What the SFMA Actually Tells Us (and What It Doesn't)

Every week, students rotating through our clinic ask the same question in some form: when do you use the SFMA, and what does it actually tell you? It's a fair question, because the Selective Functional Movement Assessment occupies a specific niche that's easy to misunderstand. It isn't a diagnostic test. It isn't a treatment. It's a structured way of asking the body which patterns are dysfunctional and painful, dysfunctional and non-painful, functional and painful, or functional and non-painful — and then deciding where to look harder¹.

This post is partly for our incoming Northwestern Health Sciences and CMCC students this month, and partly for patients who've watched us run them through the SFMA's seven top-tier movements and wondered what we were actually doing.

What the SFMA is built around

The SFMA starts with seven full-body movement patterns: cervical flexion, cervical extension, cervical rotation/lateral bending, upper extremity reach, multi-segmental flexion, multi-segmental extension, multi-segmental rotation, single-leg stance, and overhead deep squat. Each is graded as functional or dysfunctional, painful or non-painful — the four-quadrant breakdown².

The clinical insight isn't in any single test. It's in the pattern across all of them. A patient who has multi-segmental flexion as dysfunctional and painful, but cervical flexion functional and non-painful, will have a fundamentally different breakout sequence than someone whose pain only emerges in rotation.

Where it earns its keep

The strongest case for the SFMA is in patients with regional musculoskeletal pain whose presentation isn't tracking neatly to a single tissue. A shoulder that's been treated for six months, a low back that's flared seasonally for years, a runner with bilateral knee pain — these are the cases where the top-tier scan often surfaces a non-painful dysfunction in a region the patient hadn't connected to their complaint.

That maps cleanly onto what we wrote about in our piece on thoracic mobility: the painful site is rarely the whole story, and a structured assessment helps avoid the trap of repeatedly treating the loudest region while a quieter one drives the pattern.

Where it has limits

The SFMA is not a substitute for orthopedic special testing or imaging when those are clinically indicated. It doesn't tell you whether a meniscus is torn, a labrum is symptomatic, or a disc is irritating a nerve root. Its inter-rater reliability is reasonable for the seven top-tier patterns when raters are trained and credentialed, but breakouts get more variable³.

It also has limits as a predictor. The Functional Movement Screen — its asymptomatic cousin — has a mixed record as an injury-prediction tool, with some studies showing modest predictive value and others none⁴. The SFMA wasn't designed for prediction in the first place; it was designed to organize an assessment of someone already in pain. Using it for the wrong job leads to misplaced confidence.

How we actually use it

For most patients with regional musculoskeletal pain, we'll run the SFMA top-tier early in the first or second visit. The findings inform two things: which regions need closer breakouts, and which interventions to start with. A patient whose dysfunction is mobility-driven will start with mobility work. A patient whose dysfunction is motor-control-driven (mobility intact, but the pattern still falls apart) will start with control-based rehab.

This is the same principle we apply to load management — the intervention has to match the actual problem, not the patient's guess at what's wrong, and not a one-size assessment. There are no bad exercises, only too much too soon, and the SFMA is part of how we figure out what dose of what exercise is appropriate for a specific patient.

For the students rotating through this month

If you take one thing from your time observing here, let it be that the assessment is the intervention. The hands-on work, the rehab plan, the home program — all of it follows from how carefully you've asked the body what's going on. The SFMA is one structured way of doing that. The Functional Movement Screen is another. Orthopedic testing is another. None replaces the others.

The clinicians who get the best outcomes aren't the ones with the longest list of techniques. They're the ones who've built reliable assessment habits and don't skip them.

References

1. Cook G. Movement: Functional Movement Systems — Screening, Assessment, Corrective Strategies. Aptos, CA: On Target Publications; 2010.
2. Glaviano NR, Kew M, Hart JM, Saliba S. Use of the Selective Functional Movement Assessment with a patient with sacroiliac joint pain: a case report. Int J Sports Phys Ther. 2014;9(7):1052–1058.
3. Stanek JM, Smith J, Petrie J. Intra- and inter-rater reliability of the Selective Functional Movement Assessment (SFMA) in healthy participants. Int J Sports Phys Ther. 2019;14(1):107–116.
4. Bonazza NA, Smuin D, Onks CA, Silvis ML, Dhawan A. Reliability, validity, and injury predictive value of the Functional Movement Screen: a systematic review and meta-analysis. Am J Sports Med. 2017;45(3):725–732.

Author: Dr. Michael Minenna D.C., B.Sc., SFMA, FMS — Boreal Spine & Sport, Winnipeg, Manitoba.