As a high school athletic trainer, you are faced
with hundreds of patients at any given moment. During the day of chaos this
leads us to triage our patients as quickly as possible. Yes, some of us have
figured out an appointment schedule or hired a 3rd assistant, but we
are still stuck in the traffic jam of the high school setting. It is during
this traffic jam that I wonder how other athletic trainers evaluate their
patients. We are all taught how to evaluate in our own respective programs, some
use the bull’s eye approach, others use the shot gun approach. I, now, use regional
interdependence or the SFMA (Selective Functional Movement Assessment).
The bull’s eye approach is where the patient comes
into the clinic complaining of issue A and the athletic trainer evaluates issue
A and then treats issue A. The athletic trainer may evaluate above and below
immediate to issue A but do they evaluate the entire patient. This is coined the
“bull’s eye” approach because all the athletic trainer sees is one issue at a
time.
Some athletic trainers may use the shot gun approach, where the patient
comes into the clinic complaining of issue A and the athletic trainer shoots
several treatments at them such as, ice bag, heat pack or e-stim, without a
proper evaluation. Both of these strategies could be used, but are they
treating the entire patient or even the root of the patient’s complaint? All
athletic trainers should evaluate with a standardized method of some nature,
this could be a check-list in their head, a cheat sheet in a program or the
SFMA.
While being in the doctoral program at the
University of Idaho I have learned several new and exciting techniques that have
been very beneficial to my tool box. These techniques are not time consuming
and can be used with high school patients. One of these techniques is the SFMA
(Selective Functional Movement Assessment) by Gray Cook.
The Selective
Functional Movement Assessment (SFMA) is a series of 7 full-body movement
tests designed to assess fundamental
patterns of movement such as bending and squatting in those with known
musculoskeletal pain. When the clinical assessment is initiated from the
perspective of the movement pattern, the clinician has the opportunity to
identify meaningful impairments that may be seemingly unrelated to the main
musculoskeletal complaint, but contribute to the associated disability. This
concept, known as Regional Interdependence, is the hallmark of the SFMA.
The assessment
guides the clinician to the most dysfunctional non-painful movement pattern,
which is then assessed in detail. This
approach is designed to complement the existing exam and serve as a model to
efficiently integrate the concepts of posture, muscle balance and the
fundamental patterns of movement into musculoskeletal practice. By addressing
the most dysfunctional non-painful pattern, the application of targeted
interventions (manual therapy and therapeutic exercise) is not adversely
affected by pain.
SFMA offers
healthcare professionals a new approach to the treatment of pain and
dysfunction. Our standardized clinical
model ensures isolating the cause of injury and efficient care.
I have been using the SFMA for the past year with
amazing results. Instead of a bull’s eye approach or a shot gun triage I have
had success in using regional interdependence. This approach has allowed me to
really treat the whole patient with an evaluation that last less than 2 min.
For an athletic trainer on a time crunch being able to evaluate the entire
patient knowing that you have considered all the issues and possible issues that
could be presented, is priceless.
This standardized evaluation has a fool proof
breakout session that allows you as a clinician to evaluate your patient
thoroughly while monitoring their movement patterns and defining their pain or
dysfunction. It is also a wonderful and useful tool to quantify when the
patient has overcome their pain or dysfunction. I could
write pages about the SFMA, show my outcomes data, patient testimonials etc. but
in a nutshell I believe the SFMA has changed my patient care tremendously and I
believe all athletic trainers should give it a try.
So I ask you, which type of evaluation do you
perform? Are you interested in treating the whole patient in less time than
evaluating one bull’s eye or are you stuck in the traffic jam refusing to
change?
~Cathlene Webb MS, ATC/LAT
