Tough to Treat Susan Clinton and Erica Meloe

This episode zeroes in on a scenario many physical therapists face: patients diligently following their exercise routines but not seeing the expected progress or recovery. 
We discuss thorax, foot, and knee drivers as examples and why there can be holes in someone's program even after they've been doing advanced exercises. Being able to identify the patient's impairments is a good start. 
We discuss common strength holes along with typical overactivity patterns in these patients. Susan and Erica also discuss a patient who is a high-level athlete with a fear-based movement that is a big hole in her program.
A glance at this episode:
[4:00] Exercise program for patients with knee and foot issues, focusing on strengthening key muscles
[7:30] Lunges and split squats for a runner with a thoracic driver
[13:56] Proper lunge technique and addressing knee pain through strengthening exercises
[20:24] Improving lunges with a stick and target practice
[23:43] Lunges and squats for runners with a focus on proper form and progression
[29:30] Exercise safety and program development for patients with knee pain
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript

What is the difference between food allergies and food sensitivities? 
Join Susan as she discusses the importance of following the science and taking the guess work out of the food allergy vs. sensitivity issue and why this is important for systemic inflammation.
 
A glance at this episode:
[3:19] Dietary elimination for gut health and food intolerances
[9:18] Gluten sensitivity and its impact on IBS symptoms
[13:14] Gut microbiome's role in digestion, immunity, and weight gain
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript

This episode presents what should be a straightforward case of a significant nerve root irritation. Unfortunately for this client, her situation was not addressed adequately and has left her in a lot of pain for over 3 months. 
Join us as Susan presents this client case, what went wrong, and the assessment and intervention with a rich discussion of the path forward. 
Here is a Hint: center of mass and chronic loading play a strong part in this story!
 
A glance at this episode:
[2:21] Back and glute pain, stretches, and fatigue
[7:37] Back pain and re-curring mobility issues
[12:16] Chronic pain and it's relationship to mobility
[17:02] Proper standing and walking techniques for comfort and mobility
[22:00] Standing balance and stretching exercises for improved mobility
[26:51] Chronic back pain and neuroinflammation
[31:26] Back pain treatment options and the importance of proper imaging
[36:01] Proper treatment approaches for a patient with persistent 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
 

In this episode, Erica speaks about prescribing specific exercises based on the difficulty level relative to the region of the body driving the patient's symptoms. 
NOT the pain generator. 
NOT the area of symptoms. 
 
If someone has knee pain, and their driver is their foot, then the exercise program is geared towards the foot, NOT the knee. SLR's and quad sets won't work here. 
 
She also explores the significance of personalized exercise prescriptions in optimizing recovery outcomes. There are many clinical pearls in this episode, one of which is, "Why would a side-to-side deep squat be harder for the foot than the thorax?" Both are lateral movement patterns. 
 
She also discusses the clinical reasoning behind a well-thought-out exercise plan. Remember: we are trying to give our patients options for movement and variability across many activities. Building volume of exercise at low levels is key to this outcome as is challenging the driver across many planes.
 
A glance at this episode:
[3:38] Prescribing specific exercises based on the patient's main driver, not the symptom
[8:02] Identifying the level of difficulty for a specific exercise using regional analysis
[14:02] How to dose exercise based on what is meaningful for the patient
[17:58] Exercises for improving lower body control and center of mass
 
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 discuss the case of a very active woman grappling with SI (sacroiliac) joint pain. These symptoms manifest while walking and with hip external rotation. 
Furthermore, the episode unravels the complexities surrounding assessments, especially when individuals seek consultation for a single visit. We also delve into why and when using a pelvic belt is helpful. 
Also, for the non-pelvic health therapists out there, we discuss how you can palpate relevant muscles externally to further confirm or negate your hypothesis as to whether the pelvis is a driver. This patient had an extensive medical and surgical history. 
We also discuss certain aspects of her history that are very relevant for treatment. When someone has had 3 C-sections, an abdominoplasty, breast reconstruction, and more, do you think that the pelvis is the main driver? 
Think again if you do. 
Remember, we are a product of our compensations and adaptations to prior injuries and surgeries.
 
A glance at this episode:
[4:04] Pelvic girdle pain and nerve damage
[7:55] Patient's medical history and treatment options
[12:17] Pelvic girdle dysfunction and its impact on gait
[18:48] Pelvic health issues and scoliosis
[22:15] Patient's medical history and potential causes of pain
[26:23] Treating chronic pain and imbalance in a patient with a history of abdominal surgeries and scoliosis
[32:22] Pelvic floor assessment and treatment
[36:43] Treating chronic pain in a patient with complex history
[41:26] Pelvic health and its impact on overall body function
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript
 

In this short episode, Susan presents a good algorithm for the examination and interventions in clients with GI dysfunction. 
Follow along as she discusses different nuances and considerations in the presence of pelvic and abdominal aspects of GI dysfunction.
 
A glance at this episode:
[0:01] Interventions for GI dysfunction and abdominal pain
[2:03] Manual therapy for abdominal and pelvic issues
[6:19] Abdominal massage for constipation and pain relief
[9:59] Breathing, abdominal muscles, and pelvic floor function
[14:35] Abdominal surgery effects on musculoskeletal and visceral support
 
Related links:
Tough To Treat Website
Erica’s Course: Decoding the Complex Patient
Susan’s Pelvic Health Education Subscription
Access the Transcript