By Megan Plante, DPT
29 Aug, 2014
Physical Therapy Tips
car accident, debate, education, healing, MVA, Physical Therapy, rest, ROM, training
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</li class=”rinardptli”>
- 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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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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By Megan Plante, DPT
01 May, 2014
Clinical Case of the Week
Oregon, pain, pain-free, Physical Therapy, pseudo tennis elbow, PT, quality, results, reversible, Story
Lateral 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).
SYMPTOMS
Portland area patient presented to physical therapy with intermittent right elbow pain, worsening over the last 3 months. Patient reported difficulty with gripping, lifting, carrying and global limited function of the right arm. Patient described symptoms as “variable” meaning he 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 (also called tendinitis), which would indicate inflammation (in which case pain would be constant). Patient rated worst elbow pain as a 6/10.
THERAPIST’S EVALUATION AND 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, he 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
The patient 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 re-positioning the joint in order for it to articulate correctly, resulting in improved range of motion and strength after. The patient 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! The patient returned 1 week later and reported an 85% overall improvement with symptoms.
GET YOURSELF EVALUATED
Don’t be misdiagnosed! Straightforward pathologies which require one exercise to treat are commonly missed with standard treatment. This results in extra physical therapy visits, and more of your time and money. It is worth your time to see if your pain has a MECHANICAL component, otherwise a simple solution may otherwise be missed.
If you are experiencing elbow pain and are living in the Portland/Vancouver metro area, get the best results by calling us today at 503-244-6232 to schedule a physical therapy evaluation.
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By Megan Plante, DPT
21 Mar, 2014
Clinical Case of the Week
BPPV, easily treated, improvement, MDT, Mechanical Diagnosis and Therapies, Mechanical disorder, Nick Rinard physical therapy, Physical Therapy, Portland Oregon, Positive response, vertigo
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).
Curable
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!
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By Nick Rinard Physical Therapy
14 Mar, 2014
Clinical Case of the Week
ankle pain, clinical presentation, Nick Rinard, Nick Rinard physical therapy, pain-free, Physical Therapy, Portland Oregon, relationship, results, Spine, 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? Come see us at Nick Rinard Physical Therapy and find out!
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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 2
March 2014
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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 |
 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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Remember to “SPRING FORWARD” by one hour on Sunday, March 9th!
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March Events around Portland
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BACKGROUND:
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.
SYMPTOMS:
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.
THERAPIST’S EVALUATION AND FINDINGS:
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 HOMEWORK AND OUTCOMES:
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.
HAVE A MECHANICAL EVALUATION FOR YOUR LOW BACK PAIN:
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.
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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.
