Advanced Clinical Reasoning: Applications Across the PT Spectrum
Tough to Treat
In this episode, Erica explores how clinical reasoning informs decision-making across diverse areas of physical therapy practice. This is a clinical pearls discussion that will save you lots of time in the clinic. From CKC to OKC brain mapping in an MMA fighter to exercise progression in ACL rehabilitation to thoracic dysfunction in a post partum runner experiencing hip pain and incontinence, she highlights key clinical reasoning strategies that guide effective treatment and exercise progression. For example, if your patient has a bracing strategy in their lumbar spine where they always...
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Treatment Timelines and Tackling HEP Non-Compliance: Real Patient Cases
Tough to Treat
How long should you keep treating a patient? And what’s the best approach when they’re skipping their home exercise program? In this listener Q&A episode, Erica shares practical strategies—illustrated through two real patient cases, one a golfer and the other a cyclist—for answering the tough question of treatment length and for addressing non-compliance. She highlights how building a strong therapeutic relationship can improve follow-through and make these conversations more productive. Erica also highlights the most important phases of an exercise program to ensure efficiency and...
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Why is an old foot injury responsible for my current neck pain?
Tough to Treat
In this episode, Erica dives into a fascinating case of a patient experiencing neck pain and how that seemingly isolated symptom actually traced back to an old foot injury. This case exemplifies the deep, interconnected nature of the human body. For those you have been listening for a while, this should not surprise you. She unpacks the biomechanical and neural links between the foot and cervical spine, exploring how altered load distribution and compensatory patterns can persist long after the original injury appears to have healed. A key focus of the discussion is the role of the center of...
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Managing the Complex Patient – When the Body Chart Is Full
Tough to Treat
In this episode, Erica talks about how to approach care when a patient has a long history of injuries and a body chart that seems to be "lit up" everywhere. It can feel overwhelming—for both the patient and the clinician. She focuses on the importance of prioritization: identifying what’s most clinically relevant right now. This involves connecting the dots to perhaps an old injury to what the current problem is. In this particular case, frequent bilateral ankle sprains, an ACL reconstruction plus a continued pattern of bilateral issues help you nail down your focus to what is important...
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Bone and Power: Training Smarter Through Menopause
Tough to Treat
This episode dives into some of the evidence on resistance vs. high-velocity power training in postmenopausal women and its impact on bone mineral density (BMD). Research is highlighted showing that high-speed training protocols may stimulate bone more effectively than traditional resistance training by increasing strain rates and promoting osteogenic adaptation. You’ll learn how moving with speed and control helps strengthen bones and prevents age-related decline better than slow, heavy lifting alone. Some of Erica’s research for her doctoral dissertation is discussed and she then...
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Physical Performance Decline in Menopausal Women: Strength vs Power
Tough to Treat
In this episode, Erica dives into the latest research exploring how menopause affects physical performance in women—highlighting changes in power and strength. These findings are reshaping how we approach exercise and rehab in midlife women. Next, she shares an update on her dissertation, which compares premenopausal and postmenopausal women on key physical performance metrics. Erica discusses early patterns emerging from the data, including potential implications for exercise training and rehab prescription. She wraps up with a clinical case involving a woman in menopause experiencing...
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Building Better PT Practices: Courses, Clinical Reasoning, and Mentoring Insights
Tough to Treat
In this episode, we answer the most common questions we get from listeners. We dive into course recommendations, highlighting resources for continuing education, mentoring and evidence-based practices. A key focus is on clinical reasoning strategies—how to approach complex cases and integrate patient-specific factors into your decision-making. We also discuss the value of spending the majority of your first session taking the patient’s story. Your patients will make you a better physical therapist, if you listen to them. Be curious and let it lead you towards mastery. ...
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Complex shoulder pain - how the narrative and red flags paint a different picture
Tough to Treat
Clients 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 ...
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Shoulder Pain With Pull Ups or Push Ups? The Elbow Changes Everything
Tough to Treat
In this episode, we explore the surprising journey of a boxer battling chronic shoulder pain that left him struggling to do even the most basic workout. Despite focusing on his shoulder, it turns out the root of his problem lay elsewhere—his elbow. Is that surprising? It was in his injury history. Do not discount the power of an old injury that could come back and haunt you. And think about the load on the elbow when you're doing a push or pull-up. Join us as we clinically reason through this interesting case from start to finish. A glance at this episode: [0:01] Introduction and...
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Chronic Knee Pain - Where to Begin!
Tough to Treat
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] Treatment...
info_outlineIn 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 is, "Why would a side-to-side deep squat be harder for the foot than the thorax?" Both are lateral movement patterns.
She also discusses the clinical reasoning behind a well-thought-out exercise plan. Remember: we are trying to give our patients options for movement and variability across many activities. Building volume of exercise at low levels is key to this outcome as is challenging the driver across many planes.
A glance at this episode:
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[3:38] Prescribing specific exercises based on the patient's main driver, not the symptom
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[8:02] Identifying the level of difficulty for a specific exercise using regional analysis
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[14:02] How to dose exercise based on what is meaningful for the patient
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[17:58] Exercises for improving lower body control and center of mass
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