Nick Rinard Physical Therapy

Is shoulder surgery superior to physical therapy? Find out in this captivating study:

https://www.facebook.com/share/1952cPTGid/?mibextid=wwXIfr

𝗧𝗵𝗲 𝟭𝟬-𝗬𝗲𝗮𝗿 𝗩𝗲𝗿𝗱𝗶𝗰𝘁 𝗼𝗻 𝗦𝗵𝗼𝘂𝗹𝗱𝗲𝗿 𝗦𝘂𝗿𝗴𝗲𝗿𝘆: 𝗜𝘀 𝗜𝘁 𝗝𝘂𝘀𝘁 𝗮 𝗣𝗹𝗮𝗰𝗲𝗯𝗼?

◼️ Arthroscopic subacromial decompression (ASD) is one of the most common orthopaedic procedures globally, with nearly 30,000 of these surgeries performed annually for shoulder pain in England alone.

◼️ Since 2007-2008, the cumulative cost of ASD surgeries to the NHS has surpassed £1 billion.

◼️ However, a groundbreaking 10-year follow-up study from the FIMPACT trial has delivered a clear and startling verdict: this popular shoulder surgery offers no meaningful long-term clinical benefits compared to a placebo surgery or simple exercise therapy.

𝗧𝗵𝗲 𝗙𝗜𝗠𝗣𝗔𝗖𝗧 𝗧𝗿𝗶𝗮𝗹 𝗦𝘁𝗿𝘂𝗰𝘁𝘂𝗿𝗲 🔬

◼️ The Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT) was a rigorous, multicenter, randomized trial designed to test whether ASD actually works.

◼️ The study involved 210 adults, aged 35 to 65, who had suffered from subacromial pain syndrome for over three months without finding relief from non-operative treatments.

◼️ Patients with full-thickness rotator cuff tears or osteoarthritis were excluded to ensure the data was highly specific to subacromial pain syndrome.

𝗣𝗮𝗿𝘁𝗶𝗰𝗶𝗽𝗮𝗻𝘁𝘀 𝘄𝗲𝗿𝗲 𝗿𝗮𝗻𝗱𝗼𝗺𝗹𝘆 𝗮𝘀𝘀𝗶𝗴𝗻𝗲𝗱 𝘁𝗼 𝗼𝗻𝗲 𝗼𝗳 𝘁𝗵𝗿𝗲𝗲 𝗴𝗿𝗼𝘂𝗽𝘀: 👇

◼️ The Surgery Group: Received standard arthroscopic subacromial decompression.

◼️ The Placebo Group: Underwent a diagnostic arthroscopy, meaning doctors looked inside the shoulder with a camera but terminated the operation without performing the actual decompression.

◼️ The Exercise Group: Completed a progressive, individually tailored physiotherapy program supervised by specially trained physiotherapists.

◼️ Both the patients and the individuals collecting the data were blinded to who received the real surgery and who received the placebo.

◼️ Impressively, 87% of the participants completed the full 10-year follow-up.

𝗧𝗵𝗲 𝟭𝟬-𝗬𝗲𝗮𝗿 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: 𝗘𝘃𝗲𝗿𝘆𝗼𝗻𝗲 𝗚𝗼𝘁 𝗕𝗲𝘁𝘁𝗲𝗿, 𝗕𝘂𝘁 𝗦𝘂𝗿𝗴𝗲𝗿𝘆 𝗗𝗶𝗱𝗻’𝘁 𝗠𝗮𝘁𝘁𝗲𝗿 📊

◼️ After a decade of follow-up, the results yielded a surprising conclusion: all three treatment groups experienced substantial and sustained improvements in shoulder pain and function.

◼️ Most of this healing occurred within the first five years and was maintained through year ten.

◼️ However, when comparing the outcomes between the groups, the researchers found that the actual surgery provided absolutely no clinical advantage.

𝗦𝗽𝗲𝗰𝗶𝗳𝗶𝗰𝗮𝗹𝗹𝘆: ⚠️

◼️ No Difference from Placebo: There were no significant differences between the ASD group and the placebo surgery group regarding shoulder pain at rest or during arm activity.

◼️ No Difference from Exercise: The surgery group also did not experience better outcomes than the group that only performed exercise therapy.

◼️ Secondary Outcomes: Measurements for overall health-related quality of life, patient satisfaction, and shoulder function also showed no significant differences between the groups.

𝗧𝗵𝗲 𝗣𝗿𝗼𝗯𝗹𝗲𝗺 𝗼𝗳 “𝗠𝗲𝗱𝗶𝗰𝗮𝗹 𝗥𝗲𝘃𝗲𝗿𝘀𝗮𝗹” 🔄

◼️ Prior to this 10-year follow-up, eight different randomized controlled trials had already demonstrated that ASD provided no short- or medium-term advantages over placebo surgery or non-surgical management.

◼️ This new 10-year data decisively resolves any lingering clinical uncertainty, confirming that there are no hidden long-term benefits either.

◼️ Yet, ASD remains widely endorsed in certain clinical practice guidelines and is frequently performed worldwide.

◼️ The authors of the study highlight this as a classic example of “medical reversal”—a phenomenon where a medical procedure persists despite rigorous evidence proving it is ineffective.

◼️ The researchers note that the continuation of this surgery is likely sustained by entrenched professional beliefs, institutional inertia, and financial incentives.

𝗧𝗵𝗲 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆 🩺

◼️ The implications of this 10-year study are profound for both healthcare providers and patients.

◼️ The researchers strongly conclude that ASD should not be offered to patients outside of rigorously designed clinical trials.

◼️ Instead, a concerted effort toward “de-implementation” is necessary in routine care.

◼️ Moving forward, health systems, doctors, and patients should abandon this ineffective surgical route and prioritize adopting less burdensome, non-operative treatments like exercise therapy to manage subacromial shoulder pain.

Very interesting recent article about the relationship between the neck and jaw -- both biomechanically and symptomatically. Do you have TMJ pain that we can help you treat and get results? Call the clinic now at 503-244-6232.

𝗧𝗵𝗲 𝗛𝗶𝗱𝗱𝗲𝗻 𝗟𝗶𝗻𝗸 𝗕𝗲𝘁𝘄𝗲𝗲𝗻 𝗬𝗼𝘂𝗿 𝗡𝗲𝗰𝗸 𝗮𝗻𝗱 𝗝𝗮𝘄: 𝗛𝗼𝘄 𝗖𝗲𝗿𝘃𝗶𝗰𝗮𝗹 𝗦𝘁𝗮𝗯𝗶𝗹𝗶𝘇𝗮𝘁𝗶𝗼𝗻 𝗧𝗿𝗮𝗶𝗻𝗶𝗻𝗴 𝗖𝗮𝗻 𝗛𝗲𝗹𝗽 𝗧𝗠𝗝 𝗗𝗶𝘀𝗼𝗿𝗱𝗲𝗿𝘀

⬛ If you suffer from jaw clicking, restricted mouth movement, or pain in the temporomandibular joint (TMJ), you are not alone. TMJ disorders are widespread, with a prevalence ranging from 21.1% to 73.3% in the general population.

⬛ While traditional treatments often focus solely on the jaw itself, a fascinating 2025 randomized controlled trial published in BMC Musculoskeletal Disorders by Arslan et al. suggests that the key to alleviating TMJ symptoms might actually lie in your neck.

■■ 𝗧𝗵𝗲 𝗕𝗿𝗶𝗱𝗴𝗲 𝗕𝗲𝘁𝘄𝗲𝗲𝗻 𝘁𝗵𝗲 𝗡𝗲𝗰𝗸 𝗮𝗻𝗱 𝘁𝗵𝗲 𝗝𝗮𝘄

⬛ 𝗧𝗵𝗲 𝗕𝗶𝗼𝗺𝗲𝗰𝗵𝗮𝗻𝗶𝗰𝗮𝗹 𝗟𝗶𝗻𝗸

⬛ The cervical (neck) muscles are responsible for stabilizing your head and neck, which provides a solid foundation for controlled jaw movements like chewing, speaking, and swallowing.

⬛ Any biomechanical alterations in your neck posture can directly change how your TMJ positions itself and moves.

⬛ 𝗧𝗵𝗲 𝗡𝗲𝘂𝗿𝗼𝗽𝗵𝘆𝘀𝗶𝗼𝗹𝗼𝗴𝗶𝗰𝗮𝗹 𝗟𝗶𝗻𝗸

⬛ Trigeminal nerves (which serve the jaw and face) and cervical nerves (which serve the neck) converge in the brainstem at a site called the trigeminocervical complex.

⬛ Because these nociceptive (pain) signals integrate in the same place, pain and dysfunction in the neck can easily be referred to the jaw.

■■ 𝗧𝗵𝗲 𝗦𝘁𝘂𝗱𝘆: 𝗣𝘂𝘁𝘁𝗶𝗻𝗴 𝗖𝗲𝗿𝘃𝗶𝗰𝗮𝗹 𝗦𝘁𝗮𝗯𝗶𝗹𝗶𝘇𝗮𝘁𝗶𝗼𝗻 𝗧𝗿𝗮𝗶𝗻𝗶𝗻𝗴 (𝗖𝗦𝗧) 𝘁𝗼 𝘁𝗵𝗲 𝗧𝗲𝘀𝘁

⬛ The researchers set out to evaluate if adding Cervical Stabilization Training (CST) to standard TMJ treatment would yield better results for patients.

⬛ The study followed 30 participants aged 18 to 50 who were diagnosed with TMJ disorders, dividing them equally into a control group and a CST group.

⬛ Over the course of 8 weeks, both groups received a standard treatment program consisting of TMJ education and a home program of six specific jaw-targeting movements known as Rocabado exercises.

💪 ⬛ However, the CST group received an additional intervention.

⬛ Three times a week (one supervised session and two at home), they performed a 30-minute routine of cervical stabilization exercises.

⬛ This specific training targeted the deep neck flexor muscles using a pressure biofeedback unit (the Chattanooga Stabilizer) to ensure correct muscle activation.

⬛ The exercises progressed through neurodevelopmental sequences—moving from lying down to crawling and standing—and incorporated elastic resistance bands and exercise balls on unstable surfaces

■■ 𝗧𝗵𝗲 𝗦𝘂𝗿𝗽𝗿𝗶𝘀𝗶𝗻𝗴 𝗥𝗲𝘀𝘂𝗹

⬛ After 8 weeks, the researchers measured the participants' jaw pain, symptom severity, neck posture, neck mobility, and neck muscle performance.

✅ ⬛ 𝗦𝗶𝗴𝗻𝗶𝗳𝗶𝗰𝗮𝗻𝘁 𝗧𝗠𝗝 𝗮𝗻𝗱 𝗡𝗲𝗰𝗸 𝗜𝗺𝗽𝗿𝗼𝘃𝗲𝗺𝗲𝗻𝘁𝘀

⬛ Within the CST group, patients saw significant improvements in TMJ symptom severity, cervical posture (measured by the craniovertebral angle), cervical mobility in multiple directions, and overall neck muscle performance.

🏆 ⬛ 𝗦𝘂𝗽𝗲𝗿𝗶𝗼𝗿 𝘁𝗼 𝗦𝘁𝗮𝗻𝗱𝗮𝗿𝗱 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁

⬛ When compared directly to the control group (who only did standard jaw exercises), the CST group demonstrated significantly greater improvements in both TMJ pain intensity at rest and cervical muscle performance.

⬛ The control group, by contrast, only saw minor improvements in neck flexion and right lateral flexion, with no significant improvements in overall jaw pain or symptom severity.

■■ 𝗪𝗵𝘆 𝗗𝗼𝗲𝘀 𝗡𝗲𝗰𝗸 𝗦𝘁𝗮𝗯𝗶𝗹𝗶𝘇𝗮𝘁𝗶𝗼𝗻 𝗪𝗼𝗿𝗸 𝗳𝗼𝗿 𝗝𝗮𝘄 𝗣𝗮𝗶𝗻?

⬛ The researchers attribute the success of CST to a few key mechanisms.

⬛ By using pressure biofeedback to specifically target deep cervical flexor muscles (like the longus colli and capitis), CST helps normalize muscle activation patterns that are often dysfunctional in people with TMJ issues.

⬛ This targeted neck activation improves overall head and neck stability, which in turn reduces the compensatory overactivity of the jaw muscles via the trigeminocervical reflex pathway.

⬛ Furthermore, training these muscles across different functional positions (from lying down to standing) helps enhance motor control and proprioception throughout the entire neck-jaw unit.

■■ 𝗧𝗵𝗲 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆

⬛ While the researchers noted that larger studies with long-term follow-ups are needed to confirm how sustainable these results are, the clinical implications are clear.

⬛ If you are dealing with TMJ disorders—especially if you have concurrent neck pain or poor posture—jaw exercises alone may not be enough.

⬛ Integrating Cervical Stabilization Training into a comprehensive TMJ management program can significantly improve neck mobility, fix postural issues, and most importantly, help dial down the resting jaw pain that makes TMJ disorders so debilitating.

⬛ Clinicians treating TMJ should strongly consider evaluating the cervical spine and implementing deep neck flexor training to address the root of the dysfunction.

Breaking News! ERICK SEVERO graduated PT School yesterday and will start his career at Nick Rinard Physical Therapy this summer! He attained a Doctor of Physical Therapy (DPT) in addition to his BS in Health Sciences. We are very proud to congratulate ERICK on his amazing acheivement!

Referrals are not required to see a Physical Therapist.

If you are in pain, schedule your visit today.

Health Tips | Physician Referral Not Needed: You Can See a Physical Therapist First Seeing a physical therapist first, without a physician's referral, is allowed in the United States, and it is called direct access. Not only is it safe and effective, direct access can help you recover faster, among other benefits.

Nick Rinard Physical Therapy loves getting patients results!!

Nick Rinard is the best physical therapist I have ever experienced in my 87 years. Nick and his associates have kept me operational for at least 25 years. He knows exactly how to fix any problem no matter how challenging. Multiple back and leg difficulties have been conquered that have enabled me to ski for 60 years, without any surgeries.

The trick is to do your “homework”. That means doing the exercises he prescribes and the repetitions between appointments. That will keep office visits to a minimum. Then when the series of visits is complete, make those exercises a part of your daily routine.



AEM 3/22/2026

We can't post this situation enough.

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 Groundhog day!!

We cannot determine if there will be an early spring but we can help you decided if physical therapy is right for you!!

Schedule your evaluation today and we will tell you if you are a responder by the end of the week and if so get you results in 6 to 8 visits!

Nick Rinard Physical Therapy is here for you for six more weeks of winter.

Vertigo!! Get treatment at Nick Rinard Physical Therapy! Many times patients only need 1-2 visits!!

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.

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Nick Rinard Physical Therapy · Portland, OR 4.8 ⭐ · Physical therapist in Portland, Oregon

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