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 involving a hypermobile pole dancer presenting with low back pain — where the lumbar spine was the pain generator but not the driver. The real culprits? Her knee and foot. Surprised?

I walk through the clinical reasoning process that shifted the treatment focus away from the low back and down the kinetic chain, and explore what that looked like in practice through progressive exercise programming geared towards her real drivers.

This patient had a history of ACL surgery with lateral meniscus repair, along with a torn right AND left hamstring. If you don't think that is relevant to her low back pain, think again. Make the connection.

✅ Always ask youself: "Is this the pain generator or the driver?"

✅ In hypermobile patients, control and stiffness are often the missing ingredients — not flexibility

✅ Pilates offers an exceptional framework for graded loading in hypermobile movers when applied thoughtfully

✅ Treating distally can resolve proximal pain — trust the kinetic chain

✅ Know your patient's sport or art form — it shapes everything about your programming

Do you ever have patients or even yourself, that are chronically gripping their back? Using their back muscles for practically everything? It's fairly common, but can get in the way of a very strong and thoughtful rehab program.

You've seen this before. Everything is braced, stiff and locked down — they are essentially planking through their entire day. In this episode, Erica breaks down this pattern, why it develops, and most importantly — how to change it. From using your environment and simple props to reduce guarding, to a practical exercise progression to retrain movement, this episode gives you a clear roadmap.

This is a movement pattern we see frequently in clinical practice. But how do you train someone out of this habit? Take squats, for example. Then squats, holding a pillow in front of you. Same movement, but you're holding onto a pillow to reduce some of your back gripping. Erica talks about how to develop a reference for center and some strategies for weightlifting when you're on a incline bench in the gym.

This is an important episode to listen to because this is such a common pattern and often prolongs rehab when not addressed early on.

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