Q&A

2 Q’s on MSI

These questions below  in this article are based off Dr. Shirley Sahrmann’s Movement System Impairment Syndromes.
Sahrmann’s work was the first movement-based approach I studied, a year or two before finding Janda and several years before Gray Cook, McGill, Coach Boyle, and the like.  I found her work from I don’t remember who, but I remember the message was something like, “Charlie, you have to look at Sahrmann’s stuff since you are so into powerlifting.  She has an approach that looks at the whole body.”
Several years lady, I imagine Dr. Sahrmann would find it blasphemy that her work was found useful for powerlifting, but it’s clear that precise pain-free competency and high-powered capacity don’t have to be mutually exclusive.  I think we know this, and I do think it’s fair that if a large percentage of the folks you see performing general fitness are always banged up, it is hard to believe anyone can train properly.

Still required reading in my opinion

Still required reading in my opinion

Up until 2 years ago, I read the first 6 chapters of Sahrmann’s first book every year.  The principles are still timeless as they are grounded in indeniable laws of where physiology and physics intersect.  I’m hesitant to use the word biomechanics here, but I will use musculoskeletal to describe the foundations of this.  Clearly motor patterning is a big piece of Sahrmann’s message, and I think too often biomechanics are discussed in terms that motor control is simply a forgone conclusion and all that matters are resultants, vectors, and EMGs.  This is unfortunately quite foul.
Here is the most contemporary places to learn Sahrmann’s MSI methodology.

But as I discuss these questions below from my perspective, I must admit that I’ve moved away from Sahrmann’s messages for a few reasons.
1) I don’t really have any colleagues that breathe this approach as the methods that they use for evaluation and treatment.  There’s no one to influence me or say, “Hey, this stuff is the answer.”
2) While at one point it was not significant to me, as I feel my thoughts and principles have crafted, I find more gravity in a movement competency model that has a more direct funnel into fitness.  I don’t see this at all from Sahrmann’s work.
3) I just haven’t seen much change in the methodology since first being exposed to it.
4) I was never comfortable with being able to go foot to spine, but not foot to neck.  I always saw an upper vs. lower body model.

All of this is with the caveat that to a degree I’ve moved away from Sahrmann’s work, so I have not kept up, and I can not vouch for what the current version of the model is in terms of being contemporary.
But if Clare Frank says Dr. Sahrmann is coming around, then I believe it to be true.

What I had to do to find this picture of me, Dr. Clare Frank, and Dr. Shirley Sahrmann

What I had to do to find this picture of me, Dr. Clare Frank, and Dr. Shirley Sahrmann

 

Q: Sahrmann suggest flattening [the] lumbar spine in supine for patients suffering from [what she terms as a Movement Impairment Syndrome] Lumbar Extension Syndome.  [She advocates] to relax the lumbar muscles or even to train the abdominals with her heelslide progressions.
……….is this a circumstance of flattening…….[is] allowed as an exception?

This seems very in line and an efficacious approach. Flexion of the hip will bring the pelvis towards an assumed more neutral position along for the ride.  This repetitive action can normalize the lower-crossed component, T-L extension, centration, zone of apposition, whatever you want to call it.  They are all the same.  And whether that posture is always an indicator of pain or not is irrelevant.  It is important to recognize that not all similar postures always equal pain.  What is relevant is that the posture sent you down a certain pathway, in this case Sahrmann’s recommendation, and perception changed.
Other techniques that can yield this anti-extension will include the RT1 sagittal stability positions of DNS, 90/90 positions in PRI methodolgy, Leg Lowering progressions of FMS, indeed Sahrmann’s supine hooklying series, properly executed pilates, and quadruped-plank-pushup progressions. All of these techniques should be qualified with breathing and never without segmental stability and centration.
Most importantly, they have to work.  This may sound silly, but regressions like this should work very, very quickly if they are going to work.  These are neuromuscular drills, and if you are choosing the right one, the dial should be moved immediately.  That doesn’t mean they go from raging pain to a cartwheel after 2 minutes of a regression.  But they should clearly be better.  Expecting time frames significant of a physiological change in the body is not appropriate with a neurological technique.

If there is a concern that this flattening is inappropriate, I don’t consider this flattening an exception, but the proper approach.  Keeping the spine long is not flattening it. It may look flat, but it’s not. It’s just getting back to neutral.  But it has to work…..quickly, not immediately, but quickly.

All the strategies may be useful, especially proper coaching.

All the strategies may be useful, especially proper coaching.

Q: [Many] say that people have overactive upper traps.  To lift weight overhead or raising [the] arms, they advise keeping the scapulae downwards.  Sahrmann, on the other hand, hasn’t even classified an [Elevated] Scapula Syndrome, where upper traps are dominant.
In her view it’s the contrary for scapular depression and scapular downward rotation, she advises shrugging shoulders during shoulder flexion.
Which is it?

Here’s the thing. Sahrmann’s work, which I said up above, has ultimately been passed by in my mind for the more contemporary models.  My understanding of training MSI I believe Sahrmann will address her MSI’s based on biomechanics and primarily with changes in tissue stiffness.  In my experience, this may or may not address the issue.  I’ve seen both positive and marginal results.

When this shrugged reaching works, the stiffness attributed to the upper trap can provide stabilization with other muscles such as lower trap, serratus anterior, etc.  In my experience, you’ll find this option in the hyoptonic shoulder, one of that often presents lower than the other shoulder.  I think you’ll see this quite a bit in undertrained baseball pitchers.  Eric Cressey is your far better resource on this particular topic and has spoken on it liberally and with a much larger body of work than I.

While Sahrmann’s methodology has overhead shrugs as an option in this Downwardly Rotated Scapular Syndrome, the Turkish Getup and overhead press, preferably each with a KB, will also demand upper trap contribution to scapulo-humeral rhythm and potentially add to a feed-forward mechanism of the other scapular stabilizers.
I prefer this approach because if I can get someone into fitness faster, that is my interest. I think the CNS is molded quicker, more intensely. If the motor learning is ripe, then I don’t see a need to be softer with something like the overhead shrug.  That doesn’t mean it doesn’t work.  It means if other things work, I favor what provides competency and capacity at the same time.
Here’s an example where maybe Eric gets after a little of both worlds as I am suggesting.

If I have a concern about someone going overhead, it is a more viable option. But the heavy DL is also an option. While the shoulder stays low, the upper trap is definitely in the picture; the load must be too heavy for any physiological elevation of the scapula.

If the overhead shrugs fit the Sahrmann MSI, then use them liberally, and audit the motion. I don’t think it’s a wrong or useless approach; I simply don’t have much of a use for it when there are other viable options that get us into (relatively) heavy loads quicker.  For me, it lives in the warmup or cooldown for only a select group of individuals.

So the ultimate answer to this question is that it’s both depending on the person.

both is good