SFMA cheat sheet

SFMA is a movement-based diagnostic system: it classifies whole-body movement patterns, then uses breakouts to localize the impairment driving the pattern, rather than testing muscles or joints in isolation.

Core rationale: pain and dysfunction are treated as separate findings, so the first decision at every pattern is whether the movement is painful, not whether it is limited.

Scoring logic follows a top-tier to breakout hierarchy: the ten top-tier patterns are screened first, and only dysfunctional patterns receive breakout testing.

The model assumes regional interdependence: a limitation at one segment can produce an apparent limitation elsewhere, so findings must be confirmed by isolating segments.

Clinical reasoning sequence: screen (top tier) → classify (FN/DN/FP/DP) → breakout (localize) → treat the driver → retest the top tier to confirm.

SFMA is a classification and prioritization tool, not a treatment protocol; the output is a ranked problem list that guides exercise selection.

The system is criterion-referenced, not norm-referenced: each pattern has defined criteria for a functional score, and the patient is compared to the criterion, not to population data.

Reliability depends on standardized setup, verbal cues, and scoring definitions; deviations in cueing or position are the main source of scoring error.

FN (Functional Non-painful): movement meets criteria with no pain - no further breakout testing is indicated for that pattern.

FP (Functional Painful): movement meets criteria but provokes pain - the painful finding is flagged and the pattern is not broken out for range limitation.

DN (Dysfunctional Non-painful): movement fails criteria without pain - this is the primary indication for breakout testing.

DP (Dysfunctional Painful): movement fails criteria and provokes pain - breakouts are deferred or modified until the pain is addressed.

The ten top-tier patterns cover cervical flexion, cervical extension, cervical rotation, upper extremity pattern 1 (MRE), upper extremity pattern 2 (LRF), multi-segmental flexion, multi-segmental extension, multi-segmental rotation, single-leg stance, and overhead deep squat.

Scoring is binary per criterion: each criterion is met or not met, and any unmet criterion converts a functional score to dysfunctional.

Pain is scored separately from movement quality, which is why FP and DP exist as distinct categories from FN and DN.

Retest order after intervention is the same as initial screening order, so that score changes are attributable to the intervention rather than to sequencing effects.

Breakouts are only performed for dysfunctional (DN or DP) top-tier patterns; functional patterns do not receive breakouts.

Breakout logic is tiered: first determine whether the limitation is in the primary segment or is coming from a proximal or distal contributor, then isolate joints within that region.

Multi-segmental flexion breakout examines spine flexion segment by segment, then hip flexion with the spine held neutral, to separate spinal from hip limitation.

Multi-segmental extension breakout examines spinal extension, then hip extension with the spine controlled, to distinguish thoracolumbar from hip capsular limitation.

Multi-segmental rotation breakout assesses thoracic rotation with the lumbar spine stabilized, then hip rotation, to separate thoracic from hip drivers.

Single-leg stance and overhead deep squat breakouts test ankle dorsiflexion, hip flexion/extension, and thoracic extension components in a controlled position.

A breakout finding is only meaningful if it reproduces the limitation seen in the top tier; incidental tightness that does not change the pattern is not the driver.

Breakout results are recorded as the specific segment or joint that limits the pattern, and that becomes the target of the 4x4 matrix selection.

Primal patterns are the fundamental movements - squat, bend, lunge, push, pull, twist, gait - and SFMA top-tier patterns map onto these primal movements.

Joint-by-joint logic assigns a preferred behavior to each region: the ankle favors mobility, the knee stability, the hip mobility, the lumbar spine stability, the thoracic spine mobility, the glenohumeral joint mobility, and the scapulothoracic region stability.

A limitation is classified as a mobility problem or a stability/motor-control problem before exercise is selected; the classification determines whether the intervention is mobilization or retraining.

When a joint that should be mobile is restricted, the adjacent joint that should be stable often becomes the site of compensation and symptoms.

Assessment proceeds proximal-to-distal and distal-to-proximal in sequence, so that a proximal driver is ruled out before a distal site is treated.

Primal pattern screening is used to prioritize which region gets assessed first, not to replace the segmental breakout examination.

Joint-by-joint reasoning is a heuristic for hypothesis generation; it must be confirmed by the breakout finding before it drives treatment.

Dysfunction (DN/DP) indicates a movement capacity or motor-control limitation; pain (FP/DP) indicates a nociceptive or injury-related finding that changes the treatment priority.

Painful patterns take precedence in sequencing: pain is addressed before range-of-motion or motor-control work is progressed.

A painful finding that is constant, night-aggravating, unresponsive to position change, or accompanied by neurological signs is a referral indicator rather than an exercise indication.

Red flags requiring referral include progressive neurological deficit, bowel or bladder change, unexplained weight loss, night pain unrelieved by rest, and signs of fracture or infection.

A painful pattern that resolves with a positional change or with a corrective movement is more consistent with a mechanical, non-referral presentation.

Documentation must state whether pain was provoked, reproduced, or abolished, and at which pattern or breakout it occurred.

When DP is present, breakouts are modified or deferred; treating through pain to obtain a range measurement is not indicated.

Referral criteria are applied before corrective programming: a positive screen for referral removes the patient from the exercise pathway until cleared.

The 4x4 matrix has four columns (mobility, static motor control, dynamic motor control, and functional patterning) and four rows keyed to the dysfunctional pattern, and the intersection defines the exercise category.

Column 1 (mobility) addresses the joint or tissue restriction identified in the breakout; column 2 (static motor control) addresses position maintenance without load.

Column 3 (dynamic motor control) adds load or movement while maintaining the corrected position; column 4 (functional patterning) integrates the correction into the primal pattern.

Programming order is mobility first, then static control, then dynamic control, then functional patterning; progression is gated by successful performance at the prior column.

Exercise selection is driven by the breakout finding, not by the top-tier pattern alone; the same dysfunctional pattern can yield different exercises depending on the driver.

The matrix is a selection grid, not a fixed circuit: only the cells corresponding to the identified dysfunction are programmed.

Dosage is set by the principle of the minimum effective dose: the correction is performed until the pattern changes, then retested rather than repeated to fatigue.

Retest the top-tier pattern after each corrective block; if the score does not change, the driver hypothesis or the exercise selection is revised.

Motor control retraining targets the ability to maintain a neutral or corrected position under increasing load and speed, not strength alone.

Neuroplasticity principles applied: specificity of task, sufficient repetition, and progressive challenge are required for a motor pattern to change.

External focus cues (target or environment) generally produce better movement outcomes than internal focus cues (body-part instruction) for pattern retraining.

Feedback is faded over time: explicit cueing and tactile feedback are reduced as the patient demonstrates independent control, to avoid dependence on the cue.

The corrected pattern must be trained in the context in which it is used (e.g., squat, gait, lift) for transfer to occur.

Motor learning is degraded by pain and fatigue, so retraining is scheduled when pain is controlled and the patient is not fatigued.

Blocked practice is used early for acquisition; random or variable practice is introduced later for retention and transfer.

A pattern that reverts under load or speed indicates the motor-control column is incomplete, regardless of how well the pattern looks unloaded.

Document each top-tier pattern with its score (FN, DN, FP, DP) and, for dysfunctional patterns, the breakout finding that localized the driver.

Record pain location, intensity, and behavior (provoked, reproduced, abolished) at the pattern or breakout where it occurred.

Reassessment intervals are tied to the corrective block: retest the top-tier pattern after each block, and record the score change explicitly.

Outcome tracking compares initial and current scores on the same patterns and breakouts, so that change is attributable to the intervention.

Document the exercise selected, the matrix cell it came from, and the dosage, so that a failed block can be traced to selection or to execution.

A pattern that improves from DN to FN without a change in the breakout finding indicates a scoring or cueing inconsistency and should be re-examined.

Record referral decisions and the criteria that triggered them, including the date and the finding, to demonstrate clinical reasoning.

Progress notes should state the current limiting pattern, the current driver, and the next planned progression, so that reassessment is comparable across visits.