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Tough to Treat
36 minutes | 9 days ago
"Why Does My Foot Hurt? What's Going On?"
Why would someone who is 3 months post fibular fracture get worse after a basic theraband ankle exercise? Not everyone needs inversion and eversion theraband exercises. Right? This is an in depth clinical discussion on understanding the "why" hidden in the patient narrative. And a specific process on how to assess the whole foot and not just the ankle. We also discuss why this patient's center of mass is biased TOWARDS her INVOLVED side and what implications this has for treatment. Check us out @ Toughtotreat.com
41 minutes | 22 days ago
Musculoskeletal Driver of Hip Pain in a Young Dancer
When working with young athletes it is easy to have early success in treating the acute or subacute injuries. What happens when the latest injury reveals a very chronic situation elsewhere in the body? Don't be fooled by generalized and chronic complaints underlying the present situation in these teenagers. They may improve quickly in one respect, but looking deeper can help them improve adaptation strategies that will help further down the road and even alleviate a chronic situation. Join us as we discuss the chronic MSK driver to hip pain irritability in this young athlete. Check us out: ToughtoTreat.com
44 minutes | a month ago
The Knee and its Relationship to the Whole Person
How does the knee affect so many parts of the body? Join us for this discussion on this important intermediate joint of the lower kinetic chain and how dysfunction here can alter the movement system for the whole person. Check us out: Toughtotreat.com
45 minutes | 2 months ago
Chest Pain In An Endurance Athlete
Does chest pain raise your eyebrows? Red flag? Or wild goose chase? This case is an insight into a classic endurance athlete and how his past injuries reveal a true deficit which can be the potential driver for his current symptoms. These symptoms that only occur 3-4 hours after a bike ride. We discuss viscero-somatic cross talk, the cardiac sinus and its biomechanics as well as a how to start treatment in someone who has many moving parts!! Check us out: Toughtotreat.com
38 minutes | 2 months ago
Shoulder Pain and Distal Drivers
This episode features a case of shoulder pain with unusual drivers due to their distal proximity. Join us as we discuss this interesting clinical case on a very active man with chronic shoulder pain, fear avoidance, anxiety and some unique clinical reasoning to help him recover! Check us out: Toughtotreat.com
29 minutes | 3 months ago
Not Your Ordinary Knee Patient
What do you automatically think when someone tells you they have knee pain? It's worse with walking SW and walking FW. And the patient cannot sleep sidelying because his knee hurts when he sleeps on either side. He can squat no problem. Are you thinking what we're thinking? Susan and Erica unpack this patient's story and dive into specific hints or cues that the patient gives to indicate that it's more than just the knee. Treatment? Well, that depends on the driver, doesn't it? The most important piece and message in this episode is the clinical reasoning behind why this may not be your ordinary knee patient. Check us out @ Toughtotreat.com
114 minutes | 3 months ago
Thoracic Mobility Beyond The Breath
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 be the cause for 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. If you can get the thorax moving differently, this can help people out of old movement patterns that do not serve them and restore global movement patterning across many tasks. Check us out: Toughtotreat.com
47 minutes | 4 months ago
Ankle fracture rehab - what is missing?
As health care providers and rehab professionals, there is the story that ankle fracture rehab is simple. Makes sense right? A regional intervention over an obvious acute traumatic event. But what is missing and why do so many individuals recovering from this injury (post-surgical) are having difficulty months and years down the road? Join us as we explore the Biopsychosocial approach to this individual who felt her rehab care was dismissive to her real fears and complaints. How to navigate the waters when peripheral symptoms migrate to central sensitization. Of special interest here is where the secondary driver actually becomes the primary driver! Check us out: Toughtotreat.com
53 minutes | 4 months ago
Does Hip Pain Always Come From The Hip?
When someone complains of persistent hip pain, what do you think? Is the source the hip? It may be the pain generator but at this point, is the primary reason why they have hip pain because of some dysfunction intrinsic to the hip? Most likely not. Simple example- right persistent hip pain with going up stairs and standing on one leg. In standing, all their weight is on the right leg, why? Probably because of an old injury to their left side or an ingrained movement pattern they have adopted over the years. At any rate, they have lost options for movement and their left side cannot adapt, so they over use and over recruit their right hip, as a possible scenario. Listen for more! Check us out: Toughtotreat.com
50 minutes | 4 months ago
The Shoulder Is Connected To Everything
Join us for a fun discussion on the relationship of the shoulder to the rest of the body. Learn about all the connections between the shoulder, the cranium, the neck, the upper thorax and much more! Did you know that an old clavicle fracture on your left can be responsible for right shoulder pain? Check us out: Toughtotreat.com
41 minutes | 5 months ago
Double Vision Post Partum, Cause or Effect?
Tune in for an interesting discussion on a woman presenting with complaints of double vision 8 months after the birth of her third child. A coincidence? Maybe, maybe not. Either way, it needs to get addressed. Is this dural? Trigeminal wind-up? Listen in for the clinical reasoning process as well as some novel treatment techniques that worked. Check us out: Toughtotreat.com
42 minutes | 5 months ago
Neural Tension and Beyond
Can neural tension be responsible for a tight hip? Absolutely! Would you believe that neural tension in the right hip can be responsible for left hip pain? Listen as Susan and Erica discuss the many possibilities of unsolved persistent pain. They also discuss several cases where neural tension plays a role in many typical musculoskeletal issues. Check us out: Toughtotreat.com
44 minutes | 6 months ago
Neck Pain/Back Pain - Where Do You Start?
Finding clients with subjective pain in the low back and cervical region is not an uncommon presentation. The bias is to treat the most acute region and hope the other region gets better as a result. What happens when you look closely at the story, listen to the client and find a very unlikely driver of maladaption in this clinical case? Join us as Susan and Erica unravel this clinical presentation and align the intervention with the client's goals. Check us out at Toughtotreat.com
41 minutes | 6 months ago
How To Master Functional Movement Assessment
Functional movement re-patterning is the key to changing someone's movement strategy. But how do you choose the right one, so you are more organized and efficient in your assessments? And how can you clinically reason so you can hone in on one area to get better results? Understanding the inter-regional relationships in the body as someone moves may be the game changer for you and your client. How does the foot relate to the shoulder as you squat and reach over head? How does neural tension affect your ability to perform a narrow based lunge or squat? Listen in as Susan and Erica discuss this and much more! Check us out: Toughtotreat.com
36 minutes | 7 months ago
Training the Tough To Treat Shoulder
How many neck problems are really disguised as shoulder issues? A lot actually! It is extremely common to overwork some of those small muscles of the neck at the expense of a true shoulder weakness. And why is traditional cuff strengthening not always the way to start with these patients? Listen as Susan and Erica do a deep dive into this patient's underlying issue and discuss various ways to bridge the gap between early phases of exercise to higher loads. What positions do you start with? How can you provide neural input into the system without aggravating symptoms? Check us out: Toughtotreat.com
43 minutes | 7 months ago
Pelvic Pain - Things Are Not Always As They Seem!
Don't let the diagnosis be your guide, listen to the whole story, and be curious outside of pattern recognition. Is the original thought about the case straight forward. Or is it as Sherlock Holmes says: "When you have eliminated the impossible, whatever remains, however improbable, must be the truth?". Have you indeed eliminated all of the impossible? In this episode, we discuss the reasoning behind this client who has a complex presentation of symptom progression following a traumatic accident. Join us as we explore the nuances of "test-retest" in this case study. Check us out: Toughtotreat.com
54 minutes | 8 months ago
Elite Soccer Player with Low Back Pain
Why can't this athlete get rid of his low back pain? "Running- I have no problem with" "Lateral-side to side-movements really aggravate me". " Why?" How do we make a differential diagnosis here? And with significant unilateral calf weakness to add into the mix. Four ankle sprains and a 4th metatarsal fracture later, plus a "stress reaction" at L5, why wouldn't his low back be the source of his problem? Join us as we clinically reason through multiple facets of his case. Check us out: Toughtotreat.com
34 minutes | 8 months ago
Full Squat vs. Partial Squat?
A recent article on various depths of squats revealed information that a full squat is more beneficial than partial squats in improving function and pain over time. Have a listen as we explore interesting comments/bias/evidence on why we rely on the squat as a revealing part of our examination and interventions. Follow link: https://www.tandfonline.com/doi/abs/10.1080/17461391.2019.1612952?journalCode=tejs20 Check us out: Toughtotreat.com
42 minutes | 9 months ago
Medial Elbow Pain and Tingling/Numbness
Another case with elbow issues! This case involves neural tension, pins/needles, and catastrophization. What is the best way to begin to work with someone who has multiple issues around fear of neural symptoms without neuro changes? Join us as we discuss dosing, position changes, problem solving and fear reduction in this interesting case. Check us out: Toughtotreat.com
41 minutes | 9 months ago
Demystifying Tennis Elbow
Tennis elbow is one of those conditions that is extremely frustrating for both patient and practitioner alike. It turns into a persistent problem very fast. This was another one of our popular FB Lives we did recently. We unpacked the myths and theories around tennis elbow and what to do to treat it. Is it neurally driven? Cervical Spine driven? Does it emanate from poor shoulder mechanics? Or does it come from poor thoracic control? The key word here is "myths". Your pain generator may be the elbow, but the longer it persists, the driver(s) behind this frustrating problem migrate away from the elbow pretty quickly. Where do they go? Check us out: ToughtoTreat.com
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