SFMA TOP TIER

SFMA SCORING FN FP DP DN

Cervical Flexion

Cervical Extension

L
Cervical Rotation
R

L
Upper Extremity Pattern 1(MRE)
R

L
Upper Extremity Pattern 2 (LRF)
R

Multi-Segmental Flexion

Multi-Segmental Extension

L
Multi-Segmental Rotation R

L
Single-Leg Stance
R

Arms Down Deep Squat

 SFMA TOP TIER CHECKLIST
Name: Date: Total Score:
Cervical Flexion Painful
 Can’t touch sternum to chin
 Non-uniform spine curve
 Excessive effort and/or lack of motor control
Cervical Extension  Painful
 Not within 10 degrees of parallel
 Non-uniform spine curve
 Excessive effort and/or lack of motor control
Cervical Rotation  Painful Right  Painful Left
 Right  Left Chin/Nose not in line with mid-clavicle
 Right  Left Excessive effort and/or appreciable asymmetry or lack of motor control
UE Pattern #1 – MRE  Painful Right  Painful Left
 Right  Left Does not reach inferior angle of scapula
 Right  Left Excessive effort and/or appreciable asymmetry or lack of motor control
UE Pattern #2 – LRF  Painful Right  Painful Left
 Right  Left Does not reach spine of scapula
 Right  Left Excessive effort and/or appreciable asymmetry or lack of motor control
Multi-Segmental Flexion  Painful
 Cannot touch toes
 Sacral angle <70 degrees
 Non-uniform spine curve
 Lack of posterior weight shift
 Excessive effort and/or appreciable asymmetry or lack of motor control
Multi-Segmental Extension  Painful
 Upper extremity does not achieve or maintain 170
 ASIS does not clear toes
 Spine of scapula does not clear heels
 Non-Uniform spine curve
 Excessive effort and/or lack motor control
Multi-Segmental Rotation  Painful Right  Painful Left
 Right  Left Pelvis Rotation <50 degrees
 Right  Left Torso rotation <50 degrees
 Right  Left Excessive effort and/or lack of symmetry or motor control
Single-Leg Stance  Painful Right  Painful Left
 Right  Left Eyes open <10 seconds
 Right  Left Eyes closed < 10 seconds
 Right  Left Loss of Height
 Right  Left Excessive effort or lack of symmetry or motor control
Arms Down Deep Squat  Painful
 Hips do not break parallel
 Cannot reach fists to ground within footprint
 Loss of sagittal plane alignment: Right____ Left _____
 Excessive effort, weight shift, or motor control
 CERVICAL SPINE BREAKOUTS

Limited Cervical Spine Patterns

Active Supine Cervical Flexion Test (Chin to Chest)

DN, DP or FP FN

There is a postural SMCD affecting

Passive Supine Cervical Flexion Test Cervical Flexion. This includes cervical
spine, thoracic Spine and shoulder girdle
postural dysfunction.
FN DN, DP or FP

Active Cervical Active Supine OA Cervical Flexion Test (20˚)

Spine Flexion
SMCD FN
Bilateral DN DP or FP

If Passive Supine Cervical Flexion (PSCF) was OA/Upper Cervical OA/Upper

DP or DN then treat as Cervical Spine Flexion Flexion MD and/or Cervical
MD. If PSCF was FP can also be SMCD - perform possible Cervical Spine Flexion Pain/
segmental testing and soft tissue appraisal. Flexion MD. Dysfunction

Active Supine Cervical Rotation Test (80˚)

FN DN, DP or FP

There is a Postural SMCD

affecting Cervical Rotation. This Passive Supine Cervical Rotation Test (80°)
includes cervical spine, thoracic
spine and shoulder girdle
postural dysfunction. FN DN, DP or FP

Active C1-C2 Cervical Rotation Test (40°)

Cervical
Spine
Rotation
SMCD FN DP or FP DN
Supine Cervical Extension

If Passive Supine Cervical C1-C2 C1-C2 MD

DN DP or FP FN Rotation (PSCR) was Cervical and possible
DP or DN then treat as Rotation Lower
Lower Cervical Rotational Pain/ Cervical
Cervical Cervical Postural and/or MD. If PSCR was FP can Dysfunction Spine MD
Extension Active Cervical also be SMCD - perform for rotation.
Extension
Pain/ Extension segmental testing and soft
MD Dysfunction SMCD tissue appraisal.
 UPPER EXTREMITY PATTERN 1 BREAKOUT

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

FN DN, DP or FP

Active Prone UE Pattern 1 Test Passive Lumbar Locked Ext/Rot Test (50°)

FN DN, DP or FP FN DP or FP DN

If thorax was normal Thorax Extension/ Thorax

assume a Postural and/or Thorax Extension/ Extension/
Rotation SMCD Rotation Pain/
Shoulder Girdle SMCD. Dysfunction Rotation MD
Otherwise - just treat
thorax findings.

Passive Prone UE
FN Pattern 1 Test DN, DP or FP

Active Prone Shoulder 90/90 IR Test (60° &/or Total Arc of 150°)

FN DN, DP or FP

Active Prone Shoulder Extension Test (50°) Passive Prone Shoulder IR Test
(60° &/or Total Arc of 150°)

FN DN, DP or FP
FN DN DP or FP

Passive Prone Shoulder Shoulder

Extension Test (50°) Shoulder IR Shoulder IR
IR Pain/
SMCD MD
Dysfunction
FN DN DP or FP

Shoulder Shoulder Shoulder

Extension Extension Extension Pain/ Passive Prone Elbow
SMCD MD Dysfunction Flexion Test (Ext)

Active Prone Elbow Flexion Test (Ext)

FN DP or FP DN
Consider the Elbow normal.
If there are no previous
FN findings, consider this a DN, DP or FP Elbow Elbow Elbow
combined UE Pattern 1 Flexion Flexion Pain/ Flexion
SMCD Dysfunction MD
dysfunction.
 UPPER EXTREMITY PATTERN 2 BREAKOUT

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

FN DN, DP or FP

Active Prone UE Pattern 2 Test Passive Lumbar Locked Ext/Rot Test (50°)

FN DN, DP or FP FN DP or FP DN

If thorax was normal Thorax Extension/ Thorax

assume a Postural and/or Thorax Extension/ Rotation Pain/ Extension/
Shoulder Girdle SMCD. Rotation SMCD Dysfunction Rotation MD
Otherwise - just treat
thorax findings.

Passive Prone UE
FN Pattern 2 Test DN, DP or FP

Active Prone Shoulder 90/90 ER Test (90° &/or Total Arc of 150°)

FN DN, DP or FP

Active Prone Shoulder Passive Prone Shoulder ER Test

Flexion/Abduction Test (170°) (90° &/or Total Arc of 150°)

FN DN, DP or FP FN DN DP or FP

Passive Prone Shoulder Flexion/ Shoulder ER Shoulder ER Shoulder

Abduction Test (170°) SMCD MD ER Pain/
Dysfunction

FN DN DP or FP

Shoulder Shoulder Shoulder

Flexion/ Flexion/ Flexion/ Passive Prone Elbow
Abduction Abduction Abduction Pain/ Flexion Test (Flex)
SMCD MD Dysfunction

Active Prone Elbow Flexion Test (Flex) FN DP or FP DN

Consider the Elbow normal.

If there are no previous Elbow Elbow Elbow
FN findings, consider this a DN, DP or FP Flexion Flexion Pain/ Flexion
combined UE Pattern 2 SMCD Dysfunction MD
dysfunction.
MULTI-SEGMENTAL FLEXION BREAKOUT

Long Sitting Test

FN DN, DP or FP

Weight-bearing Hip Active SLR Test (70°)

Flexion pattern SMCD

0
FN DN, DP or FP(<70 )

Stabilized ASLR Test (70°)

FN DN, DP or FP

Core (Pelvic
Orientation) Passive SLR Test (80°)
SMCD

DN, DP or FP FN

Supine Knee to Chest Test (120°) Active Hip

Flexion SMCD

FN FP or DP DN

Posterior Chain MD,

Hip Flexion Hip Flexion MD
or if PSLR was FP,
could be Active Hip
Pain/ and potential
Dysfunction Posterior Chain MD
Flexion SMCD

Prone Rocking Test

FN FP or DP DN

If the spine had a non-uniform curvature in

any previous test, this a weight-bearing Spine Spine
Flexion Pain/
Flexion SMCD.
Dysfunction Spine Flexion MD
If not, and there were no previous findings,
consider the spine normal and/or a possible
plantarflexion dysfunction.
 MULTI-SEGMENTAL EXTENSION BREAKOUT

Spine/Upper Body Flowchart

Prone Press Up Test

FN DN, DP or FP

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

FN DN, DP or FP

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

FP FN DN DP

Thorax Extension/ Thorax Extension/ Thorax Extension/

Rotation SMCD Thorax Extension/ Rotation MD with
Rotation SMCD Rotation MD
with Pain Pain/ Dysfunction

Active Prone on Elbow Extension/Rotation Test (30°)

DN, DP or FP FN

Passive Prone on Elbow Extension/Rotation Test (30°) If thorax was normal,

consider this a
Weight-Bearing Spine
Extension SMCD or
FN DN DP or FP Anterior Torso MD.
If there were any
previous findings
Lumbar Extension/ consider lumbar
Lumbar Extension/ Lumbar Extension/ normal.
Rotation Pain/
Rotation SMCD Rotation MD Dysfunction

Active Prone Shoulder Girdle Flexion Test (170˚) DN, DP or FP

Passive Prone Shoulder Girdle Flexion Test (170˚)

FN

DN DP or FP FN
Shoulder Girdle
Flexion is Normal
- Go to Lower Shoulder Girdle Flexion Shoulder Girdle Flexion Shoulder Girdle Flexion
Body Extension MD - Go to Lower Body Pain/ Dysfunction SMCD - Go to Lower
Flowchart Extension Flowchart - Go to Lower Body Body Extension
Extension Flowchart Flowchart
MULTI-SEGMENTAL EXTENSION BREAKOUTS

Lower Body Flowchart

FABER Test

FN DN, DP or FP

Stabilized FABER Test

FN FP or DP DN

Core (Pelvic Hip Extension

Orientation) SMCD Hip/SI MD
Pain/Dysfuncion

Modified Thomas Test

DN FP or DP FN

If FABER was DN, DP or FP

Hip Extension MD Hip Extension then stop and treat FABER
Pain/Dysfunction

Active Prone Hip Extension Test (10°)

FN (> or = 10 degrees Extension) DN, DP or FP

If spine extension was Passive Prone Hip Extension Test (10°)

dysfunctional assume hip
is normal. If not - there is a
Weight-bearing Hip/Spine DN FP or DP FN
Extension SMCD and/or Ankle
Mobility Dysfunction (Refer to
ADDS & SLS). Hip Extension Core SMCD and/
Hip Extension Pain/ or Active Hip
MD Dysfunction Extension SMCD
MULTI-SEGMENTAL ROTATION BREAKOUTS

Spine Flowchart

Seated Torso Rotation Test (50°)

DN, DP or FP FN

Active Lumbar Locked (IR) Extension/Rotation Test (50°) Go to

Lower
Quarter
External
FN DN, DP or FP Rotation
Flowchart

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

FN FP DN DP

Thorax Thorax Thorax Extension/

Extension/ Thorax Extension/
Extension/ Rotation MD - Go Rotation MD
Rotation Rotation with Pain - Go to
SMCD with to Lower Quarter Lower Quarter
SMCD External Rotation
Pain External Rotation
Flowchart Flowchart

Active Prone on Elbow Extension/Rotation Test (30°)

DN, DP or FP FN

Passive Prone on Elbow Extension/ If Active Lumbar Locked (IR)

FN
Rotation Test (30°)
FP or DP DN
Lumbar Extension/Rotation
Lumbar
Extension/Rotation MD
Pain/Dysfunction - Go to
Lower Quarter External - Go to Lower Quarter
Rotation Flowchart External Rotation
Flowchart
was FN and Active Prone
on Elbow was FN, assume
a Weight-Bearing Spine
Extension/Rotation SMCD. If
Passive Lumbar Locked (IR)
was FN or FP and Active Prone
on Elbow was FN, then assume
Lumbar was normal. If Passive
Prone on Elbow was FN, assume
a Lumbar Spine Extension/
Rotation SMCD. Go to Lower
Quarter External Rotation
Flowchart.
MULTI-SEGMENTAL ROTATION BREAKOUTS

Lower Quarter External Rotation Flowchart

Active Prone External Hip Rotation Test (40°)

FN DN, DP or FP

Stabilized Prone External Hip Rotation Test (40°)

DN, DP or FP FN

Core (Pelvic
Passive Prone External Hip Rotation Test (40°) Orientation)
SMCD
DN FP or DP FN

External Hip Weight-bearing or

External Hip Rotation Pain/ Active External Hip
Rotation MD Dysfunction Rotation SMCD

Active Seated External Tibial Rotation Test (20°)

FN DN, DP or FP

Passive External Tibial Rotation Test (20°)

External Tibial Rotation
is Normal. Go to Lower
Quarter Internal Rotation
Flowchart FN DP or FP DN

External Tibial External Tibial External Tibial

Rotation SMCD Rotation Pain/ Rotation MD - Go
- Go to Lower Dysfunction to Lower Quarter
Quarter Internal - Go to Lower Internal Rotation
Rotation Flowchart Quarter Flowchart
Internal
Rotation
Flowchart
MULTI-SEGMENTAL ROTATION BREAKOUTS

Lower Quarter Internal Rotation Flowchart

Active Prone Internal Hip Rotation Test (30°)

FN DN, DP or FP

Stabilized Prone Internal Hip Rotation Test (30°)

DN, DP or FP FN

Core (Pelvic
Passive Prone Internal Hip Rotation Test (30°) Orientation)
SMCD

DN FP or DP FN

Internal Hip Weight-bearing or

Internal Hip Rotation Pain/ Active Internal Hip
Rotation MD Dysfunction Rotation SMCD

Active Seated Internal Tibial Rotation Test (20°)

FN DN, DP or FP

Internal Tibial Rotation is Passive Internal Tibial Rotation Test (20°)

normal.
If no previous signs of
rotation dysfunction FN DP or FP DN
consider Weight-Bearing
Rotation SMCD.
Internal Tibial Internal Tibial Internal Tibial
Rotation Rotation Pain/ Rotation MD
SMCD Dysfunction
 SINGLE-LEG STANCE BREAKOUTS

Vestibular & Core Flowchart

Vestibular Test - CTSIB (Static Head)

DN, DP or FP FN

Potential Static CTSIB (Dynamic Head Movement)

Vestibular
Dysfunction
FN Dysfunctional

Potential
Dynamic
Half-Kneeling Narrow Base Test Vestibular
Dysfunction

FN DN, DP, or FP

Consider Half-
kneeling normal Quadruped Diagonals Test
- Go to SLS Ankle
Flowchart.
FN DP or FP DN

Weight-bearing Spine and/ Quadruped Weight-bearing Hip and/

or Core SMCD - If hip Stability Pain/ or Core SMCD - If hip
extension and/or shoulder Dysfunction extension and/or shoulder
flexion are DN treat those - Go to flexion are DN, treat those
first. Go to SLS Ankle SLS Ankle first. Go to SLS Ankle
Flowchart. Flowchart. Flowchart.
 SINGLE-LEG STANCE BREAKOUTS

Ankle Flowchart
Active Tandem Dorsiflexion - Knee Extended Test

FN DN, DP or FP

Passive Prone Dorsiflexion -Knee Extended Test (20˚)

DP or FP FN DN

Dorsiflexion Pain/
Dysfunction Dorsiflexion SMCD Dorsiflexion MD

Active Tandem Plantarflexion Test (40˚)

DN, DP or FP FN

Passive Prone Plantarflexion Test (40˚)

FN DN DP or FP

Plantarflexion SMCD Plantarflexion Pain/

Plantarflexion MD Dysfunction

Active Seated Ankle InversionTest DN, DP or FP

FN Passive Ankle Inversion Test

DN DP or FP FN

Ankle Inversion MD Ankle Inversion

Pain/Dysfunction Ankle Inversion SMCD

Active Seated Ankle EversionTest DN, DP or FP

FN Passive Ankle Eversion Test

DN DP or FP FN
Ankle Eversion is normal.
If no Green Boxes so far = Ankle Eversion Ankle Eversion Ankle Eversion
Proprioceptive Deficit MD Pain/Dysfunction SMCD
 ARMS DOWN DEEP SQUAT BREAKOUT

Active Tandem Dorsiflexion - Knee Flexed Test (40˚) DN, DP or FP

FN Passive Prone Dorsiflexion Test - Knee Flexed Test (30˚)

DP or FP FN DN

Dorsiflexion Pain/ Dorsiflexion SMCD Dorsiflexion MD

Dysfunction

Active Seated Ankle Inversion/Eversion Test DN, DP or FP

Passive Ankle Inversion/Eversion Test

FN

DP or FP FN DN

Ankle Inversion and/or Ankle Inversion and/or Ankle Inversion and/or

Eversion Pain/Dysfunction Eversion SMCD Eversion MD

Supine Knees to Chest Holding Shins Test (120˚)

DN, DP or FP FN

Supine Knees to Chest Holding Thighs Test (120˚)

FN DP or FP DN

Knee Hip Flexion Pain/ Hip Flexion MD and

Flexion MD Dysfunction possible Knee Flexion MD

Active Seated Internal Hip Rotation Test (30°) DN, DP or FP

Passive Seated Internal Hip Rotation Test (30°)

FN

FN DP or FP DN

Active Internal Hip Rotation Internal Hip Rotation Internal Hip Rotation
SMCD with hip flexed Pain/Dysfunction MD with hip flexed

Active Seated External Hip Rotation Test (40°) DN, DP or FP

FN Passive Seated External Hip Rotation Test (40°)

If no previous findings FN DP or FP DN
- Weight-bearing Ankle,
Knee and/or Hip SMCD
and/or Normal Active External Hip Rotation External Hip Rotation External Hip Rotation
Anatomical Variances. SMCD with hip flexed Pain/Dysfunction MD with hip flexed