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/
Complex Persistent Pain - Part 1 Where is the driver?
44:46We 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
31:53Does 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
39:30What 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
41:29Save 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?
40:32Ankle 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
Treatment Progressions for the Tough To Treat- Clinical Pearls
40:20Clinical pearl alert! This episode tells the story of 3 patients and their treatment progressions. Typical symptoms but atypical drivers. What types of exercises do you prescribe for your patient when their symptom is in their feet and their driver lies in their thorax? What is their impairment? This is a discussion of how you would SPECIFICALLY treat and develop a well thought out exercise progression. Using your clincal reasoning doesn't stop with assessment. Check us out: Toughtotreat.com
SI Joint Pain - An Updated Approach
46:50Here is the clinical story of a client that is presenting with pain/sensitivity in the area of the (R) posterior pelvis. In this episode we discuss what has been unhelpful for her with regard to past interventions and why the biospsychosocial approach and creating the therapeutic alliance is so important to give her the ability to improve her movement system. Meaningful activities, violating expectations and movement system changes were key to her healing journey. Check us out: Toughtotreat.com
What To Do When Your Patient Plateaus
36:13What do you do when a patient plateaus? Doesn't improve? Join us for our first Q and A broadcast on how to clnically reason through a patient's treatment program when their progress starts to slow down. We discuss a specific patient example and what constitutes a solid progressive exercise program. This also includes reset exercises to restore optimal motor patterning so she can identify what movements are hindering her progress and what she can do to get herself out of a flare up. Check us out: Toughtotreat.com
Clinical Pearls for the Shoulder-Understanding the Connections in the Upper Quarter
58:13Join us for a special episode on the shoulder. This is a re-release of one of our most popular episodes to date. As a bonus, we present 3 case studies of patients with typical shoulder pain who have different drivers and certainly different exercise programs. Sometimes the key to helping a patient's persistent shoulder pain is looking at all of the underlying inputs into their system. What are the connections in the upper quarter? How do they relate to the patient's meaningful movement? Check us out: Toughtotreat.com
The Key To Functional Movement Assessments
40:26Join us for Part 2 of our discussion on functional movement patterns. How can you make your assessment more efficient and reliable? We discuss what to look for when evaluating someone's ability to move in and out of certain movements. How do you determine if a dysfunctional foot is driving your client's hip pain when squatting? Or if poor thoracic control is responsible for low back pain when assessing someone take a step forward? We discuss some basic movement patterns and how to break them down so you as a clinician can hone in on the driver quicker.