The Thorax & Pelvis - using The Integrated Systems Model for Pain & Disability
Do you see patients with recurrent problems and, in the face of limited evidence, question if you are being the most effective you can be in your approach to treatment? Do you know how to determine if the thorax, lumbar spine and/or pelvis (essentially the trunk) is playing a role in the clinical presentation and if so what to do or where to begin treatment?
Increasingly, scientific evidence suggests that function of the pelvis is essential for the performance of almost every task. However, how do we know if the loss of pelvic function is the cause of the patient's primary complaint (the criminal) or merely the victim of an impairment elsewhere. How do we know if the loss of function of the thorax is the cause of the loss of pelvic function? How do we know if the relationship between the thorax & the pelvis is responsible for the failure of the lumbar spine to transfer loads optimally?
The restoration of function and performance depends on being able to identify and treat the underlying source of the problem and it is common to find the pelvis as the criminal in some cases and the victim in others. The same is true for the thorax. Do you have a way of knowing when to treat the pelvis, when to treat the thorax, when to treat the lumbar spine and when to look elsewhere?
Course description
This course will introduce the functional interplay between the thorax and the lumbopelvic-hip region and how The Integrated Systems Model for Pain & Disability ISM - Lee & Lee) (Lee D 2011 The Pelvic Girdle) can facilitate the understanding and interpretation of each patient's unique clinical picture to determine:
How to develop an assessment that 'cuts to the chase' choosing only meaningful tasks/tests that pertain to the story being told. All stories are unique; there are no protocols or recipes in the ISM approach for any impairment or pain pattern.
Where the criminal is i.e. the primary driver. When there are multiple regions that are impaired, how do you determine which one should be the focus of your intervention? Is this a hip problem that is causing the pelvic joints to lose control and become painful (or alternately a thorax or foot problem), or is the impairment intrinsic to the pelvis itself (i.e. stiff SIJ or altered motor control of pelvic floor/transversus abdominis - a pelvic driven pelvis)?
When to choose specific system tests (articular, neural, myofascial, visceral, physiological etc) to further identify the cause and effect of various impairments within and between regions of the body so you are able to 'do the right thing at the right time'.
Clinical reasoning of multiple findings and manual and visual assessment and treatment skills are emphasized in this course with plenty of practical time/discussion devoted to these two clinical practice tools.
At the conclusion of this course, you will have new skills to assess function of the trunk from the 3rd thoracic ring to the hips) and understand how various impairments impact function of the pelvis and the thorax as well as skills to perform segmental thoracic, pelvic and hip analysis for mobility and control. You will understand how to design a multimodal treatment program (including education, manual therapy, neuromuscular release, and movement training) to restore function and performance for any patient (from postpartum moms to elite level athletes) since the principles of the ISM approach are applicable to all groups of patients.
Objectives & Learning Outcomes
Illustrate how the Integrated Systems Model provides a framework to find the underlying driver for the patient's problem - whether this is pain, loss of stability, loss of performance, or other disability.
Demonstrate and practice some key clinical tests for the pelvis, hip and thorax to determine whether or not a patient is using an optimal strategy for function performance for their chosen task and when there are multiple sites of impairment, how to determine the 'primary driver' or impairment to be addressed first.
Discuss the clinical reasoning process required to determine if the pelvis, hip or thorax is the primary driver for loss of optimal function (develop reflection skills).
Demonstrate and practice key clinical tests for the articular, neural, and myofascial systems pertaining to the determined primary driver (thorax, pelvis, hip).
Discuss the clinical reasoning process for the development of a prescriptive treatment program that targets interventions to various system impairments pertaining to the primary driver.
Demonstrate and practice treatment techniques and movement training to release, align, connect & move the trunk/hips for restoration of better strategies for function & performance.
Dagskrá
Með fyrirvara um breytingar
Day 1 – 8:30 – 4:30 pm
8:30 – 10:30 Intro and Introductory Lecture ISM
10:30 – 10:45 coffee
10:45 – 12 Terminology Spine & Pelvis, pelvis ligaments & nutation/counternutation, ant post rotation and IPT surface anatomy and land marking the pelvis
12 – 1 lunch
1-1:45 surface anatomy land marking continued
1:45-2:30 Standing Posture
2:30 – 2:45 break
2:45 – 4:30 Squat
Day 2 8:30 – 4:30
8:30 – 9:30 am Questions and debrief day 1 – squat review by assessing someone with LBP and sitting is MT
9:30 - 10:45 How time, evidence & experience change Paradigms – the thorax
1045-11 coffee
11:00 – 12 Demo surface anatomy thorax
12 – 1 lunch
1:00 - -2:45 ring position screen, Seated Trunk Rotation
2:45 – 3 coffee
3 – 4:15 – revisit squat task
4:15 – 4:30 close day
Day 3 – 8:30 – 4:30
8:30 – 9:30 Questions & review by assessing someone with OLS as MT – i.e. pain with running
9:30 – 10:30 How evidence & experience change Paradigms – the pelvic girdle Part 1
10:30 – 10:45 coffee
10:45 – 12 How evidence & experience change Paradigms – the pelvic girdle Part 2
12 – 1 lunch
1-2 Pain provocation tests SIJ (discussion only) Vector analysis SIJ
2 – 2:45 Principles of treatment and release SIJ
2:45 – 3 coffee
3 – 4:30 finish SIJ, taping, belts , vector analysis of the hip
Day 4 – 8:30 – 3:30
8:30 – 9:30 Questions Vector analysis and release of the hip joint
9:30 – 10:30 Thoracic Ring vector Analysis and ring stack and breathe MET, ring and scapular taping
10:30 – 10:45 morning break
10:45 - 12 Principle of treatment part 2 connect and move piece Abdominal wall assessment, release and cues with PD corrected
12 – 1 lunch
1-3 Back muscle assessment, release and cues with PD corrected, Thoracic ring connect cues and impact of controlling the PD on meaningful task and NZ motion
3-3:30 – questions summary and close course
