Hello all,
As many of you may know, last week I took the Selective Functional Movement Assessment (SFMA) course in Toronto. This course explains and teaches how to identify faulty movement patterns that maybe contributing to someone’s pain. This done through an assessment that is based on 7 top tier movements whereby each one is rated as functional, dysfunctional, painful and non painful (or any combo of the above). From there, we were taught breakouts, which are just ways to further assess why one of the 7 top tier movements maybe dysfunctional by isolating different areas of the body and possible culprits for the dysfunction.
The 7 Top Tier Tests
Why would I want to take such a course? Easy! It’s a pretty cool idea…who doesn’t want to try and tease out the “real” reason someone has chronic shoulder or low back pain? Who doesn’t want to know what specific exercise is best suited for each patient at our clinic? Who doesn’t want a system...and that’s they key for me. This course provides a fantastic check list to systematically assess the body in a movement based way. It gives the therapist a way to create outcome measures based on pre-determined categories that can be consistently followed within and between treatments… I bet some of you reading this are saying “but I already have this..it’s how I normally assess/treat”. And to that I would say you are probably kidding yourself. Many of us (and we all do this) jump into treatment based on what we feel like doing for that particular day. No real plan or thought…we look at a few movements, palpate a muscle or two and off we go…with very little thought for pre and post treatment measurements. I’m not saying we can’t get clients better this way…but what about the ones we don’t? Wouldn’t it better to have a system in place to check off issues that maybe causing pain? That’s what the SFMA provides. It also provides great pre-and post treatment assessments that a patient can easily see improvement in. ..hello buy in!
I bet from reading all that you think I’m in love with the SFMA. Well, that is true…but with a few key exceptions. Like I said on the video I’m going to post talking about the SFMA, I still was left wondering how a lumbar spine stability problem can end up with elbow pain (as what was said in the course). These sort of anecdotes were thrown around without very much real explanation, using evidenced based terms that the informed therapist could use to justify what was being said. This is why I left day 1 of the course sceptical. It is so easy to say amazing things and label things as dysfunctional (or whatever), but unless there is rational evidence or even sound logic to back it up I may not be so enthused by it. I found myself having to really think “why” a lot on this course…and that’s good, but I wish my why’s were answered a bit more. It would be better because I could tell a client exactly why there lumbar spine stability issue is causing their elbow pain with confidence…instead I’m left having to fill in the gaps myself.
Oh, it also pisses me off that to learn the techniques employed to treat many of the problems the SFMA finds you have to take the advanced course…ca’mon man!
Overall I would encourage SOME people to take this course. I personally believe having a few years experience before diving in would be a good idea. You need to see real pathology and pain before understanding the significance of this course (in my opinion). And I want to caution anyone who uses it or wants to take the course to not jump all in. Medical assessment and differential diagnosis can not be forgotten for the sexier and more in vogue functional assessment. Sometimes back pain is just that…back pain! There may not be some crazy anatomical/fascial/kinetic chain link causing it. It may even be serious and that’s why as a medical profession this can’t be all we do.
Here is a video of my friend and colleague, the manual therapist himself, interviewing me about my thoughts about the SFMA course. It’s 22 minutes long so feel free to fast forward if it gets full 🙂
Until next time!
jessephysio 
Thanks for your review. My boss wants me to take it ASAP but I’ve been wondering if I should hold off since I just started working three months ago. Appreciate your input in your review
Zack, I’d say take it, to give you a quick way to rule out movement asymmetry, whether it’s mobility or motor control. Jesse, great write up! Remember, it’s just an assessment, and we should all have tools in our belt to deal with what is found. It’s the stability issues according to their findings that SFMA Advanced is for. If you think about the 4×4, you are only limited by your imagination as to how to implement it to correct movement. It does help to have examples tho!
Hello Jesse,
Fellow Canadian here. I was on that course in Toronto with you and share many of the concerns you had. You are obviously an intelligent clinician with some great insights. Have you ever been to the site Soma Simple? I highly recommend it. You have to read a great deal there in order to appreciate the breadth of knowledge that exists there. Your treatment approach will be scrutinized and you will be challenged. If you want to learn…trust me this is the place. Key: any critical discussion about what you say is about your thoughts…not you personally. When I first started reading there I was highly offended (being a staunch supporter of the biomechanical model). As I read deeper, I discovered that I was the one missing a great deal of information and it changed my view on what it is we are actually doing with patients via manual therapy approaches.
Just a suggestion for you. Thanks for the write up there!
Hi Jesse,
I always enjoy reading these posts. Your passion for the job is great to see! I was going to send you an update after we worked together last year but not sure how to contact you.
Hey Darren!
Great to hear from you again and thanks for reading my blog! You can always contact me at jessephysio@hotmail.com
Would be happy to hear how you’re doing,
Take care,
Jesse
Never mind then Jesse. No response required of course.
I understand you have surfed at Soma simple before. I was hoping to have another Canadian PT over there pushing towards a more science based structure to our profession.
By all accounts, you seem on the right path. From a 44 year old, 20 year veteran of this fine profession, I hope you avoid some of the pitfalls I fell into over that time. Tons of “wizards behind the curtain” to be wary of. Always remember…it’s science first, evidence based second, and personal experience and anecdote a distant third.
Good luck on your journey!
Hi GB, Thank you for reading and your kind words. I have been to somasimple and have had multiple talks with Jason Silvernail regarding many issues. I too was shell shocked when I first came to that sight and to say I understand or even agree with everything they say would be a lie. I like the questions about manual therapy they pose, but I get turned off when they become so close minded as to not accept any other view but their own. It can get quite hostile over there…plus they “make fun” of other practitioners on their site, which I don’t agree with.
I would agree that science should come first. The unfortunate thing is that the science just can’t explain or lay out much of what we do and treat.
Thank you for your comments and I look forward to future dialogue with you.
Hey Jesse,
Yep. SS can be rather cutting but really, it’s always about the concepts and explanatory models which require defending…never the person. And frankly, after 20 years of clinical practice (wherein I’ve considered myself fully engaged the entire time), there is far far too much of a kumbaya atmosphere within our profession which stunts true growth.
I wonder…have you read the letter to the editor in the recent JOSPT co-authored by Jason Silvernail? I think that gets to the heart of the culture of SS. If you have not, it’s a darn good read.
SS is a place where a complex understanding of pain is required to reach a point where being offended is not really all that possible. No one there claims a superior “technique” or method of treating which is better than anyone else. They just put everyone’s ideas through a shredder and make sure what comes out the other end is defendable against what sciences informs us.
Plus, it’s a marvelous resource for so many things (articles, in depth discussion, anatomy etc). For example, where else would you find someone willing to share prepared slides such as the ones here: http://www.somasimple.com/forums/showthread.php?t=13656
I guess I was excited to learn that there was another PT on that SFMA course who had their brain turned on and was asking questions and searching for answers…rather than the latest and greatest technique. To me, someone like you is very encouraging for the future direction our profession takes. I hope you don’t shut out a place like SS because it can seem a bit hostile at times. we are not on the love boat here, we are talking about the care and education we provide real people with real painful problems. We best hope we get it right. Being offended be dammed.
That’s my view Jesse. Take care!
I appreciate you and Dr. E taking the time to do this, it was a great synopsis of your two experiences. I have been planning on taking this course for quite some time but my Con Ed budget has been a little depleted. I will make a blog post after I take it that will hopefully shed light on whether a different instructor covers different material (like what sounds like happened between you and Erson). It might just be a style thing where some of the smaller break out tests like the 1/2 kneeling DF test get breezed over by some SFMA instructors but covered in more detail by others. I found the same thing to be true with different instructors in my manual training, some would cover more/less techniques at the same course within the same school of thought. Anyway, thanks to you and Erson, I always learn something when I peruse the two of your blogs. Cheers