Name: Overhead Squat Assessment 12 - Sign Clusters: Lower Leg Dysfunction
Uploaded: 2023-04-26T01:01:30.000Z
Duration: 13 min 58 s

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https://stream.mux.com/Hbadx4gIgyg700bCUA2C005MM2WUCK5zeo00791Ch9FCFk.m3u8

Learn how to assess lower leg dysfunction sign clusters within the overhead squat assessment in this comprehensive step-by-step instructional video from the Brookbush Institute. This evidence-based video provides expert guidance on identifying key compensation patterns, recognizing mobility and stability impairments of the foot, ankle, and lower leg, and interpreting how these dysfunctions influence global movement patterns. Develop the skills needed to improve range of motion, identify biomechanical compensations, and inform corrective exercise strategies. Perfect for clinicians, fitness professionals, and rehabilitation clients seeking to enhance movement assessment accuracy, refine lower extremity analysis, and optimize performance and injury prevention outcomes.

Introduction to Overhead Squat Assessment Enhancements

Identifying Lower Leg Dysfunction and Its Patterns

Understanding Dorsiflexion and Its Impact on Squat Mechanics

Assessing the Source of Dysfunction: Ankle vs. Lumbo-Pelvic Complex

Evaluating Anterior Pelvic Tilt and Subsequent Adjustments

Condensing Corrective Techniques for Effective Training

Integrating Functional Anatomy and Compensatory Patterns

Overhead Squat Assessment 12 - Sign Clusters: Lower Leg Dysfunction

This is Brent and in this video we're taking our overhead squat assessment up a notch. Now in our previous videos we went through sign by sign. We discussed what each sign implicates as far as long and short muscles. Which muscles are overactive an underactive. What you've already started to notice is that you never get an overhead squat assessment where you look down at your template, and you have one box checked, that's a nice thought. I hope to meet that individual eventually where I get a very simple corrective exercise program. But most of the time we start to see several boxes checked off. If you've really been paying attention and you've really done a lot of overhead squat assessments, what you've probably started to recognize that is that there's a pattern to which boxes get checked off. Now these patterns develop into clusters, these clusters start to implicate compensation patterns. Now in this video we're going to go over the lower leg dysfunction compensation pattern. So we're going to see certain signs packaged together, and you're going to see this over and over and over again. So now we're taking our ability as assessors, to go from seeing one sign to seeing the entire compensation pattern package together. I'm going to have my friend Melissa come out, and she's going to demonstrate what this looks like, which I know you guys have seen a million times before. If I get her all set up, second toe pointing forward, arms up over her head, her feet are hip-width or in line with her ASIS, and I go okay, and she's going to exaggerate this for me. I go go ahead and squat, we watched her feet turn out, her feet are flat and her knees kissed, how many times have you guys seen that? You guys would have seen that a ton right, and then if you looked at her from the lateral view, go ahead and turn, face that way for me. She does the same thing right, knees kissed, feet turn out, feet flattened, but then you guys also notice she has excessive forward lean, a little anterior pelvic tilt. And then when we turned her around, she may or may not even have an asymmetrical weight shift. How many of you guys have seen all of this package together. Well mechanically we can describe this lower leg dysfunction. I was going to say there was a route to lower leg dysfunction, lower leg dysfunction starts with the inability to dorsiflex far enough. Alright remember dorsiflexion is just not foot up this way, but the ability to translate the knee forward. That ability to translate the knees forward, so go down into your squat a little bit, it also keeps her center of mass, right we can think like kind of in this core area, that's what keeps it over her base of support. So we can already explain the excessive forward lean, if she can't dorsiflex far enough, she has to, her butt ends up way out behind her, and she has to throw her upper body mass over, creating that excessive forward lean, just to keep her center of mass over her base of support. Let's get a little bit more technical though, some you guys have heard of this concept of relative flexibility. So if I have hypomobility a restriction at one joint, I start compensating with hypermobility at other joints, she can't dorsiflex enough. So just for her body to try to get some more motion, her feet flattened out, which is going to cause problems, and then she steals even a little mobility from her knees by doing this. Go ahead and go down in your squat, this little turnout thing all right. So she can't dorsiflex here, she's stealing from here and here. Well hypomobility hyper are sorry, hypermobility hypomobility, and then of course that leads to hip dysfunction, because tibial external rotations, femoral internal rotation which drives tightness in her tfl which is also a hip flexor; and that's going to cause an anterior pelvic tilt. So I know I just said a lot these signs aren't separate though, they're actually all mechanically linked as Melissa's body here tries to figure out how to work around this one restriction that started with an inability to dorsiflex. If you guys go back and look at all of your solutions tables, you'll even notice that the muscles involved in like let's say feet flattened, and feet turn out, both the lateral gastroc will flatten the feet and turn out the feet, and you guys saw that. Feet turn out knees bow in -lateral gastroc, biceps femoris, tfl. Knees bow in -lateral gastroc, biceps femoris tfl and gluteus minimus. You see all of this overlap, it's almost disingenuous for us to start the way we did, which is with individual signs. It's actually these entire patterns that the body tries to create. So going back to our overhead squat assessment now, you guys just took yourselves up a notch by realizing that it's not individual signs, but clusters of signs that we're looking for. The one thing we have to make sure we do now though, is make sure that it is the ankle that is driving this dysfunction and not the lumbo-pelvic hip complex. Some of you guys have already seen that squat with modifications for further assessment, so stay with me here for a second. Sure knees bow in can be driven by the fact that her feet turn out alright, so that's tibial external rotation which causes relative femoral internal rotation, and causes her knees to collapse as she goes down into a squat. But she can put her feet back here, if she just had like an anterior pelvic tilt which was driving over activity of her tfl, gluteus minimus and anterior adductors, that could also drive her knees in. Go ahead and squat for me, but that would be coming from the lumbo-pelvic hip complex. So before I start fixing here, I need to make sure that the dysfunction is being driven here in her lower leg, versus being driven by the lumbo-pelvic hip complex, and that's actually fairly easy to do. All I have to do is take my ankle out of the movement. If i take my ankle out of this and everything recklessly gets better, then i know that's where the dysfunction comes from, and that's what I'm going to correct. So I'll have her do her overhead squat and I'll do all of my signs alright, so let's go ahead and see the the overhead squat hands over your head, do your squat, we see feet turn out, we see knees bow in, that's our anterior view. Alright lateral view hands up over her head, she squats down, I see an excessive forward lean, an anterior pelvic tilt. Posterior view good and I see a little asymmetrical weight shift to the left, great now what I'm going to do is go okay where is this coming from. I'm going to have her get on high heels so I'm gonna put her in a whole bunch of plantar flexion, so now that dorsiflexion restriction is not an issue. I do get a lot of questions on how high this needs to be, you guys need to pick a platform whether it's a couple weight plates, foam a half foam roll, rolled up mats, the backs of someone's shoes, it does have to be high enough so that they don't show their ankle signs, basically feet flattened, and feet turn out. If they still feet turn out and feet flattened, your platform here for their high heels isn't high enough. For this I think she's going to be fine. So she's going to go ahead and throw her hands up over her head and squat, you noticed that all of this stuff gets cleaned up. So we know that her knee and her ankle signs of course were actually coming from lower leg dysfunction. If I turn her sideways she squats, notice how that excessive forward lean disappears, I know that was coming from here. We do see something interesting with Melissa she still has an anterior pelvic tilt all right, so that anterior pelvic tilt is probably coming from a lumbo-pelvic hip complex dysfunction. I can even double check if I have a put her hands on her hips, all right and go ahead and stand up. Do one more for me, you still see that anterior pelvic tilt. So most of our signs are coming from lower leg dysfunction, that's probably what I would aim for first. But chances are i'm going to have to come back and look at the lumbo-pelvic hip complex specifically, and write a program to fix this. If I go posterior view, we said in the posterior view before we saw an asymmetrical weight shift, she was faking it, but let's pretend that she thought we saw an asymmetrical weight shift, and then we put her in high heels and shift went away. A lot of you guys have been asking me for an asymmetrical weight shift video, and I'm going to do just one specifically dedicated be asymmetrical weight shift. But I do find a lot of people have an asymmetrical weight shift, not because of something that's going on here, but because they actually had one calf or one ankle, or one sided lower leg dysfunction, that when they squatted down was forcing them over. You're not going to correct this then, even though it's an asymmetrical weight shift I wouldn't go after this. I would go after the tighter side of their lower leg dysfunction. Thank You Melissa. So big step guys, you just took a huge huge huge step. We just went from looking at signs of dysfunction to what the body actually really tries to do, which is create a compensation pattern. Now before you freak out and go oh my goodness that is a lot of stuff I have to correct, it's actually not that bad, and you start looking at how overlapping the muscles and those signs were, how mechanically linked those joint signs were. You start realizing it's not a very long list at all. Despite all of the stuff we just saw, it only comes down to lateral gastroc, soleus, fibularis, biceps femoris, TFL VL, ITB complex and gluteus minimus. That's six release techniques. If you go back and look at some of the stretching videos, the lateral gastroc, soleus and fibularis muscles get stretched together in that modified slant board stretch I've shown. So we're already condensing down pretty quick. This gets its own stretch. The gluteus minimus, tfl gets stretched together. Tibialis posterior, medial gastroc get activated together. So that still only leaves us, let's see here, five activation techniques, and then we have our integration techniques. Even when we get really really complicated it doesn't amount to more than 20 techniques let's say, 25 techniques. Or even if you're really really sophisticated you can do all this different manual stuff 30 techniques. Try to keep in mind this isn't like resistance training, I'm not having them do multiple sets of this stuff over and over again. I'm going through each muscle doing what I need to do one set a piece, people do not get rest between sets. I guarantee at the minimum let's say this takes 16 or 17 techniques to correct, everything from ankle all the way up to here, I can get somebody to do that in 20 minutes. It might take two or three sessions before they can get through it in 20 minutes, but eventually that's one minute per technique, and they're just rocking through it; and you're fixing the entire compensation pattern which makes sure you leave a lot less behind, so that your outcomes are a lot better, your carryover from session to session is a lot better, and this is what gets really cool. So I want you guys to look up this article on brentbrookbush.com that I wrote, it's under postural dysfunction and movement impairment, called lower leg dysfunction. You'll be able to see where I start combining these signs, and it starts implicating all of this other cool stuff. Like we can start looking at subsystem activation. In this dysfunctional pattern we see that the deep longitudinal subsystem and anterior oblique subsystem become overactive, but the posterior oblique subsystem and lateral subsystem become under active. You can't really even look at that stuff though until you see the entire package. Everybody's talking about fascia, everybody's talking about it. But we know fascia isn't a single joint, a single sign thing, it spans several joints, it connects lots of muscles. Well once we're looking at several joints we do start to see a little bit of that fascial connection. We see the TFL VL ITB complex come in. Alright we see the tibial internal rotators which have this this tendinous fascial connection at the medial knee come in, lots of stuff going on here. If you guys look back at the deep longitudinal subsystem you'll see that that's actually a huge fascial system, including the sacrotuberous ligament, and the deep layers of the thoracolumbar fascia. So we're taking a big step guys. I know we're taking a huge step going from signs to patterns, to integrated functional anatomy, and some really sophisticated exercise techniques and routine design, but that gives us a whole lot more to work with. I think you guys are going to have a whole lot of fun with it. It's basically unending what you could possibly do with all of this information. I hope you guys have fun. I look forward to hearing about your outcomes. 

Home

Videos

The effects of movement dysfunction (left to right asymmetry, asymmetrical weight shift, trunk muscle weakness, core weakness, core strength, abdominal strength, erector spinae overactivity, glute strength/activity), have on back pain (LBP), history of low back pain, prevention of back injury, performance, low back strength, and stability. The reliability, validity, and application of assessment and intervention on lumbopelvic hip complex dysfunction (AWS, excessive forward lean, knee bow in, knee bow out, and anterior pelvic tilt) on preventing back and hip pain.

Does Movement Impairment Precede Low Back Injury?

The effects of movement dysfunction (reduced eccentric hip abduction strength, glute medius and maximus weakness, valgus knee, knee bow in, and greater trunk displacement), have on knee pain, knee injury, ACL (ligament) tears, patellofemoral pain syndrome (PFPS), and pathology. The reliability, validity, and application of assessment and intervention on knee bow in and lower extremity dysfunction (feet flatten and feet turn out) on preventing hip, knee, and ankle pain. 

Does Movement Impairment Precede Knee Pain and Injury?

The relationship between the hip and ankle on kinematics and muscle activity of the lower body. The effects of overactivity of the gastrocnemius, soleus, hip internal rotators (TFL and adductors), excessive pronation, and under activity of the gluteus maximus and medius (glutes) have on patellofemoral syndrome (PFPS), Achilles injury, knee injury (meniscus and ACL/MCL tears), running mechanics, gait, hip pain, knee pain, and ankle pain. The reliability, validity, and application of assessment and intervention for lower extremity and lumbopelvic hip complex dysfunction. 

Regional Interdependence: Hip and Ankle

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

Excessive lordosis (Anterior pelvic tilt)

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 

Overhead Squat Assessment: Signs of Dysfunction

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 

Overhead Squat Assessment 12 - Sign Clusters: Lower Leg Dysfunction

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

Overhead Squat Assessment 15 - Sign Clusters: Asymmetrical Weight Shift

Overhead Squat Assessment 14 - Sign Clusters: Lumbo Pelvic Hip Complex Dysfunction

Overhead Squat Assessment 13 - Sign Clusters: Upper Body Dysfunction

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