Welcome to the Diane Lee & Associates Blog

Posted on: October 28th, 2011 / by Diane / Posted in General / No Comments

Diane LeeWelcome to the new Diane Lee & Associates Blog! Why a blog? Well, our mission statement is to Empower through Knowledge, Movement and Awareness and what better way to share knowledge than to tell some stories. After all, isn’t that what a good blog is about – sharing, connecting and story telling. Our intent is to share with you some stories from our practice and life experiences and connect with you in a way that there often isn’t time for in our treatment sessions.

We hope you enjoy what follows and look forward to your comments – they will influence future blogs for sure. Follow us on Twitter @dianeleept and and Facebook to be advised when there is a new blog to read.

Please note that we cannot advise or directly answer questions through this blog – come and see us to get your questions addressed.

The Low Down on Down There After Baby

Posted on: April 30th, 2018 / by Cathy Rogers / Posted in Women's Health / No Comments

Low Down Down ThereDoes the idea of jumping on a trampoline with your kids make you cringe? Do you have to run to the bathroom when the trainer at the gym pulls out the skipping rope? Are you barely able to make it to the bathroom on time? Is intercourse painful? Does your belly still look and feel like you are pregnant?

Have you heard these comments before or have you found yourself thinking these thoughts? Child birth is a life changing experience but many moms find themselves dealing with the physical effects in the early postpartum period or maybe even years after giving birth. So many times we are told that “leaking or pain is normal” after having children or that it comes with aging. If you experience any of these issues, you are not alone. Research shows that 44.6% of women have some degree of urinary incontinence (leaking) 5-7 years after delivery 1. Ninety-two percent of new moms who are incontinent at 12 weeks post-delivery will still be incontinent 5 years later 2. There also exists a strong correlation with those who are experiencing incontinence and low back or pelvic girdle pain. Busy moms just deal with it and are frequently unaware that treatment for these issues is available.

Regardless of whether you have a vaginal delivery or deliver via Caesarean-section, many moms experience pelvic floor related symptoms that can persist for many years if left untreated. After the first 8 weeks following delivery in which the body and tissues are healing from the birth experience, new moms should be recovering all their pelvic floor related functions. It is not normal to experience any of the following:

  • Urinary symptoms including leaking with exertion, increased urge
  • Any form of loss of bowel control (e.g. increased urgency, streaking in the underwear)
  • Bulging or pressure between the legs (perineum) when exerting (e.g. cough/sneeze, lifting)
  • Pain with intercourse
  • Inability to fully empty the bladder so you may feel like you still need to pee even after recently relieving
  • Any pain, including back, pelvic girdle, hip, perineum etc.
  • Feeling really weak in tummy muscles or noticing a bulge in the belly when sitting up

If a new mom is experiencing any of the symptoms it is important to follow-up with a physiotherapist who has expertise in prenatal/postpartum and/or pelvic floor issues. A thorough postpartum assessment should not just involve assessment (either externally or internally) of the pelvic floor and its muscles but should include a comprehensive assessment of the entire body to find the cause or “driver” of your symptoms. Too many new moms are told to just do “kegels” to address any issues with leaking but frequently kegels alone will not solve the problem, and in some cases these exercises can make it worse! A comprehensive assessment by an experienced physiotherapist will help figure out the cause to why the symptoms, either pain or pelvic floor, are happening and what the best course of treatment will be. This should also include a thorough evaluation of the core muscles and abdominal wall via real-time ultrasound imaging as it is very common to develop poor or altered recruitment patterns for core muscles after pregnancy and delivery. This can result in a tummy muscle separation (Diastasis Rectus Abdominis) and/or back and pelvic girdle pain.

Every mom’s birth experience is unique and as such a thorough postpartum assessment is important to help address symptoms and recover function. If left untreated, some of these symptoms can persist for years. A physiotherapist with experience in pre/post natal and/or pelvic floor can help put together an individualized treatment plan.

If this sounds familiar to you and you are looking to start the journey to recovery, regardless of how old your kids are, find a local experienced physiotherapist to help guide you in the right and healthy direction. For those of you who are local, many of the physiotherapists at Diane Lee & Associates – Consultants in Physiotherapy can help guide you through this rehab; call the clinic to book a postpartum assessment!

1 Wilson et al., 2002
2 Viktrup et al., 2000

Moving Past Cancer with Physiotherapy

Posted on: January 3rd, 2018 / by Leigh Fortuna / Posted in Women's Health / No Comments

1 in 2 women will develop cancer over the course of their lifetime, with 1 in 8 women being diagnosed with breast cancer. With advancements in screening and detection, women are being diagnosed at younger ages. With improvements in surgical and adjuvant treatment, survivorship rates are increasing. This results in many women being alive for many years after a diagnosis, but perhaps not living the way they did pre-diagnosis because of their diagnosis and side effects from treatment.

Cancer RibbonIt is a shock to hear the words “you have cancer”. Suddenly you have many doctors, tests, appointments, all with a medical focus on helping you survive the illness. In some cases, there may be only days between a diagnosis and surgery, leaving very little time to prepare. Women undergoing surgery often have very little awareness about what their physical and functional recovery may look like after their procedure, and in some cases, are not given any guidance that physiotherapy will help.


While the rest of the medical team is focused on reducing, elimination and hopefully, curing the disease, physiotherapists focus on FUNCTION. Physiotherapists consider all aspects of a biopsychosocial approach to engage, and empower, patients in their recovery. Physiotherapists work with their patients to achieve meaningful goals to help improve quality of life. Physiotherapy can help to reduce pain, improve mobility and strength, increase participation in activities of daily living and/or hobbies and increase ability to exercise.

Physiotherapy is helpful at any stage after a diagnosis of cancer, and intervention can be divided into four stages.


In most cases, there is very little time between diagnosis and surgical intervention, leaving no time for any “prehabilitation”. If there is sufficient time before surgery is planned, physiotherapy treatment can help improve mobility, strength and function and provide education about what to expect immediately post-surgery and guidance on how to start rehabilitation in the early recovery days.

Surgery Recovery

Surgical intervention is often a first step in the treatment of cancer. Using breast cancer as an example, there are several different types of surgeries from lumpectomy, mastectomy with or without lymph node removal, prophylactic mastectomy, as well as various methods of breast reconstruction. Breast surgery often involves changes in anatomy of the chest wall and axilla, and there are many muscles, nerves, and lymph vessels that may be affected. As with any surgery, pain, limited range of motion, and decreased strength are common side effects. Physiotherapy intervention in the post-surgical phase involves a thorough assessment that includes looking at range of motion, strength, swelling, scarring, posture, and function. Treatment often includes education on topics such as lymphedema prevention, pain management, sleep and stress management, recovery expectations, as well as manual therapy and home exercise to help improve pain, range of motion and strength. When any adverse side effects do occur, such as swelling, neuropathic pain or axillary web syndrome, physiotherapists help treat these and can refer to specialists in lymphedema management if needed.

Adjuvant Treatment

In some cases, surgery is the only treatment needed, but in many other cases, chemotherapy, radiation therapy, immunotherapy or hormone therapy may be required as well. Medical interventions, chemotherapy and radiation therapy can have significant side effects such as fatigue and mental fogginess, and as contrary as it may sound, exercise can help improve fatigue levels. Knowing how to initiate or continue exercise during this period can be very difficult without guidance, and your physiotherapist can help navigate this period. Physiotherapists can provide guidance on appropriate exercise or activity, pacing, energy conservation, sleep and relaxation, all the while continuing to work on any functional deficits that may be lingering post-surgery.


Once medical treatment is finished, what comes next? Even though the medical management of cancer may be complete, for many women with cancer, that does not mean that life is back to normal. There is often ongoing worry about recurrence, and any new physical symptom can set off alarm bells that the cancer has returned. Some women may still feel the lingering side effects of medical treatment including fatigue, lower activity level and/or weakness, and may not function at their pre-diagnosis level. Continuing physiotherapy treatment after medical and treatment for cancer is complete can help women to regain strength, confidence in their body, and provide monitoring, reassurance or referral if a new symptom arises. Sometimes women realize they may have new physical goals, and physiotherapy can help achieve them.


Physiotherapy treatment can be a very useful intervention for those with a diagnosis of cancer. Physiotherapy helps shift the focus from illness to wellness, helps women regain body confidence and control, and helps to improve all aspects of physical functioning. Unfortunately, many women are not aware that there is a service that can help.

Leigh Fortuna, Physiotherapist at Diane Lee & Associates, developed an interest in the field of cancer rehabilitation following her own personal experience with breast surgery and reconstruction. She became aware of the need for physiotherapists with interest and training in working with cancer rehabilitation, and completed the PINC Cancer Rehabilitation Certification through PINC & STEEL. This training has provided Leigh with the information required to safely and effectively work with a medically complex patient during or after cancer treatment. The PINC Cancer Rehabilitation Program provides individualized, prescribed rehabilitation to women diagnosed with cancer, helping them heal as well as possible and to function at optimal levels through every stage of their treatment and recovery. Leigh combines her training and experience in orthopedics, the Integrated Systems Model, and chronic pain with the PINC Cancer Rehabilitation Program to empower women reach their physical goals. She is working on building awareness in the community about the benefits of physiotherapy for those with a diagnosis of cancer, and hopes to see more and more women seeking out physiotherapy to help them in their journey.

Running toward good health in the new year?

Posted on: January 8th, 2016 / by Calvin Wong / Posted in General / 1 Comment

RunningThe new year brings the promise of a fresh start and a chance for change. Many of us have taken the time to set goals to improve our health and fitness. Beginning a new activity such as running is a great way to kick start the journey toward better fitness, and there is indeed no better time to start than now. As we begin down this path, we are often bombarded with a plethora information about the best ways to run or the best shoes to wear. In particular, barefoot running has changed decades old thinking about how to run and what to wear when we run. Let’s consider what the research has to say about what we should and shouldn’t be doing when we run.

For those who are not familiar, barefoot running comes from the argument that humans have evolved over centuries to be able to run, and that early humans ran without shoes. As such, barefoot running is the most natural form of running our bodies are designed to do. Many barefoot running advocates suggest that the advent of traditional running shoes in the 1970’s has created a weaker foot that is less able to adapt which leads to running injuries [2]. There has been some discussion among researchers about what exactly we should be wearing on our feet (if anything) when we run. Fortunately, a review was recently published in the British Journal of Sports Medicine which may help shed some light on the issue.

The massive draw toward barefoot running centres around the idea that it promotes better foot strike, which is how your foot lands when it touches the ground. When you are running, the position of your foot as it contacts the ground determines how much force your leg absorbs. A common finding in the biomechanics studies is that a flatter more forward foot strike reduces the forces absorbed and may help decrease injury. This is because flatter forefoot contact distributes landing force over a larger surface area. This means less force and more cushioning on impact as compared to landing on your heel alone [1]. It is a commonly assumed that most barefoot runners use this forefoot striking pattern and most non-barefoot runners heel strike. In their review, Tam et al. (2013) found that this assumption is false and that “50% of runners participating in a 6-week minimalist running shoe intervention remained heel strikers.”

So why don’t all barefoot runners forefoot strike?

Motor adaptation and learning:
There is a myth that suggests runners who naturally heel strike will become forefoot strikers when they switch from traditional to barefoot or minimalist shoes. This belief overlooks the adaptation period needed when switching to new barefoot or minimalist shoes. In their review, Tam et al. (2013) found that not all runners were able to naturally adopt a forefoot striking style when they first starting using new minimalist/barefoot shoes. Furthermore, for those runners that didn’t adopt the forefoot strategy immediately, there was an 8.6% increase in impact force on the foot when running barefoot [1]. The research is limited on whether changing your gait from heel striking to forefoot or midfoot striking is a skill that anyone can learn. However, it is clear that running well isn’t as simple as strapping on a new pair of shoes. For some of us, we will need to learn how to foot strike in a new way.

What you need to know to run well this year:
It is important to understand what type of foot strike pattern you currently employ as a runner and how to change it if it isn’t right for you. Not every runner will do well in a single type of shoe (minimalist, barefoot, motion control). A physiotherapist can help determine what foot strike pattern (forefoot, midfoot etc.) is most optimal for you and how to safely incorporate this pattern into a new running routine and possibly a new shoe. Above and beyond the feet, the skill of running well is a task that requires the whole body to work in harmonious motion. The physiotherapists at Diane Lee and Associates are well equipped using the Integrated Systems Model (ISM) to assess how well your body is prepared to run. If you are unsure of how well you are running this year, do your body a favour and have an ISM assessment done.


[1] Tam N., Wilson J.L.A., Noakes T.D., Tucker R. (2013). Barefoot running: an evaluation of current hypothesis, future research and clinical applications. Best regards J Sports Med. 2014: 48:5 349-355.
[2] Lieberman D.E., Venkadesan M., Werbel W.A., Daoud A.I., D’andrea S., Davis I.S., Mang’Eni R.O., Pitsiladis Y. (2010). Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 463, 531-535.

Movember – Urinary Continence Muscle Training for the Male Pelvic Floor

Posted on: November 17th, 2015 / by Calvin Wong / Posted in In The Community, Tips For Health / 1 Comment

Movember-SloganNovember is prostate cancer awareness month, bringing to light some important issues in men’s health that are not often at the forefront of our thoughts. It has been suggested in a recent epidemiogical study that prostate cancer is the leading form of cancer for men worldwide, with 1.1 million new cases recorded globally in 2012 [1]. For many men who are affected by prostate cancer, surgical removal of the cancerous prostate is common. After this procedure, many men experience incontinence.

Historically, there has been inconsistent research on the voluntary control of urinary continence in men. Part of the problem may be the variability of cues used in retraining men with urinary incontinence [2]. Recently however, there has been published work that discusses mechanisms and possible training strategies for controlling urinary incontinence (UI) in men using pelvic floor musculature. One of these studies that looked at activation patterns of the male pelvic floor in healthy men and found that specific cueing is required to properly lift the striated urethral sphincter (SUS) which helps control continence [2,3]. Traditionally, many of the cues that are used to connect to the male floor have focused on a general lifting (i.e. “lift the bladder” or “elevate the scrotum”), or an anal cue “tighten the anus”. Both of these cues were less effective at promoting continence, and the elevation cue actually increased intra-abdominal pressure which challenges continence [2].

Cues to visualize stopping the flow of urine or shortening the penis were found to be the best because they were specific to men and they encouraged the best lift of the SUS. A key finding from the Stafford et al. (2015) study was that not all men respond the same way to the cues mentioned above. As such, there is a need for guidance by a physiotherapist who can help find the best cue and program of exercise to properly retrain continence in men with UI. At Diane Lee & Associates we use real-time ultrasound imaging to assess the male pelvic floor and can help you find the best cue to regain control and strength of your pelvic floor.


[1] Bashir, M.N., Epidemiology of Prostate Cancer. Asian Pac J Cancer Prev, 16 (13), 5137-5141

[2] Stafford, R. E., Ashton-Miller, J. A., Constantinou, C., Coughlin, G., Lutton, N. J. and Hodges, P. W. (2015), Pattern of activation of pelvic floor muscles in men differs with verbal instructions. Neurourol. Urodyn.. doi: 10.1002/nau.22745

[3] Stafford, R. E., Ashton-Miller, J. A., Constantinou, Hodges, P.W., Novel Insight into the Dynamics of Male Pelvic Floor Contractions Through Transperineal Ultrasound Imaging. The Journal of Urology, Volume 188, Issue 5, November 2012, Page 2021 movember

Cranial drivers and craniosacral therapy – how do they relate?

Posted on: April 3rd, 2014 / by Calvin Wong / Posted in General / 2 Comments

Cranial drivers and craniosacral therapy

It is not uncommon to find faulty alignment and biomechanics within the cranium in conditions such as head and neck pain, jaw and orofacial pain and even upper extremity pain and impairment.  According to The Integrated Systems Model (Lee & Lee), the cranium is considered to be the ‘driver’ (the villain) whenever correcting its alignment and biomechanics improves the symptom (i.e. the victim – headache, TMJ pain etc) and the meaningful task (i.e. movement of the head, neck, jaw or upper limb) (see a complete lecture here).  The assumption here is that the bones of the cranium move and that this movement can be felt by the human hand and that the alignment and movement pattern of cranium can be changed.  Clinical experience trumps the scientific research in this area since there are no systems yet available that can accurately measure what the human hand can feel.

Touch is one of the primary senses used by physiotherapists in daily practice. We use touch to feel the presence of movement or lack thereof in the joints of the body as well as many of its other systems. Touch has been described as the human brain’s “exquisite capacity” to detect, localize and classify sensations that we receive from our hands (Toerebjork et al.). This exquisite capacity can be used to feel more than just joint movement or muscle tissue; it can be used to feel things not yet measurable by science, things such as the rhythm of motion of the bones of the cranium.

Determining exactly what is causing the cranium to twist or move incorrectly requires that the therapist ‘listen to’ a pattern of motion that craniosacral therapists have recognized for over a century. Since scientists have not been able to measure this clinically proposed cranial rhythm many feel it does not exist. However Brian Weiss notes that “truths really do not need research support. They exist above and beyond scientific confirmation, because science is constrained by the limitations of its measuring devices. It cannot prove what it cannot yet measure.  When the appropriate tools are developed, the truths will be there, waiting to be discovered’.

According to clinical craniosacral theory, the cranial rhythm is produced by the pulsation and flow of the cerebral spinal fluid which is produced by the ventricles of the brain. This rhythm is unique much like the rhythm our heart produces when it pumps blood to our organs.  When external muscles attaching to the cranium become tight or tense, or when tension increases in the internal membranes of the cranium (the cerebral falx, cerebellar tentorium and spinal dura) this inherent normal rhythm is disturbed and this change in motion is easily detected by the experienced hand.

Both craniosacral therapy and treating cranial drivers according to The Integrated Systems Model require gentle touch that listens and is responsive to minute changes in tension, tone and thus the rhythm/motion of the cranium.  While the two approaches may use different language to explain the underlying mechanisms, the end result is that through touch the nervous system can be changed and many acute and chronic headaches, neck, jaw and upper extremity pain alleviated.


Imagine your Pelvic Floor like a Twisted Door…. How well would it Open & Close?

Posted on: February 24th, 2014 / by Diane / Posted in Conferences, Women's Health / 1 Comment

New Perspectives from The Integrated Systems Model for Women’s Health

Abstract provided for the 2014 IPPS meeting in Chicago for Diane Lee’s keynote presentation

Scientific research suggests that function of the pelvis is essential for the performance of almost every task (Vleeming et al 2012). It is particularly relevant for women suffering from pelvic girdle pain (PGP), incontinence, pelvic organ prolapse (POP), and/or sexual impairment; all possible symptoms of failed pelvic function. In addition, optimal structure and function of the pelvic floor muscles (PFMs) (e.g. anatomy, innervation, mobility, motor control, strength, endurance) is critical for these same conditions. Given the role the PFMs play in multiple tasks, it is not surprising that ‘muscle training’ is recommended as the first-line of treatment for women with these conditions (Bo & Hilde 2013, Dumoulin & Hay-Smith 2010, Fritel et al 2010, Morkved & Bo 2013).

In clinical practice, it is common to see complex patients with a combination of pain, incontinence, organ prolapse, and/or diastasis rectus abdominis (Smith et al 2008, Spitznagle et al 2007). A thorough evaluation often reveals many past injuries, thoughts/beliefs, and emotional states that have collectively led to changes in strategies for posture, movement, continence and pelvic organ support. Does the presence of pain, incontinence, or prolapse mean that the pelvis and specifically the PFMs require treatment? If not, how should a clinician determine where to intervene to effect the greatest improvement in function and reduction in symptoms?

There is little scientific evidence to guide clinicians for these complex, yet common, patients (Vleeming et al 2008). Clinical reasoning remains the recommended approach for determining best treatment for the individual patient (Jull 2012) and The Integrated Systems Model (ISM) is an example of such an approach. 

The Integrated Systems Model for Disability & Pain

The Integrated Systems Model for Disability and Pain (ISM) (Lee L-J and Lee D 2011) 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 (the best place to focus treatment). 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 that is meaningful to their story/complaint (meaningful task analysis). Subsequently, the timing of FLT (which site fails first, second, third etc.), as well as the impact of manually 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. 


IPPS-image-2-300xSometimes, two areas of the body require intervention (co-drivers) and sometimes one area requires most treatment (primary) while another requires some attention for the best outcome (secondary driver).

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 driver(s) for the specific task being assessed. Once the impaired system has been determined, specific techniques and training for release, alignment, control and integration into movement (including strength and conditioning) can be implemented to improve the function of the driver(s) and thus impact the function of the whole body/person.  

New Perspectives from the ISM for Women’s Health

IPPS-image-3-250xThis keynote presentation will highlight through short case reports how the ISM can be used to identify when the pelvic floor should be specifically released and/or trained and when interventions should be focused elsewhere. All clinicians who assess the pelvic floor with internal techniques recognize the wide variety of asymmetric activation/release patterns of the PFMs (all three layers) across many different conditions. The most consistent finding in women with PGP, incontinence, and/or POP is inconsistency. In other words, the classification or diagnosis of a condition does not predict pain or PFM behavior. 

IPPS-image-4-250xMultiple mechanisms can drive asymmetric activation/relaxation of the PFMs and the ISM can help to identify when ‘twists in the skeletal pelvis’ are causing the asymmetric activation/relaxation or a result of it. An intra-pelvic torsion (twist in the pelvis) can be primary (i.e. the driver of the problem) or secondary (i.e. the victim of a problem elsewhere and thus compensatory). The primary problem may be as far away as the foot or the cranium, although the most common driver is in the thorax. Simple tests based on the ISM concept of ‘Finding the Primary Driver’ will quickly reveal when to treat the PFMs and when treatment should be directed elsewhere and thus impact the behavior of the PFMs. 

Until we meet in Chicago next October have some fun with this test. With your patient supine and their hips and knees flexed, note the resting position of the left and right innominate. Is one side anteriorly rotated relative to the other (Chapter 8 in Lee D 2011). Assess the PFMs the way you usually do, paying particular attention to the presence of tender trigger points, ability to activate (grade of contraction), and ability to release/relax the all the various PFMs. Then neutralize the position of the left and right innominate (you can simply flex the hip on the side of the anteriorly rotated innominate in this test) and re-assess the resting tone (tenderness to palpation), activation and relaxation of the same muscles. Some will change and some will not, we will discuss what all this means next fall! Hint – stop trying to find the ‘best cue’ for PFM activation/release when this test changes the recruitment and/or relaxation pattern!


Bo K, Hilde G 2013 Does it work in the long term? A systematic review on pelvic floor muscle training for female stress urinary incontinence. Neurourol Urodyn 32:215-223

Dumoulin C, Hay-Smith J 2010 Pelvic floor muscle training versus no treatment, or inactive control treatments for urinary incontinence in women. Cochrane Database Syst Rev.

Fritel X et al 2010 Diagnosis and management of adult female stress urinary incontinence: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol and Reprod Biol 151(1):14-19

Jull G 2012 Management of cervical spine disorders: where to now? IFOMPT Quebec City, Canada

Lee L-J, Lee D 2011 Clinical Practice – The Reality for Clinicians. Chapter 7 in: 2011, The Pelvic Girdle, 4th edn. Elsevier, Edinburgh

Lee D 2011 The Pelvic Girdle, An Integration of Clinical Expertise and Research, Churchill Livingstone, Elsevier, Edinburgh

Morkved S, Bo K, Schei B, Salvesen K A 2003 Pelvic floor muscle training during pregnancy to prevent urinary incontinence: A single blind randomized controlled trial, Obstetrics and Gynecology101:313-319

Smith M D, Russell A, Hodges P W 2007c Is there a relationship between parity, pregnancy, back pain and incontinence? International Urogynecology Journal epub June

Spitznagle TM Leong FC Van Dillen 2007 Prevalence of diastasis recti abdominis in a urogynecological patient population. International Urogynecology Journal Pelvic Floor Dysfunction. 18(3):321

Vleeming A, Albert HB, Ostgaard HC, et al. (2008) European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 17, 794–819

Vleeming, A., Schuenke, M. D., Masi, A. T., Carreiro, J. E., Danneels, L., & Willard, F. H. (2012). The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. Journal of Anatomy. doi:10.1111/j.1469-7580.2012.01564.x

Week 1 of the ISM in White Rock

Posted on: February 13th, 2014 / by David Carter / Posted in General / 1 Comment

What is the Integrated System Model of Disability and Function (ISM, Lee & Lee): “it is a framework (not a classification system) to organize your tools.” Instead of abandoning the skills you already have it aims to organize your skills in a way that optimizes diagnosis and treatment. Check out these up coming courses: schedule

Key components of the model:

1. For each client it is the therapist’s goal to identify the primary driver, co driver, or secondary driver contributing to pain or dysfunction.

2.The treatment process is based upon: Release, align, connect, and move: RACM.

3. It is centred around the patients values and goals. You must aim to find out what tasks and movements have meaning to the person in front of you.

4. The Gestalt of experience. It is our goal to bring awareness to the body as a unit, not separate parts. Clients must experience their body in a different way for them to have success.

5. Body Self Neuro matrix (check out this picture from Melzack): the integration of many things contribute to our pain, our dysfunction, and our challenges.

What makes the ISM powerful? I picked out six things that really stuck out to me.

1. The ISM model is based around giving people success. If we get them to move safely and without pain, their experience is both positive and powerful.

2. The patient must feel that they have control of their recovery and must understand that they have the tools to get themselves better. We are not lying people down and fixing them!

3. The relief of pain is not the end goal. Return to function and performance is more important.

4. The first question in your assessment should not be: where is the pain? We should try “what brings you in today…tell me your story.”

5. Recognizing that when treating one area of the body we can elicit changes to the entire system. We have the power to change thoughts, emotions, and experience with our hands and our words. Can we elicit a “system-wide response?” Mark Finch, an incredible RMT out of Vancouver taking part in The Series, coined this term…thanks Mark.

6. When we begin to classify clients we begin to lose sight of who is in front us. Each client is unique!

I work at the clinic within the ISM model already but I can’t wait for parts 2 and 3 and the collaboration between therapists that has already begun

Life on the road as a team Physiotherapist: Ukraine!

Posted on: July 31st, 2013 / by Tony Gui / Posted in In The Community / No Comments

blog-tony-ukraine-1-362x blog-tony-ukraine-2-362x blog-tony-ukraine-3-362xWhat a year it has been thus so far, I have been fortunate to integrate my passion for sports, physiotherapy, and international travelling into one package multiple times this year. None of which would be possible without supportive mentors and colleagues.

I’ve just returned from Donetsk, Ukraine working with talented athletes, coaches, and medical staff from Athletics Canada. Canada showcased 50+ of their top youth athletes on the world stage at the IAAF World Youth Championships (Olympic gold medalist Usian Bolt competed at this event in 2003). The event was action packed with sprinters, runners, hurdlers, throwers, and jumpers. I’ve lost count how many records were broken, but more impressive was the countless personal best records that were achieved by the Canadian athletes.

The Integrated Systems Model (ISM) (Lee & Lee) (Lee D 2011 The Pelvic Girdle, Elsevier) proved to be an effective model to help the athletes perform with maximum efficiency and load transfer. What I also really enjoyed was the collaboration and discussions with the coaches to understand how we both look at the same problems with different lenses to best help the athletes perform.

Each trip presents itself with unique experiences and challenges, here are some tips I’ve picked up along the way and also acquired from my sport physio mentors:

1) Make sure you know your environment and pack for the unexpected – the temperature in the Ukraine was hot! Most athletes weren’t use to training or competing in 35°C weather, luckily we brought enough electrolytes to last the competition. Also, plan to bring energy bars, snacks, etc – food is not always accessible.

2) Try to make use of the space in your physio table. I recommend packing as much equipment as you can inbetween the table. You will be surprised that you can avoid paying and lugging around one extra piece of luggage.

3) Be prepare to travel through multiple time zones – start prepping your body for the changes from the beginning of your trip. Change the time on your watch as early as you can, nap on the flights at the appropriate times, eat on a regular basis, try to get as much sunlight exposure when you arrive, and try to do a light cardiovascular workout when you arrive.

Tony Gui BHkin, MPT, CAFCI

Life as a physio on the road – Turkey!

Posted on: March 20th, 2013 / by Diane / Posted in In The Community / No Comments

Tony Gui & the 2013 FIS Junior World ChampionshipsCanadians snowboarding in Turkeyturkey-3-snowboarding

Tony Gui of Diane Lee & Associates and Envision Physiotherapy ( recently travelled to Turkey as the Canadian Snowboarding team physiotherapist at the 2013 FIS Junior World Championships.  It was extremely busy and very exciting experience to work with the Canadian athletes who competed in Snowboardcross, Alpine, Halfpipe, and Slopestyle events.  The weather conditions at the Palandoeken Ski Resort were variable, it could be sunny one moment and super windy the next, but it didn’t stop Canada from taking the podium 3 times at the event.

A typical day started with breakfast with the team then a warm up series prior to training. Some athletes required treatment or taping prior to training.  Then it was time to gear up and head out to the course for inspection, training, or competition.  Countless numbers of falls occurred but thankfully our athletes did not have any serious injuries and the minor ones were able to be quickly assessed and treated. Once training or competition was completed, the athletes were treated late into the evening. Common complaints were shin splints, back pain, hip pain, knee pain, and most were due to the high compression forces incurred during landing 60 foot jumps or from multiple falls during the day.  The Integrated Systems Model (Lee & Lee) was so effective in being able to assess and treat key meaningful tasks for each individual athlete in the short amount of time we had together each evening.

Canada claimed the podium 3 times at the event! We won a bronze medal in Men’s Parallel Slalom, and had a perfect ending with 2 gold medals in Men’s and Women’s Slopestyle – it was exciting to hear the Canadian anthem twice! Snowboard Slopestyle will make it’s debut at the 2014 Olympic games in Sochi and Canada will be a top competitor for the medals. Thank you Canada Snowboard for the amazing opportunity!  Tony will be heading to the Snowboard Cross Nationals at the end of the month to provide physiotherapy coverage for athletes battling for the top podium spot.

IFOMPT 2012 – Quebec City, Canada – Rendez-vous of Hands and Minds

Posted on: October 15th, 2012 / by Diane / Posted in Conferences / No Comments

Diane and LJ at IFOMPT 2012Diane and LJ at IFOMPT 2012

Diane & LJ had a great 10 days in Quebec City at IFOMPT 2012, sharing The Integrated Systems Model (Lee & Lee) and The Thoracic Ring Approach (LJ Lee) with approximately 1500 conference delegates from over 45 countries. It was a busy time, starting with co-teaching a 2-day “Treating the Whole Person” pre- conference course, presentations during the conference, and finishing with a podium invited presentation on the last morning of the conference and a focused symposium on neuroplasticity and pelvic girdle pain.

On Thursday morning, LJ led a thought-provoking focused symposium with Roger Kerry from the University of Nottingham examining the Evidence for EBP – stay tuned as we will post the lecture on the Discover Physio website soon It was a paradigm challenging session! That same afternoon, LJ and Diane presented LJ’s innovative Thoracic Ring Approach and how it determines when and when not to treat the thorax to restore function anywhere in the body. The focus of the session was to discuss thoracic manipulation and how it fits into the Thoracic Ring Approach and The Integrated Systems Model. Diane led a discussion on neurophysiological mechanisms of spinal manipulation and how this applies to the thorax as well as key things to consider with respect to vectors and direction of force during thrust techniques. The direction depends on which level of the thorax you are manipulating – know your anatomy!

After a great gala dinner with amazing Cirque du Soleil performances, Diane and LJ were first up on Friday morning to present the key distinguishing features of The Integrated Systems Model as a clinical reasoning framework to assess and treat the whole person – not just low back pain, not just neck pain, but the whole person. The “Lee gals” were happy to receive lots of positive feedback from delegates after the presentation. You can listen to this lecture at here.

Things were full-on until the end of the conference, with Diane participating in the last session and speaking on the evolution of our understanding of articular mobility of the SIJ joint, how neuroscience is helping us understand all the factors that impact joint mobility and the way the ISM can be used as a clinical reasoning model to know when the pelvis is the primary driver of the patient’s problem – or not!

That night, champagne and great food was enjoyed to celebrate a successful conference with friends Mark Jones and his wife Helen – perfect ending to a great time of seeing old friends and making new ones. Thank you to the organizing committee for an outstanding conference. We also would like to congratulate Elaine Maheu for receiving the much-deserved Canadian David Lamb Memorial Golden Hands award.

Diane at dinner - IFOMPT 2012Golden Hands Award at IFOMPT 2012


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