SFMA and Anatomy Trains: Concepts For Assessment and Treatment

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SFMA and Anatomy Trains: Concepts For Assessment and Treatment

by Patrick   on January 31, 2011

There are many ways to assess clients prior to a soft tissue therapy session – posture, range of motion (active and passive), manual muscle testing, etc – however, it is my opinion that evaluating movement is an often overlooked component to assessment for the majority of massage therapists out there.  With this article, I will attempt to blend the concepts of two great teachers, Gray Cook and Thomas Myers, and draw correlations between Myers’ Anatomy Trains and Cook’s Selective Functional Movement Assessment (SFMA) patterns as a means of establishing a battery of tests and setting up a treatment approach.
SFMA
For those that are unfamiliar, the SFMA, consists of seven top tier tests which evaluate basic fundamental patterns that display an individuals ability to either complete the movement perfectly without pain (Functional/Nonpainful – FN), complete the movement but have pain (Functional/Painful – FP), unable to complete the movement without pain (Dysfunctional/Nonpainful – DN), or unable to complete the movement with pain (Dysfunctional/Painful – DP).
Any of these seven patterns, once found to be either dysfunctional and/or painful, can be further broken down into “breakout” tests for a more specific evaluation.  In the effort to keep things simple, I will use only the seven top tier tests to compare their relationship to Myers’ Anatomy Trains.  The seven top tier tests are:

• Cervical spine patterns – Flexion (touch the chin to chest), Extension (look back at the ceiling), and Rotation with flexion (touch the chin to each collar bone)
• Upper extremity patterns– Abduction with external rotation (reaching the arm around the head attempting to touch the superior angle of the opposite scapula) and Adduction with internal rotation (reaching the arm around the back attempting to touch the inferior angle of the scapula)
• Multi-segmental Flexion – Reach down and touch your toes
• Multi-segmental Extension – Reach overhead and extend back as far as you can
• Multi-segmental rotation – Rotate your body as far as you can to each side, keeping the feet flat on the floor
• Single leg stance– Stand on one leg with the other leg to at least 90 degrees of hip flexion for at least 10sec
• Overhead deep squat – Hands overhead feet about shoulder width apart and squat down as deep as you can while keeping the feet on the floor
  

Anatomy Trains
The Anatomy Trains, according to Myers, are the groups of myofascial meridians that run through the entire body.  With these “trains” Myers not only shows us the unique whole body connections we posses but also offers concepts for soft tissue therapy whereby treating one area along or within one of these myofascial trains can have profound influence not only locally where treatment is taking place, but globally, along that entire chain.
The five trains according to Myers are:
The Superficial Back Line
Plantar Fascia > Gastroc > Hamstrings > Sacrotuberous ligament > Thoracolumbarfascia > Erector Spinae > Nuchal Ligament > scalp fascia
The Superficial Front Line
Anterior compartment and periostium of the tibia > rectus femoris > rectus abdominus > Pectoralis/Sternalis fascia > SCM
The Lateral Line
Peroneal muscles > ITB > TFL/Glute max > External/Internal Oblique & deep QL > Internal/External intercostals > Splenius cervicis/iliocostalis cervis/SCM/Scalenes
The Spiral Line
Splenius Capitis > Rhomboids (opposite side to splenius capitis) > serratus anterior > External/internal oblique > TFL (opposite side of obliques) > ITB > Anterior tibialis > Peroneus longus > biceps femoris >sacrotuberous ligament > sacral fascia > erector spinae
The Deep Front Line
Posterior tibialis > interosseuos membrane > Knee capsule > adductor hiatus > intermuscular septum > femoral triangle > psoas > anterior longitudinal ligament > diaphragm > pericardium > mediastium > parietal pleura > fascia prevertebralis > scalenes
Back of the Arm Lines
1st tract
Trapezius > Deltoid > lateral intermuscular septum > common extensor tendon
2nd tract
Rhomboids > Infraspinatus > Triceps > Periostium of ulna to the small finger
3rd tract (stabilization)
Latissimus Dorsi > Thoracolumbar fascia > sacral fascia (opposite side of thoracolumbar fascia) > glute max (opposite side of thoracolumbar fascia) > vastus lateralis
Front of the Arm Lines
1st tract
latissimus dorsi/teres major/pectoralis major > medial intermuscular septum > medial epicondyle > common flexor tendon > palmar side of hand and fingers
2nd tract
Pec minor > biceps (short head)/coracobrachialis > radius > flexor compartment > thumb
3rd tract (stabilization)
Pec major > external oblique > adductor longus (opposite side of external oblique) > gracilis > pes anserine > tibial periostium
Putting them together
The SFMA can be used as a guide for us to go deeper into the assessment of an anatomy train line when we find one of the top tier tests to be dysfunctional or painful.  Additionally, the SFMA can (and should) serve as a means to re-check our work either during and/or following treatment to ensure that we are moving in the right direction and to allow the client to feel improvement or freedom of movement (and pain free movement) that was not present at the start of the session.
I find that the multi-segmental flexion, extension, and rotation patterns lend themselves well to the Anatomy Trains system, as they are very global movements and general movements.  The cervical spine will fall into either of these three patterns as its movement assessments (flexion, extension, and flexion with rotation) will have influence over these more global patterns, so please keep that in mind as we look deeper into these three assessments.
Multi-segmental flexion
During multi-segmental flexion (toe touch) the primary line that we are asking to be lengthened is the Superficial Back Line, which basically stems from the plantar fascia at the bottom of the foot all the way up to the scalp.  The idea of treating one part of this line and seeing a change in the entire line is evident when one attempts to touch their toes and is unable to do it.  The individual then rolls a tennis ball on the bottoms of the feet (the plantar fascia) for approximately 60sec per foot and then retests and shows an immediate improvement in range of motion, some instantly being able to touch their toes.
The Superficial Back Line
Plantar Fascia > Gastroc > Hamstrings > Sacrotuberous ligament > Thoracolumbarfascia > Erector Spinae > Nuchal Ligament > scalp fascia
Upon evaluating multi-segmental flexion, if we find it to be restricted and dysfunctional, we can choose to treat any of the structures that create this line.  Another way to breakdown the line, if the movement pattern is dysfunctional, would be to use visual observation of posture and palpation of structures along the line to get a sense for areas of restriction or fibrotic and thickened tissue.  Addressing these areas and then re-checking the movement can be a simple way to use both these two concepts together.
Oftentimes, it is not uncommon to find the main areas of restriction along this line being tight or toned gastrocnemius, lumbar erectors, or suboccipital muscles – all of which would be consistent with Dr. Janda’s upper and lower crossed postures.  It is important to remember that the idea of multi-segemental flexion also means that the cervical spine should flex, and this is where the cervical pattern from the SFMA would fall into our treatment of this pattern.
Multi-segmental extension
Multi-segmental extension, which is basically a back bend with the arms overhead and keeping the feet flat on the floor, has influence over two major lines, as it is asking both the superficial and deep front lines to stretch and show adequate mobility.
The Superficial Front Line
Anterior compartment and periostium of the tibia > rectus femoris > rectus abdominus > Pectoralis/Sternalis fascia > SCM
The Deep Front Line
Posterior tibialis > interosseuos membrane > Knee capsule > adductor hiatus > intermuscular septum > femoral triangle > psoas > anterior longitudinal ligament > diaphragm > pericardium > mediastium > parietal pleura > fascia prevertebralis > scalenes
I have written a bit about the Deep Front Line last year in a piece for Mike Robertson’s blog.
Again, by assessing the movement first, we can choose to further evaluate and when necessary treat components of these lines in an attempt to effect and improve whole body movement.  An example of this would be by treating the diaphragm and working on improving breathing can rapidly decrease tone in the hip flexor and quadriceps muscularture as well as the scalenes and SCM (which are both accessory respiratory muscles).
Again, evaluate for some of the key areas of restriction along the line, treat one or two areas, and see what sort of improvement have been made and then continue on.  Also remember that from the cervical spine patterns, cervical spine extension will feed into this movement.
Multi-segmental Rotation
Multi-segmental rotation is an interesting movement as many lines influence it.  While the two main lines that make up rotation are the lateral line and the spiral line, it is important to keep in mind that all of the lines discussed previously above can impact this movement, as flexion and extension are necessary components of good rotation.
The Lateral Line
Peroneal muscles > ITB > TFL/Glute max > External/Internal Oblique & deep QL > Internal/External intercostals > Splenius cervicis/iliocostalis cervis/SCM/Scalenes
The Spiral Line
Splenius Capitis > Rhomboids (opposite side to splenius capitis) > serratus anterior > External/internal oblique > TFL (opposite side of obliques) > ITB > Anterior tibialis > Peroneus longus > biceps femoris >sacrotuberous ligament > sacral fascia > erector spinae
Looking at these two lines and thinking about multi-segmental rotation can be a bit overwhelming as there are many considerations (especially when you take into account the other lines discussed above).  My recommendation would be to first determine which rotation is limited – left or right – and then consider the actions of the muscles in these lines.  If I rotate to the left, which muscles are internally rotating and which are externally rotating?  If I rotate to the right, which muscles are internally rotating and which are externally rotating?  Again, treat one or two areas that you have found to be major restrictions and then re-evaluate to see what kind of improvements in function have been made.
Keep in mind that our flexion with rotation range of motion test from the cervical spine pattern can also influence this line, so treating the appropriate musculature at the neck will be a necessary component to a full session if that movement is found to be restricted.
Single Leg Stance, Overhead Squat, and Upper Extremity Patterns
Our upper extremity patterns – Abduction/External Rotation and Adduction/Internal Rotation – can be addressed by treating the front of the arm lines and back of the arm lines, both of these lines having three tracts (see above).   In addition, all of the muscles in the arm lines, and especially when you look at the 3rd tract of the front and back arm lines, the stabilization tract, have in integral connection into many muscles that then plug into and influence the other lines of the body, making the treatment of these structures very comprehensive.  Following the movement assessment, a closer evaluation with palpation and visual observation, will help lead you toward a treatment of a few key structures which would then be followed up with a re-assessment of the dysfunctional movement.
The single leg stance and overhead squat patterns are rather complex as they take some of the more basic/fundamental movements like flexion, extension, and rotation, and put them all into play with a global pattern that requires higher levels of both stability and mobility.  These patterns require communication from all lines simultaneously.  Therefore, prior to considering these two patterns, it would make sense to improve and exhaust the possibilities of the previous patterns.  Occasionally, in doing so these two patterns will often improve because of the enhanced function of the more fundamental movements.
An Additional Consideration
While I attempted to lay this concept out simply, it is important to remember that we are not only evaluating the line which is being asked to lengthen during these tests, but also, we are evaluating the opposite line of this movement and its ability to shorten, or contract.   For example, when looking at multi-segmental flexion, while we are thinking about the superficial back line, its ability to lengthen, and its areas of restriction, we must also remember that both the superficial and deep front lines are being asked to shorten.  Restrictions in the superficial front line may also limit this sort of movement and may warrant treatment in order to restore full function to the movement pattern.

Conclusion
There are many ways of assessing individuals prior to treating the soft tissue.  This is just one concept, combining two great teachers of human movement, which can be utilized, to help drive our assessment and treatment process.
As I reiterated throughout this article, it is important to test, treat, and then re-test, as this is the only way to know if you are on the right path.  Treat a few structures, re-test, and then treat a few more, always keeping in mind that we must think about the lines that are being asked to lengthen and the lines that are being asked to shorten, and the interplay between them.



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