SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT (SFMA)
The Selective Functional Movement Assessment (SFMA) is a series of 7 full-body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known musculoskeletal pain. When the clinical assessment is initiated from the perspective of the movement pattern, the clinician has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main musculoskeletal complaint, but contribute to the associated disability. This concept, known as Regional Interdependence, is the hallmark of the SFMA. The assessment guides the clinician to the most dysfunctional non-painful movement pattern, which is then assessed in detail. This approach is designed to complement the existing exam and serve as a model to efficiently integrate the concepts of posture, muscle balance, and the fundamental patterns of movement into musculoskeletal practice. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain. SFMA offers doctors and physical therapists a new approach to the treatment of pain and dysfunction. Our standardized clinical model ensures isolating the cause of injury and efficient care.
Clinical Application
Once Clinical Predictive Rules and diagnosis-specific techniques are exhausted, applying the SFMA model will allow for individualized exercise prescription and progression, which encompasses the concept of regional interdependence. As musculoskeletal system experts, it is essential that healthcare providers understand the relationships between body segments and how impairments in one body region may adversely affect the function of another body region. Approaching therapeutic exercise prescription from a movement perspective model allows the concepts of muscle imbalance and regional interdependence to be addressed in a logical, methodical manner. Modeled after Cyriax’s selective tissue testing, each test of the SFMA is scored as functional/non-painful, dysfunctional/non-painful, functional/painful or dysfunctional/painful. The goal for the clinician is to identify the most dysfunctional non-painful movement pattern and break the pattern down to identify the underlying cause of the dysfunction. This includes using traditional muscle length and joint assessment tests which lead to corrective manual therapy and exercise interventions. Emphasis is placed on identifying the most dysfunctional patterns. The model calls for the intervention to be directed only at the non-painful patterns. This ensures that the adverse effects of pain on motor control will not hinder corrective strategies.
Considering Patterns of Movement
Normal movement is achieved through the integration of fundamental movement patterns with an adequate balance of mobility and stability to meet the demands of the task at hand. The human system will migrate toward predictable patterns of movement in response to pain or in the presence of weakness, tightness, or structural abnormality. Over time, these pain-attenuated movement patterns lead to protective movement and fear of movement, resulting in clinically observed impairments such as decreased ROM, muscle length changes, and declines in strength. An isolated or regional approach to either evaluation or treatment will not restore whole function. Functional restoration requires a working knowledge of functional patterns and a map of dysfunctional patterns to gain clinical perspective and design an effective treatment strategy. Pain-free functional movement for participation in occupation and lifestyle activities is desirable.
Many components comprise pain-free functional movement including adequate posture, ROM, muscle performance, motor control, and balance reactions. Impairments of each component could potentially alter functional movement resulting in or as a consequence of pain. Utilizing the SFMA, the clinician is able to identify key functional movement patterns and describe the critical points of assessment needed to efficiently restore functional movement. This approach is designed to complement the clinician’s existing exam and intervention model with the prescription of movement-based therapeutic exercise. The SFMA serves to efficiently integrate the concepts of posture, muscle balance, and the fundamental patterns of the movement system into musculoskeletal practice. Additionally, it provides feedback for the effectiveness of the therapeutic exercise program, which targets dysfunctional movement pattern and related impairments.
