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# Tough To Treat

tough to treat

## Sitemaps

- [XML Sitemap](https://toughtotreat.com/sitemap.xml): Contains all public & indexable URLs for this website.

## Posts

- [Blog](https://toughtotreat.com/blog/)
- [When Shoulder Pain is Dominant, but Not the Driver!](https://toughtotreat.com/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 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 Shoulder Pain
- [Building Better PT Practices: Courses, Clinical Reasoning, and Mentoring Insights](https://toughtotreat.com/building-better-pt-practices-courses-clinical-reasoning-and-mentoring-insights/) - In this episode, we answer the most common questions we get from listeners. We dive into course recommendations, highlighting resources for continuing education, mentoring and evidence-based practices. A key focus is on clinical reasoning strategies—how to approach complex cases and integrate patient-specific factors into your decision-making. We also discuss the value of spending the majority Uncategorized
- [Complex shoulder pain - how the narrative and red flags paint a different picture](https://toughtotreat.com/complex-shoulder-pain-how-the-narrative-and-red-flags-paint-a-different-picture/) - Clients self-refer for many reasons and we find ourselves on the front line of health care screening. Join Susan and Erica as they uncover key elements in a client’s history and narrative around long-standing shoulder pain. Simplistic presentations usually mask true underlying considerations including the client’s beliefs and red flags. A glance at this episode: Shoulder Pain
- [Shoulder Pain With Pull-Ups or Push-Ups? The Elbow Changes Everything](https://toughtotreat.com/shoulder-pain-with-pull-ups-or-push-ups-the-elbow-changes-everything/) - In this episode, we explore the surprising journey of a boxer battling chronic shoulder pain that left him struggling to do even the most basic workout. Despite focusing on his shoulder, it turns out the root of his problem lay elsewhere—his elbow. Is that surprising? It was in his injury history. Do not discount the Shoulder Pain
- [Chronic Knee Pain - Where to Begin!](https://toughtotreat.com/chronic-knee-pain-where-to-begin/) - Susan and Erica are back together for the Fall season! Chronic knee pain can be much more than a regional event. Susan presents a client with an extensive timeline and clinical reasoning as to why it is important to consider the entire system in this integrated approach. The key here is also maintaining relevance and Uncategorized
- [Assessing Knee Health For Hip-Related Walking Pain](https://toughtotreat.com/assessing-knee-health-for-hip-related-walking-pain/) - In this episode, Erica explores the often-overlooked relationship between hip pain and knee function during walking when the patient does NOT have knee pain. Join in as she dives into the role of the knee in compensating for hip dysfunction, and how a thorough knee assessment can uncover hidden contributors to hip discomfort. Remember: old Hip Pain
- [When shoulder pain is dominant, but not the driver!](https://toughtotreat.com/when-shoulder-pain-is-dominant-but-not-the-driver-2/) - Shoulder pain, like any other joint can present as primary pain and the be the #1 reason a client may be seeking help! In many cases, treating the obvious joint dysfunction (because it checks all of the boxes) may not result in optimal outcomes. Join the conversation as Susan and Erica explore the various reasons Shoulder Pain
- [Beyond Tennis: Exploring Shoulder Compression Across Sports](https://toughtotreat.com/beyond-tennis-exploring-shoulder-compression-across-sports/) - In this episode, Erica discusses the why behind shoulder problems, comparing the unique challenges faced by tennis players and non-tennis players alike. She explains why traditional shoulder treatment often fails these types of patients. A significant relationship between the shoulder and another region of the body is often missed. Erica also tells the story of Shoulder Pain
- [A Stiff 1st MTP Joint can Affect Everything!](https://toughtotreat.com/a-stiff-1st-mtp-joint-can-affect-everything-2/) - One of the most overlooked joints in the lower quarter is the first MTP joint unless that is the client's primary complaint. How does the stiffness of the MTP joint affect gait and lower quarter movement of all kinds? We spend some great time discussing differential diagnosis and practical interventions and sharing some new discoveries. FOOT PAIN
- [Fencer with Bilateral Calf Pain](https://toughtotreat.com/fencer-with-bilateral-calf-pain-2/) - What is the cause of bilateral calf pain in this young fencer? From start to finish, it shows the power of a thorough evaluation, a specific exercise progression, and a return to the sport she loves. When it comes to exercise progression in persistent pain, think about context. How can you improve optimal movement patterning CALF PAIN
- [The Role of the Diaphragm in Chronic Low Back Pain and GI Dysfunction](https://toughtotreat.com/fencer-with-bilateral-calf-pain/) - 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 CALF PAIN
- [Hypermobility and Low Back Pain](https://toughtotreat.com/hypermobility-and-low-back-pain-2/) - How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? Carefully and specifically! This episode highlights the beauty of a specific exercise progression tailored to the patient's meaningful movement. Listen as we go through the clinical reasoning process to determine what types of movement patterns will work and what LOW BACK PAIN
- [Low Back Pain - Regional vs. Movement System Considerations](https://toughtotreat.com/low-back-pain-regional-vs-movement-system-considerations/) - If it walks like a duck and quacks like a duck - it must be a duck, right? Low back pain is a descriptive term at best, indicating where symptoms present. Join Susan and Erica as they explore this Tough to Treat client with low back pain and mild stress urinary incontinence. Discover the history LOW BACK PAIN
- [What To Do When You Are Their Last Resort](https://toughtotreat.com/what-to-do-when-you-are-their-last-resort/) - Now, this is a CHALLENGING one! Ever have those patients who have been everywhere, had everything done to them (injections, surgeries, acupuncture) and nothing helped? Well, this is your lucky day because this episode really takes us down the chain from head to toe with someone who had low back pain. Pretty standard, right? But Assessment
- [Nociplastic Pain and a Visceral Driver](https://toughtotreat.com/nociplastic-pain-and-a-visceral-driver/) - What do you do when a client presents with a myriad of LQ symptoms without a clear regional driver? Look to the history and keep asking questions even further back than the recent onset or episodic flare. Join us as we discuss complex neurology of a visceral driver that has signs of dysfunction and a Assessment
- [Junior Golfer With Persistent Unsolved Knee Pain](https://toughtotreat.com/junior-golfer-with-persistent-unsolved-knee-pain/) - Golf is a sport of weight shifts and a narrow base of support. What happens when your knee can't adapt to an altered base of support? This is what exactly happened here with this case. This young golfer, in standing (and standing is VERY relevant for the golf swing) had an 80/20 load, R/L in Knee Pain
- [What's Stopping this Former Fighter from Doing Push-Ups and Pull-Ups?](https://toughtotreat.com/whats-stopping-this-former-fighter-from-doing-push-ups-and-pull-ups/) - In this episode, Erica dives into the intriguing story of a former fighter who faced unexpected challenges with basic exercises like push-ups and pull-ups. She sheds light on how years of specialized training led to muscle imbalances and problems outside the ring. The "push" and "pull" are different movement patterns. What region(s) of the body Shoulder Pain
- [Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 2](https://toughtotreat.com/chronic-constipation-interventions-beyond-pelvic-floor-dyssynergia-part-2/) - This episode is part 2 of episode 213. Utilizing evidence-based research and the latest clinical guidelines, the presentation will examine the multifactorial nature of chronic constipation, including non-pelvic interventions that can complement existing treatments. One key aspect will be the practical application of the balloon catheter, demonstrating its effective use for both assessment and therapeutic Gut
- [Chronic Constipation: Interventions beyond pelvic floor dyssynergia Part 1](https://toughtotreat.com/chronic-constipation-interventions-beyond-pelvic-floor-dyssynergia-part-1/) - Utilizing evidence-based research and the latest clinical guidelines, the presentation will examine the multifactorial nature of chronic constipation, including non-pelvic interventions that can complement existing treatments. One key aspect will be the practical application of the balloon catheter, demonstrating its effective use for both assessment and therapeutic interventions. A glance at this episode: [0:01] Chronic PELVIC GIRDLE PAIN
- [Postpartum Pelvic Pain and Urgency](https://toughtotreat.com/postpartum-pelvic-pain-and-urgency/) - There are many ways to approach pelvic pain and symptoms of urinary urge incontinence, but did you know that how the MSK system moves can affect these symptoms as well? On this podcast, we dive into the movement system, past/present autoimmune history, and post-partum process while changing this client's symptoms as well as her urinary PELVIC GIRDLE PAIN
- [How To Assess The Knee Differently](https://toughtotreat.com/how-to-assess-the-knee-differently/) - In this episode, Erica explores new and novel ways to evaluate and treat the knee. She discusses different approaches aimed at providing a more accurate assessment of the knee. Join her as she emphasizes the importance of training your vision. What does "optimal" movement look like for that particular patient? Does what you see match Assessment
- [Addressing the Gaps in a Patient's Exercise Program](https://toughtotreat.com/addressing-the-gaps-in-a-patients-exercise-program/) - This episode zeroes in on a scenario many physical therapists face: patients diligently following their exercise routines but not seeing the expected progress or recovery. We discuss thorax, foot, and knee drivers as examples and why there can be holes in someone's program even after they've been doing advanced exercises. Being able to identify the Assessment
- [Food Allergies vs. Intolerance](https://toughtotreat.com/food-allergies-vs-intolerance/) - What is the difference between food allergies and food sensitivities? Join Susan as she discusses the importance of following the science and taking the guesswork out of the food allergy vs. sensitivity issue and why this is important for systemic inflammation. A glance at this episode: [3:19] Dietary elimination for gut health and food intolerances Gut
- [Back Pain/Leg Pain - Making the Right Call For Our Clients](https://toughtotreat.com/back-pain-leg-pain-making-the-right-call-for-our-clients/) - This episode presents what should be a straightforward case of a significant nerve root irritation. Unfortunately for this client, her situation was not addressed adequately and has left her in a lot of pain for over 3 months. Join us as Susan presents this client case, what went wrong, and the assessment and intervention with LOW BACK PAIN
- [Clinical Pearls For Effective Exercise Progression](https://toughtotreat.com/clinical-pearls-for-effective-exercise-progression/) - In this episode, Erica speaks about prescribing specific exercises based on the difficulty level relative to the region of the body driving the patient's symptoms. NOT the pain generator. NOT the area of symptoms. If someone has knee pain, and their driver is their foot, then the exercise program is geared towards the foot, NOT Exercise Progression
- [When The Driver Is Not The Pelvis](https://toughtotreat.com/when-the-driver-is-not-the-pelvis/) - In this episode, we discuss the case of a very active woman grappling with SI (sacroiliac) joint pain. These symptoms manifest while walking and with hip external rotation. Furthermore, the episode unravels the complexities surrounding assessments, especially when individuals seek consultation for a single visit. We also delve into why and when using a pelvic PELVIC GIRDLE PAIN
- [Physical Therapy Examination and Intervention of GI Dysfunction](https://toughtotreat.com/physical-therapy-examination-and-intervention-of-gi-dysfunction/) - In this short episode, Susan presents a good algorithm for the examination and interventions in clients with GI dysfunction. Follow along as she discusses different nuances and considerations in the presence of pelvic and abdominal aspects of GI dysfunction. A glance at this episode: [0:01] Interventions for GI dysfunction and abdominal pain [2:03] Manual therapy Gut
- [Overactive Bladder and Hip Dysfunction](https://toughtotreat.com/overactive-bladder-and-hip-dysfunction/) - This episode presents a client with a seemingly straightforward diagnosis in pelvic health of overactive bladder (OAB). The history and physical presentation tell a different story. Join Susan and Erica as they explore why often a regional approach will not help the client progress to their highest levels of function without symptoms. We discuss the Hip Pain
- [Exploring Open Chain vs Closed Chain Exercise in Upper Extremity Dysfunction](https://toughtotreat.com/exploring-open-chain-vs-closed-chain-exercise-in-upper-extremity-dysfunction/) - In the episode, Erica explores the strategic use of open and closed-chain exercises for upper extremity dysfunction. She discusses the distinct benefits and applications of each type of movement, shedding light on how these exercises can be tailored to meet specific needs to enhance performance. She uses an example of a tennis player who suffered EXERCISE
- [The Push Up: 2 Individuals, 2 Different Drivers and 2 Distinct Treatments](https://toughtotreat.com/the-push-up-2-individuals-2-different-drivers-and-2-distinct-treatments/) - In our latest episode, we explore the fascinating stories of two individuals navigating the challenges of mastering the push-up despite their unique injury history. Both individuals had different pain experiences with this movement. Remember-What set them up? What kept them there? We explore why the push-up experience varied greatly between these 2 people and why Uncategorized
- [Outcome Measures and Pain in GI Dysfunction](https://toughtotreat.com/outcome-measures-and-pain-in-gi-dysfunction/) - This episode is a short compilation of an algorithm in looking at basic outcome measures and pain in GI Dysfunction. Susan explores the basics of the history which can give great insight into the addition of more sophisticated outcome measures and pain exploration. Start with the basics and then expand! A glance at this episode: Gut
- [The Balance System as a Driver](https://toughtotreat.com/the-balance-system-as-a-driver/) - Join us in episode #200 where Susan and Erica explore the potentiality of the balance system as a primary or secondary driver. With a client's history of injury or illness, there is an event that sets up their system for adaptation. Oftentimes, in regional-specific rehab, the balance system is not considered as a driver. What Assessment
- [The Body's Story: Finding Out Why You Hurt Through Your Story and Movement Patterns](https://toughtotreat.com/the-bodys-story-finding-out-why-you-hurt-through-your-story-and-movement-patterns/) - In this episode, we explore the profound connections between personal narratives and the origins of someone's injury. Join Erica as she delves into the stories of individuals who've experienced persistent injuries, and learn how to find clues in their narrative to help you prioritize the movement assessment and eventually find their driver(s). You will learn Assessment
- [Chronic Low Back Pain and an Underlying Pathophysiological Change: We Adapt Until We Can't](https://toughtotreat.com/chronic-low-back-pain-and-an-underlying-pathophysiological-change-we-adapt-until-we-cant/) - How important are past events to present movement patterns and restrictions? What about past events of herniated lateral discs or hypermobility on the current presentation of the movement system? Clients can heal with faulty movement systems that can show up as new and different presentations in the future. This podcast is from a presentation that LOW BACK PAIN
- [Overcoming Fear-Based Movement Patterns](https://toughtotreat.com/overcoming-fear-based-movement-patterns/) - In this empowering episode, we dive deep into the realm of fear-based movement and explore strategies to help patients conquer their anxieties, helping them move towards a more confident and pain-free existence. Anxiety and fear of movement are real things and can prevail even when we are termed "fit to play", "fit to move" or MENTAL FITNESS
- [How To Find The Driver Through Patient-Centered Listening](https://toughtotreat.com/how-to-find-the-driver-through-patient-centered-listening/) - Discover the art of being an active listener who can pick up clues in your patient's narrative to help you find their driver quicker. This will save you lots of time in your movement assessment. Listen in as Erica discusses how to reframe your patient's story to help you maximize your time with them in Assessment
- [Take Back your Mental Fitness - Part 2](https://toughtotreat.com/take-back-your-mental-fitness-part-2/) - Welcome to the New Year and one of the topics always discussed by Healthcare providers is burnout and imposter syndrome. Join Susan in this short podcast - Part 2 Taking back your mental fitness. Learn how to identify the voices of your inner Judge and Saboteurs, how to limit their voices, and find a pathway MENTAL FITNESS
- [Take Back your Mental Fitness - Part 1](https://toughtotreat.com/take-back-your-mental-fitness-part-1/) - Welcome to the New Year and one of the topics always discussed by Healthcare providers is burnout and imposter syndrome. Join Susan in this short podcast - Part 1 Taking back your mental fitness. Learn how to identify the voices of your inner Judge and Saboteurs, how to limit their voices, and find a pathway MENTAL FITNESS
- [A Case of Lateral Hip Pain](https://toughtotreat.com/a-case-of-lateral-hip-pain/) - Consideration of lateral hip pain requires a thoughtful clinical reasoning process to discover the physiology/movement patterns as well as neural contributions required to make a diagnosis and successfully build an intervention that lasts. One size does not fit all - join us as we discuss the findings in this "not so unique" case and the Hip Pain
- [Thoracic Mobility Beyond The Breath](https://toughtotreat.com/thoracic-mobility-beyond-the-breath/) - In this episode, Susan and Erica discuss the many ways the thorax can be the driver for a multitude of upper and lower extremity issues. This important region of the body tends to cause a lot of movement dysfunction we often see. As an example, the thorax is an important component in driving foot pain Breath
- [Stress, Exercise and Sleep as it Relates to the GI System](https://toughtotreat.com/stress-exercise-and-sleep-as-it-relates-to-the-gi-system/) - Many times, clinicians find that people with correlative GI system dysfunction are very overwhelming. The complexity makes it difficult to know where to begin to intervene. Join us as Susan discusses some very simple mediations to help improve the GI system with stress, exercise, and sleep. Complex clinical pictures can often change when we address Gut
- [A Complex Client With Medical Red Flags](https://toughtotreat.com/a-complex-client-with-medical-red-flags/) - Susan and Erica welcome Kelly McClain to the podcast to discuss a very complex client with pelvic health, orthopedic, and neurological issues. Follow along as the client case is presented and we pursue a rich discussion of tying together the systems involved as well as the red flags. Digging deeper into the client's story is Assessment
- [How To Diagnose A Young Soccer Player's Groin Pain](https://toughtotreat.com/how-to-diagnose-a-young-soccer-players-groin-pain/) - 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 FOOT PAIN
- [Why Does My Foot Hurt? What's Going On?](https://toughtotreat.com/why-does-my-foot-hurt-whats-going-on/) - 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 FOOT PAIN
- [The GI System - Food intolerances vs. Allergies](https://toughtotreat.com/the-gi-system-food-intolerances-vs-allergies-2/) - 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 Gut
- [The Role of the Diaphragm in Chronic Low Back Pain and GI Dysfunction](https://toughtotreat.com/the-gi-system-food-intolerances-vs-allergies/) - 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 Gut
- [When Do You Treat The Viscera?](https://toughtotreat.com/when-do-you-treat-the-viscera/) - 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 Assessment
- [Back Pain, Thoracic Outlet, Post Cancer Recovery - Where do I go from here?](https://toughtotreat.com/back-pain-thoracic-outlet-post-cancer-recovery-where-do-i-go-from-here/) - 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 LOW BACK PAIN
- [Colorectal Sensory Motor Integration](https://toughtotreat.com/colorectal-sensory-motor-integration/) - 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 Gut
- [Post Partum: Urinary Incontinence, Abdominal Bloating and a Return to High Intensity Exercise](https://toughtotreat.com/post-partum-urinary-incontinence-abdominal-bloating-and-a-return-to-high-intensity-exercise/) - 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 POSTPARTUM
- [How To Increase Patient Adherence To Exercise](https://toughtotreat.com/how-to-increase-patient-adherence-to-exercise/) - Ep 181: How To Increase Patient Adherence To Exercise 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 EXERCISE
- [Unraveling the Web of Neuralgia: Navigating the Cervical Spine](https://toughtotreat.com/unraveling-the-web-of-neuralgia-navigating-the-cervical-spine/) - 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. Cervical Spine
- [Breath, Voice and HRV as Predictors and Interventions in Pelvic Health - Part 2](https://toughtotreat.com/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 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. Breath
- [Breath, Voice, and HRV as Predictors and Interventions in Pelvic Health - Part 1](https://toughtotreat.com/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 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. Breath
- [The Mystery of This Man's Struggle With Pelvic Girdle Pain and the Breath](https://toughtotreat.com/the-mystery-of-this-mans-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 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 PELVIC GIRDLE PAIN
- [Finding Hidden Connections In Functional Movements- Why They Matter](https://toughtotreat.com/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 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 Assessment
- [Shoulder Pain- A Motor Control Problem?](https://toughtotreat.com/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 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 Shoulder Pain
- [SI Joint Pain - An Updated Approach](https://toughtotreat.com/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. In this episode, we discuss what has been unhelpful for her with regard to past interventions and why the biopsychosocial approach and creating the therapeutic alliance are so important to give her the ability Assessment
- [A Stiff 1st MTP Joint can Affect Everything!](https://toughtotreat.com/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 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 FOOT PAIN
- [HRV as A Predictor and Intervention in Sleep and Stress](https://toughtotreat.com/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 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 Hormones
- [Pain Without a Diagnosis: The Complexities of Managing Medically Unexplained Symptoms](https://toughtotreat.com/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 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 Assessment
- [Decoding Persistent Hip Labral Tears - It's Not Always What We Think](https://toughtotreat.com/decoding-persistent-hip-labral-tears-its-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 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 Hip Pain
- [Chronic Low Back Pain and Constipation - Why it Matters!](https://toughtotreat.com/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 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 LOW BACK PAIN
- [Pelvic Girdle Pain: Current Concepts Part 2](https://toughtotreat.com/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 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 PELVIC GIRDLE PAIN
- [Unraveling a Compression Fracture in a Young Male](https://toughtotreat.com/unraveling-a-compression-fracture-in-a-young-male/) - 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 Assessment
- [Meeting Patient Expectations- Navigating the Journey to Progress](https://toughtotreat.com/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 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 Assessment
- [Pelvic Girdle Pain: Current Concepts Part 1](https://toughtotreat.com/pelvic-girdle-pain-current-concepts-part-1/) - 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, PELVIC GIRDLE PAIN
- [From Neck Pain to Shoulder Pain: Unraveling the Links Between the Two](https://toughtotreat.com/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 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 Shoulder Pain
- [Unique Release Positions for the Shoulder: Positioning for Optimal Results](https://toughtotreat.com/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 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 Shoulder Pain
- [Complex Chronic Low Back Pain - When A Regional Approach Will Not be the Best Option](https://toughtotreat.com/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 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 LOW BACK PAIN
- [Pelvis Driver In A Male Weightlifter](https://toughtotreat.com/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 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, LOW BACK PAIN
- [Trigeminal System Referral Pattern](https://toughtotreat.com/trigeminal-system-referral-pattern/) - 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 Headache
- [Assessing The Knee Differently](https://toughtotreat.com/assessing-the-knee-differently/) - 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 Assessment
- [Foot Drivers - The Prequel to the Foot Progression Exercises](https://toughtotreat.com/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 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 Exercise Progression
- [Anatomy and Physiology Interactions of the GI System - Part 2](https://toughtotreat.com/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 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 Gut
- [<strong>What Do Weightlifting And Poledancing Have In Common?</strong>](https://toughtotreat.com/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 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 EXERCISE
- [Anatomy and Physiology Interactions of the GI System - Part 1](https://toughtotreat.com/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 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] Uncategorized
- [<strong>Hypermobility and Low Back Pain</strong>](https://toughtotreat.com/hypermobility-and-low-back-pain/) - 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 LOW BACK PAIN
- [Why Has My Patient Stopped Improving?](https://toughtotreat.com/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 Assessment
- [Estrogen Levels and Changes in the Musculoskeletal System](https://toughtotreat.com/podcast151/) - 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 Hormones
- [Shoulder Girdle Hypermobility vs. Thoracic Stiffness - Where is the Balance](https://toughtotreat.com/podcast150/) - 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 sound clinical reasoning to design an exercise program to bring motor control to the shoulder girdle and improve thoracic mobility? Assessment
- [<strong>Advanced Clinical Reasoning With Your Toughest Patients</strong>](https://toughtotreat.com/podcast149/) - 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 Assessment
- [<strong>Hormone Balance - Estrogen and Why it Matters</strong>](https://toughtotreat.com/podcast147/) - 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]
- [Down Training Non-Optimal Movement Patterns to Make Exercise More Effective](https://toughtotreat.com/podcast148/) - 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 Assessment
- [Grow Your Clinical Expertise By Learning How To Treat The Complex Patient (Part 1)](https://toughtotreat.com/podcast143/) - 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 Assessment
- [Grow Your Clinical Expertise By Learning How To Treat The Complex Patient (Part 2)](https://toughtotreat.com/podcast144/) - Susan and Erica present case studies during part 2 of a webinar to highlight clinical reasoning.
- [Manual Therapy Or Not? Hands Off Or Hands On? Or Both?](https://toughtotreat.com/podcast145/) - 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 Assessment
- [Shoulder Stiffness - When the Tissue is the Driver!](https://toughtotreat.com/podcast146/) - Shoulder pain, stiffness, and lack of functional mobility are 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
- [Breath and the Chest Wall](https://toughtotreat.com/podcast142/) - Let's talk about breathing patterns. Somewhere along the line, chest movement with diaphragm movement became unpopular. Was this because people equated the term "chest breathing" with "accessory muscle breathing". Join Susan in this short episode, as she discusses the differences, explores how breath drives pelvic function and why we have so much stiffness in the Breath
- [Foot and Hip Pain? Why You Treat The Thorax](https://toughtotreat.com/podcast141/) - 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 FOOT PAIN
- [Myth Busting - Rethinking Pregnancy-Related Pelvic Girdle Pain](https://toughtotreat.com/podcast121/) - In this episode, we discuss the most important systemic and movement system presentations that can greatly impact this population.
- [Racquet Sports & Back Pain: Why You Should Look At The Foot](https://toughtotreat.com/podcast131/) - In this episode, Susan and Erica discuss a young squash player with long-standing low back pain. They highlight the importance of injury and movement history and looking at different movement patterns to tease out the driver. How can you apply your clinical reasoning using a timeline of his injury history coupled with the dominant movement LOW BACK PAIN
- [#101 - SI Joint Pain - An Updated Approach](https://toughtotreat.com/podcast101/) - Here is the clinical story of a client that is presenting with pain/sensitivity in the area of the (R) posterior pelvis. In this episode we discuss what has been unhelpful for her with regard to past interventions and why the biospsychosocial approach and creating the therapeutic alliance is so important to give her the ability Uncategorized
- [#102: Treatment Progressions for the Tough To Treat-Clinical Pearls](https://toughtotreat.com/podcast102/) - Description Clinical pearl alert! This episode tells the story of 3 patients and their treatment progressions. Typical symptoms but atypical drivers. What types of exercises do you prescribe for your patient when their symptom is in their feet and their driver lies in their thorax? What is their impairment? This is a discussion of how Uncategorized
- [#103: Complex Ankle Sprains-What's Missing?](https://toughtotreat.com/podcast103/) - Ankle sprain rehab can seem so straight forward - decrease swelling, improve ROM and strength - right? Wait, why are a good number not improving and returning to previous activities? Once again, the client's story and history can really lead us further into the complexity of the foot/ankle joint and all of the systems that Uncategorized
- [#104: "X" Marks The Spot-Navigating The True Source Of Shoulder Pain"](https://toughtotreat.com/podcast104/) - Save yourself time by learning how to find the driver quicker. This is the case of a neck driven shoulder- but not in the way you think! Do all shoulder patients need strengthening? Not really. We talk about how to hone in on the impairment and narrow the assessment down to a few movements that Uncategorized
- [#105: Nociplastic Pain and a Visceral Driver](https://toughtotreat.com/podcast105/) - What do you do when a client presents with a myriad of LQ symptoms without a clear regional driver? Look to the history and keep asking questions even further back than the recent onset or episodic flare. Join us as we discuss complex neurology of a visceral driver that has signs of dysfunction and a Uncategorized
- [#106: Persistent Unsolved Hip Pain](https://toughtotreat.com/podcast106/) - Does all hip pain require strengthening? Of course not! And certainly not in this persistent case. This episode shows you the importance of digging deep into the history and really learning how to connect the dots. From the way the patient walks and what that means for symptom provocation to exposing the vestibular system as Uncategorized
- [#107 Complex Persistent Pain - Part 1 Where is the driver?](https://toughtotreat.com/podcast107/) - We always discuss history and relevant events. In this episode we take a deeper dive into all aspects of the story in the BPS lens. Join us for our discussion on the importance of uncovering significant historical pieces regardless of the referral or medical diagnosis. You have an opportunity to put on your clinical reasoning Uncategorized
- [#108 Complex Persistent Pain - Part 2 Where is the driver?](https://toughtotreat.com/podcast108/) - Do you have thoughts on the driver from part 1? In part 2 we take you through the discovery and clinical reasoning parts to determine the primary driver for this client's symptoms. For intervention - think of the easiest steps to begin to find a way into the system to make large changes. Listen in Uncategorized
- [#109 5 Symptomatic Regions Of The Body With One Main Driver- Part 1](https://toughtotreat.com/podcast109/) - What happens when you have 2 regions of the body that when treated together give your patient the best movement options and no pain? But, when they are treated separately, not only is the patient worse, but their movement lacks coordination and ease. This episode highlights someone who has over 5 regions of the body Uncategorized
- [#110 5 Symptomatic Regions Of The Body With One Main Driver- Part 2](https://toughtotreat.com/podcast110/) - After listening to Part 1 of this case (episode 109), how would you design an exercise progression? Remember you need to find the driver first. Designing a movement program based on this patient's symptoms would NOT work, as his driver(s) lie elsewhere. Once you are confident you've found it, think about the impairment. Does he Uncategorized
- [#111 A Case of Lateral Hip Pain](https://toughtotreat.com/podcast111/) - Consideration of lateral hip pain requires a thoughtful clinical reasoning process to discover the physiology/movement patterns as well as neural contributions required to make a diagnosis and successfully build an intervention that lasts. One size does not fit all - join us as we discuss the findings in this "not so unique" case and the discovery Uncategorized
- [#112 Does the Elbow Always Drive Elbow Pain?](https://toughtotreat.com/podcast112/) - A fall on an outstretched elbow (FOOSH) with resulting elbow pain. Not your typical overuse or mechanical injury common to this region of the body. What happens when your differential diagnosis leads you somewhere else? Susan and Erica discuss the backbone of the initial assessment as well as treatment specific strategies that will help you Uncategorized
- [#113 Persistent Pubic Symphysis Pain/Right Anterior Hip Pain](https://toughtotreat.com/podcast113/) - 10-20% of women with pelvic girdle pain in pregnancy will persist into the post-partum era. Join us as we share a discussion on the history that led to the eventual battery of relevant tests/measures and interventions that were not only meaningful to the client, but also were achievable in her very busy time of life Uncategorized
- [#114 Designing Exercise Progressions For The Tough To Treat](https://toughtotreat.com/podcast114/) - How do you design a sound, clinically reasoned exercise progression? Taking into account multiple drivers? If someone has low back pain, do you give them core stability exercises? I hope not, unless they have an abdominal wall deficit! In this episode Susan and Erica talk about a patient from episode 81 and what constitutes an Uncategorized
- [#115 The Psoas Triangle](https://toughtotreat.com/podcast115/) - Differentials of common segment's neurology - Join us as we discuss the shared neurology of the T12/L1 region and how this can be a driver to anterior hip and groin pain. We are looking at multitudes of clients that show up with various aspects of what Erl Pettman discusses in his work of the psoas Uncategorized
- [#116 Persistent Shin Pain-Where is the Driver(s)? Hint: Not the Lumbar Spine](https://toughtotreat.com/podcast116/) - Can there be 2 drivers to someone's shin pain? Of course! What is the relationship between them? Are they directly connected? Is there some underlying neurally driven mechanism? Or both? This episode digs deep into why certain positions like sitting in a specific environment versus other sitting positions make him worse. Why would biking be Uncategorized
- [#117 Persistent insertional tendonopathy - the importance of the systems approach](https://toughtotreat.com/podcast117/) - The movement system is adaptable until there is maladaptation! Why is tendonopathy so difficult to treat? What if straight eccentric loading doesn't work? Join us as we discuss this female client and the unique consideration of the system changes that have led to the development and persistence of her persistent heel pain. Yes, this includes Uncategorized
- [#118 The Foot and Diaphragm- Their Connection To This Skier's Hip Pain](https://toughtotreat.com/podcast118/) - What happens when you take away a compensation? Movement patterns change for starters. But what if these new strategies are not optimal for whatever activity you are trying to do? New sport you want to master? That's where the reality unfolds. Healthy systems need choices and when you take away a compensation or a movement Uncategorized
- [#119 CV joints and bladder urgency - is there a connection?](https://toughtotreat.com/podcast119/) - Clients report urgency/frequency and are most often treated with medication and pelvic floor PT. When only a regional approach to the pelvic floor over-recruitment is considered, many of the underlying drivers can be missed. Consider the client on this podcast and join us as we explore how multiple drivers can influence the hypersensitivity of the Uncategorized
- [Neurophysiological Underpinnings of the Trigeminal System - Part 1](https://toughtotreat.com/podcast138/) - In this short episode, Susan discusses the upper cervical region and its effects on the rest of the body: core, pelvic floor dysfunction, muscle recruitment, balance, dizziness, etc. Join Susan as she takes a journey into the remarkable system from one of her lectures. Erl Pettman's work has long influenced Susan on her clinical reasoning Headache
- [A Fencer With Bilateral Calf Pain - Where's The Driver?](https://toughtotreat.com/podcast139/) - What is the cause of bilateral calf pain in this young fencer? Start to finish, it shows the power of a thorough evaluation, a specific exercise progression and a return to the sport she loves. When it comes to exercise progression in persistent pain, think about context. How can you improve optimal movement patterning by
- [How To Increase Proprioception - An Updated Approach](https://toughtotreat.com/podcast140/) - 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 Assessment
- [Lumbosacral Pain Presentation - A Typical Clinical Pattern](https://toughtotreat.com/podcast137/) - In this episode, Susan and Erica discuss a series of patients that all presented lumbosacral pain. Clinical pattern recognition is an important part of the assessment process. The pattern does not dictate the intervention process, but the inability or ability of the pattern to change in the assessment and intervention process is key. This practical LOW BACK PAIN
- [What To Do When Your Treatment Stops Working](https://toughtotreat.com/podcast136/) - In this short episode, Erica discusses her perspective on how to handle patients whose treatment has stopped working. We’ve all been there. The proverbial plateau. Your patient is doing well and then all of a sudden they get stuck. Why? More often than not, there is a secondary region of the body that has cropped
- [Smart Exercise Progression](https://toughtotreat.com/podcast120/) - In this episode, two cases are presented where their drivers were distal to their symptomatic areas. Categories of movement, neutral to non-neutral, as well as unloaded to loaded are discussed with specific exercise progression. What constitutes an effective and efficient exercise progression? How do you smartly move someone through a movement program targeting their driver? EXERCISE
- [Junior Golfer with an Unusual Source to his Knee Pain](https://toughtotreat.com/podcast122/) - Erica and Susan discuss in this podcast how treating the left hip as well as the left side of the low back, got rid of this young golfer’s knee pain. A functional and interactive evaluation really hones in on where the true source of his knee pain lies. Assessing center of mass (COM) here is Knee Pain
- [Reframing the Narrative for A More Effective Assessment](https://toughtotreat.com/podcast124/) - Can you find clues in your patient’s narrative that will help you find the driver quicker? Make your assessment more efficient and save you time. Think about someone’s movement and injury history and how that can be relevant to their current symptoms. Their initial injuries will SET THEM UP for compensatory movement patterning down the Assessment
- [Hip Pain, Hypermobility, and a Subtle Driver!](https://toughtotreat.com/podcast125/) - Working with a ballet dancer with hip pain, even with a very subtle driver, means continuing to look at the full movement system in its entirety! Regional exercises targeted at the hip may not solve the issue and stretching may contribute further to the problems. Listen to the story, ask questions, and find out where Hip Pain
- [Hypermobility and Low Back Pain](https://toughtotreat.com/podcast127/) - This episode highlights the beauty of a specific exercise progression tailored to the patient's meaningful movement as well as their driver.
- [Exercise Progression for the Tough to Treat Shoulder](https://toughtotreat.com/podcast128/) - The shoulder can be tough to treat at times, right? It consists of many regions of the body and in order to design an exercise progression that gets results, you must: *Down train the old dominant strategy first*Be innovative with release positions to tease out certain muscles that are overactive*Train volume of easy exercise at Shoulder Pain
- [Low Back Pain: Regional vs. Movement System Considerations](https://toughtotreat.com/podcast129/) - Join Susan and Erica as they explore this Tough To Treat client with low back pain and mild stress urinary incontinence.
- [Shoulder and Arm Pain - What is Really the Driver?](https://toughtotreat.com/podcast133/) - tough to treat Shoulder Pain
- [The Gut-Brain Axis - Stress, Pain, and Balance](https://toughtotreat.com/podcast134/) - This clip is dedicated to the Gut-Brain Axis and why the complex interactions can have such a direct effect on the behavior of the movement.
- [Hip Pain In A Golfer: Why It's Not Going Away](https://toughtotreat.com/podcast132/) - In this short episode, Erica highlights the importance of center of mass by assessing a semi-competitive golfer with hip pain.
- [Choosing The Best Functional Movement For Your Assessment](https://toughtotreat.com/podcast123/) - Success = picking the best functional movement to assess with your patient. Can you imagine shaving minutes off of your initial evaluation time? And at the same time, connecting with your patient in a way that not only increases the therapeutic alliance but will help you find the driver quicker. Join Erica and Susan Assessment
- [Treating Knee OA The Smart Way](https://toughtotreat.com/podcast135/) - In this episode, Erica and Susan discuss how to begin and progress treatment with a knee OA without exacerbating their symptoms. Knee pain can be quite provoking as we age, especially for those older adults who have always been active and want to stay that way. Osteoarthritis is fairly common, however, exercise designed for this Knee Pain
- [Exercise Progression For Neck Pain And Headaches](https://toughtotreat.com/podcast126/) - This episode highlights exercise progression for a patient with neck pain and concurrent headaches.
- [When You Should Tape and Why](https://toughtotreat.com/podcast130/) - In this short episode, Erica gives her perspective on when you should tape and why.
- [#99: Clinical Pearls for the Shoulder-Understanding the Connections in the Upper Quarter](https://toughtotreat.com/99-clinical-pearls-for-the-shoulder-understanding-the-connections-in-the-upper-quarter/) - Join us for a special episode on the shoulder. This is a re-release of one of our most popular episodes to date. As a bonus, we present 3 case studies of patients with typical shoulder pain who have different drivers and certainly different exercise programs. Sometimes the key to helping a patient's persistent shoulder pain Uncategorized
- [#02: An Atypical Cause Of Low Back Pain And How To Treat It (Part 2)](https://toughtotreat.com/02-an-atypical-cause-of-low-back-pain-and-how-to-treat-it-part-2/) - A continuation of the prior episode. Solving a complex case of right sided low back pain. Susan and Erica further discuss the evaluative process as well as some novel treatment solutions for this particular patient. Uncategorized
- [#90: Ankle fracture rehab - what is missing?](https://toughtotreat.com/90-ankle-fracture-rehab-what-is-missing/) - 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 Uncategorized
- [#100: What To Do When Your Patient Plateaus](https://toughtotreat.com/100-what-to-do-when-your-patient-plateaus/) - What do you do when a patient plateaus? Doesn't improve? Join us for our first Q and A broadcast on how to clnically reason through a patient's treatment program when their progress starts to slow down. We discuss a specific patient example and what constitutes a solid progressive exercise program. This also includes reset exercises Uncategorized
- [#98: The Key To Functional Movement Assessments](https://toughtotreat.com/98-the-key-to-functional-movement-assessments/) - Join us for Part 2 of our discussion on functional movement patterns. How can you make your assessment more efficient and reliable? We discuss what to look for when evaluating someone's ability to move in and out of certain movements. How do you determine if a dysfunctional foot is driving your client's hip pain when Uncategorized
- [#97: "Why Does My Foot Hurt? What's Going On?"](https://toughtotreat.com/97-why-does-my-foot-hurt-whats-going-on/) - 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 on how to assess the whole foot and Uncategorized
- [#96: Musculoskeletal Driver of Hip Pain in a Young Dancer](https://toughtotreat.com/96-musculoskeletal-driver-of-hip-pain-in-a-young-dancer/) - When working with young athletes it is easy to have early success in treating the acute or subacute injuries. What happens when the latest injury reveals a very chronic situation elsewhere in the body? Don't be fooled by generalized and chronic complaints underlying the present situation in these teenagers. They may improve quickly in one Uncategorized
- [#95: The Knee and its Relationship to the Whole Person](https://toughtotreat.com/95-the-knee-and-its-relationship-to-the-whole-person/) - How does the knee affect so many parts of the body? Join us for this discussion on this important intermediate joint of the lower kinetic chain and how dysfunction here can alter the movement system for the whole person. Uncategorized
- [#94: Chest Pain In An Endurance Athlete](https://toughtotreat.com/94-chest-pain-in-an-endurance-athlete/) - Does chest pain raise your eyebrows? Red flag? Or wild goose chase? This case is an insight into a classic endurance athlete and how his past injuries reveal a true deficit which can be the potential driver for his current symptoms. These symptoms that only occur 3-4 hours after a bike ride. We discuss viscero-somatic Uncategorized
- [#93: Shoulder Pain and Distal Drivers](https://toughtotreat.com/93-shoulder-pain-and-distal-drivers/) - This episode features a case of shoulder pain with unusual drivers due to their distal proximity. Join us as we discuss this interesting clinical case on a very active man with chronic shoulder pain, fear avoidance, anxiety and some unique clinical reasoning to help him recover! Uncategorized
- [#92: Not Your Ordinary Knee Patient](https://toughtotreat.com/92-not-your-ordinary-knee-patient/) - What do you automatically think when someone tells you they have knee pain? It's worse with walking SW and walking FW. And the patient cannot sleep sidelying because his knee hurts when he sleeps on either side. He can squat no problem. Are you thinking what we're thinking? Susan and Erica unpack this patient's story Uncategorized
- [#91: Thoracic Mobility Beyond The Breath](https://toughtotreat.com/91-thoracic-mobility-beyond-the-breath/) - In this episode Susan and Erica discuss the many ways the thorax can be the driver for a multitude of upper and lower extremity issues. This important region of the body tends to be the cause for a lot of movement dysfunction we often see. As an example, the thorax is an important component in Uncategorized
- [#03: Hip Labral Tear? Or does it matter?](https://toughtotreat.com/03-hip-labral-tear-or-does-it-matter/) - In this podcast we discuss a client with a four year history of hip pain and diagnosis of labral tear. We explore her hip diagnosis vs. a central mediated pain syndrome that had her running from PT to PT and Doc to Doc without resolution of her symptoms. Find the solutions here! Uncategorized
- [#04: Junior Golfer With An Unusual Source To His Knee Pain](https://toughtotreat.com/04-junior-golfer-with-an-unusual-source-to-his-knee-pain/) - Did you know that right knee pain can be caused by an imbalance in your center of mass? Erica and Susan discuss in this podcast how treating the left hip as well as the left side of the low back, got rid of this young golfer’s knee pain. A functional and interactive evaluation really hones Uncategorized
- [#05: Pregnancy and Pelvic Girdle Pain (Part 1)](https://toughtotreat.com/05-pregnancy-and-pelvic-girdle-pain-part-1/) - In this episode we discuss the evaluation of pregnancy related pelvic girdle pain and why it is important not to dismiss these women. The Pelvic Girdle Pain Questionnaire reference is here: Uncategorized
- [#06: Pregnancy and pelvic girdle pain (part 2)](https://toughtotreat.com/06-pregnancy-and-pelvic-girdle-pain-part-2/) - This is part 2 of pregnancy related pelvic girdle pain - we discuss the novel approach to interventions and the resiliency of pregnant women. Uncategorized
- [#07: Treating The Cranium For Multiple Joint Pain (Part 1)](https://toughtotreat.com/07-treating-the-cranium-for-multiple-joint-pain-part-1/) - Susan and Erica discuss really novel and unique ways of treating the cranium, the nervous system as well as a nice progression of motor control and corrective movement practice in this really interesting patient. This case highlights taking a thorough medical history, the power of listening and then putting together the clinical puzzle pieces to Uncategorized
- [#08: Treating The Cranium For Multiple Joint Pain (Part 2)](https://toughtotreat.com/08-treating-the-cranium-for-multiple-joint-pain-part-2/) - A continuation of the prior episode, Erica and Susan further discuss innovative treatments ideas for this patient as well as novel inputs to change patients' movement patterns. Uncategorized
- [#09: Woman with diastasis and pelvic floor heaviness](https://toughtotreat.com/09-woman-with-diastasis-and-pelvic-floor-heaviness/) - This episode centers around a discussion of post-partum DRA in a patient with a long standing, complex history of pain and fear around her abdominal wall. Emphasis on a good history unmasks many MSK issues related to her condition. Uncategorized
- [#11: Driving and Slicing. The mechanics of the golf swing.](https://toughtotreat.com/11-driving-and-slicing-the-mechanics-of-the-golf-swing/) - Wellness and movement are the focus of this podcast. The discussion centers around Golf and how PTs are uniquely qualified to evaluate and change the mechanics of a golf swing. Uncategorized
- [#10: If it is foot pain, does that mean it comes from the foot?](https://toughtotreat.com/10-if-it-is-foot-pain-does-that-mean-it-comes-from-the-foot/) - A really interesting case of persistent foot pain in a stage performer. Compensations from dominant patterning and loading - the case for looking up the kinetic chain. Uncategorized
- [#12: A unique source to a young patient's leg pain](https://toughtotreat.com/12-a-unique-source-to-a-young-patients-leg-pain/) - Erica and Susan discuss novel ways of assessing and treating leg pain in a young patient where the source is not the leg! Uncategorized
- [#13: Lifting and female incontinence](https://toughtotreat.com/13-lifting-and-female-incontinence/) - Discussion around a "hot topic" - is it OK to lift and leak? Susan and Erica discuss the issue and some non-complicated approaches to this population. Uncategorized
- [#14: College Athlete Suffering from Neck and Arm Pain](https://toughtotreat.com/14-college-athlete-suffering-from-neck-and-arm-pain/) - An interesting discussion about a college softball player suffering from persistent neck and arm pain and some novel movement strategies to get her back into the game. Uncategorized
- [#18: Fencer with bilateral calf pain](https://toughtotreat.com/18-fencer-with-bilateral-calf-pain/) - What is the cause of bilateral calf pain in this young fencer? Start to finish, it shows the power of a thorough evaluation, a specific exercise progression and a return to the sport she loves. Uncategorized
- [#15: Mature ballet dancer with hip and back pain](https://toughtotreat.com/15-mature-ballet-dancer-with-hip-and-back-pain/) - Susan and Erica talk about some of the difficulties with pattern dominance in young and mature ballet dancers. This episode features someone with insidious onset of back and hip pain and the novel approach. Uncategorized
- [#16: Ex- football player with shoulder pain](https://toughtotreat.com/16-ex-football-player-with-shoulder-pain/) - A former NFL player suffering from RIGHT shoulder pain discovers that his symptoms are coming from his LEFT side. Explore this unique clinical reasoning process with Susan and Erica. Uncategorized
- [#17: Pelvic pain with intercourse](https://toughtotreat.com/17-pelvic-pain-with-intercourse/) - This client presented with pain with intercourse - and although the mechanism of dysfunction is not that surprising, the circuitous route and co-morbidities are! Uncategorized
- [#19: Walker with heel pain](https://toughtotreat.com/19-walker-with-heel-pain/) - Is heel pain really heel pain? What if the pain was an expression of symptoms from a different mechanism? Join Susan and Erica in this clinical reasoning conversation. Uncategorized
- [#20: Wrist pain & yoga- Is it really the wrist?](https://toughtotreat.com/20-wrist-pain-yoga-is-it-really-the-wrist/) - Did you ever think wrist pain that gets aggravated when performing a down dog yoga posture would emanate from the shoulder? Sustaining such a beautiful move requires almost synchronous timing and a good clinical reasoning process to discover where the true source of the pain lies. And yes, you need to analyze the person in Uncategorized
- [#21: Lumbopelvic and knee pain - What is the driver?](https://toughtotreat.com/21-lumbopelvic-and-knee-pain-what-is-the-driver/) - Lumbopelvic and knee pain sounds simple and straight forward in an individual at age for joint changes. Is it always about joint changes? Go through the clinical reasoning process with us to discover the hidden driver in this complex case. Uncategorized
- [#22: Running and Pelvic Pain](https://toughtotreat.com/22-running-and-pelvic-pain/) - Not your typical pelvic issue! This podcast shows the beauty of looking up and down the chain for a clue as to where this runner's pelvic pain came from. Looking at movements SPECIFIC to running and NOT the pelvis, were keys to her recovery. Uncategorized
- [#23: Red flags](https://toughtotreat.com/23-red-flags/) - What do red flags really mean to the Physical Therapist? Signs and symptoms need to be considered in the same light as the medical history of the client. Join us in our conversation about why the red flags became a bit more glaring with this case. Uncategorized
- [#24: Post-op hip pain- Is it really the hip?](https://toughtotreat.com/24-post-op-hip-pain-is-it-really-the-hip/) - Many people have labral tears in their hip but is surgery the only solution? More often than not, there are secondary issues causing the labral tear in the first place, especially when someone still has lingering issues that the surgery did not address. Does a lack of control in the foot cause a hip labral Uncategorized
- [#25: Chronic low back tightness](https://toughtotreat.com/25-chronic-low-back-tightness/) - How many times do you hear this complaint? I feel like I need to stretch my really tight low back! We have clients that have all kinds of complaints around their low back and this is one that is encountered frequently. Looking at functional and exercise movement patterns were the key to finding the path Uncategorized
- [#26: Exercise progression & low back pain](https://toughtotreat.com/26-exercise-progression-low-back-pain/) - Does every low back pain or pelvic girdle patient get the same exercise progression? Let's hope not!! One size does not fit all here. The keys to progressing a patient to a more optimal movement pattern lie in the specificity of an exercise progression. Exercising the wrong muscle group will not help but can actually Uncategorized
- [#27: Young ballet dancer with foot pain](https://toughtotreat.com/27-young-ballet-dancer-with-foot-pain/) - This episode centers on the unique exam findings and interventions for a young dancer with diagnosed tendonitis. The challenge in this case was to look closer at the functional movement patterns to find where the movement pattern breaks down. Uncategorized
- [#28: What To Do When You Are Their Last Resort](https://toughtotreat.com/28-what-to-do-when-you-are-their-last-resort/) - Now, this is a CHALLENGING one! Ever have those patients who have been everywhere, had everything done to them (injections, surgeries, acupuncture) and nothing helped? Well, this is your lucky day because this episode really takes us down the chain from head to toe with someone who had low back pain. Pretty standard, right? But Uncategorized
- [#29: Is shoulder pain really a shoulder problem?](https://toughtotreat.com/29-is-shoulder-pain-really-a-shoulder-problem/) - Shoulder pain - what does that really mean? Sometimes the key to helping through a patient's persistent shoulder pain is looking at all of the underlying inputs to the regional pain syndrome. Most often we find a large involvement of the cervical spine. In this episode, finding ways to decompress the system were key to Uncategorized
- [#30: Low back & pelvic pain](https://toughtotreat.com/30-low-back-pelvic-pain/) - How does the pelvis become a source of someone's low back pain? It is not always about training transversus, multifidus or the pelvic floor. Listen as we discuss how a compressed pelvis in a male patient was the source of his low back pain. Ultimately, balancing the forces across his pelvis and increasing his awareness Uncategorized
- [#31: Persistent lumbar radicular pain - is it really a spine problem?](https://toughtotreat.com/31-persistent-lumbar-radicular-pain-is-it-really-a-spine-problem/) - Radicular pain can be a complex situation and is usually treated from the perspective of the spine. What about a persistent pain problem? In this episode we discuss the exam and treatment of a gentleman with persistent radicular pain for over 10 years. You might be surprised by the real issues that drove him to Uncategorized
- [#32: Differential diagnosis of posterior thigh pain in a young female](https://toughtotreat.com/32-differential-diagnosis-of-posterior-thigh-pain-in-a-young-female/) - When a 12 year old comes to you with complaints of posterior thigh pain that is not going away, your radar should go up. Especially, when she presented with knee issues previously which were alleviated within 3 visits. Being a good listener is extremely important; but in this case, being a good questioner provided the Uncategorized
- [#33:  Shoulder pain biomechanical or systemic of origin?](https://toughtotreat.com/33-shoulder-pain-biomechanical-or-systemic-of-origin/) - Explore the origin of this client's shoulder pain as we discuss a biomechanical vs. systemic history and how the pain experience had changed her ability to fully participate in life and exercise. Uncategorized
- [#34: Hypermobility and low back pain](https://toughtotreat.com/34-hypermobility-and-low-back-pain/) - How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? Carefully and specifically! This episode highlights the beauty of a specific exercise progression tailored to the patient's meaningful movement. Listen as we go through the clinical reasoning process to determine what types of movement patterns will work and what Uncategorized
- [#35: Post-partum pelvic pain and urgency](https://toughtotreat.com/35-post-partum-pelvic-pain-and-urgency/) - There are many ways to approach pelvic pain and symptoms of urinary urge incontinence, but did you know that how the MSK system moves can affect these symptoms as well? On this podcast, we take a dive into the movement system, past/present autoimmune history and post-partum process while changing this client's symptoms as well as Uncategorized
- [#36: Shoulder Pain- A motor control problem?](https://toughtotreat.com/36-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 problem or a neuromuscular repatterning issue? Or something else? How does our nervous system adjust? In this episode we talk about the multiple sources to this person's shoulder pain and how retraining his arm Uncategorized
- [#37: Hip and back injury at Sea!](https://toughtotreat.com/37-hip-and-back-injury-at-sea/) - What happens when someone gets injured while living on their sailboat at sea? This episode explores the clinical reasoning and intervention process from a virtual platform to help this lady through an unexpected injury to her hip and back and navigating the functions needed on a sailboat. Uncategorized
- [#38: What is the real cause of her elbow pain?](https://toughtotreat.com/38-what-is-the-real-cause-of-her-elbow-pain/) - Does elbow pain really emanate from the elbow? Sometimes it does. But the longer people wait to seek help, the higher the likelihood there is another driver. And therein lies the challenge. Join us as we clinically reason through this patient's elbow/arm pain and the ensuing treatment progression and exercise prescription. Uncategorized
- [#39: Left sided pain and tightness in a professional dancer](https://toughtotreat.com/39-left-sided-pain-and-tightness-in-a-professional-dancer/) - Professional dancers tend to push through tightness, discomfort and pain. Not surprising! Often times the care they seek does not really address the driver(s) of their symptoms. More often than not, it is treat the painful part and move on. That is not a recipe for long term relief. Listen to this girl's story and see how Uncategorized
- [#40: Is spinal stenosis a mystery?](https://toughtotreat.com/40-is-spinal-stenosis-a-mystery/) - Tough To Treat Masterclass: In this episode we have guest PT, Daria Oller, who presents us with one of her tough spinal patients. Is spinal stenosis a mystery? Not really.... We clinically reason through the evaluation but move very quickly into diagnosis and movement. We brainstorm some great treatment ideas and various ways to change Uncategorized
- [#41: Not Your Ordinary Hip Problem](https://toughtotreat.com/41-not-your-ordinary-hip-problem/) - What do you do when your patient tells you that she hurts everywhere? In this episode, Susan and I discuss a patient with an EXTENSIVE injury history who happens to be a runner. Do these compensations over the years end up being what is the root cause of the problem? Or are there some cognitive Uncategorized
- [#42: Complex issues with pain and fear avoidance](https://toughtotreat.com/42-complex-issues-with-pain-and-fear-avoidance/) - 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 Uncategorized
- [#43: Neurogenic pain and complex metabolic issues](https://toughtotreat.com/43-neurogenic-pain-and-complex-metabolic-issues/) - 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. Uncategorized
- [#44: Dancer with Pelvic Pain-Is it Really the Pelvis?](https://toughtotreat.com/44-dancer-with-pelvic-pain-is-it-really-the-pelvis/) - 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 Uncategorized
- [#45: Female with bilateral hip pain? Is it really a hip joint problem?](https://toughtotreat.com/45-female-with-bilateral-hip-pain-is-it-really-a-hip-joint-problem/) - 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 Uncategorized
- [#46: Leg pain and peripheral nerves](https://toughtotreat.com/46-leg-pain-and-peripheral-nerves/) - 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 Uncategorized
- [#47: Fear avoidance with low back & pelvic pain](https://toughtotreat.com/47-fear-avoidance-with-low-back-pelvic-pain/) - 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 Uncategorized
- [#48: Complicated thigh numbness-is it really the nerve?](https://toughtotreat.com/48-complicated-thigh-numbness-is-it-really-the-nerve/) - 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 Uncategorized
- [#49: Game Changing Exercise Progressions](https://toughtotreat.com/49-game-changing-exercise-progressions/) - 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 Uncategorized
- [#50: Finding the real story through the narrative](https://toughtotreat.com/50-finding-the-real-story-through-the-narrative/) - 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 Uncategorized
- [#51: Is it really the nerve root?](https://toughtotreat.com/51-is-it-really-the-nerve-root/) - 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 Uncategorized
- [#52: A shoulder or a neck problem - what is important to the patient?](https://toughtotreat.com/52-a-shoulder-or-a-neck-problem-what-is-important-to-the-patient/) - 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 Uncategorized
- [#53: Is an overactive TFL a poor movement strategy?](https://toughtotreat.com/53-is-an-overactive-tfl-a-poor-movement-strategy/) - 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 Uncategorized
- [#54: Leaking and Running - A solution](https://toughtotreat.com/54-leaking-and-running-a-solution/) - 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 Uncategorized
- [#55: Back pain or leg pain - why is it getting worse?](https://toughtotreat.com/55-back-pain-or-leg-pain-why-is-it-getting-worse/) - 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. Uncategorized
- [#56: Is this patient tough to treat?](https://toughtotreat.com/56-is-this-patient-tough-to-treat/) - 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 Uncategorized
- [#57: Elbow pain or cervical?](https://toughtotreat.com/57-elbow-pain-or-cervical/) - 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? Uncategorized
- [#89: Does Hip Pain Always Come From The Hip?](https://toughtotreat.com/89-does-hip-pain-always-come-from-the-hip/) - 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 Uncategorized
- [#88: The Shoulder Is Connected To Everything](https://toughtotreat.com/88-the-shoulder-is-connected-to-everything/) - 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? Uncategorized
- [#87: Double Vision Post Partum, Cause or Effect?](https://toughtotreat.com/87-double-vision-post-partum-cause-or-effect/) - 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 Uncategorized
- [#86: Neural Tension and Beyond](https://toughtotreat.com/86-neural-tension-and-beyond/) - 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 Uncategorized
- [#85: Neck Pain/Back Pain - Where Do You Start?](https://toughtotreat.com/85-neck-pain-back-pain-where-do-you-start/) - 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 Uncategorized
- [#84: How To Master Functional Movement Assessment](https://toughtotreat.com/84-how-to-master-functional-movement-assessment/) - 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 Uncategorized
- [#83: Training the Tough To Treat Shoulder](https://toughtotreat.com/83-training-the-tough-to-treat-shoulder/) - 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 Uncategorized
- [#82: Pelvic Pain - Things Are Not Always As They Seem!](https://toughtotreat.com/82-pelvic-pain-things-are-not-always-as-they-seem/) - 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 Uncategorized
- [#81: Elite Soccer Player with Low Back Pain](https://toughtotreat.com/81-elite-soccer-player-with-low-back-pain/) - 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 Uncategorized
- [#80: Full Squat vs. Partial Squat?](https://toughtotreat.com/80-full-squat-vs-partial-squat/) - 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. Uncategorized
- [#79: Medial Elbow Pain and Tingling/Numbness](https://toughtotreat.com/79-medial-elbow-pain-and-tingling-numbness/) - 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. Uncategorized
- [#78: Demystifying Tennis Elbow](https://toughtotreat.com/78-demystifying-tennis-elbow/) - 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 Uncategorized
- [#77: Runners With Recurrent Knee Pain-Finding The Driver](https://toughtotreat.com/77-runners-with-recurrent-knee-pain-finding-the-driver/) - 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 Uncategorized
- [#76: Exercise progressions for the tough to treat foot](https://toughtotreat.com/76-exercise-progressions-for-the-tough-to-treat-foot/) - 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 Uncategorized
- [#74: Does scapula stabilization always work?](https://toughtotreat.com/74-does-scapula-stabilization-always-work/) - 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 Uncategorized
- [#75: Are patients really good historians?](https://toughtotreat.com/75-are-patients-really-good-historians/) - 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 Uncategorized
- [#73: Post-partum back and abdominal pain - what is the priority?](https://toughtotreat.com/73-post-partum-back-and-abdominal-pain-what-is-the-priority/) - 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 Uncategorized
- [#72: Herniated disc? Or Fear of sitting?](https://toughtotreat.com/72-herniated-disc-or-fear-of-sitting/) - 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 Uncategorized
- [#71: Pelvic girdle pain and the BPS approach](https://toughtotreat.com/71-pelvic-girdle-pain-and-the-bps-approach/) - 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. Uncategorized
- [#70: I Hurt Everywhere](https://toughtotreat.com/70-i-hurt-everywhere/) - 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 Uncategorized
- [#69: Chronic Achilles Insertional Tendonosis](https://toughtotreat.com/69-chronic-achilles-insertional-tendonosis/) - 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. Uncategorized
- [#68: Higher Load Exercise Progressions and Secondary Drivers](https://toughtotreat.com/68-higher-load-exercise-progressions-and-secondary-drivers/) - 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 Uncategorized
- [#67: Foot numbness - differentials and interventions](https://toughtotreat.com/67-foot-numbness-differentials-and-interventions/) - 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 Uncategorized
- [#66: 5 years Post-Partum with Persistent Low Back Pain](https://toughtotreat.com/5-years-post-partum-with-persistent-low-back-pain/) - 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. Uncategorized
- [#65: Heel pain - is it always a MSK issue?](https://toughtotreat.com/65-heel-pain-is-it-always-a-msk-issue/) - 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. Uncategorized
- [#64: Butt pain-where's it coming from? The low back? Hip? Pelvis?](https://toughtotreat.com/butt-pain-wheres-it-coming-from-the-low-back-hip-pelvis/) - 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 Uncategorized
- [#63: Hip arthritis! Update from #37](https://toughtotreat.com/63-hip-arthritis-update-from-37/) - 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 Uncategorized
- [#62: Persistent shin pain & a lateral shift](https://toughtotreat.com/62-persistent-shin-pain-a-lateral-shift-implications-for-gait/) - 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 Uncategorized
- [#58: Questionable foot pain](https://toughtotreat.com/58-questionable-foot-pain/) - 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 Uncategorized
- [#61: Back pain, stiffness and the search for the cause!](https://toughtotreat.com/61-back-pain-stiffness-and-the-search-for-the-cause/) - 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 Uncategorized
- [#60: Changing Symptoms](https://toughtotreat.com/changing-symptoms/) - 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 Uncategorized
- [#59 Stress Urinary Incontinence](https://toughtotreat.com/59-stress-urinary-incontinence/) - 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. Uncategorized

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## Categories

- [Uncategorized](https://toughtotreat.com/category/uncategorized/)
- [LOW BACK PAIN](https://toughtotreat.com/category/low-back-pain/)
- [Taping](https://toughtotreat.com/category/taping/)
- [Shoulder Pain](https://toughtotreat.com/category/shoulder-pain/)
- [Gut](https://toughtotreat.com/category/gut/)
- [Knee Pain](https://toughtotreat.com/category/knee-pain/)
- [Hip Pain](https://toughtotreat.com/category/hip-pain/)
- [Assessment](https://toughtotreat.com/category/assessment/)
- [Headache](https://toughtotreat.com/category/headache/)
- [PELVIC GIRDLE PAIN](https://toughtotreat.com/category/pelvic-girdle-pain/)
- [EXERCISE](https://toughtotreat.com/category/exercise/)
- [Exercise Progression](https://toughtotreat.com/category/exercise-progression/)
- [CALF PAIN](https://toughtotreat.com/category/calf-pain/)
- [FOOT PAIN](https://toughtotreat.com/category/foot-pain/)
- [Breath](https://toughtotreat.com/category/breath/)
- [Hormones](https://toughtotreat.com/category/hormones/)
- [Cervical Spine](https://toughtotreat.com/category/cervical-spine/)
- [POSTPARTUM](https://toughtotreat.com/category/postpartum/)
- [MENTAL FITNESS](https://toughtotreat.com/category/mental-fitness/)

## Tags

- [PHYSICAL THERAPY](https://toughtotreat.com/tag/physical-therapy/)
- [DRIVERS](https://toughtotreat.com/tag/drivers/)
- [PT](https://toughtotreat.com/tag/pt/)
- [PHYSICAL THERAPIST](https://toughtotreat.com/tag/physical-therapist/)
- [CLINICIAN](https://toughtotreat.com/tag/clinician/)
- [BACK PAIN](https://toughtotreat.com/tag/back-pain/)
- [LOW BACK PAIN](https://toughtotreat.com/tag/low-back-pain/)
- [MOVEMENT SYSTEM](https://toughtotreat.com/tag/movement-system/)
- [athletic taping](https://toughtotreat.com/tag/athletic-taping/)
- [lowbackpain](https://toughtotreat.com/tag/lowbackpain/)
- [kneepain](https://toughtotreat.com/tag/kneepain/)
- [physiotherapy](https://toughtotreat.com/tag/physiotherapy/)
- [shoulder pain](https://toughtotreat.com/tag/shoulder-pain/)
- [arm pain](https://toughtotreat.com/tag/arm-pain/)
- [cervicalspine](https://toughtotreat.com/tag/cervicalspine/)
- [neck pain](https://toughtotreat.com/tag/neck-pain/)
- [exercise prescription](https://toughtotreat.com/tag/exercise-prescription/)
- [holisticapproach](https://toughtotreat.com/tag/holisticapproach/)
- [movementismedicine](https://toughtotreat.com/tag/movementismedicine/)
- [gut](https://toughtotreat.com/tag/gut/)
- [gut brain](https://toughtotreat.com/tag/gut-brain/)
- [stress](https://toughtotreat.com/tag/stress/)
- [response to stress](https://toughtotreat.com/tag/response-to-stress/)
- [pain](https://toughtotreat.com/tag/pain/)
- [inflammation](https://toughtotreat.com/tag/inflammation/)
- [holistic approach](https://toughtotreat.com/tag/holistic-approach/)
- [sensory input](https://toughtotreat.com/tag/sensory-input/)
- [mmovement](https://toughtotreat.com/tag/mmovement/)
- [knee pain](https://toughtotreat.com/tag/knee-pain/)
- [kneeosteoarthritis](https://toughtotreat.com/tag/kneeosteoarthritis/)
- [SPORTSPERFORMANCE](https://toughtotreat.com/tag/sportsperformance/)
- [WHOLEPERSON](https://toughtotreat.com/tag/wholeperson/)
- [EXERCISELOAD](https://toughtotreat.com/tag/exerciseload/)
- [CLINICALREASONONING](https://toughtotreat.com/tag/clinicalreasononing/)
- [EXERCISETRAINING](https://toughtotreat.com/tag/exercisetraining/)
- [PATELLAFEMORALPAIN](https://toughtotreat.com/tag/patellafemoralpain/)
- [clinicalreasoning](https://toughtotreat.com/tag/clinicalreasoning/)
- [shoulder injury](https://toughtotreat.com/tag/shoulder-injury/)
- [HIP PAIN](https://toughtotreat.com/tag/hip-pain/)
- [CLINICAL REASONING](https://toughtotreat.com/tag/clinical-reasoning/)
- [HYPERMOBILITY](https://toughtotreat.com/tag/hypermobility/)
- [functional movement](https://toughtotreat.com/tag/functional-movement/)
- [pt assessment](https://toughtotreat.com/tag/pt-assessment/)
- [SPORTS THERAPY](https://toughtotreat.com/tag/sports-therapy/)
- [SPORTS MEDICINE](https://toughtotreat.com/tag/sports-medicine/)
- [Headache](https://toughtotreat.com/tag/headache/)
- [exercise progression](https://toughtotreat.com/tag/exercise-progression/)
- [clinical reaasoning](https://toughtotreat.com/tag/clinical-reaasoning/)
- [clinical assessment](https://toughtotreat.com/tag/clinical-assessment/)
- [PELVIC GIRDLE PAIN](https://toughtotreat.com/tag/pelvic-girdle-pain/)
- [PGP](https://toughtotreat.com/tag/pgp/)
- [EXERCISE](https://toughtotreat.com/tag/exercise/)
- [calf pain](https://toughtotreat.com/tag/calf-pain/)
- [leg pain](https://toughtotreat.com/tag/leg-pain/)
- [fencing](https://toughtotreat.com/tag/fencing/)
- [FOOT PAIN](https://toughtotreat.com/tag/foot-pain/)
- [chest movemment](https://toughtotreat.com/tag/chest-movemment/)
- [chest movement](https://toughtotreat.com/tag/chest-movement/)
- [breath](https://toughtotreat.com/tag/breath/)
- [breathing patterns](https://toughtotreat.com/tag/breathing-patterns/)
- [hormones](https://toughtotreat.com/tag/hormones/)
- [hormone balance](https://toughtotreat.com/tag/hormone-balance/)
- [estrogen](https://toughtotreat.com/tag/estrogen/)
- [msk heealth](https://toughtotreat.com/tag/msk-heealth/)
- [tought to treat](https://toughtotreat.com/tag/tought-to-treat/)
- [stiffness](https://toughtotreat.com/tag/stiffness/)
- [PELVIC PAIN](https://toughtotreat.com/tag/pelvic-pain/)
- [PREGNANCY](https://toughtotreat.com/tag/pregnancy/)
- [PREGNANCY PAIN](https://toughtotreat.com/tag/pregnancy-pain/)
- [PERFORMANCE](https://toughtotreat.com/tag/performance/)
- [TOUGH TO TREAT](https://toughtotreat.com/tag/tough-to-treat/)
- [PHYSIO THERAPY](https://toughtotreat.com/tag/physio-therapy/)
- [PELVIC GIRDLE](https://toughtotreat.com/tag/pelvic-girdle/)
- [HRV](https://toughtotreat.com/tag/hrv/)
- [SLEEP](https://toughtotreat.com/tag/sleep/)
- [POSTPARTUM](https://toughtotreat.com/tag/postpartum/)
- [BLOATING](https://toughtotreat.com/tag/bloating/)
- [UI](https://toughtotreat.com/tag/ui/)
- [ABDOMINAL](https://toughtotreat.com/tag/abdominal/)
- [ABDOMIN](https://toughtotreat.com/tag/abdomin/)
- [TREATMENT](https://toughtotreat.com/tag/treatment/)
- [COMPLEX PATIENT](https://toughtotreat.com/tag/complex-patient/)
- [MEDICAL RED FLAG](https://toughtotreat.com/tag/medical-red-flag/)
- [EXERCISE ADHERENCE](https://toughtotreat.com/tag/exercise-adherence/)
- [TEAM EFFOT](https://toughtotreat.com/tag/team-effot/)
- [TEAM EFFORT](https://toughtotreat.com/tag/team-effort/)
- [PAIN RELEIF](https://toughtotreat.com/tag/pain-releif/)
- [RED FLAGS](https://toughtotreat.com/tag/red-flags/)
- [WHOLE BODY WHOLE PERSON](https://toughtotreat.com/tag/whole-body-whole-person/)
- [center of mass](https://toughtotreat.com/tag/center-of-mass/)
- [sports performance](https://toughtotreat.com/tag/sports-performance/)
- [physio therapist](https://toughtotreat.com/tag/physio-therapist/)
- [RUNNING](https://toughtotreat.com/tag/running/)
- [RUNNER](https://toughtotreat.com/tag/runner/)
- [ACL INJURY](https://toughtotreat.com/tag/acl-injury/)
- [STRENGTH HOLES](https://toughtotreat.com/tag/strength-holes/)
- [MUSCLE OVERACTIVITY](https://toughtotreat.com/tag/muscle-overactivity/)
- [FEAR OF MOVEMENT](https://toughtotreat.com/tag/fear-of-movement/)
- [GI PAIN](https://toughtotreat.com/tag/gi-pain/)
- [PELVIC FLOOR](https://toughtotreat.com/tag/pelvic-floor/)
- [TOUGH TO TREAT PODCAST](https://toughtotreat.com/tag/tough-to-treat-podcast/)
- [NEW EPISODE ALERT](https://toughtotreat.com/tag/new-episode-alert/)
- [NEW EPISODE](https://toughtotreat.com/tag/new-episode/)
- [CLINICAL PEARLS](https://toughtotreat.com/tag/clinical-pearls/)
- [MMA](https://toughtotreat.com/tag/mma/)
- [ELBOW PAIN](https://toughtotreat.com/tag/elbow-pain/)
- [BOXING](https://toughtotreat.com/tag/boxing/)
- [BOXER](https://toughtotreat.com/tag/boxer/)
- [EVIDENCE BASED MEDICINE](https://toughtotreat.com/tag/evidence-based-medicine/)
- [HOLISTIC THERAPY](https://toughtotreat.com/tag/holistic-therapy/)
- [EVIDENCE BASED HEALTH](https://toughtotreat.com/tag/evidence-based-health/)
- [FUNCTIONAL MEDICINE](https://toughtotreat.com/tag/functional-medicine/)
- [SIGNS AND SYMPTOMS](https://toughtotreat.com/tag/signs-and-symptoms/)
- [PELVIC FLOOR THERAPY](https://toughtotreat.com/tag/pelvic-floor-therapy/)
- [PODCAST EPISODE](https://toughtotreat.com/tag/podcast-episode/)
- [LISTENING IS KEY](https://toughtotreat.com/tag/listening-is-key/)
- [NEURAL TENSION](https://toughtotreat.com/tag/neural-tension/)
- [RED GLAFS](https://toughtotreat.com/tag/red-glafs/)
- [SYSTEMS APPROACH](https://toughtotreat.com/tag/systems-approach/)