[5] Below Elbe, the river flows northwest through the foothills, passes near McKenna, Washington, and through Fort Lewis and the Nisqually Indian Reservation.

The Nisqually people were moved from the region surrounding the river after the signing of the treaty, settling on a reservation on Puget Sound east of Olympia.

After a period of resistance by the Nisqually tribe, including such leaders as Chief Leschi, a new reservation three times the size of the original was established on the river.

The bridges use a filled causeway to cross the delta that altered the river's course and contributed to increased flood risks in the basin.

Nisqually tribal members, acting in concert with the nearby Puyallup tribe, endured harassment and arrest to fish in traditional waters.