When Exercise Isn't Working

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