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Movement Chapter 8: SFMA Assessment Breakout Descriptions and Flowcharts

This is a chapter 8 summary of the book “Movement” by Gray Cook.

What to Look For

The SFMA breakouts are utilized to determine if one’s movement deficiencies have a mobility or stability origin. There are further possibilities in each of these categories.

It Could Be a Mobility Problem

There are two subsets of mobility problems that include tissue extensibility dysfunction (TED) and joint mobility dysfunction (JMD). From here, we can break it down even further in each subset.

Here are some potential TEDs

And here are some potential JMDs

It could be a Stability Problem

These issues are also known as stability or motor control dysfunction (SMCD). Most conventional therapies would treat these complaints by strengthening the stabilizers, but this is problematic. When something works reflexively, how can we train something volitionally and expect changes? To train these muscles we must focus on proprioceptive and timing-based training.

There are several examples of SMCD problems.

Relatedness

Mobility and stability can influence one another. If I were to lose mobility at one segment, motor control can be distorted at nearby segments. Conversely, if I lack motor control, abnormal mobility may occur to compensate. However, the progression remains the same—restore mobility, then improve stability.

Honorable Mentions

Though the following testing protocols did not make the SFMA, they should still be tested per Gray:

SFMA Rules

Here are some basic rules to implement when utilizing the SFMA that I picked up from there course.

1)      No warm up.

2)      If it looks like a dog and smells like a dog – it’s a dog.

3)      Be picky. Not bad = not good.

4)      No shoes.

5)      Monkey see, monkey do…perform the movement.

The SFMA generally also follows these basic ideas of testing, which can help assist you through the breakouts

You will notice that the breakouts are a little different than what is presented in the book. These are the official breakouts from the current (6/2013) SFMA course.

Active Cervical Flexion

1. Start with supine cervical flexion (looking for chin to chest)

2. Passive supine cervical flexion (chin to chest)

3. Active supine OA flexion test (20 degrees)

Active Cervical Extension

1. Supine cervical extension

Cevical Rotation-Lateral Bend

1. Active supine cervical rotation test (80 degrees)

2. Passive supine cervical rotation test (80 degrees)

3. C1-C2 cervical rotation test

Upper Extremity Pattern 1 (MRE)

1. Active prone upper extremity pattern one (touch inferior angle)

If the supine reciprocal upper extremity pattern test is…

2. Passive prone upper extremity pattern one (touch inferior angle)

3. Active prone shoulder 90/90 IR test (60 degrees &/or total arc of 150 degrees)

4. Passive prone shoulder IR (60 degrees &/or total arc of 150 deg)

5. Active prone shoulder extension test (50 degrees)

6. Passive prone shoulder extension (50 degrees)

7. Active prone elbow flexion test (thumb to shoulder)

8. Passive prone elbow flexion test (thumb to shoulder)

9. Active lumbar locked extension (50 degrees).

10. Passive lumbar locked extension (50 degrees)

Upper Extremity Pattern 2 (LRF)

1. Active prone upper extremity pattern two (touch superior medial angle)

2. Passive prone upper extremity pattern two (touch superior medial angle)

If the supine reciprocal upper extremity pattern test is…

3. Active prone shoulder 90/90 ER test (90 degrees &/or total arc of 150 degrees)

4. Passive prone shoulder ER (90 degrees &/or total arc of 150 deg)

5. Active prone shoulder flexion/abduction test (170 degrees)

6. Passive prone shoulder flexion/abduction test (170 degrees)

7. Active prone elbow flexion test (thumb to shoulder)

8. Passive prone elbow flexion test (thumb to shoulder)

9. Active lumbar locked extension (50 degrees).

10. Passive lumbar locked extension (50 degrees)

Multi-Segmental Flexion (MSF)

1. Single leg forward bend (touch toes)

2. Long sitting (touch toes; 80 degree sacral angle).

3. Active SLR (70 degrees)

4. Prone rocking (full rock back position)

5. Passive SLR (80 degrees)

7. Supine Knee to chest (knees touch chest)

Multi-Segmental Extension (MSE)

SPINE BREAKOUT

1. Backward Bend (ASIS in front of toes, scapula pass heels, uniform curve).

2. Single leg backward bend  (ASIS in front of toes, scapula pass heels, uniform curve).

3. Press up

4. Lumbar locked (IR) active rotation/extension (50 degrees)

5. Lumbar locked (IR) passive rotation/extension (50 degrees)

6. Prone on elbow unilateral extension (30 degrees)

7.  Prone on elbow unilateral extension (30 degrees)

LOWER BODY BREAKOUT

1. FABER Test (2 fist distance)

2. Modified Thomas Test (flat to mat)

3. Prone active hip extension (10 degrees or >)

4. Prone passive hip extension (10 degrees or >)

UPPER BODY BREAKOUT

1. Unilateral shoulder backward bend

2. Supine lat stretch hips flexed (arms to table)

3. Supine lat stretch hips extended (arms to table)

4. Lumbar locked (ER) Unilateral extension (50 degrees)

5. Lumbar locked (IR) active rotation/extension (50 degrees)

6. Lumbar locked (IR) passive rotation/extension

Multi-Segmental Rotation (MSR)

SPINE BREAKOUT

1. Seated rotation (50 degrees)

2. Lumbar locked (ER) unilateral extension (50 degrees)

3. Lumbar locked (IR) active rotation (50 degrees)

4. Lumbar locked (IR) passive rotation (50 degrees)

5. Prone on elbows unilateral rotation (30 degrees)

6. Passive prone on elbows unilateral rotation (30 degrees)

HIP ROTATION BREAKOUT

1. Seated active hip ER/IR (>40 degrees/>30 degrees)

2. Seated passive hip ER/IR (>40 degrees/>30 degrees)

3. Prone active hip ER/IR  (>40 degrees/>30 degrees)

4. Prone passive hip ER/IR (>40 degrees/>30 degrees)

TIBIAL ROTATION BREAKOUT

1. Seated active Tibial ER/IR

2. Seated Passive Tibial ER/IR

Single Leg Stance

VESTIBULAR AND CORE BREAKOUT

1. CTSIB (Static)

2. CTSIB (Dynamic)

3. Half-Kneeling narrow base

4. Rolling breakouts

5. Quadruped Diagonals

ANKLE BREAKOUTS

1. Heel walks

2. Prone passive dorsiflexion (20-30 degrees)

3. Toe walks

4. Prone passive plantarflexion (30-40 degrees)

5. Seated active ankle inversion/eversion

6. Seated passive ankle inversion/eversion

Overhead Deep Squat

1. Interlocked fingers behind neck deep squat

2. Assisted squat

3. Half-kneeling dorsiflexion (20-30 degrees)

4. Supine knees to chest holding shins

5. Supine knees to chest holding thighs

Segmental Rolling

1. Prone to supine upper body rolling

2. Prone to supine lower body rolling

3. Supine to prone rolling with upper body

4. Supine to prone rolling with lower body

Conclusions

Phew, that 2000+ words later and we have a lot of stuff. Digest this information, and give these breakouts a try.