This past weekend I took part in the advanced portion of the Selective Functional Movement Assessment (SFMA). The advanced course reviews the assessment and provides in depth ideas for treating stability, motor control (SMC) dysfucntions. The SFMA allows clinicians to go through a thorough full body assessment in an organized fashion. Instead of narrowing your lens on the site of pain, the assessment forces you to broaden your focus and identify other areas of the body that may be contributing to the pain. Much like Diane Lee’s Integrated Systems Model the approach helps you identify not only the source of the pain but the cause of the pain.
There were a few major lessons for me over the weekend.
1. We must identify whether the motor dysfunction (action) is due to a sensory or a processing problem. A lack of joint motion leads to sensory loss and poorly controlled movement (an inability to use all of a joints passive range of motion) is a processing problem.
2. The three biggest predictors of injury are previous injury, motor control (your ability to control movement), and asymmetries. I usually see people after injury so I treat their motor control dysfunctions and their asymmetries.
3. Mobility or limits in range of motion should always be treated before stability, motor control (SMC) dysfunctions.
4. When exercise is initiated as part of the therapy plan it should first address any mobility issues, it should then address SMC dysfunctions, and it should always follow the 4×4 matrix. Read more on the 4×4 matrix here.
5. Movement competency should be trained before movement capacity. Meaning mobility and body weight movements should be perfected before load is added to the system.
6. If the SFMA cannot provoke any pain it is our job to add stress to the system by increasing the load. This can be done by using the Functional Movement Screen or by going through a sport specific movement assessment (task analysis).
There were lots of other great lessons but they pertain more to assessment specifics that are of more interest to clinicians than clients. As was expected the talented instructor Behnad Honarbakhsh, from Fit to Train Vancouver, provided the class with a number of clinical pearls and led the class on some very informative discussions.
I use the SFMA on all my clients but this weekend refocused my attention to some the smaller details and reinforced how and why the 4×4 matrix is so useful. Over the next few weeks I am going to do a better job of coming to a clear functional diagnosis.
Thanks for reading