Category: Physical Therapy

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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When and where you feel foot pain during walking is key for diagnosis

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

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What are the 3 major issues in physical therapy and exercise?

The quality of physical therapy is not consistent between clinicians or clinics.  There are numerous reasons causing the differences: the overall rehab process, the management, how the service is paid, the time available between the clinician and patient, the use of assistants, the number of patients per provider during an hour, the clinical skill set and training of a specific physical therapist. This is far from an exhaustive list.  These issues result in a pervasive underperformance in rehab outcomes for clients. The 3 major issues in physical therapy and rehab When starting out on a rehab journey, you will not think about these problems. The major issues in physical therapy fall into 3 critical areas: Process, Patient-Provider Relationship, and Clinical Skill. Together, these drive the difference in experience and outcomes for a patient. For example, if one physical therapy clinic does not use assistants, monitors the clinical performance of their

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The 5 Most Useful Tools for Progressing Your Workouts After an Injury

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.

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The 7 Tissues to Consider When Progressing Activity After Physical Therapy

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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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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The Injury Types That Are Mismanaged During Activity Progression

The rehab standard is simple; the limit to your exercise is not how hard you can work out, but rather working as hard as possible without going past your tissue capacity.  Our team sees violation of the rehab standard as the most frequent cause of failure during activity progression. A client will feel great and start to progress their workouts. There is no symptoms during the exercise and often no symptoms the same day, but the next day they feel horrible.  We know that in activity progression, you need to understand the type of tissue that is healing, the specific exercise, and volume. We also need to consider the type of injury: chronic, recurrent, and acute.  Chronic Injury For chronic, we mean is has been present for a long time. When you have a chronic injury or chronic pain, there are two issues: your exercise capacity is lower because it

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7 Tools to overcome invisible triggers stalling your rehab progress

An invisible trigger is a problem that can stop you from fully healing. An invisible trigger is an action or activity that does not seem to be causing your injury to worsen but is actually causing your injury to remain and not heal properly. During the course of treatment, our team comes across this problem frequently when a patient will seem to stop progressing in their rehab plan. This problem presents most often during the symptom stabilization and the activity progression phases.  The physical therapist will see an improvement in symptoms during a session, but then progress is lost when the patient tries to manage the symptoms on their own. During activity progression, there is often an interaction between the activity being progressed and normal daily activities. Do you have this problem? If you say yes to the following, an invisible trigger is not being addressed. Pain keeps returning when

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The 5 Components of Invisible Triggers That Cause Your Rehab Progress to Stall

You keep getting close to feeling good but then fall back into an injury because of a common, but often unrecognized issue – invisible triggers. An invisible trigger is an action or activity that does not seem to be causing your injury to worsen but is actually causing your injury to remain and not heal. If you slammed your finger into a door, you would know the door caused your pain.  Continuing to slam your finger in the door will cause the finger pain to remain. In contrast, an invisible trigger is not as clear as slamming your finger in a door. Patients have an easier time eliminating obvious triggers. This does not happen with invisible triggers. An example would be low back pain triggered by an interaction between two activities: running followed by a bout of sitting. When we investigate running by itself, there is no problem. We repeat

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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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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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