Dysfunction Versus Pain Discrimination and Referral Criteria
Domain 5 - Dysfunction Versus Pain Discrimination and Referral Criteria
SFMA separates two questions that clinicians blur: is the pattern dysfunctional, and is it painful? The first tells you what to train; the second tells you whether you may train at all. The exam tests your ability to hold that line under case pressure, because the commonest error in practice and in answers is exercising a painful pattern.
Why the two axes are different
- DN (dysfunctional, non-painful) is the modifiable finding. It may be years old, it may be the cause of pain elsewhere, and it responds to mobility or motor-control work.
- FP (functional, painful) suggests irritable tissue with adequate range: protect and refer, do not stretch it.
- DP (dysfunctional, painful) has both problems and carries the highest priority: refer first, reassess after clearance.
- Pain is an output of the nervous system and does not map one-to-one onto tissue damage, but within SFMA it is treated as a mandatory branch point, not a nuisance variable.
Referral triggers
- Any pain reproduced during the top-tier pattern or a breakout.
- Pain at rest or at night, swelling, heat, or a joint that looks different.
- Neurological signs: numbness, tingling, progressive weakness, gait change.
- Trauma history, or a pattern that has worsened quickly.
- Red flags: unexplained weight loss, fever, cancer history, bowel or bladder change, saddle anaesthesia.
What to do while referred
Document what was found, to whom the client was referred, and what was avoided. Continue assessing non-painful patterns so the picture is complete when clearance arrives, and keep working within scope on pain-free findings.
Worked example
Multi-segmental rotation scores DP with left low-back pain; cervical and upper extremity patterns are FN. Reasoning: stop the rotation assessment, do not stretch into rotation, document the painful pattern and the referral. The FN patterns need nothing. Once cleared, retest rotation - it may now be DN, which finally becomes a trainable problem.
Traps that cost marks
- Stretching or loading a DP pattern to "gain range".
- Assuming no pain means no problem, so DN patterns are ignored.
- Skipping red-flag questions because the complaint sounds musculoskeletal.
- No written record of the referral or the reasoning behind it.