Shirley Sahrmann Workshop, Day 1 Notes

1. The charisma that I think is so beneficial to be a leader in our profession was clear in the first 5 minutes. A friendly arrogance similar to Stuart McGill was something I appreciated very much. She was a fantastic presenter and engaging.2. A 2nd book is coming out on the neck, t-spine, elbow, wrist, knee, and ankle. Maybe next year3. People don't move right.4. Her Movement Syndromes are a collection of signs and symptoms. It's the same way medical doctors assess so quickly.5. Movement Syndrome Impairment has a) a cause, b) a tissue and/or motor control component, c) a cluster of signs & symptoms, d) a direction to intervene not based on pain, and e) distinction of the cause and source of pain6. Bad movement causes something to be the source of pain.7. PTF Syndrome is bogus. Yes, she used the word bogus.8. Everyday activities are the root of all MSI; they are modifiable mechanics9. Recognize patterns in movement. This was a big deal to her.10. Physicians rarely do physical exams. Physical therapists should do them. I take this to continue to all clinicians that supervise physical activity.11. The movement system is constantly changing from birth. She made mild references to the NDT patterns that the FMS and SFMA are based on, but did not mention them by name.12. Postures change tissues.13. Direction of Suseptible Movement & contributions to MSI = the diagnosis14. 4-5 deg of pelvic rotation = shearing and translation15. Kendall wasn't quite right about TFL always being short. It doesn't really matter that much.16. Always find the DSM- what is moving too much17. Correcting MSI doesn't take nearly as long as it takes to create them. That is a good thing.18. Her closest use of ultrasound is her ultrasound toothbrush.19. She stole one of my car to body analogies. She said the tires wear out only because the allignment is bad.20. PICR = path of instanteous center of rotation; wrong force couples change this in a negative way21. Pronated foot = hip problem; Supinated foot = entire kinetic chain problem22. 6 hip ER are more important than the glutes to control femoral IR; she never really got into why, but I agree with their importance much like the rotator cuff's importance in conjunction with the deltoid force couples23. Sitting on machines training wastes an excellent opportunity to train the core and causes MSI if that is all you do24. # of sarcomeres in parallel is what matters as hypertrophy develops as a function of stiffness25. Best way to strengthen is plyometrics in the form of eccentrics26. You can't just strengthen a muscle and expect it to do the right thing.27. Long leg sit-ups are done with concurrent flexion and extension (to the keep the legs down) of the hips; this neutralizes pelvic control and leaves the spine to do the movement; nice example of how the hips take over stability, and core becomes mobile28. Adding sarcomeres in series is the way to make muscles longer; she didn't mention, but I thought swimmers right away - they train through long motion, thus “long” muscles - you can't get more sarcomeres without resistance training; strength in long positions = more sarcomeres in series = length29. Muscles test 1) weak, 2) painful, 3) long, or 4) short30. Stretching gets you 10-15% increase in length maximum; moving long gets more sarcomeres; that is the better approach, not stretching31. Stiffness by definition is good = change in tension over change in length32. Gymnasts and figure skaters are a mess by the time they are older; she did not mention Tim Vagen, but as usual, he is right33. Pelvic tilt is the ultimate consideration of the core; she didn't mention upper- and lower-crossed by name, but this is what she was describing34. Pelvic tilts are not a function of length, but rather relative stiffness of all the structures (of the myofascial slings - lots of similar principles by different names)35. Muscle stiffness comes from titin and extracellular matrix - only comes from hypertrophy36. Standing back to the wall is one of the best exercises you can do. I have been doing this for some time with many people. It is always cool when you surmise something on your own, and one of the great ones sign off on it37. Psoas overactivity is the cause of most back pain since it it is the only muscle that attaches to the vertebrae and pelvis38. DL can be precarious with individuals with a long trunk or supinated foot because of a lack of DF.39. People that lean forward a lot better have strong glutes.40. 5 degrees of knee deviation in resting stance is a Clinical Prediction Rule for knee DJD (author-Sharma)41. Minimal tibial length differences - many femoral length differences - minimal relative trunk length differences -- increased trunk length will impact LBP through squatting exercises42. Wolff's Law = bony changes in response to postural stress - causes ligamentous stress-strain43. 6 hip ER can't get tight; they are not the reason for Anterior Femoral Glide Syndrome - never stretch piriformis44. She does not believe in mobility before stability. I'm not 100% sure if that is true, but her approach falls more in the integration pattern. There is no isolated mobility/stretching training. She is just settled on getting people out of pain quickly. Enhancing the machine applies more the Functional Movement approach.45. She called out PT's as not knowing how to properly exercise people.46. Aerobic exercise 3x/week decreases dementia.47. Uses Arm Rolling primitive pattern as Gray and Lee demonstrate (obviously in different context).48. “Sit-ups are completely ridiculous.”49. “I don't care about muscle length. I care about how you cheat.”