SYMPOSIUM KEYNOTE ADDRESSES & SPEAKER BIOGRAPHIES

Peter O'Sullivan PhD
Classification of chronic low back pain disorders - dealing with a complex bio-psycho-social problem
Chronic low back pain (CLBP) must be viewed from a bio-psycho-social perspective. The classification of CLBP disorders into specific sub-groups is considered to be a top research priority. Classification systems should be mechanism based, direct management and predict outcome for a disorder. This presentation will deal with this complex issue and present an approach to diagnosis and classification based on a bio-psycho-social model.

Peter O'Sullivan PhD
Motor control impairment disorders - a mechanism for chronic low back pain
The classification of control impairment disorders represent a large sub-group of patients with Chronic Low Back Pain. These disorders are associated with mal-adaptive impairments in motor control that result in a mechanism for ongoing pain and disability in these subjects. Considerable research has been conducted at Curtin Univeristy validating this sub-group and motor learning interventions have proven effective in their management.

Peter O'Sullivan PhD

Description of Role:	Senior Lecturer in Manipulative Therapy Curtin University of Technology, Australia
Qualifications:	DipPhysio(Otago), PGradDipMTh PhD(Curtin)
Teaching Areas:	Postgraduate Manipulative Therapy Manual Therapy Clinical Practice Exercise Rehabilitation Clinical Research Supervision
Research Interests:	The clinical examination and physiotherapy management of chronic and recurrent musculo-skeletal pain disorders. Motor control and motor learning approaches to the management of patients with 'lumbar segmental instability' and chronic low back pain disorders. Examination and management of patients with sacro-iliac joint pain disorders. Detection of motor control disturbances in different chronic and recurrent musculo-skeletal pain disorders. The identification of clinical sub-groups within the chronic low back pain population.

Alan Beggs MD MSc FRCSC
Advancements in spinal surgery: Motion sparing total disk arthroplasty as an alternative to spinal fusion
Beginning with a historical perspective on intervertebral fusion as a treatment for various spine pathologies, we will examine the advances in spinal surgery over the last few decades. Recently, motion sparing implants have been proposed as a viable alternative to intervertebral fusion. Some of the devices have proven to elicit more problems than they solve, however the field of total disk arthroplasty is rapidly expanding, and demonstrates great potential to help patients with mechanical back pain. We will examine the indications, contraindications and clinical results of total disk arthroplasty in the cervical and lumbar spine. Special emphasis will be given to the biomechanics of the lumbar total disk arthroplasty in an attempt to identify its strengths and weaknesses in order to allow direct comparison to the previous gold standard of intervertabral fusion.

Alan Beggs MD MSc FRCSC
Dr. Alan Beggs M.D. M.Sc. FRCSC received his medical training at the University of Saskatchewan. Following medical school, Dr. Beggs came to the University of Western Ontario for residency training in orthopedic surgery. Subsequently Dr. Beggs completed fellowship training in spinal surgery with Dr. Kevin Gurr of the London Health Sciences Centre. He then established a private orthopedic spine practice in Regina, Saskatchewan where he also serves as an Associate Clinical Professor in the Department of Surgery of the University of Saskatchewan, College of Medicine. Dr. Beggs research interests include the use of bone morphogenic proteins in bone fusion biology; and the biomechanics of intervertebral disks adjacent to total disk arthroplasties.

Stuart McGill BPE MSc PhD
Designing back stabilization exercise progressions A therapeutic exercise is presented to two different people. One responds positively and progresses while the other breaks down and gets worse. This short presentation will introduce several notions about matching the optimal exercise with an individual together with some thoughts on progression.

Stuart McGill BPE MSc PhD Stuart McGill is a spinal biomechanist and Professor and Chair of the Department of Kinesiology at the University of Waterloo. He has been the author of over 200 scientific publications that address the issues of lumbar function, low back injury mechanisms, development of evidence-based rehabilitation and performance exercise, and the formulation of injury avoidance strategies. He has been an invited lecturer at many universities, and delivered over 200 invited addresses to various societies around the world. As a consultant, he has provided expertise on assessment and reduction of the risk of low back injury to various government agencies, many corporations, professional athletes and teams, and legal firms. He sits on the editorial boards of the journals Clinical Biomechanics, Applied Biomechanics and also SPINE. He holds other academic appointments which include the Department of Mechanical Engineering, University of Waterloo; the Institute of Medical Science, University of Toronto; and the Southern California University of Health Sciences. Much of his work is summarised in two recent books "Low back disorders: evidence based prevention and rehabilitation" published by Human Kinetics Publishers, and "Ultimate back fitness and performance" available at www.backfitpro.com.

Anita Gross MSc, BScPT, Grad Dip Manip Ther, FCAMT
Evidence-based Clinical Practice Guidelines: A clinical "routine" for managing mechanical neck disorders.
As manual therapists, we develop "routines" for the evaluation and management of mechanical neck disorders. Where do these "routines" come from? The first draft was from postgraduate training and resulted from "replicating" the advice of our respected teachers. We then gained the ability and freedom to integrate high quality evidence with our patient values and local working conditions. We, as busy clinicians, restrict our search to high quality, previously appraised evidence. Evidence-based clinical practice guidelines (EBCPG) are one tool we use to take us to the bottom-line quickly. They are systematically developed statements about best practice in health care for specific clinical conditions. EBCPG typically address a high-cost, high-volume, or high-risk area of practice. As manual therapists, we are among the first to adopt innovations in our practice. Are EBCPGs worth using? To become wise consumers of EBCPG, we ask the following questions:

1. How are EBCPG developed? All EBCPG methods stress the need to develop, implement, disseminate, and evaluate the EBCPG. The core steps we, on our Canadian journey of EBCPG development, used were: a) panel development, b) selection and framing the problem, c) generating the EBCPG, d) obtaining practitioner feedback and external review, e) dissemination and implementation of EBCPG, f) evaluation, and g) updating.
2. How can I identify the best or most valid EBCPG? The following steps are fundamental to identifying the best EBCPG: a) the clinical question should be framed, b) a search for guidelines should be conducted, c) the quality should be assessed, and d) the reasonableness of the EBCPG should be assessed.
3. What should I consider when adopting EBCPG in my practice? Several indicators can influence the actual use of EBCPG in our daily practice: a) the topic of the EBCPG itself and its development process, b) our perceptions and attitudes toward an EBCPG, c) the skills needed to apply the EBCPG, and d) external factors that are generated by our clinical environment.

Anita Gross MSc, BScPT, Grad Dip Manip Ther, FCAMT
Anita Gross received degrees from the University of Toronto in the field of Physiotherapy, Curtain University in the field of Manipulation Therapy and McMaster University in Design, Measurement and Evaluation. Anita is a clinician, researcher, and educator. She is a clinician at ProActive Physiotherapy. She is an Associate Clinical Professor in the Schools of Rehabilitation Science and teaches advance orthopaedic manipulation for the Canadian Physiotherapy Association. Her research and clinical work focuses on neck disorders. Anita's authored of over 60 peer-reviewed journal articles, reviews, book chapters and conference proceedings; She has been an invited speaker at international conferences and has refereed for numerous journals.

Leslie Bonci MPH RD
Nutrition - The x-factor in orthopaedic medicine
Optimal nutritional status is an essential component of bone and joint health, but patients are often unaware of what and how to eat to optimize their orthopaedic well-being. From eating disorders to obesity, and anti-inflammatory agents to performance enhancing substrates, providing nutrition guidelines for patients is preventive and proactive. This presentation will examine some of the nutrition guidelines for orthopaedics and provide practical recommendations for patient care.

Leslie Bonci MPH RD
Leslie J. Bonci, R.D., M.P.H., L.D.N., is the director of sports medicine nutrition for the Department of Orthopedic Surgery and the Center for Sports Medicine at the University of Pittsburgh Medical Center (UPMC). She is an adjunct assistant professor of nutrition at the University of Pittsburgh School of Health and Rehabilitation Sciences and an adjunct assistant instructor in pediatric dentistry at the university's School of Dental Medicine. She also serves on the faculty of Pitt's sports medicine fellowship training program. Bonci is a registered dietitian and Pennsylvania-licensed dietitian/nutrition with a Bachelor of Science degree in biopsychology from Vassar College and a master's degree in public health from Pitt. She serves as a nutrition consultant for Pitt's department of athletics, the Pittsburgh Steelers, Pittsburgh Penguins, Pittsburgh Pirates, Pittsburgh Riverhounds professional soccer team, Cincinnati Reds and Toronto Blue Jays. In addition, she is the company nutritionist for the Pittsburgh Ballet Theatre and a sports nutrition consultant to local and national schools and universities. She is also the consulting nutritionist for the US Olympic Canoe and Kayak Team. Bonci is on the Gatorade Sports Science Institute's Sports Nutrition Board and lectures regularly at coaches' clinics as well as at national meetings for the National Strength Professionals Association; National Strength and Conditioning Association; American Alliance for Health, Physical Education, Recreation and Dance; and National Association of Sports and Physical Education. She is also the consultant to the NCAA Division III programs and nutrition expert for the NCAA Nutrition and Performance website. Leslie has also worked in the food industry as a consultant with companies such as Frito-Lay, Gatorade and Heinz. A popular former national media spokesperson for the American Dietetic Association for eight years, she has been a frequent guest on the NBC-TV "Today" program, and has done satellite media tours on behalf of Heinz, Gatorade, and the California Dried Plum Board. Her expertise in the areas of sports nutrition, weight management, eating disorders and digestive health resulted in two book publications: "Total Fitness for Women," which she co-authored, and the "American Dietetic Association Guide to Better Digestion," of which she was sole author. An avid long-distance runner, Bonci has written chapters in several sports medicine textbooks and writes regularly for the Training and Conditioning Journal.

Connie Lebrun MDCM MPE CCFP Dip Sport Med
Evolution of sports medicine care at the Olympic Games
Since the renaissance of the modern Olympic Games by Baron Pierre de Coubertin in 1986, male athletes (and eventually female athletes as well!) have trained and competed to be the best in the world in their respective sports. The recent 2004 Olympic Games returned home to Athens to showcase this display of athletic talent. What the general public and the television audiences are largely unaware of is the "behind-the-scenes" organization and administration that must take place at many levels. Sports medicine practitioners play a critical role in ensuring that the athletes arrive at the Games in as healthy a state as possible, and complete their events free from illness or injury. With the increase in commercialism of the Games, as well as the over-riding spectre of performance-enhancing drugs, this task has become even more challenging and intense. This presentation will focus on the development of the Canadian Medical Team services at major Games, and some of the highlights, from a personal point of view.

Connie Lebrun MDCM MPE CCFP Dip Sport Med
Dr. Connie Lebrun is the Director of Primary Care Sport Medicine at the Fowler Kennedy Sport Medicine Clinic at the University of Western Ontario, in London, Ontario. Connie brings to the Clinic over 20 years of experience. Following completion of medical school at McGill University, she interned in Vancouver, and then went into private practice in North Vancouver. After 5 years of family practice, she went back to do a Fellowship in Sports Medicine, and a Master's degree in Exercise Physiology. Her current position at UWO (where she has been since 1995) allows her to combine her interests in research on women's issues in Sport Medicine with teaching, administration and clinical practice. She has also served on Committees and at the Board level in many organizations, including the Canadian Academy of Sports Medicine (CASM). In 2002 she completed a two-year term as a Vice President of the American College of Sports Medicine (ACSM). One of her most interesting recent projects was representing ACSM on a task force group of 6 sports medicine organizations to develop a Consensus Statement for the Team Physician on various issues affecting The Female Athlete.

She has been involved with athletes from the Olympic team level to individuals of all ages wishing to get back to or begin to pursue an active lifestyle. She has been a member of numerous Canadian Medical Teams at major games, including the Olympic Games in Atlanta (1996), Sydney Australia (2000) and Athens (2004), and the 2003 Pan-American Games in Santo Domingo. She was also the Chief Medical Officer for the 2001Canada Summer Games (Jeux du Canada), held in London and surrounding communities.

She is a former member of the Canadian National Women's Volleyball team, competing in the 1973 and 1977 World University Games, the 1975 Pan American Games, and the 1976 Olympics. She currently keeps active playing squash, recreational volleyball, running, cycling, kayaking, rowing and skiing. She delights in the present proliferation of opportunities for girls and women in sport. For example, soccer is an excellent game for both participation and fitness. She is a strong advocate for regular weight bearing activity for women of all ages, both for protection of bone mineral density, and for prevention of chronic diseases such as hypertension, coronary heart disease and diabetes. Even older patients with knee or hip arthritis can benefit greatly from some type of physical activity.

Peter Fowler MD FRCS(C)
Osteotomy about the knee
Why not high tibial osteotomy, a time-tested surgical option for treating osteoarthrosis of the knee? The procedure has demonstrated a survivorship of 83% at 10 years (Hutchison & Gross 1998) and success rates of 80-90% at 5 years and 60-70% at 10 years (Insall 19984; Rudan 1991; Ivarsson 1990; Coventry 1993; Yasuda 1992). No intra-articular implants are required and there is a consistent decrease in adduction moment, suggesting improved alignment (Goh 1993; Prodromos 1985; Wang 1990; Chiang 2003). Many of these patients need a biplanar correction necessitated by sagittal malalignment, cruciate deficiency and/or the particular site of the erosions. Although closing wedge osteotomy has produced decent results over the years, we prefer the opening wedge technique. This facilitates a biplanar correction to deal with anterior or posterior erosions, ACL or PCL deficiency, or a hyperextension thrust. It requires only a single cut, avoids the proximal tibiofibular joint and peroneal nerve, and does not violate the anterior compartment of the leg. The main disadvantage is the need for a graft (autograft, allograft or bone substitute) in most situations. The drawbacks of closing wedge HTO include a resultant alteration in the shape of the upper tibia, which may have implications for future TKA, difficulty in controlling the tibia slope, and the necessary violation of the proximal tibiofibular joint. Huge correction (< 2 cm) are better managed with osteotomies distal to the tibial tubercle and external fixation.

Peter Fowler MD FRCS(C)
Dr. Peter Fowler is the Director of Sport Medicine at the University of Western Ontario and Physician-in-Charge of Western's intercollegiate athletic teams. Dr. Fowler received the Sport Medicine Council of Council Lifetime Achievement in Sport Medicine and Science Award in 1992 and was recognized in Best Doctors in America, 1994. Internationally acclaimed for his excellence as an orthopaedic surgeon, the former UWO swimmer and Pan-American Games silver medalist also serves as Honourary Medical Advisor to the Commonwealth Games Association of Canada. He has headed the medical teams at many Commonwealth and Olympic Games. Dr. Fowler was the first recipient of the Alumni Professional Achievement Award, University of Western Ontario 1995.

Thomas Jenkyn BASc MASc PhD
Virtual rehabilitation: interactive computer modeling of orthopaedic biomechanics Osteoarthritis is a painful and disabling condition affecting millions of Canadians and is the most common musculoskeletal disorder of the knee. Abnormal forces within the afflicted joint could be the cause, rather than just a symptom. A computer simulation of the biomechanical function of the joint is under development at UWO that will use 3D MR imaging as anatomical input, as well as motion analysis of the patient's movement as kinematic input. Each simulation will be specific to the patient. The surgeon or therapist can then interactively perform "virtual surgery" or "virtual rehabilitation" to explore various treatment options, to determine the optimal treatment for the patient and to predict the likely success of each option. The computer simulation is being validated using three new techniques: quantitative MR imaging, 3D x-ray analysis and with implantable biosensors.

Thomas Jenkyn BASc MASc PhD
Dr. Tom Jenkyn was originally trained as an Aerospace Engineer at the University of Toronto before he switched into Biomechanical Engineering during his doctoral research. He received his PhD in Human Biomechanics from the University of Strathclyde in Glasgow, Scotland where he studied the forces and torques acting internally on the ankle joint during walking and quick turns. He held the position of post-doctoral research fellow for 3 years at the Mayo Clinic Medical School, Department of Orthopaedic Surgery in Minnesota USA, before taking up his current position at University of Western Ontario. Dr. Jenkyn currently holds the position of Assistant Professor of Human Biomechanics with a joint appointment to both the School of Kinesiology, Faculty of Health Sciences and the Department of Mechanical and Materials Engineering, Faculty of Engineering. He is the Co-Director of the Wolf Orthopaedic Biomechanics Laboratory located in the Fowler Kennedy Sports Medicine Clinic on UWO campus. His current research studies the biomechanics of walking. He has special interest in the biomechanics of the foot and ankle, its alteration due to footwear and orthotics and the disruption on normal function due to trauma and osteoarthritis.

Matt Walsh BSc (App) PT
The Running Clinic: Correlating clinical tests and movement analysis
For the last three years we have evaluated and prescribed exercise, corrective running drills, training and shoe modifications for runners. Constantly redesigning the evaluation process and collected data has allowed us more confidence in a series of clinical and functional tests that when present together predict the level of pelvic stability and foot contact time that will be present in a video running analysis. Upon completion of this short lecture, participants should be able to: recognize functional clinical tests that highly correlate with spondylolisthesis and functional pelvic instability; be able to recognize functional pelvic instability through video analysis examples and its correlation to clinical testing procedures; and understand the sport specific importance of foot contact time in running.

Matt Walsh BSc (App) PT
Originally from Sydney, Australia, Matt Walsh has taught courses on the Biomechanics of Gait and Running for 10 years in Australia, Canada and the USA. He has presented his unique approach to physical therapy at the Australian Institute of Sport and various provincial and national conferences. In addition to his work as a clinician and teacher, Matthew has also served as therapist to the Canadian Cross Country ski team, Alberta Alpine ski team and as a consultant to the PGA tour, Seattle's Pacific Northwest Ballet and Canadian U23 Rugby team. He has instructed with Richard Jackson, Jenny McConnell and has extensive teaching experience in Sports and Orthopaedic Manual Therapy in Canada, Australia and the USA. His approach is one of the integrating the disciplines of manual therapy (specific, articular, hands on treatment) with functional exercise and movement re-education. He currently practices out of his home studio (The Movement Clinic) and Nike in Beaverton, Washington.

Concurrent Session #1

CONCURRENT SESSION 1A ~ LUMBAR SPINE
SATURDAY, OCTOBER 29
1215 - 1315

CONCURRENT SESSION 1B ~ CERVICAL SPINE
SATURDAY, OCTOBER 29
1215 - 1315

CONCURRENT SESSION 1C ~ OUTCOME MEASURES
SATURDAY, OCTOBER 29
1215 - 1315

Concurrent Session #2

CONCURRENT SESSION 2A ~ PELVIS
SATURDAY, OCTOBER 29
1600 - 1700

CONCURRENT SESSION 2B ~ LOWER EXTREMITY
SATURDAY, OCTOBER 29
1600 - 1700

CONCURRENT SESSION 2C ~ ANATOMY
SATURDAY, OCTOBER 29
1600 - 1700

Concurrent Session #3

CONCURRENT SESSION 3A ~ THORAX
SUNDAY, OCTOBER 30
1115 - 1200

CONCURRENT SESSION 3B ~ ACUPUNCTURE
SUNDAY, OCTOBER 30
1115 - 1200

CONCURRENT SESSION 3C ~ UPPER EXTREMITY
SUNDAY, OCTOBER 30
1115 - 1200

Concurrent Session #4

CONCURRENT SESSION 4A ~ PELVIS
SUNDAY, OCTOBER 30
1230 - 1330

CONCURRENT SESSION 4B ~ LUMBAR, KNEE & THORAX
SUNDAY, OCTOBER 30
1230 - 1330

CONCURRENT SESSION 4C ~ CERVICAL SPINE / CLINICAL REASONING
SUNDAY, OCTOBER 30
1230 - 1330