I have really began to appreciate the value of Rolling in the SFMA after seeing some amazing results when getting people there. I can see where people get it wrong though, as it requires great mobility before attempting this stability movement. If you follow the SFMA flow charts, you’ll find several criteria that indicate someone can proceed to rolling testing.
- MSF: you need to be able to perform a sit and reach with a 80 deg sacral angle (although I also test rolling if the person demonstrates DN ASLR with a FN PSLR) – I’m not 100% sure that’s in the flow chart, but just what I remember
- MSE: A couple of ways to get there:
- FN Prone Active Hip Extension (>=10 degrees) or FN Prone Passive Hip Extension – seems like most people fall in these categories.
- FN Shoulder flexion with knees to chest – not a lot of people get there via this route – I’m guessing <20% of adult have sufficient shoulder flexion
- MSR: A couple of ways to get there from here too:
- Lumbar Locked ER Rotation / Extension Switches Sides – one of the hallmark signs of a stability problem – when things aren’t consistent, you either have a patient that is bad at faking an injury or you have a stability problem
- Lumbar Locked IR Rotation / Extension Passive FN when Active is DN or FP or DP
- Prone on Elbow Rotation FN
- Seated and Prone Passive ER or IR FN (you can also get there if both Active are FN, but if both Active are FN, then I think the stability problem might be coming from the spine)
- SLS: I rarely seem to get here with patients yet, I think as I progress with using the SFMA, I’m sure I’ll get here more, also says something about my patient population. Vestibular clear and 1/2 kneeling DN, DP, or FP.
So basically, clear mobility before you get to this great stability fix. Also if you do have a painful person, make sure they know that there can’t be any pain with any rolling exercise, or the brain won’t learn and keep the pattern. I’ve been amazed by how fast people can make improvements with rolling. I need to learn some ideas to help cement those gains though, so I’ll share when I figure that stuff out – I hear Perry Nickelson (stopchasingpain.com) is going to be coming out with an article about that very topic soon, I can’t wait to read it.
Other thoughts on rolling that I am learning as a participant and therapist:
- Rolling over the painful side is usually harder for patients – this is the pattern that seems to fit pretty well – at least more so for low back pain patients. Personally, this is the case for me when I aggravate my back (which occasionally happens when lifting a little person in my life with bad mechanics). I also find that even when I’m not hurting, I find myself holding my breath as I role over my painful side – as I relax and breathe things come much easier.
- I’m always trying to figure out what muscles are involved and I’m starting to piece things together. I think the fascial lines from Thomas Myers probably can help explain this, but this is what I’m theorizing. Let’s use supine to prone UE rolling with the RUE as an example. R serratus anterior reaching stabilizes the scapula allowing R rhomboids to pull the spine toward the scapula, at the same time working with R external obliques and L internal obliques to L rotate the spine. I’m not 100% sure on all of this, but I think I’m on to something. I also noticed that while doing a turkish get up today, when I protract and upwardly rotate my scapula on the R to initiate the movement, I can move from press to elbow without my left hip flexion.
- From an assistance perspective, I like holding a band or providing manual pressure to the heel of the stabilizing side to assist in rolling. I don’t mind making the rolling easier by building up the back side with a 1/2 foam roller, but I’m not sure it helps the pattern as much, but whatever works to get people started.
- I still follow up Rolling with whatever I would normally do for someone – sahrmann lower abs, 1/2 kneeling position (which I am starting to treat more like a stabilizer and mobilizer at the same time – hip flexor stretch + glute and ab activation), etc.
- Did I mention how amazed I am that this can relieve pain so quickly – I’ve seen several MSF and MSEs go from DP or FP to FN within a few minutes of practicing rolling – it’s like Magic.