, learning a new technique could be the most important component of treatment at this point. Correcting the movement pattern targets this problem at the source. Untreated, that extra wear and tear causes premature knee osteoarthritis.

Activities of daily living

If you are planning to engage in new, more strenuous work or exercise activities, this can be a good time for prehab. A person's own set of specific weaknesses, inflexibilities and movement patterns may or may not lead to injury depending on their regular activities, but harder activities amplify the negative effects of a person's impairments. If you're planning to run a marathon, your impairments may be more important than if you're a casual walker.

Justin Vanderleest is a Toronto-based physiotherapist at Athlete's Care and LiveActive Sport Medicine. He has a Master's of Clinical Science in Advanced Orthopaedics and Manipulation from the University of Western Ontario. He is a Fellow of the Canadian Academy of Manipulative Physical Therapists. An elite squash player and former national champion sprint canoeist, Vanderleest has developed special interests in training programs and injury prevention. You can follow him on Twitter @JDvanderLeest

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