Bull's Eye and Shot Guns

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 3^rd 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.

http://www.sfma.com/site/

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