There is usually one primary motivator that initially brings a patient to the office of Dr. Gilenson, pain. One typical case is the patient who presents with lower back pain and is given spinal manipulation with or without some kind of therapy and corrective exercise. The success rate for this is relatively high with this approach for many of these patients, but for some others, the problems can be stubbornly persistent and complex with chronic recurrences.
The Functional Movement Screen (FMS), developed by Gray Cook MSPT, and Lee Burton PhD, is a critical component of the functional movement system that uses a standardized process involving seven basic tests to evaluate fundamental movement patterns. A scoring system is used to both assess injury risk and discover pain, and to rate and rank movement patterns such as weaknesses, imbalances, asymmetries and limitations. The Selective Functional Movement Assessment (SFMA) takes the evaluation of functional movement patterns one step further.
The SFMA versus the FMS
Both the Functional Movement Screen and the Selective Functional Movement Assessment provide a complementary means to assess cause and effect, in addition to providing a rational for continuing care beyond the treatment of symptoms. The purpose of the FMS is predictive; it assesses risk and discovers pain in specific movement patterns. The purpose of the SFMA is to assess the patient who is already in pain and to discover regional movement dysfunctions that cause local symptoms. The SFMA addresses the critical issue of regional interdependence. Regional interdependence is seen throughout the interconnection of the myofascial, neural and even circulatory systems. It really is as simple as this; when one part moves, the whole body responds.
Planning effective care needs an accurate starting place. A functional diagnosis that demonstrates posture and movement patterns is crucial. The Selective Functional Movement Assessment is an excellent tool for this task. The evaluation and discovery phase of a patient takes all of 10 minutes.
The Seven Assessments
There are seven movement assessments that comprise the Selective Functional Movement Assessment. These tests seem simple or basic, but it is the interpretation of them that is difficult part.
- Cervical Spine Movement Assessment with three components: flexion chin to chest, extension face parallel to ceiling, chin left and right to shoulders.
- Upper Extremity Movement Pattern of the shoulder. Pattern one assesses internal rotation, extension and abduction of the shoulder; pattern two assesses external rotation, flexion and abduction of the shoulder. This may also include a pain provocation test.
- Multi-Segmental Flexion Assessment. It starts with the patient standing erect. They bend forward at the hips attempting to touch their fingertips to the tips of their toes.
- Multi-Segmental Extension Assessment, which tests for normal extension of the shoulders, hips and spine.
- Multi-Segmental Rotation Assessment where the objective is to test normal rotational mobility in the neck, trunk, pelvis, hips, knees and feet.
- Single-Leg-Stance Assessment and evaluates independent stabilization of each leg with dynamic leg swings.
- Overhead Deep Squat Assessment for bilateral symmetrical mobility of the hips, knees and ankles. When the patient’s arms are overhead, it also tests mobility of the shoulders and extension of the thoracic spine.
Assessment Categories and Clinical Meaning
Where the Functional Movement Screen uses a 0-3-point grading system, the Selective Functional Movement Assessment is a bit more complex and descriptive. Each movement assessment is placed into one of four categories:
- Functional Non-Painful (FN)
- Functional Painful (FP)
- Dysfunctional Painful (DP)
- Dysfunctional Non-Painful (DN)
The SFMA is a tool designed to assess patients with pain. This is where the significance and meaning of an apparently simple assessment tool is revealed and the expertise of someone like Dr. Gilenson is needed.
The Dysfunctional Painful (DP) and Functional Painful (FP) help assess obvious painful findings and are treated immediately. However it won’t uncover the significant issue in regards to regional interdependence and discovering the source of pain and dysfunction.
The pattern that most often leads to the source of a regional problem causing local pain is the Dysfunctional Non-Painful (DN). This is the starting place for Dr. Nissim that takes him through a flow chart to determine the appropriate corrective exercise and treatment strategies. The Selective Functional Movement Assessment is for licensed health care providers only including chiropractors, physical therapists, medical physicians and athletic trainers.
The combination of the SFMA and FMS gives Dr. Gilenson a more comprehensive and effective tool for risk assessment, injury prevention and treating pain caused by movement dysfunctions. In addition, his patients experience a reason to continue with care beyond pain relief, as it gives them a place to go; a road map to work from as they attempt to return to “normal.” What could be better than providing lasting pain relief and corrective exercise care for a patient while progressing them to be more functional and stronger than when they entered his office?