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.
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ
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.
READ