Prepared By: Aran Bright
One of the fundamental assessment methods that we teach as part of our Myotherapy program is the Selective Functional Movement Assessment. This approach is similar in many ways to the Range of Motion assessment methods that many Remedial Massage Therapists are familiar with, but with some significant differences. This case study will demonstrate one example.
The ClientThe client is a 37 year old massage therapist that has presented with acute on chronic lower back pain. Whilst only mild this pain has been present for many years and presenting a significant hurdle to the client being able to work and train successfully.
The AssessmentThe client was put though the SFMA as he had pain present. Full body (multi segmental) extension was painful in the lower back, consistent with the reported injury. Amongst other dysfunctional findings was a restriction of full body (multi-segmental) rotation. Specifically this meant that the client was unable to rotate their entire body to the left hand side. When attempting to do so, the pelvis would not move at all. Upon further inspection it was discovered the hip range of motion was normal but the client has significant joint mobility dysfunction and stability motor control dysfunctions in his thoracic region.
The TreatmentFollowing the results of the SFMA the client was treated with joint mobilisation techniques through the thoracic spine, this included Maitland style mobilisation and Mulligan style, mobilisation with movement. Next the client performed rotational “rib rolling” exercises. These exercises are a simple rehabilitation exercise performed side-lying that develops thoracic rotation motor control.
The ResultThe client was re-assessed for full body (multi-segmental) rotation. And despite no treatment being performed on the hips or pelvis region, the full body rotation or the pelvis improved significantly.
DiscussionUsing the SFMA the client was identified as having clear dysfunctional full body patterns. The client is experiencing ongoing lower back pain and despite years of treatment to the local region has not made significant progress on resolving the problem. Through identifying significant difficulties with thoracic function it was clear that treating the lumbar region is not addressing the clients area of greatest dysfunction. Local assessment of the lumbopelvic region demonstrated excellent lower body function and there was no notable abdominal weakness. It was only when full body assessments were used that pelvic dysfunctions became apparent, but this was improved through treating the thoracic region.