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 plus a continued pattern of bilateral issues help you nail down your focus to what is important for you to assess and what is important for the patient to feel.

These patterns not only shape your clinical focus—helping you decide what truly needs assessment—but also give the patient a clearer sense of what their body is trying to communicate. What is relevant to you may not be important to them. It's up to you to explain to them why.

Key takeaways include:

· Avoiding the trap of chasing every symptom.

· Establishing a hierarchy of concerns using patient input and objective findings.

· Acknowledging the complexity of the history without letting it dictate the entire plan.

Related links:

• Tough To Treat Website

• Erica’s Website

• Susan’s Website

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 alone.

Some of Erica’s research for her doctoral dissertation is discussed and she then presents a case study of a menopausal patient with insidious-onset shoulder pain and offers some clinical pearls as to why, especially in anyone who has played a racquet sport, the shoulder is not the only driver. She also highlights a few targeted interventions that allowed this woman to weight lift and strengthen her shoulder without feeding into her symptoms.

The content contained therein, including text, images, audio, or other formats, were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Related links:

• Tough To Treat Website

• Erica’s Website

• Susan’s Website

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 prescription.

She wraps up with a clinical case involving a woman in menopause experiencing persistent neck and shoulder pain, along with difficulty breathing. She breaks down the history along with a few clinical pearls outlining how past injuries have and continue to contribute to this woman’s issues. Erica also breaks down her exercise program, discussing the do’s and don’ts of exercise progression.

Hormonal changes can contribute to musculoskeletal tension and diaphragmatic dysfunction- we know this. But do we really educate our patients on this? Many do not. Whether you're a clinician, researcher, or someone navigating midlife changes, this episode offers insight, evidence, and strategies for supporting well-being during menopause.

Related links:

• Tough To Treat Website
• Erica' Website
• Susan's Website