Journal
Recovery, explained by North Shore physiotherapists.
Clinical notes written by the physiotherapists, RMTs, and osteopaths at our North Vancouver clinic. Not listicles or AI summaries — actual reasoning from the people who treat sport injuries, ICBC crash patients, and workplace rehab cases every week.
We cover rehab frameworks (why PEACE & LOVE replaced RICE, what criteria-based return to sport actually measures), treatment modalities (high-power laser, IMS), and the decisions patients face when choosing care in BC — physiotherapy vs chiropractic, physio vs RMT, physio vs manual osteopathy. Every post is written at a reading level that respects the patient's intelligence and cites the clinical literature it draws from.
ShoulderFrozen Shoulder and Diabetes: Why the Link Exists and What It Means for Recovery
Frozen shoulder is several times more common in people with diabetes, and it can be slower to settle. Here is why the link exists and what it changes about the plan.
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PainPiriformis Syndrome or True Sciatica? Why the Label Is Debated and What It Changes
Buttock pain that shoots down the leg gets called piriformis syndrome or sciatica, sometimes both. Here is how they differ, why the piriformis label is argued over, and why the treatment often overlaps anyway.
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WristSnowboarding and Broken Wrists: Why Beginners Are at Risk and What Wrist Guards Do
A fall on an outstretched hand is the classic snowboard injury, and the first season is the riskiest. Here is why beginners break wrists, what wrist guards actually do, and how rehab goes after a distal radius fracture.
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WristWrist Pain in Yoga: Why Planks and Down Dog Hurt, and How to Load Back In
Planks, down dog, and arm balances put your body weight through a wrist bent back near 90 degrees. Here is why it gets sore and how to build tolerance instead of just avoiding it.
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PainNight Shift and a Sore Back: Why It Happens and a Plan That Fits the Schedule
Nurses, security staff, and warehouse workers on nights often carry more back and neck pain than they expect. Poor sleep and long held postures both feed it, and the fix works around the shift rather than against it.
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PainGraded Exposure for Persistent Pain: Meeting Feared Movements a Little at a Time
When pain sticks around, the movements you fear most often become the ones you avoid most. Graded exposure is the careful way back to them, and it can lower both fear and pain.
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RecoveryBlood Flow Restriction Training: Building Strength at Low Loads After Injury
After surgery or a bad injury, you often cannot lift heavy yet. Blood flow restriction training is a way to build strength with light weights, and here is how it works and who it suits.
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RecoveryPre-Season Conditioning: How to Build Up Without Getting Hurt
Most fall-sport injuries do not come from bad luck. They come from doing too much too soon after an off-season of doing too little. Here is how to build up the safer way.
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ShoulderBack on the Ice: Returning to Hockey After a Shoulder Injury
A shoulder dislocation on the ice does not just heal on a calendar. Here is how staged criteria, not the date on your phone, decide when you are ready for contact again.
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RunningRunning Cadence and Injury: What Step Rate Really Does, and the 180 Myth
You have probably heard you should run at 180 steps per minute. That number is mostly a myth, but a small change in your cadence can still lower the load on sore knees and shins.
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RecoveryDeadlifts and Your Back: Why Load Matters More Than a Perfectly Straight Spine
The fear that a slightly rounded back while deadlifting will wreck your spine is deeper than the evidence supports. The bigger factor is how you manage load.
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ConditionsNeck Pain and Sleep: Does Your Pillow and Sleep Position Really Matter?
People spend a lot of money chasing the perfect pillow for a sore neck. The evidence is thinner than the marketing suggests. Here is what actually helps.
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PainAcute Low Back Pain: What to Do in the First 72 Hours of a Flare
A sudden back flare feels alarming, and the instinct is to lie down and wait it out. That is usually the wrong move. Here is what to do in the first three days.
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AnkleChronic Ankle Instability: Why Your Ankle Keeps Giving Way and What Finally Stops It
Once an ankle has sprained a few times it can start giving way on flat ground for no reason. The fix is usually not more rest. It is retraining balance and control.
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HipLateral Hip Pain: Is It Bursitis or Gluteal Tendinopathy? Why the Tendon Is Usually the Real Story
Pain on the outer hip gets labelled bursitis, but scans keep showing the tendon is the problem, not the sac. That changes how you should treat it.
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KneeDegenerative Meniscus Change or a Traumatic Tear? Why the Type Decides the Plan
Two knees, two different meniscus problems. One is gradual wear that responds to exercise. The other is a sudden injury that sometimes needs surgery. The type decides the plan.
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HeadacheTension-Type Headache or Migraine? How to Tell Them Apart
A pressing band around the head and a pounding one-sided headache with nausea are usually two different problems. Knowing which you have changes what actually helps.
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PregnancyDiastasis Recti After Birth: Why the Gap Number Matters Less Than Function
The gap between your tummy muscles after birth is common and often improves on its own. What matters more than the number of finger-widths is how well your core actually works.
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PregnancyPelvic Girdle Pain in Pregnancy: What Helps and What Is Safe
Pain at the front or back of the pelvis in pregnancy is common and not something you have to just put up with. Movement, support, and small daily changes usually help.
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YouthOsgood-Schlatter: Knee Pain Below the Kneecap in Growing Teens
A sore bump below the kneecap in an active teenager is usually Osgood-Schlatter. It is common, it settles with growth, and the aim is to keep sport going, not stop it.
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YouthHeel Pain in Active Kids: What Sever's Disease Is and Why It Settles
Your active child limps after sport and complains their heel hurts. It is often Sever's disease, and the reassuring part is that it settles as they grow.
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WristCarpal Tunnel Syndrome: What Helps Before You Think About Surgery
Waking with numb, tingling fingers is the classic sign of carpal tunnel syndrome. For many people the first steps are simple, and surgery is not the starting point.
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WristThat Pop in Your Finger: Climbing Pulley Injuries and How They Heal
You crimped hard, felt a pop in your finger, and now it is swollen. Here is what a climbing pulley injury is, how the grades differ, and how it actually heals.
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AnkleSprained Ankle: When You Actually Need an X-ray (The Ottawa Ankle Rules)
You rolled your ankle and it hurts. Do you need an X-ray? A well-tested set of rules can tell you when a fracture is possible and when imaging can wait.
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HeadacheHeadaches After a Car Crash: Why Your Neck Might Be the Cause
A headache that starts after a car crash often comes from the neck, not the head. Here is why whiplash causes it, and why moving early tends to help more than resting.
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RunningStress Fracture or Shin Splints? How Runners Can Tell the Difference
Shin splints and a stress fracture can start the same way, but one needs a very different plan. Here is how to tell them apart and the warning signs that mean get it checked.
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ConditionsTennis Elbow vs Golfer's Elbow: Same Idea, Opposite Sides of the Elbow
Tennis elbow and golfer's elbow sound like different injuries. They are the same tendon problem on opposite sides of the elbow, and the fix follows the same logic.
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AnkleHigh Ankle Sprain (Syndesmosis): Why It Heals Slower Than a Normal Ankle Sprain
A high ankle sprain feels like a normal rolled ankle at first, then takes far longer to settle. Here is why the syndesmosis heals slower and what safe return to sport looks like.
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HipHip Labral Tears: What They Are, When Conservative Care Works, and What Gets Confused With Them
A torn hip labrum sounds like it must be fixed with surgery. For many people it is not. Here is what the labrum does, when conservative care works, and what gets confused with it.
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KneeRunner's Knee (Patellofemoral Pain): What It Is and What Actually Settles It
Runner's knee is a vague ache around or behind the kneecap that flares with running, stairs, and long sits. Here is how it differs from other running knee pain, and what actually helps.
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ConditionsBendy Joints and Aches: How Strengthening Helps Joint Hypermobility
Being unusually flexible is not a problem in itself, but when bendy joints bring aches, fatigue, and a feeling of instability, strength and control are what settle them.
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ShoulderShoulder Bursitis or Rotator Cuff Tendinopathy? Why the Label Matters Less Than You Think
Two labels get thrown around for the same painful shoulder: bursitis and rotator cuff tendinopathy. They overlap more than they differ, and the treatment that works is much the same.
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Self-CareShovelling Snow Without Hurting Your Back on the North Shore
A heavy North Shore snowfall sends people out with a shovel and, often, into a sore back. A few changes to how you shovel take most of the strain off your spine.
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ConditionsThe Stiff Mid-Back: Why Thoracic Mobility Affects Your Neck and Shoulders
The mid-back rarely hurts on its own, but when it stiffens up, the neck and shoulders often pay for it. Here is how thoracic mobility fits into neck and shoulder pain and where it helps.
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ConditionsStiff Ankles and Shallow Squats: When Limited Dorsiflexion Holds You Back
Heels that lift and a squat that will not go deep often trace back to the ankle, not the hips. Here is how limited dorsiflexion changes movement and how we sort out why it is restricted.
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ConditionsTeen Neck Pain and Screens: What 'Text Neck' Is and What Actually Helps
Teenage neck pain linked to phones and tablets is real, but the fix is not sitting up straighter for eight hours. It is movement, breaks, and building tolerance to the load.
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ConditionsIT Band Syndrome: Why the Outside of Your Knee Hurts When You Run or Ride
Outer-knee pain that arrives at the same point in every run or ride is the classic pattern of IT band syndrome. The fix is rarely more stretching. It is load management and hip strength.
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Patient EducationHow Long Does Physiotherapy Take? A Realistic Timeline Guide
The most common question patients ask before they book. The honest answer is: it depends — but on very specific things, and we can usually narrow it down at the first assessment.
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TendinopathyHigh Hamstring Pain: The Sitting-and-Running Ache of Proximal Hamstring Tendinopathy
Deep pain right at the sit-bone, worse when you sit and when you run uphill, is the signature of proximal hamstring tendinopathy. And stretching it, the obvious instinct, usually backfires.
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ShoulderFrozen Shoulder or Rotator Cuff? Why Telling Them Apart Changes Everything
Two of the most common shoulder problems can feel similar but need opposite approaches. One clue, whether someone else can move your shoulder, tells them apart.
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RecoveryPhysiotherapy After Lions Gate Hospital Discharge: What to Expect
Most patients leave Lions Gate Hospital with a discharge sheet, a surgeon referral, and a lot of unanswered questions about the rehab ahead. Here is what to expect.
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ConditionsBone Stress Injuries in Runners: Catching a Stress Fracture Before It Stops You
A bone stress injury is the running injury you cannot push through. Catching it early, by its specific warning signs, is the difference between weeks off and months.
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Patient EducationHow to Choose a Physiotherapist in North Vancouver
There are over 30 physiotherapy clinics on the North Shore. Here is what actually matters when you are choosing one.
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Self-CareDesk Ergonomics for Neck and Back Pain: What Actually Matters
Ergonomics advice is everywhere, much of it overstated. Here is what actually reduces desk-related neck and back pain, and the one principle that beats any perfect setup.
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Return to SportHiking Injuries on the North Shore: A Trail-by-Trail Recovery Guide
Every North Shore trail makes specific demands on specific tissues. Understanding which injury comes from which trail pattern helps you recover faster and prevent the next one.
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TendinopathyGolfer's Elbow: The Inner-Elbow Tendinopathy That Loading Fixes
Golfer's elbow is the inner-elbow cousin of tennis elbow, and the fix is the same principle: load the tendon progressively. Rest and braces alone rarely do it.
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Return to SportGrouse Grind Injuries: What Goes Wrong and How to Recover
The Grouse Grind is 2.9 km of relentless climbing. Most injuries happen on the way back down — and they're very predictable once you understand why.
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Vestibular RehabilitationWhen Dizziness Isn't BPPV: The Causes a Good Assessment Rules Out
BPPV is the most treatable cause of vertigo, but dizziness has many sources. A good vestibular assessment is as much about ruling out the others as confirming BPPV.
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Return to SportMCL Sprains: What the Grade Means and How Long Recovery Really Takes
The MCL is the ligament that heals. Most MCL sprains recover well without surgery, and knowing the grade tells you roughly how long the road will be.
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HeadachesTension Headache or Neck Headache? Why the Difference Changes the Treatment
Not all headaches are the same, and two common types can feel alike. Telling a tension headache from a neck-driven one changes what actually helps.
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Return to SportPickleball Injuries on the North Shore: The New Sport's Most Common Aches
Pickleball is the fastest-growing sport on the North Shore, and it is filling our clinic. The injuries are predictable, and so is the way to avoid most of them.
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ConditionsMeniscus Tears After 40: Why Rehab Often Beats the Scope
A meniscus tear on an MRI sounds like a surgical problem. For the common age-related tear in midlife, structured rehab often works just as well as the scope.
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Healthy AgingOsteoporosis and Strength Training: Why the Right Loading Builds Bone
An osteoporosis diagnosis often leads people to do less, fearing a fracture. Done right, progressive strength training is one of the best things you can do for your bones.
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ConditionsSwimmer's Shoulder: Why Open-Water Season Brings Shoulder Pain, and What Fixes It
Swimmer's shoulder is the overuse injury of the open-water season. It is rarely about one bad stroke and almost always about volume, capacity, and technique together.
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ConditionsTrigger Finger: Why Your Finger Catches, and What to Try Before an Injection
A finger that catches, clicks, or locks when you bend it is trigger finger. Caught early, it often responds to splinting and load changes before any injection.
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ConcussionYouth Sport Concussion: A North Shore Parent's Guide to the First Two Weeks
When your child gets a concussion in sport, the old advice was a dark room and total rest. That has changed. Here is what the current guidance says to do.
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ConditionsMorning Heel Pain: What Plantar Fasciitis Is and What Actually Helps
That stabbing heel pain in your first steps of the day is the signature of plantar fasciitis. The fixes that actually work are not the ones most people try first.
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ConditionsGetting Back to Lifting After Low Back Pain: Why Loading Is the Cure, Not the Risk
After a back injury, the instinct is to stop lifting forever. That fear keeps backs weak. The spine is built to load, and getting back to lifting is part of the recovery.
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ConditionsPain on the Side of Your Hip? It's Probably Not Just Bursitis
Pain on the outer hip is often labelled bursitis and treated with rest or an injection. The bigger driver is usually a gluteal tendon problem, and that changes the fix.
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Self-CareHeat or Ice? A Straight Answer to the Most Common Injury Question
Heat or ice is the question everyone asks. The honest answer is that both are comfort tools, not cures, and knowing when each helps is simpler than the internet makes it.
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ConditionsHip Impingement (FAI): When to Manage It and When to Consider Surgery
Deep groin pain when you squat or sit for too long may be hip impingement. Many people improve with a structured physiotherapy program before surgery ever enters the picture.
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ConditionsDe Quervain's Tenosynovitis: The New-Parent Thumb Pain Nobody Warns You About
A sharp pain on the thumb side of the wrist when you lift your baby has a name, and a reason. De Quervain's tenosynovitis is common, treatable, and not your fault.
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ConditionsDizziness After Whiplash: When the Problem Is Your Neck, Not Your Inner Ear
Dizziness after a car crash unsettles people. Often it is the neck driving it, not the inner ear, and that changes how it is treated.
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ConditionsCycling Knee Pain: When It's the Bike Fit and When It's You
Cycling knee pain has a location language. Where it hurts often points to what's wrong, and the fix is usually a mix of the bike fit and your own capacity.
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Return to SportACL Prehab: Why the Weeks Before Surgery Shape Your Recovery
The weeks before ACL surgery are not just waiting time. Restoring the knee's movement and strength first measurably improves how you recover afterward.
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ConditionsShin Splints: Why Load Management Beats Stretching and New Shoes
Shin splints are a training-load problem, not a shoe problem or a stretching problem. Manage the load correctly and they settle, and you avoid the more serious injury they can hide.
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ConditionsWrist Sprain or Scaphoid Fracture? Why a Sore Wrist After a Fall Deserves a Second Look
Most sore wrists after a fall are sprains. But one small bone, the scaphoid, can fracture and barely show on an early X-ray. Missing it is a problem worth avoiding.
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ConditionsSciatica: When It's a Disc, When It's Referred, and Why It Matters
Sciatica is one of the most misused words in back pain. Telling true nerve-root pain from referred pain changes what helps, and most leg pain settles without surgery.
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Return to SportCalf Strains: How to Get Back to Running Without Re-Tearing
The calf strain is the runner's mid-life injury. It heals quickly enough to fool you, then re-tears the moment you trust it. Here is how to come back properly.
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ShoulderFirst-Time Shoulder Dislocation: Rehab, Surgery, and the Re-Injury Question
A first shoulder dislocation raises one urgent question: will it happen again? The answer depends heavily on your age and your sport, and it shapes the whole plan.
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Return to SportGroin Strains in Hockey and Soccer: Why the Copenhagen Exercise Matters
Groin strains are notorious for coming back. The reason is usually under-loaded adductors, and one exercise has become central to fixing that.
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TendinopathyAchilles Tendinopathy: Why Loading Beats Rest for a Sore Heel Cord
A sore, stiff Achilles in the morning is one of the most common running injuries on the North Shore. The fix is rarely rest. It is loading the tendon in the right way.
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For ClientsPaying for Physiotherapy in BC: Benefits, Direct Billing, and MSP
Most people leave physiotherapy coverage on the table because the rules are confusing. Here is how the funding actually works in BC, and how to use it.
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ConditionsSki Knee Injuries: When an MCL Rehabs and an ACL Needs an Opinion
A twisted knee on the local mountains usually means one of two ligaments. One almost always rehabs without surgery. The other deserves a surgical opinion early.
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ConditionsKnee Osteoarthritis: Why Strength Work Comes Before the Surgeon
A worn knee on an X-ray does not have to mean a joint replacement is next. For knee osteoarthritis, the first-line treatment is strength work, not surgery.
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ConditionsHeadaches From Your Neck: When a Desk Job Is the Cause
Some headaches start in the neck, not the head. For desk workers, that distinction changes what actually treats them.
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ConditionsWhiplash Recovery: Why Moving Your Neck Beats Resting It
After a rear-end crash, the instinct is to rest the neck and reach for a collar. The evidence points the other way, and the gap matters for long-term recovery.
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ConditionsTennis Elbow: Why a Cortisone Shot Can Cost You Later
A cortisone shot can settle tennis elbow for a few weeks. The trade-off shows up a year later, and the evidence on it is hard to ignore.
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ConditionsRotator Cuff Shoulder Pain: Why Exercise Usually Comes Before Surgery
Most rotator cuff shoulder pain responds to a structured loading program. Surgery has a narrower role than people expect, and the evidence is clear on where it sits.
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Jaw & TMJTMJ Physiotherapy: How Physio Helps Jaw Pain
Jaw pain, clicking, and limited opening are common, and most cases are not a dental problem. Manual therapy and jaw exercise are an evidence-based first-line option for temporomandibular disorders, and the neck is involved more often than people expect.
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Ankle and FootAnkle Sprain Rehab Beyond RICE: Balance Retraining and Why Reinjury Is the Real Risk
Most ankle sprains get a tensor bandage, a few days of rest, and a return to activity once the swelling settles. The reinjury rate tells us that pathway is leaving most patients functionally underprepared. Here is what we add.
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Pelvic Health and Return to SportPostpartum Return to Running: The 12-Week Readiness Screen and Why It Matters
The 6-week obstetric clearance confirms the uterus has involuted and the wound has healed. It does not confirm the pelvic floor and trunk are ready to absorb running ground reaction forces. Here is the screen that does.
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Return to SportHamstring Strains in BC Soccer and Rugby: Nordic Curls, the L-Protocol, and What the Evidence Supports
Hamstring strains are the most common time-loss injury in soccer and rugby. They also have one of the highest reinjury rates. The Askling L-protocol and Nordic hamstring program change both numbers — but only when the dose is right.
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ShoulderFrozen Shoulder Stages: Why the Right Treatment Changes Each Phase
Frozen shoulder is one of the few conditions where treating it aggressively early makes it worse. Knowing which phase you are in determines whether you should be stretching, moving, or waiting for irritability to settle.
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Custom OrthoticsCustom Orthotics vs. Off-the-Shelf Inserts: When the Extra Cost Is Worth It
Custom orthotics are not always better than the $40 insole at the drugstore. They are different tools for different problems. Here is how we decide which one is right for you at our North Vancouver clinic.
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Vestibular RehabilitationVestibular Rehab for BPPV: When the Epley Maneuver Solves It in a Single Visit
BPPV is the most common cause of vertigo. It is also the most treatable. A correctly performed positional maneuver resolves it in a single visit for most patients — but only after the involved canal is identified.
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TendinopathyPatellar Tendinopathy (Jumper's Knee): Why Heavy Slow Resistance Beats Stretching and Rest
Patellar tendinopathy does not respond to rest. It responds to heavy, slow, controlled loading. Here is the evidence behind it, what the protocol looks like, and the mistakes that send people back to square one.
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Return to SportRunning Gait Analysis for North Shore Trail Runners: What It Catches and What It Misses
A gait analysis is most useful for the runner who keeps getting injured in the same spot. Here is what a clinical analysis at Medstar looks for, what the evidence supports changing, and the trail-specific patterns we see most on the North Shore.
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Return to SportConcussion Return-to-Play: The Six-Step Protocol and What Each Step Means
The current concussion return-to-play framework is six graded steps with a medical clearance in the middle. Here is how each step looks in practice for a North Shore athlete — and the steps people most often skip.
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Treatment ModalitiesTECAR Therapy for Tendinopathy: What the Modality Actually Does
TECAR is one of the newer adjunct modalities in tendinopathy care. The mechanism is real, the evidence is early, and the role is supportive — never a replacement for the loading work.
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Coverage & PaperworkWorkSafeBC Physiotherapy: How a Claim Actually Moves Through Treatment
WorkSafeBC physiotherapy moves on a tighter reporting cadence than ICBC or private extended health. Here is what your physiotherapist is actually filing, how the phase system works, and what tends to get a claim into trouble.
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Choosing CareIMS Dry Needling vs. Acupuncture in BC: Different Tools, Different Scopes
IMS dry needling and acupuncture both use a thin filament needle. Everything else — training, regulator, scope, and clinical reasoning — is different. Here is how to pick the right one for your symptom.
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Treatment ModalitiesShockwave Therapy for Plantar Fasciitis: When It Helps and When It Doesn't
Shockwave is one of the better-supported modalities for stubborn plantar fasciitis, but it is not a first-line treatment and it is not a fix for everyone. Here is when we use it at Medstar, and the cases where we don't.
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Choosing CareWhen MRI Is Actually Needed for Low Back Pain — and When It Isn't
Most low back pain does not need imaging in the first six weeks. The cases that do are defined by red flags, not by pain intensity. Here is how the decision is made — and what a positive MRI does and doesn't mean.
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Return to SportCriteria-Based Return to Sport: Why the Calendar Is Not Your Coach
Two athletes with the same injury can be in completely different places at six weeks. Here is how sport physiotherapy makes the return-to-play decision — and why the calendar is the wrong tool for the job.
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Rehab FrameworksPEACE & LOVE: Why Sport Physiotherapy Replaced the RICE Protocol
Rest, Ice, Compression, Elevation was the standard for decades. Current sports-medicine consensus has moved on. Here's what replaced it — and why the change matters for your recovery.
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Choosing CarePhysiotherapy vs. Manual Osteopathy in BC: What's the Difference?
Manual osteopathy is not a regulated profession in British Columbia. Understanding that difference — and what manual osteopathic practitioners actually do — is how you make an informed choice.
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Choosing CarePhysiotherapy vs. RMT: Which One Is Right for Your Injury?
Both are regulated in BC. The difference is in scope, not quality — and knowing which to book first can save you a month of the wrong treatment.
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Choosing CarePhysiotherapy vs. Chiropractic: When to Choose Which in BC
Both are regulated in BC. Both treat musculoskeletal pain. The difference is in how each profession approaches the problem — and that difference matters for specific presentations.
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Coverage & PaperworkICBC Pre-Approved Physiotherapy: Your First 12 Weeks After a BC Car Accident
Under ICBC Enhanced Care, you do not need a referral or ICBC approval to start physiotherapy in the first 12 weeks after a BC car accident. Here is how the coverage actually works, what to bring, and what to expect at Medstar in North Vancouver.
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Choosing CareSport Physiotherapy vs. General Physiotherapy: When the Difference Matters
Every sport physiotherapist is a physiotherapist. Not every physiotherapist is a sport physiotherapist. Here is when the difference matters for your recovery — and when it doesn't.
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Treatment ModalitiesHigh-Power Laser Therapy (HPLT / High-Intensity Laser): What It Treats and What to Expect
Plain-English notes on what high-power (Class 4) laser therapy is, where the evidence supports it, where it doesn't, and how we use it alongside hands-on care and active rehab at Medstar.
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