When assessing movement via the SFMA, you are breaking down multi-segmental and functional movements into smaller components to assess if mobility is effecting motor control or if motor control is effecting mobility. Thats because we know we can't build up correct motor control without the inherent building blocks of mobility. For example, an ACL can't squat correctly if he or she doesn't have adequate knee mobility. So mobility will improve motor control in this case.
Alternately, we also know that pain, postural deficits (lower crossed syndrome) or overuse during aberrant movements leads to inhibition and weakness with resulting mobility issues secondary to tone. In this case motor control can improve mobility. Take for example a client who performs a hooked bridge to engage the LE post chain that takes tension off the overfacilaited posterior lumbar complex and hip flexors will improve hamstring flexibility and thus mobility.
Now the SFMA can be incredibly useful and provide a wealth of direction however additional information may improve your ability to determine if motor control is the cause or the effect. I like to apply what we'll call the SFMA+. The SFMA+ is the SMFA in addition to clinical clusters from subjective Hx and Special Tests, MDT/Mckenzie, and Clinical Prediction Rules that can and will improve our clinical decision making to rule in or out a treatment diagnosis. Below are just two examples of SFMA+ applied to the lumbar region:
SFMA + (lumbar motor control defcits as the cause):
- So you R/O mobility in MSF,MSE,MSR but how did the low back move from your observation; did you see a reverse lordosis with flexion or what about good continuity with extension? We want to see a fairly normal moving low back if we are gonna work on motor control. The normalization of lumbar mobility can be indicative of instability according to Fritz et al.
- Subjective pain with sitting and bending. This is according to Van Dillen et al’s research on reliability of the physical exam. In it, he found sitting and bending to have a good reliability towards lumbar pathology.
- Prone instability test, as part of the clinical prediction rule for lumbar instability. See more about our clinical prediction rule with the SFMA as well.
- Prone passive limb extension test, shown to have the highest sensitivity and specificity of individual lumbar instability tests.
- DP or DN with rolling LE. Rolling can be a valuable pre and post test for these patients, maybe they are still DN but hopefully this will be less pain. I tell patients that this will carryover to getting in and out of a car and finding a waking up less at night after moving into a different position.
- QL or Glut Max TrPs. TrP will result in tonal abnormalities thus causing motor control deficits.
SFMA + MDT (lumbar motor control as the effect):
- I don't want to rely on just one assessment for the back, it can really prevent us from seeing rapid responders. So many people can be rapid responders just to directional preferences from MDT or from SFMA or from TDN or from PNF or from...you get the point. Further, one mechanical assessment can assist the other.
- Take for example a patient that is knee derangement that responds to extension. They will get plenty of extension, be in active and overpressure with corrective exercises to fix MSF deficits such as active leg lowering, hamstron contract relax, long sit + pattern assist, etc.
- Or take a lumbar derangement that responds to extension, often TDN to the lumbar multifidus can assist with pain relief and allow the patient to improve their end range. Improved end range loading will assist with centralization and allow us to find lateral components.
- SO MDT will show mobility loss, secondary to a derangement, because that derangement is blocking adequate motion thus effecting the motor control.
- Specifically, here are a other ways to add SMFA + MDT:
- if it's sore, not necessarily painful but does peripheralize or makes them worse as a result, make it DP instead of a DN
- regardless of FN or DN breakout flexion and extension to get an idea of how they look unloaded. These are priory breakouts and get priority over other breakouts. In unloaded you can also appreciate lumbar motion.
- get a feel for how the lumbar spine is moving. I know this can be subjective and I don't personally go by the good, fair, poor, but we can get an idea of how a derangement if causing mobility and effecting how the pelvis and back moves.
Moral of the story is never hang your hat on just one skill set. And don't always assume one reason for the cause and the other is the effect. The body is much more complicated than that.
