Cranium/Neck/Upper Thorax - Understanding the Relationships Between the Cranium, Neck and Upper Thorax/Shoulder Girdle using The Integrated Systems Model for Pain & Disability

Course description

Headache, neck pain and symptoms of thoracic outlet syndrome are common complaints in patients with poor trunk function. When the upper thorax and shoulder girdle become restricted and/or poorly controlled more load is placed on the head and neck during everyday tasks. When the cranium is twisted due to external neuromuscular imbalances (i.e. asymmetric tone in SCM) or loss of tension 'balance' of the intra-cranial membranes (cerebellar tentorium, cerebral and cerebellar falx) (i.e. concussions, head hits etc), function of the upper thorax can be impacted.

Do you know how to determine if the upper thorax, neck or cranium is playing a role in the clinical presentation and if so what to do or where to begin treatment? A key feature of The Integrated Systems Model for Pain & Disability (ISM - Lee & Lee) (Lee D 2011 The Pelvic Girdle) is how to determine the relationships between multiple sites of non-optimal alignment, biomechanics and control and decide where the best place is to intervene. This is called finding the primary driver and is task and individual specific.

The key concepts of The Integrated Systems Model for Pain & Disability (meaningful task analysis and finding the primary driver) will be highlighted during this course with specific application to the cranium, neck and upper thorax/shoulder girdle. Once the primary driver is determined for each meaningful task, vector analysis will confirm the underlying system impairment (articular, neural, myofascial, visceral) and thus determine the treatment prescription of what to release, align, connect and move (RACM).

Clinical reasoning of multiple findings and manual and visual assessment and treatment skills are emphasized in this course with plenty of practical time/discussion devoted to these two clinical practice tools.

At the conclusion of this course, you will have new skills to assess function of the cranium to the 4th thoracic ring (including the clavicle and scapula) and how to find the primary driver for meaningful tasks involving the head, neck and shoulder girdle. You will understand how to design a multimodal treatment program (including education, manual therapy, neuromuscular release, and movement training) to restore function and performance for any patient presenting with headache, neck pain and/or shoulder girdle pain.

This course builds on previous instruction and the participants will gain the most if they have taken one other course that introduced the concepts of the ISM approach.

Objectives & Learning Outcomes
  1. Illustrate how the Integrated Systems Model provides a framework to find the underlying driver for the patient's problem - whether this is pain, loss of stability, loss of performance, or other disability.
  2. Demonstrate and practice some key clinical tests for the cranium, neck, upper thorax/shoulder girdle to determine whether or not a patient is using an optimal strategy for function & performance for their chosen task and when there are multiple sites of impairment, how to determine the 'primary driver' or impairment to be addressed first.
  3. Discuss the clinical reasoning process required to determine if the cranium, neck, upper thorax/shoulder girdle is the primary driver for loss of optimal function (develop reflection skills). Secondary and co-drivers will also be introduced/discussed.
  4. Demonstrate and practice key clinical tests for the articular, neural, and myofascial systems pertaining to the determined primary driver.
  5. Discuss the clinical reasoning process for the development of a prescriptive treatment program that targets interventions to various system impairments pertaining to the primary driver.
  6. Demonstrate and practice treatment techniques and movement training to release, align, connect & move the trunk/hips for restoration of better strategies for function & performance.
Video: Cranium/Neck/Upper Thorax Lecture

This is a one hour video/lecture of highlights from an inservice given by Diane and hosted by SportMed and Fortius Sport & Health pertaining to Finding the Driver in the Upper Quadrant when the meaningful task is head and neck rotation

Cancellation Policy - please read carefully

Diane Lee & Associates reserves the right to alter the schedule or cancel this course. If this course is cancelled by Diane Lee & Associates a full refund will be provided. If a course registrant cancels prior to one month before the course start date and the spot can be filled, a full refund (minus an administration fee of $50) will be provided. If a course participant cancels after this time, or their spot cannot be filled, there is no refund.

For cancellations please email:


Diane Lee & Associates
#102 - 15303 31 Avenue
South Surrey, BC V3Z 6X2

Phone: 604 538 8338
Fax: 604 538 3277