A recent inquiry from a friend and colleague whom I respect VERY highly.
“Where does DNS or the SFMA stuff fit into the new approach you have to therapy based on what you learned from the Mosely course? Or, are you using it but explaining things differently?”
- I’ll utilize an orthopaedic based assessment to identify the tissue injured and modulate their symptoms accordingly. Somewhere along the way, whether initially or down the road, I’ll utilize a functional approach (likely the SFMA – though sometimes modified, if I feel I need to take an early exit) to identify how I can spare the tissue.
- I’ll start with the SFMA and put the cherry on top with the appropriate orthopaedic tests. For example, in a recent discogenic case that wasn’t clear cut, the SFMA got me there. A DN MSF led me to the SLR tests which were positive, then confirmed with the other disc tests. Treated with a McKenzie style approach but the patient definitely had fundamental core stability deficiencies so low tech strategies were used. I believe I used DNS’ reflexive stimulation alongside McGill and Cook based stability exercises (though rolling was omitted) as well to spare the spine.
- I generally go straight to the SFMA. Again, I’ll exit this highway and break the rules if I feel confident that a better strategy is necessary but I generally start with the SFMA. In chronic presentations, my communication skills become paramount and I definitely pull out the teaching/educator hat. I’ll pull out whatever resource I have (e.g. “Explain Pain”) to ensure that they walk away with a better understanding of their painful experience. I have found that many patients presenting with some form of chronic pain, regardless of whether they are an athlete or not, and especially if it “has to do with the low back or neck”, will demonstrate breathing deficiencies so I will attack this route in my plan of management. Sometimes they need the witchcraft associated with DNS and other times the breathing switch turns on like butter. But I do feel that many patients can benefit from a hands on approach. If I strictly utilized the education/explanation approach, they’ll think I’m a psychologist and may even walk away with the impression that I think they’re crazy or its all in their head. We all are aware of the power of touch and since I generally place movement quality at (or near) the top of my priority list, then I’ll go after it. That’s pretty much why I use the SFMA. However, the SFMA will often lead me to a fundamental stability issue of which this takes me back full circle to breathing. But I will also respect the work of the Prague group and attempt to facilitate the external rotators, abductors, and extensors as well. Not so much in an isolative manner but more so in an integrated, subcortical, motor learning, neuroplasticity fashion that does incorporate breathing. If it leads me to a mobility issue, then I attack that.