The SFMA Highlights, Boston 4-14 to 4-15-12 | Modern Manual Therapy Blog

The SFMA Highlights, Boston 4-14 to 4-15-12



Here are some points of importance/highlights of The SFMA course I attended in Boston, MA this past weekend.

Here's a view of Boston Harbor from the hotel


The Instructor, Dr. Mike Voight is a great speaker, very charismatic and awesome use of real world (non-Hippa :) examples and great AV. His students at Belmont University are very lucky to have him and learn the SFMA among other things as part of their curriculum. He will be emailing me his unpublished by sizeable data on the reliability of SFMA testing, which according to the stats he quoted me, is extremely reliable. Kudos again to the KISS principle.



I love meeting people that make me feel stupid! And he sounds like a red neck!


He shared 3 ideas from a book, How Doctors Think, or rather 3 main errors of Dx

  1. fixation on 1 Dx or settling on 1 Dx that is quick to mind
  2. failure to come up with an alternative Dx
  3. incorrectly attributing the Sx to 1 Dx

I think all medical professionals who assess can be guilty of this, even very highly trained ones (and maybe even more so). When I asked a MDT Diplomat in fellowship training to write me a lower back patient case that he got better by only treating the hip, he asked, "Wouldn't that make them a hip patient?" The point being, he would only treat that area (or that back) but not see how one could relate to the other (and is a weakness of MDT).

A great example of the stability/mobility concept we all learned in school is someone sitting on a skateboard and then pushing a wall. The wall is a stable segment or core and with good outcome from the muscles, you get good movement. If the same person pushed on a ropes or malleable surface with equal force, the peripheral muscles output being equal would develop less movement. To achieve the same movement would require either more muscle effort, or result in a feeling of "tightness" peripheral to the lack of stability.

The SFMA, like any system, and similar to MDT, provides order to your assessment, saves time, and makes you more efficient. I am all about efficiency and often take shortcuts in MDT and my OMPT assessment from what experience has taught me. I look forward to streamlining the breakouts into my assessment, but cannot see myself using most of them. Time will tell, and my assessment this year is already different from my assessment last year.

The suggested clinical assessment by Dr. Voight is

History
Neuro testing - mainly because he sees other people's failures, which I can attest to, other clinicians miss a lot!
The SFMA (should only take 2.5 to 3 minutes)
Then your routine clinical testing, AROM, PROM, PIVM, repeated motions, neurodynamics, etc.

Rules for physical assessment
1) No warm up allowed

  • although for true stability or mobility problems, it does not matter
2) do not overthink
  • if you have to think about it, it is not normal
3) be picky (not bad = not good)
  • look for slight compensations like scapular elevation for cervical rotation/flexion to clavicle or slight foot eversion for deep squat
4) shoes off to start
  • a slight heel will make a big difference in the deep squat
5) minimal instruction and coaching
  • demonstrate it once or do it with the patient

If all numbers on the line add to 10, any less will result in someone more along the line, another way to demonstrate the stability and mobility relation
2 2
\ |
2 2
\ |
2---2--- 1---2---3
|\
2  2
|    \
3    3

So when the line should look like 2---2---2---2---2 = 10, and the middle part is the core, a loss there (or anywhere) will be made up by the body somewhere else. The above drawing was his way of representing the three planes of movement. I thought it was neat, but I'm also a geek.

The upper and lower body rolling breakout is not a test of strength, it is a test of how well the subject can activate and sequence the core muscles. It is an assessment and exercise of stability. You should not use it to test a subject with mobility issues, especially cervical and thoracic.

End Day 1. Day 2 highlights/points to be posted soon along with a vid of my SFMA.

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