Pre-Course Online Learning

Participants are required to complete the following online learning prior to attending the in-person course. These modules provide the foundational ISM concepts and anatomy that will be applied throughout the weekend.

Online Modules

The following modules are drawn from the new online ISM Series home study course that contains 30 hours of lectures, directed anatomy study, articles to read (they are provided) and directed reading in The Thorax book (D Lee 2018).

Module 1: Cranium, Cervical Spine, Upper Thorax & Shoulder Girdle Drivers – Part 2 ISM Series Lecture
Duration: 2 hours 10 minutes

Review of Functional Unit 2 assessment and driver identification for the cranium, cervical spine, upper thorax and shoulder girdle.

Module 2: Further Assessment of Part 2 Drivers  – Cranium & Neck
Duration: 1 hour

This lecture provides a review of the deep cervical fascia and related anatomy essential for assessment and clinical reasoning within Functional Unit 2.

Pre-Course Reading

The purpose of these readings is simply to familiarize yourself with the terminology surrounding the lymphatic, glymphatic and cerebrospinal fluid systems before the course. You are not expected to master the physiology prior to attending. The in-person course will focus on integrating these concepts into Integrated Systems Model (ISM) clinical reasoning through assessment, treatment and clinical application.

Open-Access Review Articles

These articles will be provided for you in the online preparatory course material.

• Adamczyk LA et al. (2016). Lymph vessels: The forgotten second circulation in health and disease.
• Aalling N et al. (2015). The Glymphatic System: A Beginner’s Guide.
• Moore JE Jr., & Bertram CD. (2018). Lymphatic System Flows.
• Schwager S., & Detmar M. (2019). Inflammation and Lymphatic Function.
• Simon MJ., & Iliff JJ. (2016). Regulation of cerebrospinal fluid flow in neurodegenerative, neurovascular and neuroinflammatory disease.

In Person Program

Day 1 (Friday Afternoon)

1:00–1:30 pm Welcome & Course Overview

• Introduction
• Course objectives
• Overview of the weekend

1:30–3:00 pm Session 1

The Story – When Should We Expand Beyond Traditional MSK Clinical Reasoning?

This session introduces the first clinical question:

When is a musculoskeletal explanation no longer sufficient?

Using the patient’s story as the starting point, participants will develop advanced pattern recognition skills to identify when traditional biomechanical reasoning may not fully explain the presentation and when further assessment of the cranium, spinal dura and fluid system impairments should be considered within the Integrated Systems Model.

This session establishes when clinicians should broaden their clinical reasoning, how to select an appropriate screening task and how to prioritize assessment before moving hands-on.

Topics include

• Recognizing symptom patterns that warrant expanding clinical reasoning
• Identifying key subjective findings from the patient story
• Selecting an appropriate screening task
• Prioritizing assessment pathways
• Determining when an MSK driver explains the presentation
• Recognizing when no MSK correction adequately changes the task and a fluid system impairment should be considered

3:00–3:30 pm Coffee Break & Networking Time

3:30–7:00 pm Session 2

Is the Driver Musculoskeletal or a Fluid System Impairment?

Hands-on application of ISM assessment principles to determine whether the patient’s presentation is explained by a musculoskeletal driver or whether fluid system impairments should enter the clinical reasoning process.

Topics include

• Review of Functional Unit 2 Driver assessment using head and neck rotation (or neck flexion)
• Relationship between the cranium, cervical spine, upper thorax and pelvis via the spinal dura
• Recognizing when musculoskeletal corrections improve the task
• Recognizing when fluid system impairments should be considered
• Listening and vector interpretation

Day 2 (Saturday)

Treating the Mechanical Barriers to Optimal Fluid Dynamics

The focus of Day 2 is identifying and treating the musculoskeletal vectors that may influence pressure regulation, drainage and fluid dynamics before considering intracranial assessment.

8:30–10:00 am Session 3

If Fluid Is Impaired, Where Do We Start?

This session will cover the assessment and treatment of extracranial influences on pressure regulation and drainage.

Topics include

• Buccopharyngeal fascia
• Suprapleural membrane
• C7, TR1 and clavicular influences
• Treatment of extracranial vectors

10:00–10:30 am Coffee Break & Networking

10:30 am–12:30 pm Session 4

Drainage Before Cranium

Understanding treatment sequencing within the ISM framework.

Topics include

• Drainage pathways and their clinical significance
• The cerebellar tentorium within the context of the entire drainage system
• Treatment sequencing
• Clinical reasoning

12:30–1:30 pm Lunch & Networking

1:30–3:00 pm Session 5

Primary Respiratory Mechanism (PRM) Assessment and Interpretation

Topics include

• Assessment of the Primary Respiratory Mechanism
• Differentiating extracranial and intracranial vectors impeding the PRM
• Clinical significance of PRM findings

3:00–3:15 pm Coffee Break & Networking

3:15–4:30 pm Session 6

Intracranial Vectors and Clinical Integration

Topics include

• Articular vectors within the cranium – listening to detect and release techniques
• Suture mobilization
• Reassessment of PRM
• Reassessment of the original screening task
• Clinical integration and discussion

Day 3 (Sunday)

Understanding the Fluid Story Behind the Driver

Having identified the driver (Day 1) and addressed the musculoskeletal vectors influencing pressure regulation and drainage (Day 2), Day 3 explores how fluid system impairments influence clinical presentation, assessment findings and treatment planning within the Integrated Systems Model.

8:30–10:30 am Session 1

Understanding the Fluid Story – Why Does This Patient Present This Way?

This session explores how pressure regulation, drainage, fluid supply and physiological adaptability contribute to common clinical presentations.

Rather than studying fluid systems in isolation, lymphatic, glymphatic, venous and cerebrospinal fluid concepts are introduced as mechanisms that help explain patient presentation and guide clinical reasoning.

Topics include

• Pressure regulation, drainage and fluid supply
• Autonomic influences on physiological regulation
• Breathing, pressure management and adaptability
• Trauma, adaptation and allostatic load
• Why symptoms fluctuate over time
• Why treatment sometimes does not hold
• How fluid system impairments influence clinical reasoning

Broader clinical considerations

• Venous thoracic outlet presentations
• Craniocervical instability
• Upper cervical influences
• First rib syndromes
• Tongue–hyoid relationships and pressure regulation

10:30–11:00 am Coffee Break & Networking

11:00 am–12:30 pm Session 2

Interpreting Fluid Findings – What Are These Findings Telling Us?

Discussion and practical application of fluid assessment findings within clinical reasoning.

Discussion topics

• What do PRM findings mean?
• What do fluctuation signs mean?
• What do asynchronous patterns mean?
• What might these findings tell us about pressure regulation?
• What might they tell us about drainage capacity?
• What might they tell us about system adaptability?
• How might they influence assessment priorities and treatment planning?

Practical Session

• PRM assessment
• Fluctuation assessment
• Clinical interpretation
• Case discussion
• Clinical decision-making

12:30–1:30 pm Lunch & Networking

1:30–4:30 pm Session 3

Practical Applications for Optimizing Flow – Fluid Through a Physiotherapy Lens

Translating fluid concepts into practical assessment, treatment and patient education strategies that clinicians can immediately integrate into everyday physiotherapy practice.

Lab 1 – Creating Capacity Before Flow

Assessment and treatment of regions influencing pressure regulation and drainage.

• Upper thorax
• Thoracic outlet
• Head and neck
• Cervical drainage pathways
• Optimizing regional capacity before addressing intracranial findings

Lab 2 – Restoring the Pumps

Foundational treatment strategies supporting fluid movement.

• BIG 6
• Pectoral lift
• Lung pump
• Pedal pump
• Diaphragm techniques
• Development of individualized home programs

Lab 3 – Integrating Fluid Thinking into Everyday Physiotherapy Practice

Applying fluid concepts within existing physiotherapy practice.

• Breathing strategies
• Movement and exercise
• Lifestyle considerations
• Recovery and pacing
• Patient education
• Integrating fluid concepts into existing ISM clinical reasoning

Come join Diane Lee & Judit Orban and catch up on their collaborative learning journey over the last 6 years that has led to a deeper appreciation of ISM for the cranium, upper thorax and pelvis in relationship to the fluid systems of the body.

This course is limited to those who have done the ISM Series since 2014 since much as changed in the last decade that will not be updated in this course. For those of you who haven’t done the ISM Series in the last 6 years, Diane highly encourages you to check out the new online ISM Series home study course to update yourself prior to attending this course. The more you review the more you will get out of this update course.