Tough to Treat

What goes through your mind in pattern recognition when you hear the word heel pain? What do you begin to think - and then their story actually does not reflect the functional limitations expected. Join the co-hosts as they discuss the impact of multimodal issues that could be affecting this clinical presentation. Check us out at: Toughtotreat.com

One main symptom but 3 potential drivers. Is this person's glute pain coming from his hip? Low back? Pelvis? In this episode Erica and Susan discuss the differential diagnosis of a patient's butt pain which gets worse with sitting and driving. They discuss how multiple exam findings can lead you to one diagnosis but when all the pieces of this clinical puzzle are put together, a different story ap...

What do you do when you run into a true hip joint limitation with persistent pain. altered patterns of movement and loss of the closed pack position? Join us as we explore the update of the female injured on her boat in Podcast #37 - what has improved, what has changed! Most importantly - how to help someone really work a new movement pattern and achieve ROM/Mobilization in some non-threatening wa...

Is a lateral shift a reaction to an irritated nerve root? Or is it part of a functional scoliosis? Or neither? This patient experienced persistent right shin pain with prolonged walking. A year ago she noticed a significant shift in her pelvis to the right. This episode highlights the importance of identifying the non-optimal movement strategy and prescribing exercise to correct it. We discuss how...

What happens when you are an athlete and have endured many injuries in your life that have all healed, and now you have a back injury that is stubborn and is now a persistent pain issue. Compound this issue with a diagnosis of a torn lumbar ligament and the thoughts of instability/grinding joints/bone on bone and other thoughts take over the movement system. Join us as we explore some strategies a...

We have all been through this-as providers or patients. One day your low back hurts on the right, the next day it's the left, and 2 days later it's your right hip and the saga goes on and on and on. Why? Is it because there is a movement control problem and you are just running out of options? Or is there perhaps another systems impairment that is contributing to all of this? Join us as we clinica...

What flashes through your mind with a diagnosis of SUI - muscle weakness? That is certainly one hypothesis! Listen in on this episode where we explore another client with a "systems" problem that is much more involved than just simple pelvic floor muscle exercises. More information at www.toughtotreat.com

Failed epidurals, back surgery and you still have buttock pain along with foot pain. Why? We all know back surgery is not always the answer, but why would someone's symptoms persist after all these interventions? Why would walking barefoot in the sand make this person feel better? Is the strategy different or is the nerve root still aggravated after all these interventions or both? Visit www.tough...

Join us on this podcast as we work through the differentials of this complex post-partum client with the onset of elbow joint pain. Issues that have become so problematic, it's interfering with her sleep. Is it the elbow or the cervical spine - or neural tension? www.toughtotreat.com

How does someone who has had 4 sessions of PT somewhere else become complex? The answer: She got the wrong treatment. And what happened? It sensitized her nervous system to the point that she was afraid that she was never going to get better. Ever hear of less is more? If you intervene at the right time with the right treatment, less is DEFINITELY more. More episodes at www.toughtotreat.com

Explore the narrative of this client with persistent hip and leg pain for over 20 years. In this episode we explore the behaviors and mitigating factors that have increased the symptoms and are slowly turning this person with confronter behavior into an avoider. Sometimes the small changes can have a huge impact. Find out more at www.toughtotreat.com

You have not run in over a year because of a foot and hip injury. Finally, it's all coming together-you have less hip pain and your foot pain has been gone for weeks. You are cleared for a return to run program and then after 2 minutes into it, you leak. Does this sound familiar to you or your patients? In this episode we bring in the patient who has these symptoms. This is a rare glimpse into "re...

Your patient cannot sit and cannot squat in the gym without lateral hip pain. They believe it is their overactive TFL. But is it the cause of the problem? Most likely, it is NOT. Why would someone have increased tone in a muscle? Think about a movement pattern where someone's center of mass is shifted to one side because of an old contralateral foot injury? You injure your foot and you weight shif...

Shoulder pain - or neck pain? Does it really matter to the intervention? What does the client believe and expect? How do you manage client expectations in this scenario? Join us in a rich discussion about this client's self-efficacy and managing expectations while reducing fear. Sound clinical reasoning shows you the value of asking the right questions to guide you in your treatment. www.toughtotr...

Searing shin pain, low back pain, night sweats, unable to sleep or walk-is it the disc? The nerve root? A sensitive nervous system? Or something else? Or all of the above? Join us as we make a differential diagnosis on this gentleman's problem. Once again, listening to his story will give you clues as to how to begin the objective exam. Find out more at www.toughtotreat

Do you ever wonder if there is a better way to evaluate the complex patient?  What do you do when the body diagram is full with a long history? I think we all are used to hearing our client's stories - but do we really listen to their full narrative? This can be the key to finding out what's important to them and sometimes, the simplest solution is revealed through their story along with the physi...

Do you want better outcomes with your patients? What do you do when a patient has plateaued? Or they're not improving as fast as they should be? One of the answers could be your exercise progression. Are you truly treating the source of the patient's problem with a specific movement program geared towards the SOURCE and NOT the symptom? What is the key to effective exercise progression? In this ep...

What happens when someone's thigh goes numb and does not go away? The nerve is obviously angry but what is the driver? What could possibly cause someone's thigh to go numb? Do hormones play a role in this case? Is it hypermobility? Is it the foot? Susan and Erica discuss all the possibilities for this particular patient's presentation and present SPECIFIC movements/exercises that the patient will...

Low back pain - the need to stretch and fear avoidance complications. What happens if the movement or postures you believe to be good are really problematic? We have delved into low back pain and the constant need to stretch, but sometimes it can also become more complex due to our thoughts and beliefs. Here are some good strategies for helping someone move and confronting their beliefs. Visit our...

What happens when someone suffers a traumatic injury, then lives with it for 8 months? Listen to this episode and find out. Susan and I discuss a former patient of mine who lived with hypersensitivity, bruising and swelling in her lower limb for months!! Think about what that does to your system? We also discuss developing a hypothesis/diagnosis based upon the subjective history. It is something w...

Join in on this differential diagnosis and use of evidence to help determine the underlying cause and progressive movements to help this very strong and resilient female overcome nagging hip pain for over 5 years. Pain can be complex and contextual, it can also have a metabolic component as well. Consistency is the key to addressing her issue and progressing her program. Visit our website at www.t...

Does this dancer with persistent left-sided pelvic girdle pain need to have her SI joint manipulated all the time? The answer is an obvious no! In this episode, we discuss how a professional dancer was able to get rid of her pelvic pain by looking up the chain. Remember- it is the movement strategy that counts. Digging deep into the demands of her performance, was the key to finding a solution for...

This episode features a gentleman with complex metabolic issues, neurogenic pain and an interesting cross-section of mechanical MSK issues. Join us as we sort out the history and discuss the treatment interventions based on his unique story and the best way for him to function. Visit our website: toughtotreat.com

Tough To Treat Masterclass: In this episode we have guest PT, Alaina Newell, who presents us with one of her tough male patients with a primary complaint of abdominal issues. Sometimes what our patients present with is only the tip of the iceberg. We clinically reason through the evaluation but move very quickly into diagnosis and movement. It is interesting how the story of this complex case unfo...