Tough to Treat

Susan Clinton and Erica Meloe
  • 5.0 (119)
  • MEDICINE
  • UPDATED WEEKLY

Welcome to Tough to Treat: A Physiotherapists' Guide to Managing Those Complex Patients, with your hosts Erica Meloe and Susan Clinton, who discuss how they successfully treated patients that others could not. Via case history discussion, they share their physical therapy expertise from treating long standing pelvic pain to persistent neck pain. They present a holistic and integrative view on assessing and treating chronic pain. Unique movement strategies and specific patient exercise prescription are also presented so you can be ahead of the curve when it comes to treating these types of patients. Oftentimes, the source of the problem is not where you think it is!! For example, chronic low back pain emanating from the neck. Or hip pain coming from the foot. It pays to look up and down the kinetic chain! Podcast music: "Fearless First" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/

  1. FEB 10

    When Exercise Isn't Working

    If you have patients or are a person who "does all the exercises," gets stronger, and still doesn't feel better—this episode is for you. In this episode, Erica dives into how to advance exercise prescription for patients who are often labeled as "tough to treat." These are the individuals who don't respond well to traditional strengthening or mobility programs and may experience pain, guarding, or flare-ups with exercise. She explores how exercise positioning, load selection, and movement strategy can dramatically change outcomes. Rather than defaulting to more reps or heavier weights, she discusses how altering body position and the relationship to gravity can allow patients to move with less threat, better control, and more efficiency. One aspect of this episode is working with people who chronically grip or brace their low back muscles. She talks through practical strategies to reduce excessive tone and reintroduce movement without reinforcing protective patterns that limit progress. Erica also discusses the role of advanced exercise positions and Pilates-based approaches, highlighting how these methods can be used thoughtfully to improve load tolerance—especially for patients who need more than basic exercises but aren't ready for high-demand training. This episode challenges the idea that "tough to treat" patients need more effort or tougher exercises, and instead reframes progress around smarter positioning, intentional loading, and movement quality to help people move with confidence again.   Related links: Erica's Website Susan's Website

    27 min

  2. 09/11/2025 · VIDEO

    Advanced Clinical Reasoning: Applications Across the PT Spectrum

    In this episode, Erica explores how clinical reasoning informs decision-making across diverse areas of physical therapy practice. This is a clinical pearls discussion that will save you lots of time in the clinic.  From CKC to OKC brain mapping in an MMA fighter to exercise progression in ACL rehabilitation to thoracic dysfunction in a post partum runner experiencing hip pain and incontinence, she highlights key clinical reasoning strategies that guide effective treatment and exercise progression. For example, if your patient has a bracing strategy in their lumbar spine where they always "grip" their back when they sit, stand and even go supine, how would you prescribe exercise to "take out" that strategy to give them more options for movement? Many people do this in our "sit up straight" culture. This will make a huge difference in your practice!   Related links: Tough To Treat Website Erica's Website Susan's Website

    29 min

  3. 08/13/2025

    Treatment Timelines and Tackling HEP Non-Compliance: Real Patient Cases

    How long should you keep treating a patient? And what's the best approach when they're skipping their home exercise program? In this listener Q&A episode, Erica shares practical strategies—illustrated through two real patient cases, one a golfer and the other a cyclist—for answering the tough question of treatment length and for addressing non-compliance. She highlights how building a strong therapeutic relationship can improve follow-through and make these conversations more productive. Erica also highlights the most important phases of an exercise program to ensure efficiency and compliance.  To close, Erica offers a brief update from her doctoral research on menopause, focusing on the role of muscle power in older women and why it may be a more critical predictor of function than strength alone.   Related links: Tough To Treat Website Erica's Website Susan's Website

    27 min

  4. 07/24/2025 · VIDEO

    Why is an old foot injury responsible for my current neck pain?

    In this episode, Erica dives into a fascinating case of a patient experiencing neck pain and how that seemingly isolated symptom actually traced back to an old foot injury. This case exemplifies the deep, interconnected nature of the human body. For those you have been listening for a while, this should not surprise you. She unpacks the biomechanical and neural links between the foot and cervical spine, exploring how altered load distribution and compensatory patterns can persist long after the original injury appears to have healed. A key focus of the discussion is the role of the center of mass—how shifts in its control can influence motor strategy and postural control, ultimately impacting regions far from the original site of injury. Erica also covers exercise options, including progressions that integrate both the foot and cervical spine.  How to adapt your treatment when load transfer is compromised is a key factor in this patient's outcome. This episode is a reminder that in rehab, it's rarely just about the joint that hurts—it's about the whole system that moves around it.   Related links: Tough To Treat Website Erica's Website Susan's Website

    29 min

  5. 07/03/2025

    Managing the Complex Patient – When the Body Chart Is Full

    In this episode, Erica talks about how to approach care when a patient has a long history of injuries and a body chart that seems to be "lit up" everywhere. It can feel overwhelming—for both the patient and the clinician. She focuses on the importance of prioritization: identifying what's most clinically relevant right now. This involves connecting the dots to perhaps an old injury to what the current problem is. In this particular case, frequent bilateral ankle sprains, an ACL reconstruction plus a continued pattern of bilateral issues help you nail down your focus to what is important for you to assess and what is important for the patient to feel.  These patterns not only shape your clinical focus—helping you decide what truly needs assessment—but also give the patient a clearer sense of what their body is trying to communicate.  What is relevant to you may not be important to them. It's up to you to explain to them why. Key takeaways include: ·       Avoiding the trap of chasing every symptom. ·       Establishing a hierarchy of concerns using patient input and objective findings. ·       Acknowledging the complexity of the history without letting it dictate the entire plan.   Related links: Tough To Treat Website Erica's Website Susan's Website

    18 min

  6. 06/19/2025

    Bone and Power: Training Smarter Through Menopause

    This episode dives into some of the evidence on resistance vs. high-velocity power training in postmenopausal women and its impact on bone mineral density (BMD). Research is highlighted showing that high-speed training protocols may stimulate bone more effectively than traditional resistance training by increasing strain rates and promoting osteogenic adaptation. You'll learn how moving with speed and control helps strengthen bones and prevents age-related decline better than slow, heavy lifting alone. Some of Erica's research for her doctoral dissertation is discussed and she then presents a case study of a menopausal patient with insidious-onset shoulder pain and offers some clinical pearls as to why, especially in anyone who has played a racquet sport, the shoulder is not the only driver. She also highlights a few targeted interventions that allowed this woman to weight lift and strengthen her shoulder without feeding into her symptoms.   The content contained therein, including text, images, audio, or other formats, were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.    Related links: Tough To Treat Website Erica's Website Susan's Website

    34 min

  7. 06/03/2025

    Physical Performance Decline in Menopausal Women: Strength vs Power

    In this episode, Erica dives into the latest research exploring how menopause affects physical performance in women—highlighting changes in power and strength. These findings are reshaping how we approach exercise and rehab in midlife women. Next, she shares an update on her dissertation, which compares premenopausal and postmenopausal women on key physical performance metrics. Erica discusses early patterns emerging from the data, including potential implications for exercise training and rehab prescription. She wraps up with a clinical case involving a woman in menopause experiencing persistent neck and shoulder pain, along with difficulty breathing. She breaks down the history along with a few clinical pearls outlining how past injuries have and continue to contribute to this woman's issues. Erica also breaks down her exercise program, discussing the do's and don'ts of exercise progression.   Hormonal changes can contribute to musculoskeletal tension and diaphragmatic dysfunction- we know this. But do we really educate our patients on this? Many do not. Whether you're a clinician, researcher, or someone navigating midlife changes, this episode offers insight, evidence, and strategies for supporting well-being during menopause.   Related links: Tough To Treat Website Erica' Website Susan's Website

    35 min

  8. 11/28/2024

    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 of your first session taking the patient's story.   Your patients will make you a better physical therapist, if you listen to them. Be curious and let it lead you towards mastery.   A glance at this episode: [2:27] Courses and Continuous Learning [12:11] Starting the Podcast and Building a Community [13:17] Mentorship and Clinical Reasoning [19:10] Treatment Sessions and Client Engagement [22:56] The Role of Patients in Clinical Learning [26:41] Reflecting on the Year and Planning for the Future   Related links: Tough To Treat Website Erica's Course: Decoding the Complex Patient Susan's Pelvic Health Education Subscription Access the Transcript

    28 min
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About

Welcome to Tough to Treat: A Physiotherapists' Guide to Managing Those Complex Patients, with your hosts Erica Meloe and Susan Clinton, who discuss how they successfully treated patients that others could not. Via case history discussion, they share their physical therapy expertise from treating long standing pelvic pain to persistent neck pain. They present a holistic and integrative view on assessing and treating chronic pain. Unique movement strategies and specific patient exercise prescription are also presented so you can be ahead of the curve when it comes to treating these types of patients. Oftentimes, the source of the problem is not where you think it is!! For example, chronic low back pain emanating from the neck. Or hip pain coming from the foot. It pays to look up and down the kinetic chain! Podcast music: "Fearless First" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/

Information

  • Creator
    Susan Clinton and Erica Meloe
  • Years Active
    2017 - 2026
  • Episodes
    198
  • Rating
    Clean
  • Show Website
    Tough to Treat

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