All posts in Physical Therapy Tips

Leg Pain; It Could Be Coming From Your back!

Many times we have patients who come for physical therapy treatment describing pain in their leg, but it turns out to be coming from their spine. This is often confusing for people, especially if they have been given a provisional medical diagnosis related to the area of pain, like “piriformis syndrome”, which is pain in one of your gluteal muscles. You may wonder how we determine where the pain is coming from and what to treat. Pain is produced by sensory nerves. Sensory nerves can be triggered locally at the spinally level, or peripherally either by muscle tension or injury. During the evaluation we always perform spine ROM to determine if the source could be coming from the spine. The screen must begin from the center outward. In some cases, knee/hip/ankle pain will decrease or increase during the lumbar spine screen, and then we know it is coming from the spine. This can be hard to understand for some patients because the pain they are experiencing feels like it is coming from that very spot, whether it is a joint or muscle, that is painful. For example, I recently evaluated a patient with ankle pain. She had even fallen, which made it possible she could have some trauma to her ankle from the fall. However, during the lumbar spine screen, her ankle pain decreased while performing a back bend. She was in disbelief that her ankle pain went away. After only a few visits her ankle pain was gone and it did not return. One of her lumbar discs was pressing on a nerve root and causing her ankle pain, and the back bending pushed the disc away from the nerve and abolished the pain. The moral of the story is, we can never assume a diagnosis until a thorough examination is performed.


What is the role of x-ray and MRI in physical therapy?

Nick Rinard MPT Cert MDT Owner of Nick Rinard Physical Therapy“Should I get an x-ray or MRI before physical therapy?” This is a common question, and the answer is – NO. Why not? I hope to clarify that in this article, and give you a convincing reason to try physical therapy first.

First, physical therapists can make an accurate clinical diagnosis that will most likely match the radiological diagnosis. A 2005 study published in the Journal of Orthopedic and Sports Physical Therapy compared the agreement between what the physical therapist thought the imaging would show, and what doctors thought the imaging would show. “Clinical Diagnostic Accuracy and Magnetic Resonance Imaging of Patients Referred by Physical Therapists, Orthopedic Surgeons, and Non-orthopedic providers.” Physical therapists could predict the correct imaging diagnosis 74.5% of the time! That’s almost as accurate as orthopedic surgeons, and over twice as good as general practitioners!

  • Physical Therapists = 74.5% (108/145)
  • Orthopedic Surgeons = 80.8% (139/172)
  • Non-orthopedic = 35.4% (86/243)

So, only in a small number of cases, will you need an x-ray or MRI to help determine your condition if it cannot be determined clinically.

False positives

Second, there are a lot of “false positive” findings associated with imaging. A false positive is when the test (radiologic image) shows you have the disease or condition, when you actually don’t. Some of you readers may know of people who were freaked out by a “finding” on their mammogram that turned out (luckily) to not be cancer. How often does this happen in the joints or spine that a physical therapist treats? If you are talking about the neck, quite a lot of people with NO NECK PAIN have a “major finding” on MRI. It is broken down below. (From The Journal of Bone and Joint Surgery 1990 “Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation”)

For people less than 40 years old:

  • Major abnormality in 14%
  • Herniated disc = 10% (of subjects)
  • Foraminal stenosis = 4%
  • No “major” bulging discs were seen
  • Narrowed disc space / degenerated discs = 25%
  • Cord abnormalities = 9%

For people older than 40 years:

  • Major abnormality in 28%
  • Herniated disc = 5%
  • Foraminal stenosis = 20%
  • Only 1 subject “major” bulging disc was seen
  • Narrowed disc space / degenerated discs = 57%
  • Cord abnormalities = 1%

Remember, these are findings in people with NO NECK PAIN. If you have neck pain, there is a good chance that you might have one of these findings, but it would not be the source of your pain. The study authors conclude: “The prevalence of cervical spine pathology in asymptomatic (pain free) individuals of a wide-range of ages, points out the danger in ordering surgery or invasive procedures, or even giving the patient an ominous-sounding diagnosis, without first correlating these MRI findings with clinical signs and symptoms.”

Imaging the lumbar spine can also lead to errors as there is even greater incidence of false positive MRI findings in asymptomatic subjects in the lower back as compared to the neck…

“Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.” J Bone Joint Surg Am. 1990

  • 33% had a “substantial” abnormality

60 years old:

  • 36% had a disc herniation
  • 21% had spinal stenosis

Accurate Diagnosis with your Physical Therapist

If you are still reading this article, then you must be interested in getting an accurate diagnosis of your problem, and you might think a physical therapist could be the one person who can do that. You would be right. Plus, a physical therapist will offer you treatment for your condition, not surgery or drugs. I have been convinced beyond a doubt in my 20 plus years of practice that one should start with a good physical therapy evaluation and possibly treatment before turning to x-ray or MRI. A good physical therapist knows when the clinical diagnosis is complete and correct and when imaging is needed to help fill in the blanks. Don’t get an x-ray or MRI first. It might point you in the wrong direction and bias the clinician trying to arrive at the correct diagnosis and treatment. If you truly need imaging, your physical therapist at Nick Rinard Physical Therapy can help guide you in that decision.


Is Your Work Out Wearing You Down?

Margo Burette, DPT, Physical Therapist at Nick Rinard Physical TherapyThe American Heart Association recommends at least 30 minutes of moderate-intensity aerobic activity at least 5 days/week. In the pursuit of good health and fitness, many people are using YouTube to access new workouts. Unfortunately, there is neither quality control nor an accreditation process to ensure that the workouts are sound. Further complicating things is the “no pain, no gain” exercise myth which leads people to expect suffering with exercise. If someone expects exercising to be painful, they may not heed the early warning signs of pain and become injured.

Recently, I treated a young woman who developed severe lower back pain after exercising with a popular fitness program online. She continued to push herself through the routines but after 2 weeks she quit exercising entirely. She was frustrated because her efforts to improve her health had actually worsened her condition. Her back pain was interrupting her sleep and limiting her ability to concentrate at work.

After just 4 sessions at Nick Rinard Physical Therapy she was pain free and equipped with an effective, individualized exercise program that supported her fitness goals without compromising her If your workout is wearing you down, we can help you get on the right track! Don’t settle for suffering through your exercise routine when you could be thriving.


The Power of Posture

ToyPoodle wearing Sunglasses Outdoor

What do a toy poodle and the human head have in common? They both share an average weight of 10-12 pounds. Your spine has three natural shock-absorbing curves which attenuate the stress of bearing that load above your shoulders while you move through your day. With good posture and frequent position changes, most of us can bear that weight without difficulty.

However, the moment you drop your chin to read the latest blog update on your cell phone the balance changes completely. When your head inclines forward 60 degrees the force your neck is bearing is equivalent to exchanging that toy poodle for a Labrador retriever – 60 pounds of force (Hansraj, 2014)! Consider that the average person sustains this position for 2-4 hours a day while using their smart phone and the load quickly becomes overwhelming. This chronic fatigue to the muscles and structure of the neck can lead to debilitating injury.

Your neck will thank you for contacting Nick Rinard Physical Therapy to address your posture.

Let us help you get that heavy Labrador off your shoulders!

Hansraj, KK. “Assessment of stresses in the cervical spine caused by posture and position of the head.” Surgical Technology International. 2014, November; 25:277-9


Balance and Aging

It is general knowledge that, as we age, our sensory systems start to decline. This includes sight, smell, temperature regulation and balance mechanisms.  It’s important to have good balance because if it declines, you are at a higher risk for falling.  And falling, results in injuries that can greatly affect your life.

Exercises that Challenge your Balance

What many people don’t know, is that you can work on making your balance stronger, just like you do a muscle: by exercising it!  What physical therapy aims to do, is find exercises that challenge your balance system, so that your body must learn to adapt to certain situations and re-train itself on what to do.

Static and Dynamic Exercises

Physical Therapists can provide both static and dynamic exercises for you, depending on what is most challenging.  Exercises can be very simple and integrated during daily routines- like balancing on one leg while brushing your teeth.

If you are having trouble with your balance, come in to Nick Rinard Physical Therapy and have an assessment by a physical therapist! 503-244-6232


Why is it important to start therapy after a motor vehicle accident (MVA)?

RinardPT recommends immediate treatment after Auto AccidentThis is a question that seems to be in debate.  At our clinic, we advise our patients to come in for treatment as soon as possible when experiencing pain in order for the fastest results.  I have experienced push-back from other health care practioners who want the person to “rest” for 4-6 weeks before starting therapy.  The problem with this? There are many things a person can be doing immediately after the MVA to facilitate healing and prevent dysfunction.  All too often, we see people 6 months or longer after the MVA. If the patient has not been given anything to work on for exercises at home, the picture is this: limited, painful movement of the spine or joint, global weakness, and poor posture that becomes painful if corrected.

What does therapy look like in the first few weeks after an MVA?

  • Initiate gentle range of motion exercise to prevent loss of movement
  • Manual techniques including passive range of motion and soft tissue mobilization to promote blood flow and healing.
  • Ultrasound modalities that decrease inflammation/swelling and promote tissue healing
  • Education and training on how to prevent dysfunction

Here at Nick Rinard Physical Therapy, we see a lot of patients who have suffered an MVA. In fact, we see it so much we have a protocol for it that is very successful for treatment.  Don’t wait! Start healing and feeling better today!


Osteoporosis Facts

Osteoporosis is the leading cause of fractures resulting in billions of dollars being spent in the healthcare system. As a physical therapist, it is important to educate the public on information for reducing the risk of fracture, which is a frequent and possibly serious co-morbidity of osteoporosis. The public is subjected to multiple commercials advertising medications that can help fight osteoporosis.  What they may not know, is that simple exercise alone can improve your bone density, decrease your risk of fractures and doesn’t come attached to a list of adverse side effects.


  • Osteoporosis is a bone disease that leads to decreased mineral content and bone density, resulting in a weakening of the bone
  • The incidence of this disease has been shown to increase with older age
  • Worldwide, 50% of women over the age of 60 will have an osteoporotic fracture, an incidence rate that is larger than the combined incident rates of heart attack, stroke, and breast cancer.
  • One study from 1992 had a worldwide projection that osteoporotic fractures would affect one-third of all men during their lifetime by the year 2050.
  • Primary risk factors for osteoporotic fractures include low bone mineral density, deterioration of bone, older age, Caucasian race, female sex, lower body weight and AN INACTIVE LIFESTYLE.


Picture of woman running wearing RinardPT logoWhat can you do?

  • Exercise can decrease the risk of an osteoporosis related fracture by 50%
  • One study found that weight bearing exercise for 20 minutes a day can positively affect risk factors associated with osteoporotic fractures among elderly women.  The exercises for the intervention group included: jumping, dancing, walking, strengthening, and balance exercises.  The exercise group had increased leg strength as well as improvement in walking speed and endurance, as compared to the control group. In a long-term follow-up study, the same authors found that the above intervention decreased mortality in women with osteopenia (a precursor to Osteoporosis).
  • A bi-weekly exercise routine developed by your PT can increase your bone density.
  • Muscle contraction and mechanical loading deform bone and stimulate activity of osteoblasts, the cells which build bone.It is, therefore, not surprising that these interventions improve bone mineral density.

Want to learn more?


LOW BACK PAIN—What you should do while waiting for your first physical therapy appointment

LOW BACK PAIN—What you should do while waiting for your first physical therapy appointment…


Sitting Posture Important Low Back PainSit as little as possible.  Standing or lying down are preferable to sitting when in acute low back pain.  If you must sit, sit only in a straight backed chair with good posture.  Avoid couches or soft chairs.  Use a towel roll to support the natural curve of your spine.


Do not bend forwards as in touching your toes when in acute low back pain—even if it feels like you are doing good by  “stretching” the muscles of the low back.  Rather than reaching down to get things, squat down using the legs and keep the back absolutely straight.


Try to lie more on your stomach rather than on your back.  Avoid the temptation to lie on your back with the head and knees propped up—this just rounds the back more and places inappropriate stress on injured structures.

Low Back Pain lie on your stomach not your back


You should stay normally active–in other words try not to stay in bed for long periods.  Move around, take walk if you can.  Do not do the knees to chest exercise you may have learned before.  This is an advanced exercise and usually not appropriate for acute conditions.  It is better in most cases to lie on your stomach and work towards supporting yourself on the elbows.

 Low Back Pain Don't do Knees To Chest Exercises  Low Back Pain Exercise On Stomach Elbow Support