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Category: Physical Therapy

The Injury Types That Are Mismanaged During Activity Progression

Craig Smith August 1, 2023

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

Craig Smith June 22, 2023

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

Craig Smith June 14, 2023

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

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

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The Modified Low Dye

Craig Smith June 1, 2023

A physical therapy band-aid for foot pain during running Running-related injuries are commonly seen for physical therapy at Smith Performance Center. Unlike some of the advice, you may hear, stopping can prolong the problem.  Rest does not automatically equal recovery or resolution of an injury.  A nice tool to consider learning is the modified low dye.  It can help to reduce foot and lower leg pain while allowing you to continue training. Where is it from? I learned about the modified low dye from Dr. Tom McPoil.  He is faculty at Regis University and was previously faculty at Northern Arizona.  He is an expert on the foot and wrote an article on tissue stress theory that still impacts my practice today.  The purpose of the modified low dye in a physical therapy program is to limit stresses to the tissue of the lower leg and foot to allow desensitization. In

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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

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

Craig Smith January 31, 2023

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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5 Treatment Options to Reduce Knee Pain without Surgery, Injections, or Drugs

Craig Smith January 30, 2023

We treat intractable knee pain on a daily basis. Our process is called the PT Solutions Treatment Hierarchy. The treatment hierarchy allows our team to support the diagnosis, reduce pain, and create a clear home plan. Building a treatment framework is a critical component of the plan and it changes based on the key sign, the structural diagnosis, and the trigger management plan.  For example, a person with an anterior horn meniscus lesion, we would first normalize painful end range extension of the knee.  Once passive extension is pain free, we would start to load their leg with the activity that normally hurts, providing them an exercise like terminal knee extension with the band that will keep their knee extension pain free.  Finally we would dig through all of their daily activities that cause symptoms like fast walking or going downhill and stop them from doing it to allow healing.

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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

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5 Rehab Mistakes and How to Solve Them

Craig Smith December 5, 2020

The majority of our patients have been treated somewhere else first without improvement. When we review their case, similar process mistakes happen over and over again. Lack of diagnosis (Mistake #1) or telling a patient to just stop the activity that hurts (Mistake #4) leads to more problems and eventually to a life of inactivity. Our passion as a company is to keep moving for a lifetime and the number one reason people stop or don’t even start an active lifestyle is pain and injury. Understanding these common mistakes can help you become a better consumer of rehab services and get better faster with longer-lasting results. The end result is the ability to do the day you want. The 5 rehab mistakes and their solutions The mistakes below are strategic errors: Mistake #1: Not Defining The Problem And Possible Problems Causing Pain Mistake #2: Confusing a Single Treatment as the Solution Mistake

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