Patient experiencing a rehabilitation flare-up with physical therapist support and quote about mastering symptom management

Understanding and Managing Flare-Ups During Rehabilitation

Craig Smith May 5, 2025

During recovery, there comes a pivotal moment when symptoms improve, and the client feels like they’ve turned a corner. Life feels good again, and naturally, activity levels increase. This change is often unconscious or unintentional—but its consequences can be significant. A rehabilitation flare-up is defined as a return or increase in the original symptoms that led the patient to seek care. The natural reaction to a flare-up is often to question whether the real problem is being addressed. Read: the diagnosis is wrong. But this reaction can lead to a critical misstep—focusing on the wrong issue and missing an opportunity for patient empowerment. Diagnostic Errors vs. Rehabilitation Flare-Up Mismanagement Achieving the correct diagnosis involves identifying potential tissue pain generators, noting local and regional contributors, considering central modulation, and uncovering triggers. This process requires careful collection, analysis, and prediction. And there can be many reasons that diagnosis is hard, but once

Triathlon Injury Rehab: How SPC Phases Prevent Setbacks

Craig Smith April 3, 2025

Recurring injuries derailed Alex’s triathlon training for years—until he adopted a structured, phase-based rehab approach. This case study shows how the Smith Performance Center Phase System helped him move from chronic pain to consistent performance by focusing on what most athletes overlook: building tissue capacity to match training demands.

Optimizing Your Strength Training: The Role of Open Clinics at Smith Performance Center

Craig Smith November 17, 2023

At Smith Performance Center (SPC), our primary aim is to facilitate a healthy and active lifestyle for all our members. One of the tools we employ to overcome potential barriers to consistent exercise is the utilization of open clinics, which play a crucial role in addressing pain and injuries. An open clinic session lasts for 15 minutes and serves four primary purposes: The genesis of the open clinic concept dates back to January 2018 at Smith Performance Center. Initially conceived as a space for members to report new injuries, discomfort, or movement issues, these sessions soon became integral to our strength training approach. On the first weekend, our physical therapist triaged six people. Now after five thousand sessions, we recognize their significance in supporting a healthy lifestyle. Why do open clinics matter? Injury prevention, often a cornerstone in healthcare and fitness, presents challenges. Being active inherently involves a degree of

7 Key Reasons Why the Home Plan Is Vital for Success in Physical Therapy

Craig Smith November 17, 2023

The significance of the home plan often gets overshadowed by in-session treatment. At Smith Performance Center, our physical therapy sessions are one hour per week with your therapist. You are responsible for the other 167 hours. Due to this, the home plan is a vital component of your physical therapy journey, capable of either propelling your progress or impeding it. It’s not uncommon for our team to encounter new clients who’ve stuck to the same ineffective home plan for years, making errors like stretching an irritated nerve, overloading painful joints, or handling an extensive plan that goes largely undone. These missteps tend to patients undervaluing the home plan. However, the home plan stands as a linchpin for your success. We want to explain the 7 key reasons why the home plan is vital for success in physical therapy. Ensuring We Target the Right Problem There are instances where immediate relief

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

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?

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

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

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.

Welcome to the

SPC Archives

Category: Physical Therapy

Understanding and Managing Flare-Ups During Rehabilitation

Triathlon Injury Rehab: How SPC Phases Prevent Setbacks

Optimizing Your Strength Training: The Role of Open Clinics at Smith Performance Center

7 Key Reasons Why the Home Plan Is Vital for Success in Physical Therapy

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

What are the phases at Smith Performance Center?

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

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

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Updates from Smith Performance Center

How to Find the Real Cause of Pain: Our 4-Pillar Diagnosis Process

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

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