Tough To Treat

Understanding movement systems and patterns is crucial when assessing complex patients.

When there's either over-recruitment or under-recruitment of muscles, it can lead to significant disruptions in the movement system. This often results in patients coming to us with pain and dysfunction.

For example, when the core system isn't functioning properly, the diaphragm may compensate by acting as a postural control muscle.

We explored this concept in 🌟Episode 118: The Foot and Diaphragm- Their Connection To This Skier's Hip Pain🌟. If you missed it, be sure to listen for more in-depth insights.

In that episode, we discussed research on the diaphragm's role in posture control, particularly in individuals with low back pain.

You can find the article we referenced in our bio, or by copying this link into your browser: https://buff.ly/45l9YBb.

We'd love to hear your thoughts on the article in the comments below!

Don't forget to listen to our bi-weekly podcast and visit our website at buff.ly/2mT1Fcv to join our email list. This way, you’ll stay updated with the latest podcast episodes and best practices to enhance your clinical skills!

👍 Bonus: When you join our email list, you'll receive our Free Clinical Pearls download and a Sleep Tips guide to help you elevate your practice.

Throwback Episode! Episode 223: Unlocking the Impact of a Stiff 1st MTP Joint

The first MTP joint, often overlooked unless it’s the primary complaint, plays a crucial role in lower quarter movement and gait. But how does stiffness in this joint affect overall movement? In this episode, we dive deep into differential diagnosis, practical interventions, and some surprising discoveries.

You might be surprised to learn that the exam and intervention don’t always focus on the stiff 1st MTP joint—there’s often a primary driver elsewhere.

Here’s what we cover:

[5:05] How to compensate and adjust your feet

[11:23] Maintaining the pyramid of the foot

[13:54] Assessing foot position for better movement

[17:17] Evaluating the big toe’s role in movement

[20:17] Treating plantar flexion inversion

[24:37] Getting started with squat mechanics

[27:46] Choosing the right shoes for diabetic feet

Tune in to gain insights that could transform your approach to treating lower quarter stiffness. Don’t miss this essential episode!

🎙️ Throwback to Episode 123: Choosing The Best Functional Movement For Your Assessment

Remember when we unlocked the secret to picking the perfect movement for your functional movement assessment? Revisiting this gem could revolutionize your initial evaluations, saving you time and deepening your connection with your patients.

In this episode, we reveal our top strategies for selecting the best functional movement, ensuring you get the most impact from your assessments. If you missed it, now's the perfect time to catch up!

🚀 How do you start your assessments? Share your process in the comments—we’d love to learn from you!

🎧 Tune in again to Episode 123 and don't forget to visit buff.ly/2mT1Fcv to join our email list. Stay updated with our latest episodes and best practices to elevate your clinical practice.

✨ Bonus: Sign up and receive Erica's Clinical Pearls PDF and Susan's Sleep Tips guide, essential tools for every clinician.

Pain is never just about the spot that hurts. Treating only the painful area often falls short of providing lasting relief.

Research consistently shows that pain is a complex experience influenced by a variety of factors, including:

🎙️ Genetics
🎙️ Psychological factors
🎙️ Social influences
🎙️ Biophysical factors
🎙️ Comorbidities
🎙️ Lifestyle choices

To truly help our patients, we need to consider all these elements as part of their treatment plan. Everything in the body is interconnected, and often, we can't make meaningful progress until we address the nervous system's response to pain.

That’s why interventions like deep breathing, mindfulness, and relaxation techniques are crucial. They help calm the nervous system, creating the foundation for lasting change.

Don’t underestimate the power of these holistic approaches—they can be the key to unlocking long-term relief for your patients.

Looking for insights on managing bilateral calf pain in young athletes?

Check out our throwback episode, Podcast 222, where we dive into the case of a young fencer. From start to finish, this episode showcases the power of a thorough evaluation, a tailored exercise progression, and the journey back to the sport she loves.

When dealing with persistent pain, context is key in exercise progression.

How can you optimize movement patterns by altering the context?

Consider these ideas: change the visual input (eyes open vs. eyes closed), modify the base of support (wide vs. narrow), or even add their favorite music to the routine.

By viewing your patients through a different lens, you’ll unlock new ways to create positive change.

Don’t miss this episode! Listen now to gain practical strategies for your practice.

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🔥 Unlock the Secrets of the Body's Hidden Drivers! 🔥

Did you know? Any region of the body with an injury history or a dominant movement pattern can be a key driver in your patients' issues.

🎧 Don’t miss out! Download Episode 124 to dive deeper into this fascinating topic!

But wait, there’s more! Head over to buff.ly/2mT1Fcv and join our email list. As a special thank you, you’ll receive:

📘 Erica's Clinical Pearls PDF: Packed with invaluable insights. 😴 Susan's Sleep Tips Guide: Essential advice for better patient care.

Join us today and take your clinical practice to the next level!

📢 We Can't Stress This Enough: The Power of Listening 📢

We've said it before, and we'll say it again—because it's that important.

When you truly listen to a patient's story, they reveal everything you need to know for a thorough evaluation and effective treatment.

Tune into our weekly podcast for deeper insights and practical tips. And don't forget to visit buff.ly/2mT1Fcv (link in bio!) to join our email list! Stay updated with the latest episodes and best practices to take your clinical practice to the next level.

✨ Exclusive Bonus: Join our email list and receive: 📘 Free Clinical Pearls Download: Packed with invaluable clinical insights. 😴 Sleep Tips Guide: Essential advice to enhance patient care.

Elevate your practice with these must-have resources. Join us today and become part of our vibrant community!

Have You Joined the Tough To Treat Newsletter Yet?

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🎙️ Latest Podcast Releases: Be the first to hear our newest episodes.
💡 Special Tips & Tricks: Get exclusive insights to elevate your practice.

But that’s not all! When you join, you’ll get:

📘 Erica's Clinical Pearls PDF: Packed with invaluable clinical insights.
😴 Susan's Sleep Tips Guide: Essential advice for better patient care.

These two must-have resources are just a click away. Join us today at buff.ly/2mT1Fcv!

We can’t wait to welcome you to our community!

💡 Unlock the Power of a Great Patient History! 💡

A thorough patient history is your secret weapon—it helps you pinpoint exactly where to begin your movement assessment. But what’s your go-to strategy for kicking off these assessments? We’d love to hear your tips!

🌟 Join Our Community! 🌟 Sign up at buff.ly/2mT1Fcv and become part of our growing community of clinicians. When you join our mailing list, you’ll receive:

📘 Erica's Clinical Pearls: A downloadable PDF packed with valuable clinical insights.
😴 Susan's Sleep Tips Guide: Essential tips to help your patients get the rest they need.

Plus, stay in the loop with our latest news, expert insights, and never miss an episode of the "Tough to Treat" podcast!

🚀 Sign Up Now and Elevate Your Practice! 🚀

In this part, Erica discusses assessing COM over BOS using hands on the wall to rule in or out upper quarter involvement.

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🚀 Breaking Through Plateaus: A Guide for Clinicians 🚀

"Ugh, I've hit a wall!"

"I'm feeling much better, but I still can't do x, y, z."

"Every time I start to jump, run, lift weights, or play golf, my symptoms flare up again."

We hear these frustrations all the time from our patients. It’s tough for them, and it’s tough for us as clinicians. But don’t worry, there’s a path forward!

🧩 Step One: Prioritize the key regions of the body during your evaluation. It’s the first step to becoming a master clinician.

🔍 Step Two: Know when to look elsewhere. Sometimes secondary regions become the main issue when a patient is under load or introducing a new movement pattern.

Re-examining and re-evaluating these situations can help break through a plateau and keep your patients on the road to recovery.

🎙️ Want to dive deeper? We tackle this topic in episode #100 of our podcast, "Tough to Treat." Tune in for more insights on breaking through plateaus and keeping your patients moving forward.

💬 What’s your go-to strategy when a patient plateaus? Share your thoughts in the comments!

homepage - Tough To Treat TOUGH TO TREATDo you want to learn how to treat complex patients? Be the first to know about the next episode and as a bonus we will send you a copy of Erica's "Clinical Pearls" with some real case examples of how to evaluate and treat the "tough to treat" patient. You will also receive a copy of Su...

🎧 Hey Tough to Treat Fam! 🎧

We hope you’re enjoying our latest episodes! If our podcast has inspired you, made you laugh, or just kept you company on your commute, we’d love to hear from you. Your feedback helps us improve and reach more listeners like you.

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Thank you for being a part of our community. Keep listening and keep sharing!

As move through our summer series, today we bring you episode 218,

🎙️ What To Do When You Are Their Last Resort🎙️

"Now, this is a CHALLENGING one!”

Ever have those patients who have been everywhere, had everything done to them (injections, surgeries, acupuncture) and nothing helped?

Well, this is your lucky day because this episode really takes us down the chain from head to toe with someone who had low back pain. Pretty standard, right?

But this was FAR from standard.

Hint: her lower back was not the source of her problem. Why do you think that is? Remember, we bring all of our compensation to our life events. And our movement and injury history sets us up and our dominant patterning keeps us there.

Visit our website: buff.ly/2mT1Fcv

As women age, estrogen decreases. This is what makes women so much more prone to tendinopathies than other patient populations. The lack of estrogen causes these tendons to become brittle when under load.

The key to helping these women is to help their system calm down and then load it with kindness. We can't just jump into a bunch of high-load eccentric exercises because we are going to make things worse. A gradual increase in load and movement is the way to go here.

Listen to episode Episode 117: Persistent insertional tendinopathy - the importance of the systems approach-- to hear more.

Pelvic healthcare is expanding. It’s not just working in pelvic health, are now being certified as pelvic health therapists. I’m thrilled that OTs are now a part of this space and I believe they bring valuable insights unique to the skill set of .

PTs and OTs have been working closely together for years, and now I'm honored to be part of a summit for all OTs in the pelvic health realm.

My friend Lindsay Vestal is hosting the OTs in Pelvic Health Summit on August 17 in Arizona and I am proud to be included in the lineup of speakers.

If you’re a PT or an OT in the pelvic health realm I urge you to take part in this summit! The in-person option is sold out but virtual attendance is still available!

Click here to learn more and register.

https://buff.ly/3ONRJ1u

As move through our summer series, today we bring you episode 217,

🎙️ Pain and a Visceral Driver🎙️

What do you do when a client presents with a myriad of LQ symptoms without a clear regional driver?

Look to the history and ask questions even further back than the recent onset or episodic flare. Join us as we discuss the complex neurology of a visceral driver that has signs of dysfunction and a somatic pain presentation. Once again, the history is so important!

A look inside!

[0:01] Left lower quadrant pain, nociceptive input from the visceral driver
[2:23] Pelvic pain and potential visceral driver
[8:05] Bladder issues and pelvic floor tension
[10:49] Bladder irritants and pelvic health with a patient
[16:49] Lower back pain and posture with a physical therapist
[20:04] Pelvic floor exercises and visceral manipulation for pelvic pain relief
[24:34] Pelvic floor exercises and core strength for bladder control
[26:45] Improving driving skills and addressing bladder issues
[32:49] Visceral mobilization and pelvic floor issues

Download wherever you get your podcasts! and be sure to tell your friends, co-workers, and colleagues about our podcast!

Don’t be afraid to use tape. Tape can sometimes get a bad rap, and there are questions about its effectiveness.

But we’ve seen time and time again in clinic and practice how useful it is in some cases to help bring awareness to a dysfunctional movement pattern and help someone access a better, novel, movement pattern allowing them to return to function.

Want to learn more about incorporating taping into your practice? Head to our website and search for “taping” to find episodes related to taping.

Sometimes there is no substitute for putting hands on someone and feeling how they move. There is so much we can learn about their movement habits and what’s really going on in their movement system just from this simple act.

Do you agree? Share your thoughts with us in the comments!

The best treatment you can give your patients is to LISTEN to them. Find a way to connect to them. Find out what their hobbies are. Their job. Their family life. Their interests.

This will create a beautiful therapeutic alliance providing trust and connection to create better outcomes and help you drive their treatment plan.

Like, comment, or share if you agree!

Get your patients into different positions during treatment! Positions such as:

👉 Quadruped

👉 Tall kneeling

👉 Half kneeling

get a bunch of muscles working together and can provide novel input to the system to create change and disrupt dysfunctional patterns.

Join us for the summer season as we go back and listen to some of our most popular and earliest episodes! Download wherever you get your podcasts!