Tough to Treat

As health care providers and rehab professionals, there is the story that ankle fracture rehab is simple. Makes sense right? A regional intervention over an obvious acute traumatic event. But what is missing and why do so many individuals recovering from this injury (post-surgical) are having difficulty months and years down the road? Join us as we explore the Biopsychosocial approach to this indi...

When someone complains of persistent hip pain, what do you think? Is the source the hip? It may be the pain generator but at this point, is the primary reason why they have hip pain because of some dysfunction intrinsic to the hip? Most likely not. Simple example- right persistent hip pain with going up stairs and standing on one leg. In standing, all their weight is on the right leg, why? Probabl...

Join us for a fun discussion on the relationship of the shoulder to the rest of the body. Learn about all the connections between the shoulder, the cranium, the neck, the upper thorax and much more! Did you know that an old clavicle fracture on your left can be responsible for right shoulder pain? Check us out: Toughtotreat.com

Tune in for an interesting discussion on a woman presenting with complaints of double vision 8 months after the birth of her third child. A coincidence? Maybe, maybe not. Either way, it needs to get addressed. Is this dural? Trigeminal wind-up? Listen in for the clinical reasoning process as well as some novel treatment techniques that worked. Check us out: Toughtotreat.com

Can neural tension be responsible for a tight hip? Absolutely! Would you believe that neural tension in the right hip can be responsible for left hip pain? Listen as Susan and Erica discuss the many possibilities of unsolved persistent pain. They also discuss several cases where neural tension plays a role in many typical musculoskeletal issues. Check us out: Toughtotreat.com

Finding clients with subjective pain in the low back and cervical region is not an uncommon presentation. The bias is to treat the most acute region and hope the other region gets better as a result. What happens when you look closely at the story, listen to the client and find a very unlikely driver of maladaption in this clinical case? Join us as Susan and Erica unravel this clinical presentatio...

Functional movement re-patterning is the key to changing someone's movement strategy. But how do you choose the right one, so you are more organized and efficient in your assessments? And how can you clinically reason so you can hone in on one area to get better results? Understanding the inter-regional relationships in the body as someone moves may be the game changer for you and your client. How...

How many neck problems are really disguised as shoulder issues? A lot actually! It is extremely common to overwork some of those small muscles of the neck at the expense of a true shoulder weakness. And why is traditional cuff strengthening not always the way to start with these patients? Listen as Susan and Erica do a deep dive into this patient's underlying issue and discuss various ways to brid...

Don't let the diagnosis be your guide, listen to the whole story, and be curious outside of pattern recognition. Is the original thought about the case straight forward. Or is it as Sherlock Holmes says: "When you have eliminated the impossible, whatever remains, however improbable, must be the truth?". Have you indeed eliminated all of the impossible? In this episode, we discuss the reasoning beh...

Why can't this athlete get rid of his low back pain? "Running- I have no problem with" "Lateral-side to side-movements really aggravate me". " Why?" How do we make a differential diagnosis here? And with significant unilateral calf weakness to add into the mix. Four ankle sprains and a 4th metatarsal fracture later, plus a "stress reaction" at L5, why wouldn't his low back be the source of his pro...

A recent article on various depths of squats revealed information that a full squat is more beneficial than partial squats in improving function and pain over time. Have a listen as we explore interesting comments/bias/evidence on why we rely on the squat as a revealing part of our examination and interventions. Follow link: https://www.tandfonline.com/doi/abs/10.1080/17461391.2019.1612952?journal...

Another case with elbow issues! This case involves neural tension, pins/needles, and catastrophization. What is the best way to begin to work with someone who has multiple issues around fear of neural symptoms without neuro changes? Join us as we discuss dosing, position changes, problem solving and fear reduction in this interesting case. Check us out: Toughtotreat.com

Tennis elbow is one of those conditions that is extremely frustrating for both patient and practitioner alike. It turns into a persistent problem very fast. This was another one of our popular FB Lives we did recently. We unpacked the myths and theories around tennis elbow and what to do to treat it. Is it neurally driven? Cervical Spine driven? Does it emanate from poor shoulder mechanics? Or doe...

We all have patients for whatever reason, who always come back for the same problem over and over again. Even if they haven't been back for over 5 years. Our bodies tend to take the path of least resistance and more often than not, when someone has fully recovered and they're back doing what they want, something happens and they return with the SAME problem in the SAME place. Why? Is that their ac...

Your client has low back, hip, or pelvic girdle pain as examples, and you determine that the foot is the driver for these symptoms. What types of exercises would you prescribe to get them back to where they want to be? This is where you take the clinical reasoning to the next level! Whether it's loaded or unloaded, movement re-patterning requires you to really "connect the dots" in the body when i...

What happens when your patient/client forgets to tell you key pieces to their history? It happens alot - and sometimes can have great impact on our decision making within the evaluation or treatment sessions. It is not their fault, it is just the way the central nervous system prioritizes events. Helping our clients remember and string these events together can not only help them solve their probl...

This episode is about a weightlifter who suffered a T1 avulsion fracture, had surgery to remove the fragment and still had symptoms. Why? Because the avulsion was not the cause for this patient's lingering symptoms. Neuromuscular holding strategies as well as poor motor patterning were still there post-operatively. Think about what a weightlifter does before he performs a heavy lift and it will gi...

Let's continue with the 3 powerful questions in determing the direction and priority of intervention. Immediate post-partum females can present with a myriad of complaints that often go "unheard" or "untold". The fears surrounding these symptoms can greatly change the person's ability to move forward with confidence in their body and their ability to achieve their life vision. Join us as we explor...

What do you do when your patient tells you she has not sat for 9 months? And furthermore, a healthcare practitioner told her this! How do you "debunk" this myth of not sitting while at the same time give her body the ability to toelrate sitting postures? Imagination, contextual change as well as letting the patient take control of the session. What? The patient takes control? Listen as Susan and E...

What are your three powerful questions that you use with your clients? Join Erica and I as we talk about working with clients from a full biopsychosocial approach. Does this mean all you do is pain education? How do clinicians best use the total approach to help clients regain self efficacy and manage their symptoms. There are also some great pearls around pelvic girdle pain in pregnancy as well....

Who hasn't heard this? This patient was seen in the clinic once just prior to the COVID-19 crisis and then progressed virtually from there. When someone says, " I hurt everywhere" and their symptoms appear randomly, how do you find a meaningful movement to assess? In particular, one that encompasses the whole body/whole person. Not an easy task, for sure, especially for someone who has significant...

What do we really know about the achilles tendon and the various forms of tendonosis? What do you do when the eccentric exercise programs outlined in the literature do not bring about a significant change of symptoms? Join us to explore some of the facets of tendonosis and a clinical discussion on changing interventions. Check us out: Toughtotreat.com

Success-your patient's original symptoms are gone and you are moving along with their program. They are progressing to higher loads, higher impact as well as incorporating tri-planar movement into their exercise. Then another region of the body starts to hurt. Why? Secondary and even tertiary drivers can appear at higher loads; even when they do not appear at the beginning. Be aware of this as you...

Have you ever had a patient where the story and the problems they were having were easy to solve, but your thoughts were - "It can't be this simple?" Follow along with us as we discuss the differentials and treatment of a gentleman with numbness on the balls of his feet. It may not be what you are thinking - and then again, maybe it is! Check us out: Toughtotreat.com

This patient has had low back pain since she was a child. She has coped well until the birth of her own children. The innate response to threat here is the inabillity to arch her back. Her system cannot lengthen and she cannot do a back bend or sit and perform an anterior pelvic tilt. But she can get into prone on elbows and extend no problem. Post-partum is ALWAYS post-partum and her standing str...