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:
- multiple past traumas to several areas of their body (high load and accumulative) many of which are only partly resolved,
- beliefs and cognitions that present barriers to recovery, and
- 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.
In clinical practice, it is common to see complex patients with a combination of impairments in multiple systems including the musculoskeletal, urogynecological and respiratory. A thorough evaluation often reveals many past injuries, thoughts/beliefs, emotional states and movement habits that have...Read More
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.