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An explanation of common groupings of movement compensation signs ("clusters") in the overhead squat assessment (OHSA) and OHSA w/ modification. Solutions tables for lower leg, upper body, lumbopelvic hip complex, posterior pelvic tilt (posterior pelvis), and sacroiliac joint dysfunction (including asymmetrical weight shift). A breakdown of related joint actions and the overactive and underactive muscles.

Overhead Squat Assessment: Sign Clusters and Compensation Patterns

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All fitness, performance, and rehabilitation programs should start with an assessment. The goal of assessment is to refine exercise and technique recommendations, with the intent of improving client or patient outcomes. This is an advanced course on the interpretation of clusters or patterns of the signs identified during the Overhead Squat Assessment (a.k.a OSA, OHSA, squat assessment, overhead squat, and similar to the deep squat of the Functional Movement Screen). This course builds on the concepts in previous courses:

Overhead Squat Assessment: Signs of Dysfunction

The Overhead Squat Assessment is particularly effective as a starting point for movement quality evaluation because it challenges the dynamic flexibility and neuromuscular control of the large joints of the kinetic chain. The Overhead Squat Assessment is the assessment of a set of reliable signs:

Excessive lordosis (Anterior pelvic tilt)

If you use the OHSA in practice, you have probably noticed it is very rare that an individual presents with a single "sign" of dysfunction. If you look closely at the tables in the article 

, you will note that many of the same muscles continue to appear, exhibiting the same changes in activity and length, throughout multiple signs/tables. This is especially true of signs related to the same joint or proximal joints (for example, "

," etc). This repetition gives inference to signs being related to one another, resulting in "sign clusters," and these clusters are likely representative of compensation patterns. In fact, practice may highlight that dysfunction most often presents in patterns. Fortunately, these patterns are repetitive, predictable, and easily categorized into a few over-arching models of postural dysfunction/movement impairment. Below you will find tables with an analysis of each compensation pattern, with the muscles and interventions hyperlinked, hyperlinks for further reading on each pattern, a video description of how to identify the compensation pattern using the OHSA, how to use the Modified OHSA for differentiation, and a brief discussion on relevant research.

Advantages of Identifying Compensation Patterns:

Consideration of multi-joint structures (e.g. sciatic nerve, iliotibial band, 

Consideration of muscle synergies (e.g. core subsystems)

Consideration of how one sign may be related to, or contribute to other signs

Optimizing "Integration Exercise" selection

Create "more complete" corrective/therapeutic interventions

Printable PDF of the Movement Assessment Template (including the OHSA):

Overhead Squat Assessment with heel rise

Course Description: Overhead Squat Assessment: Sign Clusters and Compensation Patterns

Overhead Squat Assessment, Part 2: Signs Clusters and Compensation Patterns

Overhead Squat Assessment, Part 2: Signs Clusters and Compensation Patterns Study Guide

Study Guide: Overhead Squat Assessment, Part 2: Signs Clusters and Compensation Patterns

Sign Clusters and Compensation Patterns

," etc). This repetition gives inference to signs being related to one another, resulting in "sign clusters," and these clusters are likely representative of compensation patterns. In fact, practice may highlight that dysfunction most often presents in patterns. Fortunately, these patterns are repetitive, predictable, and easily categorized into a few over-arching models of postural dysfunction/movement impairment. Below you will find tables with analysis of each compensation pattern, with the muscles and interventions hyperlinked, hyperlinks for further reading on each pattern, a video description of how to identify the compensation pattern using the OHSA, how to use the Modified OHSA for differentiation, and a brief discussion on relevant research.

Overhead Squat Assessment Sign Cluster: Lower Extremity Dysfunction (LED)

Note: All of the signs above may be related to 

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

. The "OHSA with Modification" is used to differentiate between these two compensation patterns.

Perform OHSA as described in the article Overhead Squat Assessment: Introduction.

Carefully note all "signs" as described in the article 

Place a half foam roll (flat side down) or similarly sized object underneath the heels of the individual being assessed.

Perform the OHSA again (with the "heel rise"), carefully noting all "signs" still present.

Note: The "heel rise" should be high enough to resolve 

For most cases, the OHSA with Modification can be performed once, with both "heel rise" and "arms down", to determine what signs are still present and originating from 

. For most, "heel rise" will not have an impact on upper body signs, and conversely, "arms down" will not have an impact on lower extremity signs.

Interpreting Results (Differential Reasoning)

 is likely driven by an inability to adequately dorsiflex; the resulting compensation pattern is an expression of functional range "around" this limitation. Adding a heel rise, places the ankle in relative plantar flexion to begin the assessment. This increases the amount of available dorsiflexion range of motion during the OHSA. By removing this potential restriction from the OHSA, compensations that would occur as a result of inadequate dorsiflexion will not occur, and the ankle is "pseudo-removed" from the assessment. 

 the signs noted during the OHSA are not present during the OHSA with Heel Rise, 

 we may assume that dysfunction originates at the ankle and 

 the signs noted during the OHSA are still present during the OHSA with Heel Rise, 

 we may assume that the dysfunction originates from the 

 the signs noted during the OHSA improve, but are still present during the OHSA with Heel Rise, 

 we may assume that the dysfunction originates from both 

Research on Lower Extremity Dysfunction

Lower leg dysfunction during the Overhead Squat Assessment

Video Description of Lower Extremity Dysfunction

Overhead Squat Assessment Sign Cluster: Lumbo Pelvic Hip Complex Dsyfunction (LPHCD)

Note: Many of the signs above may be related to 

OHSA with Modification - Heel Rise and Arms Down

Perform the OHSA again with "modification" (heel rise), carefully noting all "signs" still present.

Ask the patient/client to place their hands on their hips (arms down).

Perform the OHSA again with "modification" (arms down), carefully noting all "signs" still present.

Note: For most cases, the OHSA with Modification can be performed once, with both "heel rise" and "arms down", to determine what signs are still present and originating from 

 is likely driven by an inability to adequately dorsiflex; the resulting compensation pattern an expression of functional range "around" this limitation. Adding a heel rise, places the ankle in relative plantar flexion to begin the assessment. This increases the amount of available dorsiflexion range of motion during the OHSA. By removing this potential restriction from the OHSA, compensations that would occur as a result of inadequate dorsiflexion will not occur, and the ankle is "pseudo-removed" from the assessment. 

Arms Down (Hands on Hips) Rationale: If the 

 is short/over-active it may contribute to an 

Excessive lordosis (anterior pelvic tilt)

 over-activity may originate from either dysfunction. By placing the hands on the hips (

 is placed in a "shortened" position reducing their capacity to contribute to the OHSA and the observed dysfunction. 

 is present during the OHSA, but not present during the OHSA with Arms Down, 

 we may assume that dysfunction originates from 

 is present during the OHSA, and still present during the OHSA with Arms Down, 

 improves but is still present during the OHSA with Arms Down, 

 we may assume that dysfunction originates from both 

Note: The OHSA with Arms Down Modification may produce an additional sign "Trunk Flexion" and/or an increase in 

. It has been our experience that these signs are related to 

 and can best be explained by the dominance of the 

Research on Lumbo Pelvic Hip Complex Dysfunction

Example of an anterior pelvic tilt in the Overhead Squat Assessment

Video Description of Lumbo Pelvic Hip Complex Dysfunction

Overhead Squat Assessment Sign Cluster: Upper Body Dysfunction (UBD)

OHSA with Modification - Arms Down (Hands on Hips)

Perform OHSA as described in the article 

Carefully note all "signs" as described in the courses 

Perform the OHSA again with "modification" ("arms down"), carefully noting all "signs" still present.

Squat with Modification - Arms Down (Hands on Hips)

 are placed in a "shortened" positioned reducing their capacity to contribute to the OHSA and the observed dysfunction.

 and can be best explained by dominance of the 

Research on Upper Body Dysfunction

Arms Fall in the Overhead Squat Assessment

Video Description of Upper Body Dysfunction

Overhead Squat Assessment Sign Cluster: Sacroiliac Joint Dysfunction (SIJD)

Signs that may be related to Sacroiliac Joint Dysfunction:

Posterior Pelvic Tilt (PPT) and Inadequate Forward Lean

 are not common signs. It has been my experience that if a 

 are present, these are strong indicators of previous lumbosacral pathology (injury), current Sacroiliac Joint Dysfunction (SIJD

, and lumbar flexion intolerance/fear-avoidance of forward bending. However, the compensation pattern associated with these signs is commonly expressed as 

 - Analysis of the maladaptive changes in muscle activity and length results in identical tables for 

; the only difference being the likely inclusion of restricted lumbar extension in those exhibiting a 

 originates from the lumbo-pelvic hip complex. This is likely the most commonly expressed sign in those with Sacroiliac Joint Dysfunction (SIJD

. Analysis of SIJD results in the observation that one innominate is rotated relatively anterior, and the other innominate rotated relatively posteriorly (a relative 

). This is most often the side opposite the shift, i.e. the side of 

 (restricted lumbar extension and hip flexion) with optimal or excessive dorsiflexion.

 results in or is the result of - over-activity of hip external rotators (

). These over-active muscles invest in the sacrotuberous ligament. Increased tension in the sacrotuberous ligament would restrict anterior rotation (nutation) of the sacrum, resulting in a relative 

 is likely the "hallmark sign" of Sacroiliac Joint Dysfunction (SIJD) (a variation of 

 only infers unilateral dysfunction or dysfunction that is more pronounced on one side of the body. An 

 that is unilateral or more pronounced on one side. Further, 

 over-activity results in tibia on foot eversion, and a 

 over-activity forcing lumbar extension. It is of particular importance that the OHSA with Modification is used to determine the origin of dysfunction before developing an intervention when a patient/client exhibits signs of Sacroiliac Joint Dysfunction (SIJD).

 is likely driven by an inability to adequately dorsiflex, and the resulting compensation pattern being an adaptation to achieve functional range "around" this limitation. Adding a heel rise, places the ankle in relative plantar flexion to begin the assessment. This increases the amount of available dorsiflexion range of motion during the OHSA. By removing this potential restriction from the OHSA, the ankle is "removed" from the assessment. 

 noted during the OHSA is not present during the OHSA with Heel Rise, 

 (Correct by addressing the side exhibiting more 

 noted during the OHSA is still present during the OHSA with Heel Rise, 

 we may assume that the dysfunction originates from 

 noted during the OHSA improves but is still present during the OHSA with Heel Rise, 

 and SIJ dysfunction (Correct by addressing both the side exhibiting more 

 and using the SIJD corrective strategy discussed below).

 is short/over-active it may contribute to lumbar extension, an 

 are placed in a "shortened" position that reduces their capacity to contribute to the OHSA and the observed dysfunction.

 is not present during the OHSA but is present during the OHSA with Arms Down, 

 we may assume that dysfunction originates from SIJD (Correct by addressing SIJD)

 is present during the OHSA and gets worse during the OHSA with Arms Down, 

OHSA with Modification: Arms Down - relative to SIJ and the sign 

 is present during the OHSA and improves but is still present during the OHSA with Arms Down, 

 (Correct by addressing both the side exhibiting more 

Note: It has been our clinical experience that although it is possible that unilateral 

Research on Sacroiliac Joint Dysfunction

Overhead Squat Assessment with heels elevated to isolate dysfunction

Video Description of Sacroiliac Joint Dysfunction

Overhead Squat Assessment Sign Cluster: Asymmetrical Weight Shift (AWS)

A sign of unilateral dysfunction and/or dysfunction that is more pronounced on one side of the body.

, it is important to note the asymmetry between the right (R) and left (L) sides for all bilateral signs.  

 differs from the compensation patterns discussed above. Although an 

), it may also originate from unilateral 

. It is of particular importance that the OHSA with Modification is used to determine the origin of dysfunction before developing an intervention when a patient/client exhibits an 

 noted during the OHSA improves, but is still present during the OHSA with Heel Rise, 

 dysfunction (Correct by addressing both the side exhibiting more 

 are placed in a "shortened" position that reduces their capacity to contribute to the OHSA and the observed dysfunction. 

Research on Asymmetrical Weight Shift

Dr. Brent Brookbush demonstrating an asymmetrical weigth shift

Video Description of Asymmetrical Weight Shift

Deciding Which Dysfunction to Address

We started with an introduction, progressed to analysis of "

" and continued to clusters of signs that imply compensation patterns in this article, but inevitably you will begin to notice that many individuals present with more than one compensation pattern. The question arises, "how do I address multiple issues"? As the relative "completeness of a strategy" (addressing all affected structures) will inevitably affect outcomes, and time is always limited, the Brookbush Institute recommends using a comprehensive corrective strategy for one compensation pattern at a time. Use the following "filter" or algorithm to determine which compensation pattern you will address first.

 - prohibiting participation in daily activities

 - differences between right and left sides

 - when a dysfunction is clearly more extreme than other dysfunctions presented

 start with the ankle complex and work up the kinetic chain with successive programming

Video Explanation How to Decide Which Compensation Pattern to Address

Regional Interdependence of Lower Extremity

Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., & Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. 

Dos Reis, A. C., Correa, J. C. F., Bley, A. S., Rabelo, N. D. D. A., Fukuda, T. Y., & Lucareli, P. R. G. (2015). Kinematic and Kinetic Analysis of the Single-Leg Triple Hop Test in Women With and Without Patellofemoral Pain. journal of orthopaedic & sports physical therapy, 45(10), 799-807.

Noehren, B., Scholz, J., Davis, I. (2011) The effects of real-time gait retraining on hip kinematics, pain, and function in subjects with patellofemoral pain syndrome. Br Journal of Sports Medicine. 45:691-696

Ireland, ML., Wilson, JD., Ballantyne, BT., Davis, IM. (2003). Hip Strength in Females With and Without Patellofemoral Pain. J Orthop Sports Phys Ther 2003. 33: 671-676

Noehren B, Hamill J, Davis I. Prospective Evidence for a Hip Etiology in Patellofemoral Pain. 

Smith, J. A., Popovich, J. M., & Kulig, K. (2014). The influence of hip strength on lower limb, pelvis, and trunk kinematics and coordination patterns during walking and hopping in healthy women. 

Journal of Orthopaedic & Sports Physical Therapy

Mauntel, T., Begalle, R., Cram, T., Frank, B., Hirth, C., Blackburn, T., & Padua, D. (2013). The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. 

Journal Of Strength And Conditioning Research / National Strength & Conditioning Association

Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. 

Macrum et al. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. 

Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., & Fonseca, S. T. (2010). Temporal couplings between rearfoot–shank complex and hip joint during walking. 

Franettovich, S. M., Honeywill, C. O. N. O. R., Wyndow, N., Crossley, K. M., & Creaby, M. W. (2014). Neuromotor control of gluteal muscles in runners with achilles tendinopathy. 

Overhead Squat Assessment: Sign Clusters and Compensation Patterns

Related Courses:

Course Description: Overhead Squat Assessment: Sign Clusters and Compensation Patterns

Study Guide: Overhead Squat Assessment, Part 2: Signs Clusters and Compensation Patterns

Sign Clusters and Compensation Patterns

Overhead Squat Assessment Sign Cluster: Lower Extremity Dysfunction (LED)
2 Sub Sections

Overhead Squat Assessment Sign Cluster: Lumbo Pelvic Hip Complex Dsyfunction (LPHCD)
2 Sub Sections

Overhead Squat Assessment Sign Cluster: Upper Body Dysfunction (UBD)
2 Sub Sections

Overhead Squat Assessment Sign Cluster: Sacroiliac Joint Dysfunction (SIJD)
2 Sub Sections

Overhead Squat Assessment Sign Cluster: Asymmetrical Weight Shift (AWS)
2 Sub Sections

Deciding Which Dysfunction to Address
1 Sub Section

Bibliography

Related Courses:

Comments

Guest

Overhead Squat Assessment: Sign Clusters and Compensation Patterns

Related Courses:

Course Description: Overhead Squat Assessment: Sign Clusters and Compensation Patterns

Study Guide: Overhead Squat Assessment, Part 2: Signs Clusters and Compensation Patterns

Sign Clusters and Compensation Patterns

Overhead Squat Assessment Sign Cluster: Lower Extremity Dysfunction (LED)2 Sub Sections

Overhead Squat Assessment Sign Cluster: Lumbo Pelvic Hip Complex Dsyfunction (LPHCD)2 Sub Sections

Overhead Squat Assessment Sign Cluster: Upper Body Dysfunction (UBD)2 Sub Sections

Overhead Squat Assessment Sign Cluster: Sacroiliac Joint Dysfunction (SIJD)2 Sub Sections

Overhead Squat Assessment Sign Cluster: Asymmetrical Weight Shift (AWS)2 Sub Sections

Deciding Which Dysfunction to Address1 Sub Section

Bibliography

Related Courses:

Comments

Guest

Overhead Squat Assessment Sign Cluster: Lower Extremity Dysfunction (LED)
2 Sub Sections

Overhead Squat Assessment Sign Cluster: Lumbo Pelvic Hip Complex Dsyfunction (LPHCD)
2 Sub Sections

Overhead Squat Assessment Sign Cluster: Upper Body Dysfunction (UBD)
2 Sub Sections

Overhead Squat Assessment Sign Cluster: Sacroiliac Joint Dysfunction (SIJD)
2 Sub Sections

Overhead Squat Assessment Sign Cluster: Asymmetrical Weight Shift (AWS)
2 Sub Sections

Deciding Which Dysfunction to Address
1 Sub Section