Selective Functional Movement

Assessment
选择性功能运动评价
Ethan M. Kreiswirth, PhD, ATC
Director, Sports Medicine Velocity
Sports Performance
 What is the SFMA?
SFMA是什么?
• A comprehensive
assessment used to
classify movement
一个用以对运动分型的全
面测评方法
• Used to direct treatment
protocol
用于指导治疗方案
• Used to direct
therapeutic interventions
用于指导各种治疗手段

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 Medical Models医疗模式
Traditional传统的 各部位的互相依存
• Isolates individual • Considers the entire
components of body motor system
将人体各结构孤立化 对整体运动系统的分析
• Orthopedic assessment • Early ideas of looking at
“big picture” Vladimir
on a table isolated to Janda
painful area对疼痛部位孤 早期由Vladimir Janda提
立的骨科测评 出的“整体观”的观念
• Looks at one joint or • Shortened and tight,
muscle weakness 只关注 lengthened and weak
muscles肌肉的缩短和紧
单一的关节或肌肉的问题 张，拉长和薄弱的关系
Pain and Motor Control
疼痛和运动控制

Injury Pain
损伤 疼痛

Altered Motor
Control
改变的运动
控制
 Vladimir Janda “Crossed Syndromes”
Vladimir Janda的“交叉症候群”
• Proposed some theoretical frameworks for explaining
and observing movement dysfunction
为解释和观测运动功能异常提出了一定的理论框架
– Upper Crossed上交叉
– Lower Crossed下交叉
• Typical patterns典型的模式
– "shortened/overactive" and
肌肉的“短缩/过度活跃”和
– “weak/inhibited” muscles
肌肉的“松弛/抑制”
 Vladimir Janda “Crossed Syndromes”
Vladimir Janda提出的“交互式症候群”
• Postural abnormality
姿势性异常
– Increased cervical
lordosis增加的颈椎前凸
– Excessive kyphosis
过度的驼背
– Alters resting scapular
position
改变肩胛骨的休息姿势
– Scapula can result in
excessive protraction
and acromial
depression. 导致肩胛骨
过度前伸和肩峰下压。
 Crossed Syndromes
交叉式症候群
• Introduced common "
syndromes”介绍了常见的“症
候群”
– Upper Crossed上交叉
– Lower Crossed下交叉
• Typical patterns常见的模式
– "shortened/overactive"
and肌肉的“短缩/过度
活动”和
– "weak/inhibited"
muscles“松弛/抑制”
Upper Crossed Syndrome
上交叉症状
• Patterns of inhibited or
phasic muscles肌肉受抑制
或低张力的模式
• Patterns of facilitated of
tonic muscles
• 肌肉被兴奋或高张力模式
• Patient presents with
forward head posture,
rounded shoulders, and
subtle or prominent
kyphosis 患者表现为头前
伸姿势，圆肩，以及轻微或明
显的驼背
关节间隔方式
• Foot stable足—稳定
• Ankle mobile踝—灵活
• Knee stable膝—稳定
• Hip mobile髋—灵活
• Lumbar Spine stable腰椎—稳定
• T-Spine mobile胸椎—灵活
• Scapulo-Thoracic stable
肩胛-胸壁—稳定
• Gleno-humeral mobile
盂-肱—灵活
• Elbow stable肘—稳定
• Wrist mobile腕—灵活
 Lower Crossed Syndrome
下交叉症状
• Tight or facilitated muscles
in front of body 身体腹侧肌
肉的紧张或兴奋状态
• Weak or inhibited muscles
in back of body身体背侧肌
肉的松弛或抑制状态
• Causes原因：
– prolonged sitting久坐
– poor posture不良姿势
– Weak abdominal wall/
obliques腹壁/腹斜肌松
弛
 Key concept of the SFMA
SFMA主要观点
• Regional interdependence 各部位互相依存
– refers to the concept that apparently unrelated
impairments in another anatomical region may
contribute to, or be associated with, the
patient’s primary complaint
– 指在表面上看似无关的另一个解剖部位的问题可
能导致了患者的主诉症状或与主诉症状相关联。
• Don’t Chase Pain!不要追踪疼痛!
 Purpose of the SFMA
SFMA的目的
• The SFMA is a functional movement ranking system
SFMA是功能性运动分级系统
• The system directs the clinician to rank pain and
dysfunction for basic movement patterns.
这一系统指导临床人员对基础运动模式中出现的疼痛和功
能障碍进行分级。
– Patterns are broken down to terminal points or until pain or
dysfunction are no longer observed. 所有模式都被分解到不
再出现疼痛和功能异常的终末点。
• The system helps the clinician to rank movement
behavior prior to clinical measurements of strength,
ROM, joint stability, biomechanical tests.
这一系统帮助临床人员在进行肌力，关节活动度，关节稳
定性，生物力学测试前对运动行为做出分级。
 Benefits of the SMFA
SMFA的优势
• Creates a functional comparison for pre
and post treatment measurement
建立了一套对治疗前后评定结果的功能性比
较方法
• Clear demonstration of relationship of
pain provoking movement patterns and
limited dysfunctional movement patterns
对诱发疼痛的运动模式和受限的功能障碍运
动模式之间的关系作出了明确的解释
 Movement运动
– When challenged, the
human body will always
sacrifice quality over
quantity of movement当运
动困难时，人体总是以牺牲
运动的质量来维持运动的数
量。
– Compensatory
movement 代偿性运动
– Why do we move
incorrectly? 为什么我
们的动作会不正确呢？
 Why do we move incorrectly?
为什么我们的动作会不正确呢？
• - pain will alter motor control
疼痛会改变对运动的控制

• - pain will contribute to compensatory

movement 疼痛会导致出现运动代偿

• Number 1 risk of injury is previous injury

受伤的头号危险因素是过去的损伤
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 When Your Patient Has Pain
当你的患者存在疼痛时
• Muscles are inhibited or delayed (Hodges)
肌肉受到抑制或被延迟了[Hodges]
 Mobility vs. Stability
灵活性与稳定性
• Must have full mobility at all joints so
mechanoreceptors can tell the brain this joint
can go from here to there…before we can
stabilize naturally and reflexively
在我们能够自然而本能地稳定关节前，所有关节必
须都具有完整的活动性从而机械感受体能够反馈
给大脑关节的活动范围

• Stability (motor control) is second to mobility

关节灵活性之重要性高于稳定性[运动控制]
 SFMA Patterns SFMA模式
• Cervical Patterns 颈部模式
• Upper Extremity Patterns
上肢模式
• Multi-Segmental Flexion
多节段屈曲
• Multi-Segmental Extension
多节段伸展
• Multi-Segmental Rotation
多节段旋转
• Single Leg Stance单腿站立
• Deep Squat Pattern深蹲模式
Scoring the SFMA SFMA的评分
 Scoring of the SFMA
SFMA 的评分
The term functional will describe any unlimited
or unrestricted movement.
功能一词指的是任何不受限的动作。
Dysfunctional will describe movements that are
limited or restricted in some way demonstrating
a lack of mobility, stability, or symmetry within a
given movement pattern.
功能异常指在某种程度上受限的动作，呈现出在
某一动作模式当中缺乏有灵活性，稳定性，或对称
性。
Three Diagnosis Possibilities of the
SFMA SFMA的三种可能的诊断
• Joint mobility dysfunction
(JMD)
关节灵活性功能异常
(JMD)
• Tissue extensibility
dysfunction (TED)
软组织延展性功能异常
(TED)
• Stability motor control
dysfunction (SMCD)
运动控制稳定性功能异常
(SMCD)
 Key Points关键点
Points
• Always ask if the patient feels pain when
doing pattern
• 在运动模式检查中一直要询问患者有无疼
痛

• But, Do Not Chase PAIN!

• 但，不要对疼痛进行追踪！
 Key Points 关键点
• Provoke Pain through movements
在运动中诱发疼痛
• Focus on asymmetrical patterns
注意不对称的模式
• Does movement fall within norms of your clinical
experience? 根据你的临床经验运动是否正常？
• Do not ponder the cause of the dysfunctional pattern
不要考虑功能异常模式的原因
• Do they own the pattern?
他们完全拥有完成这个模式的能力么？
• Can they cycle one breath easily
他们能否轻松地完成一次呼吸循环

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 Key Points关键点
Points
• Dysfunctional does not
always mean limited
movement
功能异常不总意味着运
动受限
• It can also be an
abnormal pattern,
timing, or increased
exertion
也可能表现为异常模式，
时机选择，或费力

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Loaded vs Unloaded Movement
负重与非负重运动

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Unloaded Movement Example非
负重运动举例
When a pattern is loaded and athlete
cannot perform the movement 在负
重模式下如果患者不能完成动作
there is a motor control
dysfunction运动控制功能异常
There is a restrictive soft tissue
dysfunction限制性软组织功能异
常
There is a joint mobility
dysfunction关节活动功能异常
Unload the pattern and recheck去除
负重重试
If now able, it is a motor control
dysfunction如果可以完成，那就是
存在运动控制功能异常

• 例：过头下蹲
 Cervical Movement Patterns
颈部运动模式
• Chin to chest下巴到胸部：
chest
• Limited movement can
indicate a reduced capacity
of the short neck flexors
and may also indicate
reduced OA mobility
运动受限可能表明颈部短小
的屈肌群能力的减弱还可能
表明OA关节活动性下降

• Should be able to touch

sternum without pain
正常应该能无痛触到胸骨
 Cervical Patterns颈部模式
• Chin to shoulders下巴到肩：
shoulders
• This move is a combination
pattern that incorporates
side-bending and rotation
这是一个侧屈和旋转相结合
的复合模式
• Normal range is mid-
clavicle bilaterally without
pain. (Mouth should stay
closed) 正常活动范围为到
双侧锁骨中段无痛.[保持嘴
的闭合]
 Cervical Patterns颈部运动模式
• Face to ceiling脸向天花板:
ceiling脸向天花板
• This move evaluates the
amount of cervical spine
extension available.这个运
动评估了颈椎可达到的伸展
范围
• Should be able to get within
10º of parallel without pain.
• 应能在无痛下达到与天花板
平行的10º范围内.
Upper Extremity Shoulder Patterns (external
rotation)
上肢肩部模式[外旋]
• External rotation, flexion,
abduction of shoulder
肩的外旋,屈曲,外展
• Touch spine of scapula
触到肩胛冈
• Compare bilaterally
双侧对比
• Look for asymmetries
有无不对称
• Pain?疼痛?
Upper Extremity Shoulder Patterns (internal rotation)
上肢肩部模式[内旋]

• Internal rotation, extension,

adduction
内旋,伸展,内收
• Touch inferior angle of
scapula
触到肩胛下角
• Look for asymmetries
有无不对称
• Pain疼痛?
 Multi-Segmental Flexion
多节段屈曲
This test looks at flexion
in the hips, spine, and
muscles of the lower
back.
该测试着眼于髋关节、脊
柱和下背部肌肉的正常弯
曲情况。
 Multi Segmental Flexion
多节段屈曲
• Have the patient stand with
feet together and toes pointed
forward.
让患者脚趾朝前双足并拢站立。

• Have them bend from the hips

forward and try to touch the
ends of their fingers to the tips
of their toes, without bending
their knees.
髋关节前屈并试图用指尖触到
足尖,膝关节无弯曲。

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 MS Flexion 多节段屈曲
• SCORING: Look for a
normal, unrestricted
forward bend. The
patient should be easily
be able to touch their
toes and return to the
standing position without
pain.
• 评分:是否为正常,无限制的
前屈。患者应能轻松无痛
地触到他们的脚趾并还原
到站立姿势。
Dysfunctional Non-Painful (DN) MS Flexion
多节段屈曲的功能异常无痛 (DN)
• Cannot touch toes
不能触到足趾
• Sacrum < 80 degrees of
flexion
骶骨屈曲度< 80度
• Flat through lumbar and
thoracic joints
腰椎胸椎关节平直
• Most range at T/L junction
大部分活动于胸腰结合处
• Good posterior weight shift
良好的向后重心转移
Dysfunctional Non-Painful (DN)
功能异常无痛 (DN)
• Early Low back
hinging
• 过早的下腰部铰链
运动
Multi Segmental Extension
多节段伸展
• This assesses
normal extension
in the hips and
spine with arms
overhead.
• 它检查了在双上肢
上举过头时髋关节
和脊柱的正常伸展
情况。
Multi Segmental Extension
多节段伸展
• Scoring评分：
Scoring
• Have the patient stand with the
feet together and toes pointing
forward.
让患者脚趾朝前双足并拢站立。
• Have them raise their arms
directly above their head with the
arms extended, trying to get their
elbows in line with their ears. 双臂
伸直上举在头的正上方，尽量使双
肘与耳在一条直线上。
• Have them bend backward as far
as possible making sure that their
hips go forward & their arms go
backwards
• 尽量后仰并确保双髋向前同时双臂
向后
 Multi Segmental Extension
多节段伸展
Hips in front of toes
Scapula to clear heels
髋关节在足趾前方
肩胛骨落在足跟处
Hands behind heels
双手在足跟后方
Make sure that the patient does
not flex their knees excessively
with backward bending – this is a
common compensation for lack
of hip extension
确保患者没有在后仰时过度屈膝—
这是髋关节伸展度不够的常见代偿
 DN MS Flexion Pattern
多节段屈曲模式功能异常无疼痛
 DN MS Extension Pattern
多节段伸展模式功能异常无疼痛
 DN MS Extension Pattern
多节段伸展模式功能异常无疼痛
 Multi Segmental Rotation
多节段旋转
• Have patient stand with feet
together, toes pointing
forward, and their arms out
to their sides. 让患者脚趾朝
前，双足并拢站立，并且双臂
向两侧打开。
• Rotate their entire body as
far as possible to both the
right and left 向左右两侧尽
量旋转整个身体
• Look for asymmetry
有无不对称
 Multi Segmental Rotation
多节段旋转
• Head rotates to
shoulders头转到肩的位置
• Shoulders should rotate
100 degrees
双肩应能旋转100度
• Hips rotate 45 degrees
双髋旋转45度
• Legs locked 双腿不动
• Feet do not move
双脚不动
 Multi Segmental Rotation
多节段旋转
• This test looks for normal
rotational mobility in the neck,
trunk, pelvis, hips, knees, and
feet. 此检查观测了颈，躯干，骨
盆，双髋，双膝，和双足的正常旋
转运动性。
• Pay close attention to each
segment (hips, trunk, head) of
the body since one area may be
hypermobile due to restrictions
in an adjacent segment.
• 由于有的部分会由于相邻节段有
抵抗而存在活动过度的现象所以
要仔细观察身体每个节段[髋，躯
干，头]。
DN Multi Segmental Rotation
多节段旋转功能异常无痛
• Head does not rotate to
shoulder
头不能旋至肩的位置
• Shoulders do not rotate
肩不能旋转
• Knees not locked
膝不能保持不动
• Asymmetry of hip
rotation patterns
不对称的髋旋转模式
 Single Leg Stance单腿站立
• Lift leg to 90º hip/knee flexion
将腿抬至髋/膝屈曲90º
• Have them maintain good posture &
balance for 10 seconds.让他们保持
10秒的良好的姿势和平衡
• Look for asymetries 有无不对称
• Repeat on the other leg另一腿重复。
• DN if:如出现下述情况为功能异常：
• Lose height 高度丢失
• Lose balance失去平衡
• If no fall, repeat with eyes closed
如果没有摔倒，闭眼重复
Deep Squatting Pattern深蹲模式
• Used to assess bilateral,
symmetrical mobility of the
hips, knees, and ankles.
用来评定双侧髋关节，膝关节，
和踝关节对称灵活性。
• Combined with the hands held
overhead, this test also
assesses bilateral,
symmetrical mobility of the
shoulders as well as extension
in the thoracic spine.
同时双手举过头，还可以评估
双侧的肩关节的对称灵活性以
及胸椎伸展情况。
 DN Squatting Pattern
下蹲模式的功能异常无痛
• Patient stand with the feet
shoulder width apart and toes
pointing straight forward 患者双足
分开与肩齐宽并且足趾朝前站立
• Hold hands up above their head so
they are slightly wider than their
feet.
双手保持在头上方稍宽于双足。
• Now see if they can squat down all
the way while keeping their hands
above their head.此时观察他们能
否下蹲到底并始终保持双手在头上
方。
• Do arms come forward?
• 双臂是否向前运动？
 DN Squatting Pattern
下蹲模式的功能异常无痛
 DN Squatting Pattern
下蹲模式的功能异常无痛
 DN Squatting Patterns
下蹲模式的功能异常无痛
Hierarchy of Treatment
治疗的顺序
 Interpreting the Results
对结果的解释
• Did it produce pain?检查是否导致疼痛？
• Is the pattern asymmetrical?
模式是否为不对称？
• For unilateral active movements, if the
motion is equal - is the effort or perceived
exertion equal?
• 对于单侧主动运动，如果动作是相同的-用
力或努力程度是相等的么？
 Interpreting the Results
结果的解释

• Functional Non-Painful is the key to the

SFMA
• SFMA的关键是功能正常无痛

• Use functional pain to monitor progress

• 利用功能正常有疼痛来监控治疗进程
 Key Points to Assessment
测评的关键点
• Loaded movement 负重的运动
– Gravity involved 有重力
• Unloaded movement
非负重的运动
– Take out gravity 去除重力
– active range of motion
(AROM)
主动运动范围 (AROM)
• Unloaded movement
非负重运动
– No gravity无重力
– passive range of motion
(PROM) 被动运动范围
(PROM)
 Loaded vs. Unloaded
负重与非负重

• Loaded = Unloaded then a mobility deficit

• 负重=非负重时灵活性存在问题

• Loaded ≠ Unloaded then a motor control

deficit
• 负重≠非负重运动控制存在问题
Key Points to Functional Exercise
功能性练习的关键点

• Less is not more少不是多

• Delete some things that you are good at
删除那些你擅长的练习
• Train bad movement训练不良的运动
• Recheck bad patterns 对不良模式再评价

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Neurological Learning and Functional
Exercise Positions
神经学学习和功能性练习姿势
Functional Exercise Positions
功能性练习姿势
 How we Treat the Problems
如何治疗
• The 3 R’s 3 R
1. Reset重置
• manual therapy 手法治疗
– massage techniques, joint mobilization, needling,
trigger points, Deep Muscle Stimulator (DMS)
按摩技术，关节活动术，针刺，扳击点，深层肌肉刺激
(DMS)
2. Re enforce再强化
stretching, PNF, corrective exercise, taping techniques 拉
伸，PNF,矫正练习，帖扎技术
3. Reload再负重
– resistance or weights抗阻或负重
• DMS
DMS
• Good tool to reset tissue tone and tightness
恢复组织张力和紧张的好方法
• Good tool to relax muscles放松肌肉的好方
法
• Good tool to turn off compensatory muscle
tone 消除肌肉代偿性张力的好方法
• Feels good on athletes 患者感觉舒适
• Saves hands if treating many athletes
在对多个患者时省力
Deep Muscle Stimulator (DMS)
How we Treat the Problems
如何进行治疗
4x4 Matrix 4x4 矩阵表
1x1 Matrix Example for Neck
Patterning
颈部模式1x1 矩阵表示例
2x1 For Neck Patterning
颈部模式的2x1矩阵表
3x1 For Neck Patterning
颈部模式的3x1矩阵
Example of Teaching Squat
Pattern 下蹲模式指导示例
4x1 ASLR for Hip Patterns
髋部模式中ASLR的4x1矩阵
 What is it 定义?
• A prescription for better motor control and
movement patterns 改善运动控制和运动模式的
处方
• Motor control is unpredictable when athlete has
pain 当患者存在疼痛时运动控制是无法预测的
– Reduce the motor control and build back up
– 降低运动控制并建立备份（？）
• the human body will always sacrifice quality over
quantity of movement
• 人体总是为了保证运动数量而牺牲运动质量
 When Should it Be Used?
应该何时使用?
• When your athlete does not have stability
to do exercise
当你的患者在训练时无法保持稳定时
• When your athlete has pain
当你的患者存在疼痛时
• When your athlete cannot perform a lifting
program
当患者不能完成提举时
Turkish Get Up 土耳其式起立