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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 prescr ...
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Shoulder Pain With Pull Ups or Push Ups? The Elbow Changes Everything
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In this episode, we explore the surprising journey of a boxer battling chronic shoulder pain that left him struggling to do even the most basic workout. Despite focusing on his shoulder, it turns out the root of his problem lay elsewhere—his elbow. Is that surprising? It was in his injury history. Do not discount the power of an old injury that cou…
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Susan and Erica are back together for the Fall season! Chronic knee pain can be much more than a regional event. Susan presents a client with an extensive timeline and clinical reasoning as to why it is important to consider the entire system in this integrated approach. The key here is also maintaining relevance and sustainability for the client. …
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Assessing Knee Health For Hip-Related Walking Pain
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In this episode, Erica explores the often-overlooked relationship between hip pain and knee function during walking when the patient does NOT have knee pain. Join in as she dives into the role of the knee in compensating for hip dysfunction, and how a thorough knee assessment can uncover hidden contributors to hip discomfort. Remember: old injuries…
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When shoulder pain is dominant, but not the driver!
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Shoulder pain, like any other joint can present as primary pain and can be the #1 reason a client may be seeking help! In many cases, treating the obvious joint dysfunction (because it checks all of the boxes) may not result in optimal outcomes. Join the conversation as Susan and Erica explore the various reasons and important timelines in the clie…
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Beyond Tennis: Exploring Shoulder Compression Across Sports
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In this episode, Erica discusses the why behind shoulder problems, comparing the unique challenges faced by tennis players and non-tennis players alike. She explains why traditional shoulder treatment often fails these types of patients. A significant relationship between the shoulder and another region of the body is often missed. Erica also tells…
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A Stiff 1st MTP Joint can Affect Everything!
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One of the most overlooked joints in the lower quarter is the first MTP joint unless that is the client's primary complaint. How does the stiffness of the MTP joint affect gait and lower quarter movement of all kinds? We spend some great time discussing differential diagnosis and practical interventions and sharing some new discoveries. Hint: the e…
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What is the cause of bilateral calf pain in this young fencer? From start to finish, it shows the power of a thorough evaluation, a specific exercise progression, and a return to the sport she loves. When it comes to exercise progression in persistent pain, think about context. How can you improve optimal movement patterning by changing the context…
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The Role of the Diaphragm in Chronic Low Back Pain and GI Dysfunction
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How similar are the neuromuscular responses to pain with Chronic low back pain and GI pain? Join Susan and Erica in a great discussion of the role of the diaphragm and how this changes with pain and inhibiition/over-recruitment in the system. In chronic low back pain and abdominal bloating/distention the diaphragm becomes a postural control muscle …
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How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? Carefully and specifically! This episode highlights the beauty of a specific exercise progression tailored to the patient's meaningful movement. Listen as we go through the clinical reasoning process to determine what types of movement patterns will work and…
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Low Back Pain - Regional vs. Movement System Considerations
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If it walks like a duck and quacks like a duck - it must be a duck, right? Low back pain is a descriptive term at best, indicating where symptoms present. Join Susan and Erica as they explore this Tough to Treat client with low back pain and mild stress urinary incontinence. Discover the history and the movement system examination and interventions…
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What To Do When You Are Their Last Resort
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Now, this is a CHALLENGING one! Ever have those patients who have been everywhere, had everything done to them (injections, surgeries, acupuncture) and nothing helped? Well, this is your lucky day because this episode really takes us down the chain from head to toe with someone who had low back pain. Pretty standard, right? But this was FAR from st…
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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 histo…
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Junior Golfer With Persistent Unsolved Knee Pain
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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…
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What's Stopping this Former Fighter from Doing Push-Ups and Pull-Ups?
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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…
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Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 2
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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, demonstrat…
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Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 1
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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 assessme…
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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…
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In this episode, Erica explores new and novel ways to evaluate and treat the knee. She discusses different approaches aimed at providing a more accurate assessment of the knee. Join her as she emphasizes the importance of training your vision. What does "optimal" movement look like for that particular patient? Does what you see match what you feel?…
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Addressing the Gaps in a Patient's Exercise Program
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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…
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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 intoleranc…
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Back Pain/Leg Pain - Making the Right Call For Our Clients
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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 …
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Clinical Pearls For Effective Exercise Progression
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25:23
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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 …
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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 usi…
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Physical Therapy Examination and Intervention of GI Dysfunction
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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]…
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This episode presents a client with a seemingly straightforward diagnosis in pelvic health of overactive bladder (OAB). The history and physical presentation tell a different story. Join Susan and Erica as they explore why often a regional approach will not help the client progress to their highest levels of function without symptoms. We discuss th…
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