Itinerary: In-brief

Days 1 & 2

12 hours to cover the following in a combination of lecture, demonstration (live & video) and practical format

Evolution and Introduction to the Integrated Systems Model

Understanding the relationship between, and within, body regions and systems and the consequences of impaired function of one region/system on another is complex. Many health practitioners specialize in body regions, and/or systems and treatment is often based on the practitioner’s training and experience. However, this reductionistic approach may not be optimal in that each body region is not only an integrated system within itself (i.e. comprised of many differentiated yet linked parts but is also integrated, and interdependent, as part of the whole body/person.  No studies have correlated persistent pain anywhere in the body to a consistent impairment. Therefore, in persistent pain conditions such as low back pain, metatarsalgia, TMD, headache etc., understanding what body region and system should be treated requires an individual clinical reasoning approach. This is true whether the pain mechanism is primarily nociceptive, nociplastic, or neuropathic. The Integrated Systems Model (ISM – Lee & Lee 2011, Lee 2015) is an evidence-informed, clinical reasoning approach that embraces, and enhances, the concepts of the regional interdependence model (Sueki et al 2013).

This lecture will introduce the participant to ISM and will provide an understanding of the structured clinical reasoning approach that is ISM for understanding where to focus treatment for those with multiple impairments and persistent pain.

Thoracic Impairments and Pelvic Control: When to Treat What?  Translation of the Motor Control Evidence into Clinical Practice

Several studies have shown that motor control changes in response to pain in the trunk are highly variable and the consistent finding is a redistribution of muscle activity with deep muscles becoming inhibited and superficial muscles augmented (Hodges & Smeets 2015). The superficial muscles connect the thorax to the lumbar spine and pelvis and can potentially limit mobility, and reduce control, of the individual thoracic rings, lumbar spine and pelvis. While poor pelvic control is often addressed with motor control training, the individual thoracic rings are often not considered as part of this training. Additionally, there are no studies that have considered the role of sub-optimal alignment, biomechanics and control of the thorax on pelvic control. Therefore, in persistent pain conditions such as low back or pelvic girdle pain, understanding the role of the thorax requires an innovative, individual clinical reasoning approach that is evidence-informed.

 This lecture/practical will introduce tests to

1. determine when the thorax is playing a critical role for an individual with impaired function of the pelvic girdle (loss of mobility and/or control) with or without pain.
2. differentiate which manual therapy techniques are indicated for the impaired thoracic rings
3. predict the impact of treating the thorax on pelvic mobility & control

This is a combination of lecture, case videos and live demonstration/practice when possible of manual assessment skills for determining

1. mobility/control of the sacroiliac joint
2. mobility/control of the 3^rd to the 10^th thoracic rings
3. the relationship between sub-optimal alignment and biomechanics of the pelvis on the thorax as well as the thorax on the pelvis
4. whether the mobility restriction of the thorax is secondary to an impairment in the
   1. articular
   2. neural, or
   3. myofascial systems
5. which manual therapy technique to use to restore optimal mobility of the relevant thoracic ring

Lectures on the Greg Mortimer – 8 hours

The Abdominal Wall – Implications for Assessment and Treatment of Thoraco-Lumbar-Pelvic Pain & Disability

Impairments of abdominal wall anatomy and function have been implicated in multiple conditions associated with pregnancy and delivery including low back and pelvic girdle pain, urinary incontinence, pelvic organ prolapse and diastasis rectus abdominis (DRA). DRA is a common occurrence in pregnancy and postpartum, it does not completely recover in some, and the current evidence has not clarified the risk factors for this condition, nor provided direction for treatment. This lecture and workshop will:

1. present the current research evidence on the prevalence, risk factors known/not known and the course of recovery of DRA,
2. discuss the anatomical variations of the upper, middle and lower abdominal wall, particularly the aponeurotic extensions of the lateral muscles in all three regions and how they form the linea alba,
3. discuss the role of the abdominal wall in function of the thorax, lumbar spine and pelvic girdle in all individuals,
4. define and suggest a classification model for subgrouping women with DRA both for research and clinical practice,
5. demonstrate and practice clinical tests for determining if the individual’s strategy for transferring loads through the thorax, lumbar spine and pelvic girdle is optimal (i.e. is their motor control strategies and force closure mechanisms optimal for function),
6. clinically reason the load transfer test findings to determine which level/region of the abdomen (upper, middle lower) requires further assessment,
7. demonstrate the clinical and ultrasound evaluation of the lateral and midline abdominal muscles as well as their connective tissue connections to determine if the myofascial system can transfer loads. These tests consider the following parameters for function:
   1. anatomical integrity
   2. motor control
   3. strength and endurance capacity,
8. discuss current clinical thoughts on who should be referred for surgical repair and who should respond to treatment/training
9. present the 3 stages of motor learning training (cognitive, associative, and automatic) for the abdominal wall and how to progress this training for strength, endurance and function

Unique Ship Features

• X-Bow Design
• Rolls Royce Stabilisers
• Hydraulic viewing platforms & 360 viewing deck
• Zodiac & activity mariners
•  Tier 3 engines produce 80% less emissions
• GPS Anchoring means the ship does not have to drop anchor

Accommodation

All staterooms have private bathrooms, personal storage options, twin and double-bed configuration options, ample storage, international power outlets and daily cabin service, as well as all the basic amenities that you’ll need onboard.