Shirley Sahrmann Workshop, Day 2 Notes

1. Correcting movement is not about stretching.
2. The future of physical therapy is getting paid for 4-6 visits; you better either get paid cash or know what you’re doing
3. Pattern recognition is the most important thing = diagnostic groups = Syndromes
4. Flexion/Rotation herniated discs – never do them
5. When you can’t do a movement, trying to do more of it will not be the answer
6. Labeling the condition is critical
7. What is moving too much is what is causing the pain – she says it’s hypermobility, not instability (to me it is when a stable joint becomes mobile)
8. The body follows physics – how many people can go back to high school physics principles?
9. Too much muscle activity is just as bad as too little
10. It is not muscle shortness. It’s the compensations. I am not sure that Functional Movement is completely in agreement with this.
11. There are MSI for neuro patients (Patty Sheets)
12. You can train long muscles by making them short – this is harder for some muscles than others
13. Short muscle = length lost from the industry standard
14. Shortening muscles will lose sarcomeres; it is a cellular adaptation
15. Mechanical irritation is causes from the wrong positions of the wrong muscles
16. Never go more than 4mph on a treadmill; the pattern of keeping up with the treadmill is wrong
17. Ante- and retroversion are structural; they can not be changed; they must be accounted for
18. Never uses taping (another major difference of SFMA)
19. 10 degrees of hip extension is okay (questionable in athletic population)
20. Optimal kinesiology is based on structure, but structure is variant
21. Everyday activities are the cause of MSI. Stuff that we do over and over again is how the body gets messed up. I suggest that bad training on top of bad movement makes things even worse.
22. Side bending is okay in the t/s; not okay in the l/s
23. Temporary sx = pain from hyper mobility; chronic sx = DJD
24. One component can never be the problem. There are 2 sides to every joint. One causes the other go bad. What comes first doesn’t matter.
25. Only time to draw in is with abdominal diastasis
26. Bad posture may be okay for your back if you gets you out of pain. (not sure about that one)
27. Psoas is implicated in SLR back pain >70% of the time
28. A rotated acetabulum on a stable femur is bad and leads to labral tears- the friction of shoes lead to this
29. Anterior hip labrum is thinner and less broad
30. Acetabulum is set up to absorb posterior and superior forces – not anterior
31. Don’t force the hips through restriction or pain
32. Women are typically anteverted; men are extroverted
33. Coxa vara = genu valgus
34. Coxa valga = genu varum
35. <90 deg hip flexion = a large femoral head and an abnormal neck
36. Heavy pear shape people cause a change in hip alignment
37. Big thighs cause increased hip compression and painful sitting
38. Inclination of the hip – 125 degrees = normal, 140-145 = coxa valga, 105 = coxa vara
39. Declination of the hip – 15 degrees = normal, 35 = ante version, 5 = retroversion
40. >15 degrees on Craig’s Test = Anteverted. She went on to suggest you can not change this so don’t worry about toes out mechanics. I think this is the rationale for the recent FMS direction to not worry about getting a 3 in the squat. Some people toes straight is a horrible position because of bony ante version. It is something we should check more.
41. Women are more anteverted – dancers, ballet, cheerleading- all bad activities without corrections
42. People with Lumbar Flexion Syndrome that can not flex hips to 90 degrees – sit on a wedge to limit compressive pain – also buy a truck, not a sports car (think hip angle)
43. Quadruped rocking reveals that there is no structure in the posterior hip that can be so short that hip flexion is limited – it is an anterior problem
44. Glut Medius is IR w/hip flexion; ER w/hip Ext (Journal of Biomechanics, 1999)
45. Piriforms is IR in hip flexion (Delp)
46. Be careful in motions that IR hip/limit ER — 50% of labral tears are as a result of going through ante version
47. Hip issues are muscles like hamstrings and rectus femoris; femoral issues are at the femoral head-acetabulum (semantics)
48. Ballet dancers have such poor cores that the hip muscles take over to control the pelvis (joint by joint theory, but obviously she does not use the terminology)
49. Stiff posterior structures cause Anterior Femoral Glide Syndrome
50. We usually have to undo the bad positions that sports put us in
51. Psoas prevents hip internal rotation (by maintaining normal pelvic alignment through its contribution to normal lordosis)
52. The hamstring to glute mechanism in the book is wrong. It is just a lever arm issue that leaves the hamstrings wanting to dominate.
53. No idea why people stretch out tendonitis – argues semantics that everything is really tendonosis (lots of semantics as you can see)
54. 98/100 cadavers have hip labral tears
55. Attention in holding ABD SLR – if it not in the frontal plane, you are using TFL (I find few untrained individuals can perform this without holding onto something – it is more a function of weak rotary stability than glut med strength)
56. When the medial hamstrings are shorter than lateral hamstrings, the hip will rotate during knee extension- bad
57. Why would anybody test something in NWB?
58. 70degrees ASLR is normal, <70 degrees is psoas problem
59. With Anterior Femoral Glide Syndrome, stretch the hamstrings only with maximal hip flexion first
60. Instrinsic neck flexors are long or weak; extrinsic neck flexors dominate and cause compression, rotation, and shearing (this is Janda)
61. Watch for subtle c/s rotation during shoulder flexion training – the upper traps are dominating
62. Never do 1-arm pressing since c/s rotation is not countered by the other side (uh oh)
63. Must deload the upper traps and levator to achieve proper c/s rotation (more joint by joint)
64. Upper trap exercises compress the cervical spine – people get away from it with t/s flexion and neck forward
65. Pain @ scapular vertebral border is rooted in the neck
66. If your trunk doesn’t fit the chair, the arm rests will ruin your posture
67. Upper quarter muscles are 1) Axio-scapular, 2) Scapulo-humeral, or 3) Axio-humeral (lat and pec as the most troublesome)
68. Most important axio-scapular muscle is the serratus anterior – only m. that ABDucts, upwardly rotates, and externally rotates the scapula
69. Tilted, downwardly rotated, internally rotated scapula = impingement
70. Rib cage disorders (bad breathing – rectus abdominus dominant from crunches) can cause scap tilting and anterior rotation of the glenoid = shoulder problems
71. Push-up plus only hopes you get Serratus to do what you want – it is not the way to get upward rotatin
72. Correct the scapulae and monitor the shoulder
73. Retraction does not stretch the pec minor because end range retraction will put the scap in anterior tilt – cut it off early
74. Winging = scapulo-humeral mm. are short and/or stiff
75. Make sure the scap stays down when treating GIRD – shoulder is more stiff, so the scap will move
76. Subscap holds the humerus against anterior glide – ER are short and/or stiff = do prone IR
77. Use open hand and fingers for ER training = PNF D2 (Cook bands have an open hand attachment from Lifeline)
78. You get 1cm of GH rolling for every 22 degrees of movement
79. Great exercise is sagittal plane flexion with constant external rotation
80. Theraband ER/IR is a waste of time
81. It hurts where it moves too much
82. Muscles are never too short; it’s all just relative

  • March 22, 2010

Leave a Reply 8 comments

Simone Patuzzo Reply

Great post, very useful thanks !

Kyle Ridgeway PT, DPT Reply

80. Theraband ER/IR is a waste of time > I could not DISAGREE more. What was she referring to here??

Kyle Ridgeway PT, DPT Reply

26. Bad posture may be okay for your back if you gets you out of pain. (not sure about that one) > I TOTALLY agree with this one. Posture is the most over-rated and least supported tenant in spine care. I don’t care how it looks, if it feels good, do it. It is any PROLONGED posture that results in feelings of pain and stiffness.

Dr. E Reply

Charlie, Thanks for the very detailed summarization of Sahrmann’s workshop. I have her latest text and appreciate her approach, classification system, and exercises. I return to it every once in a while since my STM + JM + neuromuscular reeducation is much different. @Kyle, I only agree when posture relieves someone’s complaints, i.e. centralizes UE or LE Sx and improves movement quality and quantity. Posture isn’t for everyone, but it does help A LOT of patients.

paul Reply

18. Never uses taping (another major difference of SFMA)????

hmm on s sportsrehabexpert.com webinar about taping with Chris Nentarz
he shows a taping technique for DBS( dormant butt syndrome) and i believe it is from shirley sahrmann

Margaret Haughey Reply

Just took her course last year and she does use taping – but she does not do it herself – uses her colleagues.
As far as hip er/ir with theraband – often the patient will use the synergists and the incorrect motor patterns when you load the exercise with bands – so I agree that bands are not a great option often times.

Dan Padilla Reply

Hi Charlie. Great blog. I have a quick question. What does one do if they strain and or tear the weak synergist muscle (glutes)? I’ve read all about treating hamstring and groin strains with muscular balancing (PGM, lateral rotators etc.), but what does one do when they strain one of them? I’m guessing rest, but that’s kind of hard to do with symptoms on both sides and just walking involves all of those muscles. Cortisone injection an idea? Thanks. Hope all is well.

Alex nielsen Reply

Thanks for the post, I’m a great fan of sarhmanns books. I personally suffer from an anteriorly gliding humerus but I don’t think I’m doing the prone subscapularis exercise properly, are there any variations of this I could use?

Many thanks

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