It has been around 6 months or so since I had the opportunity to see Dr. Shirley Sahrmann speak in central New Jersey. My excitement around that time led me to my long outlined posts on the Forum from the notes that I scribbled down during the 2 days of the seminar. Over these last several months, I’ve had the opportunity to further understand her principles and integrate some new thoughts and strategies into how we rehab and train individuals.
Keep in mind that these bullets are new principles or things I may have changed regarding Sahrmann’s methodology after seeing her speak. There are many, many other concepts that are major principles to what I believe to be best practice.
A big key to Sahrmann’s work is the ability to identify and prioritize your strategies based on observed patterns. Sahrmann is very focused through her role in the medical profession that the reason physicians can get away with seeing us for what we think is such a short period of time in a visit to the office is because they can quickly identify signs and symptoms that fall into a definable group of problems. If you are coughing, sneezing, and a runny nose, you have a cold, and you need a Z-pack. The symptoms were the screen or assessment. The cold is the pattern of priority, and the Z-pack is the treatment.
If you see X a lot, and Y works a lot to fix X, when you see X, do Y. You are going to be right very, very often.
When time is of the essence, the identification of patterns gets you out of the blocks sprinting. Can you see things that you typically see? And when you do, what do you know that fixed it before? It’s an educated guess, but I think we all see that the U-turns in helping people aren’t as common as some may think.
Eliminate the Bad
The first step in Sahrmann’s model for helping the individual is stop making it worse. This should sound simple, but we have all seen in our clients and patients that common sense isn’t always so common. In recent months, the most referred to article on Strengthcoach.com is Does It Hurt? Too often we are so excited to add in fantastic corrective exercises or nutritional supplements, but we forget to eliminate the stuff that hurts us like crunches, seated rows, and Snickers bars.
Sahrmann suggests that the real reason behind a painful pattern is daily, every day activities. She says it’s actually not the way you stretch before you workout. It’s not the way you let your elbows flare in the bench press or how you do your crunches. None of those things are good choice, but they may not be as harmful as simpler non-training tasks.
It’s more the way you tie your shoes or reach for the seat belt or turn the corner from the basement steps into the mudroom. When the pattern is identified as the source of the problem, it’s the daily activities that have the mindless repetition, often times for years, that manifest a painful pattern. Providing the corrective strategy should start with stopping what reproduces the bad patterns. Sahrmann says if your neck hurts when your raise your right arm, stop raising your right arm. If your right hip hurts when you turn to the right, turn like a robot until it gets better. We might be getting frustrated with our excellent corrective strategies because the every day stuff that we don’t think about is getting in the way and holding us back. That stuff has to go first, and it goes back to recognizes the pattern that causes your pain.
I have asked patients and clients to really take ownership of the changes we are trying to work on and strongly agree that daily activities can make or break the success of a corrective program.
The first regular specific change I have made is including the Craig’s Test in our Lower Quarter Screen, which we use for all low back and lower extremity patients. We are also much quicker to evaluate a training client, particular our golfers, when improvements in hip rotation are not improving.
With Sahrmann’s impression of the prevalence of anatomical changes at the acetabulum, checking for anterversion/retroversion in a quick minute or two is worth the effort.
The Craig’s Test checks the angle of -version of the hip. Testing is done prone with the knee flexed to 90 degrees. One hand palpates the greater trochanter, while the other hand rotates the hip internally and externally. The position we are looking for is when the greater trochanter is most prominent. We are going to keep that position and measure the angle between the tibia and the vertical.
Semantics seem to be confusing regarding these terms, but for these purposes, anteversion of the hip will refer to a Craig’s Test with an angle of over 17 degrees. This is the person that is always in external rotation. Pounding hip mobility into ER is going to be a poor choice. Young ladies that find success in dancing, cheerleading, gymnastics, etc. are likely anteverted like this, but develop painful patterns as they age as they continue to constantly perform extensive ranges of external rotation.
A Craig’s Test with an angle under 8 degrees will be retroversion, and that individual’s femur regularly sits in internal rotation. A Deep Squat on the FMS may never be a 3 for this individual. Rotary sports may also be met with lumbar compensation as the front side hip internal rotation may not have the excursion available to achieve big whips and ranges. A golfer may need to be coached into leaving their front foot externally rotated to prevent pathology from repetitive crashing of the femoral head into the labrum and acetabulum.
As we test for prone hip extension excursion and active sequencing, this test fits in with minimal extra effort.
This next point is somewhat an extension to eliminating bad patterns that we spoke about above. Sahrmann suggests that many sports put our body into positions that are ultimately detrimental to the integrity of our bodies. I would agree that this is debatable. I think some sports are more naturally provocative than others.
What I would not disagree with is her suggestion that in our training we should improve movement qualities that do not exist in our sports of choice. Linear sports leave us without lateral and multi-directional movement skills that we need elsewhere. If “elsewhere” happens to be our daily life, again that is where we may be creating the most damage to our bodies.
As we program, extra attention is taken to make sure we are maintaining movement patterns and excursions of the limbs that are not typically performed in particular sports. At the same time, when possible and sensible, we will train qualities that are absent in that sport all together. Basketball players deep squat. Golfers do a lot of roll-outs. Dancers and endurance athletes become powerlifters.
1-arm Overhead Presses
I will finish with something Sahrmann’s was very emphatic about, yet I have not followed her rule. She was suggesting that 1-arm overhead pressing was a poor choice second to the asymmetries caused to the cervical spine musculature.
I think if technique is appropriate and symmetrical, a 1:1 right-left ratio should quell this issue. I think there is reason for further questioning, but I think a 1-arm press stabilizes thoracic rotation mobility. I’m not so sure that gaining thoracic rotation is automatically attached to the thoracic extension that we get from 2-arm presses.
I may be missing something on this movement concern, but right now, this was something I have not changed since all of Sahrmann’s updates.
All of my notes from Dr. Sahrmann’s presentation are archived at the links below.