Infographic explaining how to find the cause of pain using Smith Performance Center’s 4-pillar diagnosis process: Structural Diagnosis, Functional Diagnosis, Treatment Response, and Trigger Management. Each pillar includes a guiding question and icon to support accurate pain evaluation.

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

Craig Smith June 13, 2025

If you are trying to find the cause of pain that keeps returning, you are not alone. Many people are given quick labels like tendonitis or a pinched nerve and told to rest but that often does not solve the real issue. At Smith Performance Center, we go deeper than a label. We use a system called the 4 Pillars of Diagnosis to understand the real problem and build a clear path to recovery. Each pillar gives us critical information about what is causing your symptoms, how your body is functioning, what helps, and what triggers setbacks. It is the difference between a guess and a plan that works. 1. Structural Diagnosis: What Might Be Injured? This is the traditional starting point in most evaluations. We identify what structure might be involved—whether it is a tendon, joint, ligament, nerve, or muscle. We use hands-on testing, functional movements, and your medical

Patient experiencing a rehabilitation flare-up with physical therapist support and quote about mastering symptom management

Understanding and Managing Flare-Ups During Rehabilitation

Craig Smith May 5, 2025

During recovery, there comes a pivotal moment when symptoms improve, and the client feels like they’ve turned a corner. Life feels good again, and naturally, activity levels increase. This change is often unconscious or unintentional—but its consequences can be significant. A rehabilitation flare-up is defined as a return or increase in the original symptoms that led the patient to seek care. The natural reaction to a flare-up is often to question whether the real problem is being addressed. Read: the diagnosis is wrong. But this reaction can lead to a critical misstep—focusing on the wrong issue and missing an opportunity for patient empowerment. Diagnostic Errors vs. Rehabilitation Flare-Up Mismanagement Achieving the correct diagnosis involves identifying potential tissue pain generators, noting local and regional contributors, considering central modulation, and uncovering triggers. This process requires careful collection, analysis, and prediction. And there can be many reasons that diagnosis is hard, but once

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.

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

A person in a teal shirt holds a clipboard and pen, representing a physical therapy session. Overlaid text reads: "Why your physical therapy home exercise program is not working (And What to Do About It)."

Why Your Physical Therapy Home Exercise Program Isn’t Working

Craig Smith November 27, 2023

Not all physical therapy home exercise programs are created equal. But the reason why your physical therapy home exercise program is not working is likely due to more than one reason. Your home plan should guide your recovery with clear, effective exercises tailored to your needs, but your therapist might be overwhelmed with clients, relying too much on assistants, or emphasizing passive treatments instead of empowering you with actionable strategies. Whatever the cause, a poorly designed home plan can stall your progress—or even make your symptoms worse. 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

7 Key Reasons Why the Home Plan Is Vital for Success in Physical Therapy

Craig Smith November 17, 2023

The significance of the home plan often gets overshadowed by in-session treatment. At Smith Performance Center, our physical therapy sessions are one hour per week with your therapist. You are responsible for the other 167 hours. Due to this, the home plan is a vital component of your physical therapy journey, capable of either propelling your progress or impeding it. It’s not uncommon for our team to encounter new clients who’ve stuck to the same ineffective home plan for years, making errors like stretching an irritated nerve, overloading painful joints, or handling an extensive plan that goes largely undone. These missteps tend to patients undervaluing the home plan. However, the home plan stands as a linchpin for your success. We want to explain the 7 key reasons why the home plan is vital for success in physical therapy. Ensuring We Target the Right Problem There are instances where immediate relief

The 7 Tissues to Consider When Progressing Activity After Physical Therapy

Craig Smith September 18, 2023

The Rehab Standard is an SPC concept that defines when a client has a higher exercise capacity than tissue capacity. When your tissue capacity is lower than the exercise capacity, the focus of the workout is not how hard you worked out. It is not how much you sweat or how good of a muscle burn you got. The focus is on the healing tissue and that is was not overloaded, irritated, or provoked. A violation of the rehab standard can present as pain after the workout or the next day, even if there was no pain during the workout. The key is to focus on tissue capacity in the exercise selection, intensity, volume and the type of tissue injured. We want to look at this last one, the type of tissue injured, in relation to activity progression following an injury. The 7 Tissues to Consider When Progressing Activity Improving

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

How Long till My Rotator Cuff Pain Improves?

Craig Smith September 8, 2020

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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SPC Archives

Tag: trigger management

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

Understanding and Managing Flare-Ups During Rehabilitation

Triathlon Injury Rehab: How SPC Phases Prevent Setbacks

The 10 Strategy Mistakes of Repetitive Injury When Exercising

Why Your Physical Therapy Home Exercise Program Isn’t Working

7 Key Reasons Why the Home Plan Is Vital for Success in Physical Therapy

The 7 Tissues to Consider When Progressing Activity After Physical Therapy

7 Tools to overcome invisible triggers stalling your rehab progress

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

How Long till My Rotator Cuff Pain Improves?

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Updates from Smith Performance Center

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

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