September 2023 - Smith Performance Center

Total Knee Case Study: Why You Need A Structured Rehab Process

Craig Smith September 29, 2023

A structured rehab process that ultimately targets a full return to activity is missing in healthcare. Patients struggling with pain are treated as if they are all the same. We believe there are common, big problems to address, but there is a high degree of uncertainty with every patient presentation. Even when a patient has the same diagnosis they can have different triggers, different contributing factors, different behaviors, and drastically different needs in the rehab process. This is true when patients have the same surgery by the same surgeon. Let me use an example with a straightforward rehab plan; post-total knee replacement. The Painful Total Knee Replacement Peter Pain had a total knee replacement. He has always been active and handles pain well but this replacement has been horrible. First, he fell behind on medication post-surgery because he hated the way the drugs made his stomach feel. The second day

The 5 Common Modifiable Variables For Programming A Great Workout and Program

Craig Smith September 28, 2023

There are numerous modifiable variables in an exercise program that you can use to improve your workout experience, increase effectiveness, and make the workout more fun. A Modifiable Variable is anything you can manipulate in a workout program (which is literally everything) to change the challenge. It includes exercise choice, movement patterns, exercise pool, alternative exercises available, sets, reps, intensity, rest breaks, prep exercises, warm-up, exercise order, recovery activity, support exercises based on body response, and workout frequency. Our Team believes the most important initial modifiable variable is exercise choice, which is often not used well. This is one of the reasons we start with a movement assessment. But all of these variables are important and have a huge impact on your experience and the likelihood of success with developing an exercise habit. Our team targets these variables beginning in activity progression and it remains a critical aspect of training

When and where you feel foot pain during walking is key for diagnosis

Craig Smith September 27, 2023

When and where you experience foot pain during walking is diagnostic. This means we can figure out the pain generator. That is a large list. It can be the fat pad, your fascia (the most common, incorrect diagnosis), plantar intrinsics (muscles on the bottom of the foot which is primarily the flexor digitorum brevis, abductor hallucis, and abductor digiti minimi), the flexor hallucis longus, the tibial nerve, the medial or lateral plantar nerve, the calcaneus, the talus, the bones of the midfoot and forefoot, the foot and ankle joints, ligaments, the hallux (big toe), or the little toes. It does not include referral into the foot from your low back or hip. With the foot, we know when the different structures that can cause pain are loaded during walking and we know that the location of pain is likely where the pain generator resides because of the higher receptor field

What are the 3 major issues in physical therapy and exercise?

Craig Smith September 25, 2023

The quality of physical therapy is not consistent between clinicians or clinics. There are numerous reasons causing the differences: the overall rehab process, the management, how the client pays for the service (insurance, Medicare, cash, etc.), the time available between the clinician and patient, the use of assistants, the number of patients per provider during an hour, the clinical skill set, and training of a specific physical therapist. This is far from an exhaustive list. These issues result in a pervasive underperformance in rehab outcomes for clients. The 3 major issues in physical therapy and rehab When starting out on a rehab journey, you will not think about these problems – you just want to feel better. But these issues matter and directly impact your outcome. The major issues in physical therapy fall into 3 critical areas: Process, Patient-Provider Relationship, and Clinical Skill. Together, these drive the difference in experience

The 5 Most Useful Tools for Progressing Your Workouts After an Injury

Craig Smith September 19, 2023

Too many fail in their effort to progress activity after an injury. You arrive at the gym feeling good but later in the day the low back soreness that has been feeling better comes back or the knee pain that seemed to be going away comes back with a vengeance after your second run. The regression happened even when the workout felt easy and pain-free at the time. Why is this happening? Why is this phase of rehab frustrating? It’s due to a fundamental mistake or what we call a violation of the rehab standard, which is training at exercise capacity, not tissue capacity. When individuals make this mistake, they start telling themselves stories like ‘I am getting too old,’ or ‘I guess I need to do something with less impact.’ However, the problem is not due to aging or the fact that the body can return to preinjury levels.

The 7 Tissues to Consider When Progressing Activity After Physical Therapy

Craig Smith September 18, 2023

The Rehab Standard is an SPC concept that defines when a client has a higher exercise capacity than tissue capacity. When your tissue capacity is lower than the exercise capacity, the focus of the workout is not how hard you worked out. It is not how much you sweat or how good of a muscle burn you got. The focus is on the healing tissue and that is was not overloaded, irritated, or provoked. A violation of the rehab standard can present as pain after the workout or the next day, even if there was no pain during the workout. The key is to focus on tissue capacity in the exercise selection, intensity, volume and the type of tissue injured. We want to look at this last one, the type of tissue injured, in relation to activity progression following an injury. The 7 Tissues to Consider When Progressing Activity Improving

The 5 Big Problems Facing Clients with Pain and Injury Who Want to Get Back to an Active Lifestyle

Craig Smith September 1, 2023

There are numerous problems facing people in living an active, healthy life, but it can be difficult to articulate the problem that needs to be solved. Let’s look at two people dealing with low back pain. One person bent over this morning to grab a pencil and now cannot stand up straight. The second person developed back pain years ago and stopped doing certain movements because of discomfort. The pain is still present daily and they use a combination of meds, massage, and chiropractic to keep big flares up away. Their problems are different despite both dealing with low back pain. The solutions are very different. The person who just hurt their back needs a diagnosis and a home plan targeting healing strategies and triggers. This may mean more frequent visits and removing anything that makes their symptoms worse. We will likely see this person a few times per week

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SPC Archives

Month: September 2023

Total Knee Case Study: Why You Need A Structured Rehab Process

The 5 Common Modifiable Variables For Programming A Great Workout and Program

When and where you feel foot pain during walking is key for diagnosis

What are the 3 major issues in physical therapy and exercise?

The 5 Most Useful Tools for Progressing Your Workouts After an Injury

The 7 Tissues to Consider When Progressing Activity After Physical Therapy

The 5 Big Problems Facing Clients with Pain and Injury Who Want to Get Back to an Active Lifestyle

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