The beginning of September marked the end of the year long mentorship in the Integrated Systems Model. (Part 1 HERE; Part 2 HERE).  Part three was focused on the foot, the cranium, treatment of fascial sheaths and of course their impact on the body as a whole. Because these were new areas of study for me, there were no shortage of “aha” moments. The ISM (task specific movement analysis) can be used on any client but it is most affective on the more challenging clients in your caseload. I still need to fine tune my assessment skills but this part of the series opened my eyes to other potential areas that may be driving someone’s pain or dysfunction.

Day 1 – Learnings

1. The foot is an adaptable structure that must fan and fold (supinate and pronate) to provide stability during push off and adaptability during single leg stance.

2. Task Analysis of the squat: does the foot stay rigid? Do the toes lengthen or claw during the task? How much pronation? Do the have enough dorsiflexion to allow for a deep squat?
– If you correct the position the position of the foot by stacking the sub talar joint or improving adaptability does the meaningful task improve (i.e. reduced pain, better function, increased range).

3. The fibularis longus and the tibialis anterior act as a sling around the base of the foot. A medially compressed foot at the sub-talar joint can create a long and weak fibular muscle.

4. The foot can and will compensate for the areas in the body. If a runner is not have enough available range in the thorax or hip, the body may compensate by moving more through the foot. This can lead to plantar fasciatis among other injuries.

Day 2 Learnings

1. When should you address the knee? Although the knee is often the victim of poor or restricted movement elsewhere in the body, it is still important to provide treatment to the area for a few reasons.
– the knee can be a co-driver in a clients pain.
– the pain at the knee should be addressed with appropriate modalities.
– the clients beliefs and expectations should be met to ensure they are getting what they want from you (interaction is as important as intervention).

2. Biomechanics of the knee.
– In single leg stance the knee should unlock by internally rotating (the tibia on the femur).
-During rotation does the tib-fib joint slide like a set of wipers or are they stuck? Check the tonicity of the tibialis anterior and tibialis posterior.

Day 3 Learnings (clavicle, first ring, and cranium)

1. The deep cervical fascia surrounds subclavius, blends with the SC joint capsule and provides a direct connection between the cranium and mediastinum.

2. A medially compressed clavicle, due to injury or an over active pec, subclavius, or upper fiber of traps can reduce the adaptability of the SC joint.

3. If the first ring is twisted or compressed it can restrict the motion of the clavicle via the costoclavicular ligaments.

4. The first ring and clavicle are often co-drivers in a persons meaningful task.

5. Clavicle impairment due to poor motor control is a common dysfunction in clients with neck / head impairments.

6. The SCM compresses the neck ipsilaterally, shifts the 2nd and 3rd vertebra contralarerally and the 7th vertebrae ipsilaterally.

Day 4 Learnings (Mark Finch)

Mark Finch a registered massage therapist, who works as a structural integrationist and ralfer, taught the fourth day of the series. His knowledge of fascia and massage was integrated into the ISM.

1.Mark talked often of the 3 Ss and 3 Is. They represent the following terms.
-Strain – goal is to increase the tissues ability to elongate. 30% of the Strain transfer through muscles travels in a different direction to the line of pull.
-Slide – increase the ability of layers (muscle, fascia, connective tissue) to slide.
-Sensory – movement re-education. Attempt to make the sensory cues client centred and intrinsic (feel heals on the ground, stable, elevated through your spine).

Look for the 3 Is in a clients history.
-Inflammation – infection, injury, impact (what stage of healing).
-Inactivity – lack of movement.
-Increased load – from a task or a position.

2. Fascia is highly sensitized and acts as a strain distribution network. When treating soft tissue Mark believes he is not releasing muscle but in fact improving the sliding interfaces between muscles, changing strain transmission, and changing sensory input. Mark stresses the importance that manual therapists cannot derange connective tissue at therapeutic levels (see here).

3. When using gliding and sliding massage techniques the goal is to improve the movement of the loose pack connective tissue. The regular dense connective (RDCT) tissue can take months to years to change. Changing RDCT is not the goal of a single session.

4. Treatment applications: compress to the appropriate level, torque to create angular strain, shear to create stress between layers, and stretch by moving limbs.

5. The improvements in movement following a treatment session are due to the changes in neural output. Muscle fibers will not physically grow longer but the nervous system will allow the muscles to move further and in different directions.

Day 5 Learnings

The final day focused on cranial drivers and the art of “listening”. As a new grad and someone who is not entirely sold on the idea of feeling the stretch and strain of the nervous system through the cranium, I found this day challenging. There is lots of research to say that crania-sacral therapy is not founded in science but perhaps with time there will be ways in which I can apply these skills.

Conclusion

Although my time in White Rock has now come to an end, I am fortunate and thankful for having the opportunity to be a part of this year long mentorship. The course provides you with a wide breadth of skills, including communication, treatment, and assessment. It gives you the ability to assess more challenging clients and provides you with techniques to treat the muscular, visceral, articular, and neural systems.

It is important to have an open mind during this course but it definitely forever impact the way I treat. As a new grad I don’t really know any other way but I am sure for many more experienced therapists this course would provide great insight into why certain clients get better and others do not.

With my chapter in White Rock about to finish I look ahead to improving my dry needling skills and my movement based therapy. Next up Functional Therapeutics for dry needling and Level 2 of the Selective Functional Movement Assessment.

Thanks for reading
Dave Carter