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
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).
The Foot and Diaphragm- Their Connection To This Skier's Hip Pain
What happens when you take away a compensation? Movement patterns change for starters. But what if these new strategies are not optimal for whatever activity you are trying to do? New sport you want to master? That's where the reality unfolds. Healthy systems need choices and when you take away a compensation or a movement pattern that no longer works (i.e. painful), your brain is forced to develop another strategy. In this episode we talk about a patient from episodes 109 and 110, who has made fantastic gains but started skiing again. He resorted to an old movement strategy which included a non-optimal breathing pattern, over recruiting his diaphragm and ultimately a gripping strategy throughout his anterior chain. Hint: ski boot takes away compensatory foot pattern. We also discuss some great treatment strategies for integrating his foot in a NEW functional pattern so he can gain capacity for higher load activities such as skiing and upright movements where the foot is involved. Check us out at Toughtotreat.com
Persistent insertional tendonopathy - the importance of the systems approach
The movement system is adaptable until there is maladaptation! Why is tendonopathy so difficult to treat? What if straight eccentric loading doesn't work? Join us as we discuss this female client and the unique consideration of the system changes that have led to the development and persistence of her persistent heel pain. Yes, this includes pelvic health and the cervical spine! check us out at toughtotreat.com
Persistent Shin Pain-Where is the Driver(s)? Hint: Not the Lumbar Spine
Can there be 2 drivers to someone's shin pain? Of course! What is the relationship between them? Are they directly connected? Is there some underlying neurally driven mechanism? Or both? This episode digs deep into why certain positions like sitting in a specific environment versus other sitting positions make him worse. Why would biking be ok for someone and sitting in an office chair not be? Think about that one for a second. Susan and Erica discuss this patient's past movement history which plays a SIGNIFICANT role in his issue. You will have to listen to the episode to see what that is.
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!