Tough to Treat

Join Susan in a two-part interview about Pelvic Girdle Pain in the Antepartum Population.  Clinical practice guidelines provide the practitioner with the most up-to-date research on a certain diagnosis or condition.  In part 1 there is a rich discussion of what Clinical Practice Guidelines are, risk factors for developing pelvic girdle pain, and most importantly, the language change around the pel...

Does stretching work when a muscle is over-recruited?    Not if you don't change the movement pattern.    This is an excellent follow-up to episode #162, showing how you clinically reason through another weightlifting injury.    Join Susan and Erica as they discuss a patient who sustained a shoulder/neck injury during a "basic" tricep extension exercise.    The main takeaways are twofold: You must...

The purpose of release is to train. Remember that.  Long gone are the passive release positions for patients.  Think about the connections in the regions of the body to each other and then design a position that engages those long vectors connecting one region of the body to each other.  An example, is the use of head rotation and the GHJ, to engage the barriers BETWEEN those regions of the body t...

Where do you start with a client with complex regional pain that has full-body implications?   Listen to their story, look for the change talk, and gain active participation by allowing them to lead the way in a judgment-free zone.   Sometimes, clients know what they need to do, they just don't know how to implement the changes and find simple action steps.    Join us as we talk about this interes...

What is the referral pattern for the Trigeminal System?     What does that mean for our clients?     The cervical nucleus of the trigeminal system can have profound effects on multi-body symptoms    Join Susan as she describes this unique and vital phenomenon.   A glance at this episode: [1:45] Trigeminal system as a sensory experience [3:06] The interconnecting cranial nerves [3:51] How the trige...

This episode is all about low back pain with a pelvis component in a 33-year-old male weightlifter.    Erica and Susan discuss how his history of chronic low back pain along with some bowel issues played a significant role in how he recruits muscles under load.    Some highlights include why pelvic taping helped in this case, how to perform the same movement pattern in different positions, why ass...

In this "shortie" episode Erica discusses different ways she assesses the knee.    There are 3 parts to the knee joint and assessing a movement pattern that takes into account all these regions is key.    It's not all about patellar tracking, right?    More often than not, one part of the knee is being compressed because of some overactivity in the muscles surrounding it.    The main takeaway is t...

Erica and Susan have presented several podcasts discussing the exercise progression of the foot as the primary and secondary driver.  Today they discuss the idea of taking the movement pattern down a couple of steps in preparation for the foot to handle loads, change the body posture, and progress to appropriate AP sway.  The clinical reasoning process is key for understanding how the foot should...

This is part 2 of a short webinar on the interactions of the functional anatomy and physiology of the GI system, presented by Susan Clinton.   This will give listeners a nice story of these systems in aspects of digestion and this affects other systems.   A glance at this episode: [1:25] The importance of good digestion and intestinal mucosa [3:!7] Chemical digestion of food [5:51] Digestive enzym...

Answer : A dominant movement pattern that is the same across all this patient's activities.  No 1 - weightlifters brace and dump their shoulder blades when they rack squat. A very common pattern for this movement, especially when you are lifting over #200 +.  The problem is when this becomes dominant for all movements.  Healthy systems need choices, plural. The nervous system then grades the strat...

This is part 1 of a short webinar on the interactions of the functional anatomy and physiology of the GI system.    Listen to the unique anatomical arrangements and the neurophysiology connections.   A glance at this episode: [1:00] Where the visceral organs are located in the abdominal cavity [3:35] The neurology of the GI System [5:44] The parasympathetic and sympathetic pathways of the gut [7:3...

How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain?  Carefully and specifically!  When someone who is hypermobile complains of continued and persistent back pain, your first thought is, " Is this an overactive system? An underactive system? Or both?".  This re-release of an episode from 2018 highlights the beauty of a specific exercise progression tailored t...

Ep 152: ​​Why Has My Patient Stopped Improving? In this episode, Erica discusses the fine points of what to do when your patient stops improving. AKA a plateau.  Problem-solving through a patient plateau requires sound clinical reasoning and a reflection back to the patient's story. Looking at the injury and movement history-there can be a clue there. Change their COM and reassess another movement...

In previous episodes, Susan and Erica discussed the effects of decreased estrogen at peri and post-menopause with tendinopathies.  In this episode, Susan provides the next half of the discussion, from a webinar, on hormones (particularly estrogen) and their effect on the musculoskeletal system throughout the lifespan.  Did you know that HRT does not have an effect on tendons?  Join the conversatio...

Many of our episodes have included clients on the hypermobile end of the spectrum with a stiff thorax.  How do you balance increasing thorax movement around a hypermobile shoulder girdle region?  How do you use some sound clinical reasoning to design an exercise program that can bring motor control to the shoulder girdle and improve thoracic mobility?  Join us as we bring this clinical scenario to...

In this episode, Erica throws out some clinical gems when it comes to clinical reasoning through these scenarios.   What do you do when your patient says, "I am 85% better but I am still getting (insert symptom) when I do (insert activity)." or " I am so much better but my foot hurts on and off when I still sit at my desk".   The key is "what does my patient need at this point in time?" Using 2 ex...

In this episode, Erica and Susan discuss how to identify someone's non-optimal movement pattern, aka the "dominant pattern" or "the impairment", and use it to your advantage when positioning and prescribing exercise.  Think of it this way: If someone has a strong movement pattern, whether it is compensatory or not, they need choices to move in and out of it.  More often than not, exercises that ar...

Hormones have a significant influence not only within the balance of the endocrine system but also the effect on the MSK system.  Join a discussion Susan has had in a course about hormonal health in females.  This piece takes a nice dive into estrogen balance throughout the reproductive years.   A glance at this episode: [1:03] Estrogen and the effect on the body [3:00] What happens to estrogen in...

Shoulder pain, stiffness, and lack of functional mobility are not uncommon in clients with post-breast cancer.  Join us as we discuss the evaluation and treatment sequence that addresses the particular soft tissue involvement and drivers of this client's limitation—hint: several tissue issues are involved.  The clinical reasoning around the client's story is key here!   A glance at this episode: [...

When do you make the clinical decision to put your hands on your patient or take them off?  We are changing brain maps and our hands act as facilitators of movement. You need a clinical decision tree to decide which muscles to release and which ones to let go of.  A clinical pearl: as your patient moves forward in their program, certain muscles will appear in more loaded movement patterns that you...

Join Susan and Erica while they present case studies to highlight clinical reasoning. This is part 2 of a 2-part series from a webinar.  These case studies include pregnancy-related pelvic girdle pain, an athlete with shoulder pain, and a few more. Follow along and recognize the unique clinical reasoning for each client.   A glance at this episode: [2:26] What is a cross-legged squat [6:00] What i...

In this 2 part episode, Susan and Erica discuss what it takes to become a clinical expert, and how that translates into effectively assessing and treating the "tough to treat". They highlight common errors in clinical reasoning and how to avoid them. They also discuss common red and yellow flags and when to trust your gut. This is part of what makes an expert. Remember, the organization and struct...

Was this because people equated the term "chest breathing" with "accessory muscle breathing".

Your patient has a dysfunctional thorax and it's driving their symptoms, wherever they are. How can you clinically reason treating a non-painful thorax for distal symptoms, such as the foot and hip? The body translates the head, thorax, and the pelvis over the feet for many reasons. Offloading a painful foot, knee, hip is one reason, the other can be an ingrained movement pattern that has been the...

What are the clues and the keys to increasing somatosensory awareness in your patients? Putting someone on a dynadisc or a foam pad does not cut it anymore when your patient lacks sufficient motor control to move well. Make the clinical decision-does my patient need this NOW? Proprioception challenges the individual movement system in many different ways. In this episode, Erica discusses new and n...