Tough to Treat

Latest Episodes:

Outcome Measures and Pain in GI Dysfunction Mar 07, 2024

Show notes

This episode is a short compilation of an algorithm in looking at basic outcome measures and pain in GI Dysfunction. Susan explores the basics of the history which can give great insight into the addition of more sophisticated outcome measures and pain exploration. Start with the basics and then expand!

A glance at this episode:

[0:01] Evaluating and managing pain in people with GI dysfunction
[1:18] Abdominal pain and its relationship to GI dysfunction
[4:47] Visceral pain and myofascial pain syndromes
[9:14] Pelvic health and bowel dysfunction assessment tools
[13:12] Bowel habits and GI health assessment

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The Balance System As A Driver Feb 29, 2024

Show notes

Join us in episode #200 where Susan and Erica explore the potentiality of the balance system as a primary or secondary driver. With a client's history of injury or illness, there is an event that sets up their system for adaptation. Oftentimes, in regional-specific rehab, the balance system is not considered as a driver. What keeps the client in this adapted pattern may be the primary driver; however, the balance system adapts to keep the entire body and physiology upright against gravity. This system can change, and the need for activity to accomplish this becomes a primary consideration in the assessment and the intervention. Listen in to the conversation and find easy clues to discover in your client assessment for effective interventions.

A glance at this episode:

[5:27] Balance system adaptation and rehabilitation
[12:43] Balance, vestibular system, and eye movements
[21:04] The importance of challenging the balance system and multitasking while keeping balance intact
[25:28] Balance challenges and treatment options for various populations
[29:53] Improving balance and rotation through exercises
[35:30] Pelvic health, balance, and movement patterns
[43:47] Balance system importance in exercise and rehabilitation

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The Body's Story: Finding Out Why You Hurt Through Your Story and Movement Patterns Feb 22, 2024

Show notes

In this episode, we explore the profound connections between personal narratives and the origins of someone's injury. Join Erica as she delves into the stories of individuals who've experienced persistent injuries, and learn how to find clues in their narrative to help you prioritize the movement assessment and eventually find their driver(s). You will learn how to make the connections between the story and their movement patterning. Through the lens of their injury and movement history, we can uncover the reason why someone can't move the way they want. This leads to precise diagnosis and effective treatment. You don't treat the symptomatic region unless it's the driver. There is a video companion piece with slides on our "Tough To Treat" YouTube channel for this episode.

A glance at this episode:

[0:55] Finding the patient's primary driver from clues in their narrative
[4:30] Post-partum tennis player with neck pain during a push-up, what her story tells you
[9:11] How her injury and movement history will lead you to the driver(s)
[13:06] What movement(s) to assess and how to make this much more efficient

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Chronic Low Back Pain and an Underlying Pathophysiological Change: We Adapt Until We Can't Feb 08, 2024

Show notes

How important are past events to present movement patterns and restrictions? What about past events of herniated lateral discs or hypermobility on the current presentation of the movement system? Clients can heal with faulty movement systems that can show up as new and different presentations in the future. This podcast is from a presentation that links the neuromuscular systems together and provides insight for evaluation and interventions.

A glance at this episode:

[0:01] Lumbopelvic pain causes and treatment
[5:02] Hip extension and lumbar spine rotation for efficient walking
[8:48] Back pain and nerve root impingement
[12:17] Hypermobile spine and neural patterning
[16:20] Lumbar spine mobility and exercises for pain relief

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Overcoming Fear-Based Movement Patterns Feb 01, 2024

Show notes

In this empowering episode, we dive deep into the realm of fear-based movement and explore strategies to help patients conquer their anxieties, helping them move towards a more confident and pain-free existence.

Anxiety and fear of movement are real things and can prevail even when we are termed "fit to play", "fit to move" or "pain-free". Just because someone is pain-free, it doesn't mean that they can move well or move without fear.

We discuss the implications of movement anxiety and explore the roots of fear and how it manifests in the body. Our discussion involves 2 specific case studies where fear of a certain movement was stalling their recovery and includes specific techniques and exercises for a positive outcome.

By the end of this episode, you'll be equipped with valuable tools and insights to help your patients move better, even when fear holds them back.

A glance at this episode:

[5:37] Interoception, beliefs, and structural integrity in physical therapy
[10:12] Fear based pain with lumbar extension
[14:40] Graded exposure to movement
[18:29] Movement re-patterning with specificity
[26:11] An equestrian who is afraid to sit
[30:15] Integrating variance into exercise
[34:29] Using props to help patients overcome fear and improve movement patterns

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How To Find The Driver Through Patient-Centered Listening Jan 25, 2024

Show notes

Discover the art of being an active listener who can pick up clues in your patient's narrative to help you find their driver quicker. This will save you lots of time in your movement assessment. Listen in as Erica discusses how to reframe your patient's story to help you maximize your time with them in the clinic. She discusses clues in their "subjective" that can aid you in prioritizing regions of the body to assess in your movement analysis. This is done with 3 case studies from her practice where she discusses each patient's story (injury and movement history) and what clues she honed in on to effectively make a clinical hypothesis about their driver(s).

A glance at this episode:

[4:13] Analyzing movement and injury history and why a timeline matters
[9:44] The importance of the narrative in assessing a patient's movement patterns. How to ask the right questions.
[15:17] Why the first injury sets them up and why their movement history keeps them there
[20:20] Case study-tennis player who was unable to do a push up.
[23:43] Case study-neural tension restricting UE closed chain activities.
[27:09] Case study- runner with pelvic girdle pain whose driver was her foot

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Take Back your Mental Fitness - Part 2 Jan 18, 2024

Show notes

Welcome to the New Year and one of the topics always discussed by Healthcare providers is burnout and imposter syndrome. Join Susan in this short podcast - Part 2 Taking back your mental fitness. Learn how to identify the voices of your inner Judge and Saboteurs, how to limit their voices, and find a pathway to your Sage Brain!

A glance at this episode:

[3:21] Mindfulness techniques for neural plasticity
[6:48] Mindfulness and neural pathways for busy people
[10:33] Cultivating self-empathy and overcoming judgment
[14:09] Positive Intelligence and Self-Improvement

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Take Back Your Mental Fitness - Part 1 Jan 12, 2024

Show notes

Welcome to the New Year and one of the topics always discussed by healthcare providers is burnout and imposter syndrome. Join Susan in this short podcast episode - Part 1 Taking back your mental fitness. Learn how to identify the voices of your inner Judge and Saboteurs, how to limit their voices, and find a pathway to your Sage Brain!

A glance at this episode:

[4:38] Saboteurs in the brain and their impact on decision-making
[9:11] Personality types and their impact on work performance
[13:30] The disruptive role of saboteurs in decision-Making
[18:27] Mental fitness in healthcare with a focus on saboteurs and sage powers

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A Case of Lateral Hip Pain Jan 04, 2024

Show notes

Hip pain can be brutal. And more often than not-it's chronic. Not like an acute ankle sprain or even acute low back pain. People who suffer from hip pain, for whatever reason, sink into the chronic side of musculoskeletal pain. Let's face it-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.

A glance at this episode:

[2:15] Hip and knee pain case intro
[5:08] Chronic hip pain and potential causes
[9:35] Loss of mobility and symptoms
[12:51] Hip movement and range of motion influences
[19:04] Hip mobility and exercise prescription
[22:31] Motor planning and motor control
[25:45] Hip rotation and postural ramifications
[31:12] Pelvic floor muscles and hip rotator imbalance
[34:54] Physical therapy exercises for improving balance and reducing neurological symptoms
[41:48] Treating hip pain through physical therapy
[44:58] Manual therapy techniques for pain management

Related links:

Thoracic Mobility Beyond The Breath Dec 21, 2023

Show notes

In this episode, Susan and Erica discuss the many ways the thorax can be the driver for a multitude of upper and lower extremity issues.

This important region of the body tends to cause a lot of movement dysfunction we often see.

As an example, the thorax is an important component in driving foot pain as well as issues in the pelvic girdle.

Suppose you can get the thorax to move differently. In that case, this can help people down-train old movement patterns that do not serve them and ultimately restore global movement patterning across many tasks.

Key point: The thorax can be a key driver, in how someone transfers load after an injury (no matter when that injury took place). It is a region of the body that compensates for pain and dysfunction elsewhere and then ends up being the driver years later. Don't miss it.

A glance at this episode:

[3:26] Thoracic mobility and breath control for pain relief
[11:19] Breathing and muscle release techniques for thoracic spine mobility
[14:26] Using sensory input with a theraband for thoracic mobility
[19:19] Using closed kinetic chain exercises for thoracic mobility and abdominal strength
[23:49] Assessing and treating shoulder injuries
[29:23] Thoracic mobility and its impact on movement patterns
[34:20] Thoracic rotation and breathing exercises for runners
[43:05] Reintegrating movement patterns for whole-body wellness
[47:42] Exercise and posture for older adults
[52:12] Posture and movement for homeschooling and virtual work

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