Tough to Treat
Welcome to Tough to Treat: A Physiotherapists’ Guide to Managing Those Complex Patients, with your hosts Erica Meloe and Susan Clinton, who discuss how they successfully treated patients that others could not. Via case history discussion, they share their physical therapy expertise from treating long standing pelvic pain to persistent neck pain. They present a holistic and integrative view on assessing and treating chronic pain. Unique movement strategies and specific patient exercise prescription are also presented so you can be ahead of the curve when it comes to treating these types of patients. Oftentimes, the source of the problem is not where you think it is!! For example, chronic low back pain emanating from the neck. Or hip pain coming from the foot. It pays to look up and down the kinetic chain! Podcast music: "Fearless First" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/
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Advanced Clinical Reasoning: Applications Across the PT Spectrum
09/11/2025
Advanced Clinical Reasoning: Applications Across the PT Spectrum
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 "grip" their back when they sit, stand and even go supine, how would you prescribe exercise to "take out" that strategy to give them more options for movement? Many people do this in our "sit up straight" culture. This will make a huge difference in your practice! Related links:
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Treatment Timelines and Tackling HEP Non-Compliance: Real Patient Cases
08/13/2025
Treatment Timelines and Tackling HEP Non-Compliance: Real Patient Cases
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 compliance. To close, Erica offers a brief update from her doctoral research on menopause, focusing on the role of muscle power in older women and why it may be a more critical predictor of function than strength alone. Related links:
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Why is an old foot injury responsible for my current neck pain?
07/24/2025
Why is an old foot injury responsible for my current neck pain?
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 mass—how shifts in its control can influence motor strategy and postural control, ultimately impacting regions far from the original site of injury. Erica also covers exercise options, including progressions that integrate both the foot and cervical spine. How to adapt your treatment when load transfer is compromised is a key factor in this patient’s outcome. This episode is a reminder that in rehab, it’s rarely just about the joint that hurts—it’s about the whole system that moves around it. Related links:
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Managing the Complex Patient – When the Body Chart Is Full
07/03/2025
Managing the Complex Patient – When the Body Chart Is Full
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 for you to assess and what is important for the patient to feel. These patterns not only shape your clinical focus—helping you decide what truly needs assessment—but also give the patient a clearer sense of what their body is trying to communicate. What is relevant to you may not be important to them. It's up to you to explain to them why. Key takeaways include: · Avoiding the trap of chasing every symptom. · Establishing a hierarchy of concerns using patient input and objective findings. · Acknowledging the complexity of the history without letting it dictate the entire plan. Related links:
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Bone and Power: Training Smarter Through Menopause
06/19/2025
Bone and Power: Training Smarter Through Menopause
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 presents a case study of a menopausal patient with insidious-onset shoulder pain and offers some clinical pearls as to why, especially in anyone who has played a racquet sport, the shoulder is not the only driver. She also highlights a few targeted interventions that allowed this woman to weight lift and strengthen her shoulder without feeding into her symptoms. The content contained therein, including text, images, audio, or other formats, were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Related links:
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Physical Performance Decline in Menopausal Women: Strength vs Power
06/03/2025
Physical Performance Decline in Menopausal Women: Strength vs Power
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 persistent neck and shoulder pain, along with difficulty breathing. She breaks down the history along with a few clinical pearls outlining how past injuries have and continue to contribute to this woman’s issues. Erica also breaks down her exercise program, discussing the do’s and don’ts of exercise progression. Hormonal changes can contribute to musculoskeletal tension and diaphragmatic dysfunction- we know this. But do we really educate our patients on this? Many do not. Whether you're a clinician, researcher, or someone navigating midlife changes, this episode offers insight, evidence, and strategies for supporting well-being during menopause. Related links:
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Building Better PT Practices: Courses, Clinical Reasoning, and Mentoring Insights
11/28/2024
Building Better PT Practices: Courses, Clinical Reasoning, and Mentoring Insights
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. A glance at this episode: [2:27] Courses and Continuous Learning [12:11] Starting the Podcast and Building a Community [13:17] Mentorship and Clinical Reasoning [19:10] Treatment Sessions and Client Engagement [22:56] The Role of Patients in Clinical Learning [26:41] Reflecting on the Year and Planning for the Future Related links:
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Complex shoulder pain - how the narrative and red flags paint a different picture
11/07/2024
Complex shoulder pain - how the narrative and red flags paint a different picture
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 [15:21] Addressing Left Shoulder Pain and Movement Dysfunction [17:51] Implementing Modified Exercises and Pilates [39:28] Discussing the Power of the Narrative and Patient Advocacy [40:13] Connecting Patient Goals to Treatment Outcomes [45:17] Final Thoughts and Episode Closing Related links:
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Shoulder Pain With Pull Ups or Push Ups? The Elbow Changes Everything
10/24/2024
Shoulder Pain With Pull Ups or Push Ups? The Elbow Changes Everything
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 Patient Background [7:03] Initial Assessment and Observations [11:56] Exploring the Root Causes [14:12] Addressing the Pull-Up Challenge [32:06] Implementing Exercise Program [36:32] Final Thoughts and Key Takeaways Related links:
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Chronic Knee Pain - Where to Begin!
10/10/2024
Chronic 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] Treatment Plan and Initial Intervention [31:02] Follow-Up and Client Feedback [31:17] Advanced Treatment and Future Plans [31:31] Conclusion and Encouragement for Listeners Related links:
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Assessing Knee Health For Hip-Related Walking Pain
09/26/2024
Assessing Knee Health For Hip-Related Walking Pain
In 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: [2:23] Patient Background and Injury History [3:46] Assessment and Initial Findings [6:33] Knee and Hip Mechanics [10:11] Terminal Knee Extension and Treatment Approach [20:43] Clinical Reasoning and Patient Outcome [20:58] Conclusion and Call to Action Related links:
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When shoulder pain is dominant, but not the driver!
09/12/2024
When 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! A glance at this episode: [1:39] Shoulder pain and internal rotation [7:52] Which side of the table should you work from [12:40] Learning to tape the wrist [20:00] Opening the hands [22:46] Using the blocks for yoga blocks [27:58] Grip strength as a sign of health Related links:
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Beyond Tennis: Exploring Shoulder Compression Across Sports
09/05/2024
Beyond Tennis: Exploring Shoulder Compression Across Sports
In 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 OKC piece does not progress as quickly. A glance at this episode: [0:01] Erica's Summer Vacation and Introduction to the Episode [2:30] Clinical Pearls for Tennis Players [6:15] Assessing Upper Thorax and Glenohumeral Joint Compression [12:53] Treatment Approach for Upper Thorax and Glenohumeral Joint Issues [15:54] Progressing Patients with Glenohumeral Issues [16:14] Clinical Pearls for Closed Chain Exercises [20:37] Conclusion and Encouragement for Practitioners Related links:
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A Stiff 1st MTP Joint can Affect Everything!
08/29/2024
A Stiff 1st MTP Joint can Affect Everything!
One of the most overlooked joints in the lower quarter is the first MTP joint unless that is the client's primary complaint. How does the stiffness of the MTP joint affect gait and lower quarter movement of all kinds? We spend some great time discussing differential diagnosis and practical interventions and sharing some new discoveries. Hint: the exam and intervention do not always center around the stiff 1st MTP - there is likely a primary driver elsewhere. A glance at this episode: [0:01] Introduction and Podcast Rebroadcast [2:13] Overview of Stiff First MTP Joint [4:21] Compensation and Adaptation [6:30] Assessment and Treatment Approaches [23:22] Exercise and Proprioception [25:47] Shoe Recommendations and Adaptations [34:17] Conclusion and Final Thoughts Related links:
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Fencer with Bilateral Calf Pain
08/22/2024
Fencer with Bilateral Calf Pain
What is the cause of bilateral calf pain in this young fencer? From start to finish, it shows the power of a thorough evaluation, a specific exercise progression, and a return to the sport she loves. When it comes to exercise progression in persistent pain, think about context. How can you improve optimal movement patterning by changing the context? Think about this one. You can intervene via the visual system, eyes open, eyes closed. How about changing their base of support? Wide to narrow. And why not have them do their exercises to their favorite music? These are just some examples. Look at your patients through a different lens and then see positive change. A glance at this episode: [0:01] Introduction and Case Overview [7:46] Initial Assessment and Clinical Reasoning [10:27] Hypermobility and Initial Treatment [20:14] Progression and Additional Techniques [32:40] Advanced Techniques and Future Plans [52:04] Conclusion and Reflection Related links:
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The Role of the Diaphragm in Chronic Low Back Pain and GI Dysfunction
08/15/2024
The Role of the Diaphragm in Chronic Low Back Pain and GI Dysfunction
How 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, Kumagai K, Kobesova A. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):352-62. doi: 10.2519/jospt.2012.3830. Epub 2011 Dec 21. PMID: 22236541. 2) Villoria A, Azpiroz F, Burri E, Cisternas D, Soldevilla A, Malagelada JR. Abdomino-phrenic dyssynergia in patients with abdominal bloating and distension. Am J Gastroenterol. 2011 May;106(5):815-9. doi: 10.1038/ajg.2010.408. Erratum in: Am J Gastroenterol. 2011 Jul;106(7):1405. PMID: 21540894. 3) Sicilia-Gomez C, Fernández-Carnero S, Martin-Perez A, Cuenca-Zaldívar N, Naranjo-Cinto F, Pecos-Martín D, Cervera-Cano M, Nunez-Nagy S. Abdominal and Pelvic Floor Activity Related to Respiratory Diaphragmatic Activity in Subjects with and without Non-Specific Low Back Pain. Diagnostics (Basel). 2022 Oct 18;12(10):2530. doi: 10.3390/diagnostics12102530. PMID: 36292219; PMCID: PMC9600311. A glance at this episode: [0:01] Diaphragm function, GI dysfunction, and postural control [7:51] GI dysfunction and its impact on abdominal wall muscles and posture [13:39] Abdominal dysfunction and diaphragm movement in relation to chronic low back pain [20:36] Treating chronic low back pain through abdominal wall retraining [25:09] Abdominal wall deficit and diaphragm dysfunction in chronic low back pain patients [32:07] Treating gas and bloating through diaphragm therapy 36:32] Treating GI dysfunction through breathwork and positioning Related links:
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Hypermobility and Low Back Pain
08/08/2024
Hypermobility and Low Back Pain
How 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. A glance at this episode: [5:13] Hypermobility and pain management for a 24-year-old woman [11:26] Hypermobility, muscle imbalances, and control issues in a patient with back pain [19:00] Shoulder subluxation and its relation to past injuries and yoga practice [23:57] Diaphragm recruitment in back pain patients [27:47] Addressing short girl syndrome in a dancer [32:03] Using tape and Pilates equipment to improve abdominal strength and stability for a hypermobile patient [35:51] Improving posture and flexibility through exercises on a reformer machine [39:23] Exercises for a spin instructor with tight hip flexors [43:34] Exercises for hypermobile individuals to improve motor control and recruitment Related links:
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Low Back Pain - Regional vs. Movement System Considerations
08/01/2024
Low Back Pain - Regional vs. Movement System Considerations
If 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: A glance at this episode: [0:01] Low back pain and pelvic health issues, client with gradual onset of stress urinary incontinence [2:16] Pelvic health and trauma history after a recent fall [7:21] Patient's foot and leg issues, including supination and knee pain [13:08] Addressing knee issues through breathing and positioning [15:50] Knee and back pain treatment using bridging and lunge exercises [22:01] Treating knee pain and low back pain through exercises and manual therapy [27:45] Treating patients with movement system changes to address low back pain and pelvic health issues Related links:
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What To Do When You Are Their Last Resort
07/25/2024
What To Do When You Are Their Last Resort
Now, 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 dominant patterning keeps us there. Visit our website: A glance at this episode: [0:01] Complex medical history and treatment options [7:06] Chronic pain and potential causes [12:14] Pelvic issues and postural compensations [18:41] Pelvic and foot issues, possible nervous system impairment [23:21] Decompression techniques for a patient with nervous system issues [26:31] Yoga and physical therapy for a patient with neck pain [29:13] Treating a patient with chronic pain using movement patterns and cranial work [35:07] Standing and carrying issues, loading exercises suggested [40:07] Exercises for back pain relief, including cycling, Nordic walking, and rock climbing [42:28] Using yoga and rock climbing to improve standing tolerance for a client with chronic pain [47:30] Treating patient with chronic pelvic pain Related links:
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Nociplastic Pain and a Visceral Driver
07/18/2024
Nociplastic Pain and a Visceral Driver
What 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! A glance at this episode: [0:01] Left lower quadrant pain, nociceptive input from visceral driver [2:23] Pelvic pain and potential visceral driver [8:05] Bladder issues and pelvic floor tension [10:49] Bladder irritants and pelvic health with a patient [16:49] Lower back pain and posture with a physical therapist [20:04] Pelvic floor exercises and visceral manipulation for pelvic pain relief [24:34] Pelvic floor exercises and core strength for bladder control [26:45] Improving driving skills and addressing bladder issues [32:49] Visceral mobilization and pelvic floor issues Related links:
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Junior Golfer With Persistent Unsolved Knee Pain
07/11/2024
Junior Golfer With Persistent Unsolved Knee Pain
Golf 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 implications for loading. Erica and Susan discuss in this episode how treating the left hip as well as the left side of the low back, got rid of this young golfer’s knee pain. He needed options for movement to his left side. A functional and interactive evaluation really hones in on where the true source of his knee pain lies. Remember: for persistent, unsolved problems, correlate the patient's history with your objective assessment. Hint: this patient had a history of concussion. You think that would alter his BOS? A glance at this episode: [0:01] Chronic knee pain in a junior golfer, analyzing the cause and treatment options [4:48] Golf injury treatment and diagnosis [12:19] Golf swing mechanics and potential issues with a young golfer [17:03] Assessing a 12-year-old golf player with knee pain using a thorough history and clinical reasoning [23:49] Using visual aids and manual therapy to help a golfer improve his swing by shifting weight to the left leg [31:33] Using mirror therapy for knee rehabilitation [39:25] Rehabilitating knee injuries via changing the center of mass [43:34] Rehabilitation program for golfers with variance in exercises to improve adaptability [47:36] Physical therapy for a young golfer with a focus on listening and meeting clients where they are Related links:
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What's Stopping this Former Fighter from Doing Push-Ups and Pull-Ups?
06/27/2024
What's Stopping this Former Fighter from Doing Push-Ups and Pull-Ups?
In this episode, Erica dives into the intriguing story of a former fighter who faced unexpected challenges with basic exercises like push-ups and pull-ups. She sheds light on how years of specialized training led to muscle imbalances and problems outside the ring. The "push" and "pull" are different movement patterns. What region(s) of the body are challenged with these movements? Remember the "push" is a 4-point closed chain movement and the "pull" is not. What do fighters do on a routine basis to their wrists before a fight? Why is the "negative" on a pull-up more important than the push on a push-up? Listen in as Erica discusses how to make this type of assessment more efficient by really listening to the story, connecting the dots, and ultimately going back to basics to treat another region of the body that was a secondary driver to the "pull". If you want the visual, here is a link to our . A glance at this episode: [0:01] A patient's medical history and symptoms related to military service and boxing [5:00] Assessing push-ups and shoulder mobility in different positions related to COM [8:18] Identifying different movement patterns with the push and pull and how to clinically reason and find the true driver [12:31] How a dysfunctional elbow can limit the pull up but not the push-up Related links:
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Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 2
06/13/2024
Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 2
This episode is part 2 of episode 213. Utilizing evidence-based research and the latest clinical guidelines, the presentation will examine the multifactorial nature of chronic constipation, including non-pelvic interventions that can complement existing treatments. One key aspect will be the practical application of the balloon catheter, demonstrating its effective use for both assessment and therapeutic interventions. A glance at this episode: [0:01] Chronic constipation interventions and assessment, including muscle tightness and behavioral factors [3:27] Using balloon catheter for rectal biofeedback to treat constipation [8:37] Constipation, abdominal distension, and neural tension, with exercises to improve GI function and reduce discomfort [14:54] Stress, sleep, and nervous system regulation for chronic problems [20:16] GI health, manometry for constipation in infants, and mindfulness techniques Related links:
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Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 1
06/06/2024
Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 1
Utilizing evidence-based research and the latest clinical guidelines, the presentation will examine the multifactorial nature of chronic constipation, including non-pelvic interventions that can complement existing treatments. One key aspect will be the practical application of the balloon catheter, demonstrating its effective use for both assessment and therapeutic interventions. A glance at this episode: [0:01] Chronic constipation and its impact on pelvic floor health [4:24] Constipation and irritable bowel syndrome (IBS) causes, symptoms, and diagnosis [12:18] Bloating and distension in chronic constipation, including causes and treatments [17:07] Diaphragm function in chronic low back pain Related links:
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Postpartum Pelvic Pain and Urgency
05/23/2024
Postpartum Pelvic Pain and Urgency
There 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 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! A glance at this episode: [0:01] Postpartum pelvic pain and urinary incontinence in a 34-year-old woman [2:07] Pregnancy, autoimmune disorders, and migraines [5:36] Postpartum health, nutrition, and urinary incontinence [11:18] Postpartum care and pain management [14:40] Back pain and mobility issues [17:56] Postpartum pelvic floor dysfunction and urgency issues [24:09] Managing urinary incontinence through diet and exercise changes [27:42] Urgency and pain during sex, pelvic exam, and internal rotation [30:22] Pelvic pain and cranial flexion [36:17] Evaluating and treating a patient's urgent symptoms through neural tension and movement [38:54] Breathing techniques for managing urinary urgency and stress Related links:
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How To Assess The Knee Differently
05/16/2024
How To Assess The Knee Differently
In 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 assessing the knee in dorsiflexion and knee flexion is not efficient or effective here. Train your vision to see what optimal movement looks like. And then put your hands on the femoral condyles and the joint lines to train your own brain to feel what is optimal. That's how you increase your clinical expertise. Erica also discusses a movement you can evaluate if the patient has a hard time squatting or lunging. Finally, do not discount the patient's prior history. An old untreated hamstring tear from years ago could absolutely be relevant to someone's increased knee pain. Makes sense, right? But we often forget that - do not ignore prior history and its importance to current symptoms. A glance at this episode: [4:03] Knee pain and its compensatory patterning [8:14] Using vision and palpation to assess knee joint movement and patterning for optimal assessment and treatment [12:09] Assessing the knee through a body twist Related links:
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Addressing the Gaps in a Patient's Exercise Program
05/09/2024
Addressing the Gaps in a Patient's Exercise Program
This 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 her program. A glance at this episode: [4:00] Exercise program for patients with knee and foot issues, focusing on strengthening key muscles [7:30] Lunges and split squats for a runner with a thoracic driver [13:56] Proper lunge technique and addressing knee pain through strengthening exercises [20:24] Improving lunges with a stick and target practice [23:43] Lunges and squats for runners with a focus on proper form and progression [29:30] Exercise safety and program development for patients with knee pain Related links:
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Food Allergies vs. Intolerance
05/02/2024
Food Allergies vs. Intolerance
What 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:
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Back Pain/Leg Pain - Making the Right Call For Our Clients
04/25/2024
Back Pain/Leg Pain - Making the Right Call For Our Clients
This 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 fatigue [7:37] Back pain and re-curring mobility issues [12:16] Chronic pain and it's relationship to mobility [17:02] Proper standing and walking techniques for comfort and mobility [22:00] Standing balance and stretching exercises for improved mobility [26:51] Chronic back pain and neuroinflammation [31:26] Back pain treatment options and the importance of proper imaging [36:01] Proper treatment approaches for a patient with persistent low back pain Related links:
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Clinical Pearls For Effective Exercise Progression
04/18/2024
Clinical Pearls For Effective Exercise Progression
In 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: [3:38] Prescribing specific exercises based on the patient's main driver, not the symptom [8:02] Identifying the level of difficulty for a specific exercise using regional analysis [14:02] How to dose exercise based on what is meaningful for the patient [17:58] Exercises for improving lower body control and center of mass Related links:
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