198 episodes

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/

Tough to Treat Susan Clinton and Erica Meloe

    • Health & Fitness
    • 5.0 • 117 Ratings

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/

    Nociplastic Pain and a Visceral Driver

    Nociplastic Pain and a Visceral Driver

    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
     

    • 38 min
    Junior Golfer With Persistent Unsolved Knee Pain

    Junior Golfer With Persistent Unsolved Knee Pain

    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
     

    • 52 min
    What's Stopping this Former Fighter from Doing Push-Ups and Pull-Ups?

    What's Stopping this Former Fighter from Doing Push-Ups and Pull-Ups?

    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
     

    • 18 min
    Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 2

    Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 2

    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
     

    • 25 min
    Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 1

    Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 1

    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
     

    • 24 min
    Postpartum Pelvic Pain and Urgency

    Postpartum Pelvic Pain and Urgency

    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
     

    • 52 min

Customer Reviews

5.0 out of 5
117 Ratings

117 Ratings

Amazing cases! ,

Love these two and their case discussions!

I am a pelvic PT with ortho roots and I just started my own pelvic practice. Since I found this podcast not all that long ago, I have been binging all the episodes in the car and while I walk my dogs.

I feel like this has really brought on all kinds of new thinking for me as well as guiding me towards the next type of con ed I take. I have new intake and subjective questions I never used before as well as now frequently taking my patients to “the wall” (lol) for weight shifting and squatting assessments.

I can’t be more impressed or grateful for this podcast!!

And to Susan- I recently had a flare-up of “plantar fasciitis” that was switching sides and was definitely neural tension! So I backed off of my over stretching yoga sessions and it has cleared up!

JaneyLSC ,

Always insightful, helpful information

I have found this podcast to be very helpful in learning more in-depth clinical reasoning.

BridgetKane ,

Thought provoking

The conversations between Erica and Susan are fabulous. They have some fabulous takeaways.

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