For the Referring Physician or Clinician
A collaborative-care model aligned with value-based care principles.
Pain to Performance provides three tightly scoped pathways that helps close the care loop between surgical intervention, standard conservative care, and return to function and performance.
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Welcome to Pain to Performance
Pain to Performance is a self-pay, non-medical assessment, education, and coaching service for selected individuals across the spine-care and return-to-function continuum. From those experiencing mechanically influenced low-back and concordant leg symptoms, to individuals transitioning beyond surgical or nonsurgical rehabilitation, and those seeking guidance for recurring flare-ups associated with more demanding work, fitness, recreation, or sport.
The practice is led by McGill Method Certified Practitioner Brent Morehouse. When a mechanical low back assessment is appropriate, Morehouse conducts the high-fidelity McGill Method assessment to examine how spinal motions, postures, loading conditions, habitual movement patterns, and daily activities influence symptoms and function.
Pain to Performance’s Collaborative-Care Model is intended to support the medical, surgical, and rehabilitation professionals already involved by contributing mechanical and functional information and providing continuity into the next appropriate stage in the spine-care and return-to-function continuum. Assessment findings are translated into an individualized pedagogical plan incorporating spine-hygiene education, symptom-management strategies, spine-sparing movement, load and exposure management, movement re-education, and appropriately selected corrective exercise.
Pain to Performance operates through three primary referral pathways: (a) the Pre-Surgical Gray-Zone Individual, who remains symptomatic despite conservative care and whose next step is not clearly defined; (b) the Post-Surgical / Post-Rehabilitation Transition individual, who requires additional guidance in establishing a sustainable functional foundation after an appropriate stage of care; and (c) the Spine Fitness & Performance individual, who generally functions well in daily life but experiences recurring flare-ups as the demands of work, training, recreation, or sport increase.
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Meet Brent Morehouse, MS
Spine Rehabilitation Specialist
Brent Morehouse, M.S., is the founder of Pain to Performance, a Spine Kineticist, McGill Method Certified Practitioner, and Level 1 Neurodynamics Practitioner specializing in the assessment and non-medical management of chronic mechanical low-back pain and concordant leg and foot symptoms. He has studied the McGill Method directly with Professor Stuart McGill and the BackFit Pro faculty since 2013, and brings more than 25 years of one-on-one assessment and coaching experience to complex case management.
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Three Referral Pathways
Pain to Performance may support selected individuals at three points within the spine-care and return-to-function continuum. The following provides a brief overview; more detailed criteria are available on the Best-Fit Referrals page.
1. The Pre-Surgical "Gray-Zone" Patient
The “gray-zone” describes an individual with persistent or recurrent low-back and/or associated leg symptoms who is not an obvious surgical candidate, but is also not achieving durable improvement through routine conservative care.
A McGill Method Assessment may provide additional mechanical and functional information to help clarify symptom behavior, identify modifiable factors, and inform continued conservative management or subsequent medical decision-making.
Explore the Pre-Surgical Gray Zone
2. Post-Surgical / Post-Rehabilitation Transition
For individuals who have completed an appropriate stage of surgical or nonsurgical rehabilitation but still require additional guidance to establish a sustainable level of function.
Depending on the individual, this may involve movement re-education, physical-capacity development, self-management strategies, or a more structured progression toward the activities and responsibilities of daily life.
Explore Post-Surgical / Post-Rehabilitation Transition
3.Back Fitness & Performance
For individuals who generally function well in daily life but experience recurring low-back flare-ups when the physical demands of work, training, recreation, or sport increase.
Pain to Performance evaluates the relationship between the individual’s current physical capacity and those demands, then develops a structured coaching and training strategy intended to reduce repeated setbacks and support continued physical development.
Explore Back Fitness & Performance
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When these pathways are not appropriate.
Pain to Performance is not appropriate for individuals presenting with:
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Progressive neurological deficit;
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Signs consistent with cauda equina involvement;
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Suspected infection, fracture, tumor, or systemic pathology;
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An acute, severe disc extrusion or sequestration presentation with dominant chemical, inflammatory, or radicular behavior that does not permit useful mechanical differentiation;
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A condition requiring urgent medical or surgical management;
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An expectation of passive treatment without active participation, behavioral modification, or self-management.
DISCLAIMER: Patients whose symptoms are completely unresolved, worsening, or changing unexpectedly following spine surgery should remain under the direction of their surgical team. Pain to Performance Center’s post-surgical pathway is intended for individuals who are medically stable and appropriate to begin or continue a structured rebuilding process.
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How to Refer
Physicians and clinicians may provide Pain to Performance’s information directly to an individual who appears to fit one of the defined referral pathways. The individual then completes the Request Appointment form and participates in an initial screening before an assessment is scheduled.
When suitability is uncertain, a healthcare professional may request a brief conversation regarding the service, referral criteria, or a de-identified clinical scenario before recommending that the individual contact Pain to Performance.
Request a Professional Conversation
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The McGill Method Assessment
The McGill Method is a mechanically grounded assessment-and-coaching approach informed by the individual’s biopsychosocial context. It examines how spinal motion, posture, loading conditions, activity, physical demands, and accumulated exposure interact during both a formal physical assessment and observable clandestine movement patterns—habitual movement choices, movement planning, and behaviors that may occur outside the individual’s awareness. These findings are considered alongside the individual’s beliefs, expectations, prior experiences, confidence, coping strategies, and perception of the spine and symptoms.
The assessment seeks to determine which motions, postures, loading conditions, activities, and movement strategies reproduce the individual’s familiar symptoms—and which reduce or remove them. Coaching then translates those findings into an individualized pedagogical plan that teaches the individual to recognize and reduce symptom triggers, limit repeated tissue irritation, and create the conditions for sensitized tissues to settle. This includes spine-sparing movement that reduces unnecessary spinal loading, redirects force through the hips and distal segments, and develops proximal stiffness with distal mobility, physical capacity, and athleticism.
NOTE: Imaging impressions and images are integrated with the individual’s history, symptom behavior, mechanical testing, and functional limitations.
Discover The McGill Method
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Deliverables
The referring provider may receive a physician-centered report summarizing:
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Relevant history and presenting concerns;
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Functional limitations and goals;
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Summary of mechanical assessment findings;
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Identified symptom triggers and relieving strategies;
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Relevant neurodynamic findings;
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MRI observations, when applicable, considered in relation to the mechanical presentation;
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Cofactors potentially influencing prognosis;
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The initial treatment plan;
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Movement, load-management, and corrective-exercise strategies;
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General progression criteria;
The report is intended to provide clinically useful information regarding what changes the presentation, what the individual can currently tolerate, which strategies appear useful, how the initial plan is structured, and whether meaningful progress is occurring.
ATTENTION: The report does not replace medical diagnosis, direct the course of medical treatment, or dictate rehabilitative practice. Its purpose is to contribute mechanical and functional information that may not be fully observable during a routine medical visit, including symptom responses to motion, posture, load, activity, and accumulated exposure.
COMMUNICATION AUTHORIZATION: As part of enrollment, the individual identifies the physicians or clinicians with whom Pain to Performance may communicate and authorizes the release of relevant assessment reports and progress information.
Review Reporting and Communication
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A Clearly Defined, Collaborative Scope
Pain to Performance Center is a self-pay, non-medical assessment, education, and coaching service. We do not replace physician-directed care or physical therapy, provide radiologic interpretation, offer medication advice, issue medical diagnoses, determine surgical candidacy, or participate in surgical decision-making.
Our role is strictly limited to contributing detailed mechanical and functional information, helping the individual understand and manage the physical variables influencing the presentation, and providing an organized plan within the boundaries of the selected referral pathway.
Pain to Performance is specifically positioned to support and extend the work of the patient’s medical and surgical teams, and licensed rehabilitation providers, when a specialized mechanical assessment, post-surgical / post PT rebuilding process, or transition to higher physical demands is needed.
All medical concerns and surgical decisions remain with the patient’s medical or surgical team. Physical therapy and chiropractic care each retain their respective roles.