Tag: Strategy

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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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 6 Functional Exercises Tested During a Movement Assessment

A mistake in exercise programming that our team encounters is a heavy emphasis on variety in exercise, instead of movement pattern mastery. Our team does not focus on an endless array of exercises. The focus is on building depth in foundational movement patterns. These patterns make up every movement you perform when lifting. If these foundational movements are missing, advanced exercises will be wasted on poor form. You need to own the basic movements first. During the movement assessment, the 6 foundational movement patterns are assessed with 6 functional exercises from each movement pattern category. The movement assessment is where our strength coaches determine what may cause issues in your program: accountability, rehab standard, location/time, coaching need, and comfort level. The 6 functional exercises help our coaches determine your coaching need, if you have a tissue capacity issue (rehab standard), your comfort level with free weights, and what is the

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The 8 Reasons All HHP Clients Go Through a Movement Assessment

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

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The 5 Patient Responses That Should Impact Your Physical Therapist’s Strategy

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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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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5 Rehab Mistakes and How to Solve Them

What can you do for your pain? You have pain. You may ache from sitting for work, or walking or moving from sitting to standing. You may get headaches that creep from the back of your head to your eyes or wake up with your neck kinked and unable to move.  The pain may start in the big toe or your thumb. Or for you, it may be your back, elbow, or shoulder.  You struggle with activities you need to do and the pain has lasted long enough that you are looking for a solution.   People have many options for rehab from physical therapy, injections, and surgery to massage therapy and chiropractic.    Focusing on Treatments, instead of results (Mistake #2) We often see people in pain who have been treated with a variety of new and cutting-edge treatment methods.  It goes something like, “I get cold laser and it

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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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