This past weekend I had the pleasure of attending the Selective Functional Movement Assessment(SFMA) certification course in St. Louis, Missouri. More specifically, the course was hosted on the beautiful campus of Logan Chiropractic College/University. Logan did a great job of hosting this seminar and they were very accommodating and even had snacks/refreshments/coffee available. The only thing I could think to gripe about was my poor cellphone service in the basement classroom that we used. ;)
I was first introduced to the SFMA by a mentor of mine during my senior year of my undergraduate when he attended an SFMA course himself. He gave me some background about what it was and what they were trying to teach and ever since then I had wanted to learn it myself. Reading the book Movement by Gray Cook and becoming FMS certified didn't help my anxiousness either.
For those of you that don't know what the SFMA is..."The Selective Functional Movement Assessment (SFMA) is a series of 7 full-body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known musculoskeletal pain. When the clinical assessment is initiated from the perspective of the movement pattern, the clinician has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main musculoskeletal complaint, but contribute to the associated disability. This concept, known as Regional Interdependence, is the hallmark of the SFMA.
The assessment guides the clinician to the most dysfunctional non-painful movement pattern, which is then assessed in detail. This approach is designed to complement the existing exam and serve as a model to efficiently integrate the concepts of posture, muscle balance and the fundamental patterns of movement into musculoskeletal practice. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain." -SFMA.com
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| This is a pretty thick manual ;) |
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| Dr. Brandon ran an entire SFMA assessment and the breakouts in ~10minutes. |
There were 5 main course objectives set by this crew to instill upon us 90 something participants that included a mix of chiropractors/chiro students, athletic trainers, physical therapists, and physical therapy assistants. It was quite the melting pot of musculoskeletal professionals. This course even provides CEUs to most of these professions! :)
- Understand the importance of identifying dysfunctional movement patterns.
- Understand the importance of pain provocation during the examination process and that pain adversely affects motor control.
- Immediately apply information gained from the SFMA to select key impairments to address and design appropriate interventions to normalize dysfunctional movement.
- Describe the importance of assessing movement patterns in both the loaded and unloaded positions and how this information can be used to guide intervention.
- Link the assessment information to the initial therapeutic strategy and initiate the most appropriate treatment interventions (manual therapy and functional exercise) into the traditional rehabilitation program to normalize dysfunctional movement
I honestly feel like these five objectives were easily covered and ingrained in us all before we left on late Sunday afternoon. Even better, I feel that these instructors were able to go above and beyond and taught us more than promised. We were able to learn about their first hand experiences and real world clinical applications of the SFMA using a wide ranging patient population from children to the elderly(~95 years old!). They also shared with us vital pieces of information related to mistakes they learned from in the past, the mistakes of others, and other tidbits to decrease the size of the learning curve of this system.
The seminar setup was a good combination of lecture and lab. There was a great system of introduction a series of break-out tests and then lab time to practice the exams first hand on our own. This was also a great time to get personal help from the instructors as well. They were always willing to take questions and would share common or unique questions with the class after the lab portion was over.
We were also introduced to the basic concepts/philosophies behind addressing stability/motor control dysfunctions that are uncovered during the SFMA. This approach follows a neurodevelopment model and definitely is easy to understand and implement. This approach also eliminates the necessity of many pieces of rehab equipment and would be easy to use in many different settings with many different populations. However, this is only briefly discussed and is saved more for the advanced SFMA course where the main focus is different corrective approaches using this model.
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| My Multisegmental flexion was a big fat DN. Posterior Chain Tissue Extensibility issues :( |
I can't talk about everything that I learned this weekend or try to explain everything that I learned. I could probably write an epically long post and none of you would want to read it, despite the fact that I might enjoy talking on and on about it all. Instead I will share some of the simple and basic rules of assessing movement that we were taught.
1) NO Warmups! This allows for repeatability and evaluates raw, unaltered movement.
2) If it looks like a duck, walks like a duck, and quacks like a duck...ITS A DUCK! Don't over-think stuff too much!
3) Be Picky! If it is "not bad" that means it is "not good"...This isn't horseshoes or handgrenades
4) NO SHOES! Alters movement too much! Heel lifts will alter biomechanics, shoe wedges and orthotics can potentially alter proprioception and stability. This allows for better reliability as well.
5) Monkey See, Monkey Do...Show your patients what you want them to try- this allows for faster evaluation times. (However this means that you have to be able to show them a good example!)
Im going to try and summarize my thoughts about this system and seminar up in a few thoughts here.
1) It is a game changer...This system of evaluation/assessment will change how to think about injuries, how you look at injuries and what you think about treating said injuries.
2) This seminar left me feeling slightly ashamed and guilty for how I used to assess patients. This system will make you feel like you were blindly poking in the dark or using well-informed guesses at best in the past.
3) After the feelings of shame or guilt wash away a new feeling of excitement, wonder and intense intellectual curiosity will take over. You can even ask my girlfriend and she will tell you that I was giddy like a kid in a candy shop the entire car ride home from the seminar. I was filled with excitement for the future and the ability to help people better and more efficiently. This is one of the major reasons that I love my profession and now I can do my job even better!!!
4) I don't care how much this cost me in terms of travel, hotel and course $$$. Every dollar was worth it in my mind. For some, it may not be worth it. Those are the people that are going to take this manual home and leave it on their coffee table and only come back to it when they get stuck or have a case that they couldn't fix with their previous style of practice. For me, it changes my entire approach and will be practiced daily.
5) It is a lot of information. I won't lie. But if you learn the the philosophies, the reasons and the basic logic behind it all you will be able to take and run with it. This isn't brain surgery(cliche, I know) but it does require you to spend more time working with your patients. Who cares about spending more time on a patient evaluation and less time treating a patient but with more effective results? One thing that I always hear patients complain about is that the doctor/chiro/PT/etc didn't look at them or barely spent any time evaluating them. This has got to hamper the patient's confidence in the effectiveness of the clinician and any potential treatments that they may have to offer. Why not just make the patient feel like they have been properly assessed, and in the end actually end up with the proper course of action in the first place!
In the end, I enjoyed it all. I love things that make me self-reflect and question my beliefs. If you don't question or challenge beliefs then you probably aren't made to be in the fields of science or medicine. I look forward to sharing future cases with all of you on how I have used this system and the outcomes with my patients.
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