SFMA Update 2009 and the Significance of Regional Interdependence

Joe Heiler

As most of you know, I just hosted the Selective Functional Movement Assessment Level 1 course in Traverse City. Phil Plisky came up from Evansville to teach the course and did an excellent job. I took the first course almost 2 years ago now and some things have changed. The system is the same but the way they teach it changes with time as well as some of the corrective techniques. As with any program it should be an evolving process and always working to be better.

More Manual Therapy

The biggest change I've seen in the way they teach the SFMA is how they have added more of a manual component over time. Not that it wasn't there from the beginning, we're just talking about it much more and spending more lab time with hands-on. The time spent on the FMS and Y Balance Test 2 years ago is just touched upon in a short segment now dealing with injury prevention, which leaves more time for lab and practicing manual techniques as well as the corrective exercises. Initially everyone taking the SFMA had already been to a FMS workshop so it was the logical thing to do to bring the two together. Now that the SFMA is a little more out there, more and more therapists without prior FMS knowledge are taking the course and its working out just fine. The level 2 course I took back in April was much more manual focused and included the taping techniques I've written about as well. I gained a much greater appreciation for the power of the manual techniques at that time and have been working them in more all the time. I've always been more of an "exercise" guy I guess but they're turning me into more of a "manual" guy all the time.

All the guys are well versed in Brian Mulligan's mobilization techniques so these are a huge component of the 'isolation' phase. I just posted a video last week of the hip internal rotation Mobilization with Movement and will have more to come. Phil talked a bit about the neurological component of the mobilizations re-setting the system (he also uses manipulation when called for) and the need to immediately integrate the new found motion into functional patterns. As I become better with this I really only need to mobilize once or twice in most cases and then introduce the correct exercise to integrate the pattern. Re-check the pattern and most of the time it's significantly better if not completely functional now. Then it's up to the athlete to work on integrating the movement into a functional pattern at home and maintaining that pattern. I'll be doing a couple case studies in the near future too that will hopefully give a better understanding to the flow of the system.

High Threshold Strategy

The SFMA was developed looking at things from the neurodevelopmental perspective, understanding pain and its effect on motor control, and regional interdependence. This is just my opinion or maybe the way I understand it the best, but I believe that the idea of a High Threshold Strategy (HTS) is the heart and soul of the system. Basically what the HTS says is that the inner core is dysfunctional, for whatever reason, and because of the resulting lack of deep spinal stability we have larger muscles, which are normally prime movers, trying to be stabilizers. Glutes, hamstrings,lats, obliques, etc all trying to do two jobs at once and not really being efficient at either of them. For those of you familiar with the toe touch progression, this is why it works. Bias the athlete to fire the deep core musculature through proper breathing and weight shifting, and the tone decreases in their low back, hamstrings, and calves and all of a sudden they can touch their toes. You look like a genius! What you really did was get them out of that global HTS and made them rely on local stability to re-establish normal lumbo-pelvic rhythm.

Another component to this idea, and why we must get mobility back first, is that full mobility is needed for proprioceptive awareness and full input to the CNS. Only then can we get reactive stability through the core, and our prime movers can act like prime movers. I hope by now you've all listened to my last interview with Charlie Weingroff, who does a fantastic job of piecing this all together. Charlie discusses his idea of the 'core pendulum theory' which basically says this same thing: 'you must have full mobility to have appropriate input back into the system'. This can be applied at any joint but hip internal rotation is one example he gives because this is so common. If the athlete has great symmetrical hip external rotation of 50 degrees but only 10 degrees of hip internal rotation, the input back to the CNS will be skewed. Neutral to that person is always going to be somewhat externally rotated. Faulty input will adversely affect reactive stability at that joint. This is why the person could have great gluteus medius strength and still allow the femur to internally rotate during a squat or with single leg stance. Chances are they're using a high threshold strategy, with stabilizers firing late or too little so prime movers to the rescue.

When assessing patients we should look for abnormal patterns of movement, faulty timing, and increased exertion. Abnormal patterns would include cervical flexion and extension without cervical retraction, and multi-segmental extension (back bend) with the spine hinging at L4-5. Timing issues to watch for include: