A few weeks ago, I read an article about the need for developing a system for assessing hip rotation ROM in weight-bearing compared to our standard NWB positions. While it is great that researchers are becoming aware of the differences between anatomical ROM and functional ROM, the study has a somewhat limited focus on female golfers. In reality, the importance of these differences apply to all patients, not just athletes.
As we have stated in previous posts, we strongly encourage the type of systematic assessment for mobility that is included in the Selective Functional Movement Assessment (SFMA). The beauty of the evaluation method is that it takes the patient through various levels of required motor control for each combined or single movement. This is an essential concept as it can get to the root of the problem. With our standing tests of combined patterns, mobility, motor control/stability, and postural control are all required. If a dysfunctional movement pattern is found, the patient then is taken into a NWB (or less WB) position, where the test may be performed again. You may be surprised to find your patient's pattern is now fully functional! Should the pattern still be dysfunctional, each pattern can be broken down and tested actively versus passively to determine if mobility or stability/motor control is the primary concern.
Whether you use the SFMA system or another method, assessing movement with various levels of stability is something we should consider with all our patients. Without adequate examination, we may be mistreating the impairments of our patients. Why stretch a hamstring in someone that can't touch their toes if they have 80 degrees of active SLR? By breaking down each level of stability, we can better determine the true source of the patient's limitations.
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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