Tough to Treat Susan Clinton and Erica Meloe

In this episode Susan and Erica welcome a Tough To Treat listener, Megan Barclay.
Megan brings a case of a patient who continues to suffer neuralgia after a bout of shingles, along with persistent neck pain. 
Listen to the client's history, significant findings, and differentials as we navigate this client's journey and discuss relevant findings. 
There is also a rich discussion on possible interventions targeting many points of the trigeminal system and cranial region.
 
A glance at this episode:
[1:25] Neck pain and potential causes and drivers
[8:39] Post-shingles symptoms and treatment
[16:32] Patient’s neck and shoulder pain, possible causes and treatments
[24:38] Treating a patient with neck and head issues
[28:55] Pain perception and treatment for cervical and lumbar issues
[30:16] Improving balance and reducing trigeminal symptoms through exercises
[33:31] Treating neck and back issues with physical therapy and nutrition
[41:09] Treating a patient with shingles
[43:28] Shingles treatment and empowerment
[46:12] Exercise and posture for chronic pain management 
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript
Megan's Instagram Megan's Website  

Look beyond the traditional regional approach of the pelvic and pelvic floor and understand how discovering and addressing dysfunctions of the trigeminal and respiratory system including the voice and heart rate variability can have an impact on pelvic health. 
HRV is a well-researched indicator of the balance between the Sympathetic and the Parasympathetic nervous systems. 
The balance has a large impact on the performance of the GI system and can influence pain, motility, and inflammation. 
Working with Breath, Voice, and HRV can not only predict dysfunction but is an excellent metric to guide interventions in different domains.
This 2 part replay of a webinar is designed to expand your current practice through evidence-based and biologically plausible methods of examination and intervention into the thoracic, and cervical systems harnessing the breath and the voice can optimize respiratory mechanics and heart rate variability.
 
A glance at this episode:
[1:22] Why the vascular system is important
[2:55] What happens when we get into chronic stressors
[5:33] Nerves that fire together
[7:30] The trigeminal system and stress response
[10:35] The trigeminal system is the entire sensory system
[12:45] What is referred nociception central sensitization
[14:57] Cervical nerves and the brain
[17:31] Connections to the vagal system
[19:04] Breathing postures and sleep
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript
 

Look beyond the traditional regional approach of the pelvis and pelvic floor and understand how discovering and addressing dysfunctions of the trigeminal and respiratory system including the voice and heart rate variability can have an impact on pelvic health. 
HRV is a well-researched indicator of the balance between the Sympathetic and the Parasympathetic nervous systems. 
The balance has a large impact on the performance of the GI system and can influence pain, motility, and inflammation. 
Working with Breath, Voice, and HRV can not only predict dysfunction but is an excellent metric to guide interventions in different domains.
This 2 part replay of a webinar is designed to expand your current practice through evidence-based and biologically plausible methods of examination and intervention into the thoracic, and cervical systems harnessing the breath and the voice can optimize respiratory mechanics and heart rate variability.
 
A glance at this episode:
[1:41] Pelvic floor and breathing patterns
[4:12] What is GI dysfunction and why is it so prevalent
[5:41] The diaphragm and coughing and sneezing
8:22] The diaphragm needs to match the demands of the activity
[10:26] The diaphragm position
[12:25] The diaphragm and the chest wall
[15:09] How the diaphragm is connected to the regional nerves and inflammation
[17:21] Psoas as a trunk muscle vs. hip flexor
 
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, we dive into the often overlooked and misunderstood world of male health, exploring the complexities of groin pain, the challenges of taking deep breaths, and the impact on his pelvic girdle pain. 
The history will give you the answer. 
This is a complex case with many parts but listening to his story helps you to prioritize which regions of the body you need to rule out. 
Visceral connections are key to this presentation. 
Join Susan and Erica as they unravel the potential causes, shed light on some of his drivers, and offer insights to help those facing similar issues. 
Don't miss this great conversation that aims to bring awareness to a topic that affects both men and women.
 
A glance at this episode:
[0:01] Intro to episode and patient
[8:41] Why the patient is experiencing paresthesias along with itching
[11:15] Breathwork and the visceral driver
[15:27] Pelvic floor and the breath
[18:12] Assessing hip pain
[23:53] A head lift and why it brings on his symptoms
[29:52] The effects of decompression on head rotation
[32:28] Yoga and the thorax
[37:08] Down dog and child’s pose
[43:11] Finding the driver and the root cause of his problem
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript
 

When does motor control come into play when someone has persistent shoulder pain? 
Is it soft tissue related, a joint problem, or a neuromuscular repatterning issue? 
Or something else? 
How does our nervous system adjust? 
In this episode, we talk about the multiple sources of this person’s shoulder pain and how retraining his arm lift was the key to his recovery.
And we mean retraining, the right way.
 
A glance at this episode:
[7:27] Assessing symptoms associated with cycling
[8:47] The brachial plexus and its connection to hip pain
[12:57] Manual therapy for the shoulder? 
[16:25] Drivers of this dominant postural pattern
[18:49] Mechanics of the shoulder joint
[23:52] Recovering the superior glide, why it's necessary
[28:49] Repatterning optimal shoulder movement 
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript

Here is the clinical story of a client that is presenting with pain/sensitivity in the area of the (R) posterior pelvis. 
A common area of symptoms for many patients. But there are many potential drivers and the need to differentially diagnose is crucial.  

Why?

Because you won't want to miss the hidden connections that are so often present in patients, that when missed, can make the difference between a successful outcome and a patient who walks away unhappy. 
In this episode, we discuss what has been unhelpful for her with regard to past interventions and why the biopsychosocial approach and creating the therapeutic alliance are so important to give her the ability to improve her movement system.
Meaningful activities, violating expectations, and movement system changes were key to her healing journey.
 
A glance at this episode:
[1:35] History of the patient
[5:30] Digging deeper to find the driver
[9:19] Lifestyle changes that work
[15:00] Establishing an alliance to explore fears
[25:30] Making the evaluation meaningful to the patient
[33:23] The reset exercise
[37:33] The problem with a sagittal plane squat
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript