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Overhead Squat Assessment 17 - Deciding Which Dysfunction to Address First

"Assess overhead squat mechanics and learn how to decide which dysfunction should be addressed first. In this video, we take a detailed look at the overhead squat assessment and identifying imbalances and weaknesses."

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00:06 - 00:09This is Brent and in this video I'm going to address a question that I get quite
00:09 - 00:13often. So in previous videos we've addressed individual signs, and then we
00:13 - 00:17took individual signs and realize that we almost never get a template where we
00:17 - 00:21get one box checked off. We started looking at patterns right these
00:21 - 00:26compensation patterns which are clusters of signs and how to address those, but
00:26 - 00:31what you've inevitably started to see is that even that isn't enough. Most of the
00:31 - 00:36individuals who come in and see us have not just a couple of signs or a pattern of
00:36 - 00:41signs, they have a couple of compensation patterns, they have little bits of
00:41 - 00:45upper-body dysfunction with lower leg dysfunction, or they have lower leg
00:45 - 00:49dysfunction with a little bit of lumbo-pelvic hip complex dysfunction.
00:49 - 00:53All of these things are happening together which then makes us wonder well
00:53 - 00:58which one should you address first, or how should you address all of these
00:58 - 01:02different dysfunctions. So here's the answer to the questions according to me.
01:02 - 01:07Here's the rubric that i use, here's the filter that i use to help my decision
01:07 - 01:15making process. Number one, I go after one compensation pattern at a time. To me the
01:15 - 01:21execution, the success of your program, is dependent on the completeness of your
01:21 - 01:25strategy. Now if I'm going to go after something like let's say lower leg
01:25 - 01:31dysfunction completely, I don't have time to go over lumbo-pelvic hip complex and
01:31 - 01:35upper body dysfunction completely as well. Each one of those things takes a
01:35 - 01:39significant amount of time, and if you're training as a personal trainer, or you're
01:39 - 01:44an ATC who is also responsible for a strength and conditioning program you
01:44 - 01:48know you have an even more limited amount of time. So first things first I
01:48 - 01:54go after one compensation pattern at a time, I address it completely. When I have
01:54 - 02:00that compensation pattern under control I reduce it to as little as I can. For
02:00 - 02:04example in lower leg dysfunction maybe somebody gets reduced down to calf
02:04 - 02:10release, calf stretch, anterior tibialis activation and that's all that remains,
02:10 - 02:16and then I can move on to the next dysfunction. Now how I decide which
02:16 - 02:22dysfunction I go after is based on this, first things first I'm going to go after
02:22 - 02:29what i call obstructive dysfunction. What I mean by obstructive is it is
02:29 - 02:35dysfunction that is getting in the way of them doing something they love, or
02:35 - 02:40something they need to do. So I understand that there may be worse
02:40 - 02:47dysfunctions in their body, but like let's say this is a power lifter, I have
02:47 - 02:53them do a overhead squat and I watch their knees kiss, we know this
02:53 - 02:56wouldn't be a very good thing for a power lifter. This isn't going to
02:56 - 03:00contribute to their performance very well, but they've come in to see me
03:00 - 03:06because after their bench press, after their chest work, after their upper body
03:06 - 03:13work they get shoulder pain, guess which dysfunction I'm going after first. I'm
03:13 - 03:17going to go after upper body dysfunction, because I need to address the thing
03:17 - 03:22that's actually getting in their way now. Even some of you I know are already
03:22 - 03:26thinking but knees bow in could be contributing to right shoulder pain, it
03:26 - 03:30could, there is a theoretical model, there there is the kinetic chain checkpoints
03:30 - 03:36we could go through to talk about how, let's say knee cave in on one side leads
03:36 - 03:40to anterior and automate rotation leads to sacral dysfunction, leads to
03:40 - 03:44latissimus dorsi tightness, leads to right shoulder. We can go over that, but
03:44 - 03:47the truth of the matter is is there some sort of upper body dysfunction present.
03:47 - 03:52We need to fix that first, and if we're successful hopefully this client or
03:52 - 03:56patient will let us address the rest of their kinetic chain so we get great
03:56 - 04:02long-term outcomes. So make sure you go after what needs to be gone after first.
04:02 - 04:08You have to set up a priority list. Second, asymmetrical dysfunction. We
04:08 - 04:15actually do not have research that says tightness a lack of mobility leads to
04:15 - 04:19injury. Now some of that has to do with faults in some of the research itself,
04:19 - 04:24but there is research to indicate that asymmetrical dysfunction will cause
04:24 - 04:30injury, and I do believe that nothing leads to injury faster than asymmetry
04:30 - 04:37right to left in the human body. If somebody had an overhead squat both arms
04:37 - 04:44fell forward to here, but I saw one right foot flattened and turn out, I don't care
04:44 - 04:48how bad the upper body dysfunction is providing it's not causing them pain or
04:48 - 04:55obstructing what they love to do, if i see the asymmetry on their right leg i'm
04:55 - 05:00going to go after that first. Very important that I get to that before it
05:00 - 05:07gets to them and causes injury. So somebody comes in, why are you here, is
05:07 - 05:12there anything you can't do, okay maybe there's nothing
05:12 - 05:15that they can't do, they're coming in to see me because of general health and
05:15 - 05:19wellness. Okay do I see anything asymmetrical, i'm going to go after that.
05:19 - 05:23If I don't see anything asymmetrical I'm going to go down to the next thing on my
05:23 - 05:28list, which is what is their worst dysfunction. This actually doesn't happen
05:28 - 05:32very often, but let's say somebody has a little bit of arms fall forward but
05:32 - 05:38their feet flattened, turn way out, knees bow in, I have to go after that. I got to go
05:38 - 05:43after that. I'm going to go after the worst dysfunction first. This will
05:43 - 05:47probably maintain for a little while, it's probably not setting them up too
05:47 - 05:52bad for injury, let's take care of the thing that you know when we see it we go
05:52 - 05:58oh we need to, we need to address that before once again it gets at them. Last,
05:58 - 06:04let's say somebody has all of the dysfunctions nothing is in particular
06:04 - 06:08bothering them, or they have a whole slew of things bothering them; the right ankle
06:08 - 06:12bothers them, their left knee, they get a little low back pain from time to time,
06:12 - 06:18left shoulder. Alright how am I going to address this issue, well providing I
06:18 - 06:23don't have one thing that's more obstructive than another, I don't have a
06:23 - 06:30huge asymmetry present, there isn't a worse dysfunction, i'm going to start
06:30 - 06:36from the bottom up. So i'm going to start at the ankle because I know that if I
06:36 - 06:39correct the ankle I will get good progress
06:39 - 06:44from ankle to ankle to, or lower leg let's say to lower leg to lumbo-pelvic
06:44 - 06:48hip complex dysfunction. That'll stay pretty good, and then I can go to upper
06:48 - 06:52body dysfunction, what does not work out. Well if I start with upper body
06:52 - 06:59dysfunction and this person has feet turn out, feet flattened every time they
06:59 - 07:06take a step, little bits when they walk are going to do this, which is going to
07:06 - 07:10tighten back up their latissimus dorsi as a lumbar extensor, and put them
07:10 - 07:13right back into the upper body dysfunction I just tried to correct, and
07:13 - 07:19in essence everything stacks on your feet. Alright so just to recap this guy's
07:19 - 07:25address what needs to be addressed first, not from your point of view but from
07:25 - 07:31your patient or clients point of view, that's priority number one. Second
07:31 - 07:39asymmetry probably the best indicator we have of potential injury. Third go after
07:39 - 07:44the worst thing you see, and then last and this is probably the one that will
07:44 - 07:49stick is you stay with a patient, or stay with a client over months and years and
07:49 - 07:53they keep coming back to you for different things, start from the bottom
07:53 - 08:00up, continue to keep corrective exercise in their program with this in mind, so
08:00 - 08:05that you keep them stacked on a stable foundation. I hope this helps your
08:05 - 08:10decision making process. I hope this and all of the previous videos makes your
08:10 - 08:16assessment skills much much more refined, much more skill than they were before. I
08:16 - 08:19look forward to talking to you guys soon.
08:26 - 08:28

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