Pathology - Smith Performance Center

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

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

Craig Smith June 6, 2023

‘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

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

Craig Smith April 5, 2023

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

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

Craig Smith January 31, 2022

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

5 Steps To Develop A Diagnosis In Physical Therapy

Craig Smith September 2, 2020

“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

Knee Pain Meniscus Degeneration and Clinical Experience

Craig Smith September 1, 2020

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

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

Craig Smith August 31, 2020

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

Imaging & Pain

Craig Smith September 30, 2018

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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SPC Archives

Category: Pathology

What are the phases at Smith Performance Center?

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

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

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

5 Steps To Develop A Diagnosis In Physical Therapy

Knee Pain Meniscus Degeneration and Clinical Experience

Knee Pain and Physical Therapy: A Structured Approach to Recovery

Imaging & Pain

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Updates from Smith Performance Center

Understanding and Managing Flare-Ups During Rehabilitation

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

Triathlon Injury Rehab: How SPC Phases Prevent Setbacks