Tough to Treat

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: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

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: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

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: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

In this episode, we discuss the case of a very active woman grappling with SI (sacroiliac) joint pain. These symptoms manifest while walking and with hip external rotation. Furthermore, the episode unravels the complexities surrounding assessments, especially when individuals seek consultation for a single visit. We also delve into why and when using a pelvic belt is helpful. Also, for the non-pelvic health therapists out there, we discuss how you can palpate relevant muscles externally to further confirm or negate your hypothesis as to whether the pelvis is a driver. This patient had an extensive medical and surgical history. We also discuss certain aspects of her history that are very relevant for treatment. When someone has had 3 C-sections, an abdominoplasty, breast reconstruction, and more, do you think that the pelvis is the main driver? Think again if you do. Remember, we are a product of our compensations and adaptations to prior injuries and surgeries. A glance at this episode: [4:04] Pelvic girdle pain and nerve damage [7:55] Patient's medical history and treatment options [12:17] Pelvic girdle dysfunction and its impact on gait [18:48] Pelvic health issues and scoliosis [22:15] Patient's medical history and potential causes of pain [26:23] Treating chronic pain and imbalance in a patient with a history of abdominal surgeries and scoliosis [32:22] Pelvic floor assessment and treatment [36:43] Treating chronic pain in a patient with complex history [41:26] Pelvic health and its impact on overall body function Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

In this short episode, Susan presents a good algorithm for the examination and interventions in clients with GI dysfunction. Follow along as she discusses different nuances and considerations in the presence of pelvic and abdominal aspects of GI dysfunction. A glance at this episode: [0:01] Interventions for GI dysfunction and abdominal pain [2:03] Manual therapy for abdominal and pelvic issues [6:19] Abdominal massage for constipation and pain relief [9:59] Breathing, abdominal muscles, and pelvic floor function [14:35] Abdominal surgery effects on musculoskeletal and visceral support Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

This episode presents a client with a seemingly straightforward diagnosis in pelvic health of overactive bladder (OAB). The history and physical presentation tell a different story. Join Susan and Erica as they explore why often a regional approach will not help the client progress to their highest levels of function without symptoms. We discuss the various drivers viscerally and MSK regionally and why tendon function and the client's stage of life require the utmost consideration. Join us in the conversation and discover the multi-system approach in consideration of the examination and interventions for this client A glance at this episode: [2:22] Urinary incontinence and hip injury [6:50] Pelvic floor dysfunction and its connection to urgency frequency [11:49] Pelvic floor exam and overactive bladder symptoms [16:30] Abdominal and musculoskeletal issues [22:12] Exercise modifications for lower back pain [28:23] Exercises for pelvic health and bladder control [32:59] Pelvic health and muscle imbalances [39:00] Mental health cases and patient mentoring Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

In the episode, Erica explores the strategic use of open and closed-chain exercises for upper extremity dysfunction. She discusses the distinct benefits and applications of each type of movement, shedding light on how these exercises can be tailored to meet specific needs to enhance performance. She uses an example of a tennis player who suffered from right shoulder pain with radiculopathy. She also tackles the critical question of when to load open-chain versus closed-chain exercises, offering practical guidelines based on the stage of recovery and individual progress. OKC can be very difficult for someone who has a true shoulder driver. Based on her experience with these patients, most people who play an overhead sport, display a lot of compression in their upper rib cage and shoulder joint. This can masquerade as "thoracic outlet syndrome" or "rotator cuff strain" when it's a movement pattern created by their sport carried over to all life events. By understanding the principles of load management and exercise progression for open and closed-chain exercises, listeners will gain valuable insights into prioritizing certain movements during the rehab process. A glance at this episode: [2:28] Physical therapy for tennis player with shoulder and rib compression [5:58] Manual therapy techniques for shoulder issues [11:15] Progressing patients through closed-chain exercises [15:38] Rehabilitation techniques for chronic pain Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

In our latest episode, we explore the fascinating stories of two individuals navigating the challenges of mastering the push-up despite their unique injury history. Both individuals had different pain experiences with this movement. Remember-What set them up? What kept them there? We explore why the push-up experience varied greatly between these 2 people and why it was so unique in these 2 individuals. "Push" is a part of daily life whether we realize it or not from pushing open an umbrella to pushing a door open to a full push-up on the floor of a declined bench. The "What set them up?" is a significant factor in how they were assessed and treated. One individual was a former boxer and the other held a desk job but had an extensive exercise and injury history. Join us as we unravel the complex interplay of factors shaping each individual's journey toward mastering this seemingly simple yet profound exercise. A glance at this episode: [4:57] Two men's push-up techniques and their impact on their bodies [10:04] Elbow injuries in boxers and their impact on grip strength [18:44] Rehabilitation exercises for shoulder and elbow issues [24:03] Exercise progression for two patients-they are very different [29:53] Shoulder pain and movement analysis [35:32] Rehabilitation strategies specific to the push up [40:38] Relevant exercises for lower body and upper body strength Related links: The Franklin Method Fellowship Podcast Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

This episode is a short compilation of an algorithm in looking at basic outcome measures and pain in GI Dysfunction. Susan explores the basics of the history which can give great insight into the addition of more sophisticated outcome measures and pain exploration. Start with the basics and then expand! A glance at this episode: [0:01] Evaluating and managing pain in people with GI dysfunction [1:18] Abdominal pain and its relationship to GI dysfunction [4:47] Visceral pain and myofascial pain syndromes [9:14] Pelvic health and bowel dysfunction assessment tools [13:12] Bowel habits and GI health assessment Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

Join us in episode #200 where Susan and Erica explore the potentiality of the balance system as a primary or secondary driver. With a client's history of injury or illness, there is an event that sets up their system for adaptation. Oftentimes, in regional-specific rehab, the balance system is not considered as a driver. What keeps the client in this adapted pattern may be the primary driver; however, the balance system adapts to keep the entire body and physiology upright against gravity. This system can change, and the need for activity to accomplish this becomes a primary consideration in the assessment and the intervention. Listen in to the conversation and find easy clues to discover in your client assessment for effective interventions. A glance at this episode: [5:27] Balance system adaptation and rehabilitation [12:43] Balance, vestibular system, and eye movements [21:04] The importance of challenging the balance system and multitasking while keeping balance intact [25:28] Balance challenges and treatment options for various populations [29:53] Improving balance and rotation through exercises [35:30] Pelvic health, balance, and movement patterns [43:47] Balance system importance in exercise and rehabilitation Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

In this episode, we explore the profound connections between personal narratives and the origins of someone's injury. Join Erica as she delves into the stories of individuals who've experienced persistent injuries, and learn how to find clues in their narrative to help you prioritize the movement assessment and eventually find their driver(s). You will learn how to make the connections between the story and their movement patterning. Through the lens of their injury and movement history, we can uncover the reason why someone can't move the way they want. This leads to precise diagnosis and effective treatment. You don't treat the symptomatic region unless it's the driver. There is a video companion piece with slides on our "Tough To Treat" YouTube channel for this episode. A glance at this episode: [0:55] Finding the patient's primary driver from clues in their narrative [4:30] Post-partum tennis player with neck pain during a push-up, what her story tells you [9:11] How her injury and movement history will lead you to the driver(s) [13:06] What movement(s) to assess and how to make this much more efficient Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

How important are past events to present movement patterns and restrictions? What about past events of herniated lateral discs or hypermobility on the current presentation of the movement system? Clients can heal with faulty movement systems that can show up as new and different presentations in the future. This podcast is from a presentation that links the neuromuscular systems together and provides insight for evaluation and interventions. A glance at this episode: [0:01] Lumbopelvic pain causes and treatment [5:02] Hip extension and lumbar spine rotation for efficient walking [8:48] Back pain and nerve root impingement [12:17] Hypermobile spine and neural patterning [16:20] Lumbar spine mobility and exercises for pain relief Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

In this empowering episode, we dive deep into the realm of fear-based movement and explore strategies to help patients conquer their anxieties, helping them move towards a more confident and pain-free existence. Anxiety and fear of movement are real things and can prevail even when we are termed "fit to play", "fit to move" or "pain-free". Just because someone is pain-free, it doesn't mean that they can move well or move without fear. We discuss the implications of movement anxiety and explore the roots of fear and how it manifests in the body. Our discussion involves 2 specific case studies where fear of a certain movement was stalling their recovery and includes specific techniques and exercises for a positive outcome. By the end of this episode, you'll be equipped with valuable tools and insights to help your patients move better, even when fear holds them back. A glance at this episode: [5:37] Interoception, beliefs, and structural integrity in physical therapy [10:12] Fear based pain with lumbar extension [14:40] Graded exposure to movement [18:29] Movement re-patterning with specificity [26:11] An equestrian who is afraid to sit [30:15] Integrating variance into exercise [34:29] Using props to help patients overcome fear and improve movement patterns Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

Discover the art of being an active listener who can pick up clues in your patient's narrative to help you find their driver quicker. This will save you lots of time in your movement assessment. Listen in as Erica discusses how to reframe your patient's story to help you maximize your time with them in the clinic. She discusses clues in their "subjective" that can aid you in prioritizing regions of the body to assess in your movement analysis. This is done with 3 case studies from her practice where she discusses each patient's story (injury and movement history) and what clues she honed in on to effectively make a clinical hypothesis about their driver(s). A glance at this episode: [4:13] Analyzing movement and injury history and why a timeline matters [9:44] The importance of the narrative in assessing a patient's movement patterns. How to ask the right questions. [15:17] Why the first injury sets them up and why their movement history keeps them there [20:20] Case study-tennis player who was unable to do a push up. [23:43] Case study-neural tension restricting UE closed chain activities. [27:09] Case study- runner with pelvic girdle pain whose driver was her foot Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

Welcome to the New Year and one of the topics always discussed by Healthcare providers is burnout and imposter syndrome. Join Susan in this short podcast - Part 2 Taking back your mental fitness. Learn how to identify the voices of your inner Judge and Saboteurs, how to limit their voices, and find a pathway to your Sage Brain! A glance at this episode: [3:21] Mindfulness techniques for neural plasticity [6:48] Mindfulness and neural pathways for busy people [10:33] Cultivating self-empathy and overcoming judgment [14:09] Positive Intelligence and Self-Improvement Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

Welcome to the New Year and one of the topics always discussed by healthcare providers is burnout and imposter syndrome. Join Susan in this short podcast episode - Part 1 Taking back your mental fitness. Learn how to identify the voices of your inner Judge and Saboteurs, how to limit their voices, and find a pathway to your Sage Brain! A glance at this episode: [4:38] Saboteurs in the brain and their impact on decision-making [9:11] Personality types and their impact on work performance [13:30] The disruptive role of saboteurs in decision-Making [18:27] Mental fitness in healthcare with a focus on saboteurs and sage powers Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

Hip pain can be brutal. And more often than not-it's chronic. Not like an acute ankle sprain or even acute low back pain. People who suffer from hip pain, for whatever reason, sink into the chronic side of musculoskeletal pain. Let's face it-consideration 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. A glance at this episode: [2:15] Hip and knee pain case intro [5:08] Chronic hip pain and potential causes [9:35] Loss of mobility and symptoms [12:51] Hip movement and range of motion influences [19:04] Hip mobility and exercise prescription [22:31] Motor planning and motor control [25:45] Hip rotation and postural ramifications [31:12] Pelvic floor muscles and hip rotator imbalance [34:54] Physical therapy exercises for improving balance and reducing neurological symptoms [41:48] Treating hip pain through physical therapy [44:58] Manual therapy techniques for pain management Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

In this episode, Susan and Erica discuss the many ways the thorax can be the driver for a multitude of upper and lower extremity issues. This important region of the body tends to cause a lot of movement dysfunction we often see. As an example, the thorax is an important component in driving foot pain as well as issues in the pelvic girdle. Suppose you can get the thorax to move differently. In that case, this can help people down-train old movement patterns that do not serve them and ultimately restore global movement patterning across many tasks. Key point: The thorax can be a key driver, in how someone transfers load after an injury (no matter when that injury took place). It is a region of the body that compensates for pain and dysfunction elsewhere and then ends up being the driver years later. Don't miss it. A glance at this episode: [3:26] Thoracic mobility and breath control for pain relief [11:19] Breathing and muscle release techniques for thoracic spine mobility [14:26] Using sensory input with a theraband for thoracic mobility [19:19] Using closed kinetic chain exercises for thoracic mobility and abdominal strength [23:49] Assessing and treating shoulder injuries [29:23] Thoracic mobility and its impact on movement patterns [34:20] Thoracic rotation and breathing exercises for runners [43:05] Reintegrating movement patterns for whole-body wellness [47:42] Exercise and posture for older adults [52:12] Posture and movement for homeschooling and virtual work Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

Many times, clinicians find that people with correlative GI system dysfunction are very overwhelming. The complexity makes it difficult to know where to begin to intervene. Join us as Susan discusses some very simple mediations to help improve the GI system with stress, exercise, and sleep. Complex clinical pictures can often change when we address the foundations of health with simple interventions. A glance at this episode: [1:38] Stress, its effects on the body, and exercise as a remedy [6:38] Exercise and stress management techniques [10:56] Sleep's impact on digestion and overall health [14:16] Improving sleep quality with expert tips Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript

Susan and Erica welcome Kelly McClain to the podcast to discuss a very complex client with pelvic health, orthopedic, and neurological issues. Follow along as the client case is presented and we pursue a rich discussion of tying together the systems involved as well as the red flags. Digging deeper into the client's story is key here to help with obvious referrals and also to recognize other systems and issues deeper into the client's history to gain insight. A glance at this episode: [3:05] Pelvic health issues and treatment [12:28] Patient's symptoms and medical history [20:20] Current medical issues and imaging recommendations [26:14] Clinical reasoning and potential diagnoses [31:08] Manual therapy for perineal pain [33:24] Rectal pain and paraesthesia during squatting [38:44] Treating patients with complex symptoms Related links: Tough To Treat Website Erica’s Course: Decoding the Complex Patient Susan’s Pelvic Health Education Subscription Access the Transcript