Name: Overhead Squat Assessment 7 - Knees Bow Out
Uploaded: 2023-04-26T01:01:17.000Z
Duration: 5 min 5 s

English captions

https://stream.mux.com/lNuvnsXlP2n7yDay1mnBYKiBfERuJlFBDHDWdU5cdqw.m3u8

Learn how to identify and interpret knees bow out dysfunction using the overhead squat assessment in this comprehensive step-by-step instructional video from the Brookbush Institute. This evidence-based video provides expert guidance on evaluating frontal plane knee alignment, recognizing compensatory movement patterns, and understanding how mobility and stability impairments of the hip, foot, and lumbopelvic-hip complex contribute to excessive external rotation and altered squat mechanics. Develop the skills needed to accurately assess this deviation, inform corrective exercise and manual therapy strategies, and improve movement efficiency and squat performance. Perfect for clinicians, fitness professionals, and rehabilitation clients seeking to enhance movement assessment accuracy, optimize lower-extremity alignment, and reduce injury risk.

Understanding Knees Bowing Out in Overhead Squats

Identifying Underlying Dysfunction: Femoral External Rotation

Addressing Synergistic Dominance and Muscle Activation

Transforming Knees Bowing Out to Corrective Measures

Overhead Squat Assessment 7 - Knees Bow Out

This is Brent coming at you with another overhead squat assessment video. In this video we're going to go over the sign knees bow out. So I'm gonna have my friend Leanne come out, she's going to demonstrate knees bow out for us. I'm going talk to you guys about some of the details here. So first things first, i'm going to go ahead and have her set up with feet hip width. We know that her hips are just behind her ASIS here, so she can go a little wider than that, just a little bit. There you go, and then she's going to make sure her second toe is pointing forward. Ideally I know that the knees should track, so that the patella goes over the second and third toe. Now Leaane's going to throw her hands up over her head, and show us what knees bow out looks like, and she's doing a pretty good job demonstrating what you would commonly see here. You can see here her patella starts tracking over her pinky toe, or just passed her pinky toe. Now I know most of you guys are probably expecting to see more of a exaggerated knees bow out. Let's go ahead and show that. But the truth of the matter is that just doesn't happen all that often. Most of the time when you guys see the sign, it is going to be just a little bit of splaying out to the pinky toe, and i would say even more common than that is only on one side. So I'm going to have Leanne kind of bow out, try to show bow out just on the right side, and all I would do on my overhead squat assessment, as if I saw that, if it was only on the right side, i would just knees bow out 'r' circle right, to make sure I understood it was just the right side. If it was right side more than left but both of them did it it would be 'r' greater than left. Keep your documentation simple, easy for you to read, so that you can reproduce the same way every time. Thank you Leanne. Now let's analyze this dysfunction. Unfortunately this dysfunction is not as obvious as some of the other dysfunctions we've put up. So knees bow out, you would think towards abduction, but the truth of the matter is it's actually femoral external rotation, and then at the ankle that knees bow out is being driven by eversion. So you guys remember the joint action eversion is like this with my feet, unless its tibia on foot eversion, then if I did this with my feet and laid them back flat, my tibia would be pointed outward, so hopefully you guys can follow that. When we get into actually breaking down femoral external rotation, we have to add yet another layer. So some of you guys are already aware of this idea of agonists versus synergists, and this idea of synergistic dominance. In this dysfunction this all plays a role. So if I were to just throw my external rotators up there for the femur, I would end up with the glute max and the glute medius on my short and overactive side. I can honestly tell you guys an overactive glute max and glute medius almost never happens, these are what we call phasic muscles. They have a propensity to get really under active. What is actually happening in this dysfunction is that has happened .The glute max and the glute medius have definitely become inhibited and reduced in activity, and you have the takeover of the synergists for that, which are not quite as good as extension but better at external rotation. So we get displaying of the knees. Those three muscles are the piriformis, biceps femoris, and posterior head of the adductor Magnus. So those are going to be muscles you want to treat with release and stretching, and of course you guys know our eversion from previous videos of the fibularis and lateral gastrocnemius. So now what are we going to activate to improve this dysfunction, well my inhibited agonists, the muscles that are allowing the center just to become dominant. Once we release and stretch them and reduce their activity, we need to get the glute max and the glute medius involved again. So that's where you guys are going to do your glute max and glute medius activation, and then of course you're going to go after your inverters, being your posterior tib and your anterior tib to fix that dysfunction in the ankle. Now one small thing i will say about this dysfunction, this is one of our first dysfunctions within a dysfunction. Believe it or not if you guys started with knees bow out, corrected the dysfunction, and ended up with knees bow in, that's actually a step forward. I actually find that most people who have knees bow out, it's just knees bowing in disguise. We need to get past this synergistic dominance relationship and then once we do that, we go back to our knees bow in sign, and we start correcting that way. I hope you guys enjoyed this video. I hope you guys get lots of pointers. I hope you guys get great results to talk with you soon.

Home

Videos

Unlock optimal movement with the Overhead Squat Assessment. Evaluate dynamic flexibility and neuromuscular control in major joints. Start your journey to better fitness now!

Overhead Squat Assessment: Signs of Dysfunction

 to indicate the objective of the assessment or the signs you are attempting to identify. We do not want the client/patient attempting to "fix" their alignment.

Ask your patient/client to stand with feet hip-width apart.

Because a patient/client may assume a range of comfortable foot positions, it may be necessary to cue and manually adjust foot position so that the OHSA is started with the ideal foot position (or as close to the ideal foot position as can be achieved).

Ask your patient/client to reach "straight up over their head" with "elbows locked".

Ask your patient to "sit down" and "stand up" as many times as necessary to assess for the "signs of dysfunction".

 For those who do not know how to squat or may be at risk of falls, this can be done with a chair, and thought of as a "sit-to-stand transfer assessment".

 For advanced exercises and athletes who may "know what a squat should look like", it may be helpful to have them close their eyes, reducing visual input and their ability to self-correct

 It is tempting to start noting every "deviation" based on a personal frame-of-reference of squat form. The only signs that have been correlated with dysfunction and successful intervention are the signs discussed below. Adding additional signs to the assessment, however well-intentioned, may serve to invalidate the assessment, reduce assessment reliability, or reduce the relative efficacy of the implied interventions.

As mentioned above, this assessment is designed to highlight deviations from ideal motion with the intent of informing intervention selection. It may be helpful to review the definition (discussed above) of 

Evidence-based Ideal Posture/Alignment Definition:

 A mean range of segment alignment (bone, joint, muscle, nerve) that is absent of signs correlated with dysfunction, pain, or an increased risk of injury.

The ideal alignment described here is similar to what may be anticipated during a static postural assessment or gait assessment. However, additional details have been added to aid in differentiating between ideal motion and the deviations discussed below.

 Ideal alignment includes feet parallel (2nd metatarsal and toe pointing forward), hip width, and the medial longitudinal arch maintained. That is, the 2nd metatarsals (center of the foot) are parallel, in alignment with the hip joints which are inferior to the anterior superior iliac spine (ASIS), and significant inferior motion of the navicular tubercle is not observed.

Although the neck of the femur extends the greater trochanter laterally and gives the appearance that the hip joints extend to the lateral thigh, the hip joints are only about 7" apart (6). This is about the same width as the ASIS, and the hip joints are in fact, just inferior and in near alignment with the ASIS. Because the hip joints cannot be palpated, the ASIS are used as the reference for hip width.

 The knees should maintain alignment with the hip joint and ankle joint. If optimal foot position is maintained, the anterior and posterior motion of the patella during the squat should align with the 2nd and 3rd metatarsals.

 Ideal alignment includes an optimal lumbar curve, ASIS just inferior to the level of the posterior superior iliac spine (PSIS) (within 2 cm), and the right and left iliac crest level.

During the lateral view of the OHSA, the intersection of the mid-axillary line, and a line between the ASIS and PSIS should be near 90º.

 The tibia and the mid-axillary line should maintain near-parallel alignment during a squat.

 Ideal alignment includes depression and retraction of the scapula. Shoulder flexion should be achieved via upward rotation and posterior tipping of the scapula.

 Ideal alignment is maintaining the arms in alignment with the torso with elbows at terminal extension. That is, 180º of shoulder flexion should be maintained.

Overhead Squat Assessment 7 - Knees Bow Out

Overhead Squat Assessment 16 - Sign Clusters: Posterior Pelvic Tilt ("Butt Wink") and Inadequate Forward Lean Breakdown

Overhead Squat Assessment 11 - Shoulders Elevate

Overhead Squat Assessment 10 - Arms Fall

Overhead Squat Assessment 9 - Anterior Pelvic Tilt (Excessive Lordosis)

Anterior Pelvic Tilt Break Down (Workshop Snippet)

Overhead Squat Assessment 8 - Excessive Forward Lean

Overhead Squat Assessment 6 - Knees Bow In Breakdown

Overhead Squat Assessment 5 - Feet Turn Out Breakdown

"Feet Turn Out" Breakdown

Overhead Squat Assessment 4 - Feet Flat Breakdown

Comments

Guest