My SFMA: A Case Study - Multi-Segmental Flexion Breakouts

Today's post is the fourth part of my self-SFMA(Selective Functional Movement Assessment) case study series.  Specifically, We will look at and break out my dysfunctional Multi-segmental Flexion movement pattern from my SFMA Top Tier Post.  

I'm jealous of those that can do this.

Here are the links for the first three posts of this series:
SFMA Top Tier Pattern Assessment

SFMA CervicalSpine Pattern Breakouts

SFMA Upper Extremity Pattern Breakouts

Assessment:

The SFMA works by assessing 7 general top tier movement tests. All tests are rated and ranked by two broad categories of dysfunctional or functional, and then two sub-categorizations of painful or non-painful. This means there are four basic appraisals of FN, DN, FP or DP. From there you perform a "breakout" of each dysfunctional pattern to determine the cause of dysfunction. Dysfunctional movement patterns are broken down using an algorithm that funnels and filters the problem into either a mobility dysfunction or a stability &/or motor control dysfunction (SMCD). 

 

This video will look at the dysfunctional multi-segmental flexion pattern.  Here is the latest breakout video:

Results:

Multi-Segmental Flexion Top Tier = DN (Unable to touch toes. Why? We don't know yet. Other Criteria for passing: Uniform Spinal Curve, Posterior Weight Shift, < 70 degree Sacral Angle)

Single Leg Forward Bend Test = Bilateral DN, yet symmetrical (Still Unable to reach the toes or floor. Why? We don't know yet. Proceed to the next test.) 

This test helped to determine if the forward bend was an asymmetrical or symmetrical dysfunction…in the presence of pain with the top tier assessment we could also use this test to check for symmetry with pain provocation.

Long Sitting Test = DN (Still unable to reach toes. Why? I don’t know yet but we did pick up on a few things.)

We still do not have a clear cause of dysfunction yet, however we do know that I cannot touch my toes and I do have < 80 degree Sacral Angle. This would indicate limited hip flexion and/or limited spinal flexion, or both.

If I had been FN with this test we would have proceeded to the rolling patterns to check for a fundamental motor control dysfunction.

Active Straight Leg Raise Test: Right=DN, Left=DN (Looking for at least 70 degrees of Hip Flexion)

Passive Straight Leg Raise Test: Right=DN, Left=DN (Looking for at least 80 degrees Hip Flexion and to be within 10 degrees of the Active SLR)

It is observed that my passive SLR has more than a 10 degree difference from the active SLR. This would indicate a possibility of a core stability, hip flexion strength problem, excessive hamstring tone, guarding or a hip mobility dysfunction.

Supine Knee to Chest Holding Thighs Test = DN (Unable to bring knees and thighs to chest while supine.) This test is used to check the mobility of the hips while they are in an unloaded or non-weight-bearing position. Doing this also helps to differentiate a difference between hamstring mobility and hip mobility dysfunctions.

Breakout Findings: If we follow the breakouts one would deduce that I have a hip joint mobility dysfunction or a posterior chain tissue extensibility dysfunction or both…as well as a possible hip flexion strength or SMCD dysfunction. But that isn’t as important considering that we would need to treat the mobility dysfunction before addressing any SMCDs.

Do you have any ideas/suggestions/thoughts? Let me know in the comments below!

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A Year in Review: 13 Lessons of 2013

Happy New Year and welcome to 2014! This is my first post of the year and my 75th post overall.  This is going to be a reflection on some of the things that I learned in the previous 365 days. I was inspired to write this post after reading many of Mike Reinold's similar posts over the last few years. I guess I learned a lot this year because this turned into an epically long post. Sorry.

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My SFMA: A Case Study - Upper Extremity Breakouts

Today's post is the third part of my self-SFMA(Selective Functional Movement Assessment) case study series.  Specifically, We will look at and break out any dysfunctional upper extremity movement patterns from my SFMA Top Tier Post.  


In the first post/video, I was dysfunctional/non-painful (DN) for the Upper Extremity Pattern One (Combination of Extension/Adduction/Internal Rotation of the shoulder).  However, I was functional/non-painful (FN) for Upper Extremity Pattern Two (Combination of Flexion/Abduction/External Rotation of the shoulder). In case you missed it, here are the 7 top tier tests again. You can also check out the cervical spine patterns and breakout assessment here.

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Top 5 Posts of 2013!

Happy Holidays and a Happy New Year to all of my readers! I'm not sure if I actually have any dedicated readers yet but happy holidays to any happenstance readers as well! This post is a highlight of my top 5 viewed posts of 2013. I know it isn't technically 2014 yet so maybe I will be proved wrong. However, if you are new to my blog or haven't read all of my posts then maybe this recap will enlighten you to a popular post that you missed.

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My SFMA: A Case Study - Cervical Breakouts

Time to make an assessment of myself

Today's post is second part of my self-SFMA(Selective Functional Movement Assessment) case study series.  Specifically, We will look at the dysfunctional cervical spine movement patterns from my SFMA Top Tier Post.  In the first post/video, I was dysfunctional/non-painful (DN) for the Cervical Flexion Pattern, and the Cervical Rotation Pattern to both the Right & Left.  However, I was functional/non-painful (FN) for Cervical Extension. In case you missed it, here is the 7 top tier tests again.

The SFMA works by assessing 7 general top tier movement tests. From there you perform a "breakout" of each dysfunctional pattern to determine the cause of dysfunction. Dysfunction movement patterns are broken down using an algorithm that funnels and filters the problem into either a mobility dysfunction or a stability &/or motor control dysfunction (SMCD).

Assessment:
This video will look at the dysfunctional cervical spine patterns. Specifically, cervical flexion and cervical rotation to the left and right. I was functional for the cervical extension pattern so that pattern does not require a breakout assessment. Here is the breakout video:

Results:
Cervical Flexion Top Tier = DN (Unable to bring chin to sternum. Why? We don't know yet.)

Active Supine Cervical Flexion Test = DN (Still Unable to bring chin to sternum. Why? We don't know yet.)
If I was now FN we would know that there is a postural and motor control dysfunction or stability/motor control dysfunction...or both, affecting cervical flexion. This includes the c-spine, T-spine, and shoulder girdle postural dysfunction. Laying supine removed the postural and stability requirements of the gravity dependent/loaded standing position from the top-tier tests

Passive Supine Cervical Flexion Test = FN (Chin is now to sternum)
We can now assume the cause of the dysfunction was due to an active cervical spine flexion stability dysfunction or motor control dysfunction...or both. We know it is not a mobility issue because I had full motion when all stability and motor control requirements were removed and the movement was performed passively. If it was due to mobility reasons then my GF would not have been able to passively bring my chin to my chest. Mobility problems always present with consistent findings!

Cervical Rotation Top Tier = DN to the Left & Right (Can not rotate chin to mid-clavicle or at least 80 degrees, Why? We don't know yet)
This test no longer requires this degree of rotation and the ability to bring the chin to the clavicle, at least this is how I was instructed in October of 2013.

Active Supine Cervical Rotation Test = FN (At least 80 degrees of rotation bilaterally without a significant asymmetry)
We now know that the dysfunction was related to a postural and motor control dysfunction or a stability and motor control dysfunction...or both. This is why my top tier cervical spine rotation test was dysfunctional, not because of my perceived tissue "tightness."


Treatment:
It is said that there are many ways to skin a cat...that being said the SFMA is a tool or a system of assessment. It is not a specific approach to treatment. However, there are general guidelines based off of the findings and it also lays a road map of treatment for you(eg. mobility before stability, working your way down the top tier tests). Specifically, in my case I do not have any mobility dysfunctions within the cervical spine but if I follow the philosophy of the SFMA then I need to address the SMCD of the cervical flexion pattern before attempting to correct SMCD dysfunction of the cervical rotation.

There are many avenues for treating this dysfunction from dry needling to IASTM to MDT principles to using the 4x4 Matrix or etc. I can't advocate that one approach will be better for addressing my dysfunction than another...but I do have a system of assessment to judge the efficacy of each potential intervention. Perhaps IASTM and MDT combined will work great for 90% of my patients but I don't know that...all I need to know is how to assess-intervene-reassess. Oh and I should probably stay within my practice act, so use what tools you have and those that you are comfortable with.

Thoughts? Do you think my breakouts and assessment have been accurate so far? What would you do with me? I know what I would do....finish the SFMA breakouts, first. Come back as I continue to break out my many dysfunctional movement patterns.

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My SFMA: A Case Study - Pt. I

Howdy again Readers! Today will be the first part of a series of posts that I am lamely labeling "My SFMA." Each post will feature a video related to my own personal Selective Functional Movement Assessment (SFMA). Today's video will showcase my own seven top tier SFMA tests. Each additional blogpost and video will showcase a single dysfunctional top tier test derived from this initial video. In those videos I will perform the appropriate breakouts according to the SFMA to determine the reason for failing each individual top tier test and will discuss ways of treating these issues.

The idea behind this came from the fact that I am going to start increasing my physical activity levels, getting into better shape, and eventually getting back to marathon training. Working on preventing injuries is always easier than taking time away from exercise or training to work on treating injuries.

I also thought that doing this would help me to practice more with the SFMA system and will allow me to receive guidance or feedback from others with experience using the SFMA. If you watched the video it is obvious that I have a lot of preventing...or maybe I should say correcting to do. To find out and discuss what/how I should address, don't forget to come back for part II!

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Three Tips to Improve Posture

Howdy Readers! It has been a busy couple of months and I just finished my second to last semester of graduate school. (Yay!) I am hoping that I can start to get into the habit of rolling out more blog posts but I am not sure how the next semester will go considering that I will begin data collection for my thesis study.

Today's post will be the first step at getting back into the blogging groove and it will be a short and sweet post about posture. Posture is often discussed, known about by everyone but truly ignored by most in practice. Modern society and modern technology has really been a detriment to proper posture and promotes rounded shoulders, forward head posture, excessive kyphosis (hunch back) of the thoracic spine and excessive lordosis of the lumbar spine. None of these thing postural abnormalities are helping you out as an athlete, runner or human.

Poor posture can reduce breathing capacity, contribute to muscle imbalances, decrease power and performance. and result in injury.  To help combat this issue I am going to give you all three simple things that you can incorporate into your daily life to work on improving posture.

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Quick Vid - An Ankle Sprain And a Loss of Mobility

Hey guys! Here is a quick video that I shot the other day while working with a patient of mine. I just wanted to share a technique for ankle mobility that utilizes the Edge Mobility Band (or a theraband).

Case: 21 year old male, collegiate basketball player, 4-weeks post ankle sprain. Imaging revealed avulsion fractures of the medial deltoid and lateral calcaneal-fibular ligaments. Patient was ordered by the team physician to be immobilized in a boot and on crutches for the first three weeks following injury. Initially coming out of the boot, dorsiflexion and plantar flexion were almost a zero for both active and passive ROM.

In the video, this obviously didn't return ankle ROM to normal ranges but definitely increases it with just one set. I often repeat this 2-4 times depending on the patient's tolerance to the compression. I often have the patient walk a longer distance if tolerated as well. It also substantially lowers the patient's perceived discomfort associated with ankle "stiffness" and "soreness". I use this in conjunction with several different mobility techniques but is nice because certain techniques like a traditional posterior glide are much too uncomfortable for me to use with this patient at this stage. This is a pain free alternative for him!

Let me know how it works for you!

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Challenging Beliefs on Cryotherapy…Q&A with Joshua Stone, MA, ATC

Hey everybody, today I wanted to take the time and ask a fellow athletic trainer a few questions
regarding challenging beliefs and conventional wisdom. This post ties in perfectly with my last post when I interviewed Professor Timothy Noakes on challenging beliefs as well.  I want to introduce you all to Joshua J. Stone, MA, ATC, NASM-CPT, CES, PES, FNS. He is a fellow blogger at Athletic Medicine, and has been receiving a lot of attention lately for taking a stance on the use of ice (cryotherapy) and NSAIDS in treating both chronic and acute injuries. (Also see… Ice: The Overused Modality?)

Josh’s arguments are polarizing and have definitely stirred some controversy on a topic that can invoke strong feelings by many. However, the arguments that Josh puts forth are based on evidence, logic, and an intellectual curiosity to question everything.

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A Superb Interview w/ Prof. Timothy Noakes on High Fat Diets, Hydration, and Challenging Conventional Wisdom.

*http://chrislbecker.com/2012/10/09/government-vs-tim-noakes/

Welcome Readers!  Today I have the privilege and honor of sharing a back and forth that I had with Dr. Timothy Noakes of Capetown, South Africa. If you are big into exercise physiology, running/endurance sports or high fat/low carb diets then you probably know of or have heard of Professor Noakes! Dr. Noakes is a brilliant man and when he speaks, I listen. He is a passionate man and has strong feelings but he is also passionate about science and is no stranger to challenging beliefs or conventional wisdom.  He is infinitely curious and questions everything. Two hallmarks of a great mind.  I hope you all enjoy the interview and are able to take one or two things from it!


Me: Welcome Professor Noakes! I know you have been a man of many hats but could you give us a little background about yourself for the readers?

Professor Noakes: I trained as a medical doctor at the University of Cape Town and during my training I realized that health, sports medicine and exercise physiology really interested me rather more than did the standard medical curriculum.  So during my training I was more interested in how medicine related to sport rather than the information I was meant to be learning.  I perceived that medicine was spending a lot of money on the management of chronic disease without appearing to be particularly successful.  In addition, I realized that athletes were not getting much care from medicine and it seemed to me that the future of medicine lay more in prevention by promoting healthy lifestyles and exercise and, as a consequence, I realized that sports medicine would become increasingly more important.

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