Clinical Conversations

RinardPT Monthly – July 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 5
July 2014

We Appreciate YOU!

Did you know that you help make up 40% of the patients we see? Yes, YOU!

40% of the patients we treat are past patients returning for a different issue, or patients referred to Nick Rinard Physical Therapy by a past patient.

You make up 40 Percent of RinardPT

We want you to know that we appreciate you, and that despite all the changes that have happened to healthcare (and those to come) YOU are still still our first priority. We are committed to your PT being as effective as possible, and are still working hard to get you better in an average of 6-8 visits!

Call 503-244-6232

for your Evaluation or Free Consultation

RinardPT patients get Results:

Don’t take our word for it

“I came to Nick Rinard Physical Therapy hoping to find relief from debilitating neck pain-24/7-which had mysteriously begun about 2 weeks prior to my first visit. My husband had been treated here a few years ago-also for neck problems.
Within a few sessions my range of motion, with little to no pain, had improved tremendously! In addition, I was given specific ‘exercises’ I can easily do on my own to further improve movement, and to hopefully prevent the neck problem from happening again. Thank you!”
-Doris 06/24/2014  (5 visits total)
“I had severe neck pain and limited movement of my head-both up and down, and left to right.
The pain has now been almost completely taken care of and normal motion has returned. The exercises given have really helped.”
-James 06/03/2014 (6 visits total)


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

We are continuing to expand our collection of articles!

Here are a couple of the subjects we’ve recently covered:

Ice: The Overused Modality : How ice could be slowing your healing process.

Mechanical Pain versus Muscle Soreness : Learn to tell the difference!

Read all the helpful tips and reminders at :

Sports Injuries require Physical Therapy Treatment

Ice: The Overused Modality

‘R.I.C.E.’ Coined in 1978

‘R.I.C.E.’ (rest, ice, compression, elevation) was coined in 1978 by Dr. Gabe Mirkin. Since then, ice has been the standard treatment for injuries and sore muscles. The RICE guidelines have been used for decades, but it now appears that ice and rest may delay healing.

Scientific Articles Don’t Support Ice for Healing

Image of Ice glistening as it melts.A study from The American Journal of Sports Medicine, June 2013 asked athletes to exercise intensely enough to develop muscle damage that caused extensive muscle soreness. It was found that icing delayed swelling, but did not quicken the healing process.  A summary of 22 scientific articles found little to no evidence supporting that ice and compression facilitate healing over compression alone.


Inflammation is required for healing. Inflammation is a part of our immune system and is essential in the healing process. Inflammatory cells migrate to the injured tissue to start the healing process. Macrophages (inflammatory cells) release a hormone into injured tissues, which helps muscles and other injured tissues heal.  Applying ice to reduce swelling can delay healing by preventing the body from releasing this hormone.

Icing can also prevent healing cells from entering the injured tissues by constricting blood-flow.  It can take hours for the blood vessels to return to their size. Icing can also decrease strength, speed, endurance and coordination.

General Tips for Using Ice

If you’re going to ice, only apply ice for 10-15 minutes at a time.  Utilize ice for the first day of injury.  Seek medical attention from a mechanical physical therapist if the pain is severe or you cannot actively move a body part.


Mechanical Pain versus Muscle Soreness

Sports Injuries require Physical Therapy TreatmentA mistake that people often make is waiting too long to start physical therapy treatment for their aches and pains. This commonly occurs because you may be thinking, “this will go away on its own,” or, “it’s just normal for me to feel like this at my age.” I want to clear up some confusion on mechanical pain versus normal muscle soreness that does not require skilled therapy or treatment.

Muscular Pain:

  • Experienced after a sudden increase in activity or exercise.
    • Running 6 miles when you typically only run 2 miles
    • You increased the intensity or length of time to your typical workout
  • Will be experienced 1-2 days after the increased activity has been performed and will typically begin to dissipate or be gone in 3-5 days after onset.
  • Is typically vague pain or experienced in a general area. The pain will not be sharp or pin-point to a specific area.
  • If you’re educated on what muscles perform which actions, the sore muscles will correlate with what activity you were performing.
  • Does not have increased or decreased pain associated with positions.

Mechanical Pain:

  • May have a sudden onset without explanation of occurrence (you woke up with pain for no apparent reason).
  • Will typically have a loss in range of motion. For example: it may be difficult to stand up straight in the morning or after prolonged sitting or driving.
  • Will have positions that will increase or decrease symptoms. For example: pain increases with sitting, pain is better while lying down.

If you’re experiencing mechanical pain the sooner you seek physical therapy treatment, the better! A good Physical Therapist can determine which exercises will reduce your symptoms and get you back to doing the activities that you love!


Chronic Low Back Pain

A few months ago, I treated a young Portland area woman who was suffering from low back pain. “Beth” had been in a car accident 10 months prior to my evaluation.  She was rating her worst pain as a 9/10 and was moderately limited with walking, sitting, bending and lifting. Because of the pain associated with these activities, Beth was limited with her duties as a student nurse, and somewhat concerned with how her back condition will affect the rest of her life.  Beth had been to a chiropractor and to a different physical therapy clinic, neither of which proved to have any lasting benefits.

Beth’s objective findings included what mechanical therapists call a “Left Shift” in standing.  This means that her shoulders were not centered over her hips, but rather, off to the left side.  We know this as a relevant lateral component and is typically associated with a derangement (something out of alignment or out of place).   Beth also demonstrated limited, painful movements of the spine; primarily in the frontal plane.

The exercise to correct Beth’s shift and reduce her derangement was repeated right side glide in standing.  Beth was able to perform this exercise throughout her day to decrease her pain and by 3 weeks out, she was reporting little to no pain.  Beth was then able to begin core strengthening exercises, after her pain was gone, and get back to her duties as a nursing student.  At our last treatment visit, Beth told me that she was able to work multiple 12 hour shifts as a nurse without any pain!

If the physical therapy treatment you are receiving does not get feeling better within 1 or 2 weeks, find something that works!


Quadriceps Strengthening Exercise Routine Decreases Pain Associated With Osteoarthritis and Meniscus Injury

Quick Answers Are Never a Guarantee

Picture of woman running wearing RinardPT logo

We live in a culture that seeks immediate results and quick answers to solutions. Most of the time, unfortunately, we also want what requires the least amount of effort on our part. In the medical community, this boils down to people deciding to have surgery to fix the problem. Unfortunately, surgery is never a guarantee. Time and time again I treat patients here at Nick Rinard Physical Therapy who were advised to have surgery and, after the procedure was performed, their pain remained. This happens because of both the general public and medical practitioners’ lack of understanding about how the body moves and heals. Recently, there was a man referred to our Portland airport (PDX) clinic by his friend for knee pain. He was scheduled to have knee surgery the next week, but wanted to have a second opinion. My colleague diagnosed him with a very simple problem: knee capsulosis, and he was reporting decreased pain and improved range of motion by his 2nd visit. He cancelled his surgery and is expected to have a great outcome with conservative care.

Regimented Exercise Can Decrease Knee Pain without Surgery

I recently came across a study that found simple regimented exercise routine focusing on quadriceps strengthening and cardiovascular endurance decreases knee pain associated with osteoarthritis. What a great concept: exercise can decrease pain and improve function and avoid surgery! The authors of the study concluded: “Optimal exercise programs for knee OA should have one aim and focus on improving aerobic capacity, quadriceps muscle strength, or lower extremity performance,” the authors concluded. “For best results, the program should be supervised and carried out three times a week. Such programs have a similar effect regardless of patient characteristics, including radiographic severity and baseline pain.”

Physical Inactivity is THE Major Public Health Problem of the 21st Century

I came across a quote that really resonates with these findings: “…most medical schools only allocate a perfunctory hour to the fact that physical activity is medicine. This is a major failing of medical education when physical inactivity is the major public health problem of the 21st century.”


Meta-analysis: Quadriceps exercise best reduces knee OA pain:
Accessed on May 1st, 2014
Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. K M Khan, A Scott. Br J Sports Med 2009;43:247-252


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.