Winter Slips in Metro Vancouver: Wrist and Shoulder Injuries

Metro Vancouver rarely gets the kind of winter that keeps people indoors. It gets something more awkward: a few days each year when the temperature sits within a degree or two of freezing, rain falls on pavement that is already wet, and a thin film of ice forms on surfaces that looked fine an hour earlier.

That surface puts people down. It shows up on the transit stairs at Lougheed, on the sloped driveways in Coquitlam, on the painted crosswalk lines and metal drain covers that freeze before the asphalt around them does. Most people who fall on it were walking normally, in shoes that work fine for eleven months of the year.

What happens next is a reflex. The hand goes out to catch the body. It keeps the head off the ground, which is the trade worth making, and it sends the entire force of the fall up one arm.

Why the local pattern is ice, not snow

Deep snow is forgiving in two ways. Boots compress into it and get grip, and a fall lands on something soft. A thin glaze of ice over wet asphalt gives neither. The foot slides with no warning, the body is already past the point of recovery before the brain registers what happened, and the landing surface is concrete.

Freezing rain coats surfaces evenly and is close to transparent over dark pavement. It forms fastest where heat is lost quickly: metal grates, bridge decks, stair nosings, and the steel edge of a parkade ramp. A driveway can be clear at the top and glazed at the bottom where cold air pools.

Three local details make the pattern worse:

Rain before the freeze. A dry cold snap is safer than a wet one. Metro Vancouver almost always gets the wet version, so the water is already on the ground when the temperature drops.

Short duration. Ice that lasts one morning does not prompt anyone to change their shoes, salt their walkway, or slow down. A week of snow does.

Sloped ground. Much of Burnaby, Coquitlam, and New Westminster is built on grades. A slope that is nothing in October becomes the thing that turns a slip into a fall.

The three injuries that dominate an outstretched-hand fall

The mechanism clinicians call a fall onto an outstretched hand produces a predictable set of injuries, and the pattern shifts with age and bone quality.

The wrist. The distal radius is the bone at the thumb side of the forearm, just above the wrist joint, and it is the most commonly broken bone in this mechanism. In a 2025 hospital-based series published in Cureus, a fall onto an outstretched hand was the mechanism in 60.3% of distal radius fractures. That same series describes a bimodal age pattern, with peaks at 30 to 40 years and 65 to 75 years, and a median age of 63 for women against 39 for men. Younger patients tend to arrive from higher-energy events, while the older group is falling from standing height onto weaker bone. We cover the rehabilitation side of that injury in detail in distal radius wrist fracture rehab.

The shoulder. The acromioclavicular joint sits where the collarbone meets the tip of the shoulder blade, and you can feel it as the small bump on top of the shoulder. According to the StatPearls chapter on acromioclavicular joint injury, the most common mechanism is direct trauma to the outer shoulder with the arm at the side, and falling onto an outstretched hand or elbow can also separate the joint. Grades I and II are managed without surgery using a sling, pain relief, ice, and physiotherapy. The rotator cuff also takes load in this fall, especially in people over 50, and a shoulder that stays painful and weak past the first few weeks needs reassessment.

The tailbone and hip. A backward slip lands on the buttocks. The coccyx takes the impact directly, and a 2020 review in the Journal of Clinical Orthopaedics and Trauma by Garg and Ahuja reports a history of direct trauma in 50 to 65% of people with coccydynia, meaning persistent tailbone pain. The same review notes that conservative therapy succeeds in about 90% of cases, starting with ergonomic changes and pain relief before anything else is considered. In older adults with reduced bone density, the same backward or sideways landing can fracture the hip, which is a hospital problem rather than a clinic one.

What to do in the first 72 hours

The first three days are about protecting the tissue, keeping swelling down, and deciding whether you need an X-ray.

Stop and look before you get up. Most people scramble upright out of embarrassment. Sit for a moment and check whether you can move the joint, whether there is an obvious deformity, and whether weight-bearing is possible.

Protect and offload. A sling for a sore shoulder, a splint or a supportive wrap for a wrist, a cushion with a cut-out section for a bruised tailbone. The aim is to reduce the load on painful tissue for the first few days.

Ice and elevation for swelling. Fifteen minutes at a time, with a cloth between the ice and the skin, and the hand above heart height where practical. Swelling in the hand and fingers makes everything stiffer to move later.

Keep gentle movement where it does not hurt. Fingers, elbow, and shoulder should keep moving even when the wrist is protected. Joints above and below an injury stiffen fast, and that stiffness is often harder to undo than the injury itself.

Do not test it. Repeatedly checking whether it still hurts by loading it is the most common self-inflicted setback in the first week.

If you are managing pain medication, ask a pharmacist or physician rather than guessing, especially if you take blood thinners or have kidney or stomach conditions.

How to tell a bruise from something that needs imaging

Plenty of winter falls produce a spectacular bruise and nothing more. Some signs point toward a fracture or a more serious soft-tissue injury, and those need assessment at an urgent care centre or emergency department rather than a wait-and-see week.

Go and get it looked at the same day if you have any of these:

• Visible deformity, an angle in the forearm that was not there before, or a wrist that looks like a dinner fork from the side
• Inability to use the hand or arm at all, or inability to bear weight through a leg after the fall
• Numbness, pins and needles, a cold or pale hand, or fingers you cannot move
• Pain directly over the bone, rather than over the muscle, that stays severe past the first hour
• Swelling that builds fast and hard in the first 30 to 60 minutes

Older adults need a lower threshold for imaging. Bone quality changes with age, a fall from standing height is enough to break a wrist or a hip, and a fracture can be present with less pain than you would expect. Anyone taking a steroid medication long term, anyone with known osteoporosis, and anyone on blood thinners should be assessed after a fall rather than waiting.

Head impact, loss of consciousness, vomiting, worsening headache, confusion, or a fall in someone on blood thinners all need emergency assessment regardless of how the arm feels. Chest pain, breathlessness, or difficulty passing urine after a fall onto the pelvis are also emergency findings.

Footwear and traction devices

A shoe built for Vancouver rain behaves differently on ice. Rubber gets harder as it cools, and a hard sole grips less. Worn tread, smooth soles, and a heel with a small contact area all make a bad surface worse.

What helps:

A soft, flexible sole with an open tread pattern. Deeper channels clear water, and a sole that stays pliable in the cold keeps more contact with the ground.

A wide, low heel. Contact area and a stable base beat height. A boot with a flat outsole is more forgiving than a dress shoe with a narrow heel.

Slip-on traction cleats for ice days. Rubber harnesses with steel coils or spikes pull over a normal boot and cost less than a physiotherapy assessment. Take them off indoors, because metal studs on tile or a polished lobby floor are more slippery than the shoe alone.

Hands out of pockets. Buried hands remove the arm movement that keeps you balanced and any chance of protecting yourself. Carry a bag on the shoulder rather than filling both hands.

Walking style matters on ice too. Shorter steps, a slower pace, a flat foot landing rather than a heel strike, and keeping your weight over the front foot all reduce the chance of the foot sliding out ahead of you.

The balance and strength work that lowers fall risk

The most useful thing in this article costs nothing and works before winter arrives. The 2019 Cochrane review of exercise for preventing falls in community-dwelling older people pooled 108 randomised trials with 23,407 participants across 25 countries. Exercise reduced the rate of falls by around 23% and reduced the number of people having one or more falls by around 15%.

The detail that matters is which exercise. The review found high-certainty evidence for programmes built mainly around balance and functional training. Evidence for Tai Chi was less certain, and evidence for resistance training on its own, without balance work, was uncertain. Strength still matters for what happens after the slip, since catching yourself and getting back up both need it, but balance work is the part carrying the fall-reduction effect.

In practice that means standing balance work that gets progressively harder, stepping and reaching tasks that mimic real recoveries, sit-to-stand practice, and strength through the hips and legs. It works best when it is challenging and done consistently over months. We go through this in more depth in balance and falls prevention for older adults.

Younger adults benefit for a different reason. Ankle and hip control decides whether a slip becomes a stumble or a fall, and a history of ankle sprains usually means some of that control was lost without notice.

Coverage when the fall happens at work or near a vehicle

Two situations change who pays, and both are worth sorting out on day one rather than a month later.

A fall at work. WorkSafeBC handles claims for injuries that arise out of and in the course of employment. That includes a slip in a work parking lot, on a loading bay, or on a route you were taking as part of your job. WorkSafeBC's guidance for workers says to report the injury promptly, notes that workers have up to one year from the date of injury to report it, and asks that you tell anyone treating or assessing you that the injury happened at work. It also states that if you get treatment such as physiotherapy before the claim is accepted, you may be asked to pay the provider directly and can request reimbursement if the claim is later accepted. Your employer has its own reporting duty, which is separate from yours.

A fall connected to a vehicle incident. ICBC handles injury claims arising from a crash involving a motor vehicle, and its injury claims information covers people hurt as vehicle occupants as well as pedestrians and cyclists struck by a vehicle. A plain slip on ice in a parking lot, with no vehicle involved, is generally an extended health or private matter rather than an ICBC one. If a vehicle was part of what happened, report it and let ICBC determine how the claim is handled rather than deciding yourself.

A slip with no work and no vehicle connection usually goes through extended health benefits, and the details differ by plan. If you are unsure which route applies, we compare the two systems in WorkSafeBC and ICBC physiotherapy coverage in BC. Coverage rules change, so confirm current details with the body itself.

What a first visit looks like

A first physiotherapy assessment after a fall starts with the story: how you landed, what hit the ground first, what you felt immediately, and what has changed since. That history often tells the therapist more about the tissue involved than the examination does.

Expect your therapist to screen for anything needing imaging before treating, examine the joints above and below the painful area, test movement and strength within tolerance, and ask about your walking, your footwear, and any previous falls. If a fracture is suspected, you will be sent for imaging rather than treated.

The early plan is usually protection with gentle movement, then a graded return of range and load as pain settles. Timelines depend on which tissue was injured, whether bone is involved, your age, and how early sensible loading begins. Your therapist will set a realistic range after the assessment.

Physiotherapy is a direct-access profession in British Columbia, regulated by the College of Health and Care Professionals of BC, so you can book an assessment without a physician's referral. Some extended-health plans require a referral for reimbursement, so check with your insurer before your first visit.

When to see a doctor instead

Go to an emergency department or urgent care rather than a clinic for a visible deformity, an inability to bear weight or use the limb, numbness or a cold pale hand, fast hard swelling, a head impact, or any fall in someone taking blood thinners. Older adults with sudden hip or groin pain after a fall, or who cannot stand, need medical assessment the same day.

Talk to your physician about bone health if you are over 65 and have broken a bone from a fall at standing height. A wrist fracture from a low-energy fall is frequently the first sign of reduced bone density, and treating it as an isolated accident misses the chance to do something about the next one.

This article is general information, not personal medical advice. A regulated practitioner can confirm whether the patterns described apply to you.

Frequently asked questions

Why do so many winter injuries happen in Metro Vancouver without much snow?

Because the local hazard is freezing rain and thin ice on wet pavement, rather than accumulated snow. The temperature sits near freezing for short periods, water already on the ground turns to a transparent glaze, and people are walking in shoes chosen for rain. Snow gives boots something to grip and softens a landing, while a film of ice over concrete does neither.

What is a FOOSH injury?

FOOSH stands for a fall onto an outstretched hand, meaning the hand goes out to break the fall and takes the force through the wrist and up the arm. It is a reflex that protects the head and face at the cost of the arm. The injuries it commonly produces are a distal radius fracture at the wrist, an acromioclavicular joint sprain or separation at the shoulder, and injuries to the elbow or rotator cuff.

How do I know if my wrist is broken or just badly bruised?

Go for imaging the same day if there is visible deformity, if the forearm has an angle or a step that was not there before, if you cannot move or use the hand, if there is numbness or the hand looks pale or feels cold, or if swelling builds hard within the first hour. Pain directly over bone that stays severe is also a reason to be seen. A fall onto an outstretched hand was the mechanism in 60.3% of distal radius fractures in a 2025 series published in Cureus, so it is a common enough outcome to take seriously.

What should I do in the first 72 hours after a slip?

Protect the injured area, reduce swelling, and decide whether you need imaging. That means a sling, splint, or supportive wrap as appropriate, ice for about 15 minutes at a time with a cloth against the skin, elevation for a hand or wrist, and gentle movement of the joints above and below the injury. Avoid repeatedly loading the painful area to test how it feels, since that is a common cause of setbacks in the first week.

Is tailbone pain after a fall serious?

Usually it settles with conservative care. A 2020 review in the Journal of Clinical Orthopaedics and Trauma reports direct trauma in 50 to 65% of people with coccydynia and notes that conservative therapy succeeds in about 90% of cases, starting with ergonomic changes such as a cushion with a cut-out and simple pain relief. Seek medical assessment if you cannot pass urine or have a bowel change, if there is numbness around the saddle area, or if pain remains severe past the first few weeks.

Do ice cleats actually help?

Slip-on traction devices with steel coils or spikes give grip on ice that a rubber sole cannot. They pull over a normal boot and are worth keeping by the door through December to February. Take them off before going indoors, because metal studs on tile, polished stone, or a lobby floor slide more than the boot alone would.

What kind of footwear is safest on ice?

A boot with a soft, flexible sole, an open tread pattern with deep channels, and a wide low heel. Rubber stiffens in the cold and a hard sole grips less, so a sole that stays pliable keeps more contact with the ground. Worn tread, smooth soles, and narrow heels all make a slip more likely.

Can exercise reduce my risk of falling?

Yes, and the effect is measured. The 2019 Cochrane review of exercise for preventing falls in community-dwelling older people pooled 108 randomised trials with 23,407 participants and found that exercise reduced the rate of falls by around 23% and the number of people having one or more falls by around 15%. The strongest evidence was for programmes built mainly around balance and functional training, while evidence for resistance training on its own was uncertain.

How long does a wrist or shoulder injury from a fall take to recover?

It depends on which tissue was injured, whether bone is involved, your age, and how soon graded loading begins. A mild acromioclavicular sprain behaves differently from a displaced wrist fracture that needed setting, and the same injury recovers at different speeds in different people. Your therapist will give you a realistic range after assessing you rather than a number chosen in advance.

Does WorkSafeBC cover a slip in the work parking lot?

WorkSafeBC handles claims for injuries arising out of and in the course of employment, which can include a fall on employer premises such as a parking lot or loading area. WorkSafeBC asks workers to report the injury promptly, states that workers have up to one year from the date of injury to report, and asks you to tell anyone treating you that the injury happened at work. If you receive physiotherapy before the claim is accepted, you may be asked to pay the provider and can request reimbursement if the claim is later accepted.

When does ICBC apply to a fall?

ICBC handles injury claims arising from a crash involving a motor vehicle, including people injured as vehicle occupants and pedestrians or cyclists struck by a vehicle. A plain slip on ice in a parking lot with no vehicle involved is generally an extended health or private matter. If a vehicle was part of what happened, report it and let ICBC determine how the claim is handled.

Do I need a referral to see a physiotherapist in BC?

No. Physiotherapy is a direct-access profession in British Columbia, regulated by the College of Health and Care Professionals of BC, so you can book an assessment without a physician's referral. Some extended-health insurance plans require a referral for reimbursement even though the profession does not, so confirm with your insurer before your first visit.

Sources

• Sherrington et al., "Exercise for preventing falls in older people living in the community," Cochrane Database of Systematic Reviews, 2019
• Hospital-Based Epidemiological Study of Distal Radius Fractures at a Hand and Microsurgery Unit, Cureus, 2025
• Garg and Ahuja, "Coccydynia: a comprehensive review on etiology, radiological features and management options," Journal of Clinical Orthopaedics and Trauma, 2020
• Kiel and Kaiser, "Acromioclavicular Joint Injury," StatPearls, NCBI Bookshelf
• WorkSafeBC, "Workers: How to report an injury and what to expect"
• ICBC, injury claims information
• College of Health and Care Professionals of BC, physical therapist licensees