Tag: pain management

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

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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Smith Performance Center Tucson

How Long till My Rotator Cuff Pain Improves?

Prognosis and Outcomes in Physical Therapy One of the key differences in our practice compared to normal, insurance-based physical therapy is how we schedule our sessions.  We normally do a session once every week or two weeks. This developed as a result of our focus on the home plan including trigger management.  The second reason was how we started to use braces, tape, and training aids.     How do the anatomy and function of the rotator cuff impact physical therapy? What is my rotator cuff injury? How long till my rotator cuff injury is better?   Prognosis with a Rotator Cuff Injury In the first two parts of this series, we looked at the background information about the structure and function of the rotator cuff, the common types of Rotator Cuff injuries that lead to pain, and how to figure out what it is. With this final article, we would

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Physical Therapy Exercises

At Smith Performance Center, physical therapy exercises are used to maximize healing, build resiliency, reduce pain, and correct abnormal motor patterns. We do not use an endless array of exercises that would take an hour or two every day.  We understand more than one to two exercises mean compliance, and performance plummets. Our team wanted to put up common exercises we use to help you remember the form.  We have it broken up by body part and there is some cross-over, so you may see the same exercise in a few different categories. Let us know if you have any questions. Spine Chin Tuck Exercise   Isometric Activation Exercise   Self Massage for the Upper Trap   Self Massage for Posterior Shoulder   Suitcase Carry   Upper Extremity T Exercise   Y Prone Exercise   Serratus Plank   Lower Extremity Clamshell Exercise   Posterior Tibialis Exercise    

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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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Trigger Management Plan in Physical Therapy

Why physical therapy exercises are not enough to get you better?

What is a Trigger? We use the term trigger as a catch-all term for the activities and movements during the day that makes symptoms worse.  Trigger investigation is critical because they are the bane of feeling better. ​ The term, trigger, is an event that causes something else to happen.   You trigger the headache when you look over your shoulder. You trigger back pain when you move from sitting to standing. You trigger the shoulder pain when you reach for the shelf.   Sounds simple?  Unfortunately, determining all of the triggers to your symptoms is as difficult as it is important.   Why do we obsess on trigger management instead of building a huge list of physical therapy exercises? Imagine this scenario.  I am hitting a nail into the wall. Instead of hitting the nail, I manage to hammer my finger. I scream and drop the hammer.  Then I

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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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