Practical Approach to the SFMA

by Mitch Hauschildt, MA, ATC, CSCS

I love using the Selective Functional Movement Assessment, or SFMA, in my practice.  A few years ago, it completely changed how I approach assessing my patients.  I give Gray Cook, Lee Burton, Kyle Kiesel, Mike Voight, Greg Rose and the rest of the crew who developed the SFMA a lot of credit for systematizing the evaluation process so that you can get a great snapshot of the entire human body and its functional abilities in a quick 15 minute process.  The system is simple, organized, and plays an important role in my practice for identifying true mobility and stability problems.  I use it on just about every evaluation that I perform, regardless of the age and activity level of my patient.  If you aren’t familiar with the SFMA, you can learn about it here.

With that being said, I am finding a lot of consistent issues with my patients, which leads me to fast track some things when I am performing and correcting movement patterns based on an SFMA.  Some consistencies that I find are:

• There is usually at least 1 dysfunctional cervical pattern.  This may be a motor control or mobility issue and oftentimes a combination of the two.
• Of the 2 shoulder patterns, shoulder 1 (internal rotation) is dysfunctional far more than shoulder 2 (external rotation).
• Multisegmental rotation is almost always dysfunctional.  I honestly don’t recall the last time that I had a patient who passed the multisegmental rotation top tier test.
• Single leg balance is split about 50/50 on who is dysfunctional and who is not.  It is rather rare that I break it out, however, because I tend to find things elsewhere that are affecting their function more than their single leg balance.
• I don’t recall the last time that I had an overhead squat that was functional.  Asking someone to perform an overhead squat without compensation with no shoes on is very difficult.  In some ways, I might say that it is too difficult for most people.  And, if they are dysfunctional with the squat, there are a lot of reasons why and it is challenging to find the reason why, even with the breakouts.
• Very, very few people know how to roll.  I no longer waste my time evaluating a roll during their assessment, because it is a waste of both my time and that of my patient.  I assume that they can’t roll and even if they are decent at it, they can always improve during their training.

I do think that it is important to understand that I’m not recommending that you cut the SFMA short or that you pick and choose what you want to use from the assessment.  With that being said, I also believe that once you understand the system and the body really well, you can begin to break a few rules from time to time.

I’m a practical guy with a ton to do every day.  I have to maximize my treatment time and get right to the things that are most important.  Here are a few recommendations that I have for clinicians who are new to the SFMA to help them maximize their time and efforts while they are learning and getting comfortable with the system.

• Get comfortable with the cervical break outs.  I personally have never and still don’t feel that confident working with the cervical spine.  With that being said, usually at least one of the cervical patterns is dysfunctional and they are important to correct.  We all acknowledge that the brain controls all movement and all of those signals must travel through the cervical spine to get to the rest of the body.  If the neck doesn’t work well, it will be hard to move well in general.  When they are dysfunctional, put them towards or at the top of your list of corrections.
• Know the Shoulder 1 break out and don’t be afraid to supplement it with more traditional shoulder evaluation techniques.  I find that most dysfunctional shoulders with this pattern are a combination of stability and mobility problems.  A number of people struggle with a posterior capsular restriction.  This will cause poor internal rotation and scapular winging.  Many people will correlate the scapular winging with poor stability, which can be true, but many times this lack of stability is caused by the mobility issue in the posterior shoulder capsule.  If you don’t fix the mobility issue, you will never have stability.  But, if you don’t follow the mobility correction up with some stability work, they will always revert back to the restricted movement pattern as a way to supplement stability.

  

• It’s pretty much a given that I will be breaking out multisegmental rotation.  Very few people that I see can actually rotate efficiently.  These restrictions present in a number of different ways and you must dial into it with the break out.  I really like the flow of this breakout, so I follow it fairly closely.  The only exception to that is rolling (I’ll get there next) and tibial internal rotation.  I find that very few people can actively internally rotate at the lower leg.  Thus, I only look at it passively because most people are restricted there anyway.
• I assume that everyone is unstable and has a stability motor control issue unless proven otherwise.  I find that if someone has made it to me, they are missing some subtle timing and motor control in their deep stabilizers of their trunk and core.  Thus, I plan on rolling pretty much everyone as part of their correction process.  Since I assume that people already have a stability motor control dysfunction, much of the SFMA to me is about finding mobility restrictions.  If they fail a top tier test and I can’t find a mobility issue during the break out, it is always treated as a motor control problem.
• It is rather rare that I break out the single leg balance, because I tend to find things elsewhere that are affecting their function more than their single leg balance.
• The only time I breakout an overhead squat is if everything else looks really good, thus I don’t recall the last time I broke it out.  I’m not endorsing ignoring the squat top tier or not learning the break out, but even if they have issues with this test, they will always get better when other dysfunctional patterns are corrected.  I only break them out when I can’t find a solution for them and all other patterns are functional.

As I said earlier, I love the SFMA and I use it pretty much daily.  But, I have also learned the parts of it that are most impactful for my patient population and I have really honed in on those areas and I can always reference the rest as needed.  Experience tells me that most of your patients are likely similar to mine, but I also think that if you use the SFMA a lot in your daily practice, you will begin to see patterns with your patients and you can begin to streamline your approach.  Just make sure that you don’t go too far and lose the integrity of the overall assessment tool.  It is meant to be comprehensive to make sure you don’t miss anything in your evaluation.