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 episode, Erica dives into how to advance exercise prescription for patients who are often labeled as "tough to treat." These are the individuals who don't respond well to traditional strengthening or mobility programs and may experience pain, guarding, or flare-ups with exercise.

She explores how exercise positioning, load selection, and movement strategy can dramatically change outcomes. Rather than defaulting to more reps or heavier weights, she discusses how altering body position and the relationship to gravity can allow patients to move with less threat, better control, and more efficiency.

One aspect of this episode is working with people who chronically grip or brace their low back muscles. She talks through practical strategies to reduce excessive tone and reintroduce movement without reinforcing protective patterns that limit progress.

Erica also discusses the role of advanced exercise positions and Pilates-based approaches, highlighting how these methods can be used thoughtfully to improve load tolerance—especially for patients who need more than basic exercises but aren't ready for high-demand training.

This episode challenges the idea that "tough to treat" patients need more effort or tougher exercises, and instead reframes progress around smarter positioning, intentional loading, and movement quality to help people move with confidence again.

Related links:

• Erica's Website

• Susan's Website

In this episode, Erica explores how clinical reasoning informs decision-making across diverse areas of physical therapy practice. This is a clinical pearls discussion that will save you lots of time in the clinic.

From CKC to OKC brain mapping in an MMA fighter to exercise progression in ACL rehabilitation to thoracic dysfunction in a post partum runner experiencing hip pain and incontinence, she highlights key clinical reasoning strategies that guide effective treatment and exercise progression.

For example, if your patient has a bracing strategy in their lumbar spine where they always "grip" their back when they sit, stand and even go supine, how would you prescribe exercise to "take out" that strategy to give them more options for movement?

Many people do this in our "sit up straight" culture. This will make a huge difference in your practice!

Related links:

• Tough To Treat Website

• Erica's Website

• Susan's Website

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 episode, Erica shares practical strategies—illustrated through two real patient cases, one a golfer and the other a cyclist—for answering the tough question of treatment length and for addressing non-compliance.

She highlights how building a strong therapeutic relationship can improve follow-through and make these conversations more productive. Erica also highlights the most important phases of an exercise program to ensure efficiency and compliance.

To close, Erica offers a brief update from her doctoral research on menopause, focusing on the role of muscle power in older women and why it may be a more critical predictor of function than strength alone.

Related links:

• Tough To Treat Website

• Erica's Website

• Susan's Website