Welcome back to the Healing Pain Podcast with Shirley A. Sahrmann, PT, PhD, FAPTA

For physical therapy to be truly effective in addressing body pain, it must not only concentrate on structure alone. Instead, it must go beyond that and also involve the entire movement system. Dr. Joe Tatta sits down with the pioneer of this very concept, Shirley A. Sahrmann, PT, PhD, FAPTA. She explains how the movement system redefines physical therapy by classifying movement impairments into diagnostic categories. Sahrmann discusses how a kinesio-pathology approach can provide a better look into a person’s psychosocial factors and produce a better diagnosis. The two also discuss how to dismiss PT stereotyping of being medical cheerleaders and the right way to navigate PTA’s reimbursement cuts to their practice.

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How To Use The Movement System To Treat Pain with Shirley A. Sahrmann, PT, PhD, FAPTA

In this episode, we’re discussing the application of the movement system in physical therapy and pain management. Human movement can be defined as a complex behavior that occurs within a specific context that is influenced by social, environmental, as well as personal factors. The movement system is the integration of multiple body systems that generate and maintain movement and human function. The concept of the movement system and movement impairments was pioneered by our guest, Dr. Shirley Sahrmann. Shirley is a fellow of the American Physical Therapy Association and has had a worldwide influence on the practice of physical therapy through her seminal contributions to the approach to diagnosis and intervention.

She has led the charge to define movement and the movement system as the core focus of the physical therapy profession. She was the first to classify movement impairments into diagnostic categories. This episode on the movement system has applications to musculoskeletal pain, neurologic conditions, integrative healthcare, lifestyle medicine, and for the management of a chronic disease. Without further ado, let’s begin and learn all about the movement system with Dr. Shirley Sahrmann.

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Shirley, welcome to the show. It’s great to have you here.

Thank you. I’m pleased that I have this opportunity to talk with you.

I’m excited and many ways honored to speak with you about movement, being a physical therapist, and the movement system. Early on in my career, I took your courses. They helped shape the therapist I am now and a lot of the ideas about the human body, how we can improve both structure and function, and improve movement and disability in people. We’re going to talk about the movement system. Tell me how this conceptualization of the movement system first started for you.

I’m not calling it a system, but the movement started way back in 1980 before you were born.

I was born in 1973. I appreciate that I look younger.

At that time, I was running for the APTA Board of Directors. It was obvious to me and everything I did. I started with the polio patient progressed to the neurological patient and then inadvertently to the musculoskeletal patient. What we were all about was movement. Not only did we identify how it was problematic, but we also used it to treat patients. I was greatly influenced by Steve Rose, who unfortunately had an untimely death. He was a prescient individual and came to be Director at Washington University. He was all for both classification and defining movement and was tuned to his idea of pathokinesiology. Over time, rather than thinking about pathological influences on disrupting movement, it became much more obvious how movement induces pathology.

Our big future role is not just worrying about somebody having a lesion or a disease and therefore we come in and treat symptoms. Though I wasn’t around for Mary McMillan, I was around shortly afterward. What’s changed substantially is that physical therapy was all about treating symptoms and then the condition would heal and then the person could get on and carry on forever. What do we know if the conditions reoccur? What we know now with almost every medical condition is chronic.

Yet in some ways, we’re still operating like they’re acute problems. You get six visits and never to be seen again. Part of my career, after I got my PhD and while getting my PhD, I was in the Department of Neurology. It became clear that when you are in a department like that, that’s well defined, that being responsible for a system of the body is the way the practitioner has respect.

We’re handicapped by being therapist who have started their life with the physician figuring out what the problem is, telling us what it is, and in my day, telling us what to do except for the neurological patient, which is why I like treating them. Nobody could tell me what to do because they didn’t know and, in many ways, didn’t care. It also was my insight into the label the physician puts on it is not a label that’s useful to me at all. Saying somebody was hemiplegic, I was pretty able to figure that out by myself. Putting all that together over the years and working with some super fine people at Washington University, we came up with the idea that that it isn’t just movement. In fact, all of us in in the world of physical therapy would carve out a silo, musculoskeletal, neurological, cardiopulmonary.

Believe it or not, most of musculoskeletal treatment was stretching and strengthening. I don’t know whether it was in part because I spent a long time in the nervous system, in fact, getting my PhD in Neurobiology, I was going to solve the problems of spasticity, which is probably why I do musculoskeletal because that has not worked out well. The nervous system played a really big role in musculoskeletal disorders. That meant that we need to worry about the systems and the biomechanics. We need to know about the bioenergetics and the biocontrol. Importantly, we need to define a system of the body about which we were an expert.

That to me is the real key. If we’re people who deliver services for some region of the body after the position figures out what’s wrong, we’re short changing our contributions to the health of society. That to me is the big aspect of why the movement system is important. It’s a physiological system of the body. I know there’s some pushback because it’s not a musculoskeletal system. It’s not the nervous just system, a basic physiological system, but neither of the immune system. It’s a system of systems, like the movement system and metabolic system. You want to talk about important systems, you can’t get any more important than the immune system because almost every condition that people have now seems to be somehow related to the immune system.

It made sense to me that as practitioners, we should be identified with a body system so that we have recognition like other respected healthcare practitioners. We should spell out clearly where our expertise is. The other thing I like about it is there’s probably no system that runs the gamut of the body. Maybe the immune system, like from where synaptic transmitter is flowing, ions are going through membranes. Whether you can move one part of your body, your whole body, or out in the environment, it runs through all levels of the body. Nothing’s out of contention for our attention in research or practice. It’s all there. What could be more important than moving?

 

You’ve brought a lot of history into the conversation if I start to read into that. If we go back into our history as physical therapists starting out as “techs” potentially under a physician, the physician prescribed what we were to do. We’re using an intervention. We deliver the intervention. The doctor had control over what we did or for how long we did it. That was it. It was wrapped up. It was gone. What you’re saying, and I do appreciate this part of it, is that a neurologist, for example, is an expert in the nervous system. An endocrinologist is an expert in endocrinology. Physical therapists, you’re saying, should be the experts in the movement system.

It’s that easy. You got it. What is the movement system? That’s the other part of it.

I know you have conceptual models of this. Break down the components of the movement system for us. The truth is, and you know this Shirley, is that the movement system is not something that they’re talking about or necessarily educating about in medical school. They’re looking at neurology, orthopedics, endocrinology, pediatrics.

They weren’t looking at the immune system either, and they weren’t looking at the metabolic system if you go back far enough. They didn’t know about it either. They also don’t look at a lot of things the dentist does. They look at what they need to do. Would they like to look at what we’re doing? Yes. It’s our responsibility to fer it out and to demonstrate to them how important it is. One of the things we suffer from dramatically is a lack of respect for how complex exercise and movement is. Believe it or not, Joe, I had referrals for shoulder pain problems where they said nothing for the scapula, just the rotator cup. I didn’t want to break it out and say, “It’s on the scapula for you and mess you all up.”

There is a growing interest in the physician community for understanding better what we do. Particularly the people that Paula Ludwick works, that orthopedic surgeon says we need the physical therapist to give us some insights, a movement diagnosis, because there is no such thing as a shoulder impingement. They’re waiting on the brink. It’s our responsibility to bring that information to them. How else are they going to know it. The big thing that’s different between ourselves and an orthopedic surgeon is one orthopedic surgeon can look at the distal end of the femur and replace the knee and another orthopedic surgeon could look at the proximal end of the femur and replace the hip and not too carefully. I’ve seen mess ups from that.

What is it that we do? We look at the whole picture. How does the whole body impact that joint? How is that joint impacted by the whole body? They’ve got enough to do. They can handle it with one MRI. We’ve got to handle it by looking at the whole system. I’m not put off by the fact that they don’t know what we’re going to do, but I know they’re smart and they can learn. They will be willing to learn once we make a case. That’s what we’re doing these days, more so than in the past. How much anatomy do medical students take now? There’s the lower limb and here’s the upper limb.

I’ve even heard schools getting rid of things like gross anatomy and things like that. That’s wrong. All health professionals probably could dive into gross anatomy and benefit from it in some way. Obviously, PTs need it. We should stay with that.

That’s our lifeblood. Before, physician practice was anatomically locations. They were switching to more biochemical problems way back then in the 1950s. Now, it’s who cares about anything that’s as big as the cell? They’ve got their own thing. I even think about how sad it is for a physician who’s a general practitioner, an internist, because there is so much to know, just like I was saying before. If I want a knee replaced, I want to go to that one guy, but I’m not sure I want to find out whether that knee should be replaced by going to that one guy. My uncle got a new knee for spinal stenosis. I know what that’s about. I’m not put off by the fact that physicians don’t know. It’s my responsibility to make a case so that they want to know.

What are the parts of the movement system as you have outlined it?

The major components are obviously the musculoskeletal system. That produces the movement, the nervous system, which is the regulator of the system. In fact, that takes care of the biopsychosocial and psychosocial aspects too, because you can’t have psychosocial anything without the nervous system.

I always think about the endocrine cardiovascular pulmonary systems as the support systems for that system. In other words, they don’t produce movement, but they keep those other systems viable. They’re affected by movement. You can bring in anything you want to bring in. You can bring in the GI tract and the GU tract. That’s all well and good, but those are going to be less influential kinds of impacts on movement than these main systems. I’m open to anything. Whatever cause or part that people want to bring into it, I’m all for it.

It’s how the other systems of the body can be brought in to impact the movement system.

Influence movement. We don’t want to confine ourself to just movement because we need to take care of the components that produce movement.

 

Meaning, if you eat a poor diet, obviously, that could be considered the gastrointestinal system. At the end of the day, the three key components are the neuromuscoloskeletal system and how those interact together. The psychosocial, which is prevalent nowadays, a lot of noise around that, you have nervous system in there. It’s in there. If we stretch a little, because people are starting to venture out into lots of different interesting areas. Our profession’s huge. Depression, which is a mental health condition would be embedded in the nervous system in that component of your model.

There’s a lot of people that say if they were more physically active, they wouldn’t be so depressed.

Many people believe that if they were more physically active, they wouldn't be so depressed. Click To Tweet

We now know that exercise can have an equal potency to cognitive behavioral therapy or antidepressant medication for those with mild to moderate depression.

To me, why we should be all over it is exercise plays a role whether you have cancer or you have dementia. It runs the gamut. Yet, sadly, in my mind, I don’t think it’s just in my mind, we are not looked at as exercise experts.

Not so much.

It’s not going to be that I want to stand around counting to ten for somebody, but I want to be the one that says, “This is what you need to do. What you’re doing matches with what your structural variations are. You’re doing the right way. You’re going to make a change in your life. Come see me. Let’s get it sorted out as to what would be good for you. We should be the first hand on what is that exercise program? What sports do you want to participate in? Are you suited for it or not suited for it?”

From here, you’ve then started to look at movement system impairments and syndromes. Tell us about how that has started to evolve and where that work has gone.

It all started again with Steve Rose. He came in committed to wanting to do classifications. It ended up modifying the McKinsey approach. He called it treatment-based classification. Picking out a pathoanatomical explanation like McKinsey did. He named it for treatment methods. Tony Delitto worked on that after Steve’s untimely death. Meanwhile, I was seeing patients because of Steve. He asked me to take a look at patients with them. I got more intrigued about how movements were inducing symptoms. The movement look impaired to me. It wasn’t matching up to the industry standard. We started then changing the movement, and then the symptoms decreased and often went away.

Happily, Linda Van Dillen’s done a lot of documentation of this with her research. Also, the other thing that was occurring that we could observe was it wasn’t just moving the back itself, for example, with lumbar spine, but moving the extremities that caused the back to move. It became clear and clear that here were movements affecting the back and causing the symptoms, and we could modify them. Again, my experience in neurology was that by having a label for a condition, we were setting up pattern recognition, which is certainly the difference between a novice and an expert. To carry that on, we started naming the condition for the movement that induced the symptoms. When we modified the movement, the symptoms decreased or were eliminated. That was a pretty simplistic, non-brainy way of approaching the problem.

We’ve continued to work on that. I find it pretty awful that all of the documents that the APT has, the requirements for graduation, are to be diagnosticians, but there’s not one diagnosis that we have said you need to make. How can you be a diagnostician if you don’t have any diagnosis? I don’t know how you can be a movement expert when nobody knows what an expert is. Joe, you know as well as I do that the biggest undermining factor in our profession is unwarranted variation in practice.

You can heat somebody up, cool them down, exercise and pray over them. It all counts. Talk to them, whatever you want to do. It doesn’t matter because there are no rules. That’s why I’m keen about, here’s the movement system and the diagnosis should be movement system diagnosis. Like the neurologist makes a nervous system diagnosis, the cardiologist makes a cardiac diagnosis. We make a movement system diagnosis. It should be movement related, just like the others are nervous system related or cardiac related.

If I’m following you on this, every condition would have impairments associated with it. Right now, the orthopedic surgeon refers a patient to me with shoulder impingement, but that’s the same.

Shoulder pain is even more complicated.

We then do a complete in many ways full body examination, at least upper quarter, hopefully. Also, looking at all the other factors in someone’s life, their health, their wellbeing, their psychosocial factors. From that, you develop an impairment-based diagnosis. In some ways, it almost sounds like the DSM-5, which is what mental health providers use. They have taken clusters of symptoms and then created diagnoses from them. Similar to that. In their world, those symptoms and clusters don’t necessarily always [0:20:48.7]

The advantage we have that the DSM doesn’t have is that we have kinesiology, which is nice because if we’re going to talk about movement, there are relationships. You can’t take the nervous system and say a problem in this part of the brain necessarily affects the other part of the brain in a defined way. They had to take behaviors and try to put them together. Behaviors don’t stay too well organized. We have it much easier because we’ve got kinesiology, MRIs that tell us about things, structural variations, and things that tell us about muscular performance that we can observe in movement performance. Even these days, you’ve got a phone that records video so you can see things. We have it a lot easier than those poor psychologists and psychiatrists.

Movement is all about relationships. Problems in the nervous system affect other parts of the brain. Take all of these behaviors and put them together. Click To Tweet

My question for you would be, is movement a behavior?

It’s pretty hard to say. It isn’t. You can’t see it behaving.

I 100% think movement is a behavior.

It’s a physiological manifestation.

It’s a key behavior that many practitioners overlook, including mental health providers at times.

I don’t doubt it. There are also many things about behavior and mental function that we can’t appreciate because that’s not our area of spending years and years learning about it either.

Although there are more and more therapists interested in things like pain psychology and mental health physical therapy that are happening around the world, it’s interesting to start to think about how the movement system could start to encompass some of those growing specialties. The nervous system is embedded in there. It goes any direction you want to go in.Why do you think that the powers that DPT programs, the APTA, why have we not got together and said, “Let’s come up with our own DSM type manual for these types of things?” I know this is your life work, Shirley.

To me, it’s upsetting because in 2013, the APTA adopted the movement system as its identity. They had a board work group, a task force, and a summit. They had a call for diagnosis. Ninety diagnoses were sent in. An intake exam was also developed. I have not been able to find out. Unfortunately, two things happened that were problematic. 1) The pandemic came on. 2) The APTA was moving into new quarters. The powers that be weren’t as keen. Unfortunately, Joe, and you’re part of trying to be interested in another aspect, is it’s hard for people to stop what they’ve been doing for 100 years and look at things in a new way. It’s worked for us for 100 years. It’ll work for us for another 100.

I don’t believe that at all. We’re in deep trouble. The decrease in reimbursement is a big reflection. I know that orthopedic surgeons are replacing joints and sending patients to apps. I was with a friend paralyzed in a wheelchair from multiple sclerosis. She was referred to two apps for exercise. If they think we’re doing something valuable, they wouldn’t be using apps for treatment. They wouldn’t be cutting reimbursement. Look at how long we have been out there for direct access. How much of practice is direct access. I don’t think we’re coming on strong. We have to make a change from the way we’ve been viewed before.

 

You and I are on the same page about that. If you read this, I’m getting stronger and stronger with message. I’ve been like that from the beginning, but as you talk, you develop a bolder voice in things. I want to come back to what you said there. “The APTA’s vision statement in 2013 was transforming society about optimizing movement to improve the human experience.”

When I first read that, I thought somebody was smoking things before it was legal.

They then went on to modify it.

It’s never been modified.

They had an addendum to it that, “Their mission is building a community that advances the profession of physical therapy to improve the health of society.”

That’s what the APTA a is supposed to do, physical therapy. I believe it’s true. That’s why I’m pushing hard on kinesiopathology, which is how movement induces pathology. In many ways, physicians treat symptoms and consequences. We could treat cause. I like to tell people, I believe that if we do our job right, we will be known as the profession that slows down the onset of osteoarthritis. Believe me, you’d rather get it at 80 than at 50. I can tell you that as a senior citizen. This would be cutting down on how much intervention people have to have for things. In fact, I always loved asking my patients, “Who taught you to walk?” They’d say, “Nobody.” I said, “That’s the problem.” Just because you’re doing doesn’t mean you’re doing it.

I never thought about it that way. Someone taught them to walk, in some way, but sometimes not. Sometimes kids learn to walk in the room.

I don’t even have any kids, but I’ve observed enough that people walk. The clothes they wear and the shoes they wear, the friends they see, their size all makes a difference. If they’re a big guy with long legs, they’ll walk differently if they have little short friends.

It’s funny you say that because I’ve even heard other health professionals say, “They don’t need to go to physical therapy. They just need to move their body more.”

That’s good because it’s a good practice. It’s a good business model. They’ll be right back.

I always think to myself, “Maybe. Show me who the person is and I’ll let you know if they don’t need to see a physical therapist.” There are a lot of people who, “Yes, they need to move their body more and they need to see a physical therapist to work on the impairments that they have.”

The perfect response is you also need to do is brush your teeth and floss them and you won’t need to see your dentist. How many people go to a dentist twice a year and all you do is use your teeth for speaking and eating and you need your body for everything. The other thing, Joe, is the body works to be efficient, but it’s not optimal. That efficiency does not mean you’re using it optimally. In fact, the opposite for that. It’s efficient for what you do, but it’s a compromise for how it should function in total. There’s no way I believe that people don’t need to see a physical therapist for their movement system examination at least once a year.

Do we have a movement system examination that we have tried to standardize in physical therapy?

I mentioned to you the one task force component developed an intake exam. They’re calling it a screening exam. It’s not a true screening exam. It’s better labeled an intake exam, which says you go through your basic functions forward bending, sit to stand walking, and you pick out, is that problematic or is that not problematic? They would need a more detailed exam after that. I’ve certainly been working on an exam I would be happily take anybody even without pain and run them through that a little exam and tell them what kind of pain they’re going to get depending upon their activities.

How do we start to bring the movement system into the community?

People like you talking about it. Does it make sense to you?

It makes sense to me. Yes.  I’ve read your papers. I’ve read the perspective paper. I’ve looked at the conceptual model. I do my homework before interviews.

Thank you.

I’ve also been practicing since 1995. I’ve been aware of your work and even taken some courses and things like that. It has influenced me in some way. It’s a virus in our profession, is that people see us as treating their symptoms. People come to us and they say, “I have this pain and tightness. I can’t move.”

“The doctor told me my shoulder was bad.”

“The doctor told me I might have bad shoulder,” but they don’t conceptualize that a system of their body that keeps them alive, that makes them human is breaking down. That’s my personal view on it.

Why not?

It’s a cultural problem, because when we say physical therapy, people say, “Physical, that’s like fitness. This must be about making me stronger and flexible.” It’s like, “It is. Strength and flexibility are components of movement. It is a component of the movement system.” When you see a doctor or trained licensed health provider, they’re trained in a whole system of how to optimize your movement, not just the range of motion of your shoulders.

I wish. Do you think anybody looks at us as doctors?

When I first started my show, one of the things that I promised myself and one of the things that I take care to is I always introduce people, usually in their bio, as Dr. So and so. Yes, we are doctors.

I know we are, but I’m saying, do you think the public or other healthcare professionals looks at physical therapists as doctors?

They’re starting to. They see us as a threat, which is why they don’t want to recognize us as doctors. I don’t believe that. You don’t believe they see us as a threat?

No.

How so?

They think we’re medical cheerleaders.

That hurts, Shirley.

I’m sorry. That’s the way I started out. They see us as encouraging people to do their exercises, encouraging people to try to get better. I don’t think they have a decent concept of how complicated exercise and movement is. How can you say they have a great concept of what we do? Do you teach any continuing ed programs?

 

I do. I teach to PTs all the time. Other health professionals I teach them at some schools as well.

Do you think that most physical therapists have a good idea of what’s going on in your shoulder when there’s a pain problem?

The professionals who come into my world are extremely curious. They are interested in improving themselves and moving the profession forward.

That is not the point I’m making. I couldn’t agree with you more. Physical therapists are amazing people. They’re bright and committed. For the most part, they’re not in it to make a lot of money or they would choose medicine. Do I think they’re getting an education that provides high quality kinesiology observations? No. I don’t think most people even know how to assess the abdominal muscle function.

Physical therapists are amazing people. They are bright and committed to their practice. PTs are not in it to make a lot of money, or else they would have chosen medicine. Click To Tweet

It’s interesting because when I went to school, there was a lot more in the programs. Some of that has been pushed out slightly because there’s so much to learn nowadays. It becomes a challenge of, “How do I bring in topics like pharmacology, nutrition, or psychology.”

I agree with you. That’s why we have to decide what’s our strong base and what are our extras or what can we do post professional entry level.

You have a base and then you grow from that base into the other areas.

Are we compromising our base for other things? We haven’t defined ourself well enough to know what our base is.

To sum up a lot of your points as far as the challenges is I do think have problems in school.

Do you know how fast schools are growing?

Yeah, I do. I do think the ultimate challenge though comes with our reimbursement system. They would have to reimburse for something like this.

There’s no question. The reimbursement system is also predicated on how valuable do you think we are and how valuable are we making ourselves. We compromising what it is we’re doing out there.

That’s where I see you. You’re talking about a ground effort to say, “The time has come. We deserve the respect and the acknowledgement as Doctoral trained licensee professionals with advanced skill and knowledge in the movement system.”

I’m trying to develop criteria for what a movement expert is. I’ve gone through the accreditation criteria. There is not any knowledge base required. You have to know treatment techniques, but you don’t have to understand what the problem is you’re doing. You take courses depending upon what somebody decides to put in those courses. I know the people that teach and that are biomechanists in our profession are concerned about the decreasing emphasis on the basics of biomechanics and kinesiology.

You’re saying it’s not in the CPD requirements. Is that what you’re saying?

That’s what I’m saying. I’m saying that you have to take it, but there is no criteria for exactly what you need to know.

I can see your point in how a movement system and a base of impairments and something like the DSM could bring the profession together in some way.

It would help with unwarranted variability. Here’s the other part, if we had diagnostic categories, then that creates efficiency and effectiveness. What’s the big push now? Productivity. You’re not making so much per items. You got to get a lot of items in. The key pushing for productivity and what that gets to be is more who knows what and then send them out for a general exercise program by low-cost personnel. We’re undermining ourselves by compromising what it is we’re doing out there.

Shirley, if people want to continue to follow you and your work and the work you’re doing around the movement system, how can they do that?

The best way is to go onto the Washington University website. I don’t have a website and I don’t do social media. Keep track. Help us promote the movement system if it makes sense. I’ll make one more point, pushing along to get the APTA to fulfill their requirement about the movement system and about providing diagnosis. Why do people go to a doctor to get a diagnosis or to find out what diagnosis they’re working on. To go to a physical therapist and not get any kind of label for their condition doesn’t speak well. We need everybody in on this effort. That’s it. I don’t have a website or any of the rest of it myself.

If you’re interested in the movement system and you think this is important for physical therapists, please make sure to share this information with your colleagues on LinkedIn, Facebook, Twitter, or Instagram. You can tag me on all those social media handles. I’ll make sure to tag you back and we can enter into a discussion on when you think about the movement system and how we can move that forward for our profession. Surely, having diagnostic codes that are unique to us might improve our performance within the healthcare system. It’s been a pleasure being with you. I’ll see you next episode.

 

Important Links

• American Physical Therapy Association
• Washington University
• https://www.NCBI.nlm.nih.gov/pmc/articles/PMC5693453/
• https://www.APTA.org/patient-care/interventions/movement-system-management

 

About Shirley A. Sahrmann, PT, PhD, FAPTA

Shirley A. Sahrmann, PT, PhD, FAPTA, is professor of physical therapy, of cell biology and physiology and of neurology at Washington University School of Medicine.

As a clinician, Sahrmann’s approach is described as the perfect blend between humanism and scientific inquiry. In particular, she excels at successfully diagnosing and treating patients who have complicated impairments that have not responded to previous therapy attempts. Because of her skill, she is consulted frequently by practitioners of many disciplines within the School of Medicine and beyond.

Sahrmann has had a world-wide influence on the practice of physical therapy through her seminal contributions to the approach to diagnosis and intervention selection. She has been a national leader in defining movement as the core focus of the field; in addition, she was among the first to classify movement impairments into diagnostic categories and to promulgate the use of a systematic examination strategy that allows for effective intervention selection and delivery.

Sahrmann earned her bachelor’s degree in physical therapy from Washington University in 1958. She worked as a physical therapist at Deaconess Hospital and later Washington University, then joined the university faculty in 1961. In the early 1970s she returned to Washington University as a student to earn a master’s degree and PhD in neurobiology. She gradually moved up the faculty ranks, joining several departments, and became a professor in 1998.

Over the years, Sahrmann has shared her expertise through her service on numerous professional boards at the national and state levels. She has received five major awards for practice excellence from the American Physical Therapy Association, including its highest honor: the Mary McMillan Lecturer Award. At Washington University, Sahrmann has been recognized with the Washington University Program in Physical Therapy Alumni Award and the Distinguished Faculty Award.