A few weeks ago I was able to take the Selected Functional Movement Assessment (www.sfma.com SFMA) course along with some other great local practitioners of varying disciplines. The SFMA and Functional Movement Systems (FMS www.functionalmovement.com) have become very popular in North America. While many of the ideas in this approach are not new, they have done a very good job in helping physical practitioners to quickly identify movement faults in patients and be able to provide treatment and exercise guidance in algorithmic format.
The SFMA basic protocols are relatively simple. It takes a clinician less than five minutes to help a patient attempt the initial movement screens. The person’s ability to complete these are basically scored on a pass/fail basis and with each movement that is not successfully completed, there are much more specific breakout movement screens that are used to narrow down the problem.
One of the main components of this course was to determine whether or not a patient’s underlying problem (which we all want to solve) fell into either a mobility problem; which can be helped through manual therapy; such as Active Release Techniques, manipulation and range of motion based exercise or a stability problem where a person’s ability to recruit and activate required muscle groups in order to correctly perform basic movements.
Once a stability problem is identified, one of the go to screens/exercises is assessing a person’s ability to roll over from front to back and back to front. This may seem ridiculous and simplistic but is actually an embedded neuro-developmental activity that many (if not most) adults lose the ability to properly do. The rolling activities are not unique to SFMA; as the DNS (Dynamic Neuromuscular Stabilization) approach has long used rolling and other inherent developmental activities such as crawling. Not being able to roll properly is a sign of improper muscle recruitment and firing sequences. The rolling is a basic movement that should be mastered before moving onto more complicated stability strengthening patterns.
Mastering rolling is not a one-time accomplishment either. You can lose the ability to roll and this may be brought to your attention by an increase in pain of an old, nagging injury. Checking your rolling and practicing it during a period of increased pain may help you synchronize your movement patterns again.
Getting a proper assessment using the SFMA protocol is very useful for athletes and weekend warriors as well as people who are in chronic pain. Learning how to roll is a great tool to have in your back pocket. I have attached two videos below that show front to back rolling and back to front.
Please consult a skilled rehabilitation practitioner (chiropractor or physical therapist) who is skilled in this approach to have yourself assessed with this approach.
Part of my everyday practice is to see patients with low back pain who are also experiencing related sciatic symptoms. In the course of the initial assessment one of the most important things I can do is determine if this patient is appropriate for chiropractic treatment. Through a thorough clinical evaluation, we are able to determine if the symptoms are being caused by a mechanical or structural problem that can be resolved with manual treatment. In rare cases a patient may need to be referred for more advance imaging such as a CT scan or an MRI.
When people get sciatic pain, they usually associate that with a “pinched nerve”. The pinched nerve terminology is a simplistic (and not usually accurate) view of looking at things that unfortunately chiropractors, doctors and therapists have used to describe back pain that has referral along with it. In actuality, the majority of the time, we are not talking about a disc impinging on a nerve. It can be soft tissue that is causing the problem that is something that Active Release Techniques can help resolve. The facet joints, which are the joints between the upper and lower vertebrae can also get irritated and they themselves can cause some referral of pain into the legs.
With a true herniation or bulging disc that is impinging on a nerve root, there is a certain set of clinical symptoms that can be looked at to determine what exact nerve root and what disc level is causing the problem. In the case of getting an MRI, a good physical exam is important because often times patients will get the imaging done and have bulging discs that do not correlate with the clinical presentation. A look back at a previous article in my archives regarding MRI’s highlighted some of the concerns with using them.
A chiropractic approach to treatment of disc and nerve root related problems is very effective to hopefully eliminate the need for a surgical procedure. Combining manual therapy with the correct clinically indicated rehab exercises is the first step and it all starts with performing a thorough physical assessment. Determining what relieves pain and what increases it lets us determine what exercises will be helpful and which ones will be provocative. There is an abundance of literature showing that conservative care of these problems is preferred choice with a surgery being the last resort.
A year-long study in the Journal of Manipulative Physiologic Therapy, (October 2010) compared chronic sciatica patients with symptomatic lumbar disc herniations who received either a microdiscectomy or 21 chiropractic visits. The researchers found that 60% of the patients who received chiropractic care benefited to the same degree as those who underwent surgery. The study’s authors recommend that patients with a symptomatic lumbar disc herniation try chiropractic first, before considering surgery.
At this time of year, our bodies tend to be toxic wastelands due to all the holiday celebrating that we have been doing over the last month and we are using these first couple of weeks to refocus on some healthier lifestyle choices for the new year. It is certainly no exception in our home and we probably have more to make up due to a surprise 40th birthday party that went long into the night.
Along with exercising more, making healthier diet choices has to be the most popular changes that people decide to make. Everyone can exercise more and it’s not a complicated thing to do. Virtually anyone can get out the door and start walking or riding your bike. It takes some commitment, but it's simple and everyone is aware of the benefits of regular exercise, right? (Please say yes). Making smart diet changes can be more difficult however as there is a huge disparity in information about what is healthy and what is not. If you Google dairy and health, you will find sites that say on the very first page that label it a poison and others that tell you how good it is for you.
One of more popular approaches to eating is currently known as the Paleo diet. I was formally introduced to the Paleo Diet well before it became known in popular culture through a nutrition certification course I took eight years ago with Dr. David Seaman (www.deflame.com). He introduced the mountains of research that Dr. Loren Cordain (www.thepaleodiet.com) has accumulated in his work at Colorado State University. Dr. Cordain is without a doubt the leading authority on this style of eating and he has also authored several books on the subject.
What is it?
Basically the Paleo diet is an elimination of all processed foods in your diet including but not limited to wheat, dairy, corn and refined sugar. It may sound difficult, but it’s actually quite easy to shop for since all you really do is collect your food on the perimeter aisles of the grocery stores and avoid the inner aisles.
The goal of the Paleo diet is to drastically reduce the underlying levels of inflammation that are present in your body due to over consumption of processed foods. Why do these foods cause inflammation? Because the ratio of unhealthy Omega 6 fatty acids compared to healthy Omega 3 fatty acids is way higher than what would be considered ideal. Righting this through the elimination of processed foods and grains can help with a myriad of conditions such as chronic pain, irritable bowel syndrome and Crohn’s disease.
The reduction of sugar in the diet is also a key part of this approach to eating. The sugars that you do get are less refined and come primarily through the consumption of fruit (not juice). This helps blunt the blood sugar effect since you are also consuming a high amount of fibre relative to the sugar thereby reducing the glycemic load. The reduction of sugar is a key component in achieving weight loss.
Sources of Information
Finding credible sources of information on the Internet can be challenging, especially when it comes to make dietary choices. Besides the two links above, there are two other sites I often recommend to patients when seeking out quality Paleo related information. They are www.marksdailyapple.com and www.robbwolf.com
If you have any specific questions regarding this approach, I would be happy to try and point you in the right direction.
When a person gets injured or has chronic pain there are many traditional treatments and self-help strategies that are employed to help speed up recovery and reduce pain. Some examples of these would be RICE (Rest, ICE, Compression, Elevation), Non-Steroidal Anti-Inflammatory Drugs and other over the counter medication, topical ointments and visits to the chiropractor, physiotherapist or medical doctor.
Most of the time what gets overlooked, especially in mainstream medicine is the role that nutritional supplementation can play in helping a person both speed up recovery from an injury and help cope with chronic pain. Besides eating an anti-inflammatory, mostly plant based diet there are several nutritional supplements that you may want to consider adding if you are going through injury or pain.
Omega 3 Fish Oil – Omega 3s are considered to be very important for a number of functions of the body and frequently is recognized for its effect on brain function and development as well as cholesterol levels. It also possesses some characteristics that make it an important substance for injury management. Omega 3 fish oil targets pain receptors such as TNF, IL2 and IL6 to reduce pain and also plays a role in reducing inflammation.
Magnesium – I often recommend patients look into magnesium supplementation to help with problems such as muscle cramping, however it also plays a role in pain management. Some magnesium supplements have the problem of not being readily absorbed by the body and therefore being drastically less effective. Magnesium glycinate however is thought to have an absorption rate of over 80% and binds with NDMA which is a prominent pain relieving receptor. Magnesium can also help to improve sleep quality, which in itself is important because a rested body tends to heal much more readily than a sleep deprived one.
Vitamin D – Vitamin D has been a fashionable supplement for several years for a number of cancer prevention, cardiovascular and bone health reasons. It has become perhaps the most important vitamin on the market, especially for us in the Okanagan during our sunless winters. Its role in pain management is that it can help to replenish dopamine levels in the brain. Dopamine and serotonin are neurotransmitters that are important for feeling of happiness and satisfaction. Decreases in these have been linked with depression.
Tumeric & Bromelain – Both of these supplements are great for natural anti-inflammatory purposes and can be very effective in the management of acute injuries. Tumeric and Bromelain (and they often come together in a blended product) are relatively inexpensive, very safe to take and can markedly reduce inflammation levels in the body to help speed up recovery from sprains and strains. It can also be an useful supplement to take post surgery to reduce associated inflammation.
Always consult with your preferred health care provider when considering making changes to your supplementation regime.
Read more Back to Basics articles
- Core exercises you are better off without Nov 14
- Why your back hurts Oct 31
- Choosing a personal trainer Oct 17
- The problem with "making good time" Oct 3
- The ankle-foot complex Sep 5
- Common questions in my office Aug 22
- Are your sources reliable? May 16
- Assessment and treatment of headaches Apr 4
- Simple things with powerful effects Mar 21
- Finding the balance Mar 7
- From injury to performance Feb 21
- Fix your own back Feb 7
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