Tough to Treat

Why doesn't my groin pain go away?  When someone is an athlete, you must understand what regions of the body are challenged with their sport. With soccer, you think of the thorax, foot, hip, and pelvis from the get-go.  Listen in as Erica discusses the movement she and her patient chose to assess and what they discovered.  Short-term treatment of someone's symptomatic region may help in the short...

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 for assessing the whole foot, not just the ankle.  We also discuss why this patient's center of m...

We continue with our GI dysfunction theme in this podcast about food intolerances/sensitivities vs. allergies.  Join Susan as she takes you through the algorithm to understand how to recognize what is the underlying information behind why certain food bothers us and when we should eliminate food.   A glance at this episode: [3:49] Elimination diets for digestive health [7:42] Gluten sensitivity an...

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 inhibition/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 along...

When do you treat the viscera?  And why?  This episode discusses a bit about the abdominal viscera. It is certainly not all-encompassing by any means. We just want our audience to be aware of the possibilities.  Erica relays some clues in the patient's history as to why you would screen for GI dysfunction. She uses 2 case examples of when the abdominal viscera was the secondary driver in one case...

In this episode, Susan and Erica welcome Darcie Pervier to the mic!  Darcie is a pelvic health and orthopedic PT who practices a fully integrative approach to complex client care. Susan, Erica, and Darcie really delve into "brainstorming" various aspects of examination and intervention in connecting some dots on this complex canvas.  Dural issues, fracture healing, bone health red flags, thoracic...

This episode captures a critical aspect of integrating sensory and motor aspects of colorectal rehab from constipation and IBS to fecal incontinence.  The information is categorized under the hyposensitive vs. the hypersensitive quality of symptoms and the motor control from decreased muscle capacity, tissue quality, and motoric coordination.   A glance at this episode: [3:27] Rectal balloon thera...

In this episode, Erica and Susan welcome Julia Rosenthal to the mic.  Julia is a physical therapist in NYC. She brings a complex case of a postpartum patient of hers who has symptoms of urinary incontinence as well as other bowel and bladder issues that were made worse after giving birth.  The patient is a personal trainer and used to high-load exercise, so the need to get back to this is strong....

How do you increase patient compliance with their exercise program?  This can be very frustrating for both the therapist and the patient.  In this shortie episode, Erica discusses how she helps keep her patients on track with their movement program.  She often says, "If it's not trialed, then the chances of your patient doing the exercise are reduced at least 10-fold."  What is the goal of exercis...

In this episode Susan and Erica welcome a Tough To Treat listener, Megan Barclay. Megan brings a case of a patient who continues to suffer neuralgia after a bout of shingles, along with persistent neck pain.  Listen to the client's history, significant findings, and differentials as we navigate this client's journey and discuss relevant findings.  There is also a rich discussion on possible interv...

Look beyond the traditional regional approach of the pelvic and pelvic floor and understand how discovering and addressing dysfunctions of the trigeminal and respiratory system including the voice and heart rate variability can have an impact on pelvic health.  HRV is a well-researched indicator of the balance between the Sympathetic and the Parasympathetic nervous systems.  The balance has a larg...

Look beyond the traditional regional approach of the pelvis and pelvic floor and understand how discovering and addressing dysfunctions of the trigeminal and respiratory system including the voice and heart rate variability can have an impact on pelvic health.  HRV is a well-researched indicator of the balance between the Sympathetic and the Parasympathetic nervous systems.  The balance has a larg...

In this episode, we dive into the often overlooked and misunderstood world of male health, exploring the complexities of groin pain, the challenges of taking deep breaths, and the impact on his pelvic girdle pain.  The history will give you the answer.  This is a complex case with many parts but listening to his story helps you to prioritize which regions of the body you need to rule out.  Viscera...

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 of this person's shoulder pain and how retraining his arm lift was the key to his recovery. And we mean retraining, the righ...

Here is the clinical story of a client that is presenting with pain/sensitivity in the area of the (R) posterior pelvis.  A common area of symptoms for many patients. But there are many potential drivers and the need to differentially diagnose is crucial.   Why? Because you won't want to miss the hidden connections that are so often present in patients, that when missed, can make the difference be...

In this episode, Erica explores the intersection of functional movement and persistent pain, offering a comprehensive blueprint for understanding and addressing movement dysfunctions that may contribute to ongoing discomfort.  Join her as she discusses her insights and tips with examples from her patient caseload.  Erica also speaks to functional movements that will help you find "hidden" drivers...

One of the most overlooked joints in the lower quarter is the first MTP joint unless that is the primary complaint of the client.  How does the stiffness of the 1st MTP joint affect gait and lower quarter movement of all kinds? We spend some great time with discussions of differential diagnosis, and practical interventions and share some new discoveries.  Hint: the exam and intervention do not alw...

Heart rate variability is getting a lot of press recently.  Join Susan as she presents a webinar on HRV as a predictor and intervention in sleep and stress.  It doesn't take complicated interventions to make real changes in our health!   A glance at this episode: [1:59] What is heart rate variability [4:07] Inhibition of the flight or fight system [6:26] How you measure heart rate variability [8:5...

In this episode, we delve into the perplexing realm of medically unexplained pain and the challenges it presents for healthcare professionals.  Join us as we navigate the complex landscape of patients who continue to experience pain despite thorough medical examinations revealing no discernible underlying cause.  We explore the frustrations and uncertainties faced by both patients and practitioner...

Have you ever had patients with "diagnoses" of labral tears on MR only to find out that the hip was not the driver?  Of course, you have.  In this short episode, Erica responds to a case sent in from one of the listeners regarding persistent hip pain.  She asks Erica what would be important to look at and how to proceed with the information at her disposal.  There was not a lot of background on th...

Clients often have chronic low back pain as a primary or secondary issue.  It is often combined in complex presentations where addressing one issue is usually not going to generate optimal results.  In this episode, Susan and Erica discuss the obvious and not-so-obvious drivers in this client with chronic low back pain and constipation/bloating! They discuss the varied evidence that helps to deter...

Clinical practice guidelines provide the practitioner with the most up-to-date research on a certain diagnosis or condition.  Join Susan in a two-part interview about Pelvic Girdle Pain in the Antepartum Population.  In part 2 there is a discussion around systemic vs. biomechanical drivers and the effect of cortisol and stress.  The clinician is asked to review their confirmational biases, conside...

Compression fractures are commonly associated with osteoporosis in older adults.  However, what happens when these fractures occur in young males? In this episode, Erica and Susan discuss a patient who sustained a T6 compression fracture.  It is intriguing to note that it is a young male in his 20's not an older woman in her 70s. Do they require different treatments? Detecting a compression fractu...

This is an excerpt from Erica's DCP course call in February of 2023.  In this episode, she delves into the crucial aspect of meeting patient expectations and facilitating their progress.  She explores the dynamic relationship between healthcare providers and patients, discussing effective strategies for understanding, managing, and aligning expectations throughout the treatment journey.  Join her...

Shoulder pain, like any other joint can present as primary pain and be the #1 reason a client may seek help!  In many cases, treating the apparent joint dysfunction (because it checks all of the boxes) may not result in optimal outcomes.  Join the conversation as Susan and Erica explore the reasons and important timelines in the client's history that led to her shoulder pain.  Most importantly fol...