The Selective Functional Movement Assessment (SFMA) is a movement-based diagnostic system created by Gray Cook. It can be utilized clinically for individuals who experience pain. In our in-service with Sam Nguyen from LIFT Physiotherapy, he reviews different movement assessments that can be used to determine a dysfunctional and functional movement. SFMA allows movement practitioners to have a system to determine causes of pain through breaking down dysfunctional movement patterns and determining the root cause as a mobility and/or stability problem. The assessment allows practitioners to appropriately guide exercise treatments to address these problems.
The SFMA consists of seven full-body top tier assessments that are evaluated. They can be further broken down into “breakouts” to assess for individual movements that may be dysfunctional or painful. With each top tier assessment, clinicians are inspecting movement deficiencies. If a set criterion isn’t met and there is pain or dysfunction with the movement, then the clinician moves into the breakout. In the breakout, the movement pattern is broken down and is classified as functional painful (FP), functional non-painful (FN), Dysfunctional painful (DP), and dysfunctional (NP). These classifications will assist in determining if the dysfunction is caused by a mobility and/or stability issue in that movement.
In this blog post, we’ll be introducing one of the top tier assessments and its breakout that was shown during the in-service. The multi-segmental flexion pattern looks to assess an individual’s ability to perform lumbar flexion. This assessment is performed by having the patient perform a standing toe touch. When observing the multi-segmental flexion assessment we are looking to see if the patient
●Can touch their toes (may start to bend at knees or hinge through the spine)
●Has a sacral angle <70 degrees
●Has a non-uniform spine curve
●Has a lack of posterior weight shift
●Displays excessive effort and/or appreciable asymmetry or lack of motor control.
These criteria will guide practitioners in whether a flexion movement is functional or dysfunctional. Given that that movement does not meet any of these criteria, then the practitioner would proceed to perform the breakout to determine the cause of dysfunction.
Breakout: The multi-segmental flexion breakout involves several tests that help to determine whether the dysfunction is a mobility or stability problem. The breakout tests are organized in a progressive hierarchy, where dysfunction and/or pain determine further testing. Below is a rough summary of the breakout and how each assessment can be used to build on top of one another to provide a better picture of where the individual has dysfunction. These tests include:
Long Sitting: to rule out weight-bearing stability motor control issues with hip flexion
Active Straight Leg Raise (70°) → Passive Straight Leg Raise(80°): Used to differentiate between stability/motor control dysfunctions and mobility dysfunction with hip flexion. If passive straight leg raise is functional while active straight is dysfunctional, then that suggests that there is an active hip stability issue. However, if both are dysfunctional, then the practitioner would move into the supine knee to chest assessment to differentiate between a hip mobility dysfunction or posterior chain mobility dysfunction.
Stabilized Straight Leg Raise (70°): Active straight leg raise but with having the core engaged to re-orientate the pelvis. A functional result is indicative of a core/pelvic orientation stability motor control problem. The next hierarchy would be the prone rocking test to determine if there is dysfunction at the lumbar spine in flexion.
Supine Knee to Chest (120°): To rule out hip mobility and/or stability motor dysfunction. If functional, suggests that there is a posterior chain mobility dysfunction while a dysfunctional movement is indicative of potential hip flexion mobility dysfunction.
Prone Rocking Test: To determine if there is a lumbar flexion mobility dysfunction or possible stability control issue if there was a non-uniform curvature present.
Needless to say, each top tier movement is broken down in breakouts so that practitioners are able to pinpoint root causes of dysfunction or pain. However, SFMA does not fully replace all other assessments and could even have scenarios where it is not suitable to use (ex. individuals with acute injuries/pain). We’d like to thank Sam Nguyen for discussing with us his review of the SFMA system. We would definitely recommend movement practitioners to check out the course as it can offer more knowledge in assessments.