SFMA Case Study

<e-mailed scenario from a PT>
………patient walk through the door the other day – 15 y.o female volleyball player…………..

………with full shoulder flexion, S-C joint subluxates………….not painful.
………Shoulder Pattern 2-LRF are DN, Pattern 1-MRE are FN.
……….All cervical patterns are DN.
……….Seeing her for neck pain………….


I will try to go through this will both how I may approach the above situation (based on assumptions since we don’t have the whole picture here), and also some basic tenets of how I see the System.

1) The first thing that sticks out in this senario is that there is apparently a medical diagnosis of neck pain.
Your Top Tier did not evaluate neck pain, but that doesn’t mean it’s not there.  Perhaps the Dysfunctional Non-Painful patterns of the neck are the compensations to hide from the threats to a more efficient or complete segmental movement pattern.  Perhaps.
What I would do first in this case is run the breakouts for the Cervical Spine and come to a landing point on manual therapy or some other neuroceptive input.

Retest the neck.
Retest the shoulders and the S-C presentation.
I wouldn’t be shocked at all if the neck improved, and the S-C worsened because whatever was limiting the neck may have been hanging on for dear life in the manifestation of this alleged subluxation of the S-C.  Yes, I am suggesting that this report of subluxating S-C joint is probably just hypermobility rather than the clavicle actually popping out of the manubrium and popping back in.  It just sounds fuzzy to me.

2) Next I would look at the shoulders.

Fairly standard presentation. This is a major stability case, and after you clear the neck, work through the Pushup and Getup progressions. The Screen will lead you right to the core and scaps.

3) More generally, it is very difficult to manage the SFMA with an such an incomplete approach.  Even though the neck and shoulders take priority in the top down approach, something like a vestibular mechanism may be part of this picture, and this would be pointed towards from single-leg stance.  Some dominant pelvis issue may track to a rib cage position that affects the neck and shoulders.

4) Like most levels of training, medically or fitness oriented, it is typically a read and react approach.  I just find it so hard, often impossible to advise or give opinions on situations like this because you just don’t know how the body responds to Plan A.  If Plan A works, Plan B is very different than if Plan A didn’t work.
What clouds this even more that all of us have different skill sets and different interventions that we prefer or find success doing.  In teaching I often sense the frustration from trainers and PTs/Chiros that “just want to be told what to do.”  I can show you what I might do, but in doing that, when you approach a situation like this above, you never know how the individual will respond.
You may know what you may want to do on paper, but you never know what you’re going to do until you do it………, and it works.  Then you move to the next step.
You can follow an approach based in any approach that you like, but you can never prove anything.  In what I suggested above, there’s no way to say, even IF what I suggested worked, why any of it worked.  There’s no way to know ahead of time other than experience and expertise and expectations, on the halves of BOTH the clinician and the client.
All you can prove is that something desirable changed.

Is it always a hunt and peck approach?

Pretty much.

And it’s actually quite scientific.


You can’t prove anything other than something changed.                It’s all Hunt and Peck in between the bookshelves.



  • November 1, 2013

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John D'Amico Reply

Thank you Charlie, that was great. Sherlock Holmes loved the process as do I.

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