The SFMA Highlights, Boston 4-14 to 4-15-12 | Modern Manual Therapy Blog

The SFMA Highlights, Boston 4-14 to 4-15-12

Here are some points of importance/highlights of The SFMA course I attended in Boston, MA this past weekend.

Here's a view of Boston Harbor from the hotel

The Instructor, Dr. Mike Voight is a great speaker, very charismatic and awesome use of real world (non-Hippa :) examples and great AV. His students at Belmont University are very lucky to have him and learn the SFMA among other things as part of their curriculum. He will be emailing me his unpublished by sizeable data on the reliability of SFMA testing, which according to the stats he quoted me, is extremely reliable. Kudos again to the KISS principle.

I love meeting people that make me feel stupid! And he sounds like a red neck!

He shared 3 ideas from a book, How Doctors Think, or rather 3 main errors of Dx

  1. fixation on 1 Dx or settling on 1 Dx that is quick to mind
  2. failure to come up with an alternative Dx
  3. incorrectly attributing the Sx to 1 Dx

I think all medical professionals who assess can be guilty of this, even very highly trained ones (and maybe even more so). When I asked a MDT Diplomat in fellowship training to write me a lower back patient case that he got better by only treating the hip, he asked, "Wouldn't that make them a hip patient?" The point being, he would only treat that area (or that back) but not see how one could relate to the other (and is a weakness of MDT).

A great example of the stability/mobility concept we all learned in school is someone sitting on a skateboard and then pushing a wall. The wall is a stable segment or core and with good outcome from the muscles, you get good movement. If the same person pushed on a ropes or malleable surface with equal force, the peripheral muscles output being equal would develop less movement. To achieve the same movement would require either more muscle effort, or result in a feeling of "tightness" peripheral to the lack of stability.

The SFMA, like any system, and similar to MDT, provides order to your assessment, saves time, and makes you more efficient. I am all about efficiency and often take shortcuts in MDT and my OMPT assessment from what experience has taught me. I look forward to streamlining the breakouts into my assessment, but cannot see myself using most of them. Time will tell, and my assessment this year is already different from my assessment last year.

The suggested clinical assessment by Dr. Voight is

Neuro testing - mainly because he sees other people's failures, which I can attest to, other clinicians miss a lot!
The SFMA (should only take 2.5 to 3 minutes)
Then your routine clinical testing, AROM, PROM, PIVM, repeated motions, neurodynamics, etc.

Rules for physical assessment
1) No warm up allowed

  • although for true stability or mobility problems, it does not matter
2) do not overthink
  • if you have to think about it, it is not normal
3) be picky (not bad = not good)
  • look for slight compensations like scapular elevation for cervical rotation/flexion to clavicle or slight foot eversion for deep squat
4) shoes off to start
  • a slight heel will make a big difference in the deep squat
5) minimal instruction and coaching
  • demonstrate it once or do it with the patient

If all numbers on the line add to 10, any less will result in someone more along the line, another way to demonstrate the stability and mobility relation
2 2
\ |
2 2
\ |
2---2--- 1---2---3
2  2
|    \
3    3

So when the line should look like 2---2---2---2---2 = 10, and the middle part is the core, a loss there (or anywhere) will be made up by the body somewhere else. The above drawing was his way of representing the three planes of movement. I thought it was neat, but I'm also a geek.

The upper and lower body rolling breakout is not a test of strength, it is a test of how well the subject can activate and sequence the core muscles. It is an assessment and exercise of stability. You should not use it to test a subject with mobility issues, especially cervical and thoracic.

End Day 1. Day 2 highlights/points to be posted soon along with a vid of my SFMA.


  1. HerbisonvaughanptApril 16, 2012 at 7:47 AM

    Dr. e,
    Is SFMA similar to TMR (Total Motion Release)?

  2. Not sure what TMR is, is that the almost spam like mail every gets who belongs to certain APTA group mailings? The SFMA is a systematic method of assessment to find head to foot regions of motion or stability loss to streamline your findings. It works on the concept of regional interdependence and is extremely well thought out and easy to add to any evaluation or visit. HIGHLY recommended.

  3. I took the class from Mike et al last month and enjoyed it, also realized some of my big movement discrepancies. I am still working on integrating the break out patterns and finding myself going back to the flow charts frequently. The rolling patterns are also a unique way at looking at how people move and I have been surprised a number of times how good / bad some people are able to roll.

  4. Here is a link:

    Don't think I use this!, but just quick glimpse I saw something to the extent of 7 different body ovement tests on SFMA. TMR uses 5.

    I would like to check SfMA out more. Looking forward to your posts.

  5. It all goes back to rolling! I stink at it, but mainly b/c I have about 3 thoracic vertebrae! Working on it though! Mike is great, isn't he! Those breakouts are really well thought out. We'll see how long it takes for me to apply/memorize them.

  6. You're probably already doing most of the screening tests of the SFMA as it is just basic range of motion tests performed in standing with the addition of balance and deep squat screening. What the system does is further break out these movement patterns into a stability or mobility dysfunction, and offers a regional interdependence link from head to toe.

  7. I've got them down pretty well thus far. If it leads me to a stability problem I find myself looking for what type, then appropriate exercise intervention. I've been toying around with those all purpose bands, but need to modify some things in the clinic to set them up on our tables.

  8. I was, but wasn't looking at stability as a reason so much for a loss of motion. It just ties it all together. After this weekend, I think I have much of the breakouts down, but the, next move to this flowchart is somethink I'd need to look at.

  9. Hi Erson,
    Been a while since crossing your path.
    Like your web site - been keeping yourself busy I see.
    I became certified in FMS 2007 and attended the first 2 parts of the SFMA courses really like the material - this had me pursue more of Janda, Kolar ... stuff the Czechs seem to have a good approach in how to identify and treat the body. Really like to developental approach in which the czechs and Gray Cook uses, makes more sense to me. As for the rolling progression - that really kicks everyones butt. Good to be contacting you again.

  10. Where did we meet? At a Paris or MDT course?

  11. Erson,

    Do you need to take the FMS course before you take the SMFA course?


  12. No, despite having some crossover in faculty and founders, they are separate courses and certifications. The SFMA is stand alone.

  13. At WNYPTOT group - I managed the transit location.
    Have been working at ECMC since

  14. I just "ran" into your blog the other day and have found some really interesting topics, especially since I have developed a lot interest in manual therapy. I will be graduating in a couple of weeks and was thinking about doing the FMS certification (once I study and pass my boards of course). I hadn't heard of the SFMA before, so what would you say is the main difference between those? Which one you would recommend for an entry-level PT?

  15. The FMS is a little easy for anyone with a PT education and is really only applicable to athletes, so not most in a general ortho setting. The SFMA is assessment only and directed toward clinicians and can be used on anyone. The FMS is for fitness, trainers and not necessarily anyone with a higher education, despite many with a higher education using it. Gray keeps it real by telling anyone using the FMS to refer out as soon as anyone has pain. Bottom line, for you, SFMA.

  16. Thanks! I will keep that in mind!