As a medical practitioner trained in the Advanced Selective Functional Movement Assessment, I recently had the privilege of attending the Functional Movement Systems' internship program. Held in Evansville, Indiana, this 3 1/2 day workshop was a means to train specific practitioners in the overall integration of the Functional Movement System.
Having integrated their systems into both athletic and clinical practice over the past several years, I felt it was necessary for me to attend the internship to fully understand the goals of the "system", particularly since one of my objectives is to perform risk identification research here at the University of Alberta in the near future.
While this was certainly a comprehensive internship, my goal here is to provide you with a brief review of my internship experience.
To start off, I will first admit that while I have been using the SFMA for quite some time, there have been many instances where I have "broken the rules". So one of my objectives coming into the internship was to truly understand when breaking such rules is ok and when doing so may be a bad idea. Take for example the treatment-based classification for low back pain. Research has demonstrated that there may be instances where manipulation, stabilization exercises, and other treatment strategies are appropriate for patients presenting with low back pain. Now if you're familiar with the SFMA, you'll understand that often your assessment will lead you to areas away from the region of pain for the purposes of correction and treatment. So taking both of these into account, should we indeed be breaking the rules and adhering to the TBC or should we strictly follow the SFMA. Well based on our discussions during the internship, it basically comes down to this:
"The rules are there to keep you safe when you don't know what you don't know...that ultimately, you just need to know why you got to where you got"
Many of you who FMS trained will know that the FMS is a tool used to aid in predicting injury prior to participation in athletic activities. You will also know that the objective of the FMS is to identify movement pattern dysfunctions that may lead to injury through identifying an athlete's (in)ability to perform 7 specific movements. What you will also know however, is that the FMS has come under intense scrutiny in recent years not only due to a misunderstanding of its role in clinical scenarios, but also due to its use for anything other than its true objective. Specifically, it has been criticized to lack both a measure rotational competency as well as end-range, dynamic stability and as a result, many professionals simply aren't convinced. Ultimately, my goal here is not to change one's mind but simply to introduce the Y Balance Test.
The Y Balance test was covered heavily in this internship and since I was relatively unaware of its role in the overall system, I can honestly say that learning this test has really opened my eyes and mind to the role it plays in the identification of injury risk. Incorporating both an upper and lower quarter component to end-range, dynamic stability testing, this test now occupies a large space in my shed. Through its combination with the original FMS, as well as the software by move2perform, I really and truly think that this system holds a lot of power in identifying an athlete's future risk of injury. To put it simply, the Y Balance Test seems to be an excellent predictor of risk (at least in the current literature) while the Functional Movement Screen tells us why and how. Now combine this with a previous history of injury, the athlete's sport and age and boom...you have an excellent algorithm for risk identification. Oh wait, this already exists with the move2perform software!
One of the highlights of the internship was an evening kettlebell session with Paul Gorman, ATC, RKC, CSCS. As someone who uses kettlebells but has never been formally trained, this was an excellent learning opportunity for me to truly understand its role in the rehabilitation setting. Paul spent plenty of time teaching us methods for progressing the Deadlift, Swing, Turkish Get Up, and Goblet Squat. Specifically, he broke each of these movements down to their component parts and really elaborated on what we should be focusing on when working with our clients and athletes. I can provide you with all the specific details here but I truly believe that formal training is a more responsible form of learning that a simple blog post. What you should note however, is that adherence to proper progressions is the key to kettlebell training. That said, here are some images from this KB session.
Taking things back to the FMS, another highlight of this internship was a conference call / webinar with Rob Butler of Duke University. Rob has been heavily involved in FMS research as of late so this was an excellent way for each of us to truly understand the literature behind their system. Aside from providing us with a comprehensive review of the current literature as well as studies in progress, Rob also provided us with some notable quotes that really shed some light into what we are dealing with.
"MDs want and MRI...I want an FMS, SFMA, and Y Balance"
"Why is a dysfunctional deep squat a medical emergency at 2 years old but not at 14 years?"
"Can we upload a better motor program?"
"We need to clear fundamental movement...'but it hasn't been shown in research'...ya, but what else has?"
"FMS & Y Balance, the portable gait lab"
"When you screen someone, you're telling them something they already know...but now you're objectifying and quantifying it"
"Y Balance - to test for if...FMS - to test for why"
Another significant component to this internship was the application of the system into our everyday practices, be it the athletic or clinical setting. Each delegate was to present a case study where the group was to both critique and provide recommendations to enhance our learning. Interestingly, Kyle also provided us with a rounds type of case presentation that to our benefit, resulted in the incorporation of dry needling in treatment. One of the delegates was a therapist from kinetacore, so he was kind enough to demonstrate the use of needling in a live scenario. The video below is not of the actual case but of another delegate receiving treatment for a neck complaint.
Overall, this internship was a success for me as a practitioner at this current stage in my career. Again, my objectives for this course was not only to truly understand the system in its entirety, but also to solidify my understanding of patient management based on my current knowledge of the existing research as relates specifically to the functional movement system as well as sport medicine in general. Most certainly, one can hold a successful practice without ever taking any of these courses, however, for me, any opportunity to further myself as a clinician is just icing on the cake.
If you're interested in specific details of information that really resonated with me over the week or simply want more information of any component of the functional movement system, you're more than welcome to use the comments section below.
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