Selective Functional Movement Assessment Research Articles

Novice Inter-Rater Reliability on the Selective Functional Movement Assessment (SFMA) After a 4-Hour Training Session.

The Selective Functional Movement Assessment (SFMA) is a whole-body movement classification system that identifies non-optimal movement performance requiring further assessment. There needs to be more evidence specifying the training time required to obtain SFMA reliability for entry-level health care practitioners. The primary intent of this study was to determine SFMA inter-rater reliability between two third-year physical therapy students following an in-person three-hour training and one-hour follow-up training with a certified SFMA physical therapist. The secondary purpose was to compare rater scores of the composite criterion 50-point checklist and rater categorization using the top-tier movements in real-time assessments of healthy participants. Inter-rater reliability study. Two novice raters received training on assessing movement using the SFMA. Participants included non-pregnant healthy adults screened for general exercise, participants were excluded for history of orthopedic surgery within the prior six months. Three independent raters, including two novice and one SFMA-certified rater, individually assessed the top-tier movements in separate rooms in real-time. Participants were randomly assigned a start location, and raters were blinded to each other's criterion 50-point checklist and categorical scoring. Statistical analysis included a paired t-test, a repeated measures ANOVA, and a two-way, mixed absolute agreement ICC. Twenty-five participants (23.4 years ± 1.9; 72% female) completed the SFMA top-tier movements. Significant differences were identified with novice raters identifying fewer non-optimal movement patterns than the certified clinician. The intraclass correlation coefficient (ICC2,1) was moderate (0.60, p<0.001) for all three raters on the 50-point criterion checklist scoring. Third year physical therapy students were able to demonstrate moderate inter-rater reliability assessing healthy individuals using the 50-point criterion checklist. Variation between novice raters may reflect the amount of previous exposure assessing movement and suggests that some may require more time learning and practicing in order to identify non-optimal movement patterns that may require further assessment. 3b©The Author(s).

Predicting Subsequent Injury after Being Cleared to Return to Work from Initial Lumbar or Lower Extremity Injury.

The purpose of this study is to develop a model to predict re-injury after being cleared to return to full duty from an initial injury. This was a prediction model derivation cohort study. Military service members cleared for unrestricted full duty after sustaining a musculoskeletal injury were enrolled from three large military hospitals. Medical history, demographics, psychological profile, physical performance (Y-Balance Test™, Functional Movement Screen™, Selective Functional Movement Assessment, triple hop, closed chain ankle dorsiflexion, 2-mile run, 75% bodyweight carry time), and past injury history were assessed. Monthly text messages, medical records and limited duty databases were used to identify injuries resulting in time lost from work in the following year. Four hundred fifty participants (65 females), ages 18 to 45 yr were analyzed. Fifteen variables were included in the final model. The area under the curve was 0.74 (95% confidence interval, 0.69-0.80), indicating good performance. The calibration score of the model was 1.05 (95% confidence interval, 0.80-1.30) indicating very good performance. With an injury incidence in our cohort of 38.0%, the treat all net benefit was 0.000, and the net benefit of our predictive model was 0.251. This means 25 additional soldiers out of every 100 were correctly identified as high risk for injury compared with not using a prediction model at all. This multivariable model accurately predicted injury risk after returning for full duty and was better than not using a prediction model at all (an additional 25 of every 100 tactical athletes were correctly identified). This model provides guidance for proper decision making about when these individuals are not ready to return to full duty, with higher risk of a subsequent injury.

Outcomes of Calvarial and Soft-Tissue Reconstruction with Latissimus Dorsi-Rib Osteomyocutaneous Free Flap.

The latissimus dorsi-rib osteomyocutaneous free flap (LDRF) has been used for autologous reconstruction of large composite calvarial and scalp defects. In this study, the authors aim to present clinical and patient-reported outcomes after LDRF reconstruction. An anatomical study was conducted to evaluate the distribution of the connecting perforators between the thoracodorsal and intercostal systems. An institutional review board-approved retrospective review of 10 patients who underwent LDRF with one or two ribs for treatment of cranial defects was conducted. Patient-reported outcomes regarding quality of life, neurologic status, and functional status were evaluated using validated surveys. One-way analysis of variance and post hoc Tukey tests were used for anatomical outcomes. Preoperative and postoperative scores were compared using paired t tests. The tenth rib (4.65 ± 2.01) followed by the ninth rib (3.7 ± 1.63) had the highest number of perforators. A combination of the ninth and eleventh ribs exhibited maximal perforator number and pedicle length. All patients had stable LDRF reconstructions. Eight patients completed both preoperative and postoperative questionnaires; Median clinical follow-up was 48 months (range, 34 to 70 months). Scores trended toward improvement but did not reach statistical significance on the Karnofsky Performance Scale ( P = 0.22), the Functional Independence Measure (Motor, P = 0.52; Cognitive, P = 0.55), or the Headache Disability Index ( P = 0.38). The minimum clinically important difference was surpassed, demonstrating improvement of function for 71% of patients on the Barthel Index and 63% on the Selective Functional Movement Assessment test. The LDRF can improve cognitive and physical functional status in complex patients with prior failed reconstructions for composite scalp and skull defects. Therapeutic, IV.

D106. Outcomes of Calvarial and Soft Tissue Reconstruction with Latissimus Dorsi Rib Osteomyocutaneous Free Flap

PURPOSE: The latissimus dorsi-rib osteomyocutaneous free flap (LDRF) has been used for autologous reconstruction of large composite calvarial and scalp defects. In this study, we aim to present patient-reported and clinical outcomes for patients treated with LDRF. METHODS: An anatomical study was conducted to evaluate the distribution of the connecting perforators between the thoraco-dorsal and intercostal system. An IRB-approved retrospective review of ten patients who underwent LDRF and one or two ribs for treatment of cranial defects was conducted. Patient-reported outcomes regarding quality of life, neurological and functional status were evaluated. One-way analysis of variance (ANOVA) and post hoc Tukey’s tests were used for anatomical outcomes. Preoperative and postoperative scores were compared using paired t-tests. RESULTS: The 10th rib (4.65± 2.01) followed by 9th rib (3.7±1.63) had the highest number of perforators. A combination of the 9th and 11th ribs exhibited maximal perforator number and pedicle length. All patients had stable LDRF reconstructions. Eight patients completed both pre and postoperative questionnaires; Median clinical follow-up was 48 [34-70] months. Scores trended toward improvement but did not reach statistical significance on the Karnofsky Performance Scale (p=0.22), Functional Independence Measure (FIM; Motor p=0.52, Cognitive p=0.55), and Headache Disability Index (p=0.38). The minimum clinically important difference (MCID) was surpassed, demonstrating improvement of function for 71% of patients on the Barthel Index and 63% on the Selective Functional Movement Assessment test (SFMA). CONCLUSION: The LDRF can improve cognitive and physical functional status in complex patients with prior failed reconstructions for composite scalp and skull defects.

Selective Functional Movement Assessment (SFMA) Reliability and Proposal of Its Use in Sports.

The Selective Functional Movement Assessment (SFMA) is a functional movement assessment method to observe movement restrictions in individuals with known musculoskeletal disorders, although it has also been used to evaluate healthy athletes of different sports. The present paper aimed to evaluate the applicability of SFMA in a clinical setting and to verify whether a student can correctly perform it. An introductory and explanatory email was sent to the subjects, containing the instructions needed to produce a video with SFMA evaluation movements. SFMA methodology was then used to analyze the received videos. The results between interobserver and intraobserver agreement were compared to the literature, considered the gold standard methods. Twenty-eight subjects (17.71 ± 1.96 years aged) were rated. The functional non-painful scenario (FN) has been assigned more frequently by all raters. The student's intra-rater reliability proved to be moderate (Kappa coefficient 0.49). Results for inter-rater reliability showed that the reliability degree between the senior physiotherapist and student before and after their educational path is good (Kappa coefficient 0.60 and 0.62, respectively). The results of this study showed SFMA intra-rater reliability to be moderate, while inter-rater reliability can be considered good. These characteristics make it a valuable tool for sport's needs, even when used by students.

Effect of an on-site physical therapy on pain, posture, function and composition, and work-related health status in workers in Korea.

The incidence of work-related musculoskeletal disease is increasing despite automated manufacturing processes. To examine the effect of a customized on-site exercise program on pain, posture, body function, body composition, and work-related health status of workers at an auto-parts factory. Fifty-six participants were randomly divided into one of two groups: experimental (EG), which received a customized exercise program that included manual and exercise therapy from physiotherapy at the workplace; and control (CG), which received customized exercise sheets for a self-directed program at home. The program was performed 3 times per week for 12 weeks. Assessments were performed according to numerical rating scale (NRS), Exbody, Selective Functional Movement Assessment (SFMA), InBody, Short-Form-12 version 2 (SF-12v2), and Work Ability Index (WAI), which were evaluated before and after the program. The EG exhibited significant within-group changes in NRS, Exbody, SFMA, SF-12v2, and WAI; the CG exhibited significant within-group changes only in NRS and SFMA (p < 0.05). There were significant between-group differences in NRS, Exbody, SFMA, and WAI (p < 0.05). An on-site program including manual and exercise therapy directed by a physiotherapist among workers at an auto-parts manufacturer was effective in improving pain levels, posture, body function, and work-related health status.

Screening on Collect Students: Postural Risk Factors of Spinal Musculoskeletal Problems and Scoliosis

Background: Overuse of electronic products and decrease in levels of physical activity may lead to an increased incidence of spinal health problems in college students. This study aims to 1) identify the incidence of spinal health problems in college students, 2) to explore the key postural factors in development of spinal musculoskeletal dysfunction and scoliosis, and 3) to clarify new strategies for early identification and prevention of scoliosis. Methods: A cross-sectional screening by static posture assessment, selective functional movement assessment (SFMA) and Adam’s Forward Bend Test,was conducted to 306 college students from October to December 2019. Descriptive analysis, Spearman correlation analysis and binomial logistic regression analysis were performed on the collected data. Results: Static postural assessment was completed among 306 college students, 53% of students’ external auditory meatus and acromioclavicular joint were not in the same gravitational line, 45% had forward-head posture, 42% had uneven shoulders. When performing SFMA, we found spinal musculoskeletal dysfunctions, including abnormalities of multi-segment spine flexion (32%), cervical rotation to right (18%), cervical rotation to left (16%), etc. In Adam’s Forward Bend Test, 10.78% had a positive result, which suggested structural or functional scoliosis. Correlation analysis showed that the top three postural factors related to spinal musculoskeletal dysfunctions included uneven shoulders, forward-head, position of thorax and pelvis rotated. And top three postural factors related to scoliosis were spinous processes line deviating from midline, winged scapula and head rotation off midline. Logistic regression analysis displayed that there are two high risk factors for scoliosis, including external auditory meatus and acromioclavicular joint not in the same vertical line (OR = 6.314), and deviation of spinous processes line (OR = 12.743). Conclusions: Poor posture, spinal musculoskeletal dysfunction and scoliosis affect a significant proportion of college students. While their spinal musculoskeletal dysfunction and scoliosis are closely related to poor posture.

Recovery, Rehabilitation, and Return to Full Duty in a Military Population After a Recent Injury: Differences Between Lower-Extremity and Spine Injuries

PurposeTo compare readiness to return to duty in soldiers following recent lower-extremity versus spine injury. The secondary purposes were to provide normative data for the Selective Functional Movement Assessment Top Tier movements (SFMA-TTM) and assess the association between SFMA-TTM scores and future injury occurrence, comparing injuries of the lower extremity and thoracic/lumbar spine.MethodsSFMA was rated by trained assessors on 480 U.S. Army soldiers within 2 weeks of being cleared to return to duty after recent lower-extremity or lumbar/thoracic injury. Participants were followed for 1 year to determine incidence of subsequent time-loss injury.ResultsOnly 74.4% of soldiers felt 100% mission capable when returning to full duty (73.6% lower-extremity; 76.5% spine). After 1 year, 37.9% had sustained a time-loss injury, and pain with movement at baseline was associated with higher odds for having an injury (odd ratio 1.53 95% confidence interval 1.04-2.24; P = .032). Almost all (99.8%) had at least 1 dysfunctional pattern, and 44.1% had pain with at least 1 movement (40.3% with previous lower-extremity injury; 54.6% with previous spine injury) after being cleared to return to duty.ConclusionsOne in four patients did not feel 100% mission capable upon being cleared for full duty. Pain with movement was also associated with future injury. Regardless of recent injury type, 99.8% of soldiers returned to full unrestricted duty with at least 1dysfunctional movement pattern and 44.1% had pain with at least 1 of the SFMA-TTM movements.Level of EvidenceLevel III, retrospective comparative cohort study.

Identification of Movement Dysfunction in Cervicogenic Headaches

Background Upper cervical region mainly plays an important role in cervicogenic headaches. The measurement of cervical rotation supposedly a part of cervical spine can be used as a clinical methodology for differential diagnosis. In this study Selective Functional Movement Assessment SFMA scale has been used to identify impaired mobility in cervical spine. Since there are limited studies to identify movement disorders associated with cervical headache further research to determine dysfunctional movement patterns in cervical segment may provide an accurate approach towards diagnosis and treatment of cervicogenic headache.Method Two hundred forty healthy subjects aged 18 to 66 years were assigned to the study after meeting the inclusion and exclusion criteria. Each subject was assessed using seven top-tier SFMA tests to identify any type of pre-existing movement disorder.Result The interpretation of this study is more or less likely in both genders male and female. Subjects with cervicogenic headache showed significant movement dysfunction in cervical flexion CF with dysfunctional painful movement DPM Upper extremity pattern-2 UEP-2 with functionally painful movement FPM and Cervical Extension CE with dysfunctional non-painful movement.Conclusion The study shows that most of cervicogenic headaches are susceptible to musculoskeletal and movement dysfunctions with growing age. The operative use of the SFMA as a system or tool used to qualitatively evaluate movement at initial examination and to direct subsequent intervention choices would be helpful.

The Intra- and Inter-rater Reliability of an Arm Care Screening Tool in High School Baseball Coaches.

BackgroundPreseason movement screening can identify modifiable risk factors, deterioration of function, and potential for injury in baseball players. Limited resources and time intensive testing procedures prevent high school coaches from accurately performing frequent movement screens on their players.PurposeTo establish the intra-rater and inter-rater reliability of a novel arm care screening tool based on the concepts of the Functional Movement Screen (FMS™) and Selective Functional Movement Assessment (SFMA™) in high school coaches.Study DesignMethodological intra- and inter-rater reliability studyMethodsThirty-one male high school baseball players (15.9 years ± 1.06) were independently scored on the Arm Care Screen (ACS) by three examiners (two coaches, one physical therapist) in real-time and again seven days later by reviewing video recordings of each players’ initial screening performance. Results from each examiner were compared within and between raters using Cohen’s kappa and percent absolute agreement.ResultsSubstantial to excellent intra-rater and inter-rater reliability were established among all raters for each component of the ACS. The mean Cohen’s kappa coefficient for intra-rater reliability was 0.76 (95% confidence interval, 0.54-0.95) and percent absolute agreement ranged from 0.82-0.94 among all raters. Inter-rater reliability demonstrated a mean Cohen’s kappa value of 0.89 (95% confidence interval, 0.77-0.99) while percent absolute agreement between raters ranged from 0.81-1.00. Intra- and inter-rater reliability did not differ between raters with various movement screening experience (p>0.05).ConclusionsHigh school baseball coaches with limited experience screening movement can reliably score all three components of the ACS in less than three minutes with minimal training.Level of EvidenceLevel 3, Reliability study

Predicting Upper Quadrant Musculoskeletal Injuries in the Military: A Cohort Study.

This study aimed to identify characteristics and movement-based tests that predict upper quadrant musculoskeletal injury (UQI) in military personnel over a 12-month follow-up. A prospective observational cohort study of military members (n = 494; 91.9% male) was conducted. Baseline predictors associated with UQI were gathered through surveys and movement-based tests. Survey data included demographic information, injury history, and biosocial factors. Movement-based tests include the following: Y Balance Tests (YBT), Functional Movement Screen, Selective Functional Movement Assessment lumbar multisegmental mobility, modified-modified Schober, side bridge, ankle mobility, modified Sorensen, and passive lumbar extension. Self-reported UQI was collected through monthly online surveys, and 87% completed the follow-up. Univariate associations were determined between potential predictors and UQI. A forward, stepwise logistic regression model was used to identify the best combination of predictors for UQI. Twenty-seven had UQI. Univariate associations existed with three demographic (smoking, >1 previous UQI, baseline upper quadrant function ≤90%), three pain-related (Selective Functional Movement Assessment rotation, side bridge, hurdle step), and six movement-based variables (YBT upper quarter (UQ) superolateral worst score ≤57.75 cm, YBT-UQ composite worst score ≤81.1%, failed shoulder clearance, Sorenson <72.14 s, in-line lunge total score <15, and in-line lunge asymmetry >1). Smoking, baseline upper quadrant function ≤90%, and YBT-UQ composite score ≤81.1% predicted UQI in the logistic regression while controlling for age and sex. Presenting two or more predictors resulted in good specificity (85.6%; odds ratio, 4.8; 95% confidence interval, 2.2-10.8), and at least one predictor resulted in 81.5% sensitivity (odds ratio, 3.2; 95% confidence interval, 1.2-8.7). A modifiable movement-based test (YBT-UQ), perceived upper limb function, and smoking predicted UQI. A specific (two or more) and sensitive (at least one predictor) model could identify persons at higher risk.

Investigation of Research Trends in the Selective Functional Movement Assessment (SFMA)

Investigation of Research Trends in the Selective Functional Movement Assessment (SFMA)

The Effect of Exercise Intervention Based Upon the Selective Functional Movement Assessment in an Athlete With Non-specific Low Back Pain: A Case Report and Pilot Study.

ObjectivesTo illustrate the effectiveness of the Selective Functional Movement Assessment (SFMA) as a guide to exercise intervention on chronic non-specific low back pain (CNLBP).MethodsA 23-year-old male volleyball athlete with CNLBP was evaluated using the SFMA to assess the degree of physical dysfunctions. And then two-stage exercise protocol was designed based on the results of SFMA. The athlete conducted the exercise intervention for 8 weeks, 1 h each time, three times a week. Transverse abdominal muscles and multifidus muscle thickness, the degree of low back pain, and the degree of physical dysfunctions were measured at pre-intervention, midintervention, and post-intervention.ResultsBased on the results of SFMA, the exercise protocol in the first 4-week session was designed mainly to develop the mobility of ankle, hip, and chest and the stability of lumbar, hip, and knee, in order to improve core strength and gluteal muscle strength. The second 4-week session was an advanced stage with the increase of exercise load on the basis of flexibility and stability; its main purpose was to loosen the hamstring muscles and continue strengthening the core stability and finally help the participant to establish the correct movement pattern and solve the problems of dysfunctions. After 8-week exercise intervention, all movement patterns became functional/non-painful except the deep squat pattern; the Quebec Back Pain Disability Scale score decreased from 11 to 2; visual analog scale score decreased from 4 to 2; the thicknesses of the transverse abdominis muscles (right side: 0.2 vs. 0.31 cm, left side: 0.22 vs. 0.33 cm) and multifidus muscles (right side: 2.09 vs. 2.26 cm, left side: 2.15 vs. 2.29 cm) were both increased.ConclusionIn this case, the SFMA helped to recognize problems related to mobility and stability on the hip joint, thoracic spine, and even areas far away from the lumbar spine in an athlete with CNLBP that were not seen with more conventional examination procedures. The improvements of physical function, the increase in deep core muscles thickness, and the released pain after exercise intervention all verified the effectiveness of SFMA to qualitatively analyze movement patterns at examination and to direct subsequent exercise intervention.

Using the Selective Functional Movement Assessment for the Evaluation of Dancers' Functional Limitations and Dysfunctions: A Critically Appraised Topic.

Clinical Scenario: Dancers participate in a functionally demanding activity. Athletic participation typically requires the completion of a preparticipation examination, which involves a functional movement screen offering insight into potential injury recognition. The Selective Functional Movement Assessment (SFMA) was created to measure the status of movement-pattern-related pain and dysfunction using regionally interdependent movement to aggravate symptoms and exhibit limitations and dysfunctions. Still, a functional assessment has not been identified to recognize potential dysfunctions or limitations in this population. Clinical Question: Does the use of the SFMA improve overall evaluation of dancers by providing more information on a dancer's overall functional ability and limitations? Summary of Key Findings: The literature search discovered 12 studies and 3 books in which 4 studies were included (2 case reviews, 1 case report, and 1 original research study) based on the inclusion and exclusion criteria. Three of the studies provided clinical case studies utilizing the SFMA to improve the patient's dysfunctions, whereas 1 study examined the intrarater and interrater reliability of the SFMA. In 3 studies, participants displayed less movement dysfunction. The authors from 3 of the studies agreed the SFMA was a valuable tool for clinicians to use during evaluations, as it provided a more holistic view of the patient, discovering dysfunctional movement patterns that may better identify the source of injury. Clinical Bottom Line: Low-quality evidence, defined as poorly designed case studies, case series, and cohort studies, exist that supports improvement of overall evaluations when utilizing the SFMA. Although the studies were considered low-quality evidence, each included study displayed an effective use of the SFMA as an overall evaluation that correctly identified dysfunctional movement patterns. Strength of Recommendation: Grade C evidence exists that the SFMA contributes to the functional evaluation used in dancers.

INTRA- AND INTER-RATER RELIABILITY OF THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT (SFMA) IN HEALTHY PARTICIPANTS

The Selective Functional Movement Assessment (SFMA) is a popular assessment tool used to observe and detect components of dysfunctional movement patterns. The goal of the assessment is to identify impairments throughout the kinetic chain that may be contributing to movement dysfunction and/or pain. The purpose of this research was to determine the intra- and inter-rater reliability of the 10 top-tier movements of the SFMA using the categorical scoring system. It was hypothesized the intra- and inter-rater reliability of the SFMA would be acceptable with variations based on the objectivity of the scoring criteria and the experience of the rater. Cross-sectional reliability study. 25 (17 male, 8 female), physically active participants (age: 21.2 ± 1.6years, height: 177.1 ± 10.7cm, weight: 74.9 ± 13.9kg) were independently assessed in real time by three clinicians during two separate visits to the lab using a standard instructional script. Clinicians had varying levels of experience with the SFMA and the two visits occurred a minimum of 48 hours and maximum of seven days apart. Results from each clinician were compared within and between raters using the Kappa coefficient and ratings of absolute agreement. Overall, slight to substantial intra- and inter-rater reliability were observed using the categorical scoring tool, although variations existed depending on the movement pattern. Kappa coefficients for intra-rater reliability ranged from 0.21-1.00, while % absolute agreement ranged from 0.64-1.00. Inter-rater reliability for the same measures ranged from 0.11-0.89 and 0.52-0.96 respectively. Clinicians certified in the SFMA with the greatest amount of experience using the SFMA demonstrated higher intra-rater reliability. Similarly, higher inter-rater reliability was found between certified raters with the most experience. Certified SFMA raters with greater amounts of experience can demonstrate adequate intra- and inter-rater reliability using the categorical scoring method. 2, Reliability study.

Relationship of Movement Screens with Past Shoulder or Elbow Surgeries in Collegiate Baseball Players

Upper extremity injuries commonly occur in baseball players, and can often necessitate surgical interventions. Athletes recovering from previous surgeries may be at greater risk of a secondary injury due to potential residual deficits in global movement. Identifying individuals with residual movement dysfunction following surgery during a pre-participation examination may help health care professionals identify baseball players who may be at a greater risk of re-injury in their throwing arms so that appropriate interventions can be developed. The purpose of this study was to assess relationships between history of shoulder or elbow surgeries and Functional Movement Screen™ (FMS™) shoulder mobility scores or Selective Functional Movement Assessment (SFMA) upper extremity patterns in collegiate baseball players. Cohort study. One hundred seventy-six healthy, male, Division III collegiate baseball players (mean age = 19.65 ± 1.52 years) underwent preseason screening using the FMS™ shoulder mobility screen, and SFMA upper extremity patterns. Total FMS™ scores were dichotomized into "good" and "poor" groups (good = 2 or 3, poor = 0 or 1). SFMA scores were dichotomized into "good" and "poor" groups (good = functional non-painful (FN), poor = dysfunctional painful (DP), dysfunctional non-painful (DN), and functional painful (FP). Dichotomized FMS™ and SFMA scores were compared to questionnaire data regarding history of shoulder or elbow surgeries. Thirty participants (17%) reported a previous shoulder or elbow surgery in their dominant arms. Past surgeries in the shoulder or elbow were not related to FMS™ (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.30, 1.82), p = 0.52) or SFMA performance (OR = 0.93, 95%CI = 0.38, 2.27, p = 0.88) independent of grade and playing position. History of shoulder or elbow surgery was not related to performance on the FMS™ shoulder mobility test or SFMA upper extremity patterns. Differences in the dates of surgery at the time of testing, and sport-specific adaptations of the upper extremities that are common in baseball players due to the cumulative tissue stress from years of throwing at the collegiate level, may explain these insignificant findings. Level 3.

EFFICACY OF REFLEXIVE NEUROMUSCULAR STABILIZATION DURING TREATMENT OF SCAPULAR DYSKINESIA IN AN OVERHEAD ATHLETE: A CASE REPORT

Shoulder injuries are common amongst overhead athletes. Dysfunctional motor patterns (scapular dyskinesis) may be the cause or result. Improperly treated, they can sideline athletes or reduce quality of life. Current treatment protocols are lengthy and may result in recurrence. Individualization of treatment is key. Functional tests, like the Selective Functional Movement Assessment (SFMA), help discern and properly identify dysfunction, paving the way for interventions like reflexive neuromuscular stabilization (RNS). RNS focuses on restoring proper motor control and may positively influence healing. The purpose of this case report is to describe an evaluation and treatment strategy for scapular dysfunction in an overhead athlete. The subject was a 16-year-old, multi-sport athlete in the high school setting. He presented with upper back pain during his sophomore baseball season. Clinical findings upon examination included but were not limited to irregular scapular positioning as compared bilaterally, dysfunctional scapular movement patterns, soft tissue muscular irritability and loss of glenohumeral (GH) ROM in internal and external rotation, flexion and abduction. Intervention consisted of a combination of positional release therapy and reflexive neuromuscular stabilization aided by some traditional therapeutic modalities. The combination of conservative treatments and RNS provided relief of the subject's symptoms in a shorter time frame, three treatments over the course of six days, than just utilizing traditional protocols. The utilization of the paired treatments resulted in diminished pain, restored ROM and improvement in perceived fluidity (speed and stability) of motion as observed by the clinician. A minimal clinically important difference (MCID) was reported on the disablement of the physically active scale (DPAs) on all follow-up treatments as well as on the numeric pain rating scale (NPRS) after the first and second treatments. The minimal detectable change (MDC) requirement was met on the patient specific functional scale (PSFS) prior to the second and third treatment. The activities measured with the PSFS were: GH flexion, GH abduction and throwing a baseball. In this case report, the use of the SFMA along with a traditional orthopedic examination allowed for proper identification and location of the dysfunctional motor patterns. The coupling of a traditional modality like the moist heat pack, with PRT and RNS proved to be a beneficial treatment combination for this subject as it provided a clinically meaningful resolution of his condition. Even though current literature suggests that treatment for scapular dysfunction is comprised of three phases over the course of ten weeks, clinicians should focus on the individualization of the treatment, possibly utilizing novel interventions like PRT and RNS. 4 Case Report.

Selective Functional Movement Assessment(SFMA)-based Therapeutic Corrective Exercises Reduces Knee Joint Pain in a Patient with Patellofemoral Pain Syndrome after Pregnancy (Case study)

The aim of this study was to determine the effect of selective functional movement assessment (SFMA)-based therapeutic corrective exercise on knee joint pain in a patient with patellofemoral pain syndrome (PFPS) after pregnancy. PFPS is one of the most common causes of knee pain. The present study was conducted in a 35-year-old woman with chronic PFPS following pregnancy. She was seen every other day, 3 times a week for 8 weeks. Physical therapy was performed for tight muscles and fascia in the front, rear, left, and right following mat relaxation, with use of a form roller and corrective exercises suitable for SFMA after simple manual therapy. Corrective exercises were performed with pattern assist, unload, pattern assist with load, and load, based on a 4 × 4 matrix and the patient's status and exercise capacity. For each corrective exercise, photographic materials were also provided so that the patient could carry out the corrective exercises at home. The treatment time per session was 50 minutes. Multi-Segmental Flexion showed improvement from Dysfunctional Non-painful (DN) to Functional Non-painful (FN), Multi-Segmental Extension showed improvement from DP to FN, Single Leg Stance (both right and left) showed improvement from DN to FN, and Overhead Deep Squat showed improvement from DP to FN. The Straight Leg Raising (SLR) test showed an increase on the right from 82° to 90° and from 63° to 81° on the left. The Kujala questionnaire score increased from 63 to 94. The visual analogue scale (VAS) score decreased from 8 to 3. SFMA-based therapeutic corrective exercise was effective for chronic PFPS after pregnancy in this patient

RELATIONSHIP OF PRESEASON MOVEMENT SCREENS WITH OVERUSE SYMPTOMS IN COLLEGIATE BASEBALL PLAYERS

The shoulder mobility screen of the Functional Movement Screen™ (FMS™) and the upper extremity patterns of the Selective Functional Movement Assessment (SFMA) assess global, multi-joint movement capabilities in the upper-extremities. Identifying which assessment can most accurately determine if baseball players are at an increased risk of experiencing overuse symptoms in the shoulder or elbow throughout a competitive season may reduce throwing-related injuries requiring medical attention. The purpose of this study was to determine if preseason FMS™ or SFMA scores were related to overuse severity scores in the shoulder or elbow during the preseason and competitive season. Cohort study. Sixty healthy, male, Division III collegiate baseball players (mean age = 20.1 ± 2.0 years) underwent preseason testing using the FMS™ shoulder mobility screen, and SFMA upper extremity patterns. Their scores were dichotomized into good and bad movement scores, and were compared to weekly questionnaires registering overuse symptoms and pain severity in the shoulder or elbow during the season. Poor FMS™ performance was associated with an increased likelihood of experiencing at least one overuse symptom during the preseason independent of grade and position (adjusted odds ratio [OR] = 5.14, p = 0.03). Poor SFMA performance was associated with an increased likelihood of experiencing at least one overuse symptom during the preseason (adjusted OR = 6.10, p = 0.03) and during the competitive season (adjusted OR = 17.07, p = 0.03) independent of grade and position. FMS™ shoulder mobility and SFMA upper extremity pattern performance were related to the likelihood of experiencing overuse symptoms during a baseball season. Participants with poor FMSTM performances may be more likely to experience at least one overuse symptom in their shoulder or elbow during the preseason. Additionally, individuals with poor SFMA performances may be more likely to report overuse symptoms during the preseason or competitive season. Level 3.

CORRELATION OF SELF-REPORTED OUTCOME MEASURES AND THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT (SFMA): AN EXPLORATION OF VALIDITY

The Selective Functional Movement Assessment (SFMA) is a clinical model used to assist diagnosis and treatment of musculoskeletal disorders by identifying dysfunctions in movement patterns. Based on the premise that addressing movement dysfunction is associated with an improvement in patient outcomes, the validity of the SFMA would be strengthened by observed improvement in self-reported function being associated with change in movement patterns. The purpose of this study was to explore the validity of the SFMA by determining if a correlation exists between a change in self-reported outcome measures and attributes of the assessment. Eighty-five clinical subjects (20.3 ± 1.6 years) were administered the Patient-Specific Functional Scale and one of four region-specific outcome measures followed by the SFMA top-tier movements. When deemed appropriate for discharge or following six weeks of therapy by an independent physical therapist, each subject repeated the outcome measures and was re-evaluated on the top-tier tests by the same initial assessor who was blinded to the subject's self-reported outcomes. Correlations between changes in outcome measures, number of painful movements and measures of movement quality (number of dysfunctional movements and criterion scores) were calculated with Spearman rank correlation coefficients. Subjects were analyzed as a consolidated group and by each region based on primary complaint. Fair to good positive correlations between improvements in self-reported outcomes and decreases in the number of painful patterns were noted for the complete dataset and for those with shoulder girdle and lumbopelvic complaints (rs = 0.28, 0.52, and 0.41, respectively). Subjects with lumbopelvic complaints demonstrated fair positive correlations with improvements in self-reported outcomes and decreases in the number of dysfunctional patterns (rs = 0.41 and 0.46). No correlations between changes in outcome measures and criterion score were observed. Improvements in self-reported outcome measures were associated with fewer painful movement patterns of the SFMA. Improvements in self-reported function were not related to changes in movement quality, except for subjects presenting with lumbopelvic complaints. 2b.