pain - Smith Performance Center

Athletic woman holding her shoulder in discomfort, with a quote emphasizing how exceeding tissue capacity through high exercise demands can lead to recurring injury from exercise.

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

Craig Smith April 4, 2025

You’re Doing the Work—So Why Does Your Body Keep Breaking Down? You show up. You put in the effort. Whether it’s running, lifting, group fitness, or weekend hikes, you’re trying to stay active. But despite the commitment, you keep dealing with recurring injury from exercise. Pain shows up, progress stalls, and your body feels more unpredictable than it should. This isn’t about motivation. It’s about biology.The real issue is a mismatch between what you can make yourself do and what your body is built to tolerate. At Smith Performance Center, we call that gap the difference between exercise capacity and tissue capacity the rehab standard—and it’s one of the most overlooked problems in rehab and training. What Is Exercise Capacity? Exercise capacity is your ability to push through effort and accumulate work over time. It’s what most people think of as “fitness.” It includes: Exercise capacity reflects what you’re capable

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.

A clinician at Smith Performance Center performing manual therapy, assessing elbow range of motion. Hands-on assessment techniques help diagnose movement limitations and guide treatment

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

Craig Smith February 15, 2025

The Evolution of Thought Around Meniscus Injuries Clinical practice is filled with successes and failures. For some reason, failures tend to linger in memory the longest and often drive the biggest changes in how we approach patient care. A significant moment in my clinical career involved a meniscus tear, knee pain, and the need for surgery. One of the most impactful shifts in my approach to knee pain, particularly in cases involving meniscus tears, came from a repeated clinical pattern: patients improving, then regressing, over and over. This frustrating cycle forced me to rethink my process and align it with a more structured framework—one that incorporates the Smith Performance Center Phases. This helped me answer the question, “Does a meniscus tear require surgery, or can it be successfully rehabbed without going under the knife?” The Traditional View: Meniscus Surgery vs. Rehab For years, meniscus tears were considered a primary cause

Sean McConnell, a strength coach at Smith Performance Center, works closely with clients transitioning from physical therapy to strength training, ensuring safe and effective movement progression.

Breaking the Injury Doom Loop with Sean McConnell: Why the Right Support System Matters

Craig Smith February 14, 2025

Confidence is even more important than strength. People come in with doubt and fear of pain. If they don’t believe they can move safely, they won’t move at all. My job is to assess not just their movement, but also their psychological acceptance of movement. The best exercise is the one you can do, so we start small, monitor the response, and slowly build from there

Black and white photo of Kenny Sewall performing an elevated push-up at a gym station in Smith Performance Center, showcasing strength and form.

From Pain to Progress: Building an Exercise Habit After Injury

Craig Smith January 13, 2025

A perfect time to build the exercise habit occurs when you overcome a painful injury. At Smith Performance Center (SPC), this happens during the “activity progression” phase after stabilizing symptoms. Unlike a standard exercise routine, activity progression focuses on managing and improving tissue capacity—your body’s ability to handle physical load without pain or injury. If these terms sound unfamiliar, don’t worry. The following signs indicate you may have skipped the fundamentals of activity progression: Why Delaying Exercise Is a Mistake Many individuals delay exercise until they feel completely better. However, this approach has drawbacks: Your Path at SPC At SPC, we’ve developed a clear plan to help you build fitness while overcoming an injury. Here’s how it works: 1. Your Home Plan: Manage Symptoms and Flare-Ups The biggest hurdle to starting exercise is handling symptom increases. If daily activities cause large spikes in pain, your exercise plan must be carefully

A speaker at Smith Performance Center giving a lecture on exercise barriers and habit formation. The discussion covers evolutionary mismatch, injury risks, shifting barriers, and the gap between knowledge and action in fitness adherence.

The 4 Reasons Exercise is Hard to Start and Maintain

Craig Smith July 29, 2024

Starting an exercise program usually begins with a detailed look at your goals and a plan to achieve them. Showing up consistently is assumed. After decades in the health and wellness industry as a personal trainer, strength coach, exercise physiologist, and physical therapist, I’ve seen firsthand that the problem isn’t your goals, program structure, or knowledge of the importance of exercise. You already know regular exercise is crucial. Nor is the problem finding a place to work out, scheduling gym time, or getting the right equipment for home. The real issue is execution: showing up and doing the work. Exercise is hard to start. Exercise is hard to maintain. Why? There are four major reasons: Evolutionary Mismatch We did not evolve to exercise; we evolved to conserve calories. Our ancestors developed in an environment with limited access to calories. The body’s ability to conserve energy allowed humans to survive periods

The 10 Strategy Mistakes of Repetitive Injury When Exercising

Craig Smith December 14, 2023

Do you want to get back to exercise but keep on getting hurt? The merry-go-round misery of a repeatedly injured exerciser is a common complaint at Smith Performance Center. When someone shows up, our physical therapists listen to a series of injuries that seem to occur every time they get into a workout routine. The exerciser finishes rehab and heads back to their respective sport. The first few days go well, but inevitably the same problem comes back. In our clients’ minds, their body has lost the ability to stay healthy. They believe age is driving the problem, or the joints are shot. They think the activity they choose to do is too vigorous and must be replaced. These are not the problem. The cycle of repetitive injury is a strategic mistake. Returning to activity with a strategy We believe in a process called the SPC Phases. A phase at

The 7 Home Plan Mistakes Ruining Your Progress in Physical Therapy

Craig Smith November 27, 2023

Not all home plans are made the same. Home plans are therapeutic exercise lists that undergird your journey in physical therapy. Unfortunately, home plans can stall your progress. This happens for a variety of reasons – the home plan becomes an afterthought to your care, the physical therapist is overloaded with clients, the overuse of assistants, or too much of an emphasis on what is done to you by the practitioner versus what you can learn to do yourself. We see each of these situations when reviewing the histories of new clients with long-term injuries. The home plan is a critical component of your rehab plan in physical therapy. Our team regularly helps new clients who have been doing the same home plan from physical therapy for years which is not helping. This includes obvious mistakes like stretching an irritated nerve, overloading a painful joint with weight-bearing exercise, or making

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

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

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SPC Archives

Tag: pain

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

Triathlon Injury Rehab: How SPC Phases Prevent Setbacks

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

Breaking the Injury Doom Loop with Sean McConnell: Why the Right Support System Matters

From Pain to Progress: Building an Exercise Habit After Injury

The 4 Reasons Exercise is Hard to Start and Maintain

The 10 Strategy Mistakes of Repetitive Injury When Exercising

The 7 Home Plan Mistakes Ruining Your Progress in Physical Therapy

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

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

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