Jason Silvernail
16-10-2009, 05:24 AM
I attended a one day preconference course on the Selective Functional Movement Assessment by Kyle Kiesel PT, PhD and Phil Plisky PT, DSc.
You can check their website at http://www.kieselplisky.com/
As I understand it, the SFMA is an outgrowth of Gray Cook and Kyle Keisel's Functional Movement Screen or FMS.
FMS is aimed primarily at performance whereas the SFMA is aimed primarily for clinical applications.
There are seven basic movement tests you give to someone and based on their performance -scored Functional or Dysfunctional first and then Painful or Nonpainful. So for any given movement you could have Functional Nonpainful or Dysfunctional Painful or any permutation of those two basic ideas.
The thrust of the course was that after you have worked with someone and sorted out their clinical problem (or once local treatment is having an effect) you look at their global overall movement patterns and find a dysfunctional "nonpainful" movement to focus on correcting. This may or may not be directly relevant to their problem in-clinic, especially since it's a nonpainful movement pattern you're correcting. By correcting this movement pattern you are supposedly helping them move in a more biomechanically sound way and helping them be healthy in the long run.
There was a lot I liked about this course.
Pros:
-"You can only put fitness on top of dysfunction for so long before you get an injury" - great concept and I've seen this in the gym too many times to disagree with it. There really are better and worse ways to move mechanically and over time inefficient movement can stress some tissues beyond their tolerance.
-They emphasize that movement should be painfree when people do it and that moving with pain shouldn't be seen as a normal part of life. Even in a deep squat, it should be comfortable. Having been to the Middle East and seen 80 year old men sit like that for hours, I agree.
-the SFMA helps give a blueprint for how to complete the rehab process. I think often PTs are good at getting rid of pain and restoring basic movement but not very good about the finishing part of improving function - though that's often as much about visit caps as it is about the therapy given.
-They really had a nice "ectoderm" way to talk about manual therapy - they reinforced that nobody was breaking up connective tissue or anything like that and it was reflexive neurophysiological effects they were looking for. They talked about how you could do that with lots of different inputs - mob, manip, trigger point "work" (which they seemed to think a lot of), motor control exercise, etc. It was nice to see such frank discussion of that in a room full of manual therapists.
-They taught breathing - really taught the importance of relaxing trunk muscles and doing diaphragmatic breathing with trunk relaxation in many positions. They were concerned that the "core training" thing had created people with overactive muscles during tasks (and cited research) indicating that for many people, especially those with a history of back pain, too much muscle activity was the problem and not too little. I asked in a group setting if they felt cultural expectations of posturing and appearance was the problem, and they seemed to think that was plausible. They said that they worked with a few female clients who were concerned that breathing that way "made them look fat" from relaxing their diaphragm and breathing properly. Definitely comfort and function over appearance, and a nice dissent from some of the core training tomfoolery that is out there.
-There are several prospective cohort studies going on using the FMS to predict injury in athletes, especially at the NFL level. They are saying some of the prelim data indicates that a cutoff score on the FMS can predict who will get an injury of some kind. So there is some emerging data that indicates movement ability (almost entirely a question of motor control) can predict future problems, which really improves its construct validity.
-Good research base. They brought up emerging evidence about how things like neurogenic inhibition after injury can be problematic, the influence of previous injury on injury rate, and the use of motor control and proprioception training to treat traditional "sports" type injuries like chronic hamstring and ankle injuries.
-I think the SFMA is a good tool for improving someone's movement patterns in a way that has some good face validity and can leverage the skills and abilities of a manual therapist in a way that helps prep a person or athlete for better health (through possible reduced injury rate) and function.
Cons:
-They seemed big on doing movements related to their neurodevelopmental stages - like learning to roll and go from prone to quad to kneeling to standing. I never got a chance to really ask them how important they feel that progression is, so I can't say how much they weight it.
-Asymmetry is really important to them and they talk about the research implicating it in injury rates. I didn't have a chance to ask them how much of that they felt was really dysfunctional and how much was just the normal lateralization of function inherent to being human, and how to sort out which was which.
-They break the seven movements down rather in a detailed way with individual assessments to determine whether something was a Mobility problem or a Stability problem. More complex assessments almost certainly make reliability more difficult - but they did stress how they often would approach the same person in a slightly different way but be looking to help improve them in the same basic fashion. I think any manual therapist can understand where they are coming from there.
Well that was my basic impression. Hopefully I've been true to what they taught - this is just my impression and hope others will chime in with questions or if anyone else knows this system and can help correct me or clarify something, it's welcome.
You can check their website at http://www.kieselplisky.com/
As I understand it, the SFMA is an outgrowth of Gray Cook and Kyle Keisel's Functional Movement Screen or FMS.
FMS is aimed primarily at performance whereas the SFMA is aimed primarily for clinical applications.
There are seven basic movement tests you give to someone and based on their performance -scored Functional or Dysfunctional first and then Painful or Nonpainful. So for any given movement you could have Functional Nonpainful or Dysfunctional Painful or any permutation of those two basic ideas.
The thrust of the course was that after you have worked with someone and sorted out their clinical problem (or once local treatment is having an effect) you look at their global overall movement patterns and find a dysfunctional "nonpainful" movement to focus on correcting. This may or may not be directly relevant to their problem in-clinic, especially since it's a nonpainful movement pattern you're correcting. By correcting this movement pattern you are supposedly helping them move in a more biomechanically sound way and helping them be healthy in the long run.
There was a lot I liked about this course.
Pros:
-"You can only put fitness on top of dysfunction for so long before you get an injury" - great concept and I've seen this in the gym too many times to disagree with it. There really are better and worse ways to move mechanically and over time inefficient movement can stress some tissues beyond their tolerance.
-They emphasize that movement should be painfree when people do it and that moving with pain shouldn't be seen as a normal part of life. Even in a deep squat, it should be comfortable. Having been to the Middle East and seen 80 year old men sit like that for hours, I agree.
-the SFMA helps give a blueprint for how to complete the rehab process. I think often PTs are good at getting rid of pain and restoring basic movement but not very good about the finishing part of improving function - though that's often as much about visit caps as it is about the therapy given.
-They really had a nice "ectoderm" way to talk about manual therapy - they reinforced that nobody was breaking up connective tissue or anything like that and it was reflexive neurophysiological effects they were looking for. They talked about how you could do that with lots of different inputs - mob, manip, trigger point "work" (which they seemed to think a lot of), motor control exercise, etc. It was nice to see such frank discussion of that in a room full of manual therapists.
-They taught breathing - really taught the importance of relaxing trunk muscles and doing diaphragmatic breathing with trunk relaxation in many positions. They were concerned that the "core training" thing had created people with overactive muscles during tasks (and cited research) indicating that for many people, especially those with a history of back pain, too much muscle activity was the problem and not too little. I asked in a group setting if they felt cultural expectations of posturing and appearance was the problem, and they seemed to think that was plausible. They said that they worked with a few female clients who were concerned that breathing that way "made them look fat" from relaxing their diaphragm and breathing properly. Definitely comfort and function over appearance, and a nice dissent from some of the core training tomfoolery that is out there.
-There are several prospective cohort studies going on using the FMS to predict injury in athletes, especially at the NFL level. They are saying some of the prelim data indicates that a cutoff score on the FMS can predict who will get an injury of some kind. So there is some emerging data that indicates movement ability (almost entirely a question of motor control) can predict future problems, which really improves its construct validity.
-Good research base. They brought up emerging evidence about how things like neurogenic inhibition after injury can be problematic, the influence of previous injury on injury rate, and the use of motor control and proprioception training to treat traditional "sports" type injuries like chronic hamstring and ankle injuries.
-I think the SFMA is a good tool for improving someone's movement patterns in a way that has some good face validity and can leverage the skills and abilities of a manual therapist in a way that helps prep a person or athlete for better health (through possible reduced injury rate) and function.
Cons:
-They seemed big on doing movements related to their neurodevelopmental stages - like learning to roll and go from prone to quad to kneeling to standing. I never got a chance to really ask them how important they feel that progression is, so I can't say how much they weight it.
-Asymmetry is really important to them and they talk about the research implicating it in injury rates. I didn't have a chance to ask them how much of that they felt was really dysfunctional and how much was just the normal lateralization of function inherent to being human, and how to sort out which was which.
-They break the seven movements down rather in a detailed way with individual assessments to determine whether something was a Mobility problem or a Stability problem. More complex assessments almost certainly make reliability more difficult - but they did stress how they often would approach the same person in a slightly different way but be looking to help improve them in the same basic fashion. I think any manual therapist can understand where they are coming from there.
Well that was my basic impression. Hopefully I've been true to what they taught - this is just my impression and hope others will chime in with questions or if anyone else knows this system and can help correct me or clarify something, it's welcome.