Tough to Treat
Episodes
Low Back Pain That Wasn't a Back Problem
20 Mar 2026
Contributed by Lukas
Her back hurt. But her back wasn't the problem. This is where the nuance comes in. In this episode, I dive into a fascinating clinical case involvin...
When Exercise Isn't Working
10 Feb 2026
Contributed by Lukas
If you have patients or are a person who "does all the exercises," gets stronger, and still doesn't feel better—this episode is for you. In this epi...
Advanced Clinical Reasoning: Applications Across the PT Spectrum
11 Sep 2025
Contributed by Lukas
In this episode, Erica explores how clinical reasoning informs decision-making across diverse areas of physical therapy practice. This is a clinical p...
Treatment Timelines and Tackling HEP Non-Compliance: Real Patient Cases
13 Aug 2025
Contributed by Lukas
How long should you keep treating a patient? And what's the best approach when they're skipping their home exercise program? In this listener Q&A epis...
Why is an old foot injury responsible for my current neck pain?
24 Jul 2025
Contributed by Lukas
In this episode, Erica dives into a fascinating case of a patient experiencing neck pain and how that seemingly isolated symptom actually traced back ...
Managing the Complex Patient – When the Body Chart Is Full
03 Jul 2025
Contributed by Lukas
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" every...
Bone and Power: Training Smarter Through Menopause
19 Jun 2025
Contributed by Lukas
This episode dives into some of the evidence on resistance vs. high-velocity power training in postmenopausal women and its impact on bone mineral den...
Physical Performance Decline in Menopausal Women: Strength vs Power
03 Jun 2025
Contributed by Lukas
In this episode, Erica dives into the latest research exploring how menopause affects physical performance in women—highlighting changes in power an...
Building Better PT Practices: Courses, Clinical Reasoning, and Mentoring Insights
28 Nov 2024
Contributed by Lukas
In this episode, we answer the most common questions we get from listeners. We dive into course recommendations, highlighting resources for continuing...
Complex shoulder pain - how the narrative and red flags paint a different picture
07 Nov 2024
Contributed by Lukas
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 element...
Shoulder Pain With Pull Ups or Push Ups? The Elbow Changes Everything
24 Oct 2024
Contributed by Lukas
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 workou...
Chronic Knee Pain - Where to Begin!
10 Oct 2024
Contributed by Lukas
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 exten...
Assessing Knee Health For Hip-Related Walking Pain
26 Sep 2024
Contributed by Lukas
In this episode, Erica explores the often-overlooked relationship between hip pain and knee function during walking when the patient does NOT have kne...
When shoulder pain is dominant, but not the driver!
12 Sep 2024
Contributed by Lukas
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 obv...
Beyond Tennis: Exploring Shoulder Compression Across Sports
05 Sep 2024
Contributed by Lukas
In this episode, Erica discusses the why behind shoulder problems, comparing the unique challenges faced by tennis players and non-tennis players alik...
A Stiff 1st MTP Joint can Affect Everything!
29 Aug 2024
Contributed by Lukas
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...
Fencer with Bilateral Calf Pain
22 Aug 2024
Contributed by Lukas
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 ...
The Role of the Diaphragm in Chronic Low Back Pain and GI Dysfunction
15 Aug 2024
Contributed by Lukas
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 ...
Hypermobility and Low Back Pain
08 Aug 2024
Contributed by Lukas
How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? Carefully and specifically! This episode highlights the be...
Low Back Pain - Regional vs. Movement System Considerations
01 Aug 2024
Contributed by Lukas
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 pres...
What To Do When You Are Their Last Resort
25 Jul 2024
Contributed by Lukas
Now, this is a CHALLENGING one! Ever have those patients who have been everywhere, had everything done to them (injections, surgeries, acupuncture) an...
Nociplastic Pain and a Visceral Driver
18 Jul 2024
Contributed by Lukas
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...
Junior Golfer With Persistent Unsolved Knee Pain
11 Jul 2024
Contributed by Lukas
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 exa...
What's Stopping this Former Fighter from Doing Push-Ups and Pull-Ups?
27 Jun 2024
Contributed by Lukas
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...
Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 2
13 Jun 2024
Contributed by Lukas
This episode is part 2 of episode 213. Utilizing evidence-based research and the latest clinical guidelines, the presentation will examine the multifa...
Chronic Constipation: Interventions Beyond Pelvic Floor Dyssynergia Part 1
06 Jun 2024
Contributed by Lukas
Utilizing evidence-based research and the latest clinical guidelines, the presentation will examine the multifactorial nature of chronic constipation,...
Postpartum Pelvic Pain and Urgency
23 May 2024
Contributed by Lukas
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...
How To Assess The Knee Differently
16 May 2024
Contributed by Lukas
In this episode, Erica explores new and novel ways to evaluate and treat the knee. She discusses different approaches aimed at providing a more accura...
Addressing the Gaps in a Patient's Exercise Program
09 May 2024
Contributed by Lukas
This episode zeroes in on a scenario many physical therapists face: patients diligently following their exercise routines but not seeing the expected ...
Food Allergies vs. Intolerance
02 May 2024
Contributed by Lukas
What is the difference between food allergies and food sensitivities? Join Susan as she discusses the importance of following the science and taking...
Back Pain/Leg Pain - Making the Right Call For Our Clients
25 Apr 2024
Contributed by Lukas
This episode presents what should be a straightforward case of a significant nerve root irritation. Unfortunately for this client, her situation was n...
Clinical Pearls For Effective Exercise Progression
18 Apr 2024
Contributed by Lukas
In this episode, Erica speaks about prescribing specific exercises based on the difficulty level relative to the region of the body driving the patien...
When The Driver Is Not The Pelvis
11 Apr 2024
Contributed by Lukas
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 ...
Physical Therapy Examination and Intervention of GI Dysfunction
04 Apr 2024
Contributed by Lukas
In this short episode, Susan presents a good algorithm for the examination and interventions in clients with GI dysfunction. Follow along as she dis...
Overactive Bladder and Hip Dysfunction
28 Mar 2024
Contributed by Lukas
This episode presents a client with a seemingly straightforward diagnosis in pelvic health of overactive bladder (OAB). The history and physical prese...
Exploring Open Chain vs Closed Chain Exercise in Upper Extremity Dysfunction
21 Mar 2024
Contributed by Lukas
In the episode, Erica explores the strategic use of open and closed-chain exercises for upper extremity dysfunction. She discusses the distinct benefi...
The Push Up: 2 Individuals, 2 Different Drivers and 2 Distinct Treatments
14 Mar 2024
Contributed by Lukas
In our latest episode, we explore the fascinating stories of two individuals navigating the challenges of mastering the push-up despite their unique i...
Outcome Measures and Pain in GI Dysfunction
07 Mar 2024
Contributed by Lukas
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 ...
The Balance System As A Driver
29 Feb 2024
Contributed by Lukas
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...
The Body's Story: Finding Out Why You Hurt Through Your Story and Movement Patterns
22 Feb 2024
Contributed by Lukas
In this episode, we explore the profound connections between personal narratives and the origins of someone's injury. Join Erica as she delves into th...
Chronic Low Back Pain and an Underlying Pathophysiological Change: We Adapt Until We Can't
08 Feb 2024
Contributed by Lukas
How important are past events to present movement patterns and restrictions? What about past events of herniated lateral discs or hypermobility on the...
Overcoming Fear-Based Movement Patterns
01 Feb 2024
Contributed by Lukas
In this empowering episode, we dive deep into the realm of fear-based movement and explore strategies to help patients conquer their anxieties, helpin...
How To Find The Driver Through Patient-Centered Listening
25 Jan 2024
Contributed by Lukas
Discover the art of being an active listener who can pick up clues in your patient's narrative to help you find their driver quicker. This will save y...
Take Back your Mental Fitness - Part 2
18 Jan 2024
Contributed by Lukas
Welcome to the New Year and one of the topics always discussed by Healthcare providers is burnout and imposter syndrome. Join Susan in this short podc...
Take Back Your Mental Fitness - Part 1
12 Jan 2024
Contributed by Lukas
Welcome to the New Year and one of the topics always discussed by healthcare providers is burnout and imposter syndrome. Join Susan in this short podc...
A Case of Lateral Hip Pain
04 Jan 2024
Contributed by Lukas
Hip pain can be brutal. And more often than not-it's chronic. Not like an acute ankle sprain or even acute low back pain. People who suffer from hip...
Thoracic Mobility Beyond The Breath
21 Dec 2023
Contributed by Lukas
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 import...
Stress, Exercise and Sleep as it Relates to the GI System
14 Dec 2023
Contributed by Lukas
Many times, clinicians find that people with correlative GI system dysfunction are very overwhelming. The complexity makes it difficult to know where ...
A Complex Client With Medical Red Flags
07 Dec 2023
Contributed by Lukas
Susan and Erica welcome Kelly McClain to the podcast to discuss a very complex client with pelvic health, orthopedic, and neurological issues. Follo...
How To Diagnose A Young Soccer Player's Groin Pain
30 Nov 2023
Contributed by Lukas
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 so...
Why Does My Foot Hurt? What's Going On?
23 Nov 2023
Contributed by Lukas
Why would someone who is 3 months post-fibular fracture get worse after a basic theraband ankle exercise? Not everyone needs inversion and eversion ...
The GI System - Food intolerances vs. Allergies
16 Nov 2023
Contributed by Lukas
We continue with our GI dysfunction theme in this podcast about food intolerances/sensitivities vs. allergies. Join Susan as she takes you through t...
The Role of the Diaphragm in Chronic Low Back Pain and GI Dysfunction
09 Nov 2023
Contributed by Lukas
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 o...
When Do You Treat The Viscera?
02 Nov 2023
Contributed by Lukas
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 mean...
Back Pain, Thoracic Outlet, Post Cancer Recovery - Where do I go from here?
26 Oct 2023
Contributed by Lukas
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 ap...
Colorectal Sensory Motor Integration
19 Oct 2023
Contributed by Lukas
This episode captures a critical aspect of integrating sensory and motor aspects of colorectal rehab from constipation and IBS to fecal incontinence. ...
Post Partum: Urinary Incontinence, Abdominal Bloating and a Return to High Intensity Exercise
12 Oct 2023
Contributed by Lukas
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...
How To Increase Patient Adherence To Exercise
05 Oct 2023
Contributed by Lukas
How do you increase patient compliance with their exercise program? This can be very frustrating for both the therapist and the patient. In this s...
Unraveling the Web of Neuralgia: Navigating the Cervical Spine
28 Sep 2023
Contributed by Lukas
In this episode Susan and Erica welcome a Tough To Treat listener, Megan Barclay. Megan brings a case of a patient who continues to suffer neuralgia a...
Breath, Voice and HRV as Predictors and Interventions in Pelvic Health - Part 2
21 Sep 2023
Contributed by Lukas
Look beyond the traditional regional approach of the pelvic and pelvic floor and understand how discovering and addressing dysfunctions of the trigemi...
Breath, Voice and HRV as Predictors and Interventions in Pelvic Health - Part 1
14 Sep 2023
Contributed by Lukas
Look beyond the traditional regional approach of the pelvis and pelvic floor and understand how discovering and addressing dysfunctions of the trigemi...
The Mystery of This Man's Struggle With Pelvic Girdle Pain and the Breath
07 Sep 2023
Contributed by Lukas
In this episode, we dive into the often overlooked and misunderstood world of male health, exploring the complexities of groin pain, the challenges of...
Shoulder Pain- A Motor Control Problem?
31 Aug 2023
Contributed by Lukas
When does motor control come into play when someone has persistent shoulder pain? Is it soft tissue related, a joint problem, or a neuromuscular rep...
SI Joint Pain - An Updated Approach
24 Aug 2023
Contributed by Lukas
Here is the clinical story of a client that is presenting with pain/sensitivity in the area of the (R) posterior pelvis. A common area of symptoms f...
Finding Hidden Connections In Functional Movements- Why They Matter
17 Aug 2023
Contributed by Lukas
In this episode, Erica explores the intersection of functional movement and persistent pain, offering a comprehensive blueprint for understanding and ...
A Stiff 1st MTP Joint can Affect Everything!
10 Aug 2023
Contributed by Lukas
One of the most overlooked joints in the lower quarter is the first MTP joint unless that is the primary complaint of the client. How does the stiff...
HRV as A Predictor and Intervention in Sleep and Stress
03 Aug 2023
Contributed by Lukas
Heart rate variability is getting a lot of press recently. Join Susan as she presents a webinar on HRV as a predictor and intervention in sleep and ...
Pain Without a Diagnosis: The Complexities of Managing Medically Unexplained Symptoms
27 Jul 2023
Contributed by Lukas
In this episode, we delve into the perplexing realm of medically unexplained pain and the challenges it presents for healthcare professionals. Join ...
Decoding Persistent Hip Labral Tears - It's Not Always What We Think
20 Jul 2023
Contributed by Lukas
Have you ever had patients with "diagnoses" of labral tears on MR only to find out that the hip was not the driver? Of course, you have. In this s...
Chronic Low Back Pain and Constipation - Why it Matters!
13 Jul 2023
Contributed by Lukas
Clients often have chronic low back pain as a primary or secondary issue. It is often combined in complex presentations where addressing one issue i...
Pelvic Girdle Pain: Current Concepts Part 2
06 Jul 2023
Contributed by Lukas
Clinical practice guidelines provide the practitioner with the most up-to-date research on a certain diagnosis or condition. Join Susan in a two-par...
Unraveling a Compression Fracture in a Young Male
29 Jun 2023
Contributed by Lukas
Compression fractures are commonly associated with osteoporosis in older adults. However, what happens when these fractures occur in young males? In...
Meeting Patient Expectations- Navigating the Journey to Progress
22 Jun 2023
Contributed by Lukas
This is an excerpt from Erica's DCP course call in February of 2023. In this episode, she delves into the crucial aspect of meeting patient expectat...
When Shoulder Pain is Dominant, but Not the Driver!
15 Jun 2023
Contributed by Lukas
Shoulder pain, like any other joint can present as primary pain and be the #1 reason a client may seek help! In many cases, treating the apparent jo...
Pelvic Girdle Pain: Current Concepts Part 1
08 Jun 2023
Contributed by Lukas
Join Susan in a two-part interview about Pelvic Girdle Pain in the Antepartum Population. Clinical practice guidelines provide the practitioner with...
From Neck Pain to Shoulder Pain: Unraveling the Links Between the Two
01 Jun 2023
Contributed by Lukas
Does stretching work when a muscle is over-recruited? Not if you don't change the movement pattern. This is an excellent follow-up to episod...
Unique Release Positions for the Shoulder: Positioning for Optimal Results
25 May 2023
Contributed by Lukas
The purpose of release is to train. Remember that. Long gone are the passive release positions for patients. Think about the connections in the re...
Complex Chronic Low Back Pain - When A Regional Approach Will Not be the Best Option
18 May 2023
Contributed by Lukas
Where do you start with a client with complex regional pain that has full-body implications? Listen to their story, look for the change talk, and g...
Trigeminal System Referral Pattern
11 May 2023
Contributed by Lukas
What is the referral pattern for the Trigeminal System? What does that mean for our clients? The cervical nucleus of the trigeminal syst...
Pelvis Driver In A Male Weightlifter
04 May 2023
Contributed by Lukas
This episode is all about low back pain with a pelvis component in a 33-year-old male weightlifter. Erica and Susan discuss how his history of ch...
Assessing The Knee Differently
27 Apr 2023
Contributed by Lukas
In this "shortie" episode Erica discusses different ways she assesses the knee. There are 3 parts to the knee joint and assessing a movement patt...
Foot Drivers - The Prequel to the Foot Progression Exercises
20 Apr 2023
Contributed by Lukas
Erica and Susan have presented several podcasts discussing the exercise progression of the foot as the primary and secondary driver. Today they disc...
Anatomy and Physiology Interactions of the GI System - Part 2
13 Apr 2023
Contributed by Lukas
This is part 2 of a short webinar on the interactions of the functional anatomy and physiology of the GI system, presented by Susan Clinton. This w...
What Do Weightlifting And Poledancing Have In Common?
06 Apr 2023
Contributed by Lukas
Answer: A dominant movement pattern that is the same across all this patient's activities. No 1- weightlifters brace and dump their shoulder blades ...
Anatomy and Physiology Interactions of the GI System - Part 1
30 Mar 2023
Contributed by Lukas
This is part 1 of a short webinar on the interactions of the functional anatomy and physiology of the GI system. Listen to the unique anatomical ...
Hypermobility and Low Back Pain
16 Mar 2023
Contributed by Lukas
How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? Carefully and specifically! When someone who is hyperm...
Why Has My Patient Stopped Improving?
09 Mar 2023
Contributed by Lukas
Ep 152: Why Has My Patient Stopped Improving? In this episode, Erica discusses the fine points of what to do when your patient stops improving. ...
Estrogen Levels and Changes in the Musculoskeletal System
02 Mar 2023
Contributed by Lukas
In previous episodes, Susan and Erica discussed the effects of decreased estrogen at peri and post-menopause with tendinopathies. In this episode, S...
Shoulder Girdle Hypermobility vs. Thoracic Stiffness - Where is the Balance
23 Feb 2023
Contributed by Lukas
Many of our episodes have included clients on the hypermobile end of the spectrum with a stiff thorax. How do you balance increasing thorax movement...
Advanced Clinical Reasoning With Your Toughest Patients
16 Feb 2023
Contributed by Lukas
In this episode, Erica throws out some clinical gems when it comes to clinical reasoning through these scenarios. What do you do when your patient...
Down Training Non-Optimal Movement Patterns to Make Exercise More Effective
09 Feb 2023
Contributed by Lukas
In this episode, Erica and Susan discuss how to identify someone's non-optimal movement pattern, aka the "dominant pattern" or "the impairment", and u...
Hormone Balance - Estrogen and Why it Matters
02 Feb 2023
Contributed by Lukas
Hormones have a significant influence not only within the balance of the endocrine system but also the effect on the MSK system. Join a discussion S...
Shoulder Stiffness - When the Tissue is the Driver!
26 Jan 2023
Contributed by Lukas
Shoulder pain, stiffness, and lack of functional mobility are not uncommon in clients with post-breast cancer. Join us as we discuss the evaluation ...
Manual Therapy Or Not? Hands Off Or Hands On? Or Both?
19 Jan 2023
Contributed by Lukas
When do you make the clinical decision to put your hands on your patient or take them off? We are changing brain maps and our hands act as facilitat...
Grow Your Clinical Expertise By Learning How To Treat The Complex Patient (Part 2)
12 Jan 2023
Contributed by Lukas
Join Susan and Erica while they present case studies to highlight clinical reasoning. This is part 2 of a 2-part series from a webinar. These case s...
Grow Your Clinical Expertise By Learning How To Treat The Complex Patient (Part 1)
05 Jan 2023
Contributed by Lukas
In this 2 part episode, Susan and Erica discuss what it takes to become a clinical expert, and how that translates into effectively assessing and tre...
Breath and the Chest Wall
21 Dec 2022
Contributed by Lukas
Let's talk about breathing patterns. Somewhere along the line, chest movement with diaphragm movement became unpopular. Was this because people equ...
Foot and Hip Pain? Why You Treat The Thorax
15 Dec 2022
Contributed by Lukas
Your patient has a dysfunctional thorax and it's driving their symptoms, wherever they are. How can you clinically reason treating a non-painful thora...
How To Increase Proprioception - An Updated Approach
08 Dec 2022
Contributed by Lukas
What are the clues and the keys to increasing somatosensory awareness in your patients? Putting someone on a dynadisc or a foam pad does not cut it a...
A Fencer With Bilateral Calf Pain - Where's The Driver?
01 Dec 2022
Contributed by Lukas
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...