Course Review: SFMA 2 - Advanced | Modern Manual Therapy Blog

Course Review: SFMA 2 - Advanced

"If you see a patellofemoral syndrome, and you treat the patella, I'm going to find you and beat you up" - Dr. Greg Rose

I wanted to dive into the SFMA and the world of motor control more to help those patients that are not responding to my current inputs. This SFMA Level 2 was taught by none other than Dr. Greg Rose, one of the founders, and who came up with the 4x4 Corrective Exercise Matrix. Greg is an excellent speaker, has a great sense of humor and is full of examples to help anyone understand the finer points of the SFMA, movement, and motor control.

The course begins with a relatively quick (2.5 hour) summary of motor control research, here are some important points
  • muscles for a certain activity fired in sequence (agonist and antagonist) whether the subjects moved a lever or the lever was fixed and they thought it was going to move
  • this suggests the pattern is in the brain, not "muscle memory"
  • retention of motor skills is better than cognitive skills
    • i.e. you can ride a bike after not doing it for 10 years, but can you still do calculus?
  • H.M. a well documented patient with severe grand mal seizures underwent an experimental hemisphere separating surgery
    • upon waking up, the seizures were gone but he now lacked the ability to form new memories
    • motor control researchers performed another experiment
    • a piano teacher taught him piano every day for 3 years, daily H.M would be introduced, and have a lesson
    • despite not remembering the teacher, H.M was able to play the piano after that time suggesting a separation between motor and cognitive learning

Blocked vs Random Practice
  • Blocked more smooth at the one movement/activity, for retention test/performance, is switched when they returned after the first session and looked at activity/retention
  • Every study in the world verified this except one, that was done on Alzheimer patients (not retaining)
  • Block always does better if it's first time exposed to the skill
  • Random - "writes the book faster"
    • Greg's example
      • one participant (Canada) multiplied 11x13, took her 15-20 sec, then he asked her what 11x13 was 5 more times
      • the next (USA) multiplied 3 different numeral sets 4 times, obviously she was much slower
      • which player is more ready to perform on game day?

As a review here is the 4x4

What I appreciated most about SFMA 2 as taught by Greg Rose
  • you learn and review the framework for using the 4x4
  • you also see the Greg's pearls and go-to exercises for each of the Top Tier
  • there are round robins for resets by other clinicians, or in Greg's words "You show me yours, I'll show you mine"
  • you learn a systematic way to progress and regress exercises to improve motor control from NWB/no resistance to WB and resistance
  • there is something for every type of learner, from tactile, to auditory, to visual
  • you reinforce a system that is reset and commercial model agnostic which respects multiple ways to get a patient moving treatment wise
I have heard others say they were disappointed in the course, and I could not have been happier. It is not a "reset" course, but I think many of us have plenty of those in our toolbox. What do you do once your patient regains movement? How do you reinforce it? That's what the SFMA teaches you.

Below is a video demonstration of Dr. Dave Tilley, of The Hybrid Perspective and a Physio Answers Contributor performing a 3x1 exercise for hip mobility

  • quadruped to half kneel
  • practice that for stability
  • for mobility, step out, and in across your midline to promote lower leg hip ER and IR
  • I combined this with an EDGE Mobility Band on the lower leg which really assisted mobility
  • look for more examples in the coming weeks using EDGE Mobility Bands and Gray Cook Bands

Some pics,

me with Dr. Greg Rose, appreciate all the pearls!

My young padawan, Dr. Dave Tilley, on his way to Gymanstics Coach Education Stardom

guest appearance by my pal, Dr, Mike Reinold!
There were a good amount of blog followers there too, always great to meet those who catapulted my career out of Buffalo and all over the place!

If you skipped to the end, if you like the FMS/SFMA, you need to take SFMA 2 from Greg Rose! Learn what to do once you have restored mobility and to reinforce and reload to help your patient's between visits, where it really matters.

Keeping it Eclectic...


  1. The video looks like a scaled down version of a scaled and modified lunge matrix patter done from a tall kneeling position. Fair to say or way off base?

  2. Yeah I'd say that's fair. You eventually do it with bands to assist then resist the pattern