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.
Last week we had a patient come in for severe knee pain. He played tennis four times in a row and had no problems with his knee. He then sat in a scrunched position and had knee pain when he got up. He went to his doctor and got a referral to an orthopedist. The orthopedist sent a referral for acute knee pain. The patient scheduled with Nick Rinard Physical Therapy – Mechanical Evaluation immediately diagnosed he was experiencing a spine injury, leading to referred symptoms in the knee.
So we want you to know:
A spine 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 spine.
Her is another clinical presentation we treated at Nick Rinard Physical Therapy: By MiKayla Sanocki, SPT
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!
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.
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!
Vertigo is different than just feeling dizzy from time to time.
It is an episode that can come on quickly, resolve just as quickly or last for hours and even days.
Vertigo can be caused by no apparent reason, antibiotics, jumping, sneezing, allergies, sleeping, falling to name a few. It can have serious effects on your safety while walking and driving.
Nick Rinard Physical Therapy has had many patients call his/her MD only to be told vertigo will go away on its own or scheduled an appointment to receive a generic hand out-that is not patient individualized. We have found this one size approach does not fit all. These self-help hand-out are most beneficial with the guidance of a physical therapist.
Please do not spend days or even weeks trying to heal yourself or wait for your symptoms to go away.
In as few as 2 visits our tailored approach can get you back on solid ground. Safely walking and driving around without fear of falls or a sudden onset of dizziness while driving.
