Tough to Treat

Latest Episodes:

Myth Busting - Rethinking Pregnancy Related Pelvic Girdle Pain May 19, 2022

Show notes

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.

A glance at this episode:

[3:30] Background on Pelvic Girdle Pain
[9:34] What language you should be using when working with pregnant women with pelvic pain
[18:43] Do pelvic girdle belts work
[21:16] Sleep is a huge issue
[25:25] 3 powerful questions for pregnant patients
[27:47] The benefit of exercise throughout pregnancy
[32:27] Dispelling the myths about movement in pregnancy
[38:45] Finding out eating habits about your patient

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Smart Exercise Progression May 05, 2022

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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.

Smart Exercise Progression May 05, 2022

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CV joints and bladder urgency - is there a connection? Apr 21, 2022

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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 Apr 07, 2022

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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 Mar 24, 2022

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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!

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Persistent Shin Pain-Where is the Driver(s)? Hint: Not the Lumbar Spine Feb 24, 2022

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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.

The Psoas Triangle Feb 10, 2022

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Differentials of common segment's neurology - Join us as we discuss the shared neurology of the T12/L1 region and how this can be a driver to anterior hip and groin pain. We are looking at multitudes of clients that show up with various aspects of what Erl Pettman discusses in his work of the psoas triangle.

Designing Exercise Progressions For The Tough To Treat Jan 27, 2022

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How do you design a sound, clinically reasoned exercise progression? Taking into account multiple drivers? If someone has low back pain, do you give them core stability exercises? I hope not, unless they have an abdominal wall deficit! In this episode Susan and Erica talk about a patient from episode 81 and what constitutes an approporiate exercise progression for someone whose drivers were in his foot and thorax. They go into detail the various categories of exercise and how you would clinically reason giving one exercise over another. Link to episode #81-https://toughtotreat.com/81-elite-soccer-player-with-low-back-pain/. Join our new Premium Podcast Club: toughtotreat.supercast.com

Persistent Pubic Symphysis Pain/Right Anterior Hip Pain Jan 13, 2022

Show notes

10-20% of women with pelvic girdle pain in pregnancy will persist into the post-partum era. Join us as we share a discussion on the history that led to the eventual battery of relevant tests/measures and interventions that were not only meaningful to the client, but also were achievable in her very busy time of life with small children. Join our new Premium Podcast Club: toughtotreat.supercast.com

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