DO YOU Want to learn how to treat complex patients?

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#50: Finding the real story

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Do you sometimes want a better way to know where to start with some complex clients? 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 true key to finding out what is important to them and sometimes, the simplest solution is revealed through their story along with the physical exam. 

#51: Is it really the root nerve?

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      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 of this gentleman's problem. Once again, listening to his story will give you clues as to how to begin the objective exam.

#52: A shoulder or neck problem?

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

#53: Is an overactive TFL a poor movement strategy?

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

#54: Leaking and Running - a solution

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  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 the program and then after 2 minutes into it, you leak. Does this sound familiar to you or your patients? In this episode, we bring in the patient who has these symptoms. This is a rare glimpse into "real-time" clinical reasoning. We highlight some unique treatment ideas as well as provide the patient with a strategy she can tap into when she does leak.

#55: Back pain or leg pain - why is it getting worse?

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 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 is slowly turning this person with confronter behavior into an avoider. Sometimes the small changes can have a huge impact.

#44: Dancer with Pelvic Pain-Is it Really the Pelvis?

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

#45: Female with bilateral hip pain? Is it really a hip joint problem?

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    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 in addressing her issue and progressing her program.

#46: Leg pain and peripheral nerves

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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?  

#47: Fear avoidance with low back & pelvic pain

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

#48: Complicated thigh numbness-is it really the nerve?

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

#49: Game Changing Exercise Progressions

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Do you want better outcomes with your patients? What do you do when a patient has plateaued? Or they're not improving as fast as they should be? One of the answers could be your exercise progression. Are you truly treating the source of the patient's problem with a specific movement program geared towards the SOURCE and NOT the symptom? What is the key to an effective exercise progression? In this episode, Erica discusses what has been a real game changer in her practice. 

#38: Elbow pain

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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.

#39: Tightness in a professional dancer

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   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 we evaluated and addressed her symptoms.   Sometimes less is more....

#40: Is spinal stenosis a mystery?

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 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 this gentleman's compromised movement pattern. And it's not just the physical, this person has a significant fear based component to his problem, which can potentially prolong healing. 

#41: Not your ordinary hip problem

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  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 and emotional barriers to recovery? The main issue here is hip pain. This is not your ordinary hip issue. Subjective includes, "ripping", "burning" and "a dead leg". Does the pelvis play a role? The foot? An old clavicle fracture? Listen and find out!!

#42: Complex issues with pain & fear avoidance

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In this episode we have guest PT, Alaina Newell, who presents us with one of her tough male patients with a primary complaint of abdominal issues. Sometimes what our patients present with is only the tip of the iceberg. We clinically reason through the evaluation but move very quickly into diagnosis and movement. It is interesting how the story of this complex case unfolds over time. We brainstorm some great treatment ideas and various ways to change this gentlemen's fear avoidance. This is a fascinating story that can teach us all a lesson that healing is very individual.

#43: Neurogenic pain & complex metabolic issues

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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.

#32: Posterior Thigh Pain

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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 answer.  

#33: Shoulder pain

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  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.


#34: Hypermobility & low back pain

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Shoulder pain - what does that really mean?  Sometimes the key to helping solve a patient's persistent shoulder issue is looking at all of the underlying inputs to the regional pain syndrome.  The key here is the word "all".  People expect a thorough, full body evaluation taking into account all potential sources to their problem.

#35: Post-partum pelvic pain

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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 her urinary incontinence.  In turn she regains control over her pelvic pain! 

#36: Shoulder pain|motor control problem?

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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 lift was the key to his recovery. 

#37: Hip & back injury at sea

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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. 

#31: Lumbar radicular pain

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 Low back pain with radiculopathy is a tough condition at the best of times.  But when it is persistent, it requires a real think out of the box approach. 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. 

#30: Low back & pelvic pain

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 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 of his strategies throughout all movement tasks were integral to his recovery.

 

#29: Is it a shoulder problem?

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Shoulder pain - what does that really mean?  Sometimes the key to helping solve a patient's persistent shoulder issue is looking at all of the underlying inputs to the regional pain syndrome.  The key here is the word "all".  People expect a thorough, full body evaluation taking into account all potential sources to their problem.

#28: Are you their last resort?

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 Now, this is a CHALLENGING one!  Do you 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 this was FAR from standard.  (Hint: her low back was not the source of her problem.)

#27: Young ballet dancer & foot pain

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 Ballet dancers and foot pain-they come together, don't they?  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.

It is all about the strategy at the end of the day and finding out where the buckle point is.

 

#26: Exercise progression & back pain

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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. In this podcast Susan and I discuss the keys to progressing a patient towards more optimal movement patterns.  The answers lie in the specificity of an exercise progression.  

more episodes of tough to treat podcasts

#25: Chronic low back tightness

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 How many times do you hear this complaint?  "My back is so tight that I feel like I need to stretch it all the time!"  Is that true? Maybe, maybe not.  In our clinical experience, the low back can often be the victim of a poor movement strategy and excessive gripping of some of the lumbar spine musculature.
 

#19: Walker with heel pain

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 Is heel pain really heel pain? What if the pain was an expression of symptoms from a different mechanism? I personally have suffered this on more than one occasion. And you want it gone yesterday!  This sometimes can be complex, especially if it is recurrent and persistent.  It is all about strategy and how our nervous systems adapt, until we run out of options. 

#16: Shoulder pain

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 How does a former NFL player find out that his right shoulder injury stems from an old injury on his left side?  He finds out when he can't do a bench press or a push up. Remember how old injuries come back to haunt? In this podcast, Susan and I discuss a patient of mine who had a painful hypermobile right AC joint stemming from a poor motor pattern he had developed after having left shoulder surgery years prior.  

#15: Hip and back pain

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 We all at some point have treated a dancer or two, even long after they have stopped dancing!  Susan and I discuss a mature dancer that Susan assessed who was suffering from low back and hip pain. The evaluation of her was quite unique and really honed in on the strategy she was using while she danced.  We focus on pattern dominance and the power of making a change that quickly during the first visit. 

#13: Lifting & female incontinence

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 Do you have patients who experience some level of incontinence? Susan and I discuss some strategies to help this population. Susan had several female patients who were experiencing leaking while they deadlifted.    We discuss the strategies they employed while lifting as well as clinically reasoning with the patient in order to change their movement pattern and effectively get better performance.   

#14: Neck and arm pain

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Do you have patients who experience persistent arm pain?  Susan and I discuss a college level athlete I treated who was suffering from persistent pain in her arm as well as her neck. She was treated elsewhere for a "Cervical Radiculopathy", but did not get the results she needed to return to softball. Ultimately, it was not a radiculopathy.  The driver for her problem lay in her upper thorax and scapula; and stemmed from a poor strategy she was using for throwing and fielding ground balls.