Orthopaedic Physiotherapy



By  Terry Kane, Registered Physiotherapist (Calgary, Alberta) 

Founder | Owner, OrthopaedicsCanada.com Network | terrykane.ca

Even with an abnormal MRI – surgery is not the first treatment option for back pain, ligament, meniscal and disc injuries, rotator cuff and Achilles tendon tears, repetitive strain injuries and osteoarthritis.   

Given the potential complications with any form of surgery, it is always considered the last treatment option and only undertaken in emergency situations or when all non-surgical treatment options have been exhausted and unsuccessful.

Non-Surgical Treatment Protocols

A non-surgical treatment protocol is designed (1) to help facilitate the restoration of anatomy (healing) and (2) to restore physiological function through safe and appropriate exercises at each stage of tissue healing.

Every stage in a protocol consists of a combination of protection at the site of tissue damage and exercises to help restore function.  In the early stages, protection is the priority (healing), however as repair tissues mature, the need for protection diminishes and the amount of exercise increases.

Because injuries can vary in severity and involve multiple tissues (bone, cartilage, tendon, muscle, etc), there is no such thing as a single protocol that fits every patient. This is why protocols are individualized by orthopaedic physiotherapists to every patient based on the clinical presentation at each stage of tissue healing.

Stage 1: Obtaining an accurate clinical diagnosis

Stage one involves seeing a physician in-person and undergoing a thorough hands-on physical examination in order to arrive at an accurate clinical diagnosis.  

An accurate clinical diagnosis is critical to rule out serious conditions that may require urgent medical care (fractures, infections, tumors, pediatric injuries).  

Stage 2:  Early Healing & Pain Control (Protection)

Stage two consists of a period of protection at the site of injury. Reduced motion and / or load at the site of injury helps early repair tissue to form and prevents re-injury. Examples of protective devices include casts, braces, splints, crutches etc.

Stage 3: Early Exercise (Range of Motion)

Stage three consists of a period of resuming some activities of daily living and gentle range of motion exercises. The exercises are gentle to prevent joint stiffness without disrupting early repair tissue.

Stage 4: Middle Exercise (Muscle Strength)

Stage four consists of a period of safe, appropriate and progressive rehab exercises to restore full range of muscular strength and endurance without disrupting repair tissue.  

Stage 5:  Late Exercise (Neuromuscular Function)

Stage five consists of rehearsing neuromuscular motor programs specific to the patient’s work and sports activities. The goal is to be able to perform tasks with the required speed, accuracy, power in order to prevent re-injury from a premature return to work or sports.

Stage 6: Return to Work & Sport (Medical Clearance)

Stage six consists of a progressive return to work and / or sports performance (work hours, sports drills) but also seeing your physician and physiotherapist for medical clearance before returning to work full duties and / or sports.

Each Stage of a written protocol should include the following information;

  1. Goal(s) of the stage.
  2. Patient education on activities to modify or stop. (protection).
  3. Safe and appropriate exercises as indicated.
  4. Clear instructions on the load and volume of exercise (sets and reps)
  5. Clear instructions on when it is safe to progress to the next stage of rehab.
  6. A date for a follow up appointment with a physiotherapist to determine if it is safe to progress to the next stage of rehab.

Your to-do list.

  1. See a physician for a face-to-face hands-on physical examination and clinical diagnosis. 
  2. See an experienced orthopaedic physiotherapist and ask for a copy of a progressive non-surgical treatment protocol for your condition/injury.
  3. To avoid re-injury, always follow up with your physiotherapist before progressing to the next stage in your protocol.
  4. Reduce the use of pain and anti-inflammatory medications as soon as possible.  Masking pain with medications can result in delayed healing, internal bleeding, ulcers, kidney damage, high blood pressure and drug dependency.
  5. Stop smoking. Smoking delays tissue healing.
  6. Don’t return to work or sports without your physician and physiotherapist’s permission.
  7. Click here to view patient education videos to learn about your injury, condition and treatment options.


About Terry Kane

A graduate of the University of Toronto, Terry is one of Canada’s most experienced orthopaedic physiotherapists with over 35 years of clinical experience working with some of the top orthopaedic surgeons, sports medicine physicians and chronic pain specialists in Canada and the United States.

As former Canadian Olympic Hockey Team and Calgary Flames physiotherapist, Terry has diagnosed and designed evidence-based rehab programs for thousands of patients, including over 500 Olympic and professional athletes.

In addition, Terry has worked at the University of Calgary Sports Medicine Centre, the Calgary Chronic Pain Centre, provided primary care physiotherapy services for Calgary West Central Primary Care Network as well as served as an editorial peer reviewer for the Physician and SportsMedicine,  the Clinical Journal of Sports Medicine and Pain Research and Management Journal.

Terry has also served as an Injury Data Analyst for the National Hockey League’s Injury Analysis Panel and is the founder of Canada’s National Orthopaedic Network OrthopaedicsCanada.com

Outside of clinical care, Terry has written and lectured on sports-injuries, chronic pain and exercise-based rehabilitation locally for the University of Calgary Department of Continuing Medical Education and Department of Orthopaedics as well as international fitness conferences in Canada, United States, China, Australia, United Kingdom, Germany, and Thailand.