What is Connect TherapyTM?
ConnectTherapy is a model developed by Dr. Linda-Joy Lee that is a whole body, patient centered approach to assessing and treating the driver, based in neurophysiology. Everything we do is a whole body task and ConnectTherapy provides the framework to objectively assess each region to rule it in or out as part of the driver profile.
A driver is defined as a region, not a specific structure that influences how you move. It is the way into the nervous system to influence change. The assessment consists of identifying areas of non optimal load transfer (NOLT) as changes due to NOLT can lead to pain, decreased performance, fatigue, recurrent injuries among other conditions. A Meaningful Screening Task is determined by the patient’s meaningful task, for example a step forward for a runner, and used to assess for areas of NOLT. Corrections, a manual technique that creates temporary optimization of the functional behavior and neural representation of that region, are used to predict what effect treatment to that region will have on the whole person. When a correction is performed optimal alignment, movement and control is created and this alters the neurophysiological input from this region to the rest of the body. While the correction is maintained other regions of the body are assessed,do they improve, get worse or no change during the meaningful task? Corrections to different regions are completed until the one that makes the most regions better and no other regions worse, is identified as the driver. The Driver Diagnostic ChartTM is also used to streamline and self check throughout this process.
The Thoracic Ring ApproachTM is one portion of ConnectTherapy and is a new way of assessing the thorax as an integrated 3D ring. It looks at the thorax as a complete ring rather then individual pieces. Due to multiple articulations and strong ligamentous attachments, these structures move together. The 5th ring would include T4-T5 vertebra, T4-5 intervertebral disc, the right and left 5th rib and their anterior attachment to the sternum. In traditional models the thoracic spine is often overlooked and is considered very stiff and stable due to the rib cage but this is a common myth. There are 136 joints in the thoracic spine and it is the largest region of the spine providing a large range of motion, particularly rotation and side bend. This large range of motion and number of moving joints requires a high level of coordination of muscle activity between the deep and superficial systems. You can think of the thoracic spine as a shock absorbing spring rather then stiff and inflexible. In the Thoracic Ring Approach the rings are palpated more laterally, the benefits of this are being further away from the axis of rotation there is a greater amplitude of motion to detect and less soft tissue to palpate through.
Once the driver has been identified treatment is specific to that region. The goal is to train control not stability and create variability in the system not the one NOLT pattern that it currently has. There are three main phases to treatment and exercises are based on function not symptoms.
Using ConnectTherapy is our opportunity to stop chasing pain and systematically assess the whole person to find the true driver. This model can be used on all patients from an ankle sprain to the more complex cases: poor outcome post operatively, recurrent muscle and ligament injuries, those patients who feel like they are falling apart with one injury after another, injury prevention and those who want to perform at a higher level.
Lee LJ. Thoracic Ring Control: A Missing Link? MPA In Touch magazine, an official publication of Musculoskeletal Physiotherapy Australia, a national group of the Australian Physiotherapy Association. Issue 4, 2013: 13-16.