Foundations: Modules 1-4

Diaphragm/Pelvic Floor Piston for Adult Populations Online


Foundations: Diaphragm/Pelvic Floor Piston for Adult Populations

Formerly Piston Science Part One

Modules 1-4

Julie Wiebe, PT

Course Tools

Course Description:

Foundations will transform your approach to adult rehab, recovery and return to fitness. In Modules 1-4, the viewer is introduced to a dynamic team of muscles, inclusive of the relationship between the diaphragm and pelvic floor. That team works together to balance muscular forces and pressures, creating an integrative model of dynamic central stability. Learn to address issues with the musculoskeletal system, movement patterns, pelvic health, and fitness simultaneously by coordinating elements of this central team. Integrated as a dynamic foundation for movement and fitness programs, this inside-out strategy is reinforced and embedded to build automaticity and optimize outcomes.

Adapted for the online educational format, embedded video, case examples from recreational to high intensity athletes provide the viewer with ample opportunity to interact with the material and apply this approach in all areas of adult rehab and fitness (women’s health, orthopedics, sports medicine, fitness and neuro). The course is a bundled learning opportunity, with each of the modules building on the previous presentation.

Module 1-4 is an introduction to the theory, concepts, evidence and application of the Piston Science approach. When you’re hungry for more in depth understanding of the practical integration into clinical programming, watch the integration of the ideas filmed with a live volunteer who is a runner in Modules 5-7 here.

Module One has been approved for 2 CCUs in 30+ states by the Federation of State Boards of Physical Therapy. Modules 2-7 have been approved for an additional 10 CCUs. The entire course must be completed for a total of 12 CCUs. Please follow this link to determine if your state is among them.

Buy all 7 Modules here for less (Foundations Part One).


Women's Sports Medicine & Fitness


  • Foundations (Module 1)
  • Treating and Training the Female Runner (Module 1)
  • Female Athlete: Ready for Impact and High Intensity (Case Study)

Foundations + Running Series:
Bundle A


  • Treating and Training the Female Runner
  • Foundations (Modules 1-7)

Foundations + Running Series:
Bundle B


  • Treating and Training the Female Runner
  • Foundations (Modules 1-4)

Click here for all bundles

Module One: An in-depth discussion of the theory, evidence and concepts for the Piston Science approach, a neuromuscular and systems based path to creating central stability from the inside-out. The diaphragm is presented as the intersection of multiple systems, with breath mechanics as an accessible gateway for all populations to a new model of dynamic trunk and pelvic control. In addition, dysfunction across the lifespan is explored from this new perspective.

Module Two: Optimized alignment promotes the availability of individual components of the anticipatory core (Diaphragm, Pelvic Floor, TA and Multifidus) and augments their teamwork. The position of the ribcage relative to the pelvis contributes to maximized breath mechanics, core component teamwork and a balance of multiple systems. An assessment paradigm for evaluation of alignment, including ribcage position, and corrective cueing is presented.

Module Three: The diaphragm is the powerful link between the postural control, movement, sensory, balance, pressure, GI and continence systems. Optimized action of the diaphragm is the gateway to interacting simultaneously with all of these systems in our treatments and fitness. Identifying barriers to optimal breath, including alignment considerations as well as abdominal and pelvic floor over-recruitment, are included in an accessible assessment model of breath mechanics. Easy to apply intervention strategies are presented.

Module Four: Understanding Pelvic floor as a teammate in the stability system rather than a spectator leads to simultaneous improvement of postural control, musculoskeletal, performance and pelvic health concerns such as incontinence and prolapse. Pelvic health providers interested in developing integrative programs and promoting a return to fitness will gain new tools. For those who are new to the pelvic floor, tips are included regarding external palpation (When and when not to? How?). Alternative indirect evaluation ideas are provided through observation, functional testing, and treatment options.

Online Course FAQ’s: Total run time of these 4 modules is approximately 8 hours of content. Each single viewer purchase allows for unlimited access: review, re-watch, rewind as often as you need to for as long as you like. The online course is essentially identical to the live version, but has boosted content (more mini-case studies, videos, cues, self-labs, evidence, etc.) to facilitate independent learning.

Course Objectives:

  1. By the end of this online course the participant will be able to differentiate between the historical musculoskeletal interpretation of core strength and a neuromuscular, systems approach coined “core strategy”.
  2. By the end of this online course the participant will be able to describe the influence of the optimal muscle recruitment order on postural control for a reaching task.
  3. By the end of this online course the participant will be able to label the 4 components of the anticipatory core team.
  4. By the end of this online course, the participant will be able to describe the interaction of the four anticipatory core components to synergistically prepare for movement.
  5. By the end of this online course the participant will be able to describe 3 posture types using 1 rib cage and 1 pelvic positional descriptor for each.
  6. By the end of this online course the participant will be able to identify 4 alignment screening tools to guide therapeutic exercise selection for a treatment session.
  7. By the end of this online course the participant will be able to demonstrate 2 intervention techniques to optimize anticipatory core recruitment.
  8. By the end of this online module, the participant will be able to integrate breath mechanics as a gateway for postural control for 2 functional and 2 fitness movements (ex-sit to stand; squat).
  9. By the end of this online course the participant will be able to identify when it is and is not appropriate to palpate externally for pelvic floor activation in male and female clients.
  10. By the end of this course the participant will be able to determine when to refer a client on for an internal pelvic floor examination.

Course Audience:

This course is designed to equip adult rehabilitation professionals with the evidence, theoretical constructs and practical clinical tools to provide a neuromuscular, systems- based clinical model for postural control, inclusive of the teamwork between the diaphragm, pelvic floor and pressure systems. Musculoskeletal, movement pattern, pelvic health, and fitness issues are addressed simultaneously when this central team is coordinated, then effectively linked to the rest of the postural, movement and performance systems. All participants should apply the information within their state/jurisdictional scope of practice.

The PT/OT will gain the theoretical basis, clinical reasoning and practical tools for integrating a neuromuscular, systems-based approach to postural control from assessment to evidenced based treatment plan development integrating pelvic, musculoskeletal, and performance health concepts. Co-professional collaboration and referral will be stressed.

The PTA/COTA will gain insight to the theoretical basis for assessment process, and reasoning behind the POC designed by the therapist. Course participation and experience with specific cueing, exercise guidelines, progression parameters and treatment methods will insure continuity of care.

The Athletic Trainer/Kinesiologist (AT)/Kin will gain insight into theory, evidence and practical tools for integration of the POC into an athletes training program keeping pelvic and musculoskeletal health in mind.

Link To Full Schedule

Course Schedule:

Module One: Part One (approx. 1 hr.) Foundational Concept Introduction

Introduction/Course overview. Conceptual introduction to a neuromuscular, dynamic approach to central stability vs stiff musculoskeletal strategies. Clinical applications and the development of Core Strategy

Module One: Part Two (approx. 1. 25 hr.) Core Dysfunction Across the Lifespan

Re-framing both pelvic health and musculoskeletal dysfunctions in light of new understanding of Core Strategy across the lifespan. Clinical applications and concept synthesis

Foundations: Modules 2-4

Module Two: Part One (35 min) Alignment

Alignment as access to optimized muscular recruitment, multiple systems and inputs to the brain

Module Two: Part Two (1.5 hrs.) Alignment Screen

Demonstration via lecture and video of detailed alignment screen Movement/Functional Screen (form efficiency) cueing and clinical pearls.

Module Three: Part One (approx. 45 min) Diaphragm and Breathing Mechanics

Anatomical and functional review of the Diaphragm and breath mechanics, dysfunctional dominance patterns, barriers to a balanced breath and breath mechanics intervention strategies are presented.

Module Three: Part Two (approx. 1.25 hr) Refine the Breath

Chest and Belly Breather intervention strategies. Concept synthesis through 2 mini-case-studies of CrossFit athletes.

Module Four: Part One (approx. 1 hr) Pelvic Floor/TA

Anatomical and functional review of pelvic floor and functional partnerships. External pelvic floor assessment: palpation, self-palpation and functional tests and interpretation.

Module Four: Part Two (approx. 1 hr.) Find the Piston

Pelvic Floor intervention strategies; connect to the Diaphragm and create the Piston. Pelvic Floor tips for interventions, integration into function, motor control and building automaticity Concept Synthesis through a continuation of mini-case studies.

I need a Certificate of Completion

After you have completed the course modules, look for a link “I need a certificate of completion” at the bottom of the course page. Click the link to be directed to your post-test at Post-course test and course completion certificate is only provided for Module 1 in this bundle at this time. You must score a minimum of 70% on this test in order to receive the certificate. After you have submitted the test, you will be provided with the option to download your certificate of completion. In addition, click the link to be directed to a course self-refection to optimize the application of your learning to clinical practice. Please follow the provided link to complete the course evaluation. We value your feedback!

Is the course eligible for CEU's?

Successful completion of Module one or completion of all Modules (a total of all 7 modules) previously was eligible for CCUs through Procert. The course has been broken into smaller module bundles for your convenience (1 only, 1-4, 2-4, 5-7), however only the bundle combinations noted above ascribed to any continuing education credit. Since Procert is no longer, this course does not have CEU credit associated with it at this time. Unfortunately it is cost and time prohibitive to submit to states individually for CEU approval for each course, but we are hoping for another company or avenue to come about with the PT Compact in the future to allow us to get course pre-approval again for continuing education credits.

Individuals can apply for CEU credit retroactively through their state board after taking the course (if their state allows it). Contact your board for details about the process. If you do go this route we would greatly appreciate it if you circled back with us to let us know about the approval as it would be helpful to share with others

Computer Compatibility Needs

This course is hosted on the online streaming service designed to handle any system setup. So if you have a computer and an internet connection you should have access without issue. If you have issues with a slower bandwidth connection then you can change the video settings to a lower quality to help improve any loading issues.

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Your Instructor

Julie Wiebe, PT, DPT
Julie Wiebe, PT, DPT

Julie Wiebe, PT, DPT has over twenty-five years of clinical experience in Sports Medicine and Pelvic Health, specializing in abdominopelvic, pregnancy and postpartum health for fit and athletic populations. Her passion is to return active patients to fitness and sport after injury and pregnancy and equip professionals to do the same. She has pioneered an integrative approach to promote pelvic health in and through movement and fitness. These strategies have been successfully incorporated by medical providers, rehab practitioners and fitness professionals into a variety of populations (ortho/sports medicine, pelvic health, neurology, and pediatrics).

A published author, Dr. Wiebe is a sought after speaker to provide continuing education and lectures internationally at clinics, academic institutions, conferences and professional organizations. She provides direct care to fit and athletic populations through telehealth and her clinical practice. Recently, Dr. Wiebe joined the faculty of the University of Michigan-Flint, a welcomed opportunity to pursue both her educational and research goals to promote optimized care in clinical practice across the continuum.

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Want to book Julie for an onsite or online lecture, inservice or course? Please contact [email protected]

Contact Julie at [email protected] (Julie’s clinical practice is available to residents of California and Michigan)CV-Julie Wiebe, PT

Course Curriculum

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  Next Steps: Course Completion Certificates and CEUs
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Frequently Asked Questions

When does the course start and finish?
The course starts now and never ends! It is a completely self-paced online course - you decide when you start and when you finish.
How long do I have access to the course?
How does lifetime access sound? After enrolling, you have unlimited access to this course for as long as you like - across any and all devices you own.
Can I share a course with a friend or colleague? How does the group discount work?
Each course purchase is for a single viewer only, and may not be shared. If you are interested in group/staff viewing, please contact admin at [email protected] to arrange a group discount code specifically for your group. The larger the group, the larger the discount. Each individual must purchase separately with the discount code, and agree to the terms and conditions (legal). This provides each participant with their own copy to review at their pace, in addition to the opportunity to interact with colleagues as you all work collectively through the material. Real time group online mentoring for Q and A is available with Julie to support your distance learning as you work through each module or after completing the course. Contact admin at [email protected] to set up a group discount and group mentoring.

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