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?PHOTODISC -- LOWER BACK ACHE

PHOTODISC

Nagging injury? It hurts to exercise?

There's almost always a way to stay active.

Whether or not you should stop doing the activity you love depends not just on the degree of the injury but also whom you talk to. Lots of active people these days shop around until they find a caregiver who can keep them moving. And even if it is inadvisable to do your favourite exercise, there are plenty of activities to switch to while you rehab.

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"You don't want a doctor who will just shrug and say, 'Stop doing it'," says Kevin McIntyre, a chiropractor at Burlington Sports Therapy in Burlington, Ont.

His patients want a caregiver who understands their need to keep moving. "The solution isn't to stop exercising. You need it both for your physical and psychological health. Whether I modify the exercise or the intensity, I find a way to keep them going," he says.

There are plenty of like-minded chiropractors, family physicians, sports medicine specialists and physiotherapists, he suggests. "If they have an athletic approach and are active themselves, they have a better shot at getting it."

"Most people can continue exercising in some capacity. They may need some help finding alternatives, modifications or strategies to 'work around' the injury," says Dr. McIntyre.

Dr. Reed Ferber, director of the Running Injury Clinic and an associate professor in the faculty of kinesiology at the University of Calgary, agrees nagging injuries shouldn't preclude staying active.

"Do cross training. Get on a bike, Stair master, elliptical machine. Swim, lift weights. Maintain your cardio."

Nagging injuries affect a huge number of Canadians. Among the millions of runners, for instance, research shows that, on average, 50 per cent get injured every year, says Dr. Ferber. And this number can be as high as 80 per cent if you include minor pain that people ignore.

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Here are some workarounds to keep you active despite whatever nags you. But remember, it's important to see a professional for any injury, to rule out something that might be serious and to get help modifying your activities safely.

KNEE INJURIES

"Pain in your knee has little to do with your knee," says Dr. Ferber. "It just means your knee is the weakest link in your chain." For some people, the Achilles tendon is their weakness; for most, it is the knee.

"If you have nagging knee pain, it is probably coming from the hip down or the foot up," he says. "Eighty per cent of the time, lack of hip strength is the cause of knee pain." He suggests cross training with other exercises, as well as rehabbing your knees by doing hip-strengthening exercises.

For knee injuries, suggests Dr. McIntyre, try an elliptical machine rather than a treadmill or outdoor walking or running. "Elliptical machines do not involve as much joint compression when compared to running on a treadmill. Compressive forces are aggravating for people with pain from osteoarthritis in the weight-bearing joints (knees, hips and ankles).

Warning: Elliptical machines often require a wide stance, which can aggravate injury in those with patello-femoral syndrome, where the knee-cap is misaligned during movement. "This is a good example of how diagnosis and tailoring an individual plan with the help of a professional is important," says Dr. McIntyre.

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LOWER BACK PAIN

In the past, people with lower back pain were sent by their doctors to bed for rest, but staying active is today's antidote. Studies have found that brisk walking while swinging the arms is a wise choice to rehabilitate the back and stay active, suggests Dr. McIntyre. It helps to keep the muscles and joints of the spine mobile while dissipating compressive forces. To strengthen the core (stomach) area, Dr. McIntyre usually prescribes some form of plank exercise rather than sit-ups, as this avoids movement of the lower back. (Go to www.burlingtonsportstherapy.com to find his blogs.) CHK

NECK INJURIES

In the 1980s, people were prescribed neck collars after a neck injury, says Dr. McIntyre, but nowadays, depending on the injury, it can be safe to stay active. "We stopped using those because they prolong recovery. A little hurt is okay if it doesn't do harm and helps to keep them moving."

TENNIS ELBOW

Dr. McIntyre uses Active Release Techniques and the newer Graston Technique to speed up recovery from tennis elbow and golfer's elbow. These are both deep muscle massage techniques that are used to treat soft tissue damage. In the meantime, you may need to "unload the area," by lightening up on your racquet grip or reducing the amount of typing you do, to reduce the strain on these muscles. Cross training with other activities may be necessary to rest the elbow.

SHOULDER PAIN

Shoulder pain is very common among people who lift weights. Dr. McIntyre suggests using dumbbells instead of barbells, a lighter weight than usual, a shorter range of motion (avoiding bringing the bar down to the chest) and not bringing the arms too far away from the torso. Keeping the elbows closer to the body is easier on the shoulder during pressing exercises, he says

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