Leading rehabilitation therapists have three things in common: superb communication skills, excellent diagnosis skills and wide-ranging knowledge of the methods of treatment and training. A diagnosis system which can also be used by experienced sports therapists and fitness trainers is known as the Selective Functional Movement Assessment (SFMA).
With the SFMA, the body and its movements can be analysed and pain can be looked into in more detail. The SFMA starts with a screening of the seven most important whole-body movement patterns, known as the “top tier movement patterns”. These movements are evaluated and classified as being “functional versus dysfunctional” and “painful versus pain-free patterns”.
As soon as results from the assessment are available, the trainer or therapist who is providing the treatment starts with a systematic consideration of the dysfunctional pain-free patterns. Pain changes the patterns of movement because the body sidesteps the pain automatically and tries to compensate for it.
For this reason, the pain-free movements are analysed first. In this way, as trainers, we are able to determine the underlying causes of the dysfunctional movements without having to deal with the pain and its impact.
Through its thorough investigative approach, the SFMA gives the expert the opportunity to differentiate between dysfunctions which are attributable to limited mobility, stability or motor control in order to suggest the best intervention for the existing problem.
By developing a plan which focuses more on the general mechanical functionality of their patient and less on a medical diagnosis, the expert isn’t only able to influence the immediate symptoms, they can also achieve positive results for the individual’s physical functionality.
Those who can move normally are able to complete the underlying movement patterns which are being tested without any problems. These are characterised by a balanced ratio of mobility and motor control.
The human body responds to pain, limited mobility or the loss of motor control with adjustments or compensatory patterns. Over time, these changes can lead to a serious dysfunction or to stronger pain, as well as anxieties concerning the corresponding movements.
For this reason, an isolated or locally limited approach to the evaluation is insufficient for recreating the complete motor function. If it is only the pain that is treated, it certainly does not mean that the underlying problem has been rectified.
Only after the evaluation of all the dysfunctional patterns will the trainer or the therapist providing the treatment be in the position of being able to create an effective treatment strategy and training.
If an individual experiences pain every time s/he moves, the quality of his/her life will be impaired significantly. In addition to specific injuries there are many more components which contribute to being able to complete functional movements without experiencing pain, including the correct movement range of the joints, the elasticity of the connective tissue, motor control, correct breathing techniques and balance.
If just one of these components is limited it can impair the functional ability to move and, therefore, increase the susceptibility to injuries and/or pain. The SFMA helps the expert to identify the key dysfunctional movement patterns, to influence them, and to recreate their functioning.
This approach supplements their existing practical repertoire and helps them to focus on the area which requires particular attention in order to select the best way of restoring the health of their customer in the most effective way possible.
Every test of the SFMA is based on the selective testing of the tissue according to Cyriax and is evaluated according to the following categories:
- functional/ not painful
- functional/ painful
- dysfunctional/ not painful
- dysfunctional/ painful.
Specific criteria exist for all top tier movements which have to be fulfilled so that the pattern can be described as being functional. Since pain can change the motor control and affect the results of the evaluation, the trainer or therapist providing the treatment makes dysfunctional, pain-free patterns their principal focus.
After completing the top tier movements, the dysfunctional patterns are highlighted by way of a local examination. The movement patterns which then occur are evaluated in the same way, whereby the same four categories are used as those in the top tier movements.
All of the results have to satisfy quality and quantity criteria in the same way as they are established on the basis of the existing clinical methods of examination and normative, evidence-based values.
Every test requires a specific scope of movement and a specific motor control which has to be achieved in order to achieve a functional score.
As soon as the seven top tier movement are assessed and have been given a score, the supervising trainer or therapist focuses on the behaviour patterns which have been assessed as dysfunctional and not painful in greater detail, in order to reach a movement diagnosis.
By giving these patterns priority they are then able to address the underlying dysfunction in the movement system which is not impaired by pain. Every pattern is analysed in this way.
These patterns can be broken down on the basis of – as far as possible – certain parts of the body being removed from the equation of movement, the stability being changed, and the movement being examined in both the active and passive forms.
In the SFMA, these movement processes are known as “breakout assessments”. In this respect, traditional orthopaedic tests are applied to determine the causes of the dysfunction. Through the application of the breakout principles, a movement oriented diagnosis is achieved for the corresponding pattern.
All of the patterns are evaluated and a complete list of problems is created. This list is then categorised further with all of the dysfunctions in the hierarchy of treatments which affect the mobility are placed before those of the motor control.
At the end of an SFMA evaluation, the specialist providing the treatment has a precise idea of which movement-related causes can be attributed to the patient’s complaints and they can understand their influence. With this knowledge they are in the position of being able to alleviate the pain and – more importantly – to restore functionality.
The SFMA optimises the conventional orthopaedic tests to enable a detailed movement diagnosis. As practising, first rate trainers, we have to understand how limits to mobility or motor control in a specific area can have a negative impact on the entire body and/or its function.
The developers of the SFMA are convinced that several valuable mobility techniques and tools are available to specialists at the practical level. If these tools are used by trained personnel at the right time they are very effective when it comes to the removal of limitations to mobility.
Following from this it is important to “re-programme” the patterns to a certain extent with the correct postures and to carry out suitable exercises for improving motor control in order to recreate and normalise the patient’s ability to move.
Of course, these are not the same concepts which are applied with conventional therapy measures. On the contrary, they focus far more on the perspective of neuro-development and the correct implementation of patterns of movement.
The SFMA introduces the “4x4 matrix” – a systematic, standardised clinical approach for the training of motor control. It consists of four postures with different types of resistance.
Firstly, the extent of the dysfunction of the motor control is assessed, which is followed by proceeding through the matrix on a systematic basis until the patient is in a position of being able to complete the movements in the standing position.
As soon as the basic patterns of the SFMA have been normalised, an appropriate evidence-based conclusive test consisting of the Y-balance test and the Functional Movement Screen is recommended.
– Eberhard Schlommer