In this episode, Erica dives into a fascinating case of a patient experiencing neck pain and how that seemingly isolated symptom actually traced back to an old foot injury. This case exemplifies the deep, interconnected nature of the human body. For those you have been listening for a while, this should not surprise you. She unpacks the biomechanical and neural links between the foot and cervical spine, exploring how altered load distribution and compensatory patterns can persist long after the ...
Jul 24, 2025•29 min•Ep. 234
In this episode, Erica talks about how to approach care when a patient has a long history of injuries and a body chart that seems to be "lit up" everywhere. It can feel overwhelming—for both the patient and the clinician. She focuses on the importance of prioritization: identifying what’s most clinically relevant right now. This involves connecting the dots to perhaps an old injury to what the current problem is. In this particular case, frequent bilateral ankle sprains, an ACL reconstruction pl...
Jul 03, 2025•18 min•Ep. 233
This episode dives into some of the evidence on resistance vs. high-velocity power training in postmenopausal women and its impact on bone mineral density (BMD). Research is highlighted showing that high-speed training protocols may stimulate bone more effectively than traditional resistance training by increasing strain rates and promoting osteogenic adaptation. You’ll learn how moving with speed and control helps strengthen bones and prevents age-related decline better than slow, heavy lifting...
Jun 19, 2025•34 min•Ep. 232
In this episode, Erica dives into the latest research exploring how menopause affects physical performance in women—highlighting changes in power and strength. These findings are reshaping how we approach exercise and rehab in midlife women. Next, she shares an update on her dissertation, which compares premenopausal and postmenopausal women on key physical performance metrics. Erica discusses early patterns emerging from the data, including potential implications for exercise training and rehab...
Jun 03, 2025•35 min•Ep. 231
In this episode, we answer the most common questions we get from listeners. We dive into course recommendations, highlighting resources for continuing education, mentoring and evidence-based practices. A key focus is on clinical reasoning strategies—how to approach complex cases and integrate patient-specific factors into your decision-making. We also discuss the value of spending the majority of your first session taking the patient’s story. Your patients will make you a better physical therapi...
Nov 28, 2024•28 min•Ep. 230
Clients self-refer for many reasons and we find ourselves on the front line of health care screening. Join Susan and Erica as they uncover key elements in a client's history and narrative around long-standing shoulder pain. Simplistic presentations usually mask true underlying considerations including the client's beliefs and red flags. A glance at this episode: [1:41] Client's Initial Presentation and History [4:07] Exploring Past Injuries and Chronic Bike Riding [6:56] Impact of Corporate Life...
Nov 07, 2024•48 min•Ep. 229
In this episode, we explore the surprising journey of a boxer battling chronic shoulder pain that left him struggling to do even the most basic workout. Despite focusing on his shoulder, it turns out the root of his problem lay elsewhere—his elbow. Is that surprising? It was in his injury history. Do not discount the power of an old injury that could come back and haunt you. And think about the load on the elbow when you're doing a push or pull-up. Join us as we clinically reason through this in...
Oct 24, 2024•43 min•Ep. 228
Susan and Erica are back together for the Fall season! Chronic knee pain can be much more than a regional event. Susan presents a client with an extensive timeline and clinical reasoning as to why it is important to consider the entire system in this integrated approach. The key here is also maintaining relevance and sustainability for the client. A glance at this episode: [1:18] Explanation of Episode Structure and Content [2:59] Introduction to the Client Case Study [5:30] Client's Medical His...
Oct 10, 2024•39 min•Ep. 227
In this episode, Erica explores the often-overlooked relationship between hip pain and knee function during walking when the patient does NOT have knee pain. Join in as she dives into the role of the knee in compensating for hip dysfunction, and how a thorough knee assessment can uncover hidden contributors to hip discomfort. Remember: old injuries have a way of sneaking up on us and becoming one of the drivers of our current problem. An old hamstring tear 5 years ago as a contributor to this pa...
Sep 26, 2024•22 min•Ep. 226
Shoulder pain, like any other joint can present as primary pain and can be the #1 reason a client may be seeking help! In many cases, treating the obvious joint dysfunction (because it checks all of the boxes) may not result in optimal outcomes. Join the conversation as Susan and Erica explore the various reasons and important timelines in the client's history that has led to her shoulder pain. Most importantly follow the clinical reasoning that led to the real driver of this issue. Bonus - we a...
Sep 12, 2024•33 min•Ep. 225
In this episode, Erica discusses the why behind shoulder problems, comparing the unique challenges faced by tennis players and non-tennis players alike. She explains why traditional shoulder treatment often fails these types of patients. A significant relationship between the shoulder and another region of the body is often missed. Erica also tells the story of one of her patients who does play tennis and the reason why he can do a full pushup but can't lift his arm over his head. For our physio...
Sep 05, 2024•21 min•Ep. 224
One of the most overlooked joints in the lower quarter is the first MTP joint unless that is the client's primary complaint. How does the stiffness of the MTP joint affect gait and lower quarter movement of all kinds? We spend some great time discussing differential diagnosis and practical interventions and sharing some new discoveries. Hint: the exam and intervention do not always center around the stiff 1st MTP - there is likely a primary driver elsewhere. A glance at this episode: [0:01] Intr...
Aug 29, 2024•36 min•Ep. 223
What is the cause of bilateral calf pain in this young fencer? From start to finish, it shows the power of a thorough evaluation, a specific exercise progression, and a return to the sport she loves. When it comes to exercise progression in persistent pain, think about context. How can you improve optimal movement patterning by changing the context? Think about this one. You can intervene via the visual system, eyes open, eyes closed. How about changing their base of support? Wide to narrow. And...
Aug 22, 2024•52 min•Ep. 222
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 inhibiition/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 and is an ineffectual model for spine stiffness and visceral organ pusher. This is an excellent discussio...
Aug 15, 2024•42 min•Ep. 221
How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? Carefully and specifically! This episode highlights the beauty of a specific exercise progression tailored to the patient's meaningful movement. Listen as we go through the clinical reasoning process to determine what types of movement patterns will work and what ones won't. Doing the right thing at the right time is clinical expertise. A glance at this episode: [5:13] Hypermobility and pain management fo...
Aug 08, 2024•48 min•Ep. 220
If it walks like a duck and quacks like a duck - it must be a duck, right? Low back pain is a descriptive term at best, indicating where symptoms present. Join Susan and Erica as they explore this Tough to Treat client with low back pain and mild stress urinary incontinence. Discover the history and the movement system examination and interventions that led to the successful reduction of symptoms. *Hint: this really isn't a duck! Visit our website: toughtotreat.com A glance at this episode: [0:0...
Aug 01, 2024•33 min•Ep. 219
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 low back was not the source of her problem. Why do you think that is? Remember, we bring all of our compensations to our life events...
Jul 25, 2024•53 min
What 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! A glance at this episode: [0:01] Left lower quadrant pain, nociceptive input from visceral driver [2:23] Pelvic pain and potential...
Jul 18, 2024•38 min•Ep. 217
Golf is a sport of weight shifts and a narrow base of support. What happens when your knee can't adapt to an altered base of support? This is what exactly happened here with this case. This young golfer, in standing (and standing is VERY relevant for the golf swing) had an 80/20 load, R/L in this position. And it stayed that way throughout the golf swing. This begs the question: Did you know that right knee pain can be caused by an imbalance in your center of mass? If you continuously load your ...
Jul 11, 2024•52 min•Ep. 216
In this episode, Erica dives into the intriguing story of a former fighter who faced unexpected challenges with basic exercises like push-ups and pull-ups. She sheds light on how years of specialized training led to muscle imbalances and problems outside the ring. The "push" and "pull" are different movement patterns. What region(s) of the body are challenged with these movements? Remember the "push" is a 4-point closed chain movement and the "pull" is not. What do fighters do on a routine basis...
Jun 27, 2024•19 min•Ep. 215
This episode is part 2 of episode 213. Utilizing evidence-based research and the latest clinical guidelines, the presentation will examine the multifactorial nature of chronic constipation, including non-pelvic interventions that can complement existing treatments. One key aspect will be the practical application of the balloon catheter, demonstrating its effective use for both assessment and therapeutic interventions. A glance at this episode: [0:01] Chronic constipation interventions and asses...
Jun 13, 2024•25 min•Ep. 214
Utilizing evidence-based research and the latest clinical guidelines, the presentation will examine the multifactorial nature of chronic constipation, including non-pelvic interventions that can complement existing treatments. One key aspect will be the practical application of the balloon catheter, demonstrating its effective use for both assessment and therapeutic interventions. A glance at this episode: [0:01] Chronic constipation and its impact on pelvic floor health [4:24] Constipation and ...
Jun 06, 2024•24 min•Ep. 213
There are many ways to approach pelvic pain and symptoms of urinary urge incontinence, but did you know that how the MSK system moves can affect these symptoms as well? On this podcast, we dive into the movement system, past/present autoimmune history, and post-partum process while changing this client's symptoms as well as her urinary incontinence. In turn, she regains control over her pelvic pain! A glance at this episode: [0:01] Postpartum pelvic pain and urinary incontinence in a 34-year-old...
May 23, 2024•52 min•Ep. 212
In this episode, Erica explores new and novel ways to evaluate and treat the knee. She discusses different approaches aimed at providing a more accurate assessment of the knee. Join her as she emphasizes the importance of training your vision. What does "optimal" movement look like for that particular patient? Does what you see match what you feel? Are you assessing the knee in a movement that is relevant to the patient? If someone's right knee is sore when they are walking with that leg behind,...
May 16, 2024•17 min•Ep. 211
This episode zeroes in on a scenario many physical therapists face: patients diligently following their exercise routines but not seeing the expected progress or recovery. We discuss thorax, foot, and knee drivers as examples and why there can be holes in someone's program even after they've been doing advanced exercises. Being able to identify the patient's impairments is a good start. We discuss common strength holes along with typical overactivity patterns in these patients. Susan and Erica a...
May 09, 2024•35 min•Ep. 210
What is the difference between food allergies and food sensitivities? Join Susan as she discusses the importance of following the science and taking the guess work out of the food allergy vs. sensitivity issue and why this is important for systemic inflammation. A glance at this episode: [3:19] Dietary elimination for gut health and food intolerances [9:18] Gluten sensitivity and its impact on IBS symptoms [13:14] Gut microbiome's role in digestion, immunity, and weight gain Related links: Tough...
May 02, 2024•21 min•Ep. 209
This episode presents what should be a straightforward case of a significant nerve root irritation. Unfortunately for this client, her situation was not addressed adequately and has left her in a lot of pain for over 3 months. Join us as Susan presents this client case, what went wrong, and the assessment and intervention with a rich discussion of the path forward. Here is a Hint: center of mass and chronic loading play a strong part in this story! A glance at this episode: [2:21] Back and glute...
Apr 25, 2024•40 min•Ep. 208
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 c...
Apr 18, 2024•25 min•Ep. 207
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 furth...
Apr 11, 2024•47 min•Ep. 206
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 pel...
Apr 04, 2024•20 min•Ep. 205
