By Erick Severo
20 Jul, 2026
Clinical Case of the Week
exercise, hip, knee, MDT, Nick Rinard, Nick Rinard physical therapy, pain, pain-free, Physical Therapy, Portland Oregon, post-op, prehab, rehab, results, shoulder, Surgery, treatment
This article was written by Danya Sadler, Student Physical Therapist, during her clinical rotation at Nick Rinard Physical Therapy.
What is Prehab?
Many people assume that physical therapy begins only after surgery, but postoperative rehabilitation is just one part of what physical therapists do. The American College of Surgeons defines prehabilitation, or “prehab,” as “a process of improving the functional capability of a patient prior to a surgical procedure so the patient can withstand postoperative inactivity and the associated decline.” Physical therapists accomplish this through targeted exercise, education, and movement strategies tailored to each individual.
What the Research Shows
Prehab is much more than simply “getting ready” for surgery, it gives patients the opportunity to improve strength, mobility, and confidence while working toward their best possible outcome. A growing body of research has shown that prehab is an effective way to make the most of that opportunity. A research article by Konnyu, et al. finds that prehab prior to total knee or total hip surgeries can lead to reduced length of stay in the hospital, increased strength, and decreased stiffness post-operatively. Another article looking at orthopedic surgeries found that “prehabilitation was associated with moderate improvement in several preoperative outcomes (function, 6-minute walk test, knee flexor and hip abductor strength, etc.) among patients undergoing all orthopedic procedures and was also associated with a reduction in back pain among patients undergoing lumbar surgery.” (Punnoose et al., 2023). The research behind this topic has been vastly growing over the years but all other articles shared similar findings. In some cases, the prehab process reveals something patients weren’t expecting: surgery may not be the right next step after all.
When Physical Therapy May Help Avoid Surgery
For many musculoskeletal conditions, current evidence supports physical therapy as a first-line treatment for many musculoskeletal conditions before considering surgery, as many patients achieve similar improvements in pain and function without an operation. This is not to say that surgeries are bad nor never warranted, because they are actually very well researched and helpful in many cases. By using physical therapy first however can help patients find a potential non-surgical way of improving function and reducing pain, or, if symptoms persist despite appropriate rehabilitation, physical therapy can help patients and their healthcare team determine that surgery is the most appropriate next step. Multiple randomized control trials and systemic reviews comparing supervised exercise therapy with arthroscopic surgery for degenerative meniscal tears have found similar improvements in pain and function, while the physical therapy group demonstrated greater improvements in muscle strength early in rehabilitation.
A Closer Look at Low Back Pain
Evidence supporting conservative care extends beyond meniscal injuries. Similar recommendations exist for conditions such as knee osteoarthritis, rotator cuff injuries, and more but I want to present some evidence about its use with patients with low back pain since we see many individuals with this at the clinic. While surgery for back pain is appropriate in certain conditions like progressive neurological deficits or required fusions, most episodes of low back pain improve with conservative care. Current clinical practice guidelines from JOSPT and the American College of Physicians recommend remaining active, participating in exercise-based rehab, and working with a physical therapist before considering surgical intervention when there are no red flags found by your clinician or your physical therapist. Physical therapy can decrease pain, improve mobility, increase strength, and also help patients return to their daily activities while determining whether surgery is truly necessary.
The Right Treatment at the Right Time
Ultimately, the goal of prehab isn’t to avoid surgery at all costs, it is to ensure that each patient receives the right treatment at the right time whether it be surgery on conservative care. If surgery is found to be the best next step, patients will benefit from becoming stronger, more informed, and more active participants in their own care.
Citations
American College of Surgeons. (n.d.). Prehabilitation. Strong for Surgery. Retrieved July 8, 2026, from https://www.facs.org/for-patients/preparing-for-surgery/strong-for-surgery/prehabilitation/
Konnyu KJ, Thoma LM, Cao W, Aaron RK, Panagiotou OA, Bhuma MR, Adam GP, Pinto D, Balk EM. Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review. Am J Phys Med Rehabil. 2023 Jan 1;102(1):1-10. doi: 10.1097/PHM.0000000000002006. Epub 2022 Mar 12. PMID: 35302954; PMCID: PMC9464791.
Punnoose A, Claydon-Mueller LS, Weiss O, Zhang J, Rushton A, Khanduja V. Prehabilitation for Patients Undergoing Orthopedic Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023;6(4). doi:10.1001/jamanetworkopen.2023.8050
Kise N J, Risberg M A, Stensrud S, Ranstam J, Engebretsen L, Roos E M et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up BMJ 2016; 354 doi:10.1136/bmj.i3740
Qaseem A, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514–530.
George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., Norman, K. S., et al. (2021). Interventions for the management of acute and chronic low back pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1–CPG60. https://doi.org/10.2519/jospt.2021.0304
More
By Erick Severo
16 Jun, 2026
Clinical Case of the Week
exercise, MDT, Nick Rinard, Nick Rinard physical therapy, pain, pain-free, Physical Therapy, Portland Oregon, results, treatment
Written by: Danya Sadler, SPT
When Rib Pain Isn’t What It Seems
We had a patient this past week with a unique challenge. This patient had been fighting with a serious medical condition for the past couple months and had, a week before seeing us, started experiencing pain on their left lower ribs. This patient had great difficulty sleeping, rolling over, and generally moving around and wanted to see if this new symptom was related to the illness or if it had a mechanical component.
This visit was conducted via telehealth which is a great way for patients to be seen who either are living or travelling far away or people, like our patient in this article, who are homebound due to their illness or injury. This patient was told at the start of the visit that we were going to use this first visit to determine if there was a mechanical component to their rib pain and if there wasn’t, that we were going to help guide them to appropriate medical providers for further evaluation.
Using Movement to Find Answers
During this visit, it was difficult to conclude whether the rib pain was mechanical or visceral. The patient had tenderness around their left lower ribs, but also had right sided tenderness right underneath the ribs dealing more with internal structures. One notable finding was the patient experienced some pain relief when side-gliding to the right and side-bending to the right. Based on this response, we decided to have the patient perform these consistently over the next few days to see if this would relieve symptoms and help us conclude if this rib pain was indeed mechanically based.
An Unexpected Setback—and a Breakthrough
When we followed up with the patient a few days later, they reported an eventful week. Shortly after our initial evaluation, they went to the emergency room with severe rib pain and did not do their PT exercises at all. After testing negative for any illness related cause of her rib pain, she went home and then began performing the assigned movements consistently. They worked! The patient was happy to report that their pain had almost completely gone away! They were very grateful that we were able to provide the tools to reduce their pain and gave them hope even in these really difficult times that they were facing with their illness.
The Power of a Thorough Assessment
This case highlights the value of a thorough physical therapy evaluation, even when symptoms occur alongside a significant medical condition. Rather than making assumptions about the source of the patient’s pain, we used movement testing and symptom response to guide our clinical decision-making and determine the most appropriate next steps. By the patient’s second visit, their rib pain had improved dramatically, allowing them to move, sleep, and function more comfortably. Just as importantly, the patient gained confidence and clarity during a challenging time in their health journey.
More
Snow is coming to a mountain near you!
Are you ready for your next adventure?
I you think you may not be up to doing the things that you love with winter, call now and schedule your evaluation.
Nick Rinard Physical Therapy will make sure you are safe on the mountain this winter.
More
By Krissy Brown
04 Feb, 2025
Clinical Case of the Week, Medical Advisory, Physical Therapy Tips
ankle pain, exercise, injured, Knee pain, Leg pain, Low Back Pain, Nick Rinard physical therapy, Physical Therapy, running, treatment
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
During 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? Schedule your evaluation at Nick Rinard Physical Therapy and find out!
More
Happy Thanksgiving from everyone at Nick Rinard Physical Therapy.
Nick Rinard Physical Therapy is very Thankful to have you in our lives! We couldn’t do it without you!
Nick Rinard Physical Therapy will be CLOSED for Thanksgiving on Thursday, November 28th 2024, Friday November 29th, 2024, Monday December 2nd 2024 and Tuesday December 3rd 2024.
Regular office hours will resume Wednesday December 3rd 2024.
If you are in need before then please do not hesitate to call
503-244-6232 or email help@rinardpt.com and we will get back to you as soon as possible.
More
By Krissy Brown
12 Nov, 2024
Clinical Case of the Week, Exercise
exercise, injured, Nick Rinard, Nick Rinard physical therapy, Oregon, pain-free, Portland Oregon, thera-band, treatment
A Nick Rinard Physical Therapy patient emphasizes the importance of health and fitness in the the demanding role of a firefighter.
His home exercise plan is so convenient he can do it while he works!
Thank you for your service and courage you give to the community.
Thank you for sharing your Nick Rinard Physical Therapy story!
More
Nick Rinard Physical Therapy- where patients come to get results from physical therapy!
“I had lower back pain for the past 4 years & previous physical therapy visits & exercises only had temporary results.
After only 6 visits I can go back to my regularly scheduled daily HIT classes.
I’m so confident that if I had another pain issue in the future I can come back to Nick & get it fixed.”
Cara
More
We can get you back to walking, exercising, running, enjoying your sport again….
“I had horrible knee pain that was keeping me from being a mobile as I wanted.
Even just going up and downstairs even hurt.
Dr. Rinard was amazing- best PT experience I’ve ever had.
Exercises were easy to do + only had once/week appointments after the first week.
I can no go down stairs with no pain, one legged lunges without pain, play tennis without pain, + do 5K walks or more without knee pain.
THANK YOU ALL!”
Marla
More
Results from the heart.
Thank you Terry for sharing!
“Sometime ago, I was injured rather severely, causing a constant agonizing nerve pain. A nurse at the hospital where I was examined recommended Diagnostic Physical Therapy; namely Nick Rinard and his associates.
Under Nick’s careful supervision, these highly trained professionals diagnosed my condition and started treatment immediately, and gave explicit instructions for exercises I was to do at home between visits.
Not only did the pain improve, but also my mental outlook, as the world suddenly seemed a worthwhile place to be. Sessions took place daily at first, then weekly, and eventually my condition was so much improved that I can now live a normal life.
Nick and his team of professionals have achieved a level of care and skill I had not previously seen, with a superb knowledge of the human body, especially the arts and sciences associated with muscle, bone, nerve and sinew, as well as an unexpected understanding of one’s mental and spiritual outlook.”
Terry
More
Nick Rinard Physical Therapy has continued SAFETY MEASURES and are ALWAYS here for you!
Our staff is fully vaccinated and continues to follow social distancing, sanitation protocols and wear masks.
New patients and established patients will find every visit very valuable and should not delay care due to increases in Coronavirus cases.
We are here to diagnose, educate, offer tools, listen to concerns, and meet all safety needs of every patient.
May all our patients stay safe, healthy and have a quick recovery should they test positive for Coronavirus this summer.
Nick Rinard Physical Therapy is here for you.
More
