Clinical Conversations

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!


RinardPT Monthly – March 2014 – Happy St. Patrick’s Day!

Nick Rinard Physical Therapy Logo Traced Outline Image of Man

RinardPT Monthly

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

Volume 6, Issue 2
March 2014

Change Your Clocks! | Happy St. Patrick’s Day! ECLATT Leprechaun Girl Hat Logo

Why Wait?

Too often, we get patients in our office who have been in pain for months (or almost a year in Michael’s case!  Read his story below).  If your pain is not improving on its own, there is NO NEED TO SUFFER!  It could take just 3 visits, like it did for Jane, and you can have the tools to treat your pain and get back to living your life to the fullest.  Most of our patients are able to self-treat their problem in just 6-8 visits.  Get the tools you need now.

Are you currently suffering from pain or injury?
Call 503-244-6232 today!

RinardPT patients get Results:

Don’t take our word for it

“I hurt my knees in October 2013 while in Mexico.  I wish I had called MDT sooner and saved myself four months of pain & difficulty walking.  Going down stairs was especially painful.  In three sessions I am pain free; getting out of bed, walking, and stairs are no longer painful.  Many thanks! ”-Jane 02/12/2014 “I was in a car accident in May 2013.  I had neck pain and stiffness every day after the accident.  I came to MDT of Portland in hopes of being cured.  Within roughly 7 sessions, I would say I no longer have any pain.  Thank you guys very much-you’re all incredible!”-Michael 02/04/2014


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.


Remember to “SPRING FORWARD” by one hour on Sunday, March 9th!

ECLATT Reminds you to Change Your Clocks

March Events around Portland

RinardPT Happy St Patricks Leprechaun Girl


RinardPT Monthly – February 2014

Nick Rinard Physical Therapy Logo Traced Outline Image of Man

RinardPT Monthly

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

Volume 6, Issue 1
February 2014

Teaching YOU how to Get RESULTS

since 1999

Dear Friends,
It’s been 15 years since Nick Rinard devoted a physical therapy clinic to practicing Mechanical Diagnosis & Therapy.  In that time, we have helped so many of you get back to a pain-free life.  We’ve received pictures of our patients doing their exercises in all corners of the world, and are so proud of being part of your journey. THANK YOU for giving us all at MDT Physical Therapy the pleasure of teaching you how to get RESULTS!

Are you currently suffering from pain or injury?
Call 503-244-6232 today!

RinardPT patients get Results:

Don’t take our word for it

“I have been cutting hair for 46 years, and I have been experiencing pain in my right shoulder for at least 3 years.  The pain has been getting worse and limiting movement & my ability to cut hair.  2 weeks ago the pain diminished to the point I could forget about it.  I believe this was due to a new set of exercises designed by Megan and am very pleased with my progress. ”
-Curtis 01/21/2014
“Initially my pain level in my right let was a 10.   On my very first visit the pain subsided significantly-to the point that I believed there was some magic happening!  I would never imagined that 2 simple exercises would bring me to a pain level of zero.  The ongoing preventative exercises are part of my daily routine & will continue to be.  I truly appreciate all of the staff.  They are professional & serious about bringing their patients to a pain-free outcome.  Thank you.”-Debbie 01/09/2014


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.


Sweet (and Healthy) Chocolates for your Valentine…Or Yourself!


Valentines Chocolates in a Heart Shaped BoxJust use your favorite Valentine-shaped cookie cutters to make these treats!

  • 1 1/2 cup walnuts
  • 8 Medjool dates (these are softer than other dates, and easier to blend)
  • 1/2 cup cocoa (use less if you don’t love dark chocolate)

Blend walnuts in a high powered blender or food processor until a powder.  Pit the dates, then add walnut powder to a bowl and the pitted dates. Using your hands mix the two ingredients together until the dates are completely incorporated.  Add the cocoa.  Shape into a mold. Top with dried fruit, coconut, granola, or peanut butter!


Want more fun and healthy recipes?  See more here:




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

Low back and bilateral leg pain: Our Clinical Case of the Week


Up to 80% of the population will experience low back pain (LBP) at some point in their adult life (Croft et al 1997).  It is estimated that health care costs for low back pain are larger than for any other disease for which economic analysis is available (Maniadakis and Gray 2000) ($31 billion/year).  There is little to no evidence supporting the use of traction, thermal modalities, or electrical stimulation for the treatment of LBP. Unfortunately, these strategies are commonly used for the bulk of LBP treatment.   Many studies conclude that the McKenzie method of evaluation and treatment for LBP is superior to that of standard treatment (general stretching and strengthening).  What makes the McKenzie approach different is its classification system. Based off of symptom response to repeated lumbar spine movements, patients are classified into 1 of 3 syndromes (derangement, dysfunction, postural).  After patients have been classified, their individualized treatment plan is created. The McKenzie method also emphasizes self-treatment and long term symptom management.  I consider this the most valued aspect of treatment, as statistics show LBP is recurring in nature. Let’s review a case of a patient with a very successful outcome utilizing the McKenzie method.


Patient presented to therapy 2 weeks after the onset of LBP with bilateral leg pain.  Patient described sharp pain which radiated down to the left foot and down to the right shin. Symptoms started after a weekend of working (auto mechanic) which involved repetitive bending and lifting of heavy equipment. Patient rated worst pain as an 11/10 for the back and a 10/10 for the left leg, occurring on a daily basis.  Patient was severely limited with walking, sitting and sleep.


Patient demonstrated pain with all lumbar spine motions in standing.  There was no neurological (strength, sensory, reflex, neural tension) deficit.  This is important to test when there is a presence of leg pain.

Baseline symptoms= LBP + left foot tingling.  Patient was asked to bend forward 10 times, touching his toes.  This resulted in increased low back pain, no effect on foot tingling.  Bending backwards 10 times also increased LBP with no effect on foot tingling.  Patient was then asked to lie on his stomach and perform prone press ups (a back bend using arms to push up into extension). This exercise abolished left foot symptoms, better leaving the clinic that day.


Patient was given prone press-ups to be done every hour until his follow up appointment.  The next day, the patient returned to the clinic happily reporting that he had not experienced leg pain in over 24 hours!  The patient was even able to perform tasks associated with moving into his new home that weekend.  In 2 weeks his back pain rating had decreased to a 3/10 and he was experiencing little to no leg symptoms!  Patient continued therapy over the next few months with exercise progressions and modifications as needed.  At discharge, patient was able to perform his duties as an auto mechanic and continue his training as a member of the National Guard.


Do not fall victim to chronic low back pain.  This is associated with huge healthcare costs, over utilization of medication and surgery. All of which would otherwise be avoided with a simple exercise, requiring no special equipment.   The patient from this week’s case left the clinic feeling very empowered by his own ability to treat his symptoms and was no longer considering having major spine surgery.


Pseudo Tennis Elbow: A Commonly Misdiagnosed Mechanical Problem

Test-for-painful-grip,-wrist-and-elbow-extendedLateral 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).


Our patient, “Jane” presented to therapy with intermittent right elbow pain, worsening over the last 3 months. Jane reported difficulty with gripping, lifting, carrying and global limited function of the right arm.  Jane described symptoms as “variable” meaning she 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, which would indicate inflammation (in which case pain would be constant).  Jane rated worst elbow pain as a 6/10.

Physical Therapist Evaluation & Findings

Objective 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, she 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.

Patient Homework and Outcomes

Jane 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 repositioning the joint in order for it to articulate correctly, resulting in improved range of motion and strength after.  Jane 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!  Jane returned 1 week later and reported an 85% overall improvement with symptoms.

Get Your Own Mechanical Assessment

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