Shows
Tough to TreatComplex shoulder pain - how the narrative and red flags paint a different pictureClients self-refer for many reasons and we find ourselves on the front line of health care screening. Join Susan and Erica as they uncover key elements in a client's history and narrative around long-standing shoulder pain. Simplistic presentations usually mask true underlying considerations including the client's beliefs and red flags. A glance at this episode: [1:41] Client's Initial Presentation and History [4:07] Exploring Past Injuries and Chronic Bike Riding [6:56] Impact of Corporate Life and Breast Cancer on Health [13:08] Concerns About Bone Health and DEXA Scan [15:21] Addressing Left S...2024-11-0747 minTough to TreatComplex Shoulder Pain - How the Narrative and Red Flags Paint a Different PictureClients self-refer for many reasons and we find ourselves on the front line of health care screening. Join Susan and Erica as they uncover key elements in a client's history and narrative around long-standing shoulder pain. Simplistic presentations usually mask true underlying considerations including the client's beliefs and red flags. A glance at this episode: [1:41] Client's Initial Presentation and History [4:07] Exploring Past Injuries and Chronic Bike Riding [6:56] Impact of Corporate Life and Breast Cancer on Health [13:08] Concerns About Bone Health and DEXA Scan [15:21] Addressing Left S...2024-10-3147 minTough to TreatChronic Knee Pain - Where to Begin!Susan and Erica are back together for the Fall season! Chronic knee pain can be much more than a regional event. Susan presents a client with an extensive timeline and clinical reasoning as to why it is important to consider the entire system in this integrated approach. The key here is also maintaining relevance and sustainability for the client. A glance at this episode: [1:18] Explanation of Episode Structure and Content [2:59] Introduction to the Client Case Study [5:30] Client's Medical History and Injuries [12:47] Initial Assessment and Observations [13:33] T...2024-10-1038 minTough to TreatAssessing Knee Health For Hip-Related Walking PainIn this episode, Erica explores the often-overlooked relationship between hip pain and knee function during walking when the patient does NOT have knee pain. Join in as she dives into the role of the knee in compensating for hip dysfunction, and how a thorough knee assessment can uncover hidden contributors to hip discomfort. Remember: old injuries have a way of sneaking up on us and becoming one of the drivers of our current problem. An old hamstring tear 5 years ago as a contributor to this patient's problem? Think again. A glance at this episode: 2024-09-2622 minTough to TreatWhen shoulder pain is dominant, but not the driver!Shoulder pain, like any other joint can present as primary pain and can be the #1 reason a client may be seeking help! In many cases, treating the obvious joint dysfunction (because it checks all of the boxes) may not result in optimal outcomes. Join the conversation as Susan and Erica explore the various reasons and important timelines in the client's history that has led to her shoulder pain. Most importantly follow the clinical reasoning that led to the real driver of this issue. Bonus - we also offer a great discussion of a good exercise progression! 2024-09-1233 minTough to TreatBeyond Tennis: Exploring Shoulder Compression Across SportsIn this episode, Erica discusses the why behind shoulder problems, comparing the unique challenges faced by tennis players and non-tennis players alike. She explains why traditional shoulder treatment often fails these types of patients. A significant relationship between the shoulder and another region of the body is often missed. Erica also tells the story of one of her patients who does play tennis and the reason why he can do a full pushup but can't lift his arm over his head. For our physio listeners, oftentimes you can progress patients through a full range of CKC exercises but the...2024-09-0521 minTough to TreatThe Role of the Diaphragm in Chronic Low Back Pain and GI DysfunctionHow similar are the neuromuscular responses to pain with Chronic low back pain and GI pain? Join Susan and Erica in a great discussion of the role of the diaphragm and how this changes with pain and inhibiition/over-recruitment in the system. In chronic low back pain and abdominal bloating/distention the diaphragm becomes a postural control muscle which greatly limits the respiratory ability and is an ineffectual model for spine stiffness and visceral organ pusher. This is an excellent discussion following the podcast episode 185. 1) Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, K...2024-08-1541 minTough to TreatLow Back Pain - Regional vs. Movement System ConsiderationsIf it walks like a duck and quacks like a duck - it must be a duck, right? Low back pain is a descriptive term at best, indicating where symptoms present. Join Susan and Erica as they explore this Tough to Treat client with low back pain and mild stress urinary incontinence. Discover the history and the movement system examination and interventions that led to the successful reduction of symptoms. *Hint: this really isn't a duck! Visit our website: toughtotreat.com A glance at this episode: [0:01] Low back pain and pelvic h...2024-08-0133 minTough to TreatJunior Golfer With Persistent Unsolved Knee PainGolf is a sport of weight shifts and a narrow base of support. What happens when your knee can't adapt to an altered base of support? This is what exactly happened here with this case. This young golfer, in standing (and standing is VERY relevant for the golf swing) had an 80/20 load, R/L in this position. And it stayed that way throughout the golf swing. This begs the question: Did you know that right knee pain can be caused by an imbalance in your center of mass? If you continuously load your painful side, that has some serious...2024-07-1152 minTough to TreatHow To Assess The Knee DifferentlyIn this episode, Erica explores new and novel ways to evaluate and treat the knee. She discusses different approaches aimed at providing a more accurate assessment of the knee. Join her as she emphasizes the importance of training your vision. What does "optimal" movement look like for that particular patient? Does what you see match what you feel? Are you assessing the knee in a movement that is relevant to the patient? If someone's right knee is sore when they are walking with that leg behind, then...2024-05-1616 minTough to TreatAddressing the Gaps in a Patient's Exercise ProgramThis episode zeroes in on a scenario many physical therapists face: patients diligently following their exercise routines but not seeing the expected progress or recovery. We discuss thorax, foot, and knee drivers as examples and why there can be holes in someone's program even after they've been doing advanced exercises. Being able to identify the patient's impairments is a good start. We discuss common strength holes along with typical overactivity patterns in these patients. Susan and Erica also discuss a patient who is a high-level athlete with a fear-based movement that is a big hole in...2024-05-0935 minTough to TreatFood Allergies vs. IntoleranceWhat is the difference between food allergies and food sensitivities? Join Susan as she discusses the importance of following the science and taking the guess work out of the food allergy vs. sensitivity issue and why this is important for systemic inflammation. A glance at this episode: [3:19] Dietary elimination for gut health and food intolerances [9:18] Gluten sensitivity and its impact on IBS symptoms [13:14] Gut microbiome's role in digestion, immunity, and weight gain Related links: Tough To Treat Website Erica’s Cou...2024-05-0221 minTough to TreatBack Pain/Leg Pain - Making the Right Call For Our ClientsThis episode presents what should be a straightforward case of a significant nerve root irritation. Unfortunately for this client, her situation was not addressed adequately and has left her in a lot of pain for over 3 months. Join us as Susan presents this client case, what went wrong, and the assessment and intervention with a rich discussion of the path forward. Here is a Hint: center of mass and chronic loading play a strong part in this story! A glance at this episode: [2:21] Back and glute pain, stretches, and fat...2024-04-2539 minTough to TreatClinical Pearls For Effective Exercise ProgressionIn this episode, Erica speaks about prescribing specific exercises based on the difficulty level relative to the region of the body driving the patient's symptoms. NOT the pain generator. NOT the area of symptoms. If someone has knee pain, and their driver is their foot, then the exercise program is geared towards the foot, NOT the knee. SLR's and quad sets won't work here. She also explores the significance of personalized exercise prescriptions in optimizing recovery outcomes. There are many clinical pearls in this episode, one of which...2024-04-1825 minTough to TreatPhysical Therapy Examination and Intervention of GI DysfunctionIn this short episode, Susan presents a good algorithm for the examination and interventions in clients with GI dysfunction. Follow along as she discusses different nuances and considerations in the presence of pelvic and abdominal aspects of GI dysfunction. A glance at this episode: [0:01] Interventions for GI dysfunction and abdominal pain [2:03] Manual therapy for abdominal and pelvic issues [6:19] Abdominal massage for constipation and pain relief [9:59] Breathing, abdominal muscles, and pelvic floor function [14:35] Abdominal surgery effects on musculoskeletal and visceral support ...2024-04-0420 minTough to TreatOveractive Bladder and Hip DysfunctionThis episode presents a client with a seemingly straightforward diagnosis in pelvic health of overactive bladder (OAB). The history and physical presentation tell a different story. Join Susan and Erica as they explore why often a regional approach will not help the client progress to their highest levels of function without symptoms. We discuss the various drivers viscerally and MSK regionally and why tendon function and the client's stage of life require the utmost consideration. Join us in the conversation and discover the multi-system approach in consideration of the examination and interventions for this client...2024-03-2840 minTough to TreatExploring Open Chain vs Closed Chain Exercise in Upper Extremity DysfunctionIn the episode, Erica explores the strategic use of open and closed-chain exercises for upper extremity dysfunction. She discusses the distinct benefits and applications of each type of movement, shedding light on how these exercises can be tailored to meet specific needs to enhance performance. She uses an example of a tennis player who suffered from right shoulder pain with radiculopathy. She also tackles the critical question of when to load open-chain versus closed-chain exercises, offering practical guidelines based on the stage of recovery and individual progress. OKC can be very difficult for someone who ha...2024-03-2119 minTough to TreatOutcome Measures and Pain in GI DysfunctionThis episode is a short compilation of an algorithm in looking at basic outcome measures and pain in GI Dysfunction. Susan explores the basics of the history which can give great insight into the addition of more sophisticated outcome measures and pain exploration. Start with the basics and then expand! A glance at this episode: [0:01] Evaluating and managing pain in people with GI dysfunction [1:18] Abdominal pain and its relationship to GI dysfunction [4:47] Visceral pain and myofascial pain syndromes [9:14] Pelvic health and bowel dysfunction assessment tools [13:12] B...2024-03-0716 minTough to TreatThe Balance System As A DriverJoin us in episode #200 where Susan and Erica explore the potentiality of the balance system as a primary or secondary driver. With a client's history of injury or illness, there is an event that sets up their system for adaptation. Oftentimes, in regional-specific rehab, the balance system is not considered as a driver. What keeps the client in this adapted pattern may be the primary driver; however, the balance system adapts to keep the entire body and physiology upright against gravity. This system can change, and the need for activity to accomplish this becomes a primary consideration in the...2024-02-2948 minTough to TreatThe Body's Story: Finding Out Why You Hurt Through Your Story and Movement PatternsIn this episode, we explore the profound connections between personal narratives and the origins of someone's injury. Join Erica as she delves into the stories of individuals who've experienced persistent injuries, and learn how to find clues in their narrative to help you prioritize the movement assessment and eventually find their driver(s). You will learn how to make the connections between the story and their movement patterning. Through the lens of their injury and movement history, we can uncover the reason why someone can't move the way they want. This leads to precise diagnosis and effective treatment. You...2024-02-2217 minTough to TreatHow To Find The Driver Through Patient-Centered ListeningDiscover the art of being an active listener who can pick up clues in your patient's narrative to help you find their driver quicker. This will save you lots of time in your movement assessment. Listen in as Erica discusses how to reframe your patient's story to help you maximize your time with them in the clinic. She discusses clues in their "subjective" that can aid you in prioritizing regions of the body to assess in your movement analysis. This is done with 3 case studies from her practice where she discusses each patient's story (injury and movement history) and...2024-01-2535 minTough to TreatTake Back your Mental Fitness - Part 2Welcome to the New Year and one of the topics always discussed by Healthcare providers is burnout and imposter syndrome. Join Susan in this short podcast - Part 2 Taking back your mental fitness. Learn how to identify the voices of your inner Judge and Saboteurs, how to limit their voices, and find a pathway to your Sage Brain! A glance at this episode: [3:21] Mindfulness techniques for neural plasticity [6:48] Mindfulness and neural pathways for busy people [10:33] Cultivating self-empathy and overcoming judgment [14:09] Positive Intelligence and Self-Improvement 2024-01-1818 minTough to TreatTake Back Your Mental Fitness - Part 1Welcome to the New Year and one of the topics always discussed by healthcare providers is burnout and imposter syndrome. Join Susan in this short podcast episode - Part 1 Taking back your mental fitness. Learn how to identify the voices of your inner Judge and Saboteurs, how to limit their voices, and find a pathway to your Sage Brain! A glance at this episode: [4:38] Saboteurs in the brain and their impact on decision-making [9:11] Personality types and their impact on work performance [13:30] The disruptive role of saboteurs in decision-Making 2024-01-1224 minTough to TreatThoracic Mobility Beyond The BreathIn this episode, Susan and Erica discuss the many ways the thorax can be the driver for a multitude of upper and lower extremity issues. This important region of the body tends to cause a lot of movement dysfunction we often see. As an example, the thorax is an important component in driving foot pain as well as issues in the pelvic girdle. Suppose you can get the thorax to move differently. In that case, this can help people down-train old movement patterns that do not serve them and ultimately restore global movement pat...2023-12-2157 minTough to TreatStress, Exercise and Sleep as it Relates to the GI SystemMany times, clinicians find that people with correlative GI system dysfunction are very overwhelming. The complexity makes it difficult to know where to begin to intervene. Join us as Susan discusses some very simple mediations to help improve the GI system with stress, exercise, and sleep. Complex clinical pictures can often change when we address the foundations of health with simple interventions. A glance at this episode: [1:38] Stress, its effects on the body, and exercise as a remedy [6:38] Exercise and stress management techniques [10:56] Sleep's impact on digestion an...2023-12-1417 minTough to TreatA Complex Client With Medical Red FlagsSusan and Erica welcome Kelly McClain to the podcast to discuss a very complex client with pelvic health, orthopedic, and neurological issues. Follow along as the client case is presented and we pursue a rich discussion of tying together the systems involved as well as the red flags. Digging deeper into the client's story is key here to help with obvious referrals and also to recognize other systems and issues deeper into the client's history to gain insight. A glance at this episode: [3:05] Pelvic health issues and treatment [12:28] Patient's sy...2023-12-0743 minTough to TreatHow To Diagnose A Young Soccer Player's Groin PainWhy doesn't my groin pain go away? When someone is an athlete, you must understand what regions of the body are challenged with their sport. With soccer, you think of the thorax, foot, hip, and pelvis from the get-go. Listen in as Erica discusses the movement she and her patient chose to assess and what they discovered. Short-term treatment of someone's symptomatic region may help in the short term, but getting them back in the game is another matter entirely. When a person has an issue with a long lever movement like kicking a s...2023-11-3018 minTough to TreatThe GI System - Food intolerances vs. AllergiesWe continue with our GI dysfunction theme in this podcast about food intolerances/sensitivities vs. allergies. Join Susan as she takes you through the algorithm to understand how to recognize what is the underlying information behind why certain food bothers us and when we should eliminate food. A glance at this episode: [3:49] Elimination diets for digestive health [7:42] Gluten sensitivity and its effects on the body [11:56] Gut microbiome's role in IBS symptoms and behavioral changes [15:20] Gut microbiome and its impact on health Rel...2023-11-1621 minTough to TreatWhen Do You Treat The Viscera?When do you treat the viscera? And why? This episode discusses a bit about the abdominal viscera. It is certainly not all-encompassing by any means. We just want our audience to be aware of the possibilities. Erica relays some clues in the patient's history as to why you would screen for GI dysfunction. She uses 2 case examples of when the abdominal viscera was the secondary driver in one case and when it was a significant impairment in a patient with a dural driver in the other. Once again, it all comes down...2023-11-0218 minTough to TreatBack Pain, Thoracic Outlet, Post Cancer Recovery - Where do I go from here?In this episode, Susan and Erica welcome Darcie Pervier to the mic! Darcie is a pelvic health and orthopedic PT who practices a fully integrative approach to complex client care. Susan, Erica, and Darcie really delve into "brainstorming" various aspects of examination and intervention in connecting some dots on this complex canvas. Dural issues, fracture healing, bone health red flags, thoracic stiffness, neural tension, and GI visceral systems are tied together to help guide more meaningful interventions for this client. Hint: How to get a client to do some nervous system regulation when the...2023-10-2647 minTough to TreatPost Partum: Urinary Incontinence, Abdominal Bloating and a Return to High Intensity ExerciseIn this episode, Erica and Susan welcome Julia Rosenthal to the mic. Julia is a physical therapist in NYC. She brings a complex case of a postpartum patient of hers who has symptoms of urinary incontinence as well as other bowel and bladder issues that were made worse after giving birth. The patient is a personal trainer and used to high-load exercise, so the need to get back to this is strong. She also has complaints of abdominal bloating along with occasional musculoskeletal pain with CKC lower extremity work. This discussion is rich in...2023-10-121h 03Tough to TreatHow To Increase Patient Adherence To ExerciseHow do you increase patient compliance with their exercise program? This can be very frustrating for both the therapist and the patient. In this shortie episode, Erica discusses how she helps keep her patients on track with their movement program. She often says, "If it's not trialed, then the chances of your patient doing the exercise are reduced at least 10-fold." What is the goal of exercise? Ultimately, it's about training the brain and optimizing movement. You need to get the patient to "buy in". What will they b...2023-10-0514 minTough to TreatUnraveling the Web of Neuralgia: Navigating the Cervical SpineIn this episode Susan and Erica welcome a Tough To Treat listener, Megan Barclay. Megan brings a case of a patient who continues to suffer neuralgia after a bout of shingles, along with persistent neck pain. Listen to the client's history, significant findings, and differentials as we navigate this client's journey and discuss relevant findings. There is also a rich discussion on possible interventions targeting many points of the trigeminal system and cranial region. A glance at this episode: [1:25] Neck pain and potential causes and drivers ...2023-09-2849 minTough to TreatThe Mystery of This Man's Struggle With Pelvic Girdle Pain and the BreathIn this episode, we dive into the often overlooked and misunderstood world of male health, exploring the complexities of groin pain, the challenges of taking deep breaths, and the impact on his pelvic girdle pain. The history will give you the answer. This is a complex case with many parts but listening to his story helps you to prioritize which regions of the body you need to rule out. Visceral connections are key to this presentation. Join Susan and Erica as they unravel the potential causes, shed light on some of his...2023-09-0747 minTough to TreatFinding Hidden Connections In Functional Movements- Why They MatterIn this episode, Erica explores the intersection of functional movement and persistent pain, offering a comprehensive blueprint for understanding and addressing movement dysfunctions that may contribute to ongoing discomfort. Join her as she discusses her insights and tips with examples from her patient caseload. Erica also speaks to functional movements that will help you find "hidden" drivers in other regions of the body. Whether you're dealing with persistent pain or are a healthcare provider seeing those persistent cases, this episode equips you with advanced clinical reasoning knowledge and tools to create a solid ass...2023-08-1718 minTough to TreatHRV as A Predictor and Intervention in Sleep and StressHeart rate variability is getting a lot of press recently. Join Susan as she presents a webinar on HRV as a predictor and intervention in sleep and stress. It doesn't take complicated interventions to make real changes in our health! A glance at this episode: [1:59] What is heart rate variability [4:07] Inhibition of the flight or fight system [6:26] How you measure heart rate variability [8:58] When to measure heart rate variability [13:38] The cycles of sleep [15:31] Memory and sleep [18:07] Prolonged poor...2023-08-0327 minTough to TreatPain Without a Diagnosis: The Complexities of Managing Medically Unexplained SymptomsIn this episode, we delve into the perplexing realm of medically unexplained pain and the challenges it presents for healthcare professionals. Join us as we navigate the complex landscape of patients who continue to experience pain despite thorough medical examinations revealing no discernible underlying cause. We explore the frustrations and uncertainties faced by both patients and practitioners in these cases, as well as the importance of validating patients' experiences and concerns. We share insights on the various factors that contribute to medically unexplained symptoms, including psychological and emotional aspects, and discuss the potential imp...2023-07-2742 minTough to TreatDecoding Persistent Hip Labral Tears - It's Not Always What We ThinkHave you ever had patients with "diagnoses" of labral tears on MR only to find out that the hip was not the driver? Of course, you have. In this short episode, Erica responds to a case sent in from one of the listeners regarding persistent hip pain. She asks Erica what would be important to look at and how to proceed with the information at her disposal. There was not a lot of background on this case; so listen as she highlights what's important to rule in and rule out. Ru...2023-07-2020 minTough to TreatChronic Low Back Pain and Constipation - Why it Matters!Clients often have chronic low back pain as a primary or secondary issue. It is often combined in complex presentations where addressing one issue is usually not going to generate optimal results. In this episode, Susan and Erica discuss the obvious and not-so-obvious drivers in this client with chronic low back pain and constipation/bloating! They discuss the varied evidence that helps to determine not only the main drivers of this presentation but also the reality of utilization of the full systems and whole body consideration in care. Breath and balance pla...2023-07-1332 minTough to TreatPelvic Girdle Pain: Current Concepts Part 2Clinical practice guidelines provide the practitioner with the most up-to-date research on a certain diagnosis or condition. Join Susan in a two-part interview about Pelvic Girdle Pain in the Antepartum Population. In part 2 there is a discussion around systemic vs. biomechanical drivers and the effect of cortisol and stress. The clinician is asked to review their confirmational biases, consider changing from the relaxin conversation, and listen to the client's story. Interventions are driven by these stories, movement pattern changes, load transfer, and sensory input. A glance at this...2023-07-0614 minTough to TreatUnraveling a Compression Fracture in a Young MaleCompression fractures are commonly associated with osteoporosis in older adults. However, what happens when these fractures occur in young males? In this episode, Erica and Susan discuss a patient who sustained a T6 compression fracture. It is intriguing to note that it is a young male in his 20's not an older woman in her 70s. Do they require different treatments? Detecting a compression fracture is not difficult thanks to musculoskeletal imaging. However, considering the radiological changes that occur at the vertebral level with compression fractures can so...2023-06-2922 minTough to TreatMeeting Patient Expectations- Navigating the Journey to ProgressThis is an excerpt from Erica's DCP course call in February of 2023. In this episode, she delves into the crucial aspect of meeting patient expectations and facilitating their progress. She explores the dynamic relationship between healthcare providers and patients, discussing effective strategies for understanding, managing, and aligning expectations throughout the treatment journey. Join her as she navigates the complexities of patient satisfaction, communication, and empowerment, offering insights and practical tips to foster positive patient-provider relationships and drive meaningful progress. A glance at this episode: [2:02] How to develop a sc...2023-06-2213 minTough to TreatWhen Shoulder Pain is Dominant, but Not the Driver!Shoulder pain, like any other joint can present as primary pain and be the #1 reason a client may seek help! In many cases, treating the apparent joint dysfunction (because it checks all of the boxes) may not result in optimal outcomes. Join the conversation as Susan and Erica explore the reasons and important timelines in the client's history that led to her shoulder pain. Most importantly follow the clinical reasoning that led to the real driver of this issue. Bonus - we also offer a great discussion of a good exercise prog...2023-06-1532 minTough to TreatPelvic Girdle Pain: Current Concepts Part 1Join Susan in a two-part interview about Pelvic Girdle Pain in the Antepartum Population. Clinical practice guidelines provide the practitioner with the most up-to-date research on a certain diagnosis or condition. In part 1 there is a rich discussion of what Clinical Practice Guidelines are, risk factors for developing pelvic girdle pain, and most importantly, the language change around the pelvic joints' stability and instability. A glance at this episode: [2:16] What is pelvic girdle pain [3:36] Pelvic pain prevalence and risk factors [5:56] What drives the pain experience...2023-06-0812 minTough to TreatFrom Neck Pain to Shoulder Pain: Unraveling the Links Between the TwoDoes stretching work when a muscle is over-recruited? Not if you don't change the movement pattern. This is an excellent follow-up to episode #162, showing how you clinically reason through another weightlifting injury. Join Susan and Erica as they discuss a patient who sustained a shoulder/neck injury during a "basic" tricep extension exercise. The main takeaways are twofold: You must assess the connections between the 2 drivers and treating one region alone will not improve this patient's symptoms. Why? 2023-06-0140 minTough to TreatUnique Release Positions for the Shoulder: Positioning for Optimal ResultsThe purpose of release is to train. Remember that. Long gone are the passive release positions for patients. Think about the connections in the regions of the body to each other and then design a position that engages those long vectors connecting one region of the body to each other. An example, is the use of head rotation and the GHJ, to engage the barriers BETWEEN those regions of the body to each other. Join Erica as she discusses a unique way to achieve end-range shoulder flexion for a neck driver. 2023-05-2511 minTough to TreatComplex Chronic Low Back Pain - When A Regional Approach Will Not be the Best OptionWhere do you start with a client with complex regional pain that has full-body implications? Listen to their story, look for the change talk, and gain active participation by allowing them to lead the way in a judgment-free zone. Sometimes, clients know what they need to do, they just don't know how to implement the changes and find simple action steps. Join us as we talk about this interesting case of a surgeon hijacked by his work environment, which has accumulated several body system symptoms from GI dysf...2023-05-1837 minTough to TreatTrigeminal System Referral PatternWhat is the referral pattern for the Trigeminal System? What does that mean for our clients? The cervical nucleus of the trigeminal system can have profound effects on multi-body symptoms Join Susan as she describes this unique and vital phenomenon. A glance at this episode: [1:45] Trigeminal system as a sensory experience [3:06] The interconnecting cranial nerves [3:51] How the trigeminal system affects the voice [5:17] Trigeminal ganglion and the spinal nucleus [7:54] How to bring your heart rate down...2023-05-1116 minTough to TreatPelvis Driver In A Male WeightlifterThis episode is all about low back pain with a pelvis component in a 33-year-old male weightlifter. Erica and Susan discuss how his history of chronic low back pain along with some bowel issues played a significant role in how he recruits muscles under load. Some highlights include why pelvic taping helped in this case, how to perform the same movement pattern in different positions, why assessing the pelvis was necessary, and the clinical reasoning as to how to differentiate whether it was an overactive anterior-posterior chain. A gla...2023-05-0439 minTough to TreatAssessing The Knee DifferentlyIn this "shortie" episode Erica discusses different ways she assesses the knee. There are 3 parts to the knee joint and assessing a movement pattern that takes into account all these regions is key. It's not all about patellar tracking, right? More often than not, one part of the knee is being compressed because of some overactivity in the muscles surrounding it. The main takeaway is that evaluating these regions takes precision and it's worth it to spend a few extra minutes doing so. Your pat...2023-04-2710 minTough to TreatFoot Drivers - The Prequel to the Foot Progression ExercisesErica and Susan have presented several podcasts discussing the exercise progression of the foot as the primary and secondary driver. Today they discuss the idea of taking the movement pattern down a couple of steps in preparation for the foot to handle loads, change the body posture, and progress to appropriate AP sway. The clinical reasoning process is key for understanding how the foot should be working before strengthening and challenging movement patterns can be improved. A glance at this episode: [7:36] How to get the foot to turn on to...2023-04-2037 minTough to TreatAnatomy and Physiology Interactions of the GI System - Part 2This is part 2 of a short webinar on the interactions of the functional anatomy and physiology of the GI system, presented by Susan Clinton. This will give listeners a nice story of these systems in aspects of digestion and this affects other systems. A glance at this episode: [1:25] The importance of good digestion and intestinal mucosa [3:!7] Chemical digestion of food [5:51] Digestive enzymes [8:05] The village of Villi [9:59] Mass movements in the large intestine [11:38] The rectal inhibitory reflex [13:43] The de...2023-04-1315 minTough to TreatWhat Do Weightlifting And Poledancing Have In Common?Answer: A dominant movement pattern that is the same across all this patient's activities. No 1- weightlifters brace and dump their shoulder blades when they rack squat. A very common pattern for this movement, especially when you are lifting over #200 +. The problem is when this becomes dominant for all movements. Healthy systems need choices, plural. The nervous system then grades the strategy depending on the movement and load needed. What happens when someone uses this strategy to pole dance? No 2-a rigid thorax does not serve here. The main impai...2023-04-0639 minTough to TreatAnatomy and Physiology Interactions of the GI System - Part 1This is part 1 of a short webinar on the interactions of the functional anatomy and physiology of the GI system. Listen to the unique anatomical arrangements and the neurophysiology connections. A glance at this episode: [1:00] Where the visceral organs are located in the abdominal cavity [3:35] The neurology of the GI System [5:44] The parasympathetic and sympathetic pathways of the gut [7:32] Nervous pathways from the brain to the spine [9:34] Muscarinic receptors in the digestive system [11:14] What is the mesenteric system ...2023-03-3017 minTough to TreatHypermobility and Low Back PainHow do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? Carefully and specifically! When someone who is hypermobile complains of continued and persistent back pain, your first thought is, " Is this an overactive system? An underactive system? Or both?". This re-release of an episode from 2018 highlights the beauty of a specific exercise progression tailored to the patient's meaningful movement and her dominant impairment. Listen as we go through the clinical reasoning process to determine what types of movement patterns will work and what ones won't. 2023-03-1648 minTough to TreatWhy Has My Patient Stopped Improving?Ep 152: Why Has My Patient Stopped Improving? In this episode, Erica discusses the fine points of what to do when your patient stops improving. AKA a plateau. Problem-solving through a patient plateau requires sound clinical reasoning and a reflection back to the patient's story. Looking at the injury and movement history-there can be a clue there. Change their COM and reassess another movement pattern. Listen in as Erica gives you the steps to take when this happens to you. A case example is also presented to illustrate the point. Ultimately, challenging the human moveme...2023-03-0916 minTough to TreatEstrogen Levels and Changes in the Musculoskeletal SystemIn previous episodes, Susan and Erica discussed the effects of decreased estrogen at peri and post-menopause with tendinopathies. In this episode, Susan provides the next half of the discussion, from a webinar, on hormones (particularly estrogen) and their effect on the musculoskeletal system throughout the lifespan. Did you know that HRT does not have an effect on tendons? Join the conversation, this will be so helpful in considering your Tough to Treat female clients. A glance at this episode: [0:59] What happens when we have too much estrogen...2023-03-0215 minTough to TreatShoulder Girdle Hypermobility vs. Thoracic Stiffness - Where is the BalanceMany of our episodes have included clients on the hypermobile end of the spectrum with a stiff thorax. How do you balance increasing thorax movement around a hypermobile shoulder girdle region? How do you use some sound clinical reasoning to design an exercise program that can bring motor control to the shoulder girdle and improve thoracic mobility? Join us as we bring this clinical scenario to light with the rehab program of an archer complaining of a stiff neck and inability to increase power! This case involves the neurological, musculoskeletal, respiratory, and...2023-02-2328 minTough to TreatAdvanced Clinical Reasoning With Your Toughest PatientsIn this episode, Erica throws out some clinical gems when it comes to clinical reasoning through these scenarios. What do you do when your patient says, "I am 85% better but I am still getting (insert symptom) when I do (insert activity)." or " I am so much better but my foot hurts on and off when I still sit at my desk". The key is "what does my patient need at this point in time?" Using 2 examples from her patient caseload, Erica discusses how changing the activity and the environment may be the last piec...2023-02-1620 minTough to TreatDown Training Non-Optimal Movement Patterns to Make Exercise More EffectiveIn this episode, Erica and Susan discuss how to identify someone's non-optimal movement pattern, aka the "dominant pattern" or "the impairment", and use it to your advantage when positioning and prescribing exercise. Think of it this way: If someone has a strong movement pattern, whether it is compensatory or not, they need choices to move in and out of it. More often than not, exercises that are being prescribed reinforce this maladaptive pattern. They discuss ways to position people who have thoracolumbar solid gripping strategies in order to uncover a source of weakness or...2023-02-0931 minTough to TreatHormone Balance - Estrogen and Why it MattersHormones have a significant influence not only within the balance of the endocrine system but also the effect on the MSK system. Join a discussion Susan has had in a course about hormonal health in females. This piece takes a nice dive into estrogen balance throughout the reproductive years. A glance at this episode: [1:03] Estrogen and the effect on the body [3:00] What happens to estrogen in the body [4:45] Hydroperoxide and estrogen dials [6:01] How to make cortisol in the body [8:03] High and low levels of estrogen [9:49] Central sensitization and central sensitivity ...2023-02-0211 minTough to TreatShoulder Stiffness - When the Tissue is the Driver!Shoulder pain, stiffness, and lack of functional mobility are not uncommon in clients with post-breast cancer. Join us as we discuss the evaluation and treatment sequence that addresses the particular soft tissue involvement and drivers of this client's limitation—hint: several tissue issues are involved. The clinical reasoning around the client's story is key here! A glance at this episode: [2:04] Susan introduces her patient's history [7:34] Shoulder girdles and head position [10:34] Flexion of the cervical spine [16:40] Looking at passive vs. active range of motion [19:19] How Susan started the abduction exercise [24:21] Towel roll e...2023-01-2637 minTough to TreatManual Therapy Or Not? Hands Off Or Hands On? Or Both?When do you make the clinical decision to put your hands on your patient or take them off? We are changing brain maps and our hands act as facilitators of movement. You need a clinical decision tree to decide which muscles to release and which ones to let go of. A clinical pearl: as your patient moves forward in their program, certain muscles will appear in more loaded movement patterns that you will NOT see in a passive position, like supine. Don't miss this. What is manual therapy? The next time you...2023-01-1915 minTough to TreatGrow Your Clinical Expertise By Learning How To Treat The Complex Patient (Part 2)Join Susan and Erica while they present case studies to highlight clinical reasoning. This is part 2 of a 2-part series from a webinar. These case studies include pregnancy-related pelvic girdle pain, an athlete with shoulder pain, and a few more. Follow along and recognize the unique clinical reasoning for each client. A glance at this episode: [2:26] What is a cross-legged squat [6:00] What is a complex exercise program [8:28] Assessing the patient and how far they can walk without pain [13:44] Why you need to really take care of yourself, but a...2023-01-1234 minTough to TreatGrow Your Clinical Expertise By Learning How To Treat The Complex Patient (Part 1) In this 2 part episode, Susan and Erica discuss what it takes to become a clinical expert, and how that translates into effectively assessing and treating the "tough to treat". They highlight common errors in clinical reasoning and how to avoid them. They also discuss common red and yellow flags and when to trust your gut. This is part of what makes an expert. Remember, the organization and structure of a clinician's knowledge are more important than the content itself. Learning how to ask the right...2023-01-051h 02Tough to TreatFoot and Hip Pain? Why You Treat The ThoraxYour patient has a dysfunctional thorax and it's driving their symptoms, wherever they are. How can you clinically reason treating a non-painful thorax for distal symptoms, such as the foot and hip? The body translates the head, thorax, and the pelvis over the feet for many reasons. Offloading a painful foot, knee, hip is one reason, the other can be an ingrained movement pattern that has been there for years because of an old injury or from a dominant movement or sport history. Join Susan and Erica as they discuss thoracic drivers and how they...2022-12-1532 minTough to TreatNeurophysiological Underpinnings of the Trigeminal System - Part 1In this short episode, Susan discusses the upper cervical region and its effects on the rest of the body: core, pelvic floor dysfunction, muscle recruitment, balance, dizziness, etc. Join Susan as she takes a journey into the remarkable system from one of her lectures. Erl Pettman's work has long influenced Susan on her clinical reasoning and the importance of convergence of symptoms throughout the body from the upper cervical spine and the cervical trigeminal nucleus. Retraining this region is one of the reasons we "recommend" the Clock Yourself App - for the cervico-occular-vestibular reflex training. A glance...2022-11-1710 minTough to TreatLumbosacral Pain Presentation - A Typical Clinical PatternIn this episode, Susan and Erica discuss a series of patients that all presented lumbosacral pain. Clinical pattern recognition is an important part of the assessment process. The pattern does not dictate the intervention process, but the inability or ability of the pattern to change in the assessment and intervention process is key. This practical presentation of a typical female with lumbosacral pain demonstrates the recognition of the clinical pattern. Once this is discovered, what are the best ways to intervene? Where do you start and what do you look for? Is it better to start and t...2022-11-1033 minTough to TreatWhat To Do When Your Treatment Stops WorkingIn this short episode, Erica discusses her perspective on what to do when your patient plateaus. We’ve all been there. The proverbial plateau. Your patient is doing well and then all of a sudden they get stuck. Why? More often than not, there is a secondary region of the body that has cropped up. Go back to your patient’s movement and injury history. There will most likely be a clue there. Also, do you trial exercise at the beginning of the treatment session? If you don’t, you should. Anoth...2022-11-0309 minTough to TreatTreating Knee OA The Smart Way In this episode, Erica and Susan discuss how to begin and progress treatment with a knee OA without exacerbating their symptoms. Knee pain can be quite provoking as we age, especially for those older adults who have always been active and want to stay that way. Osteoarthritis is fairly common, however, exercise designed for this patient population tends to fall short and can often exacerbate the symptoms. Is there an articular problem? Yes, often times that’s where it starts. But it cannot stop there. ...2022-10-2732 minTough to TreatThe Gut-Brain Axis - Stress, Pain, and BalanceJoin Susan as she shares a segment from a course she teaches on GI Dysfunction. This clip is dedicated to the Gut-Brain Axis and why the complex interactions can have such a direct effect on the behavior of the movement, endocrine, nervous and visceral systems. It is all about balance and the direct need to make sense of input and the actions necessary. A glance at this episode: [0:40] Susan shares an old story about working top down [1:50] Sympathetic and parasympathetic pathways [2:35] The vagal pathway [3:48] Susan discusses ‘eye brain’ vs. ‘old brain’ [4:55] The limbic system [6:01] ‘Gut brain’ [8:08] An example of...2022-10-2012 minTough to TreatShoulder and Arm Pain - What is Really the Driver?In this episode, Susan and Erica discuss how very old drivers can present in a novel situation, as well as why new drivers will appear if compensatory patterns are allowed to become dominant. Susan’s patient in this episode came to her with shoulder pain which quickly led to full-on arm pain. Susan discusses how she used clinical reasoning and the patient’s history to find the driver. The driver here is not obvious and did require some deep investigation. Shoulder problems can be the focus of the problem with the area having faulty movement patterns associated with...2022-10-1338 minTough to TreatHip Pain In A Golfer: Why It's Not Going AwayIn this short episode, Erica highlights the importance of center of mass by assessing a semi-competitive golfer with hip pain. He suffered an avulsion fracture of his iliopsoas tendon with resulting surgery. Two years later, he became symptomatic in his hip after golfing for consecutive days. Hip pain is quite common in golf because of the rotary nature of the sport, but you have to wonder why this happened. Here’s what you need to consider: After someone has an injury or even surgery, they will generally offload that side of their body. This is understandable, but the...2022-10-0609 minTough to TreatRacquet Sports & Back Pain: Why You Should Look At The FootIn this episode, Susan and Erica discuss a young squash player with long-standing low back pain. They highlight the importance of injury and movement history. What do we know of squash players? What regions of the body are stressed in this sport? Look at different movement patterns to tease out the driver. How can you apply your clinical reasoning using a timeline of his injury history coupled with the dominant movement patterning inherent in that sport to figure out where his drivers lie? Hint: there was more than one are...2022-09-2942 minTough to TreatWhen You Should Tape and WhyIn this short episode, Erica gives her perspective on when and why you should tape. This is one of the most commonly asked questions in her practice and this episode reveals Erica’s perspective on taping all throughout the body. She also shares the types of taping techniques that she uses whether it’s for supportive purposes or facilitatory purposes, or just nervous system input. Taping can be a controversial topic in physical therapy. However, there is a time and a place for such interventions. Clinical reasoning dictates that we have a reason for why we do what...2022-09-2213 minTough to TreatLow Back Pain: Regional vs. Movement System Considerations Low back pain is a descriptive term at best, indicating where symptoms present. Discover the history and the movement system examination and interventions that led to the successful reduction of symptoms. 2022-09-1535 minTough to TreatExercise Progression for the Tough to Treat Shoulder The shoulder can be tough to treat at times, right? It consists of many regions of the body and in order to design an exercise progression that gets results, you must: *Down train the old dominant strategy first *Be innovative with release positions to tease out certain muscles that are overactive *Train volume of easy exercise at a low level *Use hands and knees as a treatment and exercise progression This episode discusses all this and much more! Reme...2022-08-2525 minTough to TreatChoosing The Best Functional Movement For Your AssessmentSuccess=picking the best functional movement to assess with your patient. Can you imagine shaving minutes off of your initial evaluation time? And at the same time, connecting with your patient in a way that not only increases the therapeutic alliance but will help you find the driver quicker. A glance at this episode: [1:21] How to assess functional movement patterns that have meaning for your patient [2:45] How do you know if you’re feeling pain [3:50] What are you doing when you’re sitting [5:58] The purpose of the exercise to help the patient connect to the movement [7:30] The powe...2022-06-2414 minTough to TreatJunior Golfer with an Unusual Source to his Knee PainErica and Susan discuss in this podcast how treating the left hip as well as the left side of the low back, got rid of this young golfer’s knee pain. A functional and interactive evaluation really hones in on where the true source of his knee pain lies. Assessing center of mass (COM) here is crucial. Think about golf, you don’t need a wide stance. Most of your patients will look different depending on how wide or narrow their stance is. Don’t miss it. We also discuss the concept of picking a “meaningf...2022-06-1655 minTough to TreatMyth Busting - Rethinking Pregnancy Related Pelvic Girdle PainThere is usually a ten-year lag from published research to accepted practice in clinical arenas. Pelvic girdle pain in Pregnancy is no exception. Join us as we discuss the most important systemic and movement system presentations that can greatly impact this population. In this episode, we cover unhelpful language, true risk factors, and functional problem-solving for these clients. We also discuss what is really happening in the biopsychosocial approach - and especially why self-efficacy is so important. A glance at this episode: [3:30] Background on Pelvic Girdle Pain [9:34] What language you should be...2022-05-1942 min
Tough to TreatPersistent Shin Pain-Where is the Driver(s)? Hint: Not the Lumbar SpineCan there be 2 drivers to someone's shin pain? Of course! What is the relationship between them? Are they directly connected? Is there some underlying neurally driven mechanism? Or both? This episode digs deep into why certain positions like sitting in a specific environment versus other sitting positions make him worse. Why would biking be ok for someone and sitting in an office chair not be? Think about that one for a second. Susan and Erica discuss this patient's past movement history which plays a SIGNIFICANT role in his issue. You will have to listen to the episode to see...2022-02-2443 min
Tough to TreatDesigning Exercise Progressions For The Tough To TreatHow do you design a sound, clinically reasoned exercise progression? Taking into account multiple drivers? If someone has low back pain, do you give them core stability exercises? I hope not, unless they have an abdominal wall deficit! In this episode Susan and Erica talk about a patient from episode 81 and what constitutes an approporiate exercise progression for someone whose drivers were in his foot and thorax. They go into detail the various categories of exercise and how you would clinically reason giving one exercise over another. Link to episode #81-https://toughtotreat.com/81-elite-soccer-player-with-low-back-pain/. Join our new Premium Podcast...2022-01-2733 min
Tough to TreatDoes the Elbow Always Drive Elbow Pain?A fall on an outstretched elbow (FOOSH) with resulting elbow pain. Not your typical overuse or mechanical injury common to this region of the body. What happens when your differential diagnosis leads you somewhere else? Susan and Erica discuss the backbone of the initial assessment as well as treatment specific strategies that will help you get these patients better quicker. They also relate some great clinical pearls behind coming up with a hypothesis as to why elbow pain can be driven from another region of the body. Join our new Premium Podcast Club: toughtotreat.supercast.com2021-12-3038 min
Tough to Treat5 Symptomatic Regions Of The Body With One Main Driver- Part 2After listening to Part 1 of this case (episode 109), how would you design an exercise progression? Remember you need to find the driver first. Designing a movement program based on this patient's symptoms would NOT work, as his driver(s) lie elsewhere. Once you are confident you've found it, think about the impairment. Does he have an overactive superficial system or underactivity somewhere else or both? Sound clinical reasoning dictates that you need to downtrain the old strategy first. Listen as Erica and Susan finish their discussion on where his driver lies and how you would design an effective treatment...2021-12-0238 min
Tough to Treat5 Symptomatic Regions Of The Body With One Main DriverWhat happens when you have 2 regions of the body that when treated together give your patient the best movement options and no pain? But, when they are treated separately, not only is the patient worse, but their movement lacks coordination and ease. This episode highlights someone who has over 5 regions of the body that are meaningful and symptomatic. Literally from head to toe! Listen as Erica and Susan discuss in Part 1 of this case, how you can differentiate between these regions to effectively design an effective treatment session and a sound exercise progression. Of note, take away the compensation...2021-11-1849 min
Tough to TreatComplex Persistent Pain - Part 2 Where is the driver?Do you have thoughts on the driver from part 1? In part 2 we take you through the discovery and clinical reasoning parts to determine the primary driver for this client's symptoms. For intervention - think of the easiest steps to begin to find a way into the system to make large changes. Listen in as Susan and Erica discuss how symptoms can be present in various positions but can be changed through focus on the one major system here. Check us out: ToughToTreat.com2021-11-0445 min
Tough to TreatPersistent Unsolved Hip PainDoes all hip pain require strengthening? Of course not! And certainly not in this persistent case. This episode shows you the importance of digging deep into the history and really learning how to connect the dots. From the way the patient walks and what that means for symptom provocation to exposing the vestibular system as a potential driver. Other candidates include the foot, thorax and neck. Listen to find out how Susan and Erica problem solve together to come up with other ways to assess and treat this interesting patient! Check us out: taughttreat.com2021-10-0731 min
Tough to TreatNot Your Ordinary Knee PatientWhat do you automatically think when someone tells you they have knee pain? It's worse with walking SW and walking FW. And the patient cannot sleep sidelying because his knee hurts when he sleeps on either side. He can squat no problem. Are you thinking what we're thinking? Susan and Erica unpack this patient's story and dive into specific hints or cues that the patient gives to indicate that it's more than just the knee. Treatment? Well, that depends on the driver, doesn't it? The most important piece and message in this episode is the clinical reasoning behind why...2021-02-2529 min
Tough to TreatThoracic Mobility Beyond The BreathIn this episode Susan and Erica discuss the many ways the thorax can be the driver for a multitude of upper and lower extremity issues. This important region of the body tends to be the cause for a lot of movement dysfunction we often see. As an example, the thorax is an important component in driving foot pain as well as issues in the pelvic girdle. If you can get the thorax moving differently, this can help people out of old movement patterns that do not serve them and restore global movement patterning across many tasks. Check...2021-02-2258 min
Tough to TreatThoracic Mobility Beyond The BreathIn this episode Susan and Erica discuss the many ways the thorax can be the driver for a multitude of upper and lower extremity issues. This important region of the body tends to be the cause for a lot of movement dysfunction we often see. As an example, the thorax is an important component in driving foot pain as well as issues in the pelvic girdle. If you can can get the thorax moving differently, this can help people out of old movement patterns that do not serve them and restore global movement patterning across many tasks. ...2021-02-111h 54
Tough to TreatNeural Tension and BeyondCan neural tension be responsible for a tight hip? Absolutely! Would you believe that neural tension in the right hip can be responsible for left hip pain? Listen as Susan and Erica discuss the many possibilities of unsolved persistent pain. They also discuss several cases where neural tension plays a role in many typical musculoskeletal issues. Check us out: Toughtotreat.com2020-12-0341 min
Tough to TreatNeck Pain/Back Pain - Where Do You Start?Finding clients with subjective pain in the low back and cervical region is not an uncommon presentation. The bias is to treat the most acute region and hope the other region gets better as a result. What happens when you look closely at the story, listen to the client and find a very unlikely driver of maladaption in this clinical case? Join us as Susan and Erica unravel this clinical presentation and align the intervention with the client's goals. Check us out at Toughtotreat.com2020-11-1944 min
Tough to TreatHow To Master Functional Movement AssessmentFunctional movement re-patterning is the key to changing someone's movement strategy. But how do you choose the right one, so you are more organized and efficient in your assessments? And how can you clinically reason so you can hone in on one area to get better results? Understanding the inter-regional relationships in the body as someone moves may be the game changer for you and your client. How does the foot relate to the shoulder as you squat and reach over head? How does neural tension affect your ability to perform a narrow based lunge or squat? Listen in...2020-11-0540 min
Tough to TreatTraining the Tough To Treat ShoulderHow many neck problems are really disguised as shoulder issues? A lot actually! It is extremely common to overwork some of those small muscles of the neck at the expense of a true shoulder weakness. And why is traditional cuff strengthening not always the way to start with these patients? Listen as Susan and Erica do a deep dive into this patient's underlying issue and discuss various ways to bridge the gap between early phases of exercise to higher loads. What positions do you start with? How can you provide neural input into the system without aggravating symptoms? Check...2020-10-2335 min
Tough to TreatHerniated disc? Or Fear of sitting?What do you do when your patient tells you she has not sat for 9 months? And furthermore, a healthcare practitioner told her this! How do you "debunk" this myth of not sitting while at the same time give her body the ability to toelrate sitting postures? Imagination, contextual change as well as letting the patient take control of the session. What? The patient takes control? Listen as Susan and Erica talk about giving the patient new and novel ways of movement while at the same time changing the patient's unhealthy belief that sitting is bad for you. ...2020-05-2143 min
Tough to TreatI Hurt EverywhereWho hasn't heard this? This patient was seen in the clinic once just prior to the COVID-19 crisis and then progressed virtually from there. When someone says, " I hurt everywhere" and their symptoms appear randomly, how do you find a meaningful movement to assess? In particular, one that encompasses the whole body/whole person. Not an easy task, for sure, especially for someone who has significant amounts of anxiety related to movement and exercise. And with a past medical history of concussion, trauma and failed treatments. Listen as Susan and Erica take a deep dive into what is really...2020-04-2358 min
Tough to TreatHigher Load Exercise Progressions and Secondary DriversSuccess-your patient's original symptoms are gone and you are moving along with their program. They are progressing to higher loads, higher impact as well as incorporating tri-planar movement into their exercise. Then another region of the body starts to hurt. Why? Secondary and even tertiary drivers can appear at higher loads; even when they do not appear at the beginning. Be aware of this as your patient progresses. Susan and Erica discuss this fun case as they paint the clinical picture and offer many options for treatment. Check us out: Toughtotreat.com2020-03-2644 min
Tough to TreatButt pain-where's it coming from? The low back? Hip? Pelvis?One main symptom but 3 potential drivers. Is this person's glute pain coming from his hip? Low back? Pelvis? In this episode Erica and Susan discuss the differential diagnosis of a patient's butt pain which gets worse with sitting and driving. They discuss how multiple exam findings can lead you to one diagnosis but when all the pieces of this clinical puzzle are put together, a different story appears. Check us out at: Toughtotreat.com2020-01-3040 min
Tough to Treat054: Leaking and Running - A SolutionYou have not run in over a year because of a foot and hip injury. Finally, it's all coming together-you have less hip pain and your foot pain has been gone for weeks. You are cleared for a return to run program and then after 2 minutes into it, you leak. Does this sound familiar to you or your patients? In this episode we bring in the patient who has these symptoms. This is a rare glimpse into "real time" clinical reasoning. We highlight some unique treatment ideas as well as provide the patient with a strategy she can tap...2019-09-0555 min
Tough to Treat048: Complicated thigh numbness-is it really the nerve?What happens when someone's thigh goes numb and does not go away? The nerve is obviously angry but what is the driver? What could possibly cause someone's thigh to go numb? Do hormones play a role in this case? Is it hypermobility? Is it the foot? Susan and Erica discuss all the possibilities for this particular patient's presentation and present SPECIFIC movements/exercises that the patient will do in order to calm that thigh down. Visit our website: www.toughtotreat.com2019-06-0641 min