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
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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.
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We want to share your great experience at Nick Rinard Physical Therapy with the world! We take great pride in what we do for our patients and are always looking to improve our care and services. Your feedback helps us with our online exposure in reaching new patients so that they too can get back to pain-free living! Here are some options as to how you can leave your feedback to share with the world!
These reviews should only take a few minutes to complete and go a long way in helping us reach patients we would not have previously!
Please feel free to contact us if you have any questions.
Thank you in advance and as always, we are here for YOU!
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Happy Thanksgiving from everyone at Nick Rinard Physical Therapy.
We are so very Thankful to have a strong community that support small business. We couldn’t do it without you, our patients, friends and family!
Nick Rinard Physical Therapy will be CLOSED for Thanksgiving on Thursday, November 27th 2025, Friday November 28th, 2025, Monday December 1st 2025 and Tuesday December 2nd 2025.
Regular office hours will resume Wednesday December 4rd 2025.
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.
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Do you have the feeling or expect that Physical Therapy should be covered by your insurance?
Physical therapy providers are starting to identify some very good reasons why involving your insurance may NOT be in your best interest!
Just like filing an auto insurance claim for damage that doesn’t meet your deductible – it is often best to forego involving your insurance and just pay out of pocket. There is no need to inform your car insurance that there was any damage and risk them increasing your premiums the next time your policy renews. It is the same with filing a health insurance claim. Filing a small claim for physical therapy can have negative complications and unintended consequences. Especially when you can get diagnosed in 2-4 visit at Nick Rinard Physical Therapy, and get good results soon after that, it is better to not have your insurance medaling in your physical therapy affairs by questioning whether you “deserve” physical therapy or not.
Health insurance companies are demanding more and more that patients meet certain criteria, through one-size-fits-none measurements to either deny you care, or begrudgingly agree to authorize just a limited number of visits. This is insulting to your legitimate pain, and disrespectful of your medical providers who should be the only ones deciding if you need care or not. Also, your insurance reserves the right to determine – even after the fact – that your care is/was not “medically necessary” and deny your claims leaving you with an unforeseeable bill. This really is unethical and undermines your relationship with your provider. Also, insurance companies are increasing your cost of care to save themselves money with patient portions closer and closer to the total bill. You, the patient, are better off just paying at time of service at our clinic and not bothering with the extra headache, expense, and disrespectful treatment associated with filing insurance claims – even though you are totally legitimate!
Nick Rinard Physical Therapy’ wants to save you money. Our pay at time of service rate eliminates billing uncertainties from insurance companies. We are making visits more affordable and getting better health outcomes for patients. Advantages to paying at time of service include that patients get uninterrupted service, higher quality care they can trust, hassle-free billing, and no surprise bills at the end. It really is a win – win for both providers and patients for those with high deductibles, who want care out-of-network, who are self-employed, self-insured, expired PIPs and for people who have health savings accounts.
Now is the time to stop insurance companies from unethically pretending to be medical providers and payment specialists that do not have the patients’ best interest at heart. We are your providers working for you! It is our oath to get you results, free of pain and back to living life… We know health insurance companies cannot promise the same.
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Nick Rinard Physical Therapy can get you back to living “a life free of pain.”
“I came in with major chronic pain and injuries from a car accident.
With care, patience, and always a great sense of humor – Nick Rinard Physical Therapy help me back to a life free of pain.
Through every twist and turn on my road to recovery, Nick help me stay informed, comfortable with the treatment, and motivated to keep going.
Thank you so much!”
Autumn
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Have you read our google reviews lately??
If you trying to find the best physical therapy clinic in the Portland Oregon area, look no further!
Nick Rinard Physical therapy is here to help!
But you don’t have to take our word for it….
“I can’t say enough on how pleased I am working with Nick as my Physical Therapist. His approach to PT gets results and his thoroughness with educating his patients on how to get better and stay better is second to none. If I ever run into physical pain/issues again, he’ll be my first stop.” Andy
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By Krissy Brown
20 Feb, 2025
Clinical Case of the Week, Exercise
arm pain, Best physical therapy, Mechanical Diagnosis and Therapies, misdiagnosed, neck pain, Nick Rinard, pain, results, sensitivity in fingers, Thoracic outlet syndrome, TOS
If you are experiencing pain in your neck, shoulders, arms and sensitivity in your fingers it may be thoracic outlet syndrome (TOS).
Get your accurate diagnosis today at Nick Rinard Physical Therapy.
“I experienced numbness in my pinkie and ring finger on both hands.
I had shoulder pain, especially when doing chest exercises.
Thoracic Outlet Syndrome.
The numbness in my finger has gotten better.
My shoulder pain is gone.
I can do chest exercises now without pain.”
Gordon
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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.
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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!
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