SFMA: Breakouts and Multi-Segmental Extension/Flexion

Domain 3 - Breakouts and Multi-Segmental Extension/Flexion

Breakouts are the second half of the SFMA and the part that turns a score into a treatment target. A breakout is a smaller, more isolated test performed only when a top-tier pattern is dysfunctional and non-painful, to identify which region and which tissue is limiting. If you cannot state which breakout reproduced the top-tier limitation, you do not yet have a limiting factor.

Breakout rules

• Break out DN patterns only; painful patterns are referred, not explored.
• Choose the breakout that reproduces the limitation, then clear the regions above and below.
• If the breakout is functional, the restriction lives elsewhere in the chain - widen the search.
• The dysfunctional breakout that matches the top-tier limitation becomes the working diagnosis and the retest target.

Multi-segmental flexion breakouts

• Standing toe touch, seated forward bend, single-leg forward bend or supine 90/90 straight-leg raise, cervical flexion.
• Typical limiters: hamstring extensibility, lumbar erector dominance, hip capsular restriction, neural tension, thoracic flexion.

Multi-segmental extension breakouts

• Prone press-up, prone on elbows, standing extension with a lumbar lock, single-leg prone extension, cervical extension.
• Prone on elbows loads thoracic extension with the lumbar spine relatively quiet; prone press-up adds lumbar extension. Comparing the two separates a thoracic limit from a lumbar or hip-flexor limit.
• Typical limiters: hip flexor and rectus femoris tightness, lumbar extension, thoracic extension, shoulder flexion.

Worked example

Standing multi-segmental extension is DN, no pain. Prone press-up is functional, so lumbar extension is available. Prone on elbows is limited with the ribs riding up, pointing to thoracic extension; a half-kneeling hip-flexor test clears the hip. Reasoning: the limiter is thoracic extension, not the lumbar spine and not the hip flexors. Treat thoracic extension, retest prone on elbows, then retest the top tier.

Traps that cost marks

• Breaking out a painful pattern "to see what is going on".
• Stopping at the first restricted breakout without clearing the joints above and below.
• Treating a breakout finding without confirming it explains the top-tier score.
• Forgetting to retest the top-tier pattern after treatment.