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

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 Big Problems Facing Clients with Pain and Injury Who Want to Get Back to an Active Lifestyle

Craig Smith September 1, 2023

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

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

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

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

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

The 8 Reasons All HHP Clients Go Through a Movement Assessment

Craig Smith April 12, 2023

The Smith Performance Center team wants to be the best in the world at helping clients who want to maintain an active lifestyle. If you search the internet, this seems like a simple problem to solve. Just do this exercise or make sure to have protein after a workout. Problem solved. This has not been our experience. There is an entire area of research devoted to what behaviors keep people moving and what makes them stop. Keeping people active is not simple and there are numerous reasons why a person will stop. The purpose of the movement assessment is to figure out issues that will stop you from moving. There are clues in your history, how you move, how you hurt, and how you think that will help guide us. Here are the 8 reasons we do the movement assessment: Figure out what may lead to failure Determine the right

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

5 Steps To Develop A Diagnosis In Physical Therapy

Craig Smith September 2, 2020

“My butt hurts.” A significant proportion of my conversations start with this statement. She continued, “ I have regular active release along with dry needling. I stretch my hamstring ALL THE TIME and I still have pain.” Her frustration was palpable. “I know I have a tight hamstring and there is scar tissue. But it’s been 8 months.” She assumes the pain must be the hamstring; we call this the pain generator. The hamstring tendon attaches right where her pain starts. The tightness is over the hamstring muscle belly. She describes the pain in a clear way that implicates the hamstring. She made a convincing argument that the hamstring is the issue and the diagnosis has been repeated by multiple medical providers including a physician and two physical therapists. The location matched. Running increased the pain. Another match. Stretching and manual therapy provided temporary relief. But 8 months into the

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SPC Archives

Tag: Rehab Process

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

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

The 5 Big Problems Facing Clients with Pain and Injury Who Want to Get Back to an Active Lifestyle

The Injury Types That Are Mismanaged During Activity Progression

7 Tools to overcome invisible triggers stalling your rehab progress

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

Four Reasons Why Patient Forms Help Improve Your Care During Your Rehab Process

The 8 Reasons All HHP Clients Go Through a Movement Assessment

5 Rehab Mistakes and How to Solve Them

5 Steps To Develop A Diagnosis In Physical Therapy

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Updates from Smith Performance Center

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

Understanding and Managing Flare-Ups During Rehabilitation

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