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					Discover the Role of the Pelvis in Groin Pain,
Knee Pain, and Recurrent Hamstring Injuries
PRESENTED BY DIANE LEE PT, BSR, FCAMT, CGIMS
November 15 - 17, 2008 • ORS Clinic - Honolulu, Hawaii

                 This course is intended for physical therapists only.



Course Description
Low back pain and pelvic girdle pain are common in all levels of recreational and elite
athletes. So too are lower extremity injuries such as groin pain, osteitis pubis, clicking
hips, recurrent quadriceps and hamstring strains, and ITB syndrome. A challenge for
therapists is that often these problems are recurrent and chronic, and evidence to
indicate what the most effective treatment protocol for these injuries is still lacking.
The pelvis is a key area of load transfer between the lower extremity and the spine.
Poor control of the joints of the pelvis, suboptimal muscle synergies, and altered
alignment have the potential to affect efficiency and length-tension relationships of
all the muscles attaching to the pelvis, and create excessive compression and tension
loading through various structures of the hip and knee. These altered biomechanics
can predispose the athlete to injury in the lower extremity, and if not corrected can
precipitate re-injury. Recent research has shown that patients with posterior pelvic
girdle pain and failed load transfer of the pelvis have altered timing and recruitment
of the biceps femoris. Studies have also shown that athletes with groin pain have
alterations in timing of the transversus abdominis muscle, one of the key lumbopelvic
stabilizer muscles. Clinically, different patterns of asymmetry and dysfunction of the
hip and local trunk muscles have been observed in patients with sacroiliac joint
dysfunction and a variety of hip and knee problems. Although further research is still
needed, it is apparent that treatment of chronic, recurrent problems such as groin
pain, osteitis pubis, iliotibial band syndrome and hamstring strains require a careful
assessment of the pelvis, with particular attention to load transfer tests.

The purpose of this 3-day evidence-based course is to review the recent advances
in science and discuss the role of the pelvis in common hip and knee problems.
The clinical application for assessment and treatment will be based on a new
model—the System based classification for Mechanism based pain syndromes
(Lee & Lee) and will be highlighted and used extensively in this course.
Course Outline/Objectives
THEORY TO BE COVERED:
• Current evidence on the known biomechanics of the joints of the pelvic girdle & hip
• Current models of how the joints of the trunk, pelvis and hips are stabilized during
  different loading tasks
• Common clinical patterns of altered hip and knee function which occur as a result
  of failed load transfer (non-optimal strategies for function & performance) through
  the pelvis
PRACTICAL - DEMONSTRATE AND/OR PRACTICE:
• Functional tests for load transfer through the pelvic girdle, hip and knee (tests to
  identify non-optimal strategies)
• Joint mobility/stability tests for the sacroiliac joint, pubic symphysis, and hip
  (articular system tests)
• Tests which analyse recruitment patterning of the local muscle system and recognize
  common substitution strategies (Real-time ultrasound imaging will be demonstrated
  for transversus abdominis and the pelvic floor via video clips) (neural system tests)
• Tests which analyse myofascial deficits (true hamstring, quadriceps and/or adductor
  strains etc) (myofascial system tests)
CLINICAL REASONING: THEORY & DISCUSSION PERTAINING TO:
• Common patterns of pelvic dysfunction and how these patterns relate to lower
  extremity injuries.
• How to develop a multi-modal treatment program which includes manual therapy,
  dry needling, education and exercise. How to use taping and external supports of
  the pelvis during sport to augment training
PRACTICAL - DEMONSTRATE AND/OR PRACTICE:
• Specific mobilization and myofascial release techniques for the sacroiliac and
  hip joints
• Motor control training for the local muscle system—this training uses imagery
  and touch for facilitation. The focus will be on how to find the optimal strategy
  and ensure that this strategy translates into better loading and function for the
  lower extremity
• Specific hip stabilization and exercises for motor control to ensure optimal balanced
  recruitment of the psoas, tensor fascia latae, quadriceps, adductors, and medial/
  lateral hamstrings during functional activities
• Exercise progressions and key components to take the rehabilitation program from
  the acute stage to restoring full return to sport and activity

Course Preparation
To get the most from this course it is advised that the participant review their anatomy!

Course Requirements
Wear comfortable clothing including shorts/sports bra which are suitable for examina-
tion of the low back, pelvis and lower extremity.



                                Course developed by Linda-Joy Lee & Diane Lee
                                www.discoverphysio.ca
Presented by Diane Lee PT, BSR, FCAMT, CGIMS
Diane graduated from the University of British Columbia with
a Bachelor degree in the Science of Rehabilitation in 1976. She
became a fellow of the Canadian Academy of Manipulative
Therapy in 1981 (FCAMT) and completed her certification in
Intramuscular Stimulation (IMS) in 2001. Currently, she is the
owner, director and physiotherapist at Diane Lee & Associates -
Consultants in Physiotherapy (www.dianelee.ca). In addition, she
is a co-founder (together with Linda-Joy Lee) of Discover Physio
www.discoverphysio.ca, an educational company. Diane is well known both nationally
and internationally for her clinical work on thoracic, lumbar and pelvic (sacroiliac)
dysfunction and has integrated the scientific research on lumbopelvic function into
a clinical model for assessment and treatment. She has published eight books,
contributed several chapters to orthopaedic textbooks and published many papers in
peer reviewed journals on this and other topics. Diane is an editorial advisor for the
journal Manual Therapy as well as the Journal of Manual and Manipulative Therapy
and a Scientific Committee member for the Interdisciplinary World Congress on Low
Back and Pelvic Pain.



General Information
Date            November 15 - 17, 2008
Location        Orthopedic Rehabilitation Specialists, Inc.
                1600 Kapiolani Blvd., Suite 600
                Honolulu, Hawaii 96814
Time            Saturday, Sunday, Monday
                8:30 am - 5:00 pm

Tuition &    $600.00*
Registration Make check payable to:
             Orthopedic Rehabilitation Specialists, Inc.
                Mail registration form & payment to:
                Orthopedic Rehabilitation Specialists, Inc.
                1600 Kapiolani Blvd., Suite 600
                Honolulu, Hawaii 96814
               * Tuition includes a non-refundable registration fee of $50.00. Refund requests
                must be submitted in writing 14 days prior to the course. No refunds will be
                made after that time or in the case of non-attendance. Only in the case of a
                substitution will tuition be refunded in full.

                Registration Deadline: Friday, October 31, 2008

                For more information, please call Craig B. Nagata at (808) 979-0700
                or email ors@carenet-hawaii.com

                Orthopedic Rehabilitation Specialists, Inc. reserves the right to alter or cancel the
                scheduling of the course. If cancellation does occur all payments will be refunded
                in full.
Schedule
Day 1 • Saturday, November 15, 2008
 8:30 am - 10:30 am Introduction to the theoretical concepts of lumbopelvic-hip
                    function (stability & mobility requirements) and incidence
                    of groin
10:30 am - 11:00 am   Break (Refreshments provided by host)
11:00 am - 11:30 am   Analysis of strategies of load transfer through the pelvis and
                      lower quadrant
12:30 pm - 1:30 pm    Lunch (On your own)
 1:30 pm - 3:00 pm    Analysis of strategies of load transfer through the pelvis and
                      lower quadrant continued
 3:00 pm - 3:30 pm    Break (Refreshments provided by host)
 3:30 pm - 5:00 pm    Articular system analysis - SIJ and pubic symphysis

Day 2 • Sunday, November 16, 2008
 8:30 am - 9:00 am Questions from Day 1
 9:00 am - 10:30 am   Articular system analysis continued - hip joint and vector
                      analysis of altered axes of motion
10:30 am - 11:00 am   Break (Refreshments provided by host)
11:00 am - 12:30 pm   Myofascial system analysis (identification of true muscular strains)
                      and introduction to neural system analysis (motor control)
12:30 pm - 1:30 pm    Lunch (On your own)
 1:30 pm - 3:00 pm    Completion of the neural system analysis (lumbopelvic and hip)
 3:00 pm - 3:30 pm    Break (Refreshments provided by host)
 3:30 pm - 5:00 pm    Case studies and clinical reasoning

Day 3 • Monday, November 17, 2008
 8:30 am - 9:00 am Questions from Day 2
 9:00 am - 10:30 am   Introduction to treatment principles
10:30 am - 11:00 am   Break (Refreshments provided by host)
11:00 am -12:30 pm    Release techniques for the sacroiliac joint (ischiococcygeus,
                      piriformis), pubic symphysis & hip joint (restoring neutral
                      pelvis and femur)
12:30 pm - 1:30 pm    Lunch (On your own)
 1:30 pm - 3:00 pm    Restoring optimal sequencing and timing of motor recruitment
                      patterns for the lumbopelvic and hip
 3:00 pm - 3:30 pm    Break (Refreshments provided by host)
 3:30 pm - 5:00 pm    Exercises and movement strategies for integrating into sport
                      and functional tasks
Discover the Role of the Pelvis in Groin Pain, Knee Pain, and
Recurrent Hamstring Injuries
PRESENTED BY DIANE LEE PT, BSR, FCAMT, CGIMS
November 15 - 17, 2008 • Orthopedic Rehabilitation Specialists - Honolulu, Hawaii

                       This course is intended for physical therapists only.


Registration Form

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                                   Mail completed registration form to:
                                Orthopedic Rehabilitation Specialists, Inc.
                                    1600 Kapiolani Blvd., Suite 600
                                        Honolulu, Hawaii 96814

				
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