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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:
    053: Is an overactive TFL a poor movement strategy? Aug 22, 2019
    Show notes

    Your patient cannot sit and cannot squat in the gym without lateral hip pain. They believe it is their overactive TFL. But is it the cause of the problem? Most likely, it is NOT. Why would someone have increased tone in a muscle? Think about a movement pattern where someone's center of mass is shifted to one side because of an old contralateral foot injury? You injure your foot and you weight shift off of that side where you stay that way for YEARS. Until one day, you run out of options. Sound familiar?

    Visit our website at www.toughtotreat.com


    052: A shoulder or a neck problem - what is important to the patient? Aug 08, 2019
    Show notes

    Shoulder pain - or neck pain? Does it really matter to the intervention? What does the client believe and expect? How do you manage client expectations in this scenario? Join us in a rich discussion about this client's self-efficacy and managing expectations while reducing fear. Sound clinical reasoning shows you the value of asking the right questions to guide you in your treatment. www.toughtotreat.com


    051: Is it really the nerve root? Jul 25, 2019
    Show notes

    Searing shin pain, low back pain, night sweats, unable to sleep or walk-is it the disc? The nerve root? A sensitive nervous system? Or something else? Or all of the above? Join us as we make a differential diagnosis on this gentleman's problem. Once again, listening to his story will give you clues as to how to begin the objective exam.

    Find out more at www.toughtotreat


    050: Finding the real story through the narrative Jul 04, 2019
    Show notes

    Do you ever wonder if there is a better way to evaluate the complex patient? What do you do when the body diagram is full with a long history? I think we all are used to hearing our client's stories - but do we really listen to their full narrative? This can be the key to finding out what's important to them and sometimes, the simplest solution is revealed through their story along with the physical exam. Have a listen to this story and the key components!

    Sign up for our newsletter at www.toughtotreat.com We have some awesome free PDF's on assessing and treating complex patients!


    049: Game Changing Exercise Progressions Jun 20, 2019
    Show notes

    Do you want better outcomes with your patients? What do you do when a patient has plateaued? Or they're not improving as fast as they should be? One of the answers could be your exercise progression. Are you truly treating the source of the patient's problem with a specific movement program geared towards the SOURCE and NOT the symptom? What is the key to effective exercise progression? In this episode, Erica discusses what has been a real game-changer in her practice. That is: appropriate exercise progression for common drivers that she sees. She shares clinical pearls from her caseload and tools of the trade that have really helped her.

    Visit our website: www.toughtotreat.com


    048: Complicated thigh numbness-is it really the nerve? Jun 06, 2019
    Show notes

    What happens when someone's thigh goes numb and does not go away? The nerve is obviously angry but what is the driver? What could possibly cause someone's thigh to go numb? Do hormones play a role in this case? Is it hypermobility? Is it the foot? Susan and Erica discuss all the possibilities for this particular patient's presentation and present SPECIFIC movements/exercises that the patient will do in order to calm that thigh down.

    Visit our website: www.toughtotreat.com


    047: Fear avoidance with low back & pelvic pain May 23, 2019
    Show notes

    Low back pain - the need to stretch and fear avoidance complications. What happens if the movement or postures you believe to be good are really problematic? We have delved into low back pain and the constant need to stretch, but sometimes it can also become more complex due to our thoughts and beliefs. Here are some good strategies for helping someone move and confronting their beliefs.

    Visit our website: www.toughtotreat.com


    046: Leg pain and peripheral nerves May 09, 2019
    Show notes

    What happens when someone suffers a traumatic injury, then lives with it for 8 months? Listen to this episode and find out. Susan and I discuss a former patient of mine who lived with hypersensitivity, bruising and swelling in her lower limb for months!! Think about what that does to your system? We also discuss developing a hypothesis/diagnosis based upon the subjective history. It is something we should do with every single patient. That is what makes you an expert. Furthermore, what happens when a patient's objective signs are worse after your treatment? I mean, right after, before they leave your office. We give you some tips and strategies to avoid this situation and give your patient a much better outcome.

    Visit our website: www.toughtotreat.com


    045: Female with bilateral hip pain? Is it really a hip joint problem? Apr 25, 2019
    Show notes

    Join in on this differential diagnosis and use of evidence to help determine the underlying cause and progressive movements to help this very strong and resilient female overcome nagging hip pain for over 5 years. Pain can be complex and contextual, it can also have a metabolic component as well. Consistency is the key to addressing her issue and progressing her program.

    Visit our website at www.toughtotreat.com


    044: Dancer with Pelvic Pain-Is it Really the Pelvis? Apr 11, 2019
    Show notes

    Does this dancer with persistent left-sided pelvic girdle pain need to have her SI joint manipulated all the time? The answer is an obvious no! In this episode, we discuss how a professional dancer was able to get rid of her pelvic pain by looking up the chain. Remember- it is the movement strategy that counts. Digging deep into the demands of her performance, was the key to finding a solution for her. We also address the relevant exercise progression. If the symptom is the pelvis and the cause is somewhere else, how would you design a movement program for her? Listen and find out!

    Visit our site at www.toughtotreat.com


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