Selective Functional Movement Assessment (SFMA)

//Selective Functional Movement Assessment (SFMA)

Selective Functional Movement Assessment (SFMA)

Last month, I took my Level 1 Selective Functional Movement Assessment (SFMA) qualification. I’ve had been waiting for and looking forward to all year as these courses are very rarely over in the UK. So, for those of you unfamiliar with SFMA, I decided to write this blog to explain to you what it is.

Pain Location vs Source of Pain

When we experience pain, we automatically assume that’s where the problem is. But as therapists, we know that isn’t always the case.

Example 1

The best example I can think of is ‘Tennis Elbow’. True tennis elbow arises from an inflammatory and/or degenerative process at the lateral epicondyle (outer lateral elbow). It is usually the result of a repetitive strain type injury. However, there can be other causes of ‘tennis elbow’. Two very common causes are a) nerve inflammation from a disc bulge in the neck. And b) trigger points in the rotator cuff muscles of the shoulder. If you were to just treat the elbow and miss out the primary source, there’s a good chance you’re probably going to make it feel worse. Doing a thorough Neurological and Orthopaedic examination would help to determine whether the pain is truly coming from the elbow. Or whether it’s from somewhere else. Going one step further – why did that disc bulge happen in the first place? Is it because there is instability in the neck due to lack of mobility in the thoracic spine? This is where SFMA comes in to play.

Example 2

Another great example is lower back pain. Lower back pain is often a sign that something else isn’t working properly. Our bodies follow a pattern of stability/mobility. Our feet should be more stable, ankles more mobile. Knees more stable, hips mobile. Pelvis and lower back more stable, upper back more mobile and so on. But what quite often happens is that this pattern reverses. So instead we end up with stiff ankles, hips and upper back. And usually less stability in the lower back which a lot of the time ends up with an injury to that area.  If we just treat the site of pain without treating the cause, that issue is likely to keep on reoccurring.


SFMA is a type of assessment method which helps me to determine where the source your pain is. It also helps me to determine whether there is a mobility issue (whether that’s joint, muscle or fascial restriction) or whether there is a motor control problem. A motor control problem is when there is a lack of stabilisation at a joint. This will result in altered motor control to muscles as a protective mechanism. This muscle guarding then gives the appearance that a joints range of movement is restricted.

First Step

The first step of SFMA is to take a person through a series of ‘Top Tier’ movement patterns. These assess the quality of movement in the neck, upper & lower back, shoulder, hip etc, as well as a simple balance test. Movement patterns are then described as being either Functional Nonpainful (FN), Functional Painful (FP), Dysfunctional Painful (DP) or Dysfunctional Nonpainful (DN).

Next Step

Once a movement pattern has been deemed as being DN, DP or FP (in that order), each movement pattern is then ‘broken out’ into the different elements that make up that movement. They are then tested both actively (patient does the movement unassisted) and passively (therapist does the movement for the patient).

By testing a movement actively and passively I can determine whether it is restricted mechanically or because of poor motor control. This then allows me to come up with the best course of treatment for you. If you cannot achieve the movement either actively or passively then I know there is some form of mechanical restriction. This restriction could be due to local dysfunction at a joint, or adhesions within muscle, fascia, ligament etc. I would determine this through local palpation. However, if a movement is restricted actively but not passively then I know that there are no mechanical restrictions, but instead there is a lack of motor control.

What Next?

A true mobility issue would need to be addressed first and foremost. I can do this using a Chiropractic Adjustment, various soft tissue techniques and active stretching. Obviously, there are circumstances which are out of the realm of a manual therapist. For example, a severely degenerated hip arthropathy. In these situations, you may need to be referred for an X-Ray – but there are always things we can try to get the joint and surrounding structures functioning as best as possible. Once any mobility issues have been dealt with, motor control issues are next. I use a rehabilitation method called Dynamic Neuromuscular Stabilisation (DNS) to do this, which you can find out more about in our services section.

How can SFMA help you?

Do you keep on getting injured and don’t know why? Do you feel like a part of the puzzle is still missing? SFMA may be the answer to your questions.

Please get in touch with me if you would like a full SFMA screening to try and get to the bottom of your pain. I also use bits of the SFMA process during a Chiropractic Plus Consultation if you do not wish to have a full screening.

Give the clinic a call on 0161 879 7701 to book an appointment with me.

Written by

Sam Davies

MChiro DC