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Movement Impairment Syndromes

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  • Movement Impairment Syndromes

    From Shirley Sahrmann

    "...clinical studies have not supported the importance of good postural alignment to health."
    JOSPT August 2002

    Does anyone have access to this paper? I'm fascinated that so many people are correcting postural alignment based on her method...especially if she's declaring that there's no supporting evidence. I realize she focuses her work in movement impairments, but the bulk of her assessments are on static postural alignment.

    Am I missing something?

    Last edited by Karen L; 18-08-2011, 04:20 AM. Reason: link removed
    “Don’t believe everything you think.”

  • #2
    there you go
    Frédéric Wellens, pht
    «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
    «
    Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
    »
    Friedrich Nietzsche
    www.physioaxis.ca
    chroniquesdedouleur blog

    Comment


    • #3
      Am I missing something?
      Yes, you apparently missed reading the rest of her comments.

      From the article

      Though I am fully aware of the lack of evidence, I cannot imagine treating any patient without assessing posture, or more precisely, alignment.
      Christopher Bryhan MPT

      "You are more likely to learn something by finding surprises in your own behavior then by hearing surprising facts about people in general"
      Daniel Kahneman - Thinking Fast and Slow

      Comment


      • #4
        Originally posted by christophb View Post
        Though I am fully aware of the lack of evidence, I cannot imagine treating any patient without assessing posture, or more precisely, alignment.


        Last edited by Karen L; 18-08-2011, 04:20 AM. Reason: link removed
        “Don’t believe everything you think.”

        Comment


        • #5
          I wouldn't be too quick to deride her decision to look at alignment. Such findings can be helpful in providing information about a patient's preferred defense strategy to deal with the abnormal neurodynamic. It's been my experience that there are similarities in defense strategies that seem to be based on the region of the body where the complaint lies. For instance, we've all seen lateral shifts.

          Her mistake is in thinking that precise, choreagraphed movements are an effective, much less the best, way to address these defense strategies. I think that's because she thinks they are defects in and of themselves. She did a study decades ago with Marilyn Gossman looking at sarcomere length changes in rabbit muscles that had been immobilized in various positions, and then apparently had a eureka moment.

          The problem with eureka moments is that they tend to stick long after subsequent information challenges their validity. Hers has lasted over 20 years.

          Doesn't hurt that she's been invited to lecture all over the world ever since- expenses paid and then some.
          John Ware, PT
          Fellow of the American Academy of Orthopedic Manual Physical Therapists
          "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
          “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
          be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

          Comment


          • #6
            I remember reading years ago in an article by Sahrmann, (I’m paraphrasing, but just a bit):

            It is unfortunate that today’s casual lifestyle does not reinforce the discipline necessary for proper posture.
            I remember being struck by this attitude and thinking that her vision of therapy was very different than my own.

            One foot on the Mothership and one on the ramp leading to it, Sahrmann has it both ways; mesodermal tradition and a sort of new-agey approach to exercise So she’s got it all and I don’t wonder at her popularity.

            Hey, maybe we can get her to join us here.

            And maybe I can get monkeys to, well, you know.
            Barrett L. Dorko

            Comment


            • #7
              Barrett, I don't know what's up with you, but your humor just keeps getting better
              Frédéric Wellens, pht
              «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
              «
              Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
              »
              Friedrich Nietzsche
              www.physioaxis.ca
              chroniquesdedouleur blog

              Comment


              • #8
                P.S.
                Did I mention that her PhD is in neurobiology?

                What a shame.
                John Ware, PT
                Fellow of the American Academy of Orthopedic Manual Physical Therapists
                "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                Comment


                • #9
                  Originally posted by John W View Post
                  I wouldn't be too quick to deride her decision to look at alignment. Such findings can be helpful in providing information about a patient's preferred defense strategy to deal with the abnormal neurodynamic. It's been my experience that there are similarities in defense strategies that seem to be based on the region of the body where the complaint lies. For instance, we've all seen lateral shifts.

                  Her mistake is in thinking that precise, choreagraphed movements are an effective, much less the best, way to address these defense strategies. I think that's because she thinks they are defects in and of themselves. She did a study decades ago with Marilyn Gossman looking at sarcomere length changes in rabbit muscles that had been immobilized in various positions, and then apparently had a eureka moment.

                  The problem with eureka moments is that they tend to stick long after subsequent information challenges their validity. Hers has lasted over 20 years.

                  Doesn't hurt that she's been invited to lecture all over the world ever since- expenses paid and then some.
                  I freely admit looking at static alignment, dynamic posture, and quite a bit more. However, it's like you said, the difference between viewing them as a defect and defense is significant.

                  Personally, I'll take choreographed movements over interventions that are focused on muscle imbalance (stretching and strengthening). A lot of her work is distilled by NASM and "fitness gurus" to chase the over-active and under-active muscles with isolated exercises.

                  Last edited by Karen L; 18-08-2011, 04:20 AM.
                  “Don’t believe everything you think.”

                  Comment


                  • #10
                    Originally posted by Barrett Dorko View Post
                    One foot on the Mothership and one on the ramp leading to it, Sahrmann has it both ways; mesodermal tradition and a sort of new-agey approach to exercise So she’s got it all and I don’t wonder at her popularity.
                    When I read this, the first thing that came to mind was Paul Theroux's essay Tarzan is an Expatriate. Today I find out it's his birthday so I'm posting a link to the essay as a way of acknowledging it.
                    "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                    Comment


                    • #11
                      Has this approach (MIS) been deconstructed somewhere? Older threads? Other websites/forums? A quick search revealed some minor threads but nothing substantial..
                      Anders.
                      "There is nothing so practical as a good theory." -Kurt Lewin

                      Comment


                      • #12
                        Seems like we've discussed this before. Try looking for "Sahrmann" and "muscle balance." That may be a more fruitful search.
                        Cory Blickenstaff, PT, OCS

                        Pain Science and Sensibility Podcast
                        Leaps and Bounds Blog
                        My youtube channel

                        Comment


                        • #13
                          Dissertation by Hannu Luomajoki

                          "Movement Control Impairment as a Sub-group of Non-specific Low Back Pain Evaluation of Movement Control Test Battery as a Practical Tool in the Diagnosis of Movement Control Impairment and Treatment of this Dysfunction"

                          http://epublications.uef.fi/pub/urn_...-61-0192-7.pdf
                          Anders.
                          "There is nothing so practical as a good theory." -Kurt Lewin

                          Comment


                          • #14
                            regnalt deux,
                            I think you are missing your APTA membership.

                            I think the take home message from Sarhmanns work is that 3 people with the same medical diagnosis (ie: hemiplegia) can have 3 completely different sets of impairments and 3 different best treatment approaches. Classifying patients by their unique impairments is the real issue she is talking about, her methods for treating patients is not the focus of her articles.

                            Comment


                            • #15
                              Classifying patients by their unique impairments is the real issue she is talking about, her methods for treating patients is not the focus of her articles.
                              Which research articles are you referring to? She and her colleagues at Wash. U. have published several articles describing her approach for treating a variety of MSK pain problems where the treatment methods were certainly the focus of the articles. Off the top of my head, I've seen case reports (a form of research paper) on everything from cervicogenic HA to patellofemoral pain being treated according to the methods described in the MSI approach.

                              By the way, what does reg's APTA membership status have to do with anything? This sounds like an ad hom. to me.
                              John Ware, PT
                              Fellow of the American Academy of Orthopedic Manual Physical Therapists
                              "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                              “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                              be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                              Comment

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