When evaluating clients early in my career, I would always focus just on their painful areas. When treating those painful spots, I would sometimes be successful, but often I would have to search elsewhere on the body in order to achieve any significant relief of pain. I had no clear cut path or system to zero in on the actual source of their pain. That was until I took the Selective Functional Movement Assessment (SFMA) a few years ago with Mike Voight as the head instructor.
This course was a true eye opener for me. The SFMA is something I now use every day in my practice, and with every single patient. It is a systematic process of looking at the body as a whole to find the primary source of movement dysfunction and pain. Interestingly, the source of dysfunction is often not at the site where clients actually experience their symptoms.
Stability vs. Mobility
The assessment is that of 7 fundamental movement patterns called the “Top Tier” testing. Those movement tests lead to further movement pattern “breakouts” which ultimately enable the clinician to determine whether the root cause is more of a mobility problem versus a stability/motor control problem.
These two main problems can cause the same painful symptoms, however each dictates a different treatment approach. The SFMA is an assessment tool that can effectively streamline the way a clinician intervenes. But, the way you treat the identified dysfunction is totally up to you.
Test and Re-Test
The top tier testing provides a great baseline measure for my clients each visit. It also allows me to check if (and how much) the treatment intervention made a difference in their functional movement patterns.
Test and then re-test. For example, if you fail Multi-Segmental Flexion (MSF), you will perform a few sets of a few different exercises. MSF will then be re-tested to see if you are now able to touch your toes. Having this baseline functional movement to gauge the effectiveness of the treatment is something that has helped me greatly. Additionally, my clients now have tangible results.
Getting to the Source of Pain
The SFMA is a total body, global approach, with the primary goal of identifying which portion of a functional movement pattern is not allowing the patient to perform the movement functionally and non-painfully, via the breakouts. It looks beyond local impairments, because it is more important to understand how this local impairment can influence their global functional movement patterns. It is not until this impairment starts to negatively impact their posture or the way they move that it becomes a problem.
For instance, if someone has limited shoulder mobility but does not exercise or play sports, this probably will not become an issue for that person. However, if he or she decides to do any overhead sport actions (tennis serve, throw a baseball, block a shot), or participates in a CrossFit program doing clean and presses, they will be at serious risk for global compensation… and injury will not be far behind.
The goal of the SFMA is to determine the local impairment and the relationship with the movement pattern. We move in patterns, not in individual segments. The whole is only as good as the sum of all its parts.
I have been utilizing the SFMA approach for a few years now. I have had a lot of success with it, and the more I use it, the more efficient my treatments get.
Disclaimer: I will say that the breakouts are very intimidating at first. I still am referencing the flow charts when taking a client through them. Initially, I wanted to go through it off of memory, but in reality they are just too complex when you are just incorporating it into your practice. The patient simply wants to get better. They will be okay with you doing whatever is necessary to put them in the best scenario for success.
Dr. Bryan Carestia is a physical therapist at Activcore in Princeton, New Jersey. He is recognized as both a Doctor of Physical Therapy (DPT) and a Certified Strength and Conditioning Specialist (CSCS). Dr. Bryan Carestia specializes in the treatment of performance athletes of all ages, integrating the SFMA along with Redcord, NeuroKinetic Therapy and various forms of manual therapy into his programs. He can be reached at firstname.lastname@example.org