Dr. Shirley Sahrmann — A Legendary PT Does a Deep Dive on Tim’s Low-Back Issues, Teaches How to Unlearn Painful Patterns, Talks About Movement as Medicine (or Poison), and More (#685)

“Usually the problem is that motion that’s problematic is occurring during all of your activities. The body follows the rules of physics. It takes the path of least resistance. So if it’s easy to move there, it keeps moving there, and that’s what you’re trying to change to make it easier to move at other places where you should be moving more.”

— Dr. Shirley Sahrmann

Shirley A. Sahrmann, PT, PhD, is Professor Emerita of Physical Therapy at Washington University School of Medicine in St. Louis, Missouri. She received her bachelor’s degree in physical therapy and her masters and doctorate degrees in neurobiology from Washington University, where she joined the physical therapy faculty and became the first director of their PhD program in movement science.

Shirley became a Catherine Worthingham Fellow of the American Physical Therapy Association in 1986 and in 1998 was selected to receive the Mary McMillan Award, the Association’s highest honor. She is a recipient of the Association’s Marion Williams Research Award, the Lucy Blair Service Award, the Kendall Practice Award, and the Inaugural John H.P. Maley Lecturer Award.  

She has also received Washington University’s Distinguished Faculty Award, the Distinguished Alumni Award, the School of Medicine’s Inaugural Distinguished Clinician Award, and an honorary doctorate from the University of Indianapolis. She has also received the Bowling-Erhard Orthopedic Clinical Practice Award from the Orthopaedic Academy of the APTA. She has served on the APTA Board of Directors and as president of the Missouri Chapter.

Her first book, Diagnosis and Treatment of Movement Impairment Syndromes, has been translated into seven languages. Her second book, Movement System Impairment Syndromes of the Cervical and Thoracic Spines and the Extremities, has been equally influential in promoting movement diagnoses.

Please enjoy!

Listen to the episode on Apple Podcasts, Spotify, Overcast, Podcast Addict, Pocket Casts, Castbox, Google Podcasts, Amazon Music, or on your favorite podcast platform. You can watch the interview on YouTube here.

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Want to hear an episode with someone who considers Dr. Sahrmann’s work a great influence? Listen to my conversation with performance coach Eric Cressey in which we discussed why pinpointing the cause of lower back pain can be so challenging, how seemingly unrelated meds can exacerbate pain, addressing and correcting suboptimal patterns of movement, improving thoracic mobility, defusing deskbound damage, how to ask the right questions when seeking treatment for what ails you, and much more.

What was your favorite quote or lesson from this episode? Please let me know in the comments.

SCROLL BELOW FOR LINKS AND SHOW NOTES…

SELECTED LINKS FROM THE EPISODE

• Connect with Dr. Shirley Sahrmann:

2023 Speaking and Course Schedule | LinkedIn

• Essential Anatomy 5 iOS app
• Essential Anatomy 5 Android app
• Diagnosis and Treatment of Movement Impairment Syndromes by Shirley Sahrmann | Amazon
• Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines by Shirley Sahrmann | Amazon
• The Shoulder Joint | TeachMeAnatomy
• Becoming a Physical Therapist | APTA
• What is Translational Research? | UAMS Translational Research Institute
• The Vertebral Column | TeachMeAnatomy
• Ilium | Physiopedia
• Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance | American Journal of Neuroradiology
• Pelvic Tilt | Physiopedia
• Lumbar Spinal Stenosis | Johns Hopkins Medicine
• Traction: Types, Risks, and Aftercare | Healthline
• Relative Stiffness: What You Know, What You Don’t, and Why It Matters | MedBridge Blog
• Tensor Fascia Latae (TFL) | Physiopedia
• Hip Flexors | Physiopedia
• Hip Abductors | Physiopedia
• Hip Adductors | Physiopedia
• Piriformis | Physiopedia
• The Finer Points of the Quadruped Position | Functional Movement Systems
• How to Wall Sit: Techniques, Benefits, Variations | Verywell Health
• Prone vs. Supine vs. Prostrate | Merriam-Webster
• Human Movement System: Our Professional Identity | Physical Therapy
• What Is Metabolic Syndrome? | Johns Hopkins Medicine
• Lumbopelvic Rhythm | Physiopedia
• Anatomy Of The Psoas & Iliacus Muscles | Dr. Nabil Ebraheim
• Femoroacetabular Impingement | AAOS
• A Comprehensive Guide to the Infrasternal Angle & Compensation Layers | Conor Harris
• Pump Handle Motion and Bucket Handle Motion | MedicoPhysio Actors
• Should Lumbar Support Be Positioned on Your Higher or Lower Back? | Autonomous
• Moving Precisely? Or Taking the Path of Least Resistance? | Physical Therapy
• Pilates: What It Is and Health Benefits | Cleveland Clinic
• Anterior Superior Iliac Spine (ASIS) | Wikipedia
• Quadratus Lumborum | Physiopedia
• External Abdominal Oblique | Physiopedia
• Paraspinal Muscles | Physiopedia
• Chronic Pain | Johns Hopkins Medicine
• Linda Van Dillen’s Research Profile | Washington University School of Medicine
• Enhancing The Movement System | Performance In Motion
• Peter Attia & Beth Lewis on Dynamic Neuromuscular Stabilization (DNS) | The Peter Attia Drive
• Dr. Shirley Sahrmann: Midlife Evaluation | St. Louis Magazine
• Shirley Sahrmann’s Lumbar Flexion Syndrome | Physiopedia
• The Confusing Concept of “Poor Posture” | Mobility Fit Physical Therapy
• Serratus Anterior | Physiopedia
• Latissimus Dorsi Muscle | Physiopedia
• How to Train Your Trapezius Muscle: Exercises & Workout | StrengthLog
• Stretching 101: Advantages and Disadvantages of Stretching | The Movement Athlete
• Kyphosis | Johns Hopkins Medicine
• Stretches for the Rectus Abdominis | eHowFitness
• Hip Bridges Are One of the Best Glute-Burning Moves — Here’s Why | Byrdie
• Shirley Sahrmann on Exercise and Aging Well | Physiospot
• Flexor Digitorum Profundus | Physiopedia
• How to do a Modified Push-Up | NASM
• Anterior Cruciate Ligament (ACL) Injuries | AAOS
• In-Toeing and Out-Toeing: Femoral Anterversion & Retroversion | SIM Physiotherapy
• What Is The Par Terre Position? | SportsLingo
• Scheuermann’s Kyphosis | Physiopedia
• Lordosis, Kyphosis, and Scoliosis: Know the Differences | Skoliosis
• AMA #41: Medicine 3.0, Developments in the Field of Aging, Healthy Habits in Times of Stress, and More | The Peter Attia Drive #231

SHOW NOTES

Editor’s Note: Timestamps will be added shortly.

• Why Shirley’s first book is so influential among physical therapists.
• The correlation between lifestyle and health hasn’t always been obvious.
• Low back pain: not a diagnosis, but a symptom.
• The trouble with overdeveloped abdominals.
• What’s my problem?
• The Movement Systems Syndromes (MSS) approach.
• The wrong walk home.
• Correcting bad habits.
• Psoas it goes.
• Other common culprits.
• Pump handle and bucket handle.
• The body follows the path of least resistance.
• Anterior superior iliac spine (ASIS)
• How Shirley examines a new patient.
• Assessing athletes vs. non-athletes.
• Dynamic neuromuscular stabilization (DNS)
• Collapso-smasho and squeezo-smasho.
• Correcting low shoulders.
• Stretching: yes or no?
• Addressing my abdominal stiffness.
• When the spine doesn’t want to go along for the ride.
• How has Shirley made it to 86 with her physical and mental health intact?
• What men should know about femoral retroversion.
• If it walks like a duck…
• Managing symptoms of Scheuermann’s disease.
• Parting thoughts.

MORE SHIRLEY SAHRMANN QUOTES FROM THE INTERVIEW

“One of the things I always loved doing with patients was saying, ‘So, who taught you to walk?’ They say ‘Nobody.’ I say, ‘That’s the problem.’ Just because you’re doing it doesn’t mean you’re doing it right. You’re just doing it.”
— Dr. Shirley Sahrmann

“Exercise won’t change the way you move. You have to change the way you move, and that can improve how muscles function.”
— Dr. Shirley Sahrmann

“Nothing is more scary than ‘Here comes the pain. What did I do? How did I do it? How do I get out of it?” And if you’re showing people, if you go this way, it hurts, if you do it this other way, it doesn’t hurt … they’re in charge of [their symptoms], and they know what to do to decrease them.”
— Dr. Shirley Sahrmann

“Usually the problem is that motion that’s problematic is occurring during all of your activities. The body follows the rules of physics. It takes the path of least resistance. So if it’s easy to move there, it keeps moving there, and that’s what you’re trying to change to make it easier to move at other places where you should be moving more.”
— Dr. Shirley Sahrmann

“You want to chase your center of gravity, not pull it.”
— Dr. Shirley Sahrmann

“It’s not inevitable what’s going to happen to you. you can do things via lifestyle to improve what your outcome’s going to be.”
— Dr. Shirley Sahrmann

“At least 70 percent of the people with back pain, it’s because their hip’s not moving optimally.”
— Dr. Shirley Sahrmann

PEOPLE MENTIONED

GLOSSARY

Pathology https://en.wikipedia.org/wiki/Pathology

Glenohumeral joint https://en.wikipedia.org/wiki/Shoulder_joint

Glenoid cavity https://en.wikipedia.org/wiki/Glenoid_fossa)

Humerus https://www.merriam-webster.com/dictionary/humerus)

Facet joint https://en.wikipedia.org/wiki/Facet_joint

Iliac crest https://en.wikipedia.org/wiki/Iliac_crest

Stenosis https://en.wikipedia.org/wiki/Stenosis

SI joint https://en.wikipedia.org/wiki/Sacroiliac_joint

Tensor fasciae latae (TFL) https://en.wikipedia.org/wiki/Tensor_fasciae_latae_muscle

Iliotibial band https://en.wikipedia.org/wiki/Iliotibial_tract

Piriformis muscle https://en.wikipedia.org/wiki/Piriformis_muscle

Psoas major https://en.wikipedia.org/wiki/Psoas_major_muscle

Psoas minor https://en.wikipedia.org/wiki/Psoas_minor_muscle

Infrasternal angle https://en.wikipedia.org/wiki/Infrasternal_angle

Lumbar spine https://en.wikipedia.org/wiki/Lumbar_vertebrae

Thoracic spine https://en.wikipedia.org/wiki/Thoracic_vertebrae

Intercostals https://en.wikipedia.org/wiki/Intercostal_muscles

Labrum https://en.wikipedia.org/wiki/Glenoid_labrum

Quadratus lumborum (QL) https://en.wikipedia.org/wiki/Quadratus_lumborum_muscle

Paraspinal muscles https://www.physio-pedia.com/Paraspinal_Muscles

Latissimus dorsi https://en.wikipedia.org/wiki/Latissimus_dorsi_muscle

Rhomboids https://en.wikipedia.org/wiki/Rhomboid_muscles

Kyphosis https://en.wikipedia.org/wiki/Kyphosis

Lordosis https://en.wikipedia.org/wiki/Lordosis

Rectus abdominis https://en.wikipedia.org/wiki/Rectus_abdominis_muscle

Supine vs. prone position: Supine is lying on your back. Prone is lying on your stomach.

Gluteus medius https://en.wikipedia.org/wiki/Gluteus_medius

Medial rotation https://en.wikipedia.org/wiki/Anatomical_terms_of_motion

Lateral rotation https://en.wikipedia.org/wiki/Anatomical_terms_of_motion

Femoral retroversion https://www.hss.edu/condition-list_hip-femoral-retroversion.asp

Scheuermann’s disease https://en.wikipedia.org/wiki/Scheuermann{1652eb1ffa4184925f6a63a9c04ea6b421acb7a78117241e7d4325cdca8339fa}27s_disease

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