Facebook Pixel
Brookbush Institute Logo
  1. Courses
  2. Overhead Squat Assessment: Sign Clusters and Compensation Patterns
Identifying dysfunction using the Overhead Squat Assessment with modified

Overhead Squat Assessment: Sign Clusters and Compensation Patterns

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.

Sign Clusters and Compensation Patterns
00:00 00:00
1.0

Test Critical Content

Mark As Complete

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

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:

Pre-approved credits for:

Pre-approved for Continuing Education Credits for:

This Course Includes:

  • AI Tutor
  • Movement Assessment Template
  • Study Guide
  • Text and Illustrations
  • Audio Voice-over
  • Research Review
  • Technique Videos
  • Practice Exam
  • Pre-approved Final Exam

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:

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 Overhead Squat Assessment: Signs of Dysfunction , 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, "feet flatten ," "feet turn-out ," "knees bow in ," 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, biceps femoris , etc.)
  • 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

The Sign Clusters Discussed:

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

Identifying dysfunction using the Overhead Squat Assessment with modified
Caption: Identifying dysfunction using the Overhead Squat Assessment with modified

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

Movement Assessment Template and Program Generator

Sign Clusters and Compensation Patterns

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

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

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

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

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

Deciding Which Dysfunction to Address
2 Sub Sections

Bibliography

Regional Interdependence of Lower Extremity

  1. 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. The American journal of sports medicine, 33(4), 492-501.
  2. 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.
  3. 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
  4. 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
  5. Noehren B, Hamill J, Davis I. Prospective Evidence for a Hip Etiology in Patellofemoral Pain. Medicine & Science in Sports & Exercise. 2013;45(6):1120–1124.
  6. 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, (Early Access), 1-23.
  7. 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, 27(7), 1813-1823.
  8. Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. Journal of athletic training, 47(5), 525
  9. Macrum et al. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. Journal of Sport Rehabilitation, 2012, 21, Pg 144-150
  10. 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. Clinical biomechanics, 25(7), 745-748.
  11. 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. Medicine and science in sports and exercise,46(3), 594-599.
  12. Gribble, P. A., & Robinson, R. H. (2009). Alterations in knee kinematics and dynamic stability associated with chronic ankle instability. Journal of Athletic Training, 44(4), 350-355.
  13. Bell, D. R., Padua, D. A., & Clark, M. A. (2008). Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement. Archives of physical medicine and rehabilitation, 89(7), 1323-1328.
  14. Bell, D. R., Vesci, B. J., DiStefano, L. J., Guskiewicz, K. M., Hirth, C. J., & Padua, D. A. (2012). Muscle activity and flexibility in individuals with medial knee displacement during the overhead squat. Athletic Training and Sports Health Care, 4(3), 117-125.
  15. Andrews, M., Noyes, F. R., Hewett, T. E., & Andriacchi, T. P. (1996). Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects: a critical analysis of the reliability of gait analysis data. Journal of orthopaedic research, 14(2), 289-295.
  16. Barrios, J. A., Crossley, K. M., & Davis, I. S. (2010). Gait retraining to reduce the knee adduction moment through real-time visual feedback of dynamic knee alignment. Journal of biomechanics, 43(11), 2208-2213.
  17. Stecco, A., Gilliar, W., Hill, R., Fullerton, B., Stecco, Carla. (2013). The anatomical and functional relation between gluteus maximus and fascia lata. Journal of Bodywork & Movement Therapies. 17. 512-51
  18. Barker, PJ., Hapuarachchi, K.S., Ross, J.A., Sambaiew, E., Ranger, T.A., and Briggs, C.A. (2013) Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint. Wiley Online Library. DOI: 10.1002/ca.22233
  19. Gibbons, S.G.T. (2004) The anatomy of the deep sacral part of the gluteus maximus and the psoas muscle: A clinical perspective. Proceeds of: The 5th interdisciplinary World Congress on Low Back Pain. November 7-11, Melbourne, Australia
    • Regional Interdependence of Lumbo Pelvic Hip Complex
  20. Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620
  21. Tateuchi, H., Taniguchi, M., Mori, N., Ichihashi, N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension (2013) Journal of Electromyography and Kinesiology 22 (3). 391-397]
  22. Ellison, JB., Rose, S., Sahrmann, S. (1990). Patterns of Hip Rotation Range of Motion: A Comparison Between Healthy Subjects and Patients with Low Back Pain. Phys Ther 1990. 70: 537-541
  23. Schache, A. G., Blanch, P. D., & Murphy, A. T. (2000). Relation of anterior pelvic tilt during running to clinical and kinematic measures of hip extension. British journal of sports medicine, 34(4), 279-283.
  24. Hodges, P., Richardson, C. (1996). Inefficient Muscular Stabilization of the Lumbar Spine Associated With Low Back Pain: A Motor Control Evaluation of Transverse Abdominis. Spine, 21(22), 2640-2650
  25. Cooper, N., Scavo, K., Strickland, K., Tipayamongkol, N., Nicholson, J., Bewyer, D., Sluka, K. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. J Euro Spine. 26 May 2015
  26. Hungerford, B., Gilleard, W., Hodges, P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14), 1593-1600
  27. O’Sullivan, P. B., Beales, D. J., Beetham, J. A., Cripps, J., Graf, F., Lin, I. B., … & Avery, A. (2002). Altered motor control strategies in subjects with sacroiliac joint pain during the active straight-leg-raise test. Spine, 27(1), E1-E8
  28. Lewis CL, Sahrmann. 2005 Timing of muscle activation during prone hip extension. Abstract. J Orhop Sports Phys Ther 35(1): A56.
  29. Matthew Shirey, D. P. T., Matthew Hurlbutt, D. P. T., Nicole Johansen, D. P. T., Gregory, W. K., Wilkinson, S. G., & Hoover, D. L. The influence of core musculature engagement on hip and knee kinematics in women during a single leg squat. Int J Sports Phys Ther. 2012 Feb; 7(1): 1–12.
  30. Barker, PJ., Hapuarachchi, K.S., Ross, J.A., Sambaiew, E., Ranger, T.A., and Briggs, C.A. (2013). Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint. Wiley Online Library. DOI: 10.1002/ca.22233
  31. Carvalhais, VO., Ocarino, Jde M., Araújo, VL., Souza, TR., Silva, PL., Fonseca, ST. (2012). Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles: An in vivo experiment. Journal of Biomechanics 46. 1003-1007
  32. Langevin, H., Fox, R., Koptiuch, C., Badger, G., Greenan-Nauman, A., Bouffard, N., Konofagou, E., Lee, W., Triano, J., Henry, S. (2011) Reduced thoracolumbar fascia shear strain in human low back pain. BMC Musculoskeletal Disorders. 12: 203.
  33. Vleeming, A., Schuenke, M.D., Danneels,Willard, F.H. The functional coupling of the deep abdominal and paraspinal muscles: the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the thoracolumbar fascia. Journal of Anatomy, 2014. 225, 447-462
  34. Hennessey, L., & Watson, A. W. (1993). Flexibility and posture assessment in relation to hamstring injury. British Journal of Sports Medicine, 27(4), 243-246.
    • Regional Interdependence of Upper Body
  35. Scovazzo, M.L., Browne, A., Pink, M., Jobe, F.W., and Kerrigan, J. (1991). The painful shoulder during freestyle swimming: An electromyographic cinematographic analysis of twelve muscles. The American Journal of Sports Medicine. 19(6). 577-582
  36. Ludewig P.M., Cook, T.M. (2000) Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical Therapy. 80 (3) 276-291
  37. Cools, A.M., Witvrouw, E.E., Declercq, G.A., Danneels, L.A., Cambier, D.C. (2003) Scapular muscle recruitment patterns: Trapezius muscle latency with and without impingement symptoms. The American Journal of Sports Medicine 31(4). 542-549
  38. Fayad F, Roby-Brami A, Yazbeck C, Hanneton S, Lefevre-Colau MM, Gautheron V, Poiraudeau S, Revel M. (2008). “Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder.” 2008 Jbiomech, 41(2): 326-332
  39. Helgadottir, H., Kristjansson, E., Einarsson, E., Karduna, A., & Jonsson, H. (2011). Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders. Journal of electromyography and kinesiology,21(6), 947-953.
  40. Kwon JW, Son SM, Lee NK. (2015). Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. J Phys Ther Sci. 27: 1739-1742
  41. Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, Stergiou N. (2010). Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. Journal of Electromyography and Kinesiology. 20: 701-709.
  42. Otoshi, K., Takegami, M., Sekiguchi, M., Onishi, Y., Yamazaki, S., Otani, K., Shishido, H., Shinichi, K., Shinichi, K. (2014). Association between kyphosis and subacromial impingement syndrome: LOHAS study. Journal of Shoulder and Elbow Surgery. 23. e300-e307
  43. Lawrence, R. L., Braman, J. P., Laprade, R. F., & Ludewig, P. M. (2014). Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. journal of orthopaedic & sports physical therapy, 44(9), 636-A8
  44. Lawrence, R.L., Braman, J.P., Staker, J.L., Laprade, R.F., Ludewig, P.M. (2014) Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, Part 2: Glenohumeral joint. Journal of Orthopaedic & Sports Physical Therapy 44(9). 646-B3
  45. José Miota Ibarra, Hong-You Ge, Chao Wang, Vicente Martínez Vizcaíno, Thomas Graven-Nielsen, Lars Arendt-Nielsen – The Journal of Pain, Volume 12, Issue 12, December 2011, Pages 1282–1288
  46. Ayhan, C., Camci, E., & Baltaci, G. (2015). Distal radius fractures result in alterations in scapular kinematics: A three-dimensional motion analysis. Clinical Biomechanics.
  47. Day, J. M., Bush, H., Nitz, A. J., & Uhl, T. L. (2015). Scapular Muscle Performance in Individuals With Lateral Epicondylalgia. Journal of Orthopaedic & Sports Physical Therapy, (Early Access), 1-35
  48. Sato, T., & Hashimoto, M. (1984). Morphological analysis of the fascial lamination of the trunk. The Bulletin of Tokyo Medical and Dental University, 31(1), 21-32.
  49. Stecco, C., Gagey, O., Belloni, A., Pozzuoli, A., Porzionato, A., Macchi, V., … & Delmas, V. (2007). Anatomy of the deep fascia of the upper limb. Second part: study of innervation. Morphologie, 91(292), 38-43.
  50. Stecco, C., Porzionato, A., Macchi, V., Stecco, A., Vigato, E., Parenti, A., … & De Caro, R. (2008). The expansions of the pectoral girdle muscles onto the brachial fascia: morphological aspects and spatial disposition. Cells Tissues Organs, 188(3), 320-329.
  51. Stecco, A., Masiero, S., Macchi, V., Stecco, C., Porzionato, A., & De Caro, R. (2009). The pectoral fascia: anatomical and histological study. Journal of bodywork and movement therapies, 13(3), 255-261.
  52. Wang, H. K., & Cochrane, T. (2001). Mobility impairment, muscle imbalance, muscle weakness, scapular asymmetry and shoulder injury in elite volleyball athletes. Journal of sports medicine and physical fitness, 41(3), 403.
    • Asymmetrical Weight Shift
  53. Adams, K. J.; Snow, C. M.; Sevene, P. G.; Debeliso, M.; O’Shea, J. P.. Weightlifters Exhibit Greater Muscle Power and Lower Back Flexibility than Non-Weightlifters 1142. Medicine and Science in Sports and Exercise: Volume 28(5) Supplement May 1996 p. 192, Copyright 2005 American College of Sports Medicine
  54. Barry Beedle, Chris Jessee and Micahel H. Stone. Flexibility Characteristics Among Athletes Who Weight Train. Journal of Applied Sport Science Research 5(3) p. 150-154, 1991, Copyright National Strength and Conditioning Association
  55. Todd S. Ellenbecker and E. Paul Roetert. Effects of a 4-Month Season on Glenohumeral Joint Rotational Strength and Range of Motion in Female Collegiate Tennis Players. J. Strength Cond. Res. 16(1), 92-96, Copyright 2002 National Strength & Conditioning Association
  56. Todd S. Ellenbecker, E. Paul Roetert, David S. Bailie, George J. Davies, and Scott W. Brown. Glenohumeral Joint Total Rotation Range of Motion in Elite Tennis Players and Baseball Pitchers. Medicine and Science in Sports and Exercise: Volume 334(12) p. 2052-2056, 2002 Copyright 2005 American College of Sports Medicine
  57. Joshua C. Barlow, Brian W. Benjamin, Patrick J. Birt, and Christopher J. Hughes. Shoulder Strength and Range-Of-Motion Characteristics in Bodybuilders. J. Strength Cond. Res. 16(3), 367-372, Copyright 2002 National Strength & Conditioning Association
  58. Witvrouw, E., Danneels, L., Asselman, P., D’Have, T., & Cambier, D. (2003). Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players a prospective study. The American Journal of Sports Medicine, 31(1), 41-46.
  59. Kiesel, K. B., Butler, R. J., & Plisky, P. J. (2014). Prediction of injury by limited and asymmetrical fundamental movement patterns in American football players. Journal of sport rehabilitation, 23(2), 88-94.
  60. Zifchock, R. A., Davis, I., Higginson, J., McCaw, S., & Royer, T. (2008). Side-to-side differences in overuse running injury susceptibility: a retrospective study. Human movement science, 27(6), 888-902.
  61. Rothbart, B. A., & Estabrook, L. (1988). Excessive pronation: a major biomechanical determinant in the development of chondromalacia and pelvic lists. J Manipulative Physiol Ther, 11(5), 373-9.
  62. Watson, A. W. S. (2001). Sports injuries related to flexibility, posture, acceleration, clinical defects, and previous injury, in high-level players of body contact sports. International journal of sports medicine, 22(03), 222-225. (Posture more predictive of pain)
    • LumboSacral Dysfunction
    • The references for LPHCD 20-29 were also used in this section.
  63. Vleeming, A., Stoeckart, R., & Snijders, C. J. (1989). The sacrotuberous ligament: a conceptual approach to its dynamic role in stabilizing the sacroiliac joint. Clinical Biomechanics, 4(4), 201-203.
  64. Vleeming, A., Van Wingerden, J. P., Snijders, C. J., Stoeckart, R., & Stijnen, T. (1989). Load application to the sacrotuberous ligament; influences on sacroiliac joint mechanics. Clinical Biomechanics, 4(4), 204-209.

© 2025 Brookbush Institute. All rights reserved.

Comments

Guest