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
Background:
I have been following Dr. Erson Religioso's blog,
The Manual Therapist, for quite some time now. I also recently subscribed to his OMPT Channel section where I have learned quite a few evaluation and treatment techniques to add to my arsenal. Dr. E has training in a plethora of different schools of thought and one of them is the Mechanical Diagnosis and Therapy or MDT for short. Part of his MDT skill-set is a various amount of techniques that he refers to as "resets". He often uses them as part of his evaluation, treatment and home exercise programs. I hope I am saying all of this accurately, at least. Here is a couple videos of Dr. Erson Religioso III, DPT, FAAOMPT explaining the what, why and how related to these resets.
This is Dr. E's video highlighting the his favorite resets, and why they work.
An updated but longer video for Dr. E's favorite resets.
The Toe Pain:
I am currently pursuing a post-professional graduate degree so that means I am still a student (will be one for life) and that I still have finals. A couple Monday’s ago I was sitting around with a few of my classmates while waiting to take a final practical exam. One classmate mentioned that she had a very painful big toe on her right foot. She had been suffering this pain for a day or two since walking around Chicago the entire weekend while wearing ill-fitting footwear. She had only had the pain on one side without any direct MOI besides gradual onset related to the shoes and walking. She had pain with great toe extension when toeing-off in her gait cycle.
Dr. E’s videos had been on my mind and I was curious if his resets would really work because they were a foreign concept related to anything I had been taught. I had the idea of doing repeated-end range flexion of the great toe for about 20 repetitions and I asked her if she minded trying out the experiment. She obliged and we went to town with the repeated “resets”.
After I finished with the 20 or so repeats I asked her to stand up and walk around. Alas, she had no pain and no other complaints appeared. I told her that there was a chance that this would be a transient effect and that she may need to repeat this exercise about 10 times every hour. However, her pain never returned that day and hasn’t to date. I believe a week later when I inquired about her toe she mentioned that my “voodoo” had fixed the issue for good. While I don’t think I was doing any magic or voodoo I do think this highlights some merit to these resets on an n=1 level. Half of evidence-based practice is clinical experience and so far my “clinical” experience has been great; although I do wish I had some more extensive training or knowledge about MDT. I was impressed enough with these results that I tried using the repeated ankle plantar flexion reset for my girlfriend’s aunt who has had years of constant heel pain. This was just an offhand encounter at Mother’s Day brunch but it immediately took her symptoms from a wince-inducing 8/10 to a 4/10. I gave her instructions to continue these as a self-empowering home exercise and I hope she sticks to them. I really want to see how she progresses.
Conclusion:
My conclusion about these resets so far is that I like them but I don’t see them as a replacement to my current clinical skill set. I see them as being another tool and a great way to put responsibility into the hands of the patient. I understand the theory and concept as explained by Dr. Religioso. However, I definitely feel and want to learn more about this stuff before it starts to become a mainstay of my clinical practice.
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Caution
All content on this blog is meant as instructional and educational. The author and guest authors of this blog are not responsible for any harm or injury that may result. Always consult a physician or another proper medical professional for medical advice.
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