Today's Quick Links come from Dr. Charlie Weingroff, BioMed Central, and Dr. Joe Brence.
Leave it up to Charlie to ruffle some feathers. He recently wrote about the SFMA vs MDT. I was asked by several readers to put my 2c in. Charlie and I already discussed the post via messenger in private. My quick take:
- I think method/system is semantics, as both are systematic in the way they are supposed to be implemented, but may change with clinician's preference and experience with certain types of patients
- For me, MDT is faster, only because I'm looking at gross movement, and not MS flexion or extension
- you only want to see if/how the movement changes something about the pt's presentation
- I can cut the repeated motion exam down to about 3-5 minutes, because I just choose the motion based on the history/intuition which I think will improve the complaints
- the use of the SFMA for me, depends on how active the patient is and how much pain they're in
- if a lateral shift comes in, like my recent acute lumbar pain case, I use MDT to correct the shift and centralize the complaints
- as she is a runner and works out avidly, I used the SFMA to clear up any DNs to improve her motion and make her musculoskeletal system more efficient
- would a MDT purist or clinicians not bothering with biomechanics do this? Most likely not, should they? That's up for debate, but I think the patient is always better off with higher quality movement
- the flip side is, if they're sedentary office workers, do I concentrate on severely limited DNs in the hips and thoracic spine after their lumbar complaints are completely abolished?
- I offer that as a choice, some patients see the value of it, some are happy with just being able to walk to their car, work station, and up the stairs to bed
- my recommended screens
- repeated motion exam in lumbar flexion/extension if central/bilateral complaints
- sidegliding in standing to see any frontal plane limitations in motion for unilateral complaints
- if these are all negative, proceed to the SFMA
- There is a right assessment/treatment for the right patient at the right time, something I always preach, the more tools you have in your bag, the better
Here's a link to an abstract on BMC that followed knee OA over 12 years. Here's a surprise, the "degenerative" changes were bilateral! Much like many of my patients who have unilateral pain and their specialists fill their mind will all kinds of thought viruses like "You'll need a knee replacement in a few years," when they have full strength and ROM. My last patient who kept getting cortisone injections in her extremely painful left knee eventually realized her knee OA was worse on the right after looking at her scan results again.
Joe Brence posted a diagram of the Neuromatrix of Pain and due to requests followed up with a post of the information he distributes to his patients. Great resource Joe and thanks for sharing!