That’s a question that needs changing of wording.
The SFMA is an assessment. To arrive at a list of movements that hurt, or are demonstrating limited movement as measured by clinical observation, then measured by goniometer, or movements that clear minimum range of motion passively but that are not able to be done passively.
So the research question would be what?
Does the SFMA reveal movements that hurt?
Does the SFMA reveal movements that are limited?
Does the SFMA reveal movements that are not limited passively but that are limited actively?
Often, the question that is asked is, is there any research that shows the SFMA works? Which is a misunderstanding. The SFMA is not a treatment. It isn’t an intervention.
The intervention follows the assessment which tells you if something hurts - then you use clinical reasoning and further evaluation (local biomechanical testing) to understand more about the painful movement.
The intervention follows the assessment which tells you if something is limited - then you use clinical reasoning and further evaluation (local biomechanical testing) to understand what is limiting the movement - is it tissue or joint? In which direction are the accessory motions limited?
And further, the intervention follows the assessment which tells you if something has above minimum mobility passively not the person can not demonstrate it actively (ie a motor control problem), which requires further evaluation of the motor control dysfunction, which starts with rolling.
Here is a publication that discusses the use of the SFMA to guide treatment of an athlete with low back pain:
1. Goshtigian, G. R., & Swanson, B. T. (2016). Using the Selective Functional Movement Assessment and Regional Interdependence Theory to Guide Treatment of an Athlete with Back Pain: A Case Report. Int J Sports Phys Ther, 11(4), 575-595. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27525182
And in this book, in chapter 29, is a case study of the Functional Movement Systems approach (using SFMA) to manage a patient where physical therapy was used, over lumbar discectomy - https://www.elsevierhealth.com.au/health-professions/manual-therapy/clinical-reasoning-in-musculoskeletal-practice-9780702059766.html
So, the question, does the SFMA model work, and has it been shown to work in research, assumes the SFMA is a treatment. It is not. It is an assessment.
Another question is - is the assessment reliable? There are two studies on this.
2. Glaws, K. R., Juneau, C. M., Becker, L. C., Di Stasi, S. L., & Hewett, T. E. (2014). Intra- and inter-rater reliability of the selective functional movement assessment (sfma). Int J Sports Phys Ther, 9(2), 195-207. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24790781
3. Dolbeer, J., Mason, J., Morris, J., Crowell, M., & Goss, D. (2017). INTER-RATER RELIABILITY OF THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT (SFMA) BY SFMA CERTIFIED PHYSICAL THERAPISTS WITH SIMILAR CLINICAL AND RATING EXPERIENCE. Int J Sports Phys Ther, 12(5), 752-763.
Another question is - is the assessment valid? The answer is that it is not a single assessment - it is a battery that contains, within it, tests that are widely used with their own protocols to ensure maximum reliability. For example, the Modified Thomas Test is reliable and valid if the tester sets up the flexed hip to the right range (too much hip flexion rotates the pelvis posteriorly and gives a potentially false positive for hip extension mobility dysfunction). For example, the C1/2 rotation test is a valid passive assessment of whether C1/2 has 40 degrees rotation as long as the tester maintains full cervical flexion. For example, the FABER(E) test is an accepted assessment of whether the individual has minimum acceptable combined hip abd/E/ER that, if not present, screens for possible hip/SI dysfunction that requires further evaluation. For example, the PSLR is a widely used test to reveal whether hip flexion is at least 80 degrees, as per minimal mobility standards, before the opposite hip moves.
Recent research has looked at the reliability and criterion validity of the ankle dorsiflexion screen used in the FMS and similarly in the SFMA:
See this link - https://www.researchgate.net/profile/Kyle_Matsel
Here is a research paper that included the SFMA and reported on overuse symptoms in baseball, prospectively:
4. Busch, A. M., Clifton, D. R., Onate, J. A., Ramsey, V. K., & Cromartie, F. (2017). RELATIONSHIP OF PRESEASON MOVEMENT SCREENS WITH OVERUSE SYMPTOMS IN COLLEGIATE BASEBALL PLAYERS. Int J Sports Phys Ther, 12(6), 960-966.
So, the SFMA is a model, using batteries of evaluations, to provide a diagnoses of movement patterns that are functional as defined by the criteria, dysfunctional, painful or not. Thus, it is a model to diagnose. IF the research question is whether the diagnosis is correct…… let’s break it down - how do you validate whether someone answering yes to “does it hurt?” Is valid or not? That’s subjective and it leads us to further evaluation. IF you said that answering yes to “does it hurt?” Is not valid, then you might argue that pain is subjective, which is correct. Which leads us to further evaluation, which is what the SFMA does.
IF the research question is whether the diagnosis of mobility dysfunction is correct, we only have to look at whether an inclinometer, goniometer, or clinical observation (using strict criteria) is reliable and valid, and that research is done independently of anything related to SFMA - which is why we borrow what is already acceptable. Research would say that there is some reliability between raters for clinical observation (such as Craigs test) and clinical use of goniometers and clinical use of inclinometers.
IF the research question is whether the diagnosis of altered motor control is correct, then we only have to rely on whether the passive mobility is present (see research question before about whether mobility is present according to clinical observation/goniometer/inclinometer) and whether the person can demonstrate smooth and easy control of that movement - the criteria in teaching SFMA is that if there is jerking during the movement, it is not smooth and thus not controlled. IF there is breath holding, it is not easy and it is thus not controlled since a high-threshold strategy for that movement of a body part is considered inappropriate.
So, the question about whether the SFMA model has been researched is not quite the right question - since it is a process to arrive at 3 possible diagnoses using previously accepted reliable/valid tests (where present). Since it is not an intervention, research about effect of intervention is not applicable.
The SFMA model, in level 2, does continue to teach local biomechanical testing, and provides a reminder of that LBT that is taught outside the SFMA 2 course. It is not a manual therapy treatment course, or ART, or dry needling, or IASTM etc. course. It is not a MET course, or visceral manipulation course, or craniosacral or biodynamics course. But it does put the clinician into the space to apply whichever intervention they are trained in, trust through research-guided understanding, and clinical experience. What the level 2 does introduce, is cueing, feedback and motor control training - of which there is a very large body of research to support such training. The intervention of rolling, based on a SMCD diagnosis, has been researched and a reference is provided:
Clark, N., Voight, M., Campbell, A., Pierce, S., Sells, P., Cook, R., Henley, C., Schiller, L. . (2017). The relationship between segmental rolling ability and lumbar multifidus activation time. Int J Sports Phys Ther, 12(6), 921-930. Retrieved from https://spts.org/docs/default-source/v12n6/ijspt-12_6-08-clark_abs.pdf?sfvrsn=2
As always, happy to continue to supply more research articles on other specific questions.
For ongoing posts of articles and case studies of the SFMA, check out this link - www.functionalmovement.com/articles
I moved away from using the term “injury prevention” years ago because:
From my article, Bulletproofing the volleyball knee
Big Bang for buck strategies force us to go for biggest risk reducers, like being warm, moving within a tolerance range and being robust enough to handle all sorts of challenges.
It doesn't matter what I used to say, but I used to say that the only people interested in injury prevention - I mean passionately and seriously interested in injury prevention - were physiotherapists who had discovered it might be possible, and researchers whose current and future livelihood hung on the possibility that they might be invited to do something and be paid to do something about injury prevention. That number is very small.
So, that leaves everybody else. Everyone who is rightfully interested in what athletes, sporting and tactical, are really interested in - getting the job done, getting the win, or at the very least (and the very most ideally) staying in the game for the pure enjoyment of having fun and being competitive. So, when we focus on preventing something that a) probably can't be done, and b) if it can be done, is hard to know if it was related to what we did or not, then we are on a hiding to nothing. Better to prepare to perform and, WITHIN THAT PREPARATION TO PERFORM, find out what might reduce the likelihood of get in the game, stay in the game and win the game. If that is injury prevention, then we've named it wrong. It should be called.........preparing. Burn the bridges and train properly. Rehab properly. Step out of opinion and into objectively moving the needle of risk.
So if we say we work for injury prevention we are doomed to fail. If we say we include risk identification and lowering strategies we can be judged on systematic efforts to reduce risk and reduce severity when they do happen. In the process we improve the athletes resources to handle when they get injured - less time to rehabilitate when they do get injured. Prepare to perform and this will include risk identification, risk lowering and enhanced preparedness.
When you get injured, you'll be better prepared to come out the other side.
When someone does not move well, the process can be described simply as this:
First, find an entry point. This means you need an objective movement diagnosis with criteria to protect you against your own subjectivity.
Then, rate and rank movement for efficiency.
Then, protect against getting worse.
Then, do something to improve information coming into their nervous system. This might mean a pain relieving treatment or a technique to change/improve mobility.
Second, we provide an exercise that gives the persons nervous system an opportunity to use that enhanced information, process it reflexively and manage their movement mistakes at the edge of their ability – this is Reactive Neuromuscular Training (RNT).
If corrective exercise is not working, it is because:
To the first point - a diagnosis is always first priority. Improve diagnostic systems.
To the second point - diagnosis will direct treatment choice. Improve treatment precision. Keep a baseline system to verify change.
To the third point - diagnosis will direct mobility treatment choice. Improve mobilisation technique. Keep a baseline system to verify change.
To the fourth point - motor control and motor learning science can be translated into artistic and systematic corrective exercise training. Improve this process. And, keep a baseline system to verify change.
Looking for strategies to do that? Reach out to me.
what is corrective exercise,
We know that the return of impaired measures of isolated strength, joint mobility, muscle flexibility and balance can be normal or can occur while movement patterns can still represent dysfunction.
Likewise, it is possible for some performance parameters to fall within normal limits even when acceptable movement patterns are not present.
The new system honours a simple understanding of a complex batch of science around movement learning and strength and conditioning that relates to injury. Get in the game, to stay in the game, win the game.
Did you know? In the Chinese Harvest Moon Festival, the death rate drops 35% below average in the week of this festival, then rises by the same amount in the week following the festival.
Did you know - three US Presidents have died on July 4th? John Adams, Thomas Jefferson and James Monroe.
What does this mean?
At times of importance - to these people, national importance - their impending death is held off by highly energetic intent to remain alive long enough for these times. Imagine that. You can will yourself to stick around until something important has passed.
How is that relevant to you?
Well, my expertise is in rehab. I can tell you that time-based rehab is evil. Criteria-based rehab is good. I said good shits on bad. I'm not afraid to use such colloquialisms in a professional manner, because it gets your attention, and the first step to changing behaviour is to break on old pattern by getting attention. So, it's up to the good physio's and other rehab clinicians to help you with a meaningful step-by-step process. If you're not buying it, your intent is not fuelled by true desire to achieve. Haven't you heard of the clinician who says your injury will take X weeks to be right? And then it isn't? Because a time-frame is out of your control and you don't have to act to make it to that time-frame.
In training or competition mode, let's look at an example:
Wayne Rooney, current forward for DC United, formerly of Everton, Manchester United and the England football team, used to visualise his success. He would ask the property steward what colour kit they would wear in the game on the following day. Red top? White top? What colour shorts and socks. Then he would visualise scoring in that kit the night before, before he went to sleep. You see, his mind didn't know the difference between a real and imagined experience, so it would form a neural connection to create a movement program for scoring the goal. He could create multiple circumstances to score that goal and he would develop strong neural connections for that program. Time and time again his reaction time and ability to score would be faster than his defending opponents could handle - because his movement programs were more competent and capacious due to prior imaginative exposure.
You too have the capacity to do this, yet it takes a coach with a plan, and a rehab clinician with a plan that is based on criteria. Note well, criteria is not based on sets and reps but on levels of competence and performance.
All you have to do is want, to desire. We will shape your desire. If you have it. Think good - it's better than bad.