» FMS for Clinicians

» The Selective Functional Movement Assessment (SFMA)

Gray Cook - Kyle KieselGray Cook, MSPT, OCS, CSCS
Kyle Kiesel PT, PhD, ATC, CSCS

» The Workshop

This workshop is designed for the musculoskeletal healthcare professional who routinely treat patients with orthopedic conditions.

The workshop will combine lecture, demonstration, and lab experience to introduce and demonstrate a model of movement assessment and subsequent therapeutic exercise choices that target dysfunctional movement patterns.

Click here to View Detailed Current Course Brochure (pdf)

» Considering Patterns of Movement

Normal movement is achieved through the integration of fundamental movement patterns with an adequate balance of mobility and stability to meet the demands of the task at hand.

The human system will migrate toward predictable patterns of movement in response to pain or in the presence of weakness, tightness, or structural abnormality. Over time, these pain attenuated movement patterns lead to protective movement and fear of movement, resulting in clinically observed impairments such as decreased ROM, muscle length changes, and declines in strength. An isolated or regional approach to either evaluation or treatment will not restore the whole of function. Functional restoration requires a map of dysfunctional patterns and a working knowledge of functional patterns to gain clinical perspective and design an effective treatment strategy.

» Abstract

It is the goal of this workshop to outline a system to capture impaired patterns of posture and functional movement which will assist in the deductive process and determination of a functional diagnosis. To this end, functional assessment information and movements presently available will be used. But, the main objective is for the learner to understand the assessment system which provides an orderly and repeatable clinical process with respect functional movement assessment and intervention, and the effects fundamental movement has on provocation of the patient’s main symptom.

» Objectives

After completing this workshop, the therapist should be able to do the following:

Movement Patterns Assessment

  1. Understand the importance of identifying dysfunctional movement patterns.
  2. Understand the difference between disability, dysfunction, and impairment as defined.
  3. Describe why it is important to assess movement patterns in both the loaded and unloaded positions and how this information can be used to guide intervention.
  4. Discuss the relationship between automatic balance reactions and the fundamental movement patterns of squatting, lunging, and forward bending.
  5. Understand the importance of pain provocation during the examination process and appreciate that pain alters motor control.
  6. Use the information gained from the SFMA to select key impairments to assess and design appropriate interventions to normalize dysfunctional movement.
  7. Link the assessment information to the initial therapeutic exercise strategy and initiate treatment.
  8. Monitor initial changes in dysfunction and impairment to guide the therapeutic exercise progression.

» Summary

Functional Movement AssessmentPain-free functional movement for participation in occupation and lifestyle activities is desirable. Many components comprise pain-free functional movement including adequate posture, ROM, muscle performance, motor control, and balance reactions. Impairments of each component could potentially alter functional movement resulting in or as a consequence of pain. In this workshop we will identify key functional movement patterns through the Selective Functional Movement Assessment (SFMA) and describe the critical points of assessment needed for clinical application to identify dysfunctional movement. Traditional muscle length, strength, and special tests should be used to help the clinician identify the impairments, which are associated with dysfunctional movement. This approach is designed to complement existing exam and intervention with therapeutic exercise. It should serve as a model to efficiently integrate the concepts of posture, muscle balance and the fundamental patterns of the movement system into musculoskeletal practice. It should also serve as a feedback system for the effectiveness of the therapeutic exercise program, which should target the dysfunctional movement pattern as well as the impairments that have been identified.

» References

  1. Cassisi JE, Robinson ME, O'Conner P, and MacMillan M. Trunk strength and lumbar paraspinal muscle activity during isometric exercise in chronic low-back pain patients and controls. Spine, 18(2): 245-51, 1993.
  2. Cook EG., and Voight, M.: Essentials of Functional Exercise. In Techniques in Musculoskeletal Rehabilitation. Edited by Prentice, W., Chicago, IL, McGraw-Hill, 2001.
  3. Cook EG, Kiesel KB. Selective Functional Movement Assessment; Physical Therapy Course Manual. Edited, Danville, VA, Functionalmovement.com, 2004.
  4. Cyriax JH, Cyriax PJ. Illustrated Manual of Orthopedic Medicine. London, Butterworths, 1983.
  5. Fairbanks JC, Couper J, Davies JB. The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy, 66: 271-273, 1980.
  6. Ferreira PH; Ferreira ML, and Hodges PW. Changes in recruitment of the abdominal muscles in people with low back pain: Ultrasound measurement of muscle activity. Spine, 29(22): 2560-6, 2004.
  7. Hodges PW. Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain. Exp Brain Res, 141(2): 261-6, 2001.
  8. Hodges PW, Moseley GL, Gabrielsson A, and Gandevia SC. Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res, 151(2): 262-71, 2003.
  9. Hodges PW, and Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil, 80(9): 1005-12, 1999.
  10. Hodges PW, and Richardson,CA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord, 11(1): 46-56, 1998.
  11. Janda V. Movement patterns in the pelvic and hip region with special reference to pathogenisis of vertebrogenic disturbances. Edited, Prague Czechoslovakia, Charles University, 1964.
  12. Kendall FP, McCreary EK. Muscle Testing and Function. Baltimore, Williams & Wilkins, 2004.
  13. Lund JP, Donga R, Widmer CG, and Stohler CS. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol, 69(5): 683-94, 1991.
  14. Mok NW, Brauer SG, and Hodges PW. Hip strategy for balance control in quiet standing is reduced in people with low back pain. Spine, 29(6): E107-12, 2004.
  15. Moseley GL. A pain neuromatrix approach to patients with chronic pain. Man Ther, 8(3): 130-40, 2003.
  16. Moseley GL, Brhyn L, Ilowiecki M, Solstad K, and Hodges PW. The threat of predictable and unpredictable pain: differential effects on central nervous system processing? Aust J Physiother, 49(4): 263-7, 2003.
  17. Moseley GL, Nicholas MK, and Hodges PW. Pain differs from non-painful attention-demanding or stressful tasks in its effect on postural control patterns of trunk muscles. Exp Brain Res, 2003.
  18. Resnik L, and Dobrzykowski E. Guide to outcomes measurement for patients with low back pain syndromes. J Orthop Sports Phys Ther, 33(6): 307-16; discussion 317-8, 2003.
  19. Richardson C, Hodges PW, and Hides J. Therapeutic Exercise for Lumbopelvic Stabilization; A Motor Control Approach for the Treatment and Prevention of Low Back Pain. Edinburgh, Churchill Livingstone, 2004.
  20. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. Edited, St. Louis, Mosby, 2002.
  21. Shirado O, Kaneda K, and Ito T. Trunk-muscle strength during concentric and eccentric contraction: a comparison between healthy subjects and patients with chronic low-back pain. J Spinal Disord, 5(2): 175-82, 1992.
  22. Zedka M, Prochazka A, Knight B, Gillard D and Gauthier M. Voluntary and reflex control of human back muscles during induced pain. J Physiol, 520 Pt 2: 591-604, 1999.