Selective Functional Movement Assessment
Katie Deaton, BS, CSCS, SPT
Goals
Disclaimer No way to provide a comprehensive course on the SFMA
and its implementation
Objectives Introduce the concept of assessing patients from a
global, movement quality perspective Present the major concepts of the SFMA, top-tier
assessments, and a top-tier breakout Facilitate a basic understanding of how to utilize the
SFMA Stimulate interest and further investigation into the
SFMA and its clinical implementation
What is the SFMA?
Meant for use by clinicians to facilitate assessment of patients who experience pain with movement Differentiates the SFMA from the Functional Movement Screen
(FMS)
Diagnostic tool designed to test a patient’s movement patterns and compare those patterns to an established minimum standard Assess quality of movement Highlight movement pattern limitations and asymmetries
Complement to other movement assessments – impairment measures (MMT) or functional performance measures (10MWT) Provides a more complete picture of dysfunction rather than
snapshots of isolated impairments Injury leads to altered motor control globally
Appropriate Application
SFMA is not always the most appropriate assessment Acute trauma or post-surgical
Conditions dominated by swelling, bruising, inflammation If these are present in sub-acute or chronic conditions, it
should be managed prior to corrective exercise involving active movement
New neurological compromise
In these situations, other examinations are more important
Once these conditions are managed, the SFMA can be utilized to determine the effects on movement
Objective Grading of Movement
Functional, Nonpainful – FN “The Dead End” This pattern is not the weak
link Do not spend time breaking
out this pattern- will only find insignificant limitations
Functional, Painful – FP “The Marker” Confirms that pain is
affected by movement Revisit the marker to assess
change or variation Don’t need to exercise this
movement because it’s functional
Dysfunctional, Nonpainful – DN “The Corrective Exercise Path” Focus on these patterns Exercise-based treatment can
be applied in this pattern without risk of exacerbating pain or reinforcing dysfunctional patterns
Dysfunctional, Painful – DP “The Logistical Beehive” Breakouts can reveal FP or DN
patterns Difficult to interpret – Is pain
causing poor movement or vice versa?
Don’t attempt corrective exercise in this pattern unless it’s a last resort
Top-Tier Assessments
Patient should be able to touch sternum with chin without pain
Patient should be able to get within 10 degrees parallel without pain
Top-Tier Assessments
Patient should be able to reach mid-clavicle bilaterally without pain
Patient reaches back with the arm trying to touch the inferior angle of the opposite scapula
Top-Tier Assessments
Patient reaches overhead with the arm trying to touch the spine of the opposite scapula
Patient places palm on opposite shoulder and lifts the elbow to the sky
Top-Tier Assessments
Patient uses hand to help passively while horizontally adducting the opposite arm as far as possible
Patient bends forward at hips trying to touch the ends of the fingers to the tips of the toes without bending the knees
Top-Tier Assessments
Patient bends backwards as far as possible, making sure the hips go forward and the arms go back simultaneously
Patient rotates the entire body – hips, shoulders, head – as far as possible to one direction while foot position remains the same
Top-Tier Assessments
Patient lifts one leg so the hips and knee are both at 90 degrees and holds for 10 seconds
Patient slowly descends as deeply as possible into a squat position
Why Treat the DN?
FNThe Dead
End
FPThe Marker
DNThe
Corrective Exercise
Path
DPThe
Logistical Beehive
+ Motor control remains altered due to past injury
+ Altered hip, hamstring & ankle musculature activity following ankle injury 2, 3, 4
+ Altered sit-to-stand movement pattern 1 yr post-TKA 5
+ Greater muscle response and delayed latency following anterior, posterior or lateral perturbations in athletes with recent history of low back pain6
+ Pain alters motor control7
+ Motor control changes are somewhat unpredictable and may be task specific- 8, 9
+ In the induced pain group:
+ Arm lift increased multifidus firing on EMG8
+ Weight shift decreased multifidus firing on EMG8
+ Decreased agonist and antagonist activity due to pain10
+ Reduced movement amplitudes7
+ Decreased agonist activity compared to antagonist activity
Hierarchy of Treatment
Once you’ve discerned which DN pattern to begin with, 3 filters guide treatment within the pattern breakout: Limitation
Resolve the greatest limitation first Could also pick the pattern with lowest physical demand or simplest pattern
Asymmetry Resolve asymmetrical limitations before symmetrical limitations
Redundancy Test/retest patterns and be aware of inconsistencies
Return to the next most significant limitation or asymmetry once the first is resolved
Cervical DN
Shoulder DN
Forward or
Backward DN
Rotational DN
Single Leg DN
Squatting DN
Stability vs. Mobility
STABILITY PROBLEM
Loaded and unloaded movements are not equal
Passive movement is substantially greater than active movement (10° rule)
Inconsistent findings
SFMA global dysfunction terminology for a stability problem: SMCD- stability &/or motor
control dysfunction
MOBILITY PROBLEM
Loaded and unloaded movements are equal
Passive movement is only slightly greater than active movement (10° rule)
Consistent findings
SFMA global dysfunction terminology for a mobility problem: TED- tissue extensibility
dysfunction JMD- joint mobility dysfunction
Breakouts
Treatment Hierarchy Rationale
Each level of movement plays a role in the next
In the context of permanent restriction (surgical fixation, extensive scarring, etc) this hierarchy might need to be altered
Exercise interventions not directed at painful movements Still treat pain but not with exercise
Utilize exercise to retrain dysfunctional movement instead
This paradigm requires buy-in on the part of the PT and patient Ex. “Why are you treating my neck when my shoulder hurts?”
“Transforming society by optimizing movement to improve the human
experience.”
REVISED APTA VISION STATEMENT
To Learn More…
Movement: Functional Movement Systems by Gray Cook
www.functionalmovement.com
SFMA certification courses and workshops
Printable flow sheets for use during SFMA examination http://graycookmovement.com/downloads/SFMA%2
0Score%20Sheets.pdf
References1. Cook, Gray. Movement: Functional Movement Systems. 2010. On Target Publications: Santa Clara, CA.
2. Hubbard, TJ. Kramer LC, Denegar CR. Hertel J. Correlations among multiple measures of functional and mechanical instability in subjects with chronic ankle instability. Journal of Athletic Training. 2007; 42 (3): 361-366.
3. Beckman, SM. Buchanan TS. Ankle inversion injury and hypermobility: effect on hip and ankle muscle electromyography onset latency. Arch Phys Med Rehabil. 1995; 76: 1138-1143.
4. Van Deun, S. Staes, FF. Stappaerts, KH. Janssens, L. Levin, O. Peers, KKH. Relationship of chronic ankle instability to muscle activation patterns during the transition from double-leg to single-leg stance. Am J Sports Med. 2007; 35 (2): 274-281.
5. Farquhar, SJ. Reisman, DS. Snyder-Mackler, L. Persistance of altered movement patterns during a sit-to-stand task 1 year following unilateral total knee arthroplasty. Phys Ther. 2008; 88: 567-579.
6. Hodges, P. van den Hoom, W. Dawson, A. Cholewicki, J. Changes in the mechanical properties of the trunk in low back pain may be associated with recurrence. Journal of Biomechanics. 2009; 41 (1): 61-66.
7. Arendt-Nielsen, L. Graven-Nielsen, T. Muscle pain: sensory implications and interactions with motor control. Clin J Pain. 2008; 24 (4): 291-298.
8. Kiesel, KB. Butler, RJ. Duckworth, A. Halaby, T. Lannan, K. Phifer, C. DeLeal, C. Underwood, FB. Experimentally induced pain alters the EMG activity of the lumbar multifidus in asymptomatic subjects. Man Ther. 2012; 17 (3): 236-240.
9. Ahern, DK. Follick, MJ. Council, JR. Comparison of lumbar paravertebral EMG patterns in chronic low back pain patients and non-patient controls. Pain. 1988; 34: 153–160.
10. Ervilha, UF. Arendt-Nielsen, L. Duarte, M. Effect of load level and muscle pain intensity on the motor control of elbow-flexion movements. Eur J Appl Physiol. 2004; 92: 168–175.