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    Health & Fitness

    Tough to Treat

    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
    http://creativecommons.org/licenses/by/3.0/

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    Latest Episodes:
    Does the Elbow Always Drive Elbow Pain? Dec 30, 2021
    Show notes

    A fall on an outstretched elbow (FOOSH) with resulting elbow pain. Not your typical overuse or mechanical injury common to this region of the body. What happens when your differential diagnosis leads you somewhere else? Susan and Erica discuss the backbone of the initial assessment as well as treatment specific strategies that will help you get these patients better quicker. They also relate some great clinical pearls behind coming up with a hypothesis as to why elbow pain can be driven from another region of the body. Join our new Premium Podcast Club: toughtotreat.supercast.com


    A Case of Lateral Hip Pain Dec 15, 2021
    Show notes

    Consideration of lateral hip pain requires a thoughtful clinical reasoning process to discover the physiology/movement patterns as well as neural contributions required to make a diagnosis and successfully build an intervention that lasts. One size does not fit all - join us as we discuss the findings in this "not so unique" case and the discovery of the underlying movement patterns, impairments and why lateral rotator strengthening is not always the answer.

    Join our new Premium Podcast Club! For details click here: toughtotreat.supercast.com


    5 Symptomatic Regions Of The Body With One Main Driver- Part 2 Dec 02, 2021
    Show notes

    After listening to Part 1 of this case (episode 109), how would you design an exercise progression? Remember you need to find the driver first. Designing a movement program based on this patient's symptoms would NOT work, as his driver(s) lie elsewhere. Once you are confident you've found it, think about the impairment. Does he have an overactive superficial system or underactivity somewhere else or both? Sound clinical reasoning dictates that you need to downtrain the old strategy first. Listen as Erica and Susan finish their discussion on where his driver lies and how you would design an effective treatment session as well as a sound exercise progression.


    5 Symptomatic Regions Of The Body With One Main Driver Nov 18, 2021
    Show notes

    What happens when you have 2 regions of the body that when treated together give your patient the best movement options and no pain? But, when they are treated separately, not only is the patient worse, but their movement lacks coordination and ease. This episode highlights someone who has over 5 regions of the body that are meaningful and symptomatic. Literally from head to toe! Listen as Erica and Susan discuss in Part 1 of this case, how you can differentiate between these regions to effectively design an effective treatment session and a sound exercise progression. Of note, take away the compensation and see where the real work begins!

    Check us out: Toughtotreat.com


    Complex Persistent Pain - Part 2 Where is the driver? Nov 04, 2021
    Show notes

    Do you have thoughts on the driver from part 1? In part 2 we take you through the discovery and clinical reasoning parts to determine the primary driver for this client's symptoms. For intervention - think of the easiest steps to begin to find a way into the system to make large changes. Listen in as Susan and Erica discuss how symptoms can be present in various positions but can be changed through focus on the one major system here.

    Check us out: ToughToTreat.com


    Complex Persistent Pain - Part 1 Where is the driver? Oct 21, 2021
    Show notes

    We always discuss history and relevant events. In this episode we take a deeper dive into all aspects of the story in the BPS lens. Join us for our discussion on the importance of uncovering significant historical peices regardless of the referral or medical diagnosis. You have an opportunity to put on your clinical reasoning cap with us as we set up this clinical case in Part 1!

    Check us out: Toughtotreat.com


    Persistent Unsolved Hip Pain Oct 07, 2021
    Show notes

    Does all hip pain require strengthening? Of course not! And certainly not in this persistent case. This episode shows you the importance of digging deep into the history and really learning how to connect the dots. From the way the patient walks and what that means for symptom provocation to exposing the vestibular system as a potential driver. Other candidates include the foot, thorax and neck. Listen to find out how Susan and Erica problem solve together to come up with other ways to assess and treat this interesting patient!

    Check us out: taughttreat.com


    Nociplastic Pain and a Visceral Driver Sep 16, 2021
    Show notes

    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 history is so important!

    Check us out: toughtotreat.com


    "X" Marks The Spot-Navigating The True Source Of Shoulder Pain Aug 26, 2021
    Show notes

    Save yourself time by learning how to find the driver quicker. This is the case of a neck driven shoulder- but not in the way you think! Do all shoulder patients need strengthening? Not really. We talk about how to hone in on the impairment and narrow the assessment down to a few movements that will help you successfully clinically reason through most upper extremity issues. We also discuss novel ways to give your patient a home program based on their impairment, the smart way.

    Check us out: Toughtotreat.com


    Complex Ankle Sprains - What is Missing? Aug 12, 2021
    Show notes

    Ankle sprain rehab can seem so straight forward - decrease swelling, improve ROM and strength - right? Wait, why are a good number not improving and returning to previous activities? Once again, the client's story and history can really lead us further into the complexity of the foot/ankle joint and all of the systems that need to be considered in returning this region to full function. Clinical Pearl Alert - Neural tension from the cutaneous nerves!

    Check us out: Toughtotreat.com


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