The Sahrmann Progression: How Physical Therapy Created an Industry of Lying on Your Back
For decades, physical therapy has been obsessed with one magical idea:
“Activate your core.”
And somewhere along the way, an entire profession decided that the pinnacle of human movement was:
lying on your back
moving one leg
trying not to spill your imaginary bowl of soup pelvis
Enter the legendary work of Shirley Sahrmann.
Now to be clear:
Sahrmann’s abdominal progression was actually an important advancement.
She helped move rehab away from:
endless crunches
random “ab workouts”
meathead spinal flexion marathons
And toward:
lumbopelvic control
movement quality
segmental stability
controlling extension forces
That part mattered.
The problem is what PTs did afterward.
Because physical therapy took a brilliant clinical concept…
…and turned it into a religion.
The Original Idea Was Actually Smart
The Sahrmann progression basically asks:
“Can you move your legs without your lumbar spine flopping around like a dying fish?”
Honestly?
That’s a reasonable question.
Especially for:
extension-sensitive low back pain
people who dump into anterior pelvic tilt
folks with terrible hip/trunk dissociation
post-partum patients
hypermobile athletes
chronic “hinge-from-L4-L5” humans
The progression became famous because it exposed compensations FAST.
A patient says:
“My core is strong.”
Then immediately arches their back the second a foot leaves the table.
Clinical gold.
The Problem: PTs Forgot the Goal
Somewhere along the line, the profession stopped using the progression as:
an assessment
a motor learning tool
a temporary control strategy
…and started treating it like:
THE FINAL FORM OF HUMAN PERFORMANCE!
So now we have:
22-year-olds doing dead bugs for 8 months
athletes “activating TVA”
patients afraid to breath “wrong”
everyone terrified of lumbar movement
Apparently the human spine is now a Fabergé egg.
The Core Industry’s Favorite Fantasy
According to Instagram rehab:
if your pelvis moves 2 millimeters:
your disc explodes (McGill)
your SI joint teleports into another dimension
your multifidus turns into a fat slob
and your transverse abdominis files for unemployment
Meanwhile construction workers with zero “deep core activation” are carrying refrigerators upstairs.
Interesting…
The Great Dead Bug Inflation Crisis
The dead bug may be the single most overprescribed exercise in modern rehab.
Not because it’s bad.
Because PTs NEVER PROGRESS PAST IT.
Patient goals:
walk better
squat
lift
return to volleyball
carry their kid
get off the floor
PT plan:
“3 sets of 10 toe taps.”
For six weeks.
Then maybe:
“advanced toe taps.”
Here’s What the Progression Was SUPPOSED to Become
The real-world progression should look something like this:
1. Hooklying Breathing
Learn:
pressure management (no blood pressure cuff needed)
rib control
pelvic awareness
Cool.
Reasonable.
2. Heel Slides
Can you maintain position while a leg moves?
Good first challenge.
3. Marches
Now the hip flexors start trying to yank the pelvis around.
Interesting things happen here.
4. Dead Bug Variations
Excellent drill IF:
you can breathe
you can control extension
you don’t turn purple
5. Toe Taps / Leg Extensions
Longer lever.
More extension torque.
More reality.
Now we’re talking.
6. Bear Position (quadruped)
Suddenly gravity matters.
Shoulders matter.
Pressure management matters.
The patient realizes life happens upright.
7. Carries
Now the trunk has to stabilize while:
walking
rotating
breathing
existing in the real world
Wild concept.
8. Split Stance Patterns
Because humans don’t actually live symmetrically.
Now we introduce:
asymmetry
gait mechanics
frontal plane control
rotational demand
9. Hinges, Squats, Step-Ups
The stuff patients ACTUALLY NEED.
Congratulations.
We’ve finally entered humanity.
10. Dynamic Integration
Running.
Cutting.
Lifting.
Reaching.
Sport.
Life.
You know…
movement.
The Dirty Secret Nobody Says Out Loud
A lot of “core weakness” isn’t weakness.
It’s:
poor timing
poor strategy
fear
stiffness
bad sensory awareness
over-bracing
terrible movement options
Some patients don’t need MORE abdominal tension.
They need:
less guarding
better breathing
rib mobility
hip motion
pelvic control
rotation
confidence
But modern rehab often treats every human like they’re one unstable vertebra away from catastrophe.
The Other Dirty Secret
Many PTs confuse:
“making an exercise harder”
with
“making it more functional.”
Adding:
bands
unstable surfaces
ankle weights
breathing drills from Mars
does not automatically improve transfer.
If the patient still can’t:
squat
hinge
roll
walk
rotate
carry load
…your “core progression” is just floor Pilates with extra paperwork.
What Sahrmann Actually Gave Us
The real value of the progression is this:
It teaches clinicians to look for:
uncontrolled lumbar extension
pelvic dumping
rib flare
compensation patterns
inability to dissociate hips from spine
That’s helpful.
Very useful.
But the progression is supposed to be:
A bridge
Not a destination.
Clinical Reality
The Sahrmann progression was never meant to create a generation of patients permanently trapped on a treatment table whispering:
“Am I activating my TVA?”
At some point:
the pelvis has to move
the spine has to rotate
the ribs have to expand
the body has to load
the patient has to live
And if your rehab progression never leaves the floor…
…it’s probably not rehab anymore.
It’s just expensive looking at the ceiling time.
-the pissed-off PT- like, comment, share-