2. Dissociation
Dissociation of movement is key. There is a reason we have over 300 joints and 600 muscles in our body. As much as I agree with the next physical therapist that we do not need to treat individual muscles and joints, I look at simple, daily movements as a screen. This is one of the hallmarks behind SFMA as it is quite simple, but effective.

An example of this is by asking the patient to rotate the cervical spine to the right. Can the patient rotate the cervical spine to the right without rotating the thoracic or lumbar spine? Or, can the patient squat down keeping the heels on the ground to inspect dorsiflexion? Or, how about one I always look at and 9 out of 10 patients cannot do: Can the patient protract and retract the scapula without lunging with their trunk? Putting undue stress on structures not meant to be stressed continuously can occur, leading to microtrauma, compensation or other strategies that will eventually lead to pain. These are all simple, daily movements that can be overlooked but highly effective strategies to address.

Look at dissociation of movements, first locally, then distally.   Choose which movements are the most appropriate to address for the patient.  It may be a cue and then the patient has it, or an active approach that he or she needs to work on as a HEP.  I look at diassociation of movements as an education tool.  Patients can usually “feel” themselves that they cannot perform this or that.  There is no bias here.  Hopefully you will not have to stay on this track long, but this pathway is worth looking down.

Stay tuned tomorrow for D #3.

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