The body can develop distorted ways of moving and poor movement patterns can develop. This may lead to poor optimization of the musculature, cause excessive wear and tear, and lead to injury. The body is connected and the motor system functions as an entity, so even if the movement dysfunction appears to happen in a certain part of the body this may affect other parts of the body as well. This article will discuss movement distortions, aka movement dysfunctions, in terms of the principles from the Selective Functional Movement Assessment (SFMA). This tool is used to assess movement patterns in the body and determine if the particular movement is either functional or dysfunctional, (and whether there is pain noted) and help diagnose whether the dysfunction noted is caused by a mobility issue or a stability and motor control issue. This assessment can be essential to determine whether manual therapy or therapeutic exercise interventions should be used to rehabilitate this person’s dysfunction.
A cause of poor movement patterns can be pain or an injury where the body will develop altered motor control because of this. Basically the body begins to act differently, sometimes unconsciously, even after the actual pain or injury has resolved. Pain can cause changes at multiple levels of the motor system. This may even cause redistribution between and within the muscles, and that changes mechanical behavior. The short term benefit of this may be protection of the injured or painful region, but the long term consequence is dysfunctional movement patterns.
The selective functional movement assessment is based on ten “top tier” particular movement patterns in the body. These are: cervical flexion, cervical extension, cervical rotation (both directions), upper extremity pattern one (hand behind back), upper extremity pattern two (hand over head), multi-segmental flexion, multi-segmental extension, multi-segmental rotation (both directions), single leg stance (eyes open and closed), and the overhead deep squat. These are observed and scored on whether the particular movement pattern is “functional” or “dysfunctional.” What constitutes a functional versus dysfunctional movement pattern will be discussed. The entire body is observed during these movements, and “regional interdependence” tells us the motor system must be considered in its entirety. Regional interdependence refers to the concept that seemingly unrelated impairments in a certain region may contribute with that person’s symptoms and/or pain in a different region of the body.
A functional cervical (neck) flexion movement is based on being able to touch the chin to the sternum (chin to chest). It is a dysfunctional movement pattern if one cannot achieve full range of motion, or if there is excessive effort or lack of motor control. Functional cervical extension should achieve 80 degrees of range of motion (within 10 degrees of horizontal). Any excessive effort or lack of motor control is noted as a dysfunctional pattern as well. Often, a non-uniform curve or excessive movement at one particular segment of the neck may be noted. Normal cervical rotation should be that the nose is in line with the mid-clavicle. Again, excessive effort and/or appreciable asymmetry or lack of motor control displays a dysfunctional pattern. Often, someone will demonstrate neck sidebending or extension in order to compensate for the lack of rotation.
The upper extremity pattern one consists of reaching the arm behind the back as far as one can move it, as if they are reaching for the opposite shoulder blade. The movements needed to complete this action are shoulder medial rotation, shoulder extension and elbow flexion. The hand should be able to reach to the inferior angle of the scapula to be functional. There should not be excessive effort noted and no “winging” of the scapula.
The upper extremity pattern two consists of reaching the arm up and over the head as far as one can move it. The particular movements needed are shoulder lateral rotation, shoulder elevation (flexion/abduction) and elbow flexion. The normal range for this pattern is reach to the spine of the opposite scapula. If a person shows excessive effort or head and neck compensations this is deemed dysfunctional. With both upper extremity patterns the trunk must remain stable and no rotation, sidebending or extension should be noted to achieve the movement.
For multi-segmental flexion, the person is asked to keep their feet together and touch their toes. The proper pattern should exhibit that the person can touch their toes, they achieve at least 70 degrees of sacral angle, a uniform and symmetrical spinal curve and a posterior weight shift noted. If any of these are absent or there is bending of the knees then it is a dysfunctional movement pattern.
In multi-segmental extension the person is asked to raise their arms up overhead, palms facing inwards. Then they are asked to extend back and push their hips forward. A functional pattern is achieved if the person is able to attain and maintain 170 degrees of shoulder flexion (arms over head), the ASIS landmark clears the toes in the front, the spine of the scapula clears the heels, and again a uniform spinal curve is observed. If the person compensates by bending the knees, excessive effort or they don’t reach full range of motion then this is dysfunctional.
Multi-segmental rotation the person is asked to keep feet together and rotate as far as they can toward the side as if they are looking behind their back. The shoulders should be able to rotate to at least 50 degrees and you should be able to see their front shoulder from viewing this person from the back. The pelvis and lower body should also rotate at least 50 degrees as well, so 100 degrees of total rotation observed. Dysfunction is noted if the range of motion is not achieved, as well as if there is spine or pelvic deviation, excessive knee flexion, excessive effort or lack of symmetry.
Single leg stance is the next movement pattern. The person should stand on one leg for ten seconds with eyes open and ten seconds with eyes closed. There should be no loss of height, no leaning of the trunk or excessive movement and the other leg can not touch the ground. If there is dropping of the pelvis or hip then this is also noted as dysfunctional.
The overhead deep squat is the last movement pattern of the SFMA. The person is asked to begin with feet facing forward and hips width apart. The instep of the foot should be in line with the person’s axilla. The arms start at 90 degree of shoulder and elbow flexion, then extend straight upwards overhead. They are asked to sit down into a full deep squat, buttocks to the floor while keeping their heels down flat on the ground. The person should be able to keep the arms in the same starting position, the tibia and torso should be parallel to the floor, the thighs should break parallel (below 90 degrees squat). The body should stay in the proper plane of alignment and they should not shift over to one side or the other. The person should be able to hold this position and return to upright without falling over. Common compensations noted as dysfunction are: changing the foot position, poor thoracic extension and loss of arm position, and heels lifting off the ground.
Within each top tier movement pattern, there are many different segments that have to function properly in order to complete the entire functional pattern properly. If not, there could either be a problem with the person’s mobility or stability and motor control.
If it’s a mobility dysfunction, that means there is either a joint mobility dysfunction or it could be a problem with the person’s tissue extensibility. Some examples of problems with joint mobility are osteoarthritis, fusion, or adhesive capsulitis. Some examples of problems with tissue extensibility are muscle shortening and tightness, scarring or fibrosis, and even neural tension.
The poor movement pattern may also be related to stability and/or motor control dysfunctions. Motor control means how the nervous system organizes muscles into coordinated movements and how this is perceived by the body. Some examples of this are that global muscles compensate and an asymmetry forms, there is poor local muscle function and stabilization or poor postural control or alignment.
The particular dysfunctional movement patterns should be further assessed and broken down to determine which piece of the puzzle is causing the poor movement. If it is a mobility dysfunction then this should be properly restored first. If there is more of an issue resulting from a stability or motor control issue then this should be addressed with particular exercises to restore the proper pattern.
The break-down of the particular dysfunctional movement pattern can be rather in-depth. For example, if the cervical spine flexion is dysfunctional in the top tier standing tests, then the next breakdown test is to assess the active cervical flexion while the person lays in supine (chin to chest). If this is normal, then one would suspect that the problem is a postural stability and motor control issue. This is because when one is non-weight bearing then they are able to attain proper movement. If this is also dysfunctional then the next test would be a passive supine cervical flexion test. If this is normal then the same conclusion can be made because the issue is not a mobility issue. If it is also dysfunctional, then one would need to break it down further to see which part of the spine may be causing the issue. One would perform the active supine OA (occipitoatlantal) cervical flexion test. This is rotation to 20* then chin to chest, and affects the OA joints. The OA joint is where the occiput (the head) meets the atlas (the C1 cervical first vertebra). If this is dysfunctional then it should be treated. If it is functional, then we assume the other parts of the neck are the issue.
These particular breakdowns are performed in every dysfunctional movement pattern. This will allow the therapist to determine the diagnosis and what treatment techniques to choose in order to rehabilitate effectively. The goal is to retest the person and that eventually this person will achieve proper movement patterns in the body. The SFMA is a great assessment tool and the movement patterns should be thoroughly assessed in every person that experiences pain or impairments.