Tough to Treat Susan Clinton and Erica Meloe

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 this was FAR from standard. Hint: her low back was not the source of her problem. Why do you think that is? Remember, we bring all of our compensations to our life events. And our movement and injury history sets us up and our dominant patterning keeps us there.
 
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A glance at this episode:
[0:01] Complex medical history and treatment options
[7:06] Chronic pain and potential causes
[12:14] Pelvic issues and postural compensations
[18:41] Pelvic and foot issues, possible nervous system impairment
[23:21] Decompression techniques for a patient with nervous system issues
[26:31] Yoga and physical therapy for a patient with neck pain
[29:13] Treating a patient with chronic pain using movement patterns and cranial work
[35:07] Standing and carrying issues, loading exercises suggested
[40:07] Exercises for back pain relief, including cycling, Nordic walking, and rock climbing
[42:28] Using yoga and rock climbing to improve standing tolerance for a client with chronic pain
[47:30] Treating patient with chronic pelvic pain
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript
 

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 somatic pain presentation. Once again, the history is so important!
 
A glance at this episode:
[0:01] Left lower quadrant pain, nociceptive input from visceral driver
[2:23] Pelvic pain and potential visceral driver
[8:05] Bladder issues and pelvic floor tension
[10:49] Bladder irritants and pelvic health with a patient
[16:49] Lower back pain and posture with a physical therapist
[20:04] Pelvic floor exercises and visceral manipulation for pelvic pain relief
[24:34] Pelvic floor exercises and core strength for bladder control
[26:45] Improving driving skills and addressing bladder issues
[32:49] Visceral mobilization and pelvic floor issues
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript
 

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 this position. And it stayed that way throughout the golf swing. This begs the question: Did you know that right knee pain can be caused by an imbalance in your center of mass? If you continuously load your painful side, that has some serious implications for loading. Erica and Susan discuss in this episode how treating the left hip as well as the left side of the low back, got rid of this young golfer’s knee pain. He needed options for movement to his left side. A functional and interactive evaluation really hones in on where the true source of his knee pain lies. Remember: for persistent, unsolved problems, correlate the patient's history with your objective assessment. Hint: this patient had a history of concussion. You think that would alter his BOS?
 
A glance at this episode:
[0:01] Chronic knee pain in a junior golfer, analyzing the cause and treatment options
[4:48] Golf injury treatment and diagnosis
[12:19] Golf swing mechanics and potential issues with a young golfer
[17:03] Assessing a 12-year-old golf player with knee pain using a thorough history and clinical reasoning
[23:49] Using visual aids and manual therapy to help a golfer improve his swing by shifting weight to the left leg
[31:33] Using mirror therapy for knee rehabilitation
[39:25] Rehabilitating knee injuries via changing the center of mass
[43:34] Rehabilitation program for golfers with variance in exercises to improve adaptability
[47:36] Physical therapy for a young golfer with a focus on listening and meeting clients where they are
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript
 

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 are challenged with these movements? Remember the "push" is a 4-point closed chain movement and the "pull" is not. 
What do fighters do on a routine basis to their wrists before a fight? Why is the "negative" on a pull-up more important than the push on a push-up? 
Listen in as Erica discusses how to make this type of assessment more efficient by really listening to the story, connecting the dots, and ultimately going back to basics to treat another region of the body that was a secondary driver to the "pull". If you want the visual, here is a link to our YouTube channel.
 
A glance at this episode:
[0:01] A patient's medical history and symptoms related to military service and boxing
[5:00] Assessing push-ups and shoulder mobility in different positions related to COM
[8:18] Identifying different movement patterns with the push and pull and how to clinically reason and find the true driver
[12:31] How a dysfunctional elbow can limit the pull up but not the push-up

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

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 interventions.
 
A glance at this episode:
[0:01] Chronic constipation interventions and assessment, including muscle tightness and behavioral factors
[3:27] Using balloon catheter for rectal biofeedback to treat constipation
[8:37] Constipation, abdominal distension, and neural tension, with exercises to improve GI function and reduce discomfort
[14:54] Stress, sleep, and nervous system regulation for chronic problems
[20:16] GI health, manometry for constipation in infants, and mindfulness techniques
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript
 

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 constipation and its impact on pelvic floor health
[4:24] Constipation and irritable bowel syndrome (IBS) causes, symptoms, and diagnosis
[12:18] Bloating and distension in chronic constipation, including causes and treatments
[17:07] Diaphragm function in chronic low back pain
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript