Case Study: Making the Most of Limited Insurance Covered Visits With a 28 Year-Old Car Accident Patient

Written by Kyle Matsel SFMA

Dr. Kyle Matsel takes us through a case example of a 28-year old mechanic with LBP and radiculopathy following a motor vehicle accident.

As you'll see, the patient had a Dysfunctional Non-painful Multi-Segmental Flexion pattern, and was unable to touch his toes at all. Watch to learn other case findings and how Dr. Matsel developed a succesful treatment plan based on SFMA principals to overcome limited insurance coverage and still achieve a succesful outcome for his patient.

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Dr. Matsel is a faculty member at the University of Evansville where he teaches in the musculoskeletal and therapeutic exercises areas of the Doctor of Physical Therapy curriculum. He received his Doctor of Physical Therapy degree from the University of Evansville and is the Director of the ProRehab/University of Evansville Sports Physical Therapy Residency program. He is a board-certified clinical specialist in sports through the American Board of Physical Therapy Specialties and a certified strength and conditioning specialist. Kyle is engaged in patient care at ProRehab as physical therapist specializing in sports and orthopedic rehabilitation. In addition to clinical practice, Kyle is pursuing his PhD in Rehabilitation Sciences from the University of Kentucky where he is studying movement screening in high school baseball players. He has also consulted with a number of professional sports teams regarding injury prevention and performance enhancement.



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  • author

    Scott A. Jones 5/21/2020 9:52:53 PM

    Dr. Matsel - thanks for pulling the curtain back and letting us in with such an in-depth explanation. Great stuff.

  • author

    Kim Shin kwang 6/7/2023 10:51:51 AM

    Thanks for the case! following through a time line, i have a question. in this case the goals of intvns was improve MSF which has DN with lumbar flxeion but the treatment was a manipulation for T-spine so it's hard to get it. can i get more explanation of this?


    Dr. Kyle Matsel 6/16/2023 12:38:03 AM

    Kim, Excellent question! Certainly the priority for this case was to progress exercise to improve MSF pattern since this pattern was also consistent with his directional preference and resulted in centralization. However, the advantage of the SFMA is that the system provides you with a full body appraisal of meaningful impairments which need to be addressed to maximize function and decrease pain. Breakouts of his MSE and MSR patterns allowed me to find the thorax MD which was very significant and likely causing increase stress to be transmitted to the lumbar spine thus keeping the spine irritated. Although, FMS does not recommend treating painful movement patterns with motor control exercises certainly using manual therapy to improve mobility and decrease pain is not only important but highly suggested. So it is totally fine to work on multiple patterns simultaneously to streamline effectiveness. In this case, I was working on his thoracic spine mobility to improve MSR and decrease pain with MSE while at the same time performing a flexion based exercise progression. Just remember three recommendations: 1) Use evidence informed practice when available (repeated movements), 2) focus on mobility prior to motor control, 3) never exercise (motor control training) in a painful movement pattern (in this case MSE). Hope this helps!