Here’s some exchange between myself and 2 other colleagues working through this case study…………
Initial SFMA
MSF: FN
MSE: DN
MSR: DN
SLS: FN
DS: DN
MRE: R DN
LRF: R DN
C/S: DN all
C/S Breakout
Active Supine Flexion: DN
Passive Supine Flexion: FN
Active OA Flexion: FN
Active and Passive Cervical Rotation: FN
C1-C2: DN
Supine Cercival Extension: Cervical Extension DN
Observation
(+) Kyphosis, Upper-Crossed
Treatment
Breathing and MET to C/S post-tx: FN
Rib Roll
RRL
TRX Row
Deadlifts – Hip Pain
Question
How do you lock in the neck?
Before my exchange, my initial impression is that this SFMA is soft. Pain in DL leads me to believe MSF was DN. I would suggest this clinician was not discriminatory enough in scoring lumbar flexion in MSF. This is not to say something like MSF has to be DN if a hip hinge or loaded hip hinge is painful, but it’s not hugely likely.
I would also not expect SLS to be FN in this case.
So to lock in the neck, I would immediately go to RT1, which I have also described as Baby Breathing or 3 1/2 month old position. Whether you use Reflex Stimulation or not, this position allows for sagittal stability and T-L junction as the fixed point. If the neck cleared quickly, specifically with Muscle Energy, it clearly is a stability problem.
RT1 is always a reliable 1st place to start when the SMFA is muddled. One of the things you will find with RT1 is that MSF can correct since the hip flexion in the legs lends to flexion stabilization as well. It’s actually more regressive version of ASLR.
If DNS isn’t your bag, a lot of yoga positions will do if executed efficiently through T4-T8 and a long spine.
Also general ROM through the freed up neck will continue to “let air in”to the proprioceptive window you opened with the manual therapy. Engaging the mechanoreceptors in a non-threatening movement will drive the core pendulum as I see it.
I think there is much more money in the centrated positions of DNS, but if you don’t know them, applying the breathing and inner core principles will apply to this approach.
I would ask the mobility to stability links of yoga and segmental rolling to come before the packed neck position of chops and lifts and anti-extension techniques.
In sidelying positions, make sure the neck starts in centration. It can rotate, but from the rear, it should look like 1 uninterruped long spine. And it should stay that way.
After this treatment, I’d look to see how the shoulders test. Remember that the order of priorities for a true SFMA is Cervical, Shoulders, MSF, MSE, MSR, Deep Squat, and Single Leg Stance.
If you can clear the shoulders and MSF, you are ready to get into DL progressions. If it’s not DL because of pain, we can try to Mulligan the hip quickly or track that down through MSE or MSR. Farmer’s Walk right off is available as always. Heavy loading of the shoulders, packed neck, and short steps that are within the box of tight hips.
If the shoulders did not clear, this is the priority along with the painful hip. Getting the painful hip off the board will open up a lot of exercise to go along with the shoulder and t-spine work like DL and SLDL.
If the shoulder is painful in the DL, this really requires some deeper assessment.
Such a severe AC is not something you see often. Remember that would have shown up in Cross-Arm Impingement.
This is a case where DNS is very preferred as the method underneath the SFMA system.
When someone has all these issues, when one is out, the whole body is out. The DNS positions attempt to bring everything into centration, and then automatically lend themselves to easier exercises to build off of.
One thing that I find very disconcerting is the lack of message in any corrective approach that the entire body can be positioned, coached, and stabilized. The neck matters in the clamshell. The down leg matters in the ASLR. The breath matters in the squat.
Fix everything and be precise, specific, and discriminatory.
Manual therapy can open the door, but when this individual has so many joint systems dysfunctional, he is just going to revert back to walking around like the Tin Man.
