Craig Smith

5 Reasons You May Struggle To Get A Diagnosis And The Right Treatment At Physical Therapy

Craig Smith November 16, 2023

Upon your arrival at Smith Performance Center, our primary goal is to comprehensively understand the source of your pain or symptoms. Our physical therapists initiate this by gathering information through a medical history form, conducting interviews about your experiences, performing thorough examinations, creating an initial list of potential diagnoses, validating our hypotheses through treatment, and finally, devising an initial home plan. This phase in our rehabilitation process is aptly termed ‘Diagnosis and Home Plan Development’. While not a creative title, it encapsulates the process our team undertakes. A workable diagnosis is pivotal. However, arriving at a diagnosis can be challenging due to various reasons. These complexities range from the diverse causes of pain (such as injury, inflammation, nerve-related issues, sensitization, psychogenic factors, and dysfunctional conditions) to individual-specific challenges. Patients may struggle to explain their experiences, while others may not show rapid responses to treatment due to the absence of a

The 4 Primary Goals In Strength Training When Struggling With An Injury or Pain

Craig Smith November 7, 2023

Goal setting is one of the most important, yet tricky aspects of training. Our team believes that goals are secondary to developing habits and systems that you can do day in and day out. We call this an exercise habit and it is a critical aspect of becoming an exerciser. However, goals can help to shape your training, increase motivation, and improve decision-making during the course of workouts. When you are returning from an injury or dealing with a particularly irritating pain, we believe your goal is very specific. You need to exercise without your body feeling terrible. While this sounds obvious, one of the most common training mistakes our coaches see clients make is too much focus on performance while ignoring a recurring injury or pain. If you have pain during your running, biking, lifting, etc., you will not achieve performance goals. We strongly believe there are 4 goals

What are the phases at Smith Performance Center?

Craig Smith November 6, 2023

At Smith Performance Center, we focus on the main problem of the client. This focused process revealed a recurring set of problems that many of our clients experienced. This led to an overall process we call SPC Phases. There are 5 phases for our clients at Smith Performance Center: Diagnostics and Home Plan Development, Symptom Stabilization, Activity Progression, Exercise, Maintenance, and Monitoring, and Maximize Performance. Each phase consists of a main problem, the common challenges experienced by the clinician, coach, and client when managing your problem, steps to achieve along the way, and a promise for what you get when you complete the phase. We believe a clear process matters to your overall success. We want to explain the problem, common challenges, steps to achieve, and the promise. The Focus On A Problem The focus of a phase is the problem being solved. In Diagnosis and Home Plan Development, we

The 4 Unique Training Variables Used By Our Team To Improve Workout Success

Craig Smith October 12, 2023

Creating a single, hard workout is easy. Creating a series of workouts that improve your overall fitness is not. Creating a true program that builds your skill set, builds your confidence, and adjusts for soreness or an emerging injury is extremely difficult. In the same vein, it is not hard to develop a physical therapy exercise list that targets a single problem, like glute inhibition. It is much harder to progress post-injury using strength training when we need to push the edge of the tissue capacity. Programming a workout needs to consider numerous, modifiable variables. Remember a modifiable variable is anything you can change in the workout to optimize the training session and the overall programming scheme. At a minimum, you need to consider intensity, sets and reps, rest intervals, frequency of workouts, and supersets. The minimum however does not optimize your workout and sometimes these are not the most

Craig Smith, PT, DPT, conducts a knee exam at Smith Performance Center, demonstrating expert physical therapy techniques in knee pain assessment, rehabilitation, and injury recovery while flexing his arm in a lighthearted moment.

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

Physical therapy quality is highly inconsistent between clinicians, clinics, and companies. Numerous factors play into these discrepancies, including clinical process, management structure, payment models, clinician-patient time, use of assistants, patient load, clinician training, and business models. These issues often culminate in underwhelming rehabilitation outcomes for clients. When embarking on a rehab journey, most patients don’t anticipate these issues. As Sarah Smith, PT, DPT, and co-founder of Smith Performance Center, observes: “Many patients don’t know where to start their rehab journey, and physical therapy is often not their first choice.” Choosing a clinic that treats 25 patients daily with heavy use of assistants is vastly different from one that sees six patients daily with dedicated one-on-one time. Blending the art and the science of physical therapy requires more than most patients realize. From our experience, three key areas drive these differences: Process, Patient-Provider Relationship, and Clinical Skill. Clinics that avoid assistant

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

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SPC Archives

Author: Craig Smith

5 Reasons You May Struggle To Get A Diagnosis And The Right Treatment At Physical Therapy

The 4 Primary Goals In Strength Training When Struggling With An Injury or Pain

What are the phases at Smith Performance Center?

The 4 Unique Training Variables Used By Our Team To Improve Workout Success

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

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Updates from Smith Performance Center

Tissue Capacity vs. Exercise Capacity: Why Most People Miss the Mark

Triathlon Injury Rehab: How SPC Phases Prevent Setbacks

Meniscus Tears & Knee Pain: Why Rehab Needs More Than Just Cutting Out the Problem