SFMA Flowcharts

SFMA FLOWCHARTS 

TOP TIER 

TOP-TIER TESTS 

SFMA Top-Tier Tests 

Cervical Patterns 

DN 

FN 

DP or FP 

Go to Cervical Breakout 

Go to Cervical Breakout—proceed with caution 

Upper Extremity Patterns 

DN 

Go to Upper Extremity Breakout 

FN 

DP or FP 

Go to Upper Extremity Breakout—proceed with caution 

Multi-Segmental Flexion 

DN 

Go to MSF Breakout 

FN 

DP or FP 

Go to MSF Breakout—proceed with caution 

Multi-Segmental Extension 

DN 

Go to MSE Breakout 

FN 

DP or FP 

Go to MSE Breakout—proceed with caution 

Multi-Segmental Rotation 

DN 

Go to MSR Breakout 

FN 

DP or FP 

Go to MSR Breakout—proceed with caution 

DN 

Go to SLS Breakout 

Single-Leg Stance 

FN 

DP or FP 

Go to SLS Breakout—proceed with caution 

SFMA 

Overhead Deep Squat 

DN 

Go to ODS Breakout 

FN 

DP or FP 

Go to ODS Breakout—proceed with caution

SFMA SCORE SHEET 

TOP-TIER 

THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT 

SFMA SCORING 

FN 

FP 

DP 

DN 

Active Cervical Flexion 

Active Cervical Extension 

Cervical Rotation-Lateral Bend 

Upper Extremity Pattern 1 (MRE) 

Upper Extremity Pattern 2 (LRF) 

L 

R 

L 

R 

L 

R 

Multi-Segmental Flexion 

Multi-Segmental Extension 

Multi-Segmental Rotation 

Single-Leg Stance 

L 

R 

L 

R 

Overhead Deep Squat 


PROVOCATION PATTERNS 

Impingement Sign 

L 

R 

Horizontal Adduction 

L 

R

SFMA FLOWCHARTS BREAKOUT 1 

CERVICAL SPINE PATTERN BREAKOUTS 

Limited Cervical Spine Patterns 

Active Supine Cervical Flexion Test (Chin to Chest) 

DN, DP or FP 

FN 

Passive Supine Cervical Flexion Test 

FN 

DN, DP or FP 

There is a postural and/or SMCD affecting 

cervical flexion. This includes cervical spine, 

thoracic spine and shoulder girdle postural 

dysfunction. 

Active cervical 

spine flexion 

SMCD 

Active Supine OA Cervical Flexion Test (20˚) 

FN Bilat. 

DN 

DP or FP 

Cervical spine JMD &/or TED 

OA rlexion JMD or TED &/or possible 

cervical spine JMD &/or TED 

Active Supine Cervical Rotation Test (80˚) 

FN 

DN, DP or FP 

There is a postural and/or SMCD 

affecting cervical rotation. This 

includes cervical spine, thoracic 

spine and shoulder girdle postural 

dysfunction. 

FN 

Passive Cervical Rotation Test 

DN, DP or FP 

Supine Cervical Extension 

Active 

cervical rotation 

SMCD 

C1-C2 Cervical Rotation Test 

DN FP or DP FN 


DN 

Poor cervical 

extension JMD 

&/or TED 

FP or DP 

FN 

If standing extension was poor then there 

is Postural Dysfunction &/or Extension 

SMCD. If not, cervical extension is FN. 

C1-C2 JMD 

&/or possible 

lower cervical 

spine JMD &/ 

or TED 

Lower cervical 

JMD &/or TED


UPPER EXTREMITY PATTERN BREAKOUTS 

Limited Upper Extremity Patterns 

Active Prone Upper Extremity Patterns 

DN, DP or FP 

FN 

Passive Prone Upper Extremity Patterns 

DN 

FN 

DP or FP 

Postural &/or shoulder 

girdle SMCD affecting 

functional shoulder 

pattern in question 

Upper extremity girdle 

JMD &/or TED—Proceed 

to local biomechanical 

testing, gleno-humeral 

& scapular goniometric 

testing. Document 

mobility impairments. 

Supine Reciprocal Upper Extremity Pattern 

FN 

Isolated gleno-humeral 

or scapular SMCD with 

mid-range dysfunction. 

Exercising isolated 

shoulder movements is 

appropriate. 

DN 

Functional upper 

extremity pattern 

SMCD with endrange 

dysfunction. 

Exercise in patterns. 

DP or FP 

SFMA


MULTI-SEGMENTAL FLEXION BREAKOUTS 

Limited Multi-Segmental Flexion 

Single-Leg Forward Bend 

Both Functional 

and Non-Painful 

Bilateral Dysfunctional or Painful 

Unilateral Dysfunctional or Painful 

Long-Sitting Toe Touch 

FN with NSA 

DN, DP or FP with Normal SA 

DN, DP, or FP with Limited Sacral Angle 

Rolling Breakout Outcome 

FN FP or DP DN 

Weight-bearing 

hip 

flexion pattern 

SMCD 

Fundamental 

flexion pattern 

SMCD 

Functional and 

Non-Painful 

FN>80 0 

Active Straight-Leg Raise 

Passive Straight-Leg Raise 

10 0 > Active & < 80 0 D (


MULTI-SEGMENTAL EXTENSION BREAKOUTS 

Spine Extension Flowchart 

Backward Bend without Upper Extremity 

Dysfunctional or Painful 

FN—Go to UB 

Extension Flowchart 

Single-Leg Backbend 


Prone Press-Up 

Both Functional and 

Non-Painful 

Symmetrical stance core 

SMCD—Go to UB 


If extension is Functional and Non- 

Painful, may have spinal weightbearing 

SMCD, but still move to Lower 

& Upper Body Extension Flowcharts 

Dysfunctional (>1 Airex Pad) 

or Painful Extension 

Lumbar Locked (IR) Active Rotation/Extension (50°) 

FN 

FP, DP or DN 

Lumbar Locked (IR) Passive Rotation/Extension (50°) 

FP or DP 

FN 

Unilateral DN 

Bilateral DN 


Thorax extension SMCD—Go to Upper 

& Lower Body Extension Flowchart 

Thorax unilateral extension 

JMD &/or TED. Go to Upper & 

Lower Body Extension 

Flowchart 

Prone-on-Elbow Rotation/Extension (30°) 

Thorax bilateral extension 

JMD &/or TED—Go to Upper 

& Lower Body Extension 

Flowchart 

Unilateral DN 

Bilateral DN 

FP or DP 

Both Functional and 

Non-Painful 

Unilateral Lumbar Extension 

JMD &/or TED or SMCD— 

Go to 

Upper & Lower Body 


Bilateral Lumbar 

Extension JMD &/or TED 

or SMCD—Go to 

Upper & Lower Body 


Bilateral Spine Extension SMCD 

Go to Upper & Lower Body 

Extension Flowchart



Lower Body Extension Flowchart 

Standing Hip Extension 

> 10 degrees Extension Bilateral 


Weight-bearing lower quarter SMCD 

&/or limited ankle dorsiflexion. 

Check ODS & SLS. 

Prone Active Hip Extension 

> or = 10 degrees Extension (FN) 

DP, FP, or DN 

Rolling Pattern Outcomes 

Prone Passive Hip Extension 

DN or Painful 

If 25% > Active Hip Extension 



Spine weightbearing 

hip 

extension SMCD 

Fundamental 

extension pattern 

SMCD 

Core SMCD &/or active 

hip extension SMCD 

FABER Test 


Fundamental extension 

pattern SMCD 


Modified Thomas Test 

Hip/SI JMD &/or TED &/or core SMCD— 

Perform local biomechanical testing of 

the hip 


FN with 

knee straight 

FN with 

hip abducted 

FN with hip abducted & 

knee straight 

DN 

DP/FP 

FN 

Anterior chain 

TED 

Lateral chain 

TED 

Anterior and lateral 

chain TED 

Hip JMD &/or TED and/ 

or core SMCD. Perform 

local biomechanical 

testing of the hip. 

Core SMCD



Upper Body Extension Flowchart 

Unilateral Shoulder Backward Bend 


Both Functional 


Supine Lat Stretch Hips Flexed 

Functional and Non-Painful 

Shoulder Flexion 


Shoulder Flexion 

Double check press-up 

on Spine Ext Flowchart 

for possible T-spine 

involvement and rule 

out C-Spine 

Involvement 


Supine Lat Stretch Hips Extended 


FN 

DN, DP or FP 

Shoulder flexion 

improves but 

not full 


upper quarter 


Fundamental 


Lat/posterior chain TED &/or 

possible hip extension 

dysfunction—Run Lower Body 


Lat/posterior chain ted &/ 

or Possible Hip Extension 

dysfunction—Run Lower 

Body Extension Flowchart 

Lumbar-Locked (ER) Rotation/Extension (50°) 

Dysfunctional or 

Painful 

Both Sides Functional 


Scapular &/or gleno-humeral 

SMCD 


Lumbar-Locked (IR) Active Rotation/Extension (50°) 

Lumbar-Locked (IR) Passive Rotation/Extension 

DN, DP or 

FP 

FN 

One side Dysfunctional 


Thorax unilateral extension/ 

rotation JMD &/or TED 

Both sides Dysfunctional 


Thorax bilateral 

extension/rotation JMD 

&/or TED 

FP or DP 

FN 

Thorax bilateral 

extension/rotation SMCD 

Shoulder 

girdle JMD 

or TED


MULTI-SEGMENTAL ROTATION BREAKOUTS 

Limited Multi-Segmental Rotation 

Seated Rotation (50°) 

DN, DP or FP 

FN 

FN 

Lumbar-Locked (ER) Rotation/Extension (50°) 

Dysfunctional or 

Painful 

DN, DP or FP Switches Sides 

Go to Hip 

Rotation 

Flowcharts 

Lumbar-Locked (IR) Active Rotation (50°) 


DN, DP or FP 

FN 

Shoulder girdle TED 

&/or JMD 


Lumbar-Locked (IR) Passive Rotation (50°) 

Unilateral DN Bilateral DN FP or DP FN 


thorax rotational 

SMCD 

Fundamental 

spine rotational 

SMCD 

Thorax unilateral 

rot/ext JMD &/or 

TED—Go to Hip 

Rotation Flowcharts 

Thorax bilateral rot/ 

ext JMD &/or TED— 

Go to Hip Rotation 



Prone-on-Elbow Rotation (30°) 


Unilateral DN 

Unilateral lumbar rotation 

JMD &/or TED &/or 

SMCD. Perform local 

lumbar spine exam— 

Go to Hip Rotation & 



FP or DP 

Bilateral DN 

Bilateral lumbar 

rot/ext JMD &/or TED &/ 

or SMCD. Perform local 

lumbar spine exam— 

Go to Hip Rotation & 



FN 

Thorax rotation 

SMCD—Go to 

Hip Rotation 


Fundamental 

spine rotational 

SMCD— 

Go to Hip Rotation 





Weight-bearing spine 

rotational SMCD—Go to 

Hip Rotation Flowcharts 

Fundamental spine rotational 

SMCD—Go to Hip 

Rotation Flowcharts



Hip Rotation Flowchart (Part 1) 

Seated Active External Hip Rotation 

Dysfunctional &/or 

Painful 

FN (>40 0) ) 

Seated Passive External Hip Rotation 

DN 

DP or FP 

FN 

Hip JMD &/or TED with external 

rotation & with hip flexed 

Prone Active External Hip Rotation 


Painful 

FN (>40 0) )—If seated passive rotation is DN, stop and treat the DN. 

If seated active or passive rotation are FN, continue flowchart. 

Prone Passive External Hip Rotation 


DN 

Hip JMD &/or TED with 

external rotation & hip 

extended. Go to Tibial 

Rotation Flowchart and 


Breakout 

DP or FP 

FN—If seated passive 

rotation is DN, 

stop and treat 

the DN. If seated 

active or passive 

rotation are FN, 

continue flowchart 

Weight-bearing lateral 

hip rotation SMCD. Go 

to Tibial Rotation 

Flowchart and Lower 

Body Extension Breakout 


FN 

DP or FP 

DN 

Fundamental hip 

rotation SMCD—Go to 

Tibial Rotation 


Body Extension 

Breakout



Hip Rotation Flowchart (Part 2) 

Seated Active Internal Hip Rotation 


Painful 

FN (>30 0) ) 

Seated Passive Internal Hip Rotation 

DN 

DP or FP 

FN 

Hip JMD &/or TED with internal 

rotation & with hip flexed 

Prone Active Internal Hip Rotation 


Painful 

FN (>30 0) )—If Seated Passive Rotation is DN, stop and treat the DN. 

If Seated Active or Passive Rotation are FN, continue flowchart 

Prone Passive Internal Hip Rotation 

DN 

Hip JMD &/or TED with 

internal rotatoin and hip 

extended—Go to Tibial 

Rotation Flowchart and 


Breakout 

DP or FP 

FN—If seated passive 

rotation is DN, 

stop and treat 

the DN. If seated 

active or passive 

rotation are FN, 

continue flowchart 

Weight-bearing internal 

hip rotation SMCD. Go 

to Tibial Rotation 


Body Extension Breakout 


FN 

DP or FP 

DN 

Fundamental hip 

rotation SMCD—Go to 

Tibial Rotation Flowchart 

and Lower Body 

Extension Breakout 




Tibial Rotation Flowchart 

Seated Active Internal Tibial Rotation 

Seated Active External Tibial Rotation 

FN 

DN, DP or FP 

FN 

DN, DP or FP 

Tibia internal rotation 

mobility is normal. 

Double-check LB Extension 

Flowchart 

Tibia external rotation 

mobility is normal. 

Double-check LB Extension 

Flowchart 

Seated Passive Internal 


Seated Passive External 


FN 

DP or FP 

DN 

FN 

DP or FP 

DN 

Tibial rotation 

SMCD 

Tibial internal 

rotation TED 

&/or JMD 

Tibial rotation 

SMCD 

Tibial external 

rotation TED &/ 

or JMD 

If spine, hips and tibia are all functional and non-painful, double-check rolling 

for spine SMCD, LB Extension and Single-Leg Stance Breakouts. 



SINGLE-LEG STANCE BREAKOUTS 

Vestibular & Core Flowchart 

Unilateral DN with eyes closed, DN on DLS, or Pain 

Bilateral DN with eyes closed 

Vestibular Test—CTSIB 

Functional and Non- 

Painful Balance 

Dysfunctional 

Half-Kneeling Narrow Base 

Vestibular Dysfunction 

FN 

DN, DP or FP 

If dynamic leg swings is DN 

or painful, perform local 

biomechanical testing for 

hip stability. 

Go to SLS Ankle Flowchart 

FN 

Rolling Breakouts Outcome 

DP or FP 

DN 

Quadruped Diagonals 

Fundamental hip &/ 

or core SMCD—Go to 

SLS Ankle Flowchart 

FN 

DP or FP 

DN 

Weight-bearing spine 

&/or hip/core SMCD— 

If hip extension is DN, 

treat it first. Go to SLS 

Ankle Flowchart 

Weight-bearing hip &/or core 

SMCD—If hip extension &/or 

shoulder Flexion are DN, treat 

those first. Go to SLS Ankle 

Flowchart 



SINGLE-LEG STANCE BREAKOUTS 

Ankle Flowchart 

Heel Walks 

FN 

DN, DP or FP 

Prone Passive Dorsiflexion 

DP or FP 

FN 

DN 

Dorsiflexion SMCD 

Lower posterior 

chain TED &/or JMD 

Toe Walks 

DN, DP or FP 

FN 

Prone Passive Plantar Flexion 

FN 

DN 

DP or FP 

Plantar flexion 

SMCD 

Lower anterior 

chain TED &/or 

JMD 


Seated Ankle Inversion/Eversion 

Can’t evert/pronate 

Can’t invert/supinate 

DP or FP 

FN 

Both DN 

Ankle eversion JMD, 

TED &/or SMCD— 

Perform local foot/ 

ankle exam 

Ankle inversion 

JMD, TED or SMCD 


ankle exam 

No red, orange or blue boxes 

so far = 

proprioceptive deficit 

Ankle JMD, TED or 

SMCD— 


ankle exam


OVERHEAD DEEP SQUATTING PATTERN BREAKOUTS 

Limited Overhead Deep Squat 

Interlocked Fingers-Behind-Neck Deep Squat 

DN, DP or FP 

If squat is now functional and 

non-painful, recheck all Extension 

Breakout Flowcharts 

Assisted Squat 

DN, DP or FP 

FN 

Core SMCD—plus make sure Multi-Segmental 

Extension Breakouts is clear 

Half-Kneeling Dorsiflexion 

FN, FP or DP 

DN 

Lower posterior chain TED &/or ankle JMD— 

plus make sure MSE and SLS Breakouts are clear 

Supine Knees-to-Chest Holding Shins 

DN, DP or FP 

FN 

Supine Knees-to-Chest Holding Thighs 

FN 

FP or DP DN 

If dorsiflexion is FN—weight-Bearing 

core, knee and/or hip flexion SMCD. If 

dorsiflexion is DN, consider knees, hips 

and core normal. If dorsiflexion is DP 

or FP, consider this a red box and treat 

dorsiflexion. Make sure Multi-Segmental 

Extension Breakouts are clear. 


Knee JMD (flexion) &/or lower 

anterior chain TED—plus make 

sure Multi-Segmental Extension 

Breakouts are clear 

Hip JMD &/or posterior chain TED—Proceed to 

Multi-Segmental Flexion Breakouts for hips, but still can be 

knee JMD. Go to Multi-Segmental Extension Breakouts


ROLLING BREAKOUTS 

Rolling Flowchart 

Prone to Supine Rolling, Upper Body 

FN or DN 

DP or FP 

Use DP or FP for your rolling 

pattern outcome. 

Go back to flowchart 

that sent you here 

Prone to Supine Rolling, Lower Body 

FN or DN 

DP or FP 


pattern outcome. 


that sent you here 

Supine to Prone Rolling, Upper Body 

FN or DN 

DP or FP 


pattern outcome. Go 

back to flowchart that sent 

you here 

Supine to Prone Rolling, Lower Body 


FN or DN 

If there are no DNs in the tests above, use FN for your 

rolling pattern outcome. If there are any DNs in the 

tests above, use DN for your rolling pattern outcome. 

Go back to flowchart that sent you here 

DP or FP 

Use DP or FP for your 

rolling pattern outcome. 


that sent you here

SFMA Flowcharts

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