The Selective Functional Movement Assessment (SFMA) is a comprehensive assessment used to classify movement patterns, identify regions for further local biomechanical examination, and ultimately direct manual therapy and therapeutic exercise interventions. By examining several fundamental movement patterns we can determine which are dysfunctional. We will then break down those dysfunctional movements by systematically taking away challenges to determine if the problem is with posture, core stabilization, muscle control/strength, joint alignment, or tissue mobility.
Clinician’s use an orthopedic exam to determine the medical diagnosis of musculoskeletal conditions, or the SOURCE of your pain. For example, a medical diagnosis may be shoulder impingement or lumbar disc herniation. The SFMA complements the orthopedic exam by helping determine the CAUSE of your pain. It answers two important questions: Why did this happen? and How do I prevent it from happening again?
There are a couple of very important concepts in the SFMA. The first is Regional Interdependence that states seemingly unrelated impairments in another anatomical region may contribute to or be associated with the patient’s primary complaint. For example, a collapsed arch in one foot can cause the knee to rotate inward, causing compensation in the hip, which could pull the pelvis out of position resulting in low back pain.
Another concept is the Joint-By-Joint Rule that states the body works in an alternating pattern of stable segments connected by mobile joints. If this pattern is altered, dysfunction and compensation will occur. If an area is restricted, especially one that should be mobile, your nervous system will develop a motor pattern to move around that restriction. This will cause an otherwise stable area to become hypermobile and lead to injury. For example, the hip is a ball and socket joint and should be able to move in many directions. When we lose the ability to move through the hip, that can cause excessive motion in either the knee or the low back resulting in pain and early degeneration.
One of the rules in our clinic is never bring a mobility problem to a stability issue. The body will always sacrifice a stable area when we have a mobility problem. We follow the three R’s, Reset-Reinforce-Retrain. Reset is when we mobilize the joint or tissue that is restricted. Reinforce is where we train the patient to maintain that mobility through self-myofascial release and stretching. Retrain is developing a new and appropriate motor pattern based on your level of motor control so that you move well. That sometimes means starting on the ground, then moving to a kneeling position, and finally to a standing position. Each level requires more stability and control and if you can’t do something on the ground you probably won’t be able to do it standing. You have to learn to crawl before you walk.