Selective Functional Movement Assessment (SFMA)

Objective

The Selective Functional Movement Assessmnet (SFMA) was developed by Gray Cook and colleagues, the same group who developed the Functional Movement Systems. The SFMA is meant to be used in a diagnostic capacity for musculoskeletal assessment when pain is present. The SFMA is a clinical model used to assist diagnosis and treatment of musculoskeletal disorders by identifying dysfunctions in movement patterns.[1]

The SFMA is meant to be used by physiotherapists / physical therapists, athletic trainers, chiropractors, and physicians. It was created to measure the status of movement-pattern related pain and dysfunction using bodily regional interdependent movement to aggravate symptoms and expose the limitations and dysfunctions.[2]

It uses a series of full-body movements to identify possible movement dysfunctions. The purpose of the SFMA is to assess the quality of the movements; it is not about how many repetitions the person can perform, but rather the quality of the movement pattern. The SFMA helps to expose possible asymmetries and pathological movements patterns, as the root cause of a painful problem. This will in turn, help guide a treatment plan to restore pain-free movement and function.

To understand how to use the tool properly, it is important for the clinician to understand the terms "tightness" and "weakness", within the SFMA framework. The SFMA system understands "tightness" as an issue with tissue extensibility and / or a joint mobility dysfunction. "Weakness", on the other hand, refers to the stability of the joint and it's associated motor control.

The SFMA tool is helpful to be used during the initial physical evaluation of a patient, but the clinician should be aware of the acuteness or irritability of the presenting signs and symptoms. The SFMA may not be practical for use during an acute episode.

The SFMA enables the evaluating clinician or therapist to identify and treat regions in the body that lack mobility (range of motion), or stability (motor control), allowing for an accurate treatment to restore pain-free function and movement.

SFMA vs. FMS

Many clinicians confuse the Select Functional Movement Assessment (SFMA) with the Functional Movement Screen (FMS). Both tools are a part of the same Functional Movement System created by Cook and colleagues, but their fundamental purposes are quite different. The SFMA is meant to be used in a diagnostic capacity, designed to identify musculoskeletal dysfunction among individuals affected by pain. Whereas the FMS is a screening tool, not intended for diagnosis. The FMS aims to identify imbalances in mobility and stability during functional movements.

Scoring

SFMA is a diagnostic system (that can only be performed by medical professionals) similar to that of the McKenzie system. The SFMA assessment is broken down into 7 Top Tier tests and graded as Functional and Non-painful (FN), Functional Painful (FP), Dysfunctional Non-painful (DN), and Dysfunctional Painful (DP). If a Top Tier test does not pass the FN grade, then that specific movement must go to a breakout pattern to find the true cause of dysfunction. To simplify things, the "true cause of dysfunction" can either be viewed as a mobility (Tissue Extensibility Dysfunction (TED)/Joint Mobility Dysfunction (JMD)) OR a Stability/Motor Control Issue (SCMD). 

The SFMA has been used to identify remote dysfunctions through the utilization of 7 top-tier (ie, basic movement) assessments:[3][2]

Cervical Patterns:

  • flexion, extension, and rotation (right [R] + left [L]);

Upper-Extremity Patterns: 

  • medial (internal)  rotation & extension pattern (R + L); 
  • lateral (external) rotation & abduction pattern (R + L);

Multi-Segmental Patterns: 

  • multi-segmental flexion; 
  • multi-segmental extension; 
  • multisegmental rotation (R + L);
  • single-leg stance (R + L); and overhead squat.

The results of the SFMA are separated into 4 categories:[4]

  1. Functional non painful;
  2. Functional painful;
  3. Dysfunctional non painful;
  4. Dysfunctional painful.

The SFMA has also been used to evaluate athletes in various sports such as soccer, weight lifting, running, and baseball.[3][5][6]

Because the SMFA system has a copyright, to see an example of the scoring system, please consult their website and their associated courses.

Evidence

Validity

A study by Riebel et al, (2017)[1] evaluated the correlation of the SFMA to the Patient-Specific Functional Scale and other site-specific self-reported outcome measures. Their study found fair to good positive correlations between the self-reported outcomes and the decreases in the number of painful patterns identified for those with shoulder girdle and lumbopelvic complaints (rs = 0.28, 0.52, and 0.41, respectively). They further found no correlational relationships were found between changes in outcome measures and the SFMA criterion score (Level of evidence: 2b). Further research is needed in this area to examine the exact relationship between the SFMA tool and site-specific outcome measures.

Reliability

The SFMA is not as widely researched as the Functional Movement Screen (FMS) tool. Presently, the research demonstrated a poor to good reliability of the SFMA. The intra-and inter-rater reliability of the categorical scoring of the ten fundamental movements of the SFMA was higher in raters with greater experience.[7] A study by Dolbeer et al. (2017)[8] found that SMFA qualified clinicians boasted moderate to better reliability when using the SFMA.

Videos and Resources

The SFMA tool is taught to clinicians through structured courses. If you are interested in any of the SMFA courses, please visit their official website


The SFMA is part of a collection of Functional Movement Systems, you can also refer to their other tools:

References

  1. 1.0 1.1 Riebel M, Crowell M, Dolbeer J, Szymanek E, & Goss D. Correlation of self-reported outcome measures and the selective functional movement assessment (SFMA): an exploration of validity. Int J Sports Phys Ther. 2017; 12(6):931-947.
  2. 2.0 2.1 Fauntroy, V., Fyock, M., Hansen-Honeycutt, J., Nolton, E. & Ambegaonkar, J.P. (2019). Using the Selective Functional Movement Assessment for the Evaluation of Dancers’ Functional Limitations and Dysfunctions: A Critically Appraised Topic.[null Journal Of Sport Rehabilitation] [J Sport Rehabil] 2019 Feb 19, pp. 1-6. 2019 Feb 19.
  3. 3.0 3.1 Goshtigian, G.R., Swanson, B.T. (2016). Using the selective functional movement assessment and regional interdependence theory to guide treatment of an athlete with back pain: a case report. Int J Sports Phys Ther. 2016;11(4):575–595. PubMed ID: 27525182
  4. Cook G. Movement: Functional Movement Systems: Screening, Assessment and Corrective Strategies. Aptos, CA: Target Publications; 2010.
  5. Mocha, G.M., Sprague, P.A., Rodriguez, R., Gatens, D.R. (2015). Functional movement pattern training improves mechanics in a female runner with external snapping hip syndrome. Int J Athl Ther Train. 2015; 20(1):25–33. doi:10.1123/ijatt.2014-0095.
  6. Busch, A.M., Clifton, D.R., Onate, J.A., Ramsey, V.K., & Cromartie, F. (2017). Relationship of preseason movement screens with overuse symptoms in collegiate baseball players. Int J Sports Phys Ther. 2017;12(6): 960–966. PubMed ID: 29158957 doi:10.26603/ijspt20170960
  7. Glaws KR, Juneau CM, Becker LC, Di Stasi SL, & Hewett TE. Intra- and inter-rater reliability of the selective functional movement assessment (sfma). Int J Sports Phys Ther. 2014; 9(2):195-207.
  8. Dolbeer J, Mason J, Morris J, Crowell M, Goss D. Inter-rater reliability of the selective functional movement assessment (SFMA) by SFMA certified physical therapists with similar clinical and rating experience. Int J Sports Phys Ther. 2017;12(5):752-763.