Clinical Conversations

Chronic Shoulder Pain: Treated Successfully in 6 visits

Shoulder Pain was affecting his Job until he came to RinardPTPatient is a 60 y/o male “Mike” with chronic shoulder pain. Mike’s symptoms started in 1994 after falling onto his left shoulder. Overall, his symptoms had been unchanging and severely affecting his job. He has had previous physical therapy and massage therapy to no avail. He was severely limited with lifting, carrying and working out.

During his initial evaluation, it was found that Mike had painful, limited range of all shoulder movements with the exception of lateral rotation. He also had weak/painful resisted tests of shoulder abduction, medial rotation and flexion. His most limited impairment was painful, weak abduction.

It was determined that Mike had chronic dysfunction of the supraspinatus muscle tendon (one of the rotator cuff muscles). Because of the anatomical position of this tendon, it is the most commonly injured and torn of the rotator cuff. Mike began remodeling his tendon with targeted, dosed loading. By the next visit, he was strong, in less pain and had improved range of motion.

Mike continued his remodeling exercises for the next 4 weeks. By his 6th visit to our Portland clinic he had virtually no pain and was no longer limited with his work or life from his shoulder pain. Mike is a classic example of how conservative treatment that targets the root of the problem results in fast, effective results!

Don’t wait 20 years to have your simple problem solved. Have a mechanical evaluation at Nick Rinard Physical Therapy today!


Thoracic Outlet Syndrome – TOS

Recently, I have had 3 physical therapy patients in the clinic with a complicated clinical presentation.  All 3 patients have a different cluster of symptoms and impairments. What they each have in common is that they have upper extremity symptoms that are not of cervical spine (radiculopathy) origin.  Instead, their pathology is a result of tight chest and neck musculature, compressing the bundle of nerves that control the movement and sensation of the arm.  Clinically, this is known as Thoracic Outlet Syndrome, or, TOS.

What is Thoracic Outlet Syndrome?

  • Compression of the artery, vein and/or nerves that pass through the thoracic outlet.
  • There are 3 possible locations for the compression to occur:
    • In between your scalene (neck muscles)
    • In between the clavicle and first rib
    • Under the peck minor (chest muscle)
The most common compression is of the nerves.  This results in vague pain of the arm as well as various sensations: itchy, hot, cold, pins and needles, etc.It may be painful to the touch for any of the muscles involved with the compression.

Poor posture as well as decreased flexibility of the thoracic spine are also associated with TOS.

Rarely, an extra rib (cervical rib) is the cause.

Image of muscle and skeletal region affected by TOS


Physical Therapy Treatment for TOS

  • Physical therapy is the first line of treatment for Thoracic Outlet Syndrome (TOS).
  • A therapist will teach you how to stretch what needs to be lengthened as well as how to strengthen muscles that will improve posture.
  • Physical therapists also have manual techniques to help you progress your treatment
  • Most people diagnosed with TOS  have a good prognosis and will have complete resolution of symptoms with conservative treatment only.

RinardPT Monthly – May 2014

Nick Rinard Physical Therapy in Portland Oregon Logo White

RinardPT Monthly

Nick Rinard Physical Therapy
9700 SW Capitol Hwy Suite 140
Portland, OR 97219

Volume 6, Issue 3
April 2014

SW Portland Open House

Should you be resting?


Should you be ‘working through’ the pain?

Is the source of your pain serious?

Ask an experienced MDT Physical Therapist at Nick Rinard PT! With a 15 minute Free Consultation, we can often find the cause of your pain and give you advice to help treat your symptoms.

Xray highlighting region of severe back pain

Join us for a special Open House and ask about your pain “while you’re here.” Light refreshments will be offered, and appointments are encouraged though WALK-INS are always welcome!

Tuesday, June 17th – 5:00pm-8:00pm

Call 503-244-6232

for your Evaluation or Free Consultation

RinardPT patients get Results:

Don’t take our word for it

“I came into Nick Rinard PT because of a car accident in December that I sustained a neck injury in. I had very limited neck motion, & had pain when I tried to move my neck. I had severe pain when sitting for long periods of time, trouble driving, and doing other everyday activities. I also had random headaches every day that kept me from doing normal tasks. Now I feel much better. My headaches have almost gone away, I have my range of motion back, and I am not in pain anymore.”-Lauren 04/28/2014 “I was referred for treatment after PT elsewhere was not improving my symptoms for a post-operative L5-S.1 discectomy/laminectomy. Once starting treatment at Nick Rinard PT I knew it was the right fit. After my 1st visit I had increased symptoms and called that evening. I was immediately helped over the phone and scheduled to return the next day. From then on, it was steady improvement with detailed explanation of exercises and physiology. I’m beyond grateful for the care and staff at Nick Rinard PT.”-Shelley 04/17/2014


Nick Rinard Physical Therapy 4 people jumping on the beach


In just 5-10 minutes, MDT can determine if your pain is mechanical or not. If so, we can help get you out of pain and back to enjoying your life.


Clinical Conversations NOW at

From low back pain, hip pain, ‘pseudo tennis elbow’…

We’ve seen it all at
Nick Rinard Physical Therapy!

Come see our success stories, get advice for how to avoid pain, and what to do while you wait for your physical therapy visit with us.

Mobilization with Movement with Grip

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?


Pseudo Tennis Elbow: A Commonly Misdiagnosed Mechanical Problem

Lateral epicondylitis, more commonly known as “tennis elbow,” is a pathology that is familiar to physical therapists and the general public. What is lesser known is “pseudo tennis elbow,” a mechanical problem with a very simple solution! Unfortunately, therapists whom are not familiar with the utilization of mechanical diagnosis may unknowingly miss this common elbow derangement. As a therapist practicing the McKenzie method of mechanical diagnosis, I have diagnosed BOTH of my current elbow pain patients as derangements (or pseudo tennis elbow).


Portland area patient presented to physical therapy with intermittent right elbow pain, worsening over the last 3 months. Patient reported difficulty with gripping, lifting, carrying and global limited function of the right arm. Patient described symptoms as “variable” meaning he could perform a task that produced his elbow pain. Then, perform the same task or movement again without experiencing any pain at all! This variability of pain is the hallmark of a derangement and should not be misdiagnosed as a tendonitis (also called tendinitis), which would indicate inflammation (in which case pain would be constant). Patient rated worst elbow pain as a 6/10.


Mobilization with Movement with GripObjective findings included pain with passive elbow flexion and extension as well as pain with active wrist extension and with gripping a tennis ball. Because of my experience as a mechanical therapist, I am familiar with a technique called a mobilization with movement (MWM), developed by Brian Mulligan (a colleague of Robin McKenzie). The mobilization provides a lateral force over the ulna at the elbow joint. While the patient applied this force, he was able to grip the tennis ball PAIN FREE! This same technique was applied for other painful baselines and achieved the same results of ABOLITION OF ALL PAIN! This ability to turn symptoms off with a mobilization indicates an elbow derangement and the MWM is used as the treatment strategy.


The patient was asked to perform the MWM utilizing the lateral glide while gripping a tennis ball to be performed 10-20 times every hour. The theory is that this mobilization is re-positioning the joint in order for it to articulate correctly, resulting in improved range of motion and strength after. The patient returned to the clinic the next day with reports of at least 25% improvement! Objective findings were retested and nearly all baselines had improved in less than 24 hours! The patient returned 1 week later and reported an 85% overall improvement with symptoms.


Don’t be misdiagnosed! Straightforward pathologies which require one exercise to treat are commonly missed with standard treatment. This results in extra physical therapy visits, and more of your time and money. It is worth your time to see if your pain has a MECHANICAL component, otherwise a simple solution may otherwise be missed.

If you are experiencing elbow pain and are living in the Portland/Vancouver metro area, get the best results by calling us today at 503-244-6232 to schedule a physical therapy evaluation.


RinardPT Monthly – April 2014

Nick Rinard Physical Therapy in Portland Oregon Logo White

RinardPT Monthly

Nick Rinard Physical Therapy
9700 SW Capitol Hwy Suite 140
Portland, OR 97219

Volume 6, Issue 3
April 2014

New Look, Same Great Care!

MDT of Portland is Now Nick Rinard Physical Therapy

With a new name and a new logo, we’ve had a lot of exciting changes. We hope that you like our new look, and rest assured that the changes stop there.

Nick Rinard Physical Therapy is committed to continuing to provide specialized McKenzie (MDT) based personal care for you and your loved ones-just like we have since we opened our doors in SW Portland, Oregon in 1999.

Nick, Natasha, and the entire Nick Rinard PT team are here for you!

Call 503-244-6232
for your Evaluation or Free Consultation

RinardPT patients get Results:

Don’t take our word for it

“When I first came for PT, my lower back was very stiff & it was painful to do side-bends. I my lower back became fatigued from walking/running I would experience muscle spasms in my back.Now I can walk/run my normal 45 minutes or hike and I feel good-no spasms!”-Maureen 03/14/2014 “I was referred by my doctor after 6 weeks of going to another PT clinic with no results. I wasn’t hopeful that Nick Rinard PT would get any better results. After 4 visits, I could tell things were changing for the better. My pain while standing was a 10 at worst, down to a 3 at the end of my day. The people and staff are amazing and friendly. I loved how they put their ‘thinking caps’ on before they start. Thank you so much.”-Teresa 03/26/2014


Nick Rinard Physical Therapy 4 people jumping on the beachFREE CONSULTATION COUPON

(503) 244-6232
In just 5-10 minutes, MDT can determine if your pain is mechanical or not. If so, we can help get you out of pain and back to enjoying your life.


Join the Walk to Cure Arthritis! We’ll Meet you There!


Oregon and SW Washington Walk to Cure ArthritisSaturday, May 17th in Vancouver, Washington
Nick Rinard Physical Therapy will be at the Health Fair from 9am-1pm.

Esther Short Park
Columbia St
Vancouver, WA 98660
  • Choose to walk a 1 or 3 mile loop

Registration and more information at :

Can’t make it? You can make a donation for the cause at the the link above to show your support!




Chronic Shoulder Pain with a Mechanical Cause

I recently had a follow up appointment with a patient of mine.  “Sam” came to our clinic after having failed attempts of treatment from standard Physical Therapy and chiropractic care.  His past physical therapist had given him generalized stretching with little to no benefit, and by the time I evaluated him, Sam admitted that, “(he) was not impressed with his therapy treatment.”  He had heard about Nick Rinard Physical Therapy, and he was hoping to get the results he desired with us.

During his initial evaluation, Sam presented with limited, painful movements in several motions of the shoulder. The most painful motion was the motion of putting the arm behind him (like he was going to scratch in between his shoulder blades).  Incidentally, this was also the motion which initially caused his pain three months ago.

Shoulder Stretch Exercise from RinardPTI had Sam passively stretch into the painful motion. This was not a random decision. It was a clinical decision based off of his baselines and has been clearly documented and researched by the works of Mark Laslett.  As Sam repeated this movement, the pain dissipated and all of his baselines improved.  Sam continued to perform this exercise until his next visit, at which, he reported 95% improvement.

Sometimes the exercise required to fix the mechanical problem is counterintuitive (moving into the pain).  A trained mechanical therapist is able to recognize these pain patterns and can make a clinical decision as to what exercise should be performed and interpret the results.


Vertigo: A mechanical cause and treatment!

The most common cause of vertigo (dizziness) is benign paroxysmal positional vertigo (BPPV) and it is a mechanical disorder. A trained clinician can evaluate and treat this condition based off of the patient’s symptoms. The evaluation consists of moving the head into specific positions. Symptoms of BPPV include vertigo with change in head position, nausea with or without vomiting and disequilibrium (poor balance).


Image of Inner Ear and Vestibular System edited by Dan Yedinak

Vestibular System

BPPV is a curable condition affecting the vestibular system (inner ear). Your inner ear is comprised of 3 semicircular canals (SCC) and 2 otolith organs. These structures detect head movements (acceleration). Crystals called otoconia are embedded in the otolith organs. Sometimes, the crystals can become dislodged and misplace into the semicircular canals. The misplaced crystals result in increased sensitivity to head movements.

Hopes for a Positive Response

I was treating a patient for low back pain when she mentioned that she was experiencing severe episodes of dizziness. I informed her about BPPV and mentioned that the treatment was very simple and effective. She agreed to have an evaluation in hopes for a positive response.

My patient tested positive for BPPV utilizing the Hallpike-Dix test for the left semicircular canals. I also performed a few other tests and exercises to rule out other potential causes for symptoms. Once we had our diagnosis of BPPV, the treatment was very simple.

Improvement in just one week

I took my patient through a series of head movements that reposition the crystals back into the otolith organs (the saccule and ultricule). After performing the repositioning maneuver, baseline symptoms were decreased and she returned the next week without having any severe episodes of vertigo.

BPPV – A Common Vertigo that is Easily Treated

BPPV is the most common cause for vertigo. Luckily, it is very easy to diagnose and treat with a trained therapist. If you or someone you know has vertigo as a result from head movements, have a physical therapist evaluation so that you may start feeling better today!


Ankle pain from the spine?!

By MiKayla Sanocki, SPT

Did you know a back problem can cause symptoms such as pain, decreased strength and decreased sensations into the thigh, calf, ankle or foot? Physical therapists trained in Mechanical Diagnosis and Therapy (MDT) here at Nick Rinard Physical Therapy can determine during the evaluation if any of these lower leg symptoms are coming from your back.

Check out this bizarre clinical presentation we treated at Nick Rinard Physical Therapy:

She did not remember any trauma to the ankle

The patient came to physical therapy for an “ankle sprain” that occurred 3-months earlier.  She stated she woke up unable to put any weight on her right foot. The pain had remained constant in her ankle, so bad at times that she couldn’t walk!  Upon further questioning, the patient revealed what she had been doing the day before: She had driven 2 hours, on her way home from helping clean a house. During the drive she had discomfort in her buttock and hamstring that made her want to pull the car over to stretch.  She did not remember any trauma to the ankle, however, but the ankle pain was the only pain she was experiencing now.

Her ankle pain has caused her to quit running and yoga — two of her favorite activities.

Mechanical Evaluation finds cause in spine

Picture of woman running wearing RinardPT logoDuring the mechanical evaluation we found that certain directions of low back movements decreased the pain in her ankle.  After being sent home with 1 simple exercise to perform every waking hour – which she did perfectly – she returned within 24 hours reporting 90% recovery in pain! Over the next week we were able to progress her exercises and now the patient reports no ankle pain at all. In only 4 visits we were able to abolish her ankle pain, and she is now getting back to running and yoga!

The patient reports, “I now have the tools to prevent the return of my back and ankle pain”.

Treatment at Nick Rinard Physical Therapy vs Traditional PT

In contrast to MDT, traditional PT would not have uncovered the spinal cause of the patient’s ankle pain.  Treatment would have been ineffective since it would have focused only on trying to treat the symptom.

Do you know if your pain in the legs or arms could be coming from the spine?  Come see us at Nick Rinard Physical Therapy and find out! 


Post op shoulder pain was really coming from the neck

Nick Rinard PT ExerciseVery interesting clinical presentation today!  The patient had been treated for neck pain here (Nick Rinard Physical Therapy) in the past with good results.  Later, she developed shoulder pain and consulted her MD, who referred her to an orthopedic surgeon.  There were “findings” on MRI and she ended up getting arthroscopic surgery.  She returned to us for physical therapy to rehabilitate after surgery.

No Surgery Needed

Interestingly, she reported that her surgeon was surprised that her rotator cuff tendons were in “good condition” and did not require a repair – he had noticed that during the surgery procedure itself, apparently.  So, physical therapy should be easy in such cases, right?  No big surgical repair to worry about.  

However, 6 weeks after the operation, her shoulder pain was not subsiding as it should have.  Inflammation normally resolves in that amount of time and she should have been strong enough to resume normal office work duties consisting of keyboard and filing.

Finding the True Cause of the Pain

We had to take a closer look at her neck.  It turned out that her neck was referring pain to the shoulder!  In one neck treatment, the shoulder pain was abolished!  The patient probably had had a recurrence of her old neck problem, it referred pain to her shoulder, and neither she, her MD, nor the orthopedic surgeon considered the true cause of the pain…

This is a frequent occurrence here at Nick Rinard Physical Therapy, where we use the Mechanical Diagnosis and Therapy (MDT) system of evaluation and treatment.  Robin McKenzie started this method and it is the best method – and most supported by research – at getting to the true cause of pain.

Save time, money, and maybe avoid surgery!

If you or someone you know is having any problems that could be mechanical, a thorough mechanical assessment should be performed.  In as little as one visit the problem might be identified and solved, saving a lot of time, money, and suffering!  Plus, the patient might avoid unnecessary surgery!