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
Reframing The Narrative For A More Effective Assessment
Can you find clues in your patient's narrative that will help you find the driver quicker? Make your assessment more efficient and save you time? Think about someone's movement and injury history and how that can be relevant to their current symptoms. Their initial injuries will SET THEM UP for compensatory movement patterning down the road. There are 2 case examples in this episode that highlight the importance of how the movement and injury histories revealed the driver(s).
Choosing The Best Functional Movement For Your Assessment
Success=picking the best functional movement to assess with your patient. Can you imagine shaving minutes off of your initial evaluation time? And at the same time, connecting with your patient in a way that not only increases the therapeutic alliance but will help you find the driver quicker.
Check out some NEW clinical pearls and sleep tips for patients at www.toughtotreat.com
Junior Golfer with an Unusual Source to his Knee Pain
This is a rebroadcast of a popular earlier episode. Assessing center of mass (COM) here is crucial. Think about golf- you don't need a wide stance. Most of your patients will look different depending on how wide or narrow their stance is. Don't miss it. We also discuss the concept of picking a "meaningful" movement to assess with your patient. This alone will help you hone in on the driver quicker. Did you know that right knee pain can be caused by an imbalance in your center of mass? Erica and Susan discuss in this podcast how treating the left hip as well as the left side of the low back, got rid of this young golfer’s knee pain. A functional and interactive evaluation really hones in on where the true source of his knee pain lies.
Myth Busting - Rethinking Pregnancy Related Pelvic Girdle Pain
There is usually a ten year lag from published research to accepted practice in clinical arenas. Pelvic girdle pain in Pregnancy is no exception. Join us as we discuss the most important systemic and movement system presentations that can greatly impact this population. In this episode, we cover unhelpful language, true risk factors and functional problem solving for these clients. We also discuss what is really happening in the biopsychosocial approach - and especially why self-efficacy is so important.
Smart Exercise Progression
What constitutes an effective and efficient exercise progression? How do you smartly move someone through a movement program targetting their driver? Do not get hung up on someone's symptomatic region if that's not what is driving their symptoms. In this episode 2 cases are presented where their drivers were distal to their symptomatic areas. Categories of movement, neutral to non neutral, as well as unloaded to loaded are discussed with specific exercise progression. Remember: you are building new brain maps here. Variance and clinically reasoning through a smart movement progression will get your patient far.
CV joints and bladder urgency - is there a connection?
Clients report urgency/frequency and are most often treated with medication and pelvic floor PT. When only a regional approach to the pelvic floor over-recruitment is considered, many of the underlying drivers can be missed. Consider the client on this podcast and join us as we explore how multiple drivers can influence the hypersensitivity of the bladder. Taking into consideration the possibility of a knee driver and a visceral driver (constipation) can only explain one part of the system change. What about other possibilities that can be discovered and explored in the movement exam. (Hint: Lifestyle/work pattern dominance and consequences).
Loving the podcast! Came across a great note on sitting postue that allowed me to make a small tweak that helped tremendously, can't wait to listen to more!
Binge worthy clinical reasoning
I love this podcast! I have used insight from Susan and Erica’s cases to help assess and solve puzzles with my own patients. I’ve listened to almost all of the episodes. It’s helping me develop my skills and appreciate being a PT more and more.
This podcast is amazing! I have learned so much and am able to take clinical pearls and tools to use immediately in my practice. Thank you!