The Tim Ferriss Show
#685: 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
Episode guests
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Quick takeaways
- Identifying and changing movement patterns can reduce pain and improve function.
- Assessing alignment and movement patterns provides a clearer understanding of underlying issues.
- Targeting specific muscles can alleviate movement-related pain by releasing tension and improving flexibility.
- Individualized treatment plans tailored to specific needs and goals can achieve long-term relief and improved function.
Deep dives
Identifying the Path of Least Resistance
The body follows the path of least resistance, and identifying this path is crucial in addressing movement-related pain. By pinpointing the specific movements that exacerbate symptoms, such as excessive lumbar flexion or inadequate hip mobility, individuals can work towards changing their movement patterns to reduce pain and improve function.
Examining Alignment and Movement Patterns
Assessing alignment and movement patterns is an essential part of the evaluation process. This includes observing an individual's standing posture, assessing their ability to forward bend, rotate, and side bend, and identifying any asymmetries or restrictions. By examining how these movements relate to the individual's symptoms, a clearer understanding of the underlying issues can be gained.
Addressing Muscle Imbalances
Muscle imbalances play a significant role in movement-related pain. Targeting specific muscles, such as the psoas and iliacus, tensor fasciae latae, and external obliques, can help alleviate symptoms by releasing tension and improving flexibility. Gentle exercises and stretches that elongate these muscles can be incorporated into everyday activities.
Individualized Treatment and Management
Each individual's treatment plan should be tailored to their specific needs and goals. This may involve a combination of manual therapy, targeted exercises, and postural modifications. By actively involving the individual in their own care and empowering them to make positive changes in their movement patterns, long-term relief and improved function can be achieved.
Importance of Movement and Proper Alignment
The podcast episode emphasizes the significance of movement in maintaining overall health and preventing physical disabilities. It highlights the importance of proper alignment and how it affects various parts of the body, such as the spine, shoulders, and hips. The speaker suggests that everyday activities and exercise routines should be done with mindfulness to prevent and address movement-related issues.
Addressing Shoulder Alignment
The podcast discusses the common problem of "wearing the shoulders too low" and suggests corrective measures. It explains that the shoulders should be positioned higher, with a slight upward angle of the clavicle. The speaker recommends using exercises that engage the serratus anterior muscle to help support and align the shoulder blades properly. These exercises aim to improve shoulder positioning, reduce strain on the neck, and minimize the risk of shoulder injuries.
Understanding Stretching and Muscle Stiffness
The podcast delves into the concept of stretching and challenges the traditional belief that muscles need to be lengthened when certain movements are restricted. Instead, the speaker suggests focusing on improving stiffness, which is often the underlying issue. They explain that relative stiffness problems can be addressed by strengthening associated muscles or addressing factors contributing to muscle shortening. Additionally, they emphasize the importance of understanding what activities cause muscle shortening and addressing those underlying causes.
The Importance of Individualized Approach
The podcast emphasizes the need for an individualized approach to movement and exercise. It highlights the importance of considering structural variations, such as femoral retroversion, when designing exercise routines or addressing movement-related issues. The speaker suggests that exercise programs should be tailored to an individual's specific needs and limitations, taking into account their unique body structure and movement patterns.
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Resources from this episode: https://tim.blog/2023/08/04/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 Extremities, Cervical and Thoracic Spines, has been equally influential in promoting movement diagnoses.
Please enjoy!
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[07:12] A brief terminology primer.
[13:00] Why Shirley's first book is so influential among physical therapists.
[15:54] The correlation between lifestyle and health hasn't always been obvious.
[18:16] Low back pain: not a diagnosis, but a symptom.
[20:41] The trouble with overdeveloped abdominals.
[22:32] What's my problem?
[30:14] The Movement Systems Syndromes (MSS) approach.
[31:29] The wrong walk home.
[33:01] Correcting bad habits.
[35:00] Psoas it goes.
[37:03] Other commonly repeating culprits.
[40:36] Pump handle and bucket handle.
[43:41] The body follows the path of least resistance.
[48:00] Anterior superior iliac spine (ASIS)
[49:20] How Shirley examines a new patient.
[55:11] Assessing athletes vs. non-athletes.
[56:18] Dynamic neuromuscular stabilization (DNS)
[57:49] Collapso-smasho and squeezo-smasho.
[59:10] Correcting low shoulders.
[1:05:26] Stretching: yes or no?
[1:09:56] Addressing my abdominal stiffness.
[1:16:28] When the spine doesn't want to go along for the ride.
[1:18:38] How has Shirley made it to 86 with her physical and mental health intact?
[1:34:32] What men should know about femoral retroversion.
[1:38:44] If it walks like a duck...
[1:41:11] Managing symptoms of Scheuermann's disease.
[1:42:49] Parting thoughts.
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