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Category: Pathology

A circular diagram illustrating the “Hamstring Tightness Doom Loop.” It shows how stretching the hamstrings provides brief relief through nervous system inhibition, but leads to post-stretch soreness, increased tightness, and a repeated cycle of stretching that worsens sensitivity.

Why Your Hamstrings Hurt After Stretching (and What’s Really Going On)

Stretching is supposed to make your hamstrings feel better—looser, lighter, more flexible. So why are you experiencing only temporary relief at best—and often feel even more sore after stretching? There’s a deep cultural belief in the power of stretching to reduce pain, improve mobility, and prevent injury. The support for those claims is, at best, inconsistent or non-existent. 1,2 If you’ve found this article, you’ve likely noticed a pattern yourself: every time you stretch your hamstrings, they get worse. At Smith Performance Center, we see this pattern constantly. The sensation of “tight” hamstrings is rarely about flexibility—even in those with limited motion. We hear people complain of tightness in tissue disorders that actually cause more motion than normal.  More often, it’s a protective signal that something is off in how your system is moving, processing information, or managing load. In this article, we’ll walk through what actually causes post-stretching soreness

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Close-up of a foot highlighting the big toe with a labeled list of differentials: joint, tendon and intrinsic, nerve, and systemic or referrals — representing possible causes of big toe pain.

Why Big Toe Pain Keeps Coming Back (and Why It’s So Hard to Fix)

Case Study: The Dancer With Recurrent Big Toe Pain A former college dancer came into the clinic frustrated. She’d stopped dancing years ago, but every time she returned to even basic classes, her big-toe pain spiked. She tolerated hiking in her stiff boots, a little pain but nothing that stopped her — yet one night of dancing, and she’d hobble for a week with a throbbing big toe. Her frustration was visible, and the best advice she’d heard—stop dancing—wasn’t one she wanted to follow. Her last visit with a podiatrist ended with an injection that helped for about a week before the pain returned. She started to believe her big toe would never handle the way she moved in college.  There didn’t seem to be a path forward. Her experience—the fake improvement with time off, followed by a big flare when she tries to get back to what she loves—mirrors

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Visual diagram showing the journey through the Smith Performance Center system, including clinical phases of rehabilitation, activity progression, and performance development. Highlights each stage a patient moves through from initial injury to independent training and long-term success.

What are the phases at Smith Performance Center?

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

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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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diagram showing heel pain in Tucson caused by different structures in the foot including the plantar fascia and flexor digitorum brevis

7 Signs Your Heel Pain Isn’t Plantar Fasciitis (and What’s Really Causing It)

If you’re dealing with heel pain in Tucson that hasn’t improved despite treatment for plantar fasciitis, you’re not alone. At Smith Performance Center, we often see people who’ve tried injections, stretching, shoe inserts, and ice bottles—yet their heel still hurts. In many of these cases, the real problem isn’t the plantar fascia at all, but a muscle on the bottom of the foot called the flexor digitorum brevis. 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 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

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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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Smith Performance Center Tucson

Knee Pain Meniscus Degeneration and Clinical Experience

  How do you manage knee pain with a meniscus tear?   Meniscectomy, sham surgery, and clinical experience avoiding surgery for pain and function Clinical practice is filled with successes and failures. For some reason, the failures are the thing you remember most and for me, lead to the biggest changes in practice.  The patient that never feels better will never quite leave your mind even when you go home from work.  Knee pain and Meniscus Tear – Round 1 Since my main interest has always been the lower extremity, specifically the foot, ankle, and knee pathomechanics and pathology, I wanted to be the best at rehabbing these injuries right off the bat. My failure with a patient suffering from chronic knee pain led me to the literature surrounding meniscal surgery. The patient reported sharp pain with occasionally catching in the knee joint. The joint had mild joint effusion and

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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.

Knee Pain and Physical Therapy: A Structured Approach to Recovery

  Updated by Craig Smith February 22, 2025 Understanding Knee Pain: Why Won’t It Go Away? Knee pain is a common and persistent problem that affects daily life. Whether you’re avoiding stairs, switching from running to biking, or waiting for a knee replacement, chronic knee pain can disrupt your routine. And it is more complicated than we often admit or see online. At Smith Performance Center, we believe that effective knee pain treatment requires more than just exercises or quick fixes—it needs a structured plan. This is where our SPC Phases come into play. Our phase-based system ensures that each step of rehab is intentional, guiding patients from pain relief to long-term performance. This article explores why knee pain occurs, how physical therapy should address it, and what steps you can take to regain control over your movement. Why Is Knee Pain So Common? The knee may seem like a

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Smith Performance Center Tucson

Imaging & Pain

In the clinic, we get a lot of questions about pain because it is the main reason people walk through the door.  Today I am going to go through a brief review of pain and imaging. Imaging refers to radiographs (x-rays), MRIs, and CT scans. These are typically used to help a medical provider determine what is causing the pain and the best intervention to resolve the problem.   What do we know?  Numerous imaging studies ranging from the knee to the low back show that the level of pathology cannot predict a person’s pain experience.  We cannot predict pain, the level of disability, or long-term activity based on an image.  Individuals with chronic low back pain have been compared to those with no back pain.  The findings on the imaging do not show consistent differences between these two samples.  For example, a woman with nasty, limiting pain may show

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