"I had a question about the SFMA and FMS. I know Gray designed the SFMA for patients who have pain, but couldn't the FMS really be used for the same thing? Based on the clinic audit process that Craig (Liebenson) spoke about, couldn't the test from the FMS be used to identify dysfunctional movement and then treat accordingly? Craig also said that every exercise is a test, so that is why I thought the FMS could be used on patients with pain, although that was not what is was intended for."
Before I answer this question, here's what Charlie Weingroff had to say in our interview several months ago.
“I believe Gray wrote in Movement that you actually can use the FMS to treat pain. I would suggest you must be on your game and quite skilled to be able to cull out if it is pain causing bad movement or bad movement causing pain.
Also consider that the deeper screens to the FMS are designed to bucket mobility vs. stability fixes. When there is pain, it is still challenging to always discern if you are seeing a limitation of some level, or if it’s pain creating the situation. You may be able to diffuse the pain, and the limitations fixes. Or it may not fix.
Also see Brett Jones' thoughts about the FMS and rendering a diagnosis.
Now for my thoughts. The short answer is, any clinician should be able to use whatever means they want. Craig has his "Mag Seven", Greg Rose, Gray Cook and the TPI/FMS gangs have the SFMA, and Janda had his own system. And I think we should respect each system...Perhaps that's why I break the rules and incorporate all three on occasion.
That said, the true intention of the FMS was indeed to identify movement pattern dysfunctions (for pre-participation purposes) and filter out the painful from the non-painful, while the true intention of the SFMA is for the purposes of "peeling back the layers", if you will, to identify the key dysfunction. Like Charlie said, of course one can use the FMS for the purposes of identifying the key link but I (and he) would caution against this. Reason being is aside from a practicality standpoint, there really are no peel back mechanisms and again, the presence of pain may lead one in the wrong direction. Surely each individual case is different and textbook protocol may need to be abandoned, but we should first truly understand each textbook published before us prior to writing our own.
Back to breaking the rules. Does that mean I'm ready to write my own text? I don't think so. In fact, I believe I'm far from that. But I feel that I do have a good understanding of each system and well enough to take shortcuts when clinically warranted. But when I hit a roadblock, I go straight back to the map and get my four wheels on that highway that I deviated from. To put it simply, we need to see the forest and not get enamored by the tree right in front of us.
Every exercise IS indeed a test, but I think this principle is most relevant in the self and rehabilitative care exercises that we employ. Additionally, each exercise has its own progression and regression resulting in a continuum of exercises within a database. And finally, each joint complex has its corresponding interdependent relationship with its neighbor that must be taken into account. But ultimately, I believe that we should respect each system as intended. These pioneers have put an insurmountable amount of effort into developing their systems and it would be hard for me to believe such considerations failed to cross their minds. Granted, we as clinicians have all developed from our own educational upbringings and therefore may also have our own assessment and treatment procedures, but when we play in their backyards, I do think we should play by their rules.
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