The program began with an overview of what the SFMA approach is from a theoretical and practical explanation and slowly we moved to hands-on movement assessment using the "big 7" global movements designed to target dysfunctional movement patterns pre and post intervention.
After finishing chiropractic school, I left feeling like all the dots weren't connected in the assessment of movement. I felt like I had mastered adjusting skills, orthopedic, neurologic and primary care physical exams, but there was a huge gap between these skills and exams and how to assess the issue if it wasn't one outlined by the above exams or if irresponsive to an adjustment. The question became, how do we assess whether our manipulations and physiotherapies are doing anything at all besides decreasing pain? Just because pain is gone, that doesn't mean dysfunction is gone. Assuming an issue is better after pain is gone, is a poor assessment protocol. We must consider the kinetic chain. In the PT world, this is the concept of regional interdependence.
Regional interdependence is a concept that suggests a painful problem in one area can be caused by a dysfunctional area nearby. For example, knee pain can be caused by immobile hips and elbow pain can be caused by cervical joint restrictions. Focusing entirely on the painful area is not a longterm strategy to the patients issue. If we approach patient care using the pain model, we become the people who put out fires versus fix the problem. I became a chiropractor because I felt the medical approach to musculoskeletal care was aimed at symptom reduction versus actually fixing the problem. I definitely learned to do just that, but ever since DC school began adhering to evidence-based practice, we have slowly become symptomatologists with a lack of ability to intervene appropriately.
Besides palpation, what is our objective marker for improved biomechanics? ADL improvement is not objective, it is subjective and inaccurate. Retesting orthopedic tests is our only objective indicator of successful treatment and we know how limited these tests are with biomechanical joint dysfunction diagnoses because they revolve around a painful response. We need a system to guide us with our adjustments besides simply palpating and orthopedic tests. We also need a system to check our work pre and post intervention to show that our work was effective. This will create trust with our patients because they can see exactly how our manipulations improved their biomechanics. This is a very important concept.
What if a patient didn't need an adjustment but actually needed to reactivate a lost motor program? Do you have time to test every muscle? Can you test multiple muscles in a global movement and know what to look for? Probably not. Say you learn to spot dysfunctional global movement, you reactivate the inhibitied musculature and the movement improves significantly and the patient's symptoms reduce without ever adjusting the person? What if you could differentiate between a stability issue and a mobility issue? That would greatly affect clinical results and the two issues require totally different interventions. See how there are gaps in our education? To make you feel better, PT's are taught to exercise the issue until it goes away and their manual therapy skills are acquired in seminars, which leaves them with gaps in their education, causing a misunderstanding on how to intervene.
Chiropractic school focused intently on overall health from a primary care perspective with a musculoskeletal focus. However, there was a serious lack in movement assessment pre and post treatment besides asking, "how do you feel now?". They sort of left it all up to us to decide how to treat the patient and taught us a limited toolbox revolving around vague therapeutic exercises and adjusting the body for ALL issues, even if an adjustment was not needed. This is the underlying reason why I pursued the SFMA seminar series. I wanted a way to assess movement, differentiate between treatment options (ie, manipulation or therapeutic exercise or both) and to have the ability to re-evaluate the area treated using a standardized set of cardinal movements. SFMA was the solution.
I am looking forward to sharing this knowledge back home and applying this all into clinical practice.
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