An Introduction to the Integrated Systems Model & How to Find the Primary Driver for Linking Chains for Optimal Function
The Physiotherapy New Zealand Conference – Keynote presentation, Auckland, September 2014
In clinical practice, it is common to see complex patients with a combination of impairments in the musculoskeletal, urogynecological, respiratory and posture/equilibrium systems and there is little scientific evidence to guide clinicians for these complex, yet common, patients. Clinical reasoning remains the recommended approach for determining best treatment for the individual patient. The Integrated Systems Model for Disability and Pain (ISM) (Lee & Lee) is a framework to help clinicians organize knowledge and develop clinical reasoning to facilitate wise decisions for treatment. A key feature of this approach is Finding the Primary Driver. In short, this involves understanding the relationships between, and within, multiple regions of the body and how impairments in one region can impact the other. Specific tests are used to determine sites of non-optimal alignment, biomechanics and control (defined as failed load transfer (FLT)) during analysis of a task. Subsequently, the timing of FLT, as well as the impact of correcting one site on another, is noted. Clinical reasoning of the various results determines the site of the primary driver, or the primary region of the body, that if corrected will have a significant impact on the function of the whole body/person. Further tests of specific systems (e.g. articular, neural, myofascial, visceral) then determine the underlying impairment causing the non-optimal alignment, biomechanics and/or control of the primary driver for the specific task being assessed. This keynote presentation was captured during the Physiotherapy New Zealand Conference in Auckland in September 2014 and outlines key features of the ISM approach to illustrate how all regions of the body are connected and how to determine which region is creating a kink in the linked chain.
New perspectives from The Integrated Systems Model for Treating Women with Pelvic Girdle Pain, Urinary Incontinence, Pelvic Organ Prolapse, and Diastasis Rectus Abdominis
The Associated Charter of Physiotherapists in Women’s Health Conference in Bristol, England, September 2013
- To understand how dysfunction in any area of the trunk can be a primary underlying cause, or significant contributing factor, of common postpartum conditions such as pelvic girdle pain, pelvic organ prolapse, urinary incontinence, diastasis rectus abdominis and
- how The Integrated Systems Model for Disability & Pain (Lee & Lee) facilitates the identification of the primary cause (Find the Primary Driver).
- To understand the behaviour and morphology of the linea alba in healthy vs individuals with diastasis rectus abdominis and the current clinical research of Diane Lee on this topic.
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. 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 will be highlighted in part one of this lecture 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 (how to Find the Primary Driver).
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. Part two of this lecture will highlight Diane’s research that led to clinical tests that reveal who can be treated conservatively and who will require a surgical intervention.