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An Introduction To The Integrated Systems Model (ISM) For The Complex Patient

No study to date has demonstrated a direct relationship between pathology and pain for any pain related condition (Clauw, 2015). Neither the presence or absence of pain nor the intensity of pain can be accurately predicted by the presence or absence of pathology (Catley, Moseley, & Jones, 2019).

How do you know when to treat what in any individual with multiple impairments and persistent pain?

Research-supported management efficacy is still lacking for most clinical problems; therefore, skilled reasoning is the clinicians' best tool to minimize the risk of mismanagement and over-servicing (Jones & Rivett, 2019). Clinical experience and the evidence suggests that clinical reasoning and individualized assessment and treatment are required for best outcomes.

The Integrated Systems Model (ISM) is an evidence-informed, clinical reasoning framework to optimize strategies for function and performance. 

The Integrated Systems Model has evolved from 40 years of collaborative clinical and education experience.  It is a framework to help clinicians organize their knowledge and provide the best possible treatment for the individual patient.  Since every clinician has a different skill set, an ISM therapist will never be a clone of someone else nor will they only adhere to specific therapies or algorithms. Each therapist is as unique and individual as the people they seek to help, why would therapy be any different?  The Integrated Systems Model umbrellas all others.

In 2010, Diane Lee and Linda-Joy Lee decided on the words the ‘Integrated Systems Model’ to identify the collaborative approach they were teaching, lecturing and writing about. Diane invited Linda-Joy to contribute to the 4th edition of The Pelvic Girdle (first edition 1989) since their collaborative work was going to be featured throughout this version. After much deliberation and clinical reflection, they settled on the word ‘integration’ as being representative of what they were trying to help clinicians understand.  How do the various systems we primarily treat in the scope of physiotherapy contribute to both optimal and non-optimal strategies for function and performance? They hoped that consistent language and communication would expedite and facilitate better treatment for better outcomes for their individual patients.

After naming their approach the Integrated Systems Model for Disability and Pain, they were introduced to Dan Siegel’s work through his book Mindsight.  Siegel defines integration as ‘the linkage of differentiated elements to illuminate a pathway to health’. How perfect was that! It still is.

In order to treat a whole person with a biopsychosocial model, one needs to understand the relationship and contribution of various systems (differentiated elements) that are ultimately manifesting as cognitive, emotional or sensorial dissonance.  In complex situations, a clinician often wonders ‘where do I start’? Treating the underlying problem and not merely the symptom is fundamental to CAMT teaching, long established in the Canadian orthopaedic curriculum. ‘Finding the Driver’ (ISM language) is merely another way of saying the same thing – find the best place to start treatment.

Join Diane Lee and Nicole Sullivan for a one-hour complimentary webinar where they will discuss models that consider interdependence of body regions. They will present a synopsis of the current evidence on motor control, posture, movement, and the neuroscience of pain that informs the ISM approach.

Click Here to Register

The Details:

  • When: Dec 10 at 12pm EST
  • What: One hour complimentary webinar
  • Who: Diane Lee and Nicole Sullivan

What You Will Learn:

  • Principles of the ISM approach
  • Discuss the role of clinical reasoning in ISM
  • Outline the specific tests and clinical reasoning of the findings that are used to facilitate better predictions of the relationships between impaired regions to determine where to focus treatment. In ISM this is called finding the driver
  • Outline the further tests of the driver that help determine the underlying system impairment(s), articular, neural, myofascial, and/or visceral, and thus develop individualized treatment programs based on the patients' meaningful tasks and goals
  • An introduction to individualized assessments and treatment plans for the whole person

Any healthcare provider and movement specialist who is interested in learning an evidence-informed, clinical reasoning framework that they can use with their patients is welcome to join this webinar

Click Here to Register

About the Panelists:

Nicole Sullivan

Owner, Co-Director & Registered Physiotherapist at [mend]physio + Therapy Lead at Volleyball Canada Beach National Team

Physiotherapist, strength and conditioning specialist, a lead therapist with Volleyball Canada’s Beach National Team, and co-founder of [mend]physio. An avid learner, she has studied and taught with many teachers in a variety of settings but continues to learn the most from her patients and their stories. She uses an individualized, evidence-informed approach in clinical practice and is passionate about patient empowerment, simplifying complex concepts, and understanding the barriers to knowledge translation in physiotherapy education and practice.


Diane Lee


Diane graduated with distinction from UBC with a Bachelor of Science in Rehabilitation in 1976.  She has been a fellow of the Canadian Academy of Manipulative Therapy (CAMT) since 1981, completed her certification in Intramuscular Stimulation (IMS) in 2001 and became a registered Yoga instructor and certified in examination of the pelvic floor in 2013.  She was an instructor and chief examiner for CAMT for over 20 years. Diane is also the owner, director, and a practicing physiotherapist at Diane Lee & Associates (, a private multi-disciplinary physiotherapy clinic in South Surrey, BC, Canada. In addition, she is the principal instructor of Learn with Diane Lee (

Diane provides both online and in-class courses and in South Surrey, BC Canada, as well as nationally throughout Canada and internationally. Her premier course is called the Integrated Systems Model Series which provides clinical mentorship which is the prerequisite for certification. This program aims to help clinicians of all levels of experience to become efficient and effective through the development of reliable palpation and sound clinical reasoning skills.

She has been a keynote speaker at many conferences including The World Congress on Low Back and Pelvic Pain has contributed chapters to several books and self-published the book The Thorax – An Integrated Approach.  Her book, The Pelvic Girdle, was first published by Churchill Livingstone in 1989, is now in its 4thedition (2011) and has been translated into multiple languages. She holds the North American patent for two sacroiliac belts, The Com-Pressor, and The Baby Belly Belt™. With respect to research, she continues to investigate the behaviour of the abdominal wall in women with diastasis rectus abdominis and has received a grant from the Clinical Center of Research Excellence from the University of Queensland to further these studies.

Click Here to Register

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