In this episode, Erica speaks about prescribing specific exercises based on the difficulty level relative to the region of the body driving the patient's symptoms. 

NOT the pain generator. 

NOT the area of symptoms. 

If someone has knee pain, and their driver is their foot, then the exercise program is geared towards the foot, NOT the knee. SLR's and quad sets won't work here. 

She also explores the significance of personalized exercise prescriptions in optimizing recovery outcomes. There are many clinical pearls in this episode, one of which is, "Why would a side-to-side deep squat be harder for the foot than the thorax?" Both are lateral movement patterns. 

She also discusses the clinical reasoning behind a well-thought-out exercise plan. Remember: we are trying to give our patients options for movement and variability across many activities. Building volume of exercise at low levels is key to this outcome as is challenging the driver across many planes.

A glance at this episode:

• [3:38] Prescribing specific exercises based on the patient's main driver, not the symptom

• [8:02] Identifying the level of difficulty for a specific exercise using regional analysis

• [14:02] How to dose exercise based on what is meaningful for the patient

• [17:58] Exercises for improving lower body control and center of mass

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

In this episode, we discuss the case of a very active woman grappling with SI (sacroiliac) joint pain. These symptoms manifest while walking and with hip external rotation. 

Furthermore, the episode unravels the complexities surrounding assessments, especially when individuals seek consultation for a single visit. We also delve into why and when using a pelvic belt is helpful. 

Also, for the non-pelvic health therapists out there, we discuss how you can palpate relevant muscles externally to further confirm or negate your hypothesis as to whether the pelvis is a driver. This patient had an extensive medical and surgical history. 

We also discuss certain aspects of her history that are very relevant for treatment. When someone has had 3 C-sections, an abdominoplasty, breast reconstruction, and more, do you think that the pelvis is the main driver? 

Think again if you do. 

Remember, we are a product of our compensations and adaptations to prior injuries and surgeries.

A glance at this episode:

• [4:04] Pelvic girdle pain and nerve damage

• [7:55] Patient's medical history and treatment options

• [12:17] Pelvic girdle dysfunction and its impact on gait

• [18:48] Pelvic health issues and scoliosis

• [22:15] Patient's medical history and potential causes of pain

• [26:23] Treating chronic pain and imbalance in a patient with a history of abdominal surgeries and scoliosis

• [32:22] Pelvic floor assessment and treatment

• [36:43] Treating chronic pain in a patient with complex history

• [41:26] Pelvic health and its impact on overall body function

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

In this short episode, Susan presents a good algorithm for the examination and interventions in clients with GI dysfunction. 

Follow along as she discusses different nuances and considerations in the presence of pelvic and abdominal aspects of GI dysfunction.

A glance at this episode:

• [0:01] Interventions for GI dysfunction and abdominal pain

• [2:03] Manual therapy for abdominal and pelvic issues

• [6:19] Abdominal massage for constipation and pain relief

• [9:59] Breathing, abdominal muscles, and pelvic floor function

• [14:35] Abdominal surgery effects on musculoskeletal and visceral support

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

This episode presents a client with a seemingly straightforward diagnosis in pelvic health of overactive bladder (OAB). The history and physical presentation tell a different story. 

Join Susan and Erica as they explore why often a regional approach will not help the client progress to their highest levels of function without symptoms. We discuss the various drivers viscerally and MSK regionally and why tendon function and the client's stage of life require the utmost consideration. 

Join us in the conversation and discover the multi-system approach in consideration of the examination and interventions for this client

A glance at this episode:

• [2:22] Urinary incontinence and hip injury

• [6:50] Pelvic floor dysfunction and its connection to urgency frequency

• [11:49] Pelvic floor exam and overactive bladder symptoms

• [16:30] Abdominal and musculoskeletal issues

• [22:12] Exercise modifications for lower back pain

• [28:23] Exercises for pelvic health and bladder control

• [32:59] Pelvic health and muscle imbalances

• [39:00] Mental health cases and patient mentoring

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

In the episode, Erica explores the strategic use of open and closed-chain exercises for upper extremity dysfunction. She discusses the distinct benefits and applications of each type of movement, shedding light on how these exercises can be tailored to meet specific needs to enhance performance. 

She uses an example of a tennis player who suffered from right shoulder pain with radiculopathy. She also tackles the critical question of when to load open-chain versus closed-chain exercises, offering practical guidelines based on the stage of recovery and individual progress. 

OKC can be very difficult for someone who has a true shoulder driver. Based on her experience with these patients, most people who play an overhead sport, display a lot of compression in their upper rib cage and shoulder joint. This can masquerade as "thoracic outlet syndrome" or "rotator cuff strain" when it's a movement pattern created by their sport carried over to all life events. 

By understanding the principles of load management and exercise progression for open and closed-chain exercises, listeners will gain valuable insights into prioritizing certain movements during the rehab process.

A glance at this episode:

• [2:28] Physical therapy for tennis player with shoulder and rib compression

• [5:58] Manual therapy techniques for shoulder issues

• [11:15] Progressing patients through closed-chain exercises

• [15:38] Rehabilitation techniques for chronic pain

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

In our latest episode, we explore the fascinating stories of two individuals navigating the challenges of mastering the push-up despite their unique injury history. Both individuals had different pain experiences with this movement. 

Remember-What set them up? 

What kept them there? 

We explore why the push-up experience varied greatly between these 2 people and why it was so unique in these 2 individuals. 

"Push" is a part of daily life whether we realize it or not from pushing open an umbrella to pushing a door open to a full push-up on the floor of a declined bench. The "What set them up?" is a significant factor in how they were assessed and treated. 

One individual was a former boxer and the other held a desk job but had an extensive exercise and injury history. 

Join us as we unravel the complex interplay of factors shaping each individual's journey toward mastering this seemingly simple yet profound exercise.

A glance at this episode:

• [4:57] Two men's push-up techniques and their impact on their bodies

• [10:04] Elbow injuries in boxers and their impact on grip strength

• [18:44] Rehabilitation exercises for shoulder and elbow issues

• [24:03] Exercise progression for two patients-they are very different

• [29:53] Shoulder pain and movement analysis

• [35:32] Rehabilitation strategies specific to the push up

• [40:38] Relevant exercises for lower body and upper body strength

Related links:

• The Franklin Method Fellowship Podcast

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

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

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

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

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

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

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

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

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript