New Perspectives from The Integrated Systems Model for Treating Women with Pelvic Girdle Pain, POP, SUI and/or DRA

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Maurice Harrington
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1 New Perspectives from The Integrated Systems Model for Treating Women with Pelvic Girdle Pain, POP, SUI and/or DRA Diane Lee BSR, MCPA, FCAMT 11th Feb 2015, 12th Feb 2015, 13th Feb 2015, 14th Feb 2015 Bookham Scout Centre Eastwick Park Avenue Bookham (Nr Leatherhead) Surrey KT23 3NA

2 Summary This is Diane Lee's only UK trip in 2015 and with a packed course and assistants it promises to be a good one if you treat or have an interest in pregnancy. It is well known that the abdominal wall and pelvic floor play key roles in function of the trunk and that pregnancy and delivery can have a significant, and long lasting impact. Postnatal non-optimal strategies for the transference of loads through the trunk can create pain in a multitude of areas as well as affect the urinary continence mechanism and support of the pelvic organs. The Integrated Systems Model for Disability & Pain (Lee & Lee) will be highlighted in this course to demonstrate its use for determining when to treat the thorax, when to treat the pelvis and when to train the various muscles of the deep system (i.e. transversus abdominis and/or pelvic floor) for the restoration of form and function after pregnancy. Widening of the linea alba and separation of the recti, known as diastasis rectus abominis (DRA), may prevent restoration of both the appearance and the function of the trunk and women with this condition often ask whether surgery will help them. Currently, there are no guidelines for clinicians to know which patients with DRA are appropriate for conservative treatment and which ones will also require surgery. This course will highlight Diane's research that led to clinical tests that reveal who can be treated conservatively and who will require a surgical intervention. Who to treat, who to refer and how to close the DRA were the initial questions that prompted a series of studies on this subgroup of postpartum women. The course teaching is supplemented by not only Diane but also 3 assistants which significantly improves the tutor student ratio to 1:8, which is very high compared with the vast majority of other courses available with other providers. Lunch is a time for relaxing or practising as we provide lunch on all days for this course. PAYMENT OPTIONS: Ideally we require full payment up front via a credit/debit card or a bank transfer. Alternatively, you may pay in instalments (this must be done through the office as the website cannot process part payments). Please contact us to find out more on info@physiouk.co.uk or Content What is The Integrated Systems Model for Disability & Pain? The Integrated Systems Model for Disability & Pain (Lee & Lee), is a framework to help clinicians organize knowledge (evidence and experientially based) and develop clinical reasoning skills that subsequently facilitate best decisions for treatment. A key feature of this approach is Meaningful Task Analysis and Finding the Primary Driver.

3 Briefly, this involves choosing tasks to assess that are relevant to the patient's story (meaningful to the patient's complaints and functional difficulties), assessing the whole body (strategy analysis of the task) to find the criminal (the driver), and then developing sound hypotheses as to how the criminal relates to its multiple victims. Objectives 1. To understand how dysfunction in any area of the trunk can be a primary underlying cause or significant contributing factor to common postpartum conditions such as pelvic girdle pain, pelvic organ prolapse, urinary incontinence, diastasis rectus abdominis. To illustrate how The Integrated Systems Model for Disability & Pain can provide a framework for knowledge organization and translation. 2. 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. 3. Demonstrate the relationship between the primary driver (from 3rd thoracic ring to the hips) can impact resting tone and activation patterning of the abdominal wall AND the pelvic floor. External palpation of the PFM will be taught. 4. Demonstrate and practice treatment techniques and movement training to release, align, connect & move the trunk/hips for restoration of form and function of the postnatal woman. 5. To understand the behaviour of the linea alba in nulliparous vs postnatal women with diastasis rectus abdominis that suggests when surgery (abdominoplasty and recti plication) vs conservative treatment is indicated. 6. Introduce the new Baby Belly Belt - a pelvic support for pregnancy and beyond. Clinical reasoning of multiple findings and manual/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 both form and function of the abdominal wall and pelvic floor and thus the musculoskeletal, respiratory and urogynecological systems. You will understand how to design a multimodal treatment program (including education, manual therapy, neuromuscular release, and movement training) to restore function and performance with a focus on conditions specific to postnatal women. You will also know how to prescribe the new Baby Belly Belt!

4 Preparation Pre course reading is recommended, this information will be made available in your PhysioUK account on successful application. Day Registration 8.30 Intro and Introductory Lecture ISM with WH focus Terminology Spine & Pelvis, pelvis ligaments & nutation/counternutation, ant post rotation and IPT Surface anatomy lab Standing Posture analysis lab Break Squat lab - Finding the primary driver within the lumbo-pelvic-hip complex Finish Day Questions and debrief day Pelvic Floor dysfunction and The Integrated Systems Model How time, evidence & experience change Paradigms â the thorax lecture Break The Thorax lecture: with some practical included Demo surface anatomy thorax, thoracic ring position screen, Seated Trunk Rotation analysis Break Revisit squat task: is the LPH primary driver the real driver? Extend analysis up to 3rd thoracic ring Finish Day 3

5 8.30 Questions & review - assess someone with OLS as meaningful task i.e. pain with running 9.30 How evidence & experience change Paradigms: the pelvic girdle Part How evidence & experience change Paradigms: the pelvic girdle Part Pain provocation tests SIJ (discussion only) Vector analysis SIJ Principles of treatment and release SIJ Break Role of taping, belts, vector anlyasis of the hip End of day release movement for iliocostalis & hips Standing shins in thighs out with assist, forward fold Balansana assist Wide standing forward fold Sitting deep hip rotator release with partner Lunge with hamstring and then rec fem stretch and twist Malasana Crow Finish Day Questions and Day 3 review 9.00 Principles of Treatment: Connect & Move 9.30 DRA Lecture & Research DRA Abdominal wall assessment and treatment, release and cues with primary driver corrected Pelvic floor assessment and treatment:external palpation of levator ani, release and connect cue with PD corrected: when to directly treat the PF, when to refer to a PF trained PT Back muscle assessment and treatment Movement lab and close the course Finish

EXPERIENCE. ENGAGE. EMPOWER.

EXPERIENCE. ENGAGE. EMPOWER. Diane Lee PT, BSR, FCAMT, CGIMS presents a 4-Day course The Thorax & Pelvis - Understanding the Relationship between the Thorax & Pelvis when Treating the Whole Person using