The Integrated Systems Model (ISM) (Lee L-J & Lee D 2011, Lee 2015) is an evidence-informed, clinical reasoning approach to help clinicians organize knowledge from multiple fields of science and clinical practice for the conservative care of individuals with disability and pain. In order to treat a ‘whole person’ one needs to understand the relationship between, and the contribution of, various body regions and systems that are ultimately manifesting as cognitive, emotional or sensorial dissonance.  Collectively, this dissonance can be interpreted by the cortical body-matrix (Moseley et al 2012) as threatening and manifested as physical pain anywhere in the body, fear of movement, movement impairments, anxiety, breathing disorders, and/or incontinence/pelvic organ prolapse. Chronic low back pain (LBP) patients often present with many of these features and have complex histories containing:

  1. multiple past traumas to several areas of their body (high load and accumulative) many of which are only partly resolved,
  2. beliefs and cognitions that present barriers to recovery, and
  3. poor lifestyle habits (e.g. diet, sleep, hydration, alcohol, drugs, lack of supportive relationships).

Acute back pain patients often have similar histories but present at a different stage of their condition.  Ultimately, best conservative care should consider, and address, the role each system and body region is having on the collective cortical body-matrix. This sounds difficult, complicated, and perhaps impossible and yet is the challenge clinicians face daily in their practice. Clinical experts are able to organize all their knowledge (evidence and clinical expertise) and apply it specifically to the individual. The evidence-informed ISM approach aims to facilitate clinical expertise by helping clinicians organize knowledge and develop clinical reasoning skills for these often complex, challenging patients. Increasingly, the evidence supports clinical experience in that individual assessment is always necessary.

This lecture addresses how the ISM approach helps a clinician determine when specific training of the deep muscles of the trunk (e.g. transversus abdominis, pelvic floor, deep multifidus) is necessary and when it is not when presented with a complex patient with lumbopelvic pain.

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Learning Objectives

Upon completion of this module you should be able to:

  • Understand how dysfunction in any area of the trunk can be a primary underlying cause, or significant contributing factor, of common sub-optimal strategies for recruitment and/or relaxation of the core trunk muscles
  • Explain how the Integrated Systems Model facilitates the identification of the primary area to treat to restore optimal recruitment and relaxation strategies.
  • Understand how to determine when isolated muscle training of the deep muscles of the trunk is indicated and when it is not.

Course Reviews

  1. A preview into how Diane assess & treats and an overview of adaptative responses to pain and the clinicians intervention role


    Diane has given insights into how she approach cases. One highlight of it would be particularly the importance of the patient’s ability to accept and receive force-transference; the role the thorax(ribs) play in respective of how the pelvis behaves or vice versa. I enjoyed the short case study presentation. How’s she is able to interpret this data presented through her manual skillsets is very impressive and aspiring to a young clinician like myself. The clinical reasoning model she propose in her closing takes into consideration what are currently presented and impressively is able to accomodate if needed or new discoveries are being made. A Progressive Model!

    Thank you Diane for being generous in sharing


  2. All around great course


    As always Diane does a great job explaining the integrated systems model and how to apply it with very helpful picture, videos and descriptions.

  3. Thank you very much for this special gift


    . Diane Lee is amazing and I love the way she teaches , she makes the content easier. Merci

  4. Very interesting course


    I enjoyed Diane’s presentation and the video examples she gave. I will be looking more at the thoracic rings for the patients who present with pelvic imbalance! Thank you Diane.

  5. great course


    I’ve learned many.

  6. Fantastic free course


    This is a great course if you want to become familiar with Diane Lee’s work. I think it’s a great way to see if the non-free courses are worth paying for.

  7. supplement to my pelvic floor training


    This lecture give me one possible idea why some of my patients are hard to do pelvic floor activation. I need to go back and check.

  8. 5

    Concise and to the point! I found it a great introduction to ISM, but also a great summary of importance of our listening skills and patient & task meaningful hands-on assessment/treatment.

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