ISM 1: Introducing Diane Lee’s Integrated Systems Model

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Do you have any questions that I can help with?​

Last year, I created a blog series about the Sarah Key Method, in which I talked about the way the Queen’s physiotherapist, Sarah, has developed her own theories about what happens in your spine when you get back pain. I’m the only therapist in central London who is fully trained in the Sarah Key Method (in fact, many years ago, I qualified as one of the first therapists that Sarah trained to teach her techniques). I still use Sarah’s explanations and techniques regularly.  However, in January 2013, I was introduced to a new way of thinking called the Integrated Systems Model (ISM), developed by Canadian physiotherapist Diane Lee and her then-colleague Dr Linda-Joy (LJ) Lee (no relation) – and it completely changed the way I look at the human body.

I was on a physiotherapy course which I wasn’t enjoying; and during one of the lunchbreaks I got chatting to another participant, Dublin physiotherapist Simon Greene. Simon told me he was treating a Gaelic football player with a painful left knee, and explained that he was treating the player’s knee through giving him exercises for his right shoulder; and that the player was making a fantastic recovery. I was intrigued: why on earth would exercises for the right shoulder be helping the player’s left knee, and how had Simon known that they would? “You have to go and train with Diane Lee,” said Simon, cryptically.

I was incredibly lucky. Diane was due to come to the UK to run her six-month “Discover Physio Series” which is where she teaches the full Integrated Systems Model (ISM) just two months later. The course was sold out, but I joined the waiting list, and with two weeks to go, someone dropped out and I got their space (whoever you are – thank you!) – and I loved it so much that since 2013, I’ve done at least one course with Diane or LJ every year, including re-doing the whole Series in 2019!

One of the interesting things about the Series is that, unlike many other course leaders, Diane doesn’t tell you that everything you’ve learned up to this point is wrong, and that her techniques are the One True Way. In fact, it’s quite the opposite: the ISM is not a set of techniques, it’s a framework for expertise. Her view is that when you are a qualified physiotherapist, you go on lots of postgraduate courses to learn techniques, and that what generally happens is that your “toolbox” of techniques gets ever-bigger, and ever more cluttered. (This is true. The more research papers you read, which apparently or actually contradict each other’s findings, the easier it is to get confused.) So the ISM is more like the organising system for your toolbox: if you follow it, you can work out which technique to use, on which body part, for which patient. And it can be effective working alongside any tools you have learned along the way, whether these are based around acupuncture, exercise, manual therapy, psychology, taping, energy work… the list is actually pretty much endless.

The other thing I found fascinating was that where most courses tell you what is going wrong with the body (eg Achilles tendinitis, a sprained knee ligament, a torn hip cartilage, an inflamed facet joint, a “slipped disc”), Diane’s method tells you why the painful area is sore. Your sore knee may be painful due to trauma, for sure; but very often, the painful area is simply overloaded because it is trying to compensate for a dysfunction somewhere else in the body, and has reached the end of its tether. And how do you know? You test, you change something, and you retest. For something like 35% of patients, the problem does not originate from the bit that hurts – and these are often the patients who don’t respond to traditional physiotherapy, and who end up coming to me for something a bit different.

The point of the ISM is that every patient is individual. Each patient’s body has different problems, and responds to those problems in completely individual ways – which means that the most successful way to treat each patient is (you guessed it) individual. Over the next few weeks, I will explain how the ISM works, and will then go through some case studies, including:

  • The doctor with an acutely inflamed ankle tendon which was caused by a dysfunction in her neck.
  • The lawyer whose lower back pain was coming from issues in her ribcage.
  • The executive whose chronic knee pain was due to her collapsed, weak feet.
  • The farmer whose full-body, fibromyalgia-like symptoms were coming from his stiff, high-arched feet.
  • The analyst whose Achilles problems were coming from his ribcage.

I’m looking forward to going through it all; but if you’d like to experience it for yourself (especially if you think you’re one of the 35% of people whose problem doesn’t respond to traditional physio) then please do call my team on 0207 175 0150 and come and see me for a 90-minute physiotherapy assessment.

Do you have any questions that I can help with?

Clinic reopening 5 Oct!

(online treatment still available)

I’ve been keeping a close eye on the COVID-19 situation and I’m delighted to announce that I will be reopening my Liverpool Street physiotherapy clinic on 5 October, with everything wipe-clean and COVID-safe!

"Virtual first" continues...

However, the current government advice is that I have to see patients online before I can see you in clinic, and that I should only see you face to face (or mask to mask!) if we both agree that the benefits of hands-on treatment outweigh the risks of coronavirus transmission.  If this is not the case, then I do plan to continue to offer online treatment for the foreseeable future.

But if you want to be one of the first people to see me in clinic on my return, call my team on 0207 175 0150 and book an online session before 25 Sept.