Shows
Tough 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 TreatWhat To Do When You Are Their Last ResortNow, this is a CHALLENGING one! Ever have those patients who have been everywhere, had everything done to them (injections, surgeries, acupuncture) and nothing helped? Well, this is your lucky day because this episode really takes us down the chain from head to toe with someone who had low back pain. Pretty standard, right? But this was FAR from standard. Hint: her low back was not the source of her problem. Why do you think that is? Remember, we bring all of our compensations to our life events. And our movement and injury history sets us up and our do...
2024-07-2552 min
This EndoLifeREPLAY: How to Manage Early Menopause, Medically Induced Menopause and Natural Menopause with Endometriosis, with Susan ClintonToday is a special episode, because my mentor, the woman who coached me through my coaching training, Susan Clinton, is joining us!Susan Clinton is a board certified women’s health physical therapist, a fellow of the American Academy of Orthopedic Manual Therapy, and a board certified health and wellness coach - to name just a few of her hats! She is also a Master Coach for the Integrative Women’s Health Institute, hence why she ended up being my coach and mentor!In today’s episode, Susan and I are discussing endometriosis and menopause - and...
2024-05-0654 min
Your Pelvic HealthEp. 30 - The RIGHT way to improve GI/Gut Health and Function for long term results with Susan Clinton Dr. Clinton is an award-winning physical therapist in professional achievement and the owner of LTI Physio in Sault Ste. Marie, MI. Susan is board certified in orthopedic and women’s health physical therapy, a fellow of the American Academy of Orthopedic Manual Therapy, and a board certified health, wellness and life coach. She is an international instructor/mentor of post-professional education in women’s health (including GI issues in women), orthopedic manual therapy, health/wellness coaching for the health care practioner and business psychology. Susan is the co-founder and board member for the foundation: Global Women’s Health Initiative. She is a...
2023-08-0851 minYour Pelvic HealthEp. 11 - “Why Am I Hurting and Why It May be Somewhere Else in the Body that's Causing it to Hurt?”Erica Meloe is a physical therapist in private practice in NYC. After a decade solving financial puzzles on Wall Street for a global investment bank, Erica took her MBA and problem solving skills into the clinic. She specializes in treating patients with persistent unsolved pain and her mission is to raise awareness of the physical therapy profession to a level like no other. Erica is co-host of the highly acclaimed podcast “Tough To Treat. A Physiotherapist’s Guide To Managing Those Complex Patients.” She is also a thought leader in the profession and has taug...
2023-03-1445 min
This EndoLifeHow to Manage Early Menopause, Medically Induced Menopause and Natural Menopause with Endometriosis, with Susan ClintonToday is a special episode, because my mentor, the woman who coached me through my coaching training, Susan Clinton, is joining us!Susan Clinton is a board certified women’s health physical therapist, a fellow of the American Academy of Orthopedic Manual Therapy, and a board certified health and wellness coach - to name just a few of her hats! She is also a Master Coach for the Integrative Women’s Health Institute, hence why she ended up being my coach and mentor!In today’s episode, Susan and I are discussing endometriosis and menopause - and...
2022-11-0757 minTough to TreatHypermobility and Low Back Pain How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? And their driver is NOT the lumbar spine. This episode highlights the beauty of a specific exercise progression tailored to the patient's meaningful movement as well as their driver. A very important principle of successful and long lasting improvement is training new movement strategies and giving the body healthy choices to move. We want our patients to have options to move and move well. Listen as we go through the clinical reasoning process to determine what types of movement patterns will work and...
2022-08-1150 min
Tough to TreatThe Foot and Diaphragm- Their Connection To This Skier's Hip PainWhat happens when you take away a compensation? Movement patterns change for starters. But what if these new strategies are not optimal for whatever activity you are trying to do? New sport you want to master? That's where the reality unfolds. Healthy systems need choices and when you take away a compensation or a movement pattern that no longer works (i.e. painful), your brain is forced to develop another strategy. In this episode we talk about a patient from episodes 109 and 110, who has made fantastic gains but started skiing again. He resorted to an old movement strategy which included...
2022-04-0732 min
Tough to TreatPersistent insertional tendonopathy - the importance of the systems approachThe movement system is adaptable until there is maladaptation! Why is tendonopathy so difficult to treat? What if straight eccentric loading doesn't work? Join us as we discuss this female client and the unique consideration of the system changes that have led to the development and persistence of her persistent heel pain. Yes, this includes pelvic health and the cervical spine! check us out at toughtotreat.com
2022-03-2436 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 TreatPersistent Pubic Symphysis Pain/Right Anterior Hip Pain10-20% of women with pelvic girdle pain in pregnancy will persist into the post-partum era. Join us as we share a discussion on the history that led to the eventual battery of relevant tests/measures and interventions that were not only meaningful to the client, but also were achievable in her very busy time of life with small children. Join our new Premium Podcast Club: toughtotreat.supercast.com
2022-01-1340 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.com
2021-12-3038 min
Tough to TreatA Case of Lateral Hip PainConsideration of lateral hip pain requires a thoughtful clinical reasoning process to discover the physiology/movement patterns as well as neural contributions required to make a diagnosis and successfully build an intervention that lasts. One size does not fit all - join us as we discuss the findings in this "not so unique" case and the discovery of the underlying movement patterns, impairments and why lateral rotator strengthening is not always the answer. Join our new Premium Podcast Club! For details click here: toughtotreat.supercast.com
2021-12-1551 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.com
2021-11-0445 min
Tough to TreatComplex Persistent Pain - Part 1 Where is the driver?We always discuss history and relevant events. In this episode we take a deeper dive into all aspects of the story in the BPS lens. Join us for our discussion on the importance of uncovering significant historical peices regardless of the referral or medical diagnosis. You have an opportunity to put on your clinical reasoning cap with us as we set up this clinical case in Part 1! Check us out: Toughtotreat.com
2021-10-2144 min
Tough to TreatNociplastic Pain and a Visceral DriverWhat do you do when a client presents with a myriad of LQ symptoms without a clear regional driver? Look to the history and keep asking questions even further back than the recent onset or episodic flare. Join us as we discuss complex neurology of a visceral driver that has signs of dysfunction and a somatic pain presentation. Once again, the history is so important! Check us out: toughtotreat.com
2021-09-1639 min
Tough to Treat"X" Marks The Spot-Navigating The True Source Of Shoulder PainSave yourself time by learning how to find the driver quicker. This is the case of a neck driven shoulder- but not in the way you think! Do all shoulder patients need strengthening? Not really. We talk about how to hone in on the impairment and narrow the assessment down to a few movements that will help you successfully clinically reason through most upper extremity issues. We also discuss novel ways to give your patient a home program based on their impairment, the smart way. Check us out: Toughtotreat.com
2021-08-2641 min
Tough to TreatComplex Ankle Sprains - What is Missing?Ankle sprain rehab can seem so straight forward - decrease swelling, improve ROM and strength - right? Wait, why are a good number not improving and returning to previous activities? Once again, the client's story and history can really lead us further into the complexity of the foot/ankle joint and all of the systems that need to be considered in returning this region to full function. Clinical Pearl Alert - Neural tension from the cutaneous nerves! Check us out: Toughtotreat.com
2021-08-1240 min
Tough to TreatTreatment Progressions for the Tough To Treat- Clinical PearlsClinical pearl alert! This episode tells the story of 3 patients and their treatment progressions. Typical symptoms but atypical drivers. What types of exercises do you prescribe for your patient when their symptom is in their feet and their driver lies in their thorax? What is their impairment? This is a discussion of how you would SPECIFICALLY treat and develop a well thought out exercise progression. Using your clincal reasoning doesn't stop with assessment. Check us out: Toughtotreat.com
2021-07-1540 min
Healthy Wealthy & SmartErica Meloe: Knowing your Strength as an EntrepreneurIn this episode, Owner and Founder of Velocity Physiotherapy, Erica Meloe, talks about the business of physical therapy. Today, Erica talks about her previous career, how to foster motivation and commitment in patients, and addressing company culture. What does it mean to be out-of-network? Hear about the biggest lessons Erica has learned in her career, the importance of mentorship, and get some valuable advice, all on today's episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways "Being an entrepreneur, you need to be able to know what your strengths are...
2021-07-0545 min
Tough to TreatSI Joint Pain - An Updated ApproachHere is the clinical story of a client that is presenting with pain/sensitivity in the area of the (R) posterior pelvis. In this episode we discuss what has been unhelpful for her with regard to past interventions and why the biospsychosocial approach and creating the therapeutic alliance is so important to give her the ability to improve her movement system. Meaningful activities, violating expectations and movement system changes were key to her healing journey. Check us out: Toughtotreat.com
2021-07-0146 min
Full Capacity LivingPelvic Health: Solutions to make every day better with Susan Clinton, DScPTToday I am joined by Susan Clinton, doctorate in PT who some might call the guru of pelvic floor physical therapy! She is an award winning PT and co-owner of Embody Physiotherapy and Wellness, on faculty at Andrews University in the Doctor of Science in PT program, the host of the podcast Tough to treat and so much more. Check the show notes for her full bio.She happens to be a long time friend yet the offering of this conversation really had me thinking of all the clients I have that experience urinary frequency, incontinence or co...
2021-06-211h 05
Tough to TreatWhat To Do When Your Patient PlateausWhat do you do when a patient plateaus? Doesn't improve? Join us for our first Q and A broadcast on how to clnically reason through a patient's treatment program when their progress starts to slow down. We discuss a specific patient example and what constitutes a solid progressive exercise program. This also includes reset exercises to restore optimal motor patterning so she can identify what movements are hindering her progress and what she can do to get herself out of a flare up. Check us out: Toughtotreat.com
2021-06-1736 minTough to TreatWhat To Do When Your Patient PlateausWhat do you do when a patient plateaus? Doesn't improve? Join us for our first Q and A broadcast on how to clnically reason through a patient's treatment program when their progress starts to slow down. We discuss a specific patient example and what constitutes a solid progressive exercise program. This also includes reset exercises to restore optimal motor patterning so she can identify what movements are hindering her progress and what she can do to get herself out of a flare up. Check us out: Toughtotreat.com
2021-06-1736 min
Tough to TreatClinical Pearls for the Shoulder-Understanding the Connections in the Upper QuarterJoin us for a special episode on the shoulder. This is a re-release of one of our most popular episodes to date. As a bonus, we present 3 case studies of patients with typical shoulder pain who have different drivers and certainly different exercise programs. Sometimes the key to helping a patient's persistent shoulder pain is looking at all of the underlying inputs into their system. What are the connections in the upper quarter? How do they relate to the patient's meaningful movement? Check us out: Toughtotreat.com
2021-06-0358 min
Tough to Treat"Why Does My Foot Hurt? What's Going On?"Why would someone who is 3 months post fibular fracture get worse after a basic theraband ankle exercise? Not everyone needs inversion and eversion theraband exercises. Right? This is an in depth clinical discussion on understanding the "why" hidden in the patient narrative. And a specific process on how to assess the whole foot and not just the ankle. We also discuss why this patient's center of mass is biased TOWARDS her INVOLVED side and what implications this has for treatment. Check us out @ Toughtotreat.com
2021-05-0536 min
Tough to TreatMusculoskeletal Driver of Hip Pain in a Young DancerWhen working with young athletes it is easy to have early success in treating the acute or subacute injuries. What happens when the latest injury reveals a very chronic situation elsewhere in the body? Don't be fooled by generalized and chronic complaints underlying the present situation in these teenagers. They may improve quickly in one respect, but looking deeper can help them improve adaptation strategies that will help further down the road and even alleviate a chronic situation. Join us as we discuss the chronic MSK driver to hip pain irritability in this young athlete. Check us...
2021-04-2240 min
Tough to TreatThe Knee and its Relationship to the Whole PersonHow does the knee affect so many parts of the body? Join us for this discussion on this important intermediate joint of the lower kinetic chain and how dysfunction here can alter the movement system for the whole person. Check us out: Toughtotreat.com
2021-04-0843 min
Tough to TreatChest Pain In An Endurance AthleteDoes chest pain raise your eyebrows? Red flag? Or wild goose chase? This case is an insight into a classic endurance athlete and how his past injuries reveal a true deficit which can be the potential driver for his current symptoms. These symptoms that only occur 3-4 hours after a bike ride. We discuss viscero-somatic cross talk, the cardiac sinus and its biomechanics as well as a how to start treatment in someone who has many moving parts!! Check us out: Toughtotreat.com
2021-03-2644 min
Tough to TreatShoulder Pain and Distal DriversThis episode features a case of shoulder pain with unusual drivers due to their distal proximity. Join us as we discuss this interesting clinical case on a very active man with chronic shoulder pain, fear avoidance, anxiety and some unique clinical reasoning to help him recover! Check us out: Toughtotreat.com
2021-03-1138 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 TreatAnkle fracture rehab - what is missing?As health care providers and rehab professionals, there is the story that ankle fracture rehab is simple. Makes sense right? A regional intervention over an obvious acute traumatic event. But what is missing and why do so many individuals recovering from this injury (post-surgical) are having difficulty months and years down the road? Join us as we explore the Biopsychosocial approach to this individual who felt her rehab care was dismissive to her real fears and complaints. How to navigate the waters when peripheral symptoms migrate to central sensitization. Of special interest here is where the secondary driver actually...
2021-01-2846 min
Tough to TreatDoes Hip Pain Always Come From The Hip?When someone complains of persistent hip pain, what do you think? Is the source the hip? It may be the pain generator but at this point, is the primary reason why they have hip pain because of some dysfunction intrinsic to the hip? Most likely not. Simple example- right persistent hip pain with going up stairs and standing on one leg. In standing, all their weight is on the right leg, why? Probably because of an old injury to their left side or an ingrained movement pattern they have adopted over the years. At any rate, they have lost...
2021-01-1453 min
Tough to TreatThe Shoulder Is Connected To EverythingJoin us for a fun discussion on the relationship of the shoulder to the rest of the body. Learn about all the connections between the shoulder, the cranium, the neck, the upper thorax and much more! Did you know that an old clavicle fracture on your left can be responsible for right shoulder pain? Check us out: Toughtotreat.com
2020-12-3149 min
Tough to TreatDouble Vision Post Partum, Cause or Effect?Tune in for an interesting discussion on a woman presenting with complaints of double vision 8 months after the birth of her third child. A coincidence? Maybe, maybe not. Either way, it needs to get addressed. Is this dural? Trigeminal wind-up? Listen in for the clinical reasoning process as well as some novel treatment techniques that worked. Check us out: Toughtotreat.com
2020-12-1741 min
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.com
2020-12-0341 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.com
2020-11-1944 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 TreatPelvic Pain - things are not always as they seem!Don't let the diagnosis be your guide, listen to the whole story, and be curious outside of pattern recognition. Is the original thought about the case straight forward. Or is it as Sherlock Holmes says: "When you have eliminated the impossible, whatever remains, however improbable, must be the truth?". Have you indeed eliminated all of the impossible? In this episode, we discuss the reasoning behind this client who has a complex presentation of symptom progression following a traumatic accident. Join us as we explore the nuances of "test-retest" in this case study. Check us out: Toughtotreat.com
2020-10-0842 min
Tough to TreatElite Soccer Player with Low Back PainWhy can't this athlete get rid of his low back pain? "Running- I have no problem with" "Lateral-side to side-movements really aggravate me". " Why?" How do we make a differential diagnosis here? And with significant unilateral calf weakness to add into the mix. Four ankle sprains and a 4th metatarsal fracture later, plus a "stress reaction" at L5, why wouldn't his low back be the source of his problem? Join us as we clinically reason through multiple facets of his case. Check us out: Toughtotreat.com
2020-09-2454 min
Tough to TreatFull squat vs. Partial SquatA recent article on various depths of squats revealed information that a full squat is more beneficial than partial squats in improving function and pain over time. Have a listen as we explore interesting comments/bias/evidence on why we rely on the squat as a revealing part of our examination and interventions. Follow link: https://www.tandfonline.com/doi/abs/10.1080/17461391.2019.1612952?journalCode=tejs20 Check us out: Toughtotreat.com
2020-09-1033 min
Tough to TreatMedial Elbow Pain and Tingling/NumbnessAnother case with elbow issues! This case involves neural tension, pins/needles, and catastrophization. What is the best way to begin to work with someone who has multiple issues around fear of neural symptoms without neuro changes? Join us as we discuss dosing, position changes, problem solving and fear reduction in this interesting case. Check us out: Toughtotreat.com
2020-08-2742 min
Tough to TreatDemystifying Tennis ElbowTennis elbow is one of those conditions that is extremely frustrating for both patient and practitioner alike. It turns into a persistent problem very fast. This was another one of our popular FB Lives we did recently. We unpacked the myths and theories around tennis elbow and what to do to treat it. Is it neurally driven? Cervical Spine driven? Does it emanate from poor shoulder mechanics? Or does it come from poor thoracic control? The key word here is "myths". Your pain generator may be the elbow, but the longer it persists, the driver(s) behind this frustrating...
2020-08-1340 min
Tough to TreatRunners With Recurrent Knee Pain-Finding The DriverWe all have patients for whatever reason, who always come back for the same problem over and over again. Even if they haven't been back for over 5 years. Our bodies tend to take the path of least resistance and more often than not, when someone has fully recovered and they're back doing what they want, something happens and they return with the SAME problem in the SAME place. Why? Is that their achilles heel, so to speak? Or has their strategy changed because of something new in their life? Check us out: Toughtotreat.com
2020-07-3036 min
Tough to TreatExercise progressions for the tough to treat footYour client has low back, hip, or pelvic girdle pain as examples, and you determine that the foot is the driver for these symptoms. What types of exercises would you prescribe to get them back to where they want to be? This is where you take the clinical reasoning to the next level! Whether it's loaded or unloaded, movement re-patterning requires you to really "connect the dots" in the body when it comes to moving someone through a sound exercise progression. This was initially recorded as one of our popular FB lives and we decided to share it as...
2020-07-1633 minTough to TreatAre patients really good historians?What happens when your patient/client forgets to tell you key pieces to their history? It happens alot - and sometimes can have great impact on our decision making within the evaluation or treatment sessions. It is not their fault, it is just the way the central nervous system prioritizes events. Helping our clients remember and string these events together can not only help them solve their problem, but might be just the piece they need to integrate for healing. Check us out: Toughtotreat.com
2020-07-0248 min
The Postpartum RevolutionOptimizing GI Health Postpartum with Susan Clinton, PT, DScPT, OCS, WCS, COMT, FAAOMPTSusan is a revolutionary thought leader in the pelvic PT and health coaching world, and in this episode she explains:- How your bowels can contribute to bladder leaking- The hormone-gut connection: serotonin, estrogen, cortisol are all affected by the health of our GI system.- How to eat to maximize your energy, support your recovery, and minimize brain fog, fatigue and the baby blues- Why we can develop food sensitivities and allergies “all of a sudden” during postpartum.- How to “weed, seed and feed” your gut microbiome so your GI system i...
2020-06-2647 min
Tough to TreatDoes scapula stabilization always work?This episode is about a weightlifter who suffered a T1 avulsion fracture, had surgery to remove the fragment and still had symptoms. Why? Because the avulsion was not the cause for this patient's lingering symptoms. Neuromuscular holding strategies as well as poor motor patterning were still there post-operatively. Think about what a weightlifter does before he performs a heavy lift and it will give you a clue as to what we needed to change. Check us out: Toughtotreat.com
2020-06-1852 min
Living a Better LifeEP 61 – Physiotherapy Approach to Treating Constipation and GI tractDescription: In this episode I interview Susan Clinton a physical therapist from the US about the physiotherapy approach to treating constipation and gastrointestinal problems. We dive into what contributes to constipation, what areas need to be assessed and treated to get long term changes and what is normal pooping. We dive deep into a systems approach to health and how that has helped her in her physiotherapy career. This podcast is both for those suffering from constipation but clinicians who want a deeper understanding of how to approach treating constipation.
Contact info for Susan:
People can find me at www.em...
2020-06-0856 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 TreatPelvic girdle pain and the BPS approachWhat are your three powerful questions that you use with your clients? Join Erica and I as we talk about working with clients from a full biopsychosocial approach. Does this mean all you do is pain education? How do clinicians best use the total approach to help clients regain self efficacy and manage their symptoms. There are also some great pearls around pelvic girdle pain in pregnancy as well. Check us out: Toughtotreat.com
2020-05-0746 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 TreatChronic Achilles Insertional TendonosisWhat do we really know about the achilles tendon and the various forms of tendonosis? What do you do when the eccentric exercise programs outlined in the literature do not bring about a significant change of symptoms? Join us to explore some of the facets of tendonosis and a clinical discussion on changing interventions. Check us out: Toughtotreat.com
2020-04-0933 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.com
2020-03-2644 min
The Women’s Health Podcast031 - Susan Clinton - Relax, Rest, And Digest! A Special COVID-19 EpisodeIn this special episode, we speak to Dr Susan Clinton, physical therapist/physiotherapist extraordinaire, about how long periods of stress can affect our health and well being... and what we can do to try to combat this.
Around the globe, huge changes have been taking place since the arrival of COVID-19. Our daily routines and the simplicity of things like going to the gym or having a coffee with friends have been completely upended. We are all feeling some degree of anxiety, wondering "when will this end? How bad is it going to get?"
So...
2020-03-241h 39
Tough to TreatFoot numbness - differentials and interventionsHave you ever had a patient where the story and the problems they were having were easy to solve, but your thoughts were - "It can't be this simple?" Follow along with us as we discuss the differentials and treatment of a gentleman with numbness on the balls of his feet. It may not be what you are thinking - and then again, maybe it is! Check us out: Toughtotreat.com
2020-03-1233 min
Tough to Treat5 years Post-Partum with Persistent Low Back PainThis patient has had low back pain since she was a child. She has coped well until the birth of her own children. The innate response to threat here is the inabillity to arch her back. Her system cannot lengthen and she cannot do a back bend or sit and perform an anterior pelvic tilt. But she can get into prone on elbows and extend no problem. Post-partum is ALWAYS post-partum and her standing strategy is reflective of this. Check us out: Toughtotreat.com
2020-02-2739 min
Tough to TreatHeel pain - is it always a MSK issue?What goes through your mind in pattern recognition when you hear the word heel pain? What do you begin to think - and then their story actually does not reflect the functional limitations expected. Join the co-hosts as they discuss the impact of multimodal issues that could be affecting this clinical presentation. Check us out at: Toughtotreat.com
2020-02-1332 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.com
2020-01-3040 min
Real Talk with the Pelvic DocsGetting The Runs When You Run?: Interview with Susan Clinton PT, DScPT, OCS, WCS, COMT, FAAOMPTIn today's episode, Joc and Jenny sit down with Susan Clinton PT, DScPT, OCS, WCS, COMT, FAAOMPT to discuss a topic that is very common: fecal urgency with running. Whether you are a marathoner, tri-athlete, or recreational runner, you have probably experienced this at some point in your running career. Why does it happen and what can you do about? Susan dives into this in today's episode. Interested in connecting with Susan? Find her at www.embody-pt.com - her online courses are listed on the website as well as her live courses - check back in f...
2020-01-2637 min
Tough to Treat063: Hip arthritis! Update from #37What do you do when you run into a true hip joint limitation with persistent pain. altered patterns of movement and loss of the closed pack position? Join us as we explore the update of the female injured on her boat in Podcast #37 - what has improved, what has changed! Most importantly - how to help someone really work a new movement pattern and achieve ROM/Mobilization in some non-threatening ways! Check us out on ToughToTreat.com
2020-01-1640 min
Tough to Treat062: Persistent shin pain & a lateral shift-implications for gaitIs a lateral shift a reaction to an irritated nerve root? Or is it part of a functional scoliosis? Or neither? This patient experienced persistent right shin pain with prolonged walking. A year ago she noticed a significant shift in her pelvis to the right. This episode highlights the importance of identifying the non-optimal movement strategy and prescribing exercise to correct it. We discuss how to re-pattern her movements with a focus on the "why" she moves a certain way vs just training a muscle in an isolated non-meaningful exercise. Visit our website: Toughtotreat.com
2020-01-0241 min
Tough to Treat061: Back pain, stiffness and the search for the cause!What happens when you are an athlete and have endured many injuries in your life that have all healed, and now you have a back injury that is stubborn and is now a persistent pain issue. Compound this issue with a diagnosis of a torn lumbar ligament and the thoughts of instability/grinding joints/bone on bone and other thoughts take over the movement system. Join us as we explore some strategies and option for changing fear and moving in novel ways. Visit our website: Toughtotreat.com
2019-12-1937 min
Tough to Treat060: Changing symptoms- a motor control problem or something else?We have all been through this-as providers or patients. One day your low back hurts on the right, the next day it's the left, and 2 days later it's your right hip and the saga goes on and on and on. Why? Is it because there is a movement control problem and you are just running out of options? Or is there perhaps another systems impairment that is contributing to all of this? Join us as we clinically reason through a male patient of Erica's who is experiencing these symptoms. Hormones are not just the domain of the female.
2019-12-0544 min
Tough to Treat059: Stress urinary incontinence - muscle weakness or load transfer?What flashes through your mind with a diagnosis of SUI - muscle weakness? That is certainly one hypothesis! Listen in on this episode where we explore another client with a "systems" problem that is much more involved than just simple pelvic floor muscle exercises. More information at www.toughtotreat.com
2019-11-1442 min
Tough to Treat058: Foot pain of questionable originFailed epidurals, back surgery and you still have buttock pain along with foot pain. Why? We all know back surgery is not always the answer, but why would someone's symptoms persist after all these interventions? Why would walking barefoot in the sand make this person feel better? Is the strategy different or is the nerve root still aggravated after all these interventions or both? Visit www.toughtotreat.com for all episodes
2019-10-3143 min
Tough to Treat057: Elbow pain or cervical?Join us on this podcast as we work through the differentials of this complex post-partum client with the onset of elbow joint pain. Issues that have become so problematic, it's interfering with her sleep. Is it the elbow or the cervical spine - or neural tension? www.toughtotreat.com
2019-10-1740 min
Tough to Treat056: Is this patient tough to treat?How does someone who has had 4 sessions of PT somewhere else become complex? The answer: She got the wrong treatment. And what happened? It sensitized her nervous system to the point that she was afraid that she was never going to get better. Ever hear of less is more? If you intervene at the right time with the right treatment, less is DEFINITELY more. More episodes at www.toughtotreat.com
2019-10-0335 min
Tough to Treat055: Back pain or leg pain - why is it getting worse?Explore the narrative of this client with persistent hip and leg pain for over 20 years. In this episode we explore the behaviors and mitigating factors that have increased the symptoms and are slowly turning this person with confronter behavior into an avoider. Sometimes the small changes can have a huge impact. Find out more at www.toughtotreat.com
2019-09-1941 min
Tough to Treat053: Is an overactive TFL a poor movement strategy?Your patient cannot sit and cannot squat in the gym without lateral hip pain. They believe it is their overactive TFL. But is it the cause of the problem? Most likely, it is NOT. Why would someone have increased tone in a muscle? Think about a movement pattern where someone's center of mass is shifted to one side because of an old contralateral foot injury? You injure your foot and you weight shift off of that side where you stay that way for YEARS. Until one day, you run out of options. Sound familiar? Visit our website...
2019-08-2248 min
Tough to Treat052: A shoulder or a neck problem - what is important to the patient?Shoulder pain - or neck pain? Does it really matter to the intervention? What does the client believe and expect? How do you manage client expectations in this scenario? Join us in a rich discussion about this client's self-efficacy and managing expectations while reducing fear. Sound clinical reasoning shows you the value of asking the right questions to guide you in your treatment. www.toughtotreat.com
2019-08-0837 min
Tough to Treat051: Is it really the nerve root?Searing shin pain, low back pain, night sweats, unable to sleep or walk-is it the disc? The nerve root? A sensitive nervous system? Or something else? Or all of the above? Join us as we make a differential diagnosis on this gentleman's problem. Once again, listening to his story will give you clues as to how to begin the objective exam. Find out more at www.toughtotreat
2019-07-2538 min
Tough to Treat050: Finding the real story through the narrativeDo you ever wonder if there is a better way to evaluate the complex patient? What do you do when the body diagram is full with a long history? I think we all are used to hearing our client's stories - but do we really listen to their full narrative? This can be the key to finding out what's important to them and sometimes, the simplest solution is revealed through their story along with the physical exam. Have a listen to this story and the key components! Sign up for our newsletter at www.toughtotreat.com We ha...
2019-07-0435 min
Tough to Treat049: Game Changing Exercise ProgressionsDo you want better outcomes with your patients? What do you do when a patient has plateaued? Or they're not improving as fast as they should be? One of the answers could be your exercise progression. Are you truly treating the source of the patient's problem with a specific movement program geared towards the SOURCE and NOT the symptom? What is the key to effective exercise progression? In this episode, Erica discusses what has been a real game-changer in her practice. That is: appropriate exercise progression for common drivers that she sees. She shares clinical pearls from her caseload...
2019-06-2043 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.com
2019-06-0641 min
Tough to Treat047: Fear avoidance with low back & pelvic painLow back pain - the need to stretch and fear avoidance complications. What happens if the movement or postures you believe to be good are really problematic? We have delved into low back pain and the constant need to stretch, but sometimes it can also become more complex due to our thoughts and beliefs. Here are some good strategies for helping someone move and confronting their beliefs. Visit our website: www.toughtotreat.com
2019-05-2336 min
Tough to Treat046: Leg pain and peripheral nervesWhat happens when someone suffers a traumatic injury, then lives with it for 8 months? Listen to this episode and find out. Susan and I discuss a former patient of mine who lived with hypersensitivity, bruising and swelling in her lower limb for months!! Think about what that does to your system? We also discuss developing a hypothesis/diagnosis based upon the subjective history. It is something we should do with every single patient. That is what makes you an expert. Furthermore, what happens when a patient's objective signs are worse after your treatment? I mean, right after, before they...
2019-05-0936 min
Tough to Treat045: Female with bilateral hip pain? Is it really a hip joint problem?Join in on this differential diagnosis and use of evidence to help determine the underlying cause and progressive movements to help this very strong and resilient female overcome nagging hip pain for over 5 years. Pain can be complex and contextual, it can also have a metabolic component as well. Consistency is the key to addressing her issue and progressing her program. Visit our website at www.toughtotreat.com
2019-04-2544 min
Tough to Treat044: Dancer with Pelvic Pain-Is it Really the Pelvis?Does this dancer with persistent left-sided pelvic girdle pain need to have her SI joint manipulated all the time? The answer is an obvious no! In this episode, we discuss how a professional dancer was able to get rid of her pelvic pain by looking up the chain. Remember- it is the movement strategy that counts. Digging deep into the demands of her performance, was the key to finding a solution for her. We also address the relevant exercise progression. If the symptom is the pelvis and the cause is somewhere else, how would you design a movement program...
2019-04-1149 min
Tough to TreatNeurogenic pain and complex metabolic issuesThis episode features a gentleman with complex metabolic issues, neurogenic pain and an interesting cross-section of mechanical MSK issues. Join us as we sort out the history and discuss the treatment interventions based on his unique story and the best way for him to function. Visit our website: toughtotreat.com
2019-03-2847 min
Tough to Treat042: Complex issues with pain and fear avoidanceTough To Treat Masterclass: In this episode we have guest PT, Alaina Newell, who presents us with one of her tough male patients with a primary complaint of abdominal issues. Sometimes what our patients present with is only the tip of the iceberg. We clinically reason through the evaluation but move very quickly into diagnosis and movement. It is interesting how the story of this complex case unfolds over time. We brainstorm some great treatment ideas and various ways to change this gentlemen's fear avoidance. This is a fascinating story that can teach us all a lesson that healing...
2019-03-1457 min
Tough to Treat041: Not Your Ordinary Hip ProblemWhat do you do when your patient tells you that she hurts everywhere? In this episode, Susan and I discuss a patient with an EXTENSIVE injury history who happens to be a runner. Do these compensations over the years end up being what is the root cause of the problem? Or are there some cognitive and emotional barriers to recovery? The main issue here is hip pain. This is not your ordinary hip issue. Subjective includes, "ripping", "burning" and "a dead leg". Does the pelvis play a role? The foot? An old clavicle fracture? Listen and find out!!
2019-02-2848 min
Tough to Treat040: Is spinal stenosis a mystery?Tough To Treat Masterclass: In this episode we have guest PT, Daria Oller, who presents us with one of her tough spinal patients. Is spinal stenosis a mystery? Not really.... We clinically reason through the evaluation but move very quickly into diagnosis and movement. We brainstorm some great treatment ideas and various ways to change this gentleman's compromised movement pattern. And it's not just the physical, this person has a significant fear based component to his problem, which can potentially prolong healing. Visit our website: www.toughtotreat.com
2019-02-1453 min
Tough to Treat039: Left sided pain and tightness in a professional dancerProfessional dancers tend to push through tightness, discomfort and pain. Not surprising! Often times the care they seek does not really address the driver(s) of their symptoms. More often than not, it is treat the painful part and move on. That is not a recipe for long term relief. Listen to this girl's story and see how we evaluated and addressed her symptoms. Sometimes less is more. Visit our website www.toughtotreat.com
2019-01-3132 min
Tough to Treat038: What is the real cause of her elbow pain?Does elbow pain really emanate from the elbow? Sometimes it does. But the longer people wait to seek help, the higher the likelihood there is another driver. And therein lies the challenge. Join us as we clinically reason through this patient's elbow/arm pain and the ensuing treatment progression and exercise prescription. Visit our website: ToughtoTreat.com
2019-01-1743 min
Tough to Treat037: Hip and back injury at Sea!What happens when someone gets injured while living on their sailboat at sea? This episode explores the clinical reasoning and intervention process from a virtual platform to help this lady through an unexpected injury to her hip and back and navigating the functions needed on a sailboat. Visit our website: toughtotreat.com
2019-01-0346 min
Tough to Treat036: Shoulder Pain- A motor control problem?When does motor control come into play when someone has persistent shoulder pain? Is it soft tissue related, a joint problem or a neuromuscular repatterning issue? Or something else? How does our nervous system adjust? In this episode we talk about the multiple sources to this person's shoulder pain and how retraining his arm lift was the key to his recovery. Visit our website: toughtotreat.com
2018-12-2037 min
Tough to Treat035: Post-partum pelvic pain and urgencyThere are many ways to approach pelvic pain and symptoms of urinary urge incontinence, but did you know that how the MSK system moves can affect these symptoms as well? On this podcast, we take a dive into the movement system, past/present autoimmune history and post-partum process while changing this client's symptoms as well as her urinary incontinence. In turn she regains control over her pelvic pain! Visit our website: toughtotreat.com
2018-12-0654 min
Tough to Treat034: Hypermobility and low back painHow do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? Carefully and specifically! This episode highlights the beauty of a specific exercise progression tailored to the patient's meaningful movement. Listen as we go through the clinical reasoning process to determine what types of movement patterns will work and what ones won't. Doing the right thing at the right time is clinical expertise. Visit our website: toughtotreat.com
2018-11-2248 min
Tough to Treat033: Shoulder pain biomechanical or systemic of origin?Explore the origin of this client's shoulder pain as we discuss a biomechanical vs. systemic history and how the pain experience had changed her ability to fully participate in life and exercise. Visit our website: toughtotreat.com
2018-11-0837 minThe Women’s Health Podcast005 - Intraabdominal and Intrathoracic Pressure And How It Affects You - Susan ClintonDr Susan Clinton discusses intraabdominal and intrathoracic pressure and why it is important for women to understand these.
Susan is also on a podcast called Tough To Treat with Erica Meloe and can be found on iTunes and at http://toughtotreat.libsyn.com/website
More information on Susan can be found at www.embody-pt.com
The Women’s Health Podcast
Website – womenshealthpodcast.com
Podbean – womenshealthpodcast.info
Facebook – fb.me/womenshealthpodcast
Instagram – instagram.com/womenshealthpodcast
Twitter – twitter.com/womenshealthpod
Antony Lo – The Physio Detective
Business Website – physiodetective.com
2018-08-141h 10
The Health and Fitness Connector PodcastPelvic Health in Women- When it's normal and when it's not- peeing/leaking/prolapsingWOW! This episode goes there! We talk all about pelvic health- peeing, leaking, prolapsing (what the heck is prolapsing?!). When it's normal and when it's not- hint: it's never normal and if this conversation hit's home for you, you should talk to a specialist or your PCP/OBGYN today! Leaking urine is unfortunately a common occurrence with sport- often dismissed and laughed off or hidden never to be discussed! Susan and Tonya bring up some great tips to help if this is happening to you so listen in until the end! Like, share and tag a friend! Let's stop normal...
2018-02-1255 min