Many times, clinicians find that people with correlative GI system dysfunction are very overwhelming. The complexity makes it difficult to know where to begin to intervene. 

Join us as Susan discusses some very simple mediations to help improve the GI system with stress, exercise, and sleep. Complex clinical pictures can often change when we address the foundations of health with simple interventions.

A glance at this episode:

• [1:38] Stress, its effects on the body, and exercise as a remedy

• [6:38] Exercise and stress management techniques

• [10:56] Sleep's impact on digestion and overall health

• [14:16] Improving sleep quality with expert tips

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

Susan and Erica welcome Kelly McClain to the podcast to discuss a very complex client with pelvic health, orthopedic, and neurological issues. 

Follow along as the client case is presented and we pursue a rich discussion of tying together the systems involved as well as the red flags. Digging deeper into the client's story is key here to help with obvious referrals and also to recognize other systems and issues deeper into the client's history to gain insight.

A glance at this episode:

• [3:05] Pelvic health issues and treatment

• [12:28] Patient's symptoms and medical history

• [20:20] Current medical issues and imaging recommendations

• [26:14] Clinical reasoning and potential diagnoses

• [31:08] Manual therapy for perineal pain

• [33:24] Rectal pain and paraesthesia during squatting

• [38:44] Treating patients with complex symptoms

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

Why doesn't my groin pain go away? 

When someone is an athlete, you must understand what regions of the body are challenged with their sport. With soccer, you think of the thorax, foot, hip, and pelvis from the get-go. 

Listen in as Erica discusses the movement she and her patient chose to assess and what they discovered. 

Short-term treatment of someone's symptomatic region may help in the short term, but getting them back in the game is another matter entirely. When a person has an issue with a long lever movement like kicking a soccer ball, recognize and respect the length-tension relationships of the muscles involved in the movement, like how someone's lack of adductor power can stem from an overactive posterior tibialis muscle.

A glance at this episode:

• [4:05] Prioritizing physical therapy treatment based on specific sport and movement patterns

• [7:19] How to choose an appropriate movement pattern that is relevant to the patient yet specific to their sport

• [11:07] Where is the non-optimal patterning?  In the set up to the shot or in the kick?

• [15:21] Improving athletic performance through training optimal movement patterns

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

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 for assessing the whole foot, not just the ankle. 

We also discuss why this patient's center of mass is biased toward her involved side and what implications this has for treatment.

A glance at this episode:

• [5:28] Patient's ankle injury and physical therapy

• [10:58] Assessing a patient's foot after a prolonged boot immobilization

• [15:14] Menopause and tendon issues after a fibula fracture

• [19:17] Rehabilitation strategies for a patient with a booted leg

• [23:53] Foot and ankle assessment and treatment

• [29:38] Assessing and treating a patient with lower extremity pain

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

We continue with our GI dysfunction theme in this podcast about food intolerances/sensitivities vs. allergies. 

Join Susan as she takes you through the algorithm to understand how to recognize what is the underlying information behind why certain food bothers us and when we should eliminate food.

A glance at this episode:

• [3:49] Elimination diets for digestive health

• [7:42] Gluten sensitivity and its effects on the body

• [11:56] Gut microbiome's role in IBS symptoms and behavioral changes

• [15:20] Gut microbiome and its impact on health

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

How similar are the neuromuscular responses to pain with chronic low back pain and GI pain?

Join Susan and Erica in a great discussion of the role of the diaphragm and how this changes with pain and inhibition/over-recruitment in the system.

In chronic low back pain and abdominal bloating/distention the diaphragm becomes a postural control muscle which greatly limits the respiratory ability along with an ineffectual model for spine stiffness and visceral organ pusher.

This is an excellent discussion following the podcast episode 185. 

A glance at this episode:

• [3:13] How lying on your back affects breathing and posture

• [7:42] Abdominal wall dysfunction and its impact on GI function and low back pain

• [12:05] Abdominal diaphragm dysfunction in chronic low back pain

• [19:43] Treatment for diaphragm and abdominal wall dysfunction in chronic low back pain

• [25:24] Abdominal wall deficits and breathwork for chronic low back pain

• [31:43] Treating gas and bloating through pelvic health therapy

• [38:24] Treating GI dysfunction and Cushing's syndrome

Articles mentioned in the episode:

Postural function of the diaphragm in persons with and without chronic low back pain.

Abdomino-phrenic dyssynergia in patients with abdominal bloating and distension.

Abdominal and Pelvic Floor Activity Related to Respiratory Diaphragmatic Activity in Subjects with and without Non-Specific Low Back Pain.

• Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

When do you treat the viscera? 

And why? 

This episode discusses a bit about the abdominal viscera. It is certainly not all-encompassing by any means. We just want our audience to be aware of the possibilities. 

Erica relays some clues in the patient's history as to why you would screen for GI dysfunction. She uses 2 case examples of when the abdominal viscera was the secondary driver in one case and when it was a significant impairment in a patient with a dural driver in the other. 

Once again, it all comes down to listening to your patient and connecting the dots. 

A glance at this episode:

• [2:24] GI dysfunction and its relationship to manual therapy

• [7:10] Abdominal palpation and soft tissue work for low back pain

• [9:46] Identifying visceral dysfunction in patients with low back pain

• [14:26] Abdominal viscera and soft tissue restrictions

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, Susan and Erica welcome Darcie Pervier to the mic! 

Darcie is a pelvic health and orthopedic PT who practices a fully integrative approach to complex client care. Susan, Erica, and Darcie really delve into "brainstorming" various aspects of examination and intervention in connecting some dots on this complex canvas. 

Dural issues, fracture healing, bone health red flags, thoracic stiffness, neural tension, and GI visceral systems are tied together to help guide more meaningful interventions for this client. 

Hint: How to get a client to do some nervous system regulation when they don't want to!

A glance at this episode:

• [1:36] Patient's chronic pain and health history

• [9:47] Patient's medical history and physical exam findings

• [13:40] Patient's lower back pain and potential neural tension testing

• [21:24] Cancer survivor's pelvic floor issues and potential treatments

• [25:50] Patient's strengths and weaknesses in physical therapy exercises

• [27:59] Treating pelvic floor dysfunction and GI issues through manual therapy

• [35:37] Abdominal breathwork and body mechanics

• [41:19] Managing a complex patient with back pain

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript

This episode captures a critical aspect of integrating sensory and motor aspects of colorectal rehab from constipation and IBS to fecal incontinence. 

The information is categorized under the hyposensitive vs. the hypersensitive quality of symptoms and the motor control from decreased muscle capacity, tissue quality, and motoric coordination.

A glance at this episode:

• [3:27] Rectal balloon therapy for bowel dysfunction

• [7:58] Rectal muscle exercises for constipation management

• [12:46] Rectal sensitivity in IBS patients

• [17:01] Treating anal inertia through physical therapy

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, Erica and Susan welcome Julia Rosenthal to the mic. 

Julia is a physical therapist in NYC. She brings a complex case of a postpartum patient of hers who has symptoms of urinary incontinence as well as other bowel and bladder issues that were made worse after giving birth. 

The patient is a personal trainer and used to high-load exercise, so the need to get back to this is strong. She also has complaints of abdominal bloating along with occasional musculoskeletal pain with CKC lower extremity work. 

This discussion is rich in treatment interventions for Julia's patient- from nutritional strategies to hormonal interventions to specific exercises the patient can do while feeling like she is loading her system in the necessary ways. Erica and Susan also discuss the importance of the thorax and its relationship to the pelvis and how best to balance these 2 regions of the body.

A glance at this episode:

• [2:13] Pelvic floor and orthopedic physical therapy for a postpartum woman with GI issues and fecal smearing

• [9:50] Postpartum bladder issues and musculoskeletal complaints

• [17:33] Thyroid issues and autoimmune disorders

• [21:36] Assessment and intervention for a patient with chronic constipation and pelvic floor dysfunction

• [27:36] Patient's pelvic floor mobility and lifestyle changes

• [33:06] Abdominal issues and breathing patterns

• [38:01] Managing IBS symptoms through breathing exercises and mindful eating

• [44:02] Using Nerva app for mental health

• [47:31] Exercises for a pregnant woman with thoracic issues

• [53:27] Addressing a personal trainer's physical and mental health issues

• [1:00:01] Patient care and therapy approaches.

Related links:

• Tough To Treat Website

• Erica’s Course: Decoding the Complex Patient

• Susan’s Pelvic Health Education Subscription

• Access the Transcript 

• Julia Rosenthal Website

• Julia Rosenthal IG