All posts in Medical Advisory

Health insurance companies are not health care specialists.  They do not have a degree that is centered around healing the human body.  So, I ask, why are they withholding coverage because they have deemed your aches and pains not “medically necessary?” This leaves you to pay the bill they have promised, as your client, to pay on your behalf.

When health insurance inappropriately “diagnoses” your symptoms, they are compromising the quality of care you receive.

Nick Rinard Physical Therapy never sacrifices the QUALITY of care we provide!

Take control of your health TODAY at our Friends and Family Rates.

At Nick Rinard Physical Therapy a lot of patients come to see us with knee pain and/or knee arthritis, both before and after various knee surgeries, including total knee replacement surgeries.

Since 2010, knee replacements have been the most performed surgery on people over 45 years of age. Knee replacements are performed at the rate of 700,000 per year. Because of this increasing rate, the efficacy of pain relief and improvement of function should be investigated.

100 patients with knee arthritis

A researcher, Soren Thorgaard Skou, has done just that. In his study, he looked at 100 patients with knee arthritis and assigned them to a surgical group or non-surgical group (which received physical therapy, medication and diet education). After one year, 85% percent of the surgical group had significant improvements in pain vs 68% of the physical therapy group. The surgical group and larger gains in their ability to climb stairs and walk. However, the study also showed that the surgical group is at greater risk for complications that the physical therapy group is not. The surgical group is more likely to have blood clots or a manipulation (another procedure performed by the surgeon to increase range of motion). The surgical group had more adverse side effects vs the physical therapy group (24 vs. 6).

Physical therapy is effective

Physical therapy is effective and should be considered a viable option before jumping to surgery. If the first knee replacement can be delayed, this can decrease the necessity for a second surgery (current replacements last 10-15 years).  We urge our patients to remember that we are always here for you before or after surgery.  Nick Rinard Physical Therapy is a phone call away 503-244-6232 !

1/3rd of knee replacements are unnecessary

This, taken into consideration with the study that came out last summer that found nearly 1/3rd of knee replacements are unnecessary, should be considered when deciding to have a knee replacement or a trial of physical therapy to determine effectiveness.

Sources:

http://health.usnews.com/health-news/articles/2015/10/21/knee-replacement-brings-less-pain-better-function
Dr. Skou’s report (N Engl J Med. 2015 373;17:1668-9)

Physical Therapy clinicians are not only therapists, they are educators. A big part of being a physical therapist is answering patient’s questions and educating them on anatomy, the proper way to perform an exercise, how to walk and transfer safely, and what to expect going into surgery.

One-on-one educational session with a physical therapist

A recent study looked at the benefit of having a one-on-one educational session with a physical therapist prior to having a total joint replacement surgery. A researcher split 126 patients into two groups: one group had a group class prior to having surgery, the second group had an additional one-on-one session with a physical therapist. “Significantly more patients who attended the extra one-on-one counseling session with the physical therapist before surgery indicated that they were better prepared to leave the hospital after surgery and were, overall, more satisfied with the preoperative education they received,” Dr. Joshi stated.

Additionally, the patients who received the one-on-one session had required fewer PT sessions in the hospital and met discharge criteria (walking up/down stairs and transferring out of bed) faster.

What this indicates is that patients benefit from a one-on-one educational session with a physical therapist prior to joint replacement.

Improve overall satisfaction

Patients, therefore, may consider having a pre-surgical appointment with a physical therapist to improve their overall satisfaction and outcomes following a total joint replacement

Source: http://www.news-medical.net/news/20160222/Patients-benefit-from-one-on-one-counseling-session-prior-to-knee-or-hip-replacement-surgery.aspx

Seeing a physical therapist first for low back pain decreases overall out of pocket costs, opioid use, and less ER visits.

Study from the University of Washington and George Washington University

A study split patients into three groups. The first group saw a physical therapist first “PT first” group. A second group was “PT later” group, as they saw another provider initially, but eventually had physical therapy.  The last group was “No PT” as they never had physical therapy.

This study found that the group that saw “PT first” for low back pain had lower costs for care vs the “PT later” and “No PT” groups (this includes what they are paying out of pocket). The “PT first” group also had lower costs with emergency room visits, imaging, and opioid use.

Physical Therapy reduces prescription medication use

What this means is that seeing a physical therapist can not only reduce your pain and use for prescription medication, it also costs you less! Since Oregon has direct access for physical therapists (by law, you do not need a physician referral to see a physical therapist), patients should be using this route directly for treatment of their low back pain. Call Nick Rinard Physical Therapy today and schedule your pain away! 503-244-6232

Source:

http://www.apta.org/PTinMotion/News/2016/2/29/PTFirstDirectAccessLBP/

At Nick Rinard Physical Therapy a lot of patients come to see us with knee pain and/or knee arthritis, both before and after various knee surgeries, including total knee replacement surgeries.

Since 2010, knee replacements have been the most performed surgery on people over 45 years of age. Knee replacements are performed at the rate of 700,000 per year. Because of this increasing rate, the efficacy of pain relief and improvement of function should be investigated.

100 patients with knee arthritis

A researcher, Soren Thorgaard Skou, has done just that. In his study, he looked at 100 patients with knee arthritis and assigned them to a surgical group or non-surgical group (which received physical therapy, medication and diet education). After one year, 85% percent of the surgical group had significant improvements in pain vs 68% of the physical therapy group. The surgical group and larger gains in their ability to climb stairs and walk. However, the study also showed that the surgical group is at greater risk for complications that the physical therapy group is not. The surgical group is more likely to have blood clots or a manipulation (another procedure performed by the surgeon to increase range of motion). The surgical group had more adverse side effects vs the physical therapy group (24 vs. 6).

Physical therapy is effective

Physical therapy is effective and should be considered a viable option before jumping to surgery. If the first knee replacement can be delayed, this can decrease the necessity for a second surgery (current replacements last 10-15 years).  We urge our patients to remember that we are always here for you before or after surgery.  Nick Rinard Physical Therapy is a phone call away 503-244-6232 !

1/3rd of knee replacements are unnecessary

This, taken into consideration with the study that came out last summer that found nearly 1/3rd of knee replacements are unnecessary, should be considered when deciding to have a knee replacement or a trial of physical therapy to determine effectiveness.

Sources:

http://health.usnews.com/health-news/articles/2015/10/21/knee-replacement-brings-less-pain-better-function
Dr. Skou’s report (N Engl J Med. 2015 373;17:1668-9)

Nick came across this article about shoulder pain and MDT approach to treatment that we use at Nick Rinard Physical Therapy clinic.  He thought it would be informational for our audience.

Excerpt

Case Report

Rapid resolution of chronic shoulder pain classified as derangement using the McKenzie method: a case series Maria Corazon Aytona1 , Karlene Dudley2 1 Southeastern Regional Medical Center, Lumberton, NC, USA, McKenzie Institute, NY, USA, 2 Southeastern Regional Medical Center, Lumberton, NC, USA The McKenzie method, also known as Mechanical Diagnosis and Therapy (MDT), is primarily recognized as an evaluation and treatment method for the spine. However, McKenzie suggested that this method could also be applied to the extremities. Derangement is an MDT classification defined as an anatomical disturbance in the normal resting position of the joint, and McKenzie proposed that repeated movements could be applied to reduce internal joint displacement and rapidly reduce derangement symptoms. However, the current literature on MDT application to shoulder disorders is limited. Here, we present a case series involving four patients with chronic shoulder pain from a duration of 2–18 months classified as derangement and treated using MDT principles. Each patient underwent mechanical assessment and was treated with repeated movements based on their directional preference. All patients demonstrated rapid and clinically significant improvement in baseline measures and the disabilities of the arm, shoulder, and hand (QuickDASH) scores from an average of 38% at initial evaluation to 5% at discharge within 3–5 visits. Our findings suggest that MDT may be an effective treatment approach for shoulder pain.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822320/pdf/jmt-21-04-207.pdf

Medical Advisory: MDT is a Superior Form of Physical Therapy

This is page 2, continued from <<Choose your Physical Therapist Wisely

If you sustained your injuries in a motor vehicle accident, or work-related injury, then your chances of getting better are improved if you choose an MDT therapist. There is a financial advantage also since the total cost of your therapy will be less, based on the fewer number of visits MDT uses. Your PIP money will go further, and you will not have to sacrifice a large amount of money out of your settlement just to pay high physical therapy bills. If you are a worker, your case will be less likely to be denied if you are getting better faster, than if your recovery drags on. Believe me, insurance adjusters are less likely to keep your case open if you are not improving in physical therapy.

So you can see that MDT is a superior form of physical therapy. What about MDT compared to Chiropractic care? I tell my patients that Chiropractic treatment is indeed mechanical, but there are two distinct reasons it is not superior to MDT. The first reason has to do with the evaluation, and the second reason has to do with the treatment. A chiropractor first must take an X-ray to make the diagnosis. Unfortunately, there is little evidence to suggest a chiropractic diagnosis is reliable, and therefore, treatment based on an unreliable diagnosis is a guess at best. Secondly, chiropractic treatment is performed to the patient, not by the patient. Any improvement in the patient’s condition, therefore, is dependent on them going back for more visits! As mentioned, MDT treatments consist primarily of exercises that the patient performs so you can treat yourself when not in the clinic. This obviously results in less pain, a speedier recovery, less visits, and money saved!

By reading this essay, you are now equipped with knowledge to seek out the best care possible for your injuries. Don’t waste time going to traditional physical therapy, or chiropractic for many visits. It is better to get an MDT evaluation to determine if your condition will respond mechanically or not, and if it is mechanical, then the treatment is more effective and takes less time!

In closing, I would like to mention how MDT compared to traditional physical therapy in an objective study conducted by a third party. The average improvement in traditional physical was only 78 percent, and it took an average of 11 visits to achieve this. By contrast, MDT got patients 93 percent better in only 6.5 visits! The data speak for themselves. Don’t settle for less effective treatment for your injury – find a Cert MDT therapist who is using the MDT method properly, and get better faster!

Nick Rinard is president of, and a therapist at, Nick Rinard Physical Therapy, a private physical therapy clinic.

Medical Advisory: Choose Your Physical Therapist Wisely

by

Nick Rinard

The purpose of this essay is to inform you that not all Physical Therapy is the same. Some are more effective than others. If you had Physical Therapy, did it work? If you are going to Physical Therapy now, is it helping? If yes, you should continue until you are better. However, if you are not getting better, or if you need Physical Therapy in the future, then you should read on.

First choice for treating spinal pain

Mechanical Diagnosis and Therapy (MDT) has been shown in numerous scientific studies to be the most effective type of Physical Therapy available today. In a poll of Physical Therapists nationwide, MDT was the first choice for treating spinal pain (APTA publication 2002). This is a good thing, since it shows that the profession of Physical Therapy is gaining more and more scientific evidence to support its use. However, you should know just what MDT is so you can be sure you are actually receiving it.

Development of MDT

MDT was developed in New Zealand by a physiotherapist named Robin McKenzie. Mr. McKenzie noticed that his patients got better faster, and could control their pain themselves, compared to patients being treated traditionally. He founded the McKenzie Institute and has been training therapists since 1980. You should choose a therapist that is a certified MDT therapist, designated by Cert MDT.

What – no gadgets?

The MDT method does not rely on technological gadgets such as ultrasound or electrical stimulation commonly used in traditional Physical Therapy. There is little evidence to show that these machines actually help in recovery. Instead, Mechanical Diagnosis and Therapy, as its name suggests, uses mechanical forces to centralize referred pain, and to correct the physical problem. Exercises designed specifically for each patient, affect pain immediately, and can be performed by the patient whenever pain arises. Over a short time, these exercises heal the injury and allow full recovery. In our clinic, Nick Rinard Physical Therapy, the average number of visits is only six and a half!

Your Time is Valuable

A very important part of the MDT method is the evaluation on the first day. A qualified Cert MDT therapist should be able to identify if you will respond or not. This way, if the problem is not mechanical, valuable time in your recovery is not wasted, since you would not go through several weeks of rehabilitation to discover at the end that it did not help. Doctors who have the best interests of their patient in mind prefer MDT for this very reason. If your doctor is not aware of the MDT method, then you can choose an MDT therapist yourself. It is considered standard practice and has been accepted by the medical community.

Medical Advisory: MDT is a Superior Form of Physical Therapy

If you sustained your injuries in a motor vehicle accident, or work-related injury, then your chances of getting better are improved if you choose an MDT therapist. There is a financial advantage also since the total cost of your therapy will be less, based on the fewer number of visits MDT uses. Your PIP money will go further, and you will not have to sacrifice a large amount of money out of your settlement just to pay high physical therapy bills. If you are a worker, your case will be less likely to be denied if you are getting better faster, than if your recovery drags on. Believe me, insurance adjusters are less likely to keep your case open if you are not improving in physical therapy.

MDT compared to Chiropractic

So you can see that MDT is a superior form of physical therapy. What about MDT compared to Chiropractic care? I tell my patients that Chiropractic treatment is indeed mechanical, but there are two distinct reasons it is not superior to MDT. The first reason has to do with the evaluation, and the second reason has to do with the treatment. A chiropractor first must take an X-ray to make the diagnosis. Unfortunately, there is little evidence to suggest a chiropractic diagnosis is reliable, and therefore, treatment based on an unreliable diagnosis is a guess at best. Secondly, chiropractic treatment is performed to the patient, not by the patient. Any improvement in the patient’s condition, therefore, is dependent on them going back for more visits! As mentioned, MDT treatments consist primarily of exercises that the patient performs so you can treat yourself when not in the clinic. This obviously results in less pain, a speedier recovery, less visits, and money saved!

MDT Treatment is more effective and takes less time

By reading this essay, you are now equipped with knowledge to seek out the best care possible for your injuries. Don’t waste time going to traditional physical therapy, or chiropractic for many visits. It is better to get an MDT evaluation to determine if your condition will respond mechanically or not, and if it is mechanical, then the treatment is more effective and takes less time!

Better in only 6.5 visits

In closing, I would like to mention how MDT compared to traditional physical therapy in an objective study conducted by a third party. The average improvement in traditional physical was only 78 percent, and it took an average of 11 visits to achieve this. By contrast, MDT got patients 93 percent better in only 6.5 visits! The data speak for themselves. Don’t settle for less effective treatment for your injury – find a Cert MDT therapist who is using the MDT method properly, and get better faster!

Nick Rinard is president of, and a therapist at, Nick Rinard Physical Therapy, a private physical therapy clinic.