Category: Diagnosis and Home Plan Development

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

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

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

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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Four Reasons Why Patient Forms Help Improve Your Care During Your Rehab Process

‘Not all relevant outcomes can be assessed with a device, a laboratory test, a physical finding or some other data gathering independent of the patient’s perception and voice.’ -Kroenke, Monahan, and Kean 2016 We want to share with you how filling out patient forms is not only useful to our team but also critical for receiving the best care. In the ranking of where you want to spend your time, completing forms for a medical visit is just above a tooth extraction. The act is mind-numbing. Partially due to the perceived lack of benefit and partially because you know the healthcare provider isn’t using it. They will even ask the same questions that were already answered in the form.  Our team would like to change your mind on this by showing how we use your forms to impact your care – the why, how, and when. There are three clear

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The 5 Patient Responses That Should Impact Your Physical Therapist’s Strategy

In a session, the first rule as a practitioner is to make sure we do not lie to ourselves about what’s happening, and lying to ourselves is the easiest thing to do. We can lie to ourselves when we make errors in reasoning due to a plethora of cognitive pitfalls like confirmation or optimism bias, overconfidence, or mistaken availability heuristics. This can ruin the chances of a great outcome if I only search for facts that confirm my dominant theory, or if I want the patient to have a great response so I ignore portions of the medical history that would lead me to a think of worse prognosis. These cognitive errors ‘help’ me to lie to myself. One solution is to get very clear on what the patient is reporting. There are only 5 patient responses in the session: great, good, bad, terrible, and no response. Certain pathologies readily

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4 Ways Individuals With Heel Pain Can Make Their Pain Go Away

Why is your heel pain not getting better? Heel pain is a common, painful foot condition leading internet searches for “cures to heel pain” or “treatments for plantar fasciitis.” The pain resolves with time if the cause of symptoms is removed, but up to 10% of individuals with heel pain do not get better. These chronic sufferers try everything to get rid of the pain including plantar fascia releases, injections, and pain medications. The causes of heel pain are numerous, ranging from plantar tendinopathies like the flexor digitorum brevis, nerve involvement with tarsal tunnel syndromes or lateral plantar nerve, low back referrals, and double crush syndrome to fat pad injuries. The answer is not more stretching and new orthotics. If you are stuck with heel pain and the typical treatment for plantar fasciitis is not making you feel better, then you likely have a different problem and require a different

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7 Signs Your Heel Pain Is Not Coming From Your Plantar Fascia

Seven Signs the Flexor Digitorum Brevis is causing your heel pain NOT the Plantar Fascia You wake up, swing your legs to the edge of the bed, and…hesitate. You know this is going to hurt. The good foot moves to the ground first – you learned from that mistake over a month ago.  You brace and put down the other foot, the ungrateful one that will not get better despite the trip to the podiatrist, the injection, physical therapy, the shoe inserts, the ice bottle massage, and the stretching exercises. The foot touches down.   It’s not so bad, you think ‘those stretches and night socks are helping!’ Then you step and the sharp pain feels as if the tissue from the back of the heel is ripping apart. You think to yourself, this plantar fasciitis won’t go away, as you force your leg forward and take the next step and the next

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5 Steps To Develop A Diagnosis In Physical Therapy

“My butt hurts.” A significant proportion of my conversations start with this statement. She continued, “ I have regular active release along with dry needling. I stretch my hamstring ALL THE TIME and I still have pain.” Her frustration was palpable. “I know I have a tight hamstring and there is scar tissue.  But it’s been 8 months.” She assumes the pain must be the hamstring; we call this the pain generator.  The hamstring tendon attaches right where her pain starts. The tightness is over the hamstring muscle belly.  She describes the pain in a clear way that implicates the hamstring.   She made a convincing argument that the hamstring is the issue and the diagnosis has been repeated by multiple medical providers including a physician and two physical therapists. The location matched.  Running increased the pain. Another match. Stretching and manual therapy provided temporary relief. But 8 months into the

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Craig Smith

Craig Smith

BUSINESS Craig Smith is the co-owner of Smith Performance Center. He founded SPC with Sarah Smith in 2015 with a mission to provide the Tucson community with the support and tools to manage their health and stay active for life. He is a partner with Evolve Flagstaff. Founded in 2017, Evolve brings together gym, physical therapy, nutrition, and meal preparation services to support the Flagstaff community. Craig Smith founded Amptimum with Ryan Seltzer in 2020. Their mission is to unleash the clinical skill set of allied health professionals by developing documentation mastery, patient management processes, and robust analytics. WORK As a physical therapist, Craig is interested in physical therapy concepts with clinical application, PT diagnostic methodology, innovative healthcare solutions, and team-based practice. He specializes in lower extremity care, gait analysis, and physical therapy. As clinical director, Craig works to develop a shared framework for his physical therapy and coaching team. The shared framework, called PT Solutions and the HHP Program, is carried out daily with hundreds of patients and members. As a consultant, Craig works with allied health professionals to understand their clinical processes. This focus allows for clinicians to optimize their operations and to improve their clinical outcomes, train new staff, and reduce the burden of practice. AWARDS Craig graduated from NAU with distinction and was awarded the Distinguished Graduate for the Department. He graduated with honors from the University of Nebraska at Kearney and was awarded the Outstanding Major of the Year in Exercise Science by NAHPERD. Most recently, he was awarded the Excellence in Achievement from Northern Arizona by the NAU Alumni Association in 2020. RESEARCH Craig has presented research at the American Society of Biomechanics National Conference, the American College of Sports Medicine Annual Meeting, and the National NEXT conference along with numerous local and regional meetings on topics surrounding injury screening and prevention. He has publications in the Journal of Strength and Conditioning Research, Journal of Athletic Training, Journal of Orthopedic and Sports Physical Therapy, Medicine and Science in Sports and Exercise, Journal of Sports Medicine, and Lower Extremity Review. Craig and his colleagues, Dr. Warren and Dr. Chimera, were selected as one of the “Best Clinic Case/Research Submissions” at the 60th Annual Meeting and 4th World Congress on Exercise is Medicine of the American College of Sports Medicine.
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