Workshops
PRE CONGRESS WORKSHOPS
Tuesday, October 31st
WORKSHOP 1:
Pelvic Girdle Pain & Dysfunction – The Form and Force Closure Mechanisms for Pelvic Control
30 Years of Research to Clinical Practice (1993-2023)
Speaker: Diane Lee PT
Description
The form and force closure mechanisms describing how loads are transferred through the pelvic girdle come from the pivotal research of Dr. Andry Vleeming, Dr. R Stoeckart, Professor Chris Snijders in the early 1990’s. These mechanisms provided evidence for the clinical tests of both passive and active control of the SIJ that were evolving in clinical practice concurrently (Diane Lee, Dr. Barb Hungerford).
Subsequently from the mid-90s to this present day, the understanding of how force closure of the pelvis can be impacted by motor control strategies, pain, trauma and certain emotional states, broadened our clinical assessment during which a true biopsychosocial model for managing pelvic girdle pain and dysfunction has evolved.
What remains to investigate, and is being considered today in clinical practice, is the impact remote impairments can have on these mechanisms of pelvic control. In other words, can clinicians reliably determine that the pelvic girdle is a victim of impairments elsewhere?
The pelvic girdle is part of the whole body/whole person and this workshop will focus primarily on the clinical application of the evidence to date (assessments of form and force closure mechanisms, motor control strategies and myofascial impairments (DRA)) after briefly describing a regional interdependent approach (the Integrated Systems Model (ISM)) that helps determine when to treat the pelvis and when to look elsewhere to improve strategies for effective load transfer.
9-10.30 Theory & Evidence
- The Beginning: 1990 – 1993 the research that led to the form and force closure mechanism models for pelvic control (Vleeming, Snjiders, Stoeckart)
- The Middle: 1995 – 2012 the research that improved our understanding of the force closure mechanism (motor control transversus abdominis, pelvic floor, sacral fibres of multifidus (Hodges, Sapsford, Hides & more) and led to the Integrated Model of Function (Lee & Vleeming) and ultimately recognition that pelvic girdle pain/dysfunction is not always caused by the pelvis (The Integrated Systems Model) (Lee 2011)
- The Present: 2012 – 2023 How understanding the phenotypes of pain, and the impact trauma and the emotional state in relationship to threat/safety has on pain and motor control, facilitates choice of approach to patient care (biomechanical & motor control (movement based) vs cognitive-behaviour approaches)
10:30 – 10:50 Morning tea
10:50 – 12:30 Knowledge Translation – From the Evidence to Clinical Practice (Part 1)
- The Integrated Systems Model – A Regional Interdependent Model to understand when the pelvis is a victim of impairments elsewhere (this workshop will only introduce this model via clinical videos)
- When the pelvis is the driver/problem (practical session):
- Further assessment of the Form Closure Mechanism – Active and Passive Mobility, Passive Control tests for the sacroiliac joint and pubic symphysis
- Further assessment of the Force Closure Mechanism – Active Control tests for the SIJ & pubic symphysis
12:30 – 1:30 Lunch Break
13:30 – 15:00 Knowledge Translation – From the Evidence to Clinical Practice (Part 2)
- Motor control analysis of the deep muscle system of the pelvic girdle (demonstration)
- Low fibres of transversus abdominis – clinical tests and ultrasound imaging
- ii).The pelvic floor – iliococcygeus & coccygeus – when to refer to a pelvic health physiotherapist
- ii).The sacral fibres of multifidus – clinical tests
- Diastasis Rectus Abdominis (DRA): Impact of a low DRA on the force closure mechanism of the pelvis – demonstrate clinical tests for myofascial integrity of the lowest part of the linea alba
15:00 – 15:20 Afternoon tea
15:20 – 16:30 Knowledge Translation – From the Evidence to Clinical Practice
- Clinical reasoning of clustered test findings (form & force closure and motor control tests) to guide individualized patient management
- Manual treatment techniques to release the restricted SIJ – demo or video
- Progressive stages of exercise training to restore motor control and the force closure mechanism – discussion
WORKSHOP 2:
WHY FASCIA MATTERS? Scientific evidence for the role of fascia in low back pain and how to manage it with Fascial Manipulation technique
Speaker: Prof. Carla Stecco, MD
WHY FASCIA MATTERS? Scientific evidence for the role of fascia in low back pain and how to manage it with Fascial Manipulation technique
While vertebrae, discs, neural tissues and muscles serve as prime targets in low back pain research, recent developments have revealed a surprising significance of fascial tissue in human biomechanics and neurophysiology. This workshop will present the gross and microscopic anatomy of the thoracolumbar fascia, with a special focus into its role in tensional force transmission, proprioception and nociception. Finally, the diagnosis, treatment and prevention will be discussed, presenting the recent researches about imaging and the main concepts of Fascial Manipulation technique.
PROGRAM:
| 9.00-9.45 | Anatomy of the TLF and its connections with the pelvis, abdomen, inferior and superior limbs | Carla Stecco |
| 9.45-10.30 | Imaging of the TLF | Carmelo Pirri |
| 10.30-10.45 | Morning tea | |
| 10.45-11.40 | Microscopic anatomy and Innervation of the superficial and deep fasciae of the back | Carla Stecco |
| 11.40-12.30 | Fascia and mechanotrasduction | Carmelo Pirri |
| 12.30-13.30 | lunch | |
| 13.30-14.30 | The MFU and the biomechanical model of Fascial Manipulation | Carla Stecco |
| 14.30-15.00 | How the fascial concepts changes the assessment and treatment of our patients | Carmelo Pirri |
| 15.00-15.20 | Afternoon tea | |
| 15.20-16.10 | The assessment chart of Fascial Manipulation | Carla Stecco |
| 16.10-16.30 | Discussion and conclusion | All |
WORKSHOP 3:
Surgical Treatment of the Sacroiliac Joint – When the Physiotherapy is not Enough
Speakers:
Bengt Sturesson MD, PhD
Inge Dahlberg PT
The course is built up from the algorithm we have developed in Ängelholm, Sweden during 12 years with minimal invasive surgery of the sacro-iliac joint. It includes anatomy and biomechanics, the use of diagnostic imaging, clinical tests, surgical procedure, and outcome of surgery. The course is practical with hands on diagnostic testing, performing blocks on 3D model, surgery using 3D model and practical demonstration of postoperative physical exercise.
| 9.00 Diagnostic algorithm | Bengt Sturesson |
| 9.45 Diagnostic block – tips and tricks for the procedure | Bengt Sturesson |
| 10.30 Morning tea | |
| 10.45 Diagnostic tests – practical education | Inge Dahlberg |
| Practical education on 3D – model | Bengt Sturesson |
| 12.30 Lunch | |
| 13.30 Surgical procedure with iFuse – tips and tricks | Bengt Sturesson |
| 14.00 Outcome of surgery – report after 550 cases | Bengt Sturesson |
| 14.30 Physical exercise after surgery – practical demonstration | Inge Dahlberg |
| Practical surgical education on 3D – model | Bengt Sturesson |
| 15.00 Afternoon tea | |
| 15.20 Physical exercise after surgery – practical demonstration | Inge Dahlberg |
| Practical surgical education on 3D – model | Bengt Sturesson |
| 16.00 Q&A | All |
POST CONGRESS WORKSHOPS
Sunday, November 5th
WORKSHOP 4:
Cognitive Functional Therapy for people with disabling low back pain
Speaker: Prof. Peter O’Sullivan
Cognitive Functional Therapy is a person-centred and evidence informed behavioural intervention for people with disabling low back pain.
This one-day seminar will present an overview of:
- The multidimensional nature of low back pain
- Clinical reasoning process to identify modifiable targets for care
- Best practice guidelines for the treatment of people with low back pain disorders
- Person-centred communication and care
- Cognitive Functional Therapy
- Case presentation
- Evidence of efficacy
WORKSHOP 5:
Optimising dynamic function of the lumbo pelvic region
Speaker: Trish Wisbey-Roth PT
Description of Workshop:
This course provides a functional muscular assessment and comprehensive functional rehab stratagies for the lumbo-pelvic region.
This clinically focused One day course is intensely practical where participants are exposed to a wide variety of functional exercises and theory/research behind how to assess and progress a lumbo/pelvic functional program and adherence rehab strategies
A comprehensive exercise protocol will be explained and demonstrated with take home exercise examples for clinical use.
The clinical assessment protocol and exercise program design can be progressed from very specific retraining of spinal and pelvic function through to dynamic functional movement patterns required for work, ADL through to high level sport.
The course includes:
• A detailed outline of the dynamic slings of the lumbo-pelvic and hip regions and how they relate to individual patient presentation
• A specific and graded assessment protocol for lumbo-pelvic-hip function
• Detailed practical strategies that can be incorporated into rehabilitation and maintenance training programs to optimise dynamic lumbo-pelvic function and proprioception.
• Detailed exercise handouts included in the training manual that can be applied in the clinic immediately
• A grading system to assess and progress a spinal/pelvic functional program from the acute stage of treatment, to return to normal function.
• Practical session on a wide variety of graded functional exercises for the lumbar, pelvic region for the appropriate grade of dynamic function exhibited and how to progress.
Learning outcomes
- Learn assessment of dysfunctional muscle recruitment patterns of the lumbar spine and pelvis.
- Incorporate a grading system to assess and progress a lumbo-pelvic functional program from the acute stage of treatment, to return to normal function.
- Practice a wide variety of graded and progressed functional exercises using proprioceptive cues and recognising the correct level of exercise difficulty and how to progress.
More info about Trish and her courses provided here.
WORKSHOP 6:
Speaker: Prof. Paul Hodges PhD MedDr DSc
