THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT

- 33 - THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT SFMA SCORING FP DP Active Cervical Flexion Active Cervical Extension Cervical Rotation Upper Extremity Pattern 1(MRE) Upper Extremity Pattern 2 (LRF) L R L R L R Multi-Segmental Flexion Multi-Segmental Extension Multi-Segmental Rotation Single-Leg Stance L R L R Overhead Deep Squat

- 34 - THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT Name: Date: Total Score: Cervical Flexion Painful Can t touch Sternum to Chin Excessive effort and/or lack of motor control Cervical Extension Painful Not within 10 degrees of parallel Excessive effort and/or lack of motor control Cervical Rotation Painful Right Painful Left Right Left Nose not in line with mid-clavicle Right Left Excessive effort and/or appreciable asymmetry or lack of motor control Pattern #1 MRE Painful Right Painful Left Right Left Does not reach inferior angle of scapula Right Left Excessive effort and/or appreciable asymmetry or lack of motor control Pattern #2 LRF Painful Right Painful Left Right Left Does not reach spine of scapula Right Left Excessive effort and/or appreciable asymmetry or lack of motor control Multi-Segmental Flexion Painful Cannot touch toes Sacral angle <70 degrees Non-uniform spinal curve Lack of posterior weight shift Excessive effort and/or appreciable asymmetry or lack of motor control Multi-Segmental Extension Painful UE does not achieve or maintain 170 ASIS does not clear toes Spine of scapula does not clear heels Non-Uniform spinal curve Excessive effort and/or lack motor control Multi-Segmental Rotation Painful Right Painful Left Right Left Pelvis Rotation <50 degrees Right Left Shoulders rotation <50 degrees Right Left Spine/pelvic deviation Right Left Excessive Knee flexion Right Left Excessive effort and/or lack of symmetry or motor control Single Leg Stance Painful Right Painful Left Right Left Eyes open <10 seconds Right Left Eyes closed < 10 seconds Right Left Loss of Height Right Left Excessive effort or lack of symmetry or motor control Overhead Deep Squat Painful Loss of UE start position Tibia and Torso are not parallel or better Thighs do not break parallel Loss of sagittal plane alignment: Right Left Excessive effort, weight shift, or motor control

- 53 - CERVICAL SPINE PATTERN BREAKOUTS Limited Cervical Spine Patterns Active Supine Cervical Flexion Test (Chin to Chest) Passive Supine Cervical Flexion Test There is a Postural affecting Cervical Flexion. This includes Cervical Spine, Thoracic Spine and Shoulder Girdle postural dysfunction. Active Cervical Spine Flexion Active Supine OA Cervical Flexion Test (2 ) Bilat. If Passive Supine Cervical Flexion (PSCF) was DP or then treat as Cervical Spine Flexion JMD &/or TED. If PSCF was FP can also be - perform segmental testing and soft tissue appraisal. OA Flexion JMD &/or TED &/or possible Cervical Spine Flexion JMD &/or TED Active Supine Cervical Rotation Test ( ) There is a Postural affecting Cervical Rotation. This includes Cervical Spine, Thoracic Spine and Shoulder Girdle postural dysfunction. Passive Supine Cervical Rotation Test Supine Cervical Extension Active Cervical Spine Rotation C1-C2 Cervical Rotation Test Cervical Extension JMD &/or TED There is Postural &/ or affecting Cervical Extension. If Passive Supine Cervical Rotation (PSCR) was DP or then treat as Lower Cervical Rotational JMD &/or TED. If PSCR was FP can also be - perform segmental testing and soft tissue appraisal. C1-C2 JMD &/or TED &/or possible Lower Cervical Spine JMD &/or TED.

- 64 - UPPER EXTREMITY PATTERN BREAKOUTS Limited Upper Extremity Pattern One Active Prone Upper Extremity Pattern One (IR) Act. Prone Elbow Flex. Test (Ext.) Passive Prone Upper Extremity Pattern One (IR) Passive Prone Elbow Flexion Test (Ext.) Active Prone Shoulder 90/90 IR Test (60 &/or Total Arc of 150 ) Elbow Flex Pain Elbow Flex JMD or TED Passive Prone Shoulder IR Test Shoulder IR Shoulder IR JMD or TED Active Prone Shoulder Ext. Test (50 ) Passive Prone Shoulder Ext. Test Chemical Pain Lumbar Locked (CH) Act Ext./Rot. If no previous Orange Boxes consider this a Postural &/ or Shoulder Girdle. Otherwise treat orange boxes first. Thorax &/or Shoulder Girdle Lumbar Locked (CH) Passive Ext./Rot. Pain Thorax Ext./Rot. JMD or TED Shoulder Ext Shlder Ext. JMD or TED Chem Pain

- 65 - UPPER EXTREMITY PATTERN BREAKOUTS Limited Upper Extremity Pattern Two Active Prone Upper Extremity Pattern Two (ER) Act. Prone Elbow Flex. Test (Flex) Passive Prone Upper Extremity Pattern Two (ER) Passive Prone Elbow Flexion Test (Flex) Prone Shoulder 90/90 ER Test (90 &/or Total Arc of 150 ) Elbow Flex Pain Elbow Flex JMD or TED Passive Prone Shoulder ER Test Shoulder ER Shoulder ER JMD or TED Active Prone Shldr Flx/Abd Test (170 ) Passive Prone Shoulder Fl/Ab Test Chemical Pain Lumbar Locked (CH) Act Ext./Rot. If no previous Orange Boxes consider this a Postural &/ or Shoulder Girdle. Otherwise treat orange boxes first. Lumbar Locked (CH) Passive Ext./Rot. Pain Thorax &/or Shoulder Girdle Thorax Ext./Rot. JMD or TED Shoulder Fl/ Ab Shlder Fl/Ab JMD or TED Chem Pain

- 87 - MULTI-SEGMENTAL FLEXION BREAKOUTS Limited Multi-Segmental Flexion Single Leg Forward Bend Bilateral Unilateral Long Sitting (80 0 Sacral Angle) Weight-Bearing Hip Flexion pattern Active SLR (<70 0 ) Passive SLR >80 0 Core &/or Active Hip Flexion Prone Rocking Supine Knee to Chest (T) If no previous mobility findings consider this a Weight-bearing Spine &/or Hip - otherwise treat orange boxes first. Spinal Flexion JMD &/or TED Hip Flexion TED or if PSLR was FP could be Active Hip Flexion Chemical Pain in Hip Hip JMD &/ or Posterior Chain TED

- 101 - MULTI-SEGMENTAL EXTENSION BREAKOUTS Spine Extension Flowchart Backward Bend w/o UE Single Leg BB Go to UB Ext. Flowchart Weight-bearing Spine Extension. Go to Lower & Upper Body Ext. Flowcharts Press Up (>1 Airex Pad) Symmetrical Stance Core or Anterior Torso TED. - Go to UB Ext. Flowchart Lumbar Locked (IR) - Active Extension/Rotation (50 ) Lumbar Locked (IR) - Passive Extension/Rotation (50 ) Pain - Go to Lower Body Ext. FC Thorax Ext./Rot. Thorax Ext./Rot. JMD &/or TED - Go to Lower Body Ext. Flowchart Active Prone on Elbow Unilateral Extension/Rotation (30 ) Passive Prone on Elb Uni. Ext./Rot. (30 ) If Thorax has assume L-Spine is normal. Lumbar Spine Ext. or Ant. Torso TED- Go to LB then UB Ext. FC Pain - Go to LB then UB Ext FC Lumbar Ext./ Rot. JMD &/or TED - Go to LB then UB Ext FC

- 102 - MULTI-SEGMENTAL EXTENSION BREAKOUTS Lower Body Extension Flowchart FABER Test Stabilized FABER Test Hip/Core Hip/SI JMD &/or TED - Perform Local Biomechanical Testing of the Hip and SI. Modified Thomas with Knee Straight with Hip Abducted with Hip Abducted & Knee Straight DP/FP Lower Anterior Chain TED Lower Lateral Chain TED Lower Anterior and Lateral Chain TED Hip Ext. JMD &/or TED and/or Core. If FABER was then stop and treat FABER Prone Active Hip Extension (> or = 10 degrees Extension) Prone Passive Hip Extension If Spine Ext. was dysfunctional consider Hip normal. If not - there is a Weightbearing Hip Extension &/or Limited Ankle Dorsiflexion (Refer to ODS & SLS). Hip Extension JMD &/or TED Core &/ or Active Hip Extension

- 103 - MULTI-SEGMENTAL EXTENSION BREAKOUTS Upper Body Extension Flowchart Unilateral Shoulder Backward Bend Supine Lat Stretch Hips Flexed Potential Anterior Torso TED or Cervical Spine involvement - Double Check Cervical Patterns If no previous Hip or Spine extension mobility dysfunctions consider this a Weight-bearing Upper Quarter Extension - otherwise treat hips and spine first. Supine Lat Stretch Hips Extended Shoulder Flexion improves but not Full Posterior/Lateral Chain TED &/or Possible Hip Extension dysfunction - Go to Lower Body Extension Flowchart Posterior/Lateral Chain TED &/or Possible Hip Extension dysfunction - Make sure you also run Lower Body Extension Flowchart Lumbar Locked (ER) - Active Unilateral Ext./Rot. (50 ) Shoulder Girdle Lumbar Locked (IR) - Active Extension/Rotation (50 ) Lumbar Locked (IR) - Passive Extension/Rotation Shoulder Girdle Flex. JMD or TED Thorax Ext./ Rot. JMD &/or TED - possible Shoulder JMD/TED as well Thorax Ext./Rot.

- 132 - MULTI-SEGMENTAL ROTATION BREAKOUTS Limited Multi-Segmental Rotation Seated Rotation (50 ) Lumbar Locked (ER) - Active Unilateral Ext./Rot. (50 ) Go to Hip Rotation Flowcharts & Switches Sides Lumbar Locked (IR) - Active Unilateral Ext./Rot. (50 ) Shoulder Girdle Rot. JMD &/or TED Lumbar Locked (IR) - Passive Ext./Rot. (50 ) Thorax Ext./Rot. JMD &/or TED - Go to Hip Rotation Flowcharts Pain - Go to Hip Rotation Flowcharts Thorax Rotation Active Prone on Elbow Unilateral Ext./Rot. (30 ) Passive Prone on Elb Uni. Ext/Rot. (30 ) If Thorax Ext./Rot. exists lumbar spine is normal. If not consider this a Weight-bearing Spine or Shoulder Girdle Rot. - Go to Hip Rot FC Pain - Go to Hip Rotation Flowchart Lumbar Spine Ext./Rot. JMD &/ or TED - Go to Hip Rotation FC

- 133 - MULTI-SEGMENTAL ROTATION BREAKOUTS Hip Rotation Flowchart (Part 1) Seated Active External Hip Rotation (>40 0) ) Seated Passive External Hip Rotation Hip JMD &/or TED for Ext. Rotation with Hip Flexed Pain - Go to Hip Rot. Part 2 Flowchart Prone Active External Hip Rotation (>40 0) ) Prone Passive External Hip Rotation Hip JMD &/ or TED for Ext. Rot. with Hip Extended - Go to Hip Rotation 2 Flowchart and Lower-body Extension Breakout Pain - Go to Hip Rotation 2 Flowchart If Seated Passive Rotation was stop and treat the. If not consider this a Weight-bearing or Active External Hip Rotation - Go to Hip Rotation 2 Rotation Flowchart. If Seated Passive Rotation was stop and treat the. If no previous signs of hip rotation dysfunction consider the hips normal and go to Tibial Rotation Flowchart. If not consider this a Weightbearing or Active External Hip Rotation - Go to Hip Rotation 2 Flowchart.

- 134 - MULTI-SEGMENTAL ROTATION BREAKOUTS Hip Rotation Flowchart (Part 2) Seated Active Internal Hip Rotation (>30 0) ) Seated Passive Internal Hip Rotation Hip JMD &/or TED for Medial Rotation with Hip Flexed Pain - Go to Tibia Rot. Flowchart Prone Active Internal Hip Rotation (>30 0) ) Prone Passive Internal Hip Rotation Hip JMD &/or TED for Medial Rot. with Hip Extended - Go to Tibial Rotation Flowchart and Lower-body Extension Breakout Pain - Go to Tibia Rot. Flowchart If Seated Passive Rotation was stop and treat the. If not consider this a Weightbearing or Active Internal Hip Rotation - Go to Tibial Rotation Flowchart. If Seated Passive Rotation was stop and treat the. If no previous signs of hip rotation dysfunction consider the hips normal and go to Tibial Rotation Flowchart. If not, consider this a Weightbearing or Active Internal Hip Rotation - Go to Tibial Rotation Flowchart.

- 135 - MULTI-SEGMENTAL ROTATION BREAKOUTS Tibial Rotation Flowchart Seated Act Internal Tibial Rot. Passive Internal Tibial Rotation Tibial Internal Rotation Tibial Internal Rotation TED &/or JMD Seated Act External Tibial Rot. Tibia External Rotation Mobility is Normal (If no previous Rotation findings - Go to Lower-body Extension Flowchart) Passive External Tibial Rotation Tibial Extenal Rotation Tibial External Rotation TED &/ or JMD

- 157 - SINGLE-LEG STANCE BREAKOUTS FLOWCHART Vestibular & Core Flowchart Vestibular Test - CTSIB (Static Head) Potential Static Vestibular Dysfunction CTSIB (Dynamic Head Movement) Dysfunctional Half-Kneeling Narrow Base Dynamic Vestibular Dysfunction, DP, or FP Go to SLS Ankle Flowchart Quadruped Diagonals Weight-bearing Spine &/or Core - (If Hip Extension is treat it first). Go to SLS Ankle Flowchart. Pain - Go to SLS Ankle Flowchart. Weight-bearing Hip &/or Core (If Hip Extension &/or Shoulder Flexion are treat those first) Go to SLS Ankle Flowchart.

- 158 - SINGLE-LEG STANCE BREAKOUTS FLOWCHART Ankle Flowchart Heel Walks Prone Passive Dorsiflexion Pain Dorsiflexion Dorsiflexion TED &/or JMD Toe Walks Prone Passive Plantarflexion Plantarflexion Plantarflexion TED &/or JMD Pain Seated Active Ankle Inversion/Eversion Passive Ankle Inversion/Eversion Ankle (Eversion or Inversion) JMD, TED - * Perform local foot/ ankle exam Ankle (Eversion or Inversion) - * Perform local foot/ankle exam If no Red, Orange or Positive Blue Boxes so far = Proprioceptive Deficit

- 173 - OVERHEAD DEEP SQUATTING PATTERN BREAKOUTS Limited Overhead Deep Squat Deep Squat If Squat is now - Go to Multi- Segmental Extension Breakout. Half-kneeling Dorsiflexion Pain Dorsiflexion TED &/Or Ankle JMD Supine Knees to Chest Holding Shins w/ Dorsiflexion w/ Dorsiflexion w/ Dorsiflexion Dorsiflexion Chemical Pain Dorsiflexion - Consider Knee & Hip Flexion Normal Supine Knees to Chest Holding Thighs Assisted Squat Knee Flexion JMD &/or TED Chemical Pain Hip Flexion JMD &/or TED, but still can have Knee Flexion JMD Weightbearing Ankle, Knee and/ or Hip/Core Flexion Weight-bearing Ankle, Knee and/or Hip/Core Flexion. Go to MSE Breakout Chemical Pain in Hip, Knee or Ankle