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RinardPT Monthly
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Nick Rinard Physical Therapy
9700 SW Capitol Hwy Suite 140
Portland, OR 97219
Volume 6, Issue 7
September 2014
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Waiting to start PT after an accident can actually INCREASE your healing time
Some people are told to “rest” for 4-6 weeks before starting therapy after an accident. The problem with this? There are many things a person can do immediately after a car accident to facilitate healing and prevent dysfunction.
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All too often, we see people 6 months or more after a car accident (MVA). Without exercises at home, the picture is this: limited, painful movement of the spine or joint, global weakness, and poor posture that becomes painful when corrected.
The same is true for other types of trauma as well! Prolonged rest causes stiffness, and can lead to increased pain.
Nick Rinard Physical Therapy has a very effective treatment protocol that helps patients avoid loss in range in motion, and decrease pain!
Read more about this in our post “Why is it important to start therapy after a motor vehicle accident (MVA)“
Call today!
503-244-6232
RinardPT patients get Results:
Don’t just take our word for it
“I’ve had back pain for 3 years. My doctor and other physical therapists were unable to diagnose or treat the pain. Nick Rinard PT was able to give me exercises and treatments that have reduced the level of pain, and to make it go away following the exercises. Pain levels have gone from a level three (out of 10) to a one.”
-Gregg 08/20/2014 |
“I want to thank Ms. Megan Plante for turning my life around. When I can to your clinic suffering relentless pain and weakened from nerve trauma, and having experienced a severe drug reaction, I was not only in a state of withering health from these pathologies; I was also in a diminished mental state. Megan changed all that. With sincere dedication and intensive study and planning, she not only trained my body to a state of improved muscle function and control, she also gave me the encouragement I needed to achieve an improved mental outlook.
In short, Megan turned it all around to the point where my general health is now, in some ways, actually better than before the onset of this malady. I’ll always be grateful.”
-Terry 08/21/2014 |
Phone: 503-244-6232 | Fax: 503-296-2305
help@mdtclinics.com | rinardpt.com
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FREE CONSULTATION COUPON
MENTION THIS COUPON AND SCHEDULE YOUR FREE SCREEN TODAY
(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. |
Now a Preferred Provider with Regence Blue Cross Blue Shield
Nick Rinard Physical Therapy is now IN-NETWORK with Blue Cross Blue Shield!
We make every effort to make treatment affordable, and believe that we save patients time and money by providing our specialized care, regardless of insurance coverage.
Not sure of your physical therapy insurance coverage?
Nick Rinard PT checks insurance for ALL patients at no cost!
Call RinardPT today! 503-244-6232
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Read all the helpful tips and reminders at :
http://RinardPT.com/clinical-conversations/
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This 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!
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RinardPT Monthly
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Nick Rinard Physical Therapy
9700 SW Capitol Hwy Suite 140
Portland, OR 97219
Volume 6, Issue 6
August 2014
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Now a Preferred Provider With
Regence Blue Cross Blue Shield!
Nick Rinard Physical Therapy is now IN-NETWORK with Blue Cross Blue Shield!
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We make every effort to make treatment affordable, and believe that we save patients time and money by providing our specialized care,
regardless of insurance coverage.
Not sure of your physical therapy insurance coverage?
Nick Rinard Physical Therapy checks insurance for ALL patients at no cost!
Call today!
503-244-6232
RinardPT patients get Results:
Don’t take our word for it
“After 1.5 years of caregiving for my sweet husband, I found my back was shot and motion difficult. You discovered that I was shifted to the left and not using my muscles symmetrically (what muscle I had, which wasn’t much!). The gradual prescription of more exercises for core strengthening (after correcting the shift) has been phenomenal. I am so glad to have my body working for me again, instead of yelling at me for living my life.”
-Shirley 07/29/2014 |
“I came to Nick Rinard PT with a chronic pain in my left shoulder area. I sit a lot: driving, computer work, TV, etc. I would go to the chiropractor one a month for relief, but the pain never went away. I finally went to my doctor who referred me to Nick. I was seen by Megan who spent a lot of time troubleshooting my pain. She came up with an exercise that gave me relief on the spot. I went home and performed the exercise several times per day. Within 3 days, the pain was completely gone! I went for one follow-up visit (only my 2nd visit) and was given instructions on how to incorporate the exercise as part of my ongoing therapy. This place is great!”
-James 07/07/2014 |
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FREE CONSULTATION COUPON
MENTION THIS COUPON AND SCHEDULE YOUR FREE SCREEN TODAY (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.
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How Important is Your Posture?
VERY IMPORTANT!
In fact, almost all of our patients are instructed in proper posture as a part of therapy.
Want to get the most mileage from your spine? Straighten up!
If you’re unable to sit up straight without pain, it’s time to give us a call.
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Read all the helpful tips and reminders at :
http://RinardPT.com/clinical-conversations/
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Last week, I had a patient come into the clinic with neck pain that had started the week before. He had been a patient in the past and knew that the sooner he got in for treatment, the better.
Terry had pain medial to his left shoulder blade. This pain was limiting him with sleeping and with driving, as left rotation caused pain. He was rating his pain a 4/10 at the time of the evaluation.
Evaluation and Assessment
Scapula connects Upper Arm with Collar Bone
During the evaluation, left and right rotation motions produced pain medial to the left scapula. Upon palpation, the musculature where the pain was produced was very tender, acting like trigger points. I chose not to treat the trigger points, as these things are likely secondary to the real problem: a derangement.
During the repeated movement assessment, I had Terry go through retraction, extension and flexion. When we tested repeated left rotation, Terry’s pain decreased with repetition. Terry was sent home performing repeated left rotation with over-pressure. By his next visit, his pain was significantly decreased and the trigger points of the muscles had also decreased with pain when palpated. I had Terry increase the frequency of which he was to perform the rotation exercise. By the next visit, Terry had abolition of all pain, no limitation with sleeping or driving and the trigger points were completely gone!
Getting to the Root of the Problem
The Mechanical Diagnosis and Therapy (MDT) Method is very effective at getting to the root of the problem. When the core issue is fixed, the secondary impairments almost always resolve on their own. If a clinician is always treating the symptoms and not the cause, this will lead to more visits, more time until recovery and more money from the patient. This is one of the fundamental reasons that we practice the MDT Method here at Nick Rinard Physical Therapy – to fix your core issues!
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RinardPT Monthly
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Nick Rinard Physical Therapy
9700 SW Capitol Hwy Suite 140
Portland, OR 97219
Volume 6, Issue 5
July 2014
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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.
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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) |
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FREE CONSULTATION COUPON
MENTION THIS COUPON AND SCHEDULE YOUR FREE SCREEN TODAY (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.
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Clinical Conversations NOW at RinardPT.com
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‘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
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
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.
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A 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!
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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!
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Quick Answers Are Never a Guarantee
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.”
Resources
Meta-analysis: Quadriceps exercise best reduces knee OA pain:
http://news.todayinpt.com/article/20140329/TODAYINPT04/140328005&SearchID=73533945353381?utm_content=sf25084815&utm_medium=spredfast&utm_source=facebook&utm_campaign=social2013&sf25084815=1
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
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Patient 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!
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