Tough to Treat

Latest Episodes:

Complex Chronic Low Back Pain - When A Regional Approach Will Not be the Best Option May 18, 2023

Show notes

Where do you start with a client with complex regional pain that has full-body implications?

Listen to their story, look for the change talk, and gain active participation by allowing them to lead the way in a judgment-free zone.

Sometimes, clients know what they need to do, they just don't know how to implement the changes and find simple action steps.

Join us as we talk about this interesting case of a surgeon hijacked by his work environment, which has accumulated several body system symptoms from GI dysfunction, neural tension, pain, and pressure system dysfunction.

This starts with simple action steps and progresses to a complete lifestyle change.

A glance at this episode:

[1:58] What does microsurgery look like
[4:52] How to deal with the pain of surgery
[10:14] Looking at the problem in this case
[13:01] Breathing to relieve neural tension
[15:37] Rolling a towel method
[22:16] Solving the problem of constipation
[22:25] Tai Chi pros and cons
[31:00] Tennis balls and headstands

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Trigeminal System Referral Pattern May 11, 2023

Show notes

What is the referral pattern for the Trigeminal System?

What does that mean for our clients?

The cervical nucleus of the trigeminal system can have profound effects on multi-body symptoms

Join Susan as she describes this unique and vital phenomenon.

A glance at this episode:

[1:45] Trigeminal system as a sensory experience
[3:06] The interconnecting cranial nerves
[3:51] How the trigeminal system affects the voice
[5:17] Trigeminal ganglion and the spinal nucleus
[7:54] How to bring your heart rate down
[8:31] Trigeminal system and tooth pain
[10:32] Lateral spinal thalamic track and ventral trigeminal limb
[12:28] Convergence of the trigeminal nerve
[14:02] How chewing gum impacts the sympathetic nervous system

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Pelvis Driver In A Male Weightlifter May 04, 2023

Show notes

This episode is all about low back pain with a pelvis component in a 33-year-old male weightlifter.

Erica and Susan discuss how his history of chronic low back pain along with some bowel issues played a significant role in how he recruits muscles under load.

Some highlights include why pelvic taping helped in this case, how to perform the same movement pattern in different positions, why assessing the pelvis was necessary, and the clinical reasoning as to how to differentiate whether it was an overactive anterior-posterior chain.

A glance at this episode:

[5:42] What triggered this patient's symptoms
[8:33] The primary driver for his low back pain, it's not what you think
[12:49] What's the lower extremity component of his problem
[19:50] Diarrhea, constipation, and how it relates to his symptoms
[25:38] Letting go of the coccygeal muscles
[32:25] Mass movement patterns and internal rotation

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Assessing The Knee Differently Apr 27, 2023

Show notes

In this "shortie" episode Erica discusses different ways she assesses the knee.

There are 3 parts to the knee joint and assessing a movement pattern that takes into account all these regions is key.

It's not all about patellar tracking, right?

More often than not, one part of the knee is being compressed because of some overactivity in the muscles surrounding it.

The main takeaway is that evaluating these regions takes precision and it's worth it to spend a few extra minutes doing so. Your patients will appreciate the specificity.

A glance at this episode:

•[1:45] Why the knee is the victim

•[2:57] Knee assessment

•[5:08] Clinical pearl on knee mechanics

•[7:03] How to assess the knee in 3D

•[8:48] Assessing the knee with a body twist

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Foot Drivers - The Prequel to the Foot Progression Exercises Apr 20, 2023

Show notes

Erica and Susan have presented several podcasts discussing the exercise progression of the foot as the primary and secondary driver.

Today they discuss the idea of taking the movement pattern down a couple of steps in preparation for the foot to handle loads, change the body posture, and progress to appropriate AP sway.

The clinical reasoning process is key for understanding how the foot should be working before strengthening and challenging movement patterns can be improved.

A glance at this episode:

[7:36] How to get the foot to turn on to work
[11:05] Creating a tripod position for the foot
[15:32] How to mobilize your feet
[20:17] Neural tension work and increasing mobility
[24:45] The split squat position
[28:18] How do you learn to squat down
[33:23] The importance of building volume at low levels

The other episode mentioned in this podcast on exercise progressions for the tough to treat foot. Episode # 76.

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Anatomy and Physiology Interactions of the GI System - Part 2 Apr 13, 2023

Show notes

This is part 2 of a short webinar on the interactions of the functional anatomy and physiology of the GI system, presented by Susan Clinton.

This will give listeners a nice story of these systems in aspects of digestion and this affects other systems.

A glance at this episode:

[1:25] The importance of good digestion and intestinal mucosa
[3:!7] Chemical digestion of food
[5:51] Digestive enzymes
[8:05] The village of Villi
[9:59] Mass movements in the large intestine
[11:38] The rectal inhibitory reflex
[13:43] The descending colon and rectum

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What Do Weightlifting And Poledancing Have In Common? Apr 06, 2023

Show notes

Answer: A dominant movement pattern that is the same across all this patient's activities.

No 1- weightlifters brace and dump their shoulder blades when they rack squat. A very common pattern for this movement, especially when you are lifting over #200 +.

The problem is when this becomes dominant for all movements.

Healthy systems need choices, plural. The nervous system then grades the strategy depending on the movement and load needed.

What happens when someone uses this strategy to pole dance?

No 2-a rigid thorax does not serve here. The main impairment in our clinical practice is not a stiff thoracic spine but one with a loss of control.

Imagine that?

How does that transcend into low back pain?

Listen in as Erica and Susan discuss how to down train this common problem and give this patient more choices for optimal movement.

A glance at this episode:

[8:24] Stretching and why it isn't helpful here
[13:11] Movement options at home
[17:04] The importance of hands-on work and the wall squat
[21:28] Abdominal synergy
[25:21] The diaphragm and what it takes to move well
[30:58] Connections to the neck
[35:00] Adaptation for athletes with lower back pain

Related links:

Anatomy and Physiology Interactions of the GI System - Part 1 Mar 30, 2023

Show notes

This is part 1 of a short webinar on the interactions of the functional anatomy and physiology of the GI system.

Listen to the unique anatomical arrangements and the neurophysiology connections.

A glance at this episode:

[1:00] Where the visceral organs are located in the abdominal cavity
[3:35] The neurology of the GI System
[5:44] The parasympathetic and sympathetic pathways of the gut
[7:32] Nervous pathways from the brain to the spine
[9:34] Muscarinic receptors in the digestive system
[11:14] What is the mesenteric system
[13:22] Endocrine cells in the gut
[15:32] Why stress over time can be damaging to the gut system

Related links:

Hypermobility and Low Back Pain Mar 16, 2023

Show notes

How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain?

Carefully and specifically!

When someone who is hypermobile complains of continued and persistent back pain, your first thought is, " Is this an overactive system? An underactive system? Or both?".

This re-release of an episode from 2018 highlights the beauty of a specific exercise progression tailored to the patient's meaningful movement and her dominant impairment.

Listen as we go through the clinical reasoning process to determine what types of movement patterns will work and what ones won't.

Doing the right thing at the right time is clinical expertise.

A glance at this episode:

[5:55] Hypermobility Syndrome and the pelvic floor
[12:11] How and why her back extensors are overworking
[19:44] Taping-does it help here?
[24:42] Recruitment of the diaphragm in back pain
[28:34] Taking out the overactivity-Posterior pelvic tilt on all fours
[32:33] Spinning and mirroring that into exercise
[36:35] Not a stretching issue but a coordination problem
[39:55] Flexion based stabilization and progression
[44:38] Resistance bands on the bike

Related links:

Why Has My Patient Stopped Improving? Mar 09, 2023

Show notes

Ep 152: Why Has My Patient Stopped Improving?

In this episode, Erica discusses the fine points of what to do when your patient stops improving. AKA a plateau.

Problem-solving through a patient plateau requires sound clinical reasoning and a reflection back to the patient's story. Looking at the injury and movement history-there can be a clue there. Change their COM and reassess another movement pattern.

Listen in as Erica gives you the steps to take when this happens to you. A case example is also presented to illustrate the point. Ultimately, challenging the human movement system in different ways along with an objective look at the patient's narrative will give you your answer.

A glance at this episode:

[2:15] Going back to the patient's story
[4:06] Reassess another movement pattern
[5:50] Why another assessment tool is crucial
[7:45] When to problem solve through a plateau
[10:02] The first injury sets them up and their movement history keeps them there
[12:01] How to assess center of mass
[13:52] Training the center of mass in a functional movement pattern
[15:16] Why the knee mattered

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