use of selective functional movement assessment … of selective functional movement assessment to...
TRANSCRIPT
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: