No Plateau Podcast

About No Plateau Podcast

Henry Hoffman, licensed Occupational Therapist and Co-founder of Saebo Inc., always believed there was no such thing as "plateauing" in stroke and traumatic brain injury recovery. When survivors stop seeing progress in their recovery journey, they're often told that they've "plateaued" and have no choice but to accept this reality. If you ask Hoffman, he'll tell you this – "It's not the patient that plateaus, it's their treatment options that do." It's why he co-founded his company Saebo (a medical device company focused on stroke and TBI rehab) on the mantra "No Plateau in Sight." So, how exactly can survivors keep pushing to overcome the fate of plateau? Hoffman is on a mission to speak to anyone and everyone out there defying the norm in neuro-rehab. This is the No Plateau Podcast – the podcast for stroke and brain injury survivors, their caregivers, and the therapists helping them to break boundaries in their recovery journey.

Publisher

Henry Hoffman

Category

education · health & fitness · science

Language

en

Explicit

No

First episode

11 Jul 2022

Latest episode

1 Oct 2026

Latest episodes

29 episodes in the feed.

1. 

   1 Oct 2026

   The Painful Shoulder After Stroke: Finding the Right Treatment with Dr. Clay Guynn

   In this episode of the No Plateau Podcast, host Henry Hoffman sits down with Dr. Clay Guynn, a board-certified PM&R physician with fellowship training in sports medicine, to tackle one of the most common and frustrating complications after stroke: hemiplegic shoulder pain. Dr. Guynn breaks down why shoulder pain after stroke is rarely a single diagnosis; it can arise from spasticity, musculoskeletal issues, neuropathic pain, or any combination of the three. He explains his "onion" approach to evaluation, where each layer of pain must be identified and addressed individually. The conversation covers diagnostic workups, the role of ultrasound-guided procedures, and how interventions like hydrodilation, diagnostic nerve blocks, Botox, and cryoneurolysis fit into the treatment puzzle. Henry and Dr. Guynn also explore why early physiatry involvement matters, the critical role of therapists in both identifying pain generators and maximizing the benefits of medical interventions, and why communication between providers is the single most important factor in successful outcomes. Dr. Guynn shares practical insights from his practice, from performing suprascapular nerve blocks to using hydrodilation for frozen shoulder to leveraging cryoneurolysis for longer-lasting spasticity relief. The episode underscores that hemiplegic shoulder pain isn't just about treating pain; it's about enabling patients to engage their impaired side, which directly impacts neuroplasticity and long-term recovery. Listen to the full episode to learn how a multidisciplinary, layered approach can transform the way we understand and treat post-stroke shoulder pain. In This Episode Introduction to Dr. Clay Guynn (01:00) Personal and professional background (01:52) Connecting at the AOCAPMR cryoneurolysis course (04:30) Stroke shoulder pain by the numbers (06:25) The 3 pain generator buckets: spasticity, orthopedic, neuropathic (08:42) Understanding neuropathic pain after stroke (13:47) What frozen shoulder really is (and isn't) after stroke (16:58) Frozen shoulder and subluxation prevalence data (21:45) Building a diagnostic workup: history, exam, and ultrasound (23:32) Diagnostic nerve blocks in practice (28:11) Case example: suprascapular, Sargent's patch, and lateral pectoral blocks (30:59) Blocking pain vs. fixing the underlying problem (34:08) What the evidence actually shows for PT/OT interventions (39:39) The physiatrist's role: pain, psych referrals, and CBT (41:13) Why hemiplegic shoulder patients need a neuro-trained therapist (44:48) Choosing an intervention: clinical reasoning and timing (46:05) Hydrodilation for adhesive capsulitis (48:05) Introduction to cryoneurolysis for shoulder pain (52:04) Tenotomies and fascial scraping (54:53) Treating CRPS and central post-stroke pain (56:44) Neuroplasticity, learned non-use, and why timing matters (01:00:07) Fixing the communication gap between physicians and therapists (01:01:22) Why therapists should shadow procedures (01:05:30) The future of shoulder pain rehab: shockwave, PNS, and beyond (01:07:58) Pain, motor relearning, and cortical reorganization (01:13:02) Closing thoughts and contact information (01:16:49) Our Guest Clay Guynn, DO Dr. Clay Guynn is a triple board-certified PM&R physician and osteopathic physician fellowship-trained in sports medicine, currently practicing in Atlanta, Georgia. He completed his PM&R residency at the University of Kentucky and a sports and spine fellowship in Florida. His clinical practice spans the full spectrum of physiatry, from spinal cord injury, stroke, and cerebral palsy patients to elite athletes, he serves as head team doctor for USA Blind Soccer (traveling with the team through the 2028 Games) and cares for athletes at four high schools and a college. His interventional toolbox includes diagnostic nerve blocks, joint and soft tissue injections, botulinum toxin, radiofrequency procedures, and cryoneurolysis, which he has used for spasticity management for the past four years with strong results. Resources & Links Dr. Clay Guynn on LinkedIn Henry Hoffman on LinkedIn Saebo On YouTube On Instagram On LinkedIn

2. 

   13 Apr 2026

   Cryoneurolysis: The Next Frontier in Spasticity Treatment

   In this episode of the No Plateau podcast, host Henry Hoffman sits down with physiatrist and researcher Dr. Paul Winston to talk about cryoneurolysis, an emerging treatment that is gaining attention in neurorehabilitation. Dr. Winston breaks down how this minimally invasive technique works and why it is generating excitement among clinicians treating spasticity. Using a probe that delivers extremely cold temperatures, around −88°C, through gases like nitrous oxide, clinicians create a small “ice ball” around targeted peripheral nerves. This controlled freezing temporarily interrupts the nerve signals that drive muscle overactivity. The key advantage is that the nerve’s structure stays intact, allowing it to regenerate over time and creating a valuable window for rehabilitation and functional recovery. Henry and Dr. Winston also explore how cryoneurolysis compares with more familiar treatments like botulinum toxin injections, nerve blocks, and surgical approaches. While some treatments chemically block or damage nerve signaling, cryoneurolysis uses a physical process that allows nerves to recover gradually. Dr. Winston shares stories that will stick with you, the husband grasping his wife's hand for the first time in years, the 12-year-old boy applying his own deodorant, the patient who threw away his AFO and now runs through the neighborhood. These aren't just clinical successes; they're reminders of why we do this work. The conversation also highlights how collaboration between physicians, occupational therapists, and physical therapists can help patients make the most of this recovery window. Listen to the full episode to learn how cryoneurolysis may reshape the future of spasticity treatment and what it could mean for your clinical practice or rehabilitation journey. In This Episode Podcast disclaimer (00:09) Introduction to Dr. Paul Winston (01:21) From dance to rehab (02:44) How cryoneurolysis differs from cryotherapy (05:35) How cryoneurolysis became part of Dr. Winston’s practice (09:11) The first cryoneurolysis patient: eureka moment that changed everything (13:13) Anatomy of a nerve: what actually happens during cryo (16:28) Using ultrasound and electrical stimulation to target nerves (23:30) Sensory vs motor nerves in cryoneurolysis treatment (25:58) What spasticity really is beyond textbook definitions (30:02) Comparing common spasticity interventions: Botox, phenol, and cryoneurolysis (33:44) Choosing cryo vs Botox (38:35) Toxin vs cryo: comparing mechanisms and applications (39:26) How Botox works (41:33) Contraindications and potential side effects of cryoneurolysis (43:21) How therapists should use cryoneurolysis in rehab (50:01) Real patient outcomes and functional improvements (56:01) The future of cryoneurolysis in rehabilitation (01:00:53) Understanding reducible deformity vs contracture (01:05:38) Where clinicians can learn more about cryoneurolysis (01:07:56) Our Guest Dr. Paul Winston, MD Dr. Paul Winston is a Canadian physiatrist and Clinical Associate Professor at the University of British Columbia specializing in neurological rehabilitation and spasticity management. Originally trained as a dancer at Canada’s National Ballet School, he brings a unique perspective on movement to rehabilitation medicine. He is widely recognized for advancing cryoneurolysis and is a co-founder of the Canadian Advances in Neuro Orthopedics for Spasticity Consortium. His work focuses on improving movement and quality of life for people living with neurological disabilities. Resources & Links Dr. Paul Winston on LinkedIn Henry Hoffman on LinkedIn Saebo On YouTube On Instagram On LinkedIn

3. 

   23 Feb 2026

   Spasticity Without the Plateau: Science, Access, and the Path Forward

   In this episode of the No Plateau Podcast, host Henry Hoffman dives deep into one of the most misunderstood and impactful challenges in neurorehabilitation: spasticity. Joined by nationally recognized physiatrist and researcher Dr. Monica Verduzco-Gutierrez, the conversation goes far beyond definitions to explore how spasticity truly affects function, quality of life, access to care, and long-term outcomes for stroke and brain injury survivors. Dr. Verduzco-Gutierrez breaks down why the classic, textbook definition of spasticity falls short in real-world practice and explains how clinicians should think about spasticity as part of a broader upper motor neuron syndrome. Together, they unpack how spasticity actually presents in daily life, how to explain it clearly to patients and caregivers, and why functional assessment matters more than a number on a scale. The discussion walks through the full spectrum of spasticity management, from therapy and home exercise to oral medications, botulinum toxin injections, neurolysis options like phenol, alcohol, and emerging cryoneurolysis, and when surgical interventions may be appropriate. Henry and Monica also explore why spasticity treatment must be goal-driven, revisited over time, and always paired with rehabilitation rather than viewed as a one-time fix. The episode closes with an eye-opening look at disparities in access to spasticity care, cost-effectiveness research, and why treating spasticity early and appropriately can reduce hospitalizations, complications, and overall healthcare costs. This is a must-listen for clinicians, caregivers, and survivors who want a clearer, more practical roadmap for managing spasticity well. In This Episode Introduction to the No Plateau Podcast (00:00) Meet Dr. Monica Verdusco Gutierrez (00:59) Understanding spasticity: Definitions and misconceptions (02:59) Assessing spasticity: Tools and techniques (08:35) Treatment options for spasticity (12:38) Neurolysis: Phenol, alcohol, and cryo (16:23) The importance of functional goals in spasticity management (22:43) Introducing the AAPM&R consensus guidance (24:39) Getting feedback from patients and therapists (28:37) Botox and other toxin treatments (29:07) Exploring cryotherapy for spasticity (29:57) Disparities in access to spasticity care (31:10) Cost efficiency in spasticity management (36:56) Caregiver challenges in managing spasticity (42:14) Communication between therapists and physicians (44:47) Future directions in spasticity management (51:20) Conclusion and final thoughts (54:51) Our Guest Monica Verduzco-Gutierrez, MD Dr. Monica Verduzco-Gutierrez is a board-certified physiatrist specializing in neurorehabilitation and spasticity management. She is a Professor and Distinguished Chair of Rehabilitation Medicine at UT Health San Antonio, Medical Director of Neurorehabilitation at Warm Springs Rehabilitation Hospital, and lead author of the AAPM&R Consensus Guidance on Spasticity Assessment and Management. Dr. Verduzco-Gutierrez is widely published on spasticity, health equity, and cost-effectiveness in rehabilitation medicine. Resources & Links AAPM&R Consensus Guidance on Spasticity Assessment and Management (2024) UT Health San Antonio – Department of Rehabilitation Medicine Monica Verduzco-Gutierrez on LinkedIn Monica Verduzco-Gutierrez UT Health Henry Hoffman on LinkedIn Saebo On YouTube On Instagram On LinkedIn Saebo’s Stroke Caregiver Support Group Saebo’s Stroke Survivor Support Group Stroke Guidelines 2023

Reach and audience

Public platform figures. Ratings count people who left a rating, not total listeners.

YouTube views

3,816,622

Score snapshot 15 Sept 2025

Apple Podcasts (US)

5.0 / 5

5 ratings

Podcast Authority Score: 60 / 100

A composite of feed quality, social presence, YouTube performance and engagement. Read the methodology.

Quality

70

Social presence

0

YouTube

93

Engagement

32

Contact No Plateau Podcast

Guest appearances

Books guests

Based on episode analysis; this does not confirm that the show is currently accepting guests.

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