In this episode, Susan and Erica discuss how very old drivers can present in a novel situation as well as why new driver will appear if compensatory patterns are allowed to become dominant. Susan’s patient in this episode came to her with shoulder pain which quickly led to full on arm pain. Susan discusses how she used clinical reasoning and the patient’s history to find the driver. The driver here is not obvious and did require somme deep investigation.

Shoulder problems can be the focus of the problem with the area has faulty movement patterns associated with the pain. This is especially prominent in the acute pain. Follow Erica and Susan on this case with selective tissue testing to tease out the root level of nerve pain and shoulder movement dysfunction. See how this patient gained her mobility back in her shoulder and neck.

A glance at this episode:

• [2:14] Susan presents the case history of a patient who developed shoulder pain after pressure washing her house
• [4:21] Susan discusses her movement assessment of the shoulder and differential diagnosis- is this really a shoulder issue? 
• [8:04] Susan starts treatment by using interventions to calm the system down
• [8:51] Susan performs a cervical assessment
• [11:52] Susan discusses assessing nerve root compression at C2/3 and atlantoaxial and atlantooccipital joints
• [13:37] The driver is finally discovered
• [14:12] Erica talks about using evidence-based practice and clinical reasoning to determine what’s relevant and meaningful to a patient’s case
• [16:30] Techniques used to increase mobility in the cervical spine
• [17:17] How Susan incorporated taping to relieve nerve compression/traction
• [21:00] Susan discusses the role of tape in providing sensory input 
• [22:20] Susan’s instructions to reduce the acute nerve root pain
• [25:35] How Susan’s patient does in the next few days after initial treatment and acute phase exercises
• [28:53] Susan discusses the importance of  training the vestibular-occulo-cervical reflex in improving upper cervical issues
• [29:20] Susan goes in-depth with the exercise progression she used to help her patient
• [33:32] Susan and Erica discuss habitual movement patterns resulting in movement restrictions
• [35:44] Susan and Erica clinically reason on when to look up or down the chain for drivers.

Related Links:

• Tough To Treat Website
• Erica’s Course: Decoding the Complex Patient
• Susan’s Pelvic Health Education Subscription
• Access the Transcript