One of the most divisive things in the physical preparation and rehabilitation community is the emotional attachment people develop to specific continuing education courses. The courses that deal with movement analysis tend to be some of the most polarizing despite the fact that they all attempt to answer the same question. Since there are scores of movement “systems” (the definition of system is a blog post in itself), I will only opine on the ones I’ve experienced firsthand, those from the Postural Restoration Institute®, The Selective Functional Movement Assessment, and Functional Range Conditioning. I did not review my notes from these courses in preparation for this post because I want to focus on the things that continue to resonate with me years later. Consequently, my current interpretation of the material might differ from each model’s official stance. I will review each system in the order that I think makes the most sense.
Functional Movement Systems offers The Functional Movement Screen (FMS) for non-clinicians and The Selective Functional Movement Assessment (SFMA) for medical providers. Generally, the former is supposed to be applied in the fitness setting and the latter to people in pain. However, the boundary between rehabilitation and fitness is often more of a legal/political distinction than a practical one. I’ll focus on the SFMA here because it is the more comprehensive of the two assessments. In other words, the SFMA will tell you everything the FMS tells you and more. The SFMA assumes the provider can safely and effectively evaluate a joint, which is something non-clinicians should do with caution, if at all.
Essentially, the SFMA is a triage system. Sometimes the site of a patient’s pain is not something medical professionals can, or should, do an anything about. A global triage system like the SFMA reduces the potential for pain myopia. However, the SFMA does not preclude people from “chasing pain” when it is necessary. The SFMA breaks down top tier, gross movement patterns into painful/non-painful and functional/dysfunctional. The painful/non-painful differentiation should be obvious. The functional/dysfunctional determination is based on objective joint angle measurements and subjective categorization of what looks “clean”. Based on the results of these top tier screens, the provider ultimately addresses dysfunctional, non-painful patterns with a more detailed orthopedic evaluation of the requisite joints. The rationale here is that pain alters motor control so painful patterns may not be reflective of an individual’s actual movement capabilities. So, for example, if a deep squat tests functional/non-painful, there is no further testing for that particular pattern. If, however, the deep squat is deemed to be dysfunctional/non-painful all the involved joints must be screened to determine the source of the limitation. Painful patterns are not ignored but provocation is kept to a minimum.
One nice feature about the SFMA is that many of the top tier movements involve the same joints so there is sufficient redundancy that a problematic joint doesn’t slip through the cracks. The breakouts for each gross movement attempt to differentiate between mobility (think tissue) and motor control limitations. Regardless of the site of pain, therefore, the SFMA helps identify where one doesn’t move well with the ultimate goal of reestablishing movement variability. The SFMA does not specify what interventions to use. It is a principle-based system that allows providers to more strategically implement what they already know.
None of the individual components of the SFMA should be unfamiliar to orthopedically trained clinicians. However the systematic nature in which these components are integrated is unique. Most proficient clinicians probably do something like an SFMA intuitively. I completed the SFMA course while still in physical therapy school. Most orthopedic special tests in entry-level physical therapy programs are taught by region. This reductionist model facilitates learning in the short term but is difficult to apply when treating human beings and not body parts. A global assessment like the SFMA should be taught in every entry level PT program to help students better organize the hundreds of special tests they learn to allow for more efficient triage. Moreover, many patients complain of pain at multiple sites simultaneously. While the concept of regional interdependence can be taken to the extreme, it does matter. The SFMA provides a nice balance between joint centric testing and integrated movement.
Stay tuned for Part II about the Postural Restoration Institute.