FC2O Episode 20 – Diane Lee Show Notes

0:00 Introduction 

Diane Lee

3:56 Diane’s early career

  • Mary Walsh Workbook of Manual Therapy Techniques
  • The Pelvic Girdle 1989

5:49. Competitive Gymnastics

  • Backpacking Europe
  • Physiotherapy Training, University of British Columbia
  • Evolution of the physiotherapy profession
  • Cliff Fowler, John Oldham, David Lamb, Earl Pettman
  • Early versions of evidence based practice and clinical reflection

9:40. Mentorship and Integration

10:54. Let go… one door closes, another opens

  • From 1 to 25 to 18
  • Examiner Fellow of Canadian Academy of Manupulative Therapy
  • Teaching
  • Chief Examiner for 20 years – development of the Canadian Orthopaedic Manipulative Therapy Curriculum
  • Biomechanics (never things being “in” or “out”)
  • What’s changed = the mechanisms

13:47. The Pelvic Girdle

The Pelvic Girdle, 4th Edition
  • An invitation not meant for Diane
  • 4 years’-worth of references…
  • Labour through scarcity vs labour through volume!
  • 3-4 years’-worth of writing… State of the Art (in 1989)

16:17. The formulation of the World Congress on Low Back & Pelvic Pain

  • A call from a guy named “Vleeming” … or something?!
  • Meeting “Trannie”
  • Paul Hodges, Andry Vleeming, Motor Control & Form/Force closure
  • Trusting what your hands feel
Paul Hodges and “Trannie”!

20:36. Hands-on versus Hands-off Research

  • 1995 Dr Bengt Sturesson
  • “You can’t teach this with a video”
  • Training brain maps
  • 2001 Barb Hungerford
  • “ROM too small to measure”
  • Testing goes full- circle… Gillet’s back in!
  • Jo Abbott: accurate to 0.0056 degrees
    • inter and intra-tester reliability
    • “The evidence based methodology has failed the evidence based understanding for inter-tester reliability”
Gillet’s Test… back in favour!

27:58. Serge Gracovetsky – skin markers – reflecting a composite

  • The optimum spine
  • Dr Jean Claude Guimberteau – fascia
  • Clinical relevance
  • Hands as clinical tools

31:17. Vleeming – “Manual Therapy is ‘fiddling’ – give it up!”

  • Panjabi’s Neutral Zone
  • Passive mobility for SIJ
  • Interoception
  • Practitioner-Patient Interaction through touch

36:19. Dennis Keily – “You have to love the body”

  • Soft, but strong
  • Patient is always in control
  • Manual treatment as safe stimulation, change the experience from a part of the body that normally hurts
Active Straight Leg Raise

39:03. Force Closure (NOTE: Matt accidentally says “Form” closure in the podcast, but he’s referring to “Force Closure”)

  • Hamstring strain… or pelvic driver?
  • Even if the theory is wrong, there’s a clinical value to it

42:12. The Thorax

  • 10 pelvises stacked on top of one another
    • “Thoracic Lesion”
  • Linda-Joy Lee
  • 2003 Thoracic Ring Correction
  • ASLR – Gold Standard for pelvic control
  • Hamstring may be driven by thoracic ring control issue
  • Compressor Belt (Baby Belly Pelvic Support)
  • Subgroup gets worse with compression
  • Finding the driver
A “Thoracic Ring”…

48:39. Recurrent Hamstring Strain

  • Why
  • Pelvis as Platform
  • Loss of pelvic control
  • Foot driver?

52:27. Spinal Manipulation & Motor Control. 

  • Spinal Manipulation Therapy – is it all about the brain?
  • Neurophysiological effect of impulse
  • Entrapped meniscoids…
  • Over-manipulation – cracking the belief

58:50. Prevention in Physical Therapy

  • Reason for consulting a therapist is most commonly pain
  • Dental v.s Chiropractic model of prevention
  • Judging v.s Picking up relevant information
  • You have to know the meaningful task
  • Catastrophising
  • Musts:
    • Good Pelvic Control
  • Manchester City FC
  • Won Premiership & Lowest Injury Level in Premiership that level
  • Cirque du Soleil
  • But hasn’t yet extended to the general public…

1:04:21. CHEK Training – reconciling the 

The effect of eating gluten in someone with IBS
  • Nutrition as preventive AND restorative
  • Visceral Health
  • Visceral function
  • Visceral inflammation
  • Visceral pain
  • Viscerosomatic reflexes
  • Somatovisceral reflexes
  • Those with multiple co-morbidities – I start with gut health.
  • Food & Pain, Anti-aging conference, Las Vegas
  • Jessica Drummond – Physio with Special interest in the gut

1:08:34. IBS – Asperoz & Malagelada 2005

  • 18% of bloating is accounted for by gas
  • 82% (presumably) accounted for by inhibition
  • Pain inhibits tonic motoneurons

1:11:47. Evolution of Body Plans & Gut Function

1:12:48. Could an RCT ever assess a client with complex pain?

  • Mixed methods research
  • N=1 Case Reports
  • Why do inclusion criteria for research begin with pain?
  • Ground point – reliable clinical testing methodologies
    • Sensitive
    • Specific
  • Improving function & movement efficiency
  • It’s good to be critically challenged
  • Not single modal anymore… we’re now multimodal and integrated

1:16:50. World Congress on Low Back & Pelvic Pain

  • Targeted interventions for individualised care
  • Too much non-targeted research leading to non-significant findings
  • If there’s no deficit, then training will provide no benefit
Recent World Congress Scientific Committee

1:19:47. Concerns with Systematic Review / Meta-analysis only, research

  • The pendulum is swinging back
  • Complex patients with persistent pain – often excluded from research in any instance
  • Most practitioners are simply seeking to be better at what they do

1:24:52. Diane Lee’s & Linda-Jo Lee’s Clinical Puzzle (2007)

  • Strategies for Function & Performance
Image borrowed from “Stability, continence and breathing: The role of fascia following pregnancy and delivery”. Journal of Bodywork and Movement Therapies (2008) 12, 333–348
  • Reflection tool… to encourage looking at the whole person
  • Sensorial
  • Cognitive beliefs
  • How has this affected you? 
  • A closet organizer

1:31:08. Journal of Bodywork & Movement Therapies

  • Morley & Traum (2019) The effects of dorso-lumbar motion restriction on energy use and center of mass movement during running. JBMT 23-4
  • Motor Control Research: Hodges & Smeets (2015)
  • Finding & addressing the relevant thoracic ring
  • Fatiguing early
  • Increased injury risk / decreased performance
  • Knee OA
  • Aberrant Load over time causes OA
  • Changes of CoM over base of support – weight shift
  • Victims: neck / back / knee
  • Perpetrators: foot / pelvis / thorax / cranium

This is the ShareLink for the JBMT paper Diane and I wrote together: https://authors.elsevier.com/a/1a3PE4rR6wMniX

1:38:44. Finding Order among the Chaos. 

  • First 5 years after qualifying: find a mentor
  • … Someone you resonate with.
  • Give yourself the gift of time
  • Remember the power of your hands

1:41:07. Closing Comments. To learn with Diane head over to learnwithdianelee.com

1:43:00 ENDS

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