Today's post is the third part of my self-SFMA(Selective Functional Movement Assessment) case study series.  Specifically, We will look at and break out any dysfunctional upper extremity movement patterns from my SFMA Top Tier Post.  


In the first post/video, I was dysfunctional/non-painful (DN) for the Upper Extremity Pattern One (Combination of Extension/Adduction/Internal Rotation of the shoulder).  However, I was functional/non-painful (FN) for Upper Extremity Pattern Two (Combination of Flexion/Abduction/External Rotation of the shoulder). In case you missed it, here are the 7 top tier tests again. You can also check out the cervical spine patterns and breakout assessment here.

Assessment:
The SFMA works by assessing 7 general top tier movement tests. All tests are rated and ranked by two broad categories of dysfunctional or functional, and then two sub-categorizations of painful or nonpainful. This means there are four basic appraisals of FN, DN, FP or DP. From there you perform a "breakout" of each dysfunctional pattern to determine the cause of dysfunction. Dysfunctional movement patterns are broken down using an algorithm that funnels and filters the problem into either a mobility dysfunction or a stability &/or motor control dysfunction (SMCD). 


This video will look at the dysfunctional upper extremity one pattern. I was functional and nonpainful for the upper extremity pattern two so that pattern did not require a breakout assessment. Here is the latest breakout video:
Results:


Upper Extremity Pattern One Top Tier = DN (Unable to reach inferior angle of the scapula. Why? We don't know yet. Right side is more dysfunctional than the Left)

Active Supine Upper Extremity Pattern One Test = Bilateral DN, R worse than L (Still Unable to reach inferior angle of the scapula. Why? We don't know yet. Proceed to the next test.) 

If I was now FN we would know that there is a postural and motor control dysfunction or shoulder girdle stability and motor control dysfunction...or both, affecting this shoulder pattern standing. Laying prone only requires minimal stability from the shoulder girdle, thoracic spine, and cervical spine.



Passive Supine Upper Extremity Pattern One Test = Bilateral DN, R Worse than L still (Still Unable to reach inferior angle of the scapula.)
*You must also look for at least 10 degrees of additional ROM compared to normative values seen while standing due to the passive nature.

We still do not have a clear cause of dysfunction yet, now we much check each of the major individual motions involved...Shoulder IR, Shoulder Extension, and Elbow Flexion.

Active Prone Shoulder 90/90 IR Test: Right=DN Left=FN (Looking for at least 60 degrees of IR or a total arc of 150 degrees or more)

What does this tell us? It shows us that Internal Rotation on the left is clear and means that we must move on to looking at shoulder extension. However, before we can do that we must assess the right shoulder for passive IR to determine if a mobility or a stability problem exists here.

Passive Prone Shoulder 90/90 IR Test: The Right Shoulder is now Functional & Nonpainful (FN) when tested passively. We can rule out a mobility dysfunction and decipher that there is a shoulder internal rotation SMCD. However, there could still be more compounding dysfunction on top of the IR SMCD. So we must proceed further into the breakouts.

Active Prone Shoulder Extension Test: R & L are both DN (Unable to get at least 50 degrees of shoulder extension. Why not? We don't know.) We must continue to passive assessment of this motion to determine if there is a mobility or stability issue.


Passive Prone Extension Test: R & L are now both FN. This tells us that I have bilateral shoulder extension SMCD and not a mobility dysfunction with shoulder extension. Mobility Findings are always consistent. This means if mobility was the problem my tissues would not magically have adequate ROM with passive appraisal of motion. We still must continue with the breakouts and clear elbow flexion and thoracic extension of any possible dysfunctions.



Active Prone Elbow Flexion Test (Shoulder is Extended): R & L are both FN (Functional Non-painful, thumb is able to touch the thumb to the shoulder.)
This reveals to us that elbow flexion is free of any mobility or stability issues and is not contributing to my problems with the top tier movement pattern. We must now rule out any potential thoracic spine dysfunction.


Active Lumbar Lock Extension & Rotation Test (Tests thoracic ext./rot.): R& L are both FN (There is at least 50 degrees of rotation relative to the floor when using the angle of the raised shoulder.)
Because this was FN we can consider the thoracic spine uninvolved and not a contributing factor to my dysfunctional shoulder pattern.


Breakout Findings:
Left: Shoulder Extension SMCD
Right: Shoulder Internal Rotation SMCD, Shoulder Extension SMCD


Treatment:
I know that if I wasn't SFMA trained and I saw somebody like me perform this motion in the clinic I would automatically assume they had some major mobility restrictions. Even before performing the breakouts on myself I assumed they were due to mobility issues. This kind of disheartening because previously I would have tried stretching/tissue work/IASTM/MET until the cows came home...all to no avail.

I definitely think some of my SMCD's could be traced back to my cervical SMCD's...so before I would attempt to treat my Upper Extremity Pattern I think it would be wise to address the cervical patterns first. This would also follow the philosophy/logic of the SFMA. However, I do have some ideas to begin addressing these problems once I clear the cervical spine if they still exist in the same fashion. 


Do you have any ideas/suggestions/thoughts? Let me know in the comments below!