What’s unique about this assessment tool is that it compares the way your body moves as a whole to a standardised movement baseline to expose any mobility restrictions and/or altered motor control problems that you may have. So regardless of whether you’re coming in with a sore shoulder or knee, we will look at how you move, top to bottom. This is because we believe individual parts of the body move in a coordinated effort to create different movements — therefore restrictions in other parts of the body, no matter how seemingly unrelated they may be to your area of pain, can contribute or be associated with what you’ve come into the clinic for.
This concept is called regional interdependence. The human body is a series of stable segments connected by mobile joints. This means if we work our way up from the bottom, we see that the foot is supposed to be “stable”, ankle “mobile”, knee “stable”, hip “mobile”, low back “stable” and so on. If this pattern is disrupted, it will result in altered function of the joint. Segments above and below will start compensating so a “stable” segment may begin to become more “mobile” to make up for the lack of mobility in the adjacent joint thus resulting in injury because it will exceed the limited range of motion it can provide. We believe that the “source” of your pain, which is where you experience your pain and discomfort, may be different to the “cause” of the pain which will be any part of the body that has mobility or motor control issues.
We want to treat the “cause(s)” of your pain to ensure your body restores appropriate mobility and motor control to prevent your pain from coming back. If we were to only treat the “source” of your pain (e.g. treating just the painful knee) then the surrounding dysfunctions elsewhere in the body will remain. Your pain may go away, but there is a high risk of issues returning as the joint by joint model has not been respected.
A 38 year old female (we’ll name her “Jane”) came into the clinic with a neck injury after lifting a mattress by herself. She complained of pain down the left side of her neck into her left trapezius, which caused sharp pain when turning her head — this is known as the “source” of her pain. She had experienced many previous twinges in her neck in the past from lifting and although it would go away after a period of time, she was frustrated that she kept re-injuring her neck. Firstly we checked her Top Tier, which screens her global movement, which helped us identify which movements we need to “breakout” to identify the potential “causes” of her neck pain. The results of the Top Tier are shown below:
From her Top Tier, we were most interested in the movements where she couldn’t do them but they didn’t cause pain (classified as Dysfunctional Non-painful — “DN”). If she could meet the criteria of the movement without pain then we disregarded the movement (Functional Non-painful — “FN”) and we wouldn’t look into any painful movements until necessary to avoid aggravating her neck pain (classified as Dysfunctional Painful — “DP” or Functional Painful — “FP”).
After this, we went on to “breakout” all movements that were classified as DN (right cervical rotation, bilateral UE 12, MSF, bilateral MSR, SLS) which helped identify areas of the body that were adversely affecting her neck pain. Movements are sorted into two classifications — mobility dysfunctions (MDs) and Stability Motor Control Dysfunctions (SMCD). An MD is any tissue or joint that decreases or limits full range of motion within the tissue or joint e.g. trigger points, joint stiffness, neural tension, muscle spasm/guarding etc. An SMCD is when full mobility is present, but due to an input or processing problem, you are unable to demonstrate full mobility of the region yourself e.g. due to breathing dysfunction, high threshold strategy, poor static stabilisation etc. The breakouts are listed below:
- Right OA/upper Cervical flexion
- Right upper & mid-lower Cervical rotation
- Bilateral thoracic extension/rotation*
- Bilateral shoulder extension, ER, flexion/abduction*
- R shoulder internal rotation*
- Spine flexion
- Bilateral FABERE
- Right>Left rectus femoris
- Bilateral hip flexion MD & potential posterior chain
- Bilateral hip external rotation (both seated 90º and prone neutral)
- Bilateral tibial IR*
- Bilateral ankle inversion, eversion, plantarflexion
- Left OA/Upper & lower cervical flexion with pain
- Left C1/C2 rotation with pain
- Cervical extension with pain
We now had what we call an “SFMA diagnosis” for Jane which may look confusing to you, but helped guide our treatment. This is different to the medical diagnosis for her, which was diagnosed as a neck sprain. In Jane’s case, the closest mobility restrictions she had to her neck were in her thoracic spine and both shoulders, which are supposed to be “mobile” segments according to the regional interdependence model mentioned earlier. It is important that this mobility is restored so that compensation of adjacent segments does not continue to occur. We improved her range of motion at these segments with dry needling, mobilisations, soft tissue massage and stretching and when we rechecked her movements, neck flexion and extension were now painfree with restriction, although left neck rotation was still a bit painful.
Since her neck pain had improved without even touching her neck, we could conclude that her thoracic spine and shoulders were contributing “causes” of her neck pain. If we had begun assessing and treating her neck straight away, there could have been a risk of aggravating her pain or just slapping a bandaid on the pain rather than treating the root cause.
Now that her neck pain had eased, we were able to assess and treat parts of her neck, as pain allowed. We know that the C1/C2 joints are meant to be “mobile” joints that provide most of our rotation and flexion and the middle-lower cervical joints are “stable” joints. Once we improved mobility of Jane’s C1/2 joints, we restored stability to her mid-lower cervical joints by working on motor control exercises for the neck and scapulo-thoracic (shoulder blade and mid back) region. It was important that that her range of motion was restored first before beginning these motor control exercises because if a region of the body lacks fundamental mobility, it also lacks sensory input, therefore appropriate motor control would not be able to be achieved. Motor control exercises will teach her how to use her newly gained mobility and achieve appropriate stability in her “stable” segments to prevent another injury from lifting as this was a recurring issue for her.
In between appointments, we sent Jane home with re-sets which are exercises that helped maintain her newly gained range of motion so that she did not lose the progress in pain and mobility between treatments. Once she had achieved a a painfree Top Tier, which is the goal of the SFMA, our next step was to take her through the FMS.