Procedural interventions The subject was seen for 13 visits over nine weeks. The therapists believed that if the subject could not display effective motor control in foundational lower level developmental positions, he likely would compensate in more complex higher level developmental patterns leading to continued stress on his back. Based on the subject’s inability to maintain and control pelvic tilt and lumbopelvic positioning during exercise activities for example an inability to maintain a neutral spine while performing quadruped stability exercises the therapists believed based on clinical experience there were also underlying core stability deficits contributing to excessive stress at the lumbopelvic junction. Therapists initially prioritized pain relief in the lumbar region for the initial one to three weeks, theorizing that pain would disrupt normal movement patterns and cause continued dysfunction. Did not test dermatomes or deep tendon reflexes Musculoskeletal Impaired Hip Strength: Deadlift with neutral spine right figure. Efficacy of spinal manipulation and mobilization for low back pain and neck pain:

STM erector spinae, posterior rotator cuff 10 minutes. If a Top Tier test does not pass the FN grade, then that specific movement must go to a breakout pattern to find the true cause of dysfunction. Br J Gen Pract. Conservative treatment of acute and chronic nonspecific low back pain: Stand erect with feet together, shoes off, toes pointing forward. The ICD — 9 code was Lumbago Therefore a stability progression, with a goal of return to power lifting activities, began with cat-camel pelvic tilting to increase proprioceptive sense of a neutral spine.

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Therapists hypothesized that dysfunctional movements identified in basic SFMA patterns indicated a poor fundamental foundation for proper movement, causing excessive compensation at the lumbar spine. Based on history, it was suspected that the subject may have had muscle imbalances in the lumbopelvic region leading to LBP with activity.

Open in a separate window. Conservative treatment of acute and chronic nonspecific low back pain: As a result, each PT may have different approaches for interventions. Bend forward to stuyd toes and come back to standing. He was otherwise independent in all activities of daily living despite some discomfort.

Excessive anterior pelvic tilt remained during gait analysis but gait was otherwise unremarkable. Inspiratory muscle training affects proprioceptive use and low back pain. The SFMA tool is helpful to be used during the initial physical evaluation of a patient, but the clinician should be aware of the acuteness or irritability of the presenting signs and symptoms. This will in turn, help guide a treatment plan to restore pain-free movement and function. If a Top Tier test does not pass the FN grade, then that specific movement must go to a breakout pattern to find the true cause of dysfunction.


His stability and mobility limitations were consistent with the joint-by-joint theory which argues that joints alternate in their primary role from stability to mobility and when a joint isn’t able to carry out it’s typical mobility or stability role, the next joint in the chain eventually will.

Touches spine of contralateral scapula Evaluating: Therapists communicated to the subject that the plan of care POC was to alleviate symptoms first before progressing to mobility, then stability exercises.

Clinical Impression 1 The subject’s general complaints of LBP for two years and recent left hip pain could be the result of many possible diagnoses; however, he did not present with any red flag signs and therefore had not undergone any diagnostic imaging at the time of evaluation. The SFMA helps to expose possible asymmetries and pathological movements patterns, as the root cause of a painful problem.

Selective Functional Movement Assessment (SFMA)

Therefore it is not known if other treatments for this patient would have resulted in similar outcomes. J Man Manip Ther.

sfma case study

ABSTRACT Background Despite the multidirectional quality of human movement, common measurement procedures used in physical therapy examination are often uni-planar and lack the ability to assess functional complexities involved in daily activities. Mobility limitations can be categorized as tissue extensibility or joint mobility dysfunction. The SFMA is a clinical model used to assist diagnosis and treatment of musculoskeletal disorders by identifying dysfunctions in movement patterns.

Visits ranged from 45 minutes to one hour in duration and began with one to two visits per week initially, then one visit per week during the last three weeks. Once he demonstrated good control of his pelvis with loading to the spine, he was progressed to double leg squatting and deadlifting with kettlebells, followed by asymmetrical lunging and single leg exercises in order to continue to strengthen his hips and promote core stability in more challenging positions.


Selective Functional Movement Assessment (SFMA) – Physiopedia

He reported that the pain had been present for the prior two years, and had become worse in the last three months, including new onset of symptoms in the posterolateral left hip. Examination findings confirmed the hypothesis that the subject had functional movement pattern dysfunctions contributing to his LBP.

In sfmw case, the SFMA helped therapists to recognize dysfunctional movements that were present in subsequent regions that were not fase with more conventional examination procedures. It was determined that the patient had mobility limitations remote to the site of pain thoracic spine and hips which therapists hypothesized were leading to compensatory hypermobility at the lumbar spine.

sfma case study

Based on findings from the examination, therapists determined the subject’s primary PT diagnosis was impaired muscle performance pattern 4C due to chronic musculoskeletal dysfunction as well as a secondary diagnosis of impaired posture pattern 4B. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: At the time of evaluation he had decreased his lifting frequency from five days a week to two and had significantly adjusted his exercise routine due to his pain; however, he was still playing soccer two to three times a week.

The purpose of this case report is to illustrate the application of the SFMA as a guide to the examination, evaluation, and management of a patient with non-specific low back pain LBP. Currently, there is no sutdy accepted, validated standard to assess movement quality. Reach cass and up spine with arm to try and touch opposite shoulder blade.

Once the subject could consistently perform these activities with a stabile pelvis, and without excessive lumbar extension, he was progressed to powerlifting with a barbell and finally to sport-specific training for soccer.