12 Tips for Successfully Implementing the SFMA

Written by Aron McConnell, DPT SFMA

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Information Overload

“Is anyone functional?”

“I have so much wrong with me.”

“Where do you start if everything is dysfunctional?”

“What about someone who has [insert specific diagnosis that permanently prevents mobility and/or motor control]?”

The examples above are just a few common first-time participants’ reactions I witness as a Selective Functional Movement Assessment (SFMA) instructor. My natural reaction to participants’ experiences is to smile with empathy because I get it. I felt the same way when I first took the SFMA course. I was Dysfunctional Non-painful (DN) and Dysfunctional Painful (DP) on almost everything; my ego was crushed. I was not as awesome as I’d previously thought at movement. I thought, “How can this be?! I am a physical therapist and a trainer! How can I have so much wrong with myself and be missing so much when working with clients?” During my initial disbelief, however, a part of me was excited. I reasoned, “At least now, I’ve acquired a more comprehensive list of problems and some principles about how to move forward for myself as well as my clients.”

What NOT To Do

Then, Monday came, and I did exactly what the SFMA instructors said not to do. I had an evaluation scheduled for a new client, a 14-year-old female with an ankle sprain, with an empty slot afterward. I had all the time in the world. With my course manual at the ready, I went through the Top Tier, checking each criterion with each corresponding flowchart in order to determine the movement diagnoses. Two hours later, I was done with the evaluation and knew all of my client’s movement problems, but my satisfaction was short-lived. I looked at all of the problems, had no clue where to start. I felt overwhelmed with the findings. So I resorted back to what I would have normally done - I did some soft tissue work and ankle mobilization, then sent her home with ankle exercises. 

It took me some time thinking and reviewing the material to be willing to attempt another SFMA evaluation with a client. This time, I had a much better plan. I returned to the logic of the SFMA but reorganized the approach to determine where its different parts could fit into my usual evaluation. Here is where I wish I could say that I was able to make it work and suddenly incorporate the SFMA into every client evaluation, but that would be a complete lie. It took me numerous attempts and failures to reach a place where I felt I had a good understanding of the material and how to apply it to my practice. 

Strategies for Success

Now that you have read my mistake-ridden story, I want to provide you with a few strategies for incorporating the SFMA into your practice. Some of these you hear in your first SFMA course and then likely hear again in future audits; nevertheless, I think it is worth reinforcing.

1. Start by running the Top Tier on everyone without changing anything else in your evaluation. Even just using the Top Tier will start providing you with more data about how your clients move. You may also uncover painful patterns that were previously unidentified.
    
2. Go through single breakouts on anyone who is willing to give you the opportunity: Clients, colleagues, family, friends....pets.
    
3. Understand the logic process rather than the exact order of the flow chart. If the flow chart works well for how you think, I envy you. For many other individuals (myself included), you will need to reorganize the approach and follow the logic principles. In Physical Therapy (PT) school, we were always taught to organize your evaluation to minimize position changes. You can apply this idea to the SFMA.
    
4. Many of the breakout components of the SFMA are already part of your normal examination. If you compare your normal examination to the components of the breakouts, that may help you to see how the SFMA can fit more readily into your examination.
    
5. Functional Non-painful (FN) of the Top Tier is not the goal. It's great when your clients present with FN patterns in the Top Tier or get there through treatment, but it is not the goal. Eliminating pain is the goal.
    
6. Don’t try to do it all at once on the first day. Perform the breakouts on the Dysfunctional Non-painful (DN) patterns that relate most to the client’s primary complaint and finish the other breakouts during the follow-up appointments.
    
7. Remember that there are redundancies built into the SFMA (e.g. Lumbar Lock, hip flexion, ankle eversion/inversion), which will shorten the examination process.
    
8. Consider seeking out an evaluation with or shadowing a local instructor or clinician who regularly uses the SFMA. This will give you a chance to see it in a live setting and how that individual organizes and uses the process. Along this line, reach out to one or multiple of your instructors with questions to gain a better understanding of how you can apply the SFMA in your setting. We are all instructors, because we believe in the model and will happily help a fellow clinician.
    
9. There is a page near the end of your manual (page number depends on the version) entitled “SFMA Clinical Pearls.” Reading through this will provide you with some of the most important central concepts of the SFMA.
    
10. If there is a permanent change like a fusion, joint replacement, or nerve damage, focus on the model of regional interdependence. Look at all of the connecting parts that can be modified to provide support for what you cannot change.
     
11. There are a number of clients who might not be immediate candidates to take through the SFMA (e.g., post-operative, acute pain, Parkinson’s Disease, etc.). However, you can still apply the principles, go through appropriate breakouts, and/or wait until the client has improved to the point of being able to utilize the SFMA.
     
12. Take advantage of the option to audit* the SFMA for free. I know a number of clinicians, including myself, who continue to gain insight and understanding, even though we have seen the material repeatedly. (Even easier with the addition of Live Virtual courses)
    *Active Members may audit any course they have previously taken for FREE.

Author

Aron is an orthopedic physical therapist working with a wide range of clients focusing on improving movement quality to reduce pain and advance physical capacity. He graduated from the University of Miami in 2008 with his doctorate in physical therapy and maintains certifications with the NSCA as well as Maitland Australian Physiotherapy Seminars and Precision Nutrition. The Functional Movement Systems approach, along with training through a variety of approaches, allows him to facilitate his clients’ progress more effectively and rapidly. His personal ideology of treatment is that each client should have a custom-designed program based on an individualized assessment and the client’s personal goals. He views this as a collaborative process with his clients and applies manual techniques, therapeutic exercise, neuromuscular re-education, and nutrition to generate positive change for each person.

 

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