treating back pain with Selective Functional Movement Assessment (SFMA)“Even when you have gone as far as you can, and everything hurts, and you are staring at the specter of self-doubt, you can find a bit more strength, deep inside you, if you look closely enough.” Hal Higdon

Hal Higdon is an American writer and accomplished marathon runner. If any of you reading this are marathon runners you understand the mental and physical obstacles you face each time you run. Some athletes are lucky to never come face to face with an injury to their backs. But what if you do find yourself facing an injury to your back? What should you do? We believe assessing and treating back pain with the Selective Functional Movement Assessment (SFMA) should be something you heavily consider for several reasons.

What is SFMA?

Before we discuss why assessing and treating back pain with SFMA can be a path of treatment for you to take, let’s explain what it is and what it entails.

First off, Selective Functional Movement Assessment is, to assess a patient who is already in pain and to discover regional movement dysfunctions that cause local symptoms. The SFMA addresses the critical issue of regional interdependence. SFMA will also allow a determination if these movements are due to tightness or weakness.

The 7 Movements

When we begin accessing and treating back pain with SFMA, the first assessment we’ll do is the Cervical Spine Movement Assessment. This assessment has three components involved with it. They are a flexion chin to chest evaluation, followed by an extension of the face parallel to the ceiling evaluation, and then a chin left and right to the shoulders.

The second assessment is the Upper Extremity Movement Pattern of the shoulder. The first pattern will assess the internal rotation of the shoulder and the extension and adduction of the shoulder. The Second pattern assesses the external rotation, flexion and abduction of the shoulder. This evaluation will also include a pain provocation exam.

This next assessment is the Multi-Segmental Flexion Assessment. This evaluation will start with our patient standing upright. Then we’ll have them bend forward at their hips while attempting to touch fingertips to the tips of their toes.

Following the Multi-Segmental Flexion assessment is the Multi-Segmental Extension Assessment which is the 4th of the movements. This will test for normal extension of the shoulders, hips and spine.

Our next assessment and the fifth on this list is the Multi-Segmental Rotation Assessment. The main purpose for this test is to determine your normal rotational mobility in the neck, trunk, pelvis, hips, knees and feet.

The sixth assessment is the Single-Leg-Stance Assessment. This will allow us to evaluate independent stabilization of each leg with dynamic leg swings.

Finally, the seventh assessment is the Overhead Deep Squat Assessment for bilateral symmetrical mobility of the hips, knees and ankles. When the patient’s arms are overhead, it also tests mobility of the shoulders and extension of the thoracic spine.

The Outcomes

The first seven movement tests, also known as the “top-tier” – have four possible outcomes in testing, based on two parameters:

  • Did the movement pass the standards, yes/no or (functional/dysfunctional)
  • Was the movement painful, yes/no or (painful/nonpainful)

After running through the top-tier, we have a list of areas that need to be assessed further. Anything that was painful or dysfunctional needs to “broken out” which is using SFMA lingo. Upon completion of the breakouts, we essentially have a list of things that are going to need Active Release Technique or a joint mobilization. That is followed by a list of things that may or may not need Neurokinetic Therapy, Anatomy in Motion or other forms of motor control reprogramming. First and foremost, we must treat mobility, since one of the rules of the Selective Functional Movement Assessment is, indeed, that!

The Benefits of SFMA

When assessing and treating back pain with SFMA the benefits are enormous. In our opinion, the most important benefit of SFMA treatments is for our patients to have relief much more rapidly and more proficiently than other treatment procedures. SFMA targets the cause of the issue and systematically targets it with specific treatment activities.

SFMA and the treatment for your back pain can be a preventative tool. If we examine your body’s movements and their detrimental patterns, the injuries that might be sustained can be accessed and prevented.


When you decide to go down the path in allowing us to start assessing and treating your back pain with SFMA, we want you to know that every person is unique. Using these 7 movement assessments will help us to determine where you and you alone are experiencing the most discomfort. They will also allow us to determine any other form of treatment that will allow your body to heal faster and more efficiently. Feel free to contact us if you have any further questions or if you’d like to set up your first consultation. At Pain and Performance Solutions we believe that proper diagnosis will lead to the proper treatment.