Tough to Treat Susan Clinton and Erica Meloe

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 incontinence. In turn, she regains control over her pelvic pain!
 
A glance at this episode:
[0:01] Postpartum pelvic pain and urinary incontinence in a 34-year-old woman
[2:07] Pregnancy, autoimmune disorders, and migraines
[5:36] Postpartum health, nutrition, and urinary incontinence
[11:18] Postpartum care and pain management
[14:40] Back pain and mobility issues
[17:56] Postpartum pelvic floor dysfunction and urgency issues
[24:09] Managing urinary incontinence through diet and exercise changes
[27:42] Urgency and pain during sex, pelvic exam, and internal rotation
[30:22] Pelvic pain and cranial flexion
[36:17] Evaluating and treating a patient's urgent symptoms through neural tension and movement
[38:54] Breathing techniques for managing urinary urgency and stress
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 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 what you feel?
Are you assessing the knee in a movement that is relevant to the patient?
If someone's right knee is sore when they are walking with that leg behind, then assessing the knee in dorsiflexion and knee flexion is not efficient or effective here.
Train your vision to see what optimal movement looks like. And then put your hands on the femoral condyles and the joint lines to train your own brain to feel what is optimal. That's how you increase your clinical expertise.
Erica also discusses a movement you can evaluate if the patient has a hard time squatting or lunging. Finally, do not discount the patient's prior history. An old untreated hamstring tear from years ago could absolutely be relevant to someone's increased knee pain. Makes sense, right? But we often forget that - do not ignore prior history and its importance to current symptoms. 
A glance at this episode:
[4:03] Knee pain and its compensatory patterning
[8:14] Using vision and palpation to assess knee joint movement and patterning for optimal assessment and treatment
[12:09] Assessing the knee through a body twist
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript
 

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 patient's impairments is a good start. 
We discuss common strength holes along with typical overactivity patterns in these patients. Susan and Erica also discuss a patient who is a high-level athlete with a fear-based movement that is a big hole in her program.
A glance at this episode:
[4:00] Exercise program for patients with knee and foot issues, focusing on strengthening key muscles
[7:30] Lunges and split squats for a runner with a thoracic driver
[13:56] Proper lunge technique and addressing knee pain through strengthening exercises
[20:24] Improving lunges with a stick and target practice
[23:43] Lunges and squats for runners with a focus on proper form and progression
[29:30] Exercise safety and program development for patients with knee pain
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript

What is the difference between food allergies and food sensitivities? 
Join Susan as she discusses the importance of following the science and taking the guess work 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
[9:18] Gluten sensitivity and its impact on IBS symptoms
[13:14] Gut microbiome's role in digestion, immunity, and weight gain
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript

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 a rich discussion of the path forward. 
Here is a Hint: center of mass and chronic loading play a strong part in this story!
 
A glance at this episode:
[2:21] Back and glute pain, stretches, and fatigue
[7:37] Back pain and re-curring mobility issues
[12:16] Chronic pain and it's relationship to mobility
[17:02] Proper standing and walking techniques for comfort and mobility
[22:00] Standing balance and stretching exercises for improved mobility
[26:51] Chronic back pain and neuroinflammation
[31:26] Back pain treatment options and the importance of proper imaging
[36:01] Proper treatment approaches for a patient with persistent 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
 

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 the knee. SLR's and quad sets won't work here. 
 
She also explores the significance of personalized exercise prescriptions in optimizing recovery outcomes. There are many clinical pearls in this episode, one of which is, "Why would a side-to-side deep squat be harder for the foot than the thorax?" Both are lateral movement patterns. 
 
She also discusses the clinical reasoning behind a well-thought-out exercise plan. Remember: we are trying to give our patients options for movement and variability across many activities. Building volume of exercise at low levels is key to this outcome as is challenging the driver across many planes.
 
A glance at this episode:
[3:38] Prescribing specific exercises based on the patient's main driver, not the symptom
[8:02] Identifying the level of difficulty for a specific exercise using regional analysis
[14:02] How to dose exercise based on what is meaningful for the patient
[17:58] Exercises for improving lower body control and center of mass
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript