UseofSelectiveFunctionalMovementAssessmentto

IdentifyImpairmentstoDirectPilatesProgramming:

ACaseStudy

MeganWacker,PT,DPT

5/7/17

2016/SynergyinAvon,CO

Instructor:AmyDeSa

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Abstract:

ThepresenceofPilates-basedexercisehasincreasedinrehabilitationsettingsin

recentyearsforpatientswithawiderangeofdiagnoses.Whiletherearemany

methodsofevaluatingmovementofpatientsbeforeandafterPilatesinterventions,

theauthorofthispapersoughttoutilizeamorespecificassessmenttoguide

programmingforPilatessessions.Thiscasereportwillhighlighttheuseofthe

SelectiveFunctionalMovementAssessment(SFMA)todirectexerciseselectionfora

patientwithmultiplefunctionalmovementdysfunctions.

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TableofContents

Abstract………………………………………………………………………………………………2

TableofContents…………………………………………………………………………………3

Images……………………………………………………………………………………………....…4

Content……………………………………………………………………………………………….5

Bibliography………………………………………………………………………………………11

Table1………………………………………………………………………………………………12

AppendixA………………………………………………………………………………………..13

AppendixB………………………………………………………………………………………..14

AppendixC………………………………………………………………………………………..15

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Glutealmuscleshelpstabilizethespine.Aninabilitytoactivateglutealmusclescanleadtoanover-recruitmentofhipflexormuscles.Chronicsittingcanreduceutilizationandthereforecausedeconditioningoftheglutealmuscles.ImageFrom(5).

Theerectorspinaemusclesworktoextend,sidebend/rotate,andstabilizethespine.ImageFrom(2).

Trapeziusandrhomboidsworktoposturallyretractthescapula.Thelatisimusdorsimuscleworksasashouldermoverandextendsandsidebends/rotatesthelumbarspine.ImageFrom(6).

Rectusfemorisandpsoasworktoflexthehip.Thehipflexormusclesworkinconjunctiontotheglutealmusclestohelpstabilizethelumbopelvic/hipregion.ImageFrom(8).

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ThepresenceofPilates-basedexercisehasincreasedinrehabilitationsettings

inrecentyearsforpatientsofawiderangeofdiagnoses.PilatesandmodifiedPilates

exercisesaregoodoptionswhenintegratingtherapeuticexercisesintoaplanofcare

orhomeexerciseprogramduringtherehabilitationprocessbecauseofthemind-

bodyapproachitprovides(4).Thereareseveralwaystoassesspatientmovement

pre-andpost-Pilatessessions.Oftentimes,thesemeasurementstendtoonlyfocuson

oneplaneofmotionandarepotentiallyincompletemeasuresoffunctional

movement.Inordertounderstandhowtomostappropriatelyplananyindividual

exercisetreatmentprogram,Pilatesorotherwise,itisimperativetobeableto

understandmorecontributingfactorstothatperson’smovementpatternsasawhole.

Thisisespeciallynecessarywhendealingwithclientswhoaresymptomatic.

“Inefficientanduneconomicalmovementpatterns,oncelearned,willperpetuatethe

muscularimbalanceandjointdysfunctionthatmayhavecausedthem”(4).Withthat

said,assessmentofthosemovementpatternsforaclientofPilatesneedstobefairly

succinctinordertobeabletoprogressintomovementandexerciseinatypicalhour

privatePilatessession.Thispaperwillhighlightanassessmentwhichcanbeutilized

quicklyandsufficientlyandyieldvaluableinformationregardingclientsmovement

patterns.

TheSelectiveFunctionalMovementAssessment(SFMA)isanobjective

system,whichassistshealthcareprofessionalsinapplyingaqualitativeapproach

alongwithquantitativemeasurementsinordertoguidetreatmentofmusculoskeletal

painandassociatedmovementdysfunctionusingtargetedinterventions(1).The

SFMAisbasedonthetheoryofRegionalInterdependence,whichviewsallregionsof

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thebodyasbeing“musculoskeletallylinked”(7).TheSFMAconsistsofaseriesoften

top-tierfunctionalmovementsdesignedtoassessfundamentalmovementpatternsof

individualswithknownmusculoskeletalpain(AppendixA)(1).Thesetenwholebody

movementsarethenfurtherassessedviaalgorithmsthatdissecteachpatternto

identifythesourceofthedysfunction(1,7).Patientsarescoredbybothpainand

functionandgivendesignationsineachareaof“FunctionalNon-Painful,”“Functional

Painful,”“DysfunctionalNon-Painful,”or“DysfunctionalPainful.”AppendixBoutlines

thebreakdownofhowthesefourdesignationsaregiven(1).Thesystemisintended

toidentifymeaningfulimpairmentsinordertoefficientlyguidethedevelopmentand

implementationofanindividualizedplanofcare.WhiletheSFMAisclearlyintended

foruseinthediagnosisandtreatmentofpatientspresentinginaclinicwithsome

formofsymptomaticcomplaint,itcanadditionallybequiteusefulincaseswhere

individualsareasymptomatic.

PatientA(nameomittedduetoHIPPA)presentedwithcomplaintofchronic

neckandlowbackpain.Sheisa59year-oldfemalewithalong-standingcomplaintof

neckandbackissueslikelyandpartiallyduetoapersistentsittingworkstation

positionduringher32-yearcareerasanaccountant.PatientAunderwentsurgeryin

2011forspinalfusionL4-S1.Previoustosurgery,sheenjoyedhiking,tennis,andgolf

inherfreetime,howevershehasbeenlaxinparticipatinginseveralofthese

activitiesduetopainandoverallphysicaldeconditioning.Posturalassessment

revealedsignificantforwardheadposturewithakyphoticthoracicspine.Herposture

additionallysuggestsPatientAhasdecreasedfiringandrecruitmentofherabdominal

andglutealmuscles.

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TheSFMAforPatientArevealedFunctionalNon-Painfulflexion,extension,

androtationofhercervicalspine(TABLE1).ShealsodemonstratedFunctionalNon-

Painfulshoulderpatterns.PatientAscoredFunctionalNon-Painfulonmultisegmental

flexion.Duringmultisegmentalextensionhowever,shetestedDysfunctionalNon-

Painful.FollowingthealgorithmbreakoutfortheDysfunctionalNon-Painfulscorein

multisegmentalextension(ashighlightedinAppendixC),PatientAcontinuedto

scoreDysfunctionalNon-Painfulthroughbackwardbendwithoutupperextremity,

singlelegbackwardbend,pressup,lumbarlockedexternalrotation,andactiveand

passivelumbarlockedinternalrotation.UltimatelythisledtoPatientA’sfirst

dysfunctionalmovementdiagnosisof“thoracicextensionandrotationjointmobility

dysfunctionand/ortissueextensibilitydysfunction.”Therefore,followingtheSFMA,

initialinterventionsforPatientAshouldaddressandfocusonimprovingherthoracic

mobility/tissueextensibility.TheinformationfromtheSFMAwasthencombined

withposturalassessmentandpatienthistorytostartafocusedPilatesrehabilitation

program.

TohelpPatientAimproveherfunctionalmovementpatternswhileapatient

intheclinicbutalsoaddresslifeoutsideoftheclinic,aclinicalPilatesprogramwas

developedforherinadditiontoabriefhome-basedmatprogramandoffice

stretchingprogram.Specialattentionwaspaidtotheinclusionofexerciseswhich

wouldaddressPatientA’sdysfunctionalmovementsasidentifiedbytheSFMA,

specificallythoracicspinerotationandextension.Exerciseswerealsoincludedto

addressposturalconcernsincludingabdominalandglutealstrength,hipflexor

lengthening,andscapularretraction.WhiletheclinicalprogramfollowedtheBASI

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blocksystem,theprogramsforathomeandinofficewerekeptbriefforthispatient

inordertoensuretheintegrityofexercisesweremaintainedaswellaspatient

compliance.Exercisesfortheseprogramswerechosenbasedonwhichexercisesthe

clinicianfeltcomfortablewouldbecompletedcorrectlyaswellasthosethatwould

mosteffectivelyaddresstheareasofhighestconcernspertheSFMA.PatientAwas

additionallygivenashortexerciseprogramtocompleteatherofficeeachdayseveral

timesthroughouttheday.Exercisesforthisincludedaseatedthoracicchairstretch,

briefbreaksforwalksaroundtheoffice,andfoamrollerposturalmobilityexercises.

ItwasfurtherrecommendedthatPatientAchangeherworkstationtoastanding

workstationwithcorrectergonomics.

Theclinicalprogramandhome-basedmatprogramareasfollows:

ClinicalProgram:

• FundamentalWarmUp:pelviccurl,spinetwistsupine,chestlift,chestlift

withrotation.

• FootworkonReformer:parallelheels,paralleltoes,Vpositiontoes,openV

heels,openVtoes,calfraises,prances,prehensile,singlelegheel,singleleg

toes.

• Abdominals:hundredprep,coordination

• HipWork:frog,circlesdown,circlesup,openings

• SpinalArticulation:bottomlift

• Stretch:standinglunge

• FullBodyIntegration:flatback,downstretch,longstretch

• Arms:supinearmseries;extension,adduction,upcircles,downcircles,triceps

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• Legs:legpressstanding(Wundachair),singlelegskate

• LateralFlexion/Rotation:mermaid,sidestretch(Wundachair)

• Extension:breaststrokeprep,swanbasic(Wundachair)

Home-BasedMatProgram:

• Foundation:pelviccurls,spinetwistsupine

• Bridging:shoulderbridgeprep,frontsupport

• BackExtension:swimming,catstretch

ItisimportanttostatethatwhiletheBASIblocksystemwasfollowedforthe

developmentofPatientA’sPilatesprogram,thepremiseofcorrectingmobility/tissue

extensibilitydeficitsbeforeperformingstabilityexercisesfromtheSFMAwas

implementedintreatingthispatientandthereforesomebriefstretchingwasdone

priortobeginningtheBASIblocks.Thosestretchesincludedshoulderstretch

sidelyingandthoracicmobilitystretchesonthefoamroller.

Following8weeksoftreatmentPatientAwasre-evaluatedandfoundtohave

decreasedoverallsymptoms.Shehasnocomplaintoflowbackpainandasignificant

decreaseinneckpain.SFMAfollow-uprevealsimprovingmultisegmentalextension

althoughitstillremaineddysfunctionalnon-painful.PatientAhasdecreasedforward

headpostureandimprovedscapularretraction.Shereturnedtoplayingtennisandis

continuingbi-weeklyPilatessessions.

Thereisaneedforasuccinctassessmentofmovementdysfunctionfor

amoreeffectiveintegrationofPilatesexerciseprogramminginPhysicalTherapy

settings.Inefficientmovementpatternsoncelearnedwillperpetuatethemuscular

imbalanceandjointdysfunctionthatmayhavecausedthem(4).Exerciseprograms

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oftenfailtoassessoraddressthisaspectoftraining.Asaresult,alteredmovement

patternsarenotidentifiedandre-educated(4).UseoftheSFMAcanbebeneficialin

guidingamoreeffectivePilatesprogramforbothpatientspresentingwithsymptoms

andforthosewhoareasymptomatic.

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Bibliography

1.Cook,Gray.Movement.OnTargetPublications,2010.

2.“ErectorSpinae.”Pinterest.Axonblogg.Web.4Jan.2012.

3.Goshtigian,GabriellaR.andBrianT.Swanson.“UsingtheSelectiveFunctional

MovementAssessmentandRegionalInterdependenceTheoryToGuideTreatmentof

anAthleteWithBackPain:ACaseReport.”TheInternationalJournalofSportsPhysical

Therapy11.4(2016):575-596.Print.

4.Isacowitz,Rael.StudyGuide:ComprehensiveCourse.CostaMesa,California:Body

ArtsandScienceInternational,2013.

5.“MyFavoriteGlutealMuscleActivationExercises.”Physiospot.MeshdigitalLimited.

Web.23Jul.2014.

6.“SixTipstoPreventShoulderInjuries.”Nopainmeansgain.Fastdomain,INC.Web.

24Jan.2017.

7.Sueki,DG,ClelandJA,andWainnerRS.“ARegionalInterdependenceModelof

MusculoskeletalDysfunction:ResearchMechanisms,andClinicalImplications.”

JournalofManualandManipulativeTherapy21.2(2013):90-102.

8.“TheHipFlexorGroup.”LowBackPainProgram.Enom,INC.Web.2Jan.2017.

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Table1:

Left Right

CervicalFlexion FN

CervicalExtension FN

CervicalRotation FN FN

UpperExtremity(LRA) FN FN

UpperExtremity(MRE) FN FN

MultisegmentalFlexion FN

MultisegmentalExtension

DN

MultisegmentalRotation DN DN

SingleLegStance FN FN

DeepSquat DN DN

FN=FunctionalNon-Painful,DN=DysfunctionalNon-Painful,LRA=Lateral

Rotation/Abduction,MRE=MedialRotation/Extension

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AppendixA:

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AppendixB:

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AppendixC: