Clinical Conversations

Nick Rinard Physical Therapy can help you rapidly reverse your low back pain “No area of clinical over-treatment is as egregious as musculoskeletal care. Mis-diagnoses…

Posted by McKenzie Institute International on Saturday, November 10, 2018


Nick Rinard Physical Therapy cert MDT: Staying up to date

Just published. Yet more evidence about directional preference: "The most prevalent Directional Preference (DP)…

Posted by McKenzie Institute USA on Monday, November 12, 2018


Knee pain: The complete question and answer by Nick Rinard Physical Therapy

1). What is a surprising fact about knees that most people don’t know?


The most relevant misinformation about knees for patients is that radiologic findings (either x-ray or MRI) are what’s responsible for their pain.  On the contrary – something ‘wrong’ found in imaging is most likely NOT associated with pain!  In one study of 24 elite athletes NOT complaining of knee pain, “EVERY knee imaged had at least one structural anomaly” (  The rate of “false positives’ (what researchers call it when a positive test for a disease is incorrect because the patient does not actually have the disease) varied from around 50% to 80% in this study.  So, if your knee hurts, and you get a radiological diagnosis, you have a high chance of getting misdiagnosed.  Better to get a full examination to get a better clue as to the source of pain.


2.) How do your knees affect your stride?


Technically speaking your knees (the joint parts) do not affect stride since running is a “mid-range” motion.  Walking, on the other hand, does involve end range extension, so limited extension could have an effect – but not in running.  Pain in the knee is likely to affect your ability to tolerate a running stride, and your body will find ways to avoid pain – thus affecting your stride in varying ways.  There is no typical way this happens, so if you have knee pain, you need to have a good mechanical examination to find out how to best treat or manage it.


3).  Is ‘runner’s knee’ a real problem (and is it as big a one as people think?)


‘Runner’s Knee’ could be any one of many diagnoses, so, as a term, it is not really a diagnosis – it is a symptom.  Consider this:  Meriam Webster’s “Medical Definition of ‘Runner’s Knee: pain in the region of the knee especially when related to running that may have a simple anatomical basis (as tightness of a muscle) or may be a symptom of iliotibial band syndrome or chondromalacia patellae.”  It can be a real problem, and it can be a big one if not well understood by the patient or treating healthcare provider, like a physical therapist.  If your pain does not subside quickly after running, or is so bad that you cannot increase your running distance due to pain, then it is best to get a full mechanical evaluation from a trained provider (and given the answer to question 1 above, imaging should not be necessary first.)


4).  What are the most important things a runner can do to keep their knees injury free?


The body is amazing and can be trained to do almost anything.  Injury creeps in when your training load exceeds your body’s ability to adapt.  Progress your training in small increments and don’t underestimate the power of a rest day to give your tissues a chance to heal and catch up.


5).  Anything specific we didn’t talk about that you think I should mention?


Yes, over the years I have seen a high incidence of spinal problems being either the sole source, or contributing to, knee pain.  This rate is up to 40% or higher based on my anecdotal experience and confirmed by research in progress (presented at the 2017 McKenzie Institute International Conference in San Francisco).  Many runners have consulted with me right in the middle of training for an event (like a marathon, mostly), desperate to not interrupt their training due to knee pain.  I have helped them stay in training and complete the event by effectively screening for spinal issues that are masquerading as knee pain.  Often the patient dismisses this since they “always have a sore back, but the knee pain is new”.  Given the important role the spine plays in controlling everything in the extremities, it should not be surprising how relevant it can be in knee pain – and how important it is that your properly trained specialist can identify and treat it effectively!




Nick Rinard MPT, Cert MDT


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What Physical Therapist at Nick Rinard Physical Therapist know about muscle mass

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Nick Rinard Physical Therapy believe in the power of self management

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Let Nick Rinard Physical Therapy talk with your more about McK method and pain “… just because you can’t see it, doesn’t mean it’s not there, or wasn’t there earlier. Maybe…

Posted by McKenzie Institute International on Friday, October 26, 2018


Get the correct diagnosis from a MDT specialist at Nick Rinard Physical Therapy “These findings reveal the empowering effect investigation findings can have when concordant…

Posted by McKenzie Institute International on Friday, October 26, 2018


Centalization is key with the MDT method at Nick Rinard PT

'Centralization of symptoms and lumbar range of motion in patients with low back pain.' Have you observed that spinal…

Posted by McKenzie Institute USA on Tuesday, July 17, 2018


Build credibility with yourself

Here are 5 easy ways to help build credibility with yourself and to insure you follow through with all good intentions.

  • Make an appointment with yourself – Schedule time on your calendar each day, even if it is just 20 minutes, to do your home exercise program. Honor this time the same way you would honor any other medical appointment.
  • Reward yourself when you follow through – Improving your health is its own reward, but you may need other tangible incentives to keep you motivated on your course. Make a barter system with yourself – “For every 10 minutes I spend on this treadmill, I will get 10 minutes of guilt-free Netflix veg time.”
  • Get friends and family on board – One of my patients found the best way to correct his posture was to recruit his children, “It’s open season, kids – anytime you can catch me slouching, call me on it and I will give you a dollar.”
  • Keep it visible – Put those running shoes in a high visibility area of your home so that you have a visual reminder to gear up and get outside for a jog. Are you using a thera-band for your exercise routine? Don’t hide it – hang it in plain sight so that you are prompted to put it to good use!
  • Teach what you’ve learned – If you have mastered a new exercise or healthy recipe, share it! Pay it forward and reap the benefit of better understanding through teaching. You know you have truly mastered a technique when you can teach it effectively to someone else.

So let me know – what do you do to encourage yourself to follow through with your commitments to yourself?  Have you tried any of these suggestions before?  Do you have new ideas you’d like to share with us? Let’s support each other in making the end of 2018 and 2019 a year of abundant good health!


Margo Burette DPT