Feel "Tightness" During Movement? Change the Pattern! | Modern Manual Therapy Blog

Feel "Tightness" During Movement? Change the Pattern!


One of the more eye opening concepts you learn during the SFMA is the concept of motor control/stability issues.

Reminder, terminology post is always in a tab in the menu bar and can be found here.

The patient in the video below is a former gymnast and current pre-DPT student. He contacted me due to limitations in left cervical mobility and feelings of left UQ instability with UE movements. In screening his cervical mobility, we found (I use the older SFMA Top Tier for Cervical Mobility criteria)

  • cervical rotation/flexion Left DN, mod loss Right FN
  • cervical flexion and extension were both FN
  • passive NWB cervical rotation/flexion was FN, indicating a motor control issue
  • In addition, cervical retraction and SB was moderately limited to the left (DN), and FN to the right
He is a well read individual and does a lot of self treatment. However, like many active individuals, he was used to "smashing" everywhere and anywhere that is tender, and painful foam rolling. The interventions were
  • education on motor control, and passive versus active assessments
  • education on modern manual therapy and rapid changes as neurophysiologic and not mechanical
    • light IASTM was performed along the cervical patterns and left upper trap
  • to his surprise, cervical rotation, rotation/flexion, and retraction with sidebending to the left along with OP were all FN now
    • all of this motion normalized with a 3-4 minute treatment that was completely pain free
HEP was cervical retraction with sidebending to the left. The next week, he was very pleased that his normally very "tight" cervical rotation to the left was FN. However, he figured out a novel movement strategy on his own. For the cervical rotation and flexion test, he was still 2 finger widths away from his clavicle. He realized however, if he flexed then rotated, that he could easily touch his chin to mid clavicle. Changing the strategy behind the movement pattern to a novel one mitigates any threat behind rotating first. A quick video of him demonstrating this is below.




If you haven't picked up A Guide to Better Movement: The Science and Practice of Moving with More Skill and Less Pain, by Todd Hargrove, do yourself a favor and read it. If you have a passion for movement, rehab, and incorporating Pain Science into your practice and patient education, it's indispensable! My original review of one of the best texts I have read in years is here.

Keeping it Eclectic...

4 comments:

  1. Hi, Just interested why you opted for iastm as first line treatment given that the exam hinted at a motor control issue. Cheers

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  2. That is a good question. Any clinician who is adept at instructor motor control strategies like the SFMA/FMS 4x4 would have been able to restore motor control. I tend to use IASTM to give proprioceptive feedback to an area, thus restoring mobility and making repeated loading strategies much less threatening. This makes them more likely to load the newly gained range hourly or whatever their mode needs to be to keep it. Many different ways to skin a cat and your success varies with the techniques that you are most proficient with using and explaning.

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