
TOUGH TO TREAT
Do you want to learn how to treat complex patients?

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Latest Episodes
Breath, Voice and HRV as Predictors and Interventions in Pelvic Health – Part 2
Look beyond the traditional regional approach of the pelvic and pelvic floor and understand how discovering and addressing...
Breath, Voice, and HRV as Predictors and Interventions in Pelvic Health – Part 1
Look beyond the traditional regional approach of the pelvic and pelvic floor and understand how discovering and addressing...
The Mystery of This Man’s Struggle With Pelvic Girdle Pain and the Breath
In this episode, we dive into the often overlooked and misunderstood world of male health, exploring the complexities of...
Shoulder Pain- A Motor Control Problem?
When does motor control come into play when someone has persistent shoulder pain? Is it soft tissue related, a joint...
SI Joint Pain – An Updated Approach
Here is the clinical story of a client that is presenting with pain/sensitivity in the area of the (R) posterior pelvis. ...
Finding Hidden Connections In Functional Movements- Why They Matter
In this episode, Erica explores the intersection of functional movement and persistent pain, offering a comprehensive...
A Stiff 1st MTP Joint can Affect Everything!
One of the most overlooked joints in the lower quarter is the first MTP joint unless that is the primary complaint of the...
HRV as A Predictor and Intervention in Sleep and Stress
Heart rate variability is getting a lot of press recently. Join Susan as she presents a webinar on HRV as a predictor and...
Pain Without a Diagnosis: The Complexities of Managing Medically Unexplained Symptoms
In this episode, we delve into the perplexing realm of medically unexplained pain and the challenges it presents for...
Decoding Persistent Hip Labral Tears – It’s Not Always What We Think
Have you ever had patients with "diagnoses" of labral tears on MR only to find out that the hip was not the driver? Of...
Chronic Low Back Pain and Constipation – Why it Matters!
Clients often have chronic low back pain as a primary or secondary issue. It is often combined in complex presentations...
Pelvic Girdle Pain: Current Concepts Part 2
Clinical practice guidelines provide the practitioner with the most up-to-date research on a certain diagnosis or...
Unraveling a Compression Fracture in a Young Male
Compression fractures are commonly associated with osteoporosis in older adults. However, what happens when these...
Meeting Patient Expectations- Navigating the Journey to Progress
This is an excerpt from Erica's DCP course call in February of 2023. In this episode, she delves into the crucial aspect...
When Shoulder Pain is Dominant, but Not the Driver!
Shoulder pain, like any other joint can present as primary pain and be the #1 reason a client may seek help! In many...
Pelvic Girdle Pain: Current Concepts Part 1
Join Susan in a two-part interview about Pelvic Girdle Pain in the Antepartum Population. Clinical practice...
From Neck Pain to Shoulder Pain: Unraveling the Links Between the Two
Does stretching work when a muscle is over-recruited? Not if you don't change the movement pattern. This is an...
Unique Release Positions for the Shoulder: Positioning for Optimal Results
The purpose of release is to train. Remember that. Long gone are the passive release positions for patients. Think...
Complex Chronic Low Back Pain – When A Regional Approach Will Not be the Best Option
Where do you start with a client with complex regional pain that has full-body implications? Listen to their story, look...
Trigeminal System Referral Pattern
What is the referral pattern for the Trigeminal System? What does that mean for our clients? The...
Pelvis Driver In A Male Weightlifter
This episode is all about low back pain with a pelvis component in a 33-year-old male weightlifter. Erica and Susan...
Assessing The Knee Differently
In this "shortie" episode Erica discusses different ways she assesses the knee. There are 3 parts to the knee joint...
Foot Drivers – The Prequel to the Foot Progression Exercises
Erica and Susan have presented several podcasts discussing the exercise progression of the foot as the primary and...
Anatomy and Physiology Interactions of the GI System – Part 2
This is part 2 of a short webinar on the interactions of the functional anatomy and physiology of the GI system, presented...
What Do Weightlifting And Poledancing Have In Common?
Answer: A dominant movement pattern that is the same across all this patient's activities. No 1- weightlifters brace...
Anatomy and Physiology Interactions of the GI System – Part 1
This is part 1 of a short webinar on the interactions of the functional anatomy and physiology of the GI system. Listen to...
Hypermobility and Low Back Pain
How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? Carefully and...
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. ...
Estrogen Levels and Changes in the Musculoskeletal System
In previous episodes, Susan and Erica discussed the effects of decreased estrogen at peri and post-menopause with...
Shoulder Girdle Hypermobility vs. Thoracic Stiffness – Where is the Balance
Many of our episodes have included clients on the hypermobile end of the spectrum with a stiff thorax. How do you...
Advanced Clinical Reasoning With Your Toughest Patients
In this episode, Erica throws out some clinical gems when it comes to clinical reasoning through these...
Down Training Non-Optimal Movement Patterns to Make Exercise More Effective
In this episode, Erica and Susan discuss how to identify someone's non-optimal movement pattern, aka the "dominant pattern"...
Hormone Balance – Estrogen and Why it Matters
Hormones have a significant influence not only within the balance of the endocrine system but also the effect on the MSK...
Shoulder Stiffness – When the Tissue is the Driver!
Shoulder pain, stiffness, and lack of functional mobility are uncommon in clients with post-breast cancer. Join us as...
Manual Therapy Or Not? Hands Off Or Hands On? Or Both?
When do you make the clinical decision to put your hands on your patient or take them off? We are changing brain maps...
Grow Your Clinical Expertise By Learning How To Treat The Complex Patient (Part 2)
Join Susan and Erica while they present case studies to highlight clinical reasoning. This is part 2 of a 2-part series...
Grow Your Clinical Expertise By Learning How To Treat The Complex Patient (Part 1)
In this 2 part episode, Susan and Erica discuss what it takes to become a clinical expert, and how that translates into...
Breath and the Chest Wall
Let's talk about breathing patterns. Somewhere along the line, chest movement with diaphragm movement became unpopular. Was...
Foot and Hip Pain? Why You Treat The Thorax
Your patient has a dysfunctional thorax and it's driving their symptoms, wherever they are. How can you clinically reason...
How To Increase Proprioception – An Updated Approach
What are the clues and the keys to increasing somatosensory awareness in your patients? Putting someone on a dynadisc or a...
A Fencer With Bilateral Calf Pain – Where’s The Driver?
What is the cause of bilateral calf pain in this young fencer? Start to finish, it shows the power of a thorough...
Neurophysiological Underpinnings of the Trigeminal System – Part 1
In this short episode, Susan discusses the upper cervical region and its effects on the rest of the body: core, pelvic...
What To Do When Your Treatment Stops Working
In this short episode, Erica discusses her perspective on how to handle patients whose treatment has stopped working. ...
Treating Knee OA The Smart Way
In this episode, Erica and Susan discuss how to begin and progress treatment with a knee OA without exacerbating their...
The Gut-Brain Axis – Stress, Pain, and Balance
Join Susan as she shares a segment from a course she teaches on GI Dysfunction. This clip is dedicated to the...
Shoulder and Arm Pain – What is Really the Driver?
In this episode, Susan and Erica discuss how very old drivers can present in a novel situation as well as why new driver...
Hip Pain In A Golfer: Why It’s Not Going Away
In this short episode, Erica highlights the importance of center of mass by assessing a semi-competitive golfer with hip...
When You Should Tape and Why
In this short episode, Erica gives her perspective on when you should tape and why. This is one of the most commonly asked...
Meet The Hosts

Meet Erica
I solved unique financial puzzles on Wall Street for a decade. Now I utilize those same strengths to help rid my patients of pain so that they can live their lives on their own terms.
The greatest victories in my physical therapy career are realized when I apply my natural problem-solving skills, honed even further on Wall Street, to help alleviate my patients’ pain; … pain that in many cases no one else has been able to resolve.
I work with my patients to uncover the true source of their pain, and together we work towards them becoming pain-free.
I’m so fortunate to have found my true calling and to be able to help people in the most important area of their lives – their health!

Meet Susan
Susan is a certified and award-winning physical therapist in professional achievement, health and wellness coach, and owner of LTI Physio (Learn, Think, Innovate) in Sault Sainte Marie, MI. She is an international instructor of post-professional education in women’s health (including pelvic health issues in women), orthopedic manual therapy, and positive intelligence coaching for Healthcare providers and business psychology. She is faculty at Andrews University, a Master Coach for the Integrative Women’s Health Institute, and faculty for North American Institute of Orthopedic Manual Therapy and ASPIRE OMT
In addition to co-hosting Tough to Treat, Susan also co-hosts “The Genius Project,” reframing the treatment of persistent musculoskeletal pain. She is the co-founder and board member for the foundation: Global Women’s Health Initiative and a reviewer and advisory board member for the Journal of Women’s Health Physical Therapy. She also has recently launched her Pelvic Health Education Subscription aimed at helping clinicians become more proficient and confident in treating pelvic health conditions.
When she isn’t advocating for women’s health and mentoring other clinicians, Susan enjoys walking/hiking, country line dance, and ballroom dancing, a supporter of music, the arts, and international objectives for women’s health.