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

The Overhead Squat Assessment 14 - Sign Clusters: Lumbo Pelvic Hip Complex Dysfunction is a comprehensive evaluation of the biomechanics of the lower half of the body. This assessment looks at the various movement patterns in the lumbo-pelvic-hip complex that are affected by poor posture or dysfunctional movement. The assessment will highlight any dysfunctional movement patterns or postural compensations, as well as any dysfunction in the muscles and connective tissue of the area. The goal of

Transcript

00:00:0500:00:10
This is Brent and in this video we're
00:00:0500:00:10
going from individual signs, to clusters
00:00:1000:00:15
of signs that start indicating a compensation pattern. In this video we're
00:00:1500:00:19
going over lumbo-pelvic hip complex dysfunction. So we can start off thinking
00:00:1900:00:24
about which boxes would be checked in a lumbo-pelvic hip complex dysfunction
00:00:2400:00:28
just by breaking this down a little bit. So we got lumbar, which is our lumbar
00:00:2800:00:35
spine, pelvis, which is a bone driven by the lumbar spine and hip, and then we can
00:00:3500:00:41
also look at hip signs as well. So you guys will notice anterior view knees bow
00:00:4100:00:45
in, or knees bow out right. That can be driven by hip internal rotation or hip
00:00:4500:00:49
external rotation. Those could be hip signs. And then when we come to my
00:00:4900:00:52
lateral view, we have an excessive forward lean, which can be driven by hip
00:00:5200:00:59
flexion, in excess of lordosis or anterior pelvic tilt, really that's the
00:00:5900:01:02
sign at the heart of this dysfunction, anterior pelvic tilt, sometimes known as
00:01:0200:01:08
lower cross syndrome definitely is where all of this starts building. And then
00:01:0800:01:14
arms fall, stay with me here guys, I know the arms do not necessarily connect to
00:01:1400:01:21
the hip, but if we look at an anterior pelvic tilt, it's hip flexion and lumbar
00:01:2100:01:26
extension, my lats can become overactive as a lumbar extensors and cause my arms
00:01:2600:01:31
to fall. So all of these signs guys right. We've been moving from checking a single
00:01:3100:01:36
box to noticing that we never check a single box, and trying to recognize these
00:01:3600:01:43
patterns, these are all the signs that could come from dysfunction at this
00:01:4300:01:46
segment of the body. I'm going to have my friend Melissa come out, she's going to
00:01:4600:01:51
help me demonstrate what this looks like. So first things first, I want to point
00:01:5100:01:54
out something that Melissa and I have noted as we've done this a couple
00:01:5400:02:00
times, is if she turns sideways and sets up her squat, so I have her second toe
00:02:0000:02:03
pointing forward, her feet are going to be underneath your ASIS, which her hips
00:02:0300:02:08
are just underneath, so bring your feet a little closer together. We can note that
00:02:0800:02:13
if I put her pants on her PSIS and the front of her pants and her ASIS, those
00:02:1300:02:18
should be within a centimeter to an inch of each other, all right depending
00:02:1800:02:25
centimeter to an inch. If there's any more slope to that, you can see that from
00:02:2500:02:28
this pant line she already has an anterior pelvic tilt. I don't need her to
00:02:2800:02:33
do an overhead squat assessment. I can just from right here, go ahead and check
00:02:3300:02:38
off this one box. In fact this particular sign, and if she throws her hands up it
00:02:3800:02:42
actually gets a little worse. You guys can see how that line comes down, this
00:02:4200:02:47
particular sign once they start the squat they might even tuck back under
00:02:4700:02:52
and this might improve, but don't take notice of that, the sign is still here.
00:02:5200:02:55
When you do your math and your corrective strategy, you still need to
00:02:5500:03:01
solve for this dysfunction. Alright go ahead and turn back forward, so second
00:03:0100:03:05
toe pointing forward, bring your feet in just a little bit. So in the anterior view we've
00:03:0500:03:09
already been through what's up here. I'm going to be looking for knees bow in or
00:03:0900:03:13
knees bow out, have her do her overhead squat like she always does. She squats
00:03:1300:03:18
down, her feet turn out a little bit which is not a lumber pelvic hip complex
00:03:1800:03:23
dysfunction sign, it's a lower leg dysfunction sign, but guys look we got a
00:03:2300:03:28
little bit of femoral external rotation, a little bit of femoral external rotation
00:03:2800:03:32
and her knees are bowing out a little bit, that could be coming from lower leg as
00:03:3200:03:35
we discussed in a previous video, but that could also be coming from the
00:03:3500:03:42
lumbo-pelvic hip complex. Let's go ahead and have you turn that way, arms up, good.
00:03:4200:03:46
You notice this anterior pelvic tilt, check. Go ahead and have her into her
00:03:4600:03:50
squat, and you guys can see we have an excessive forward lean which could be a
00:03:5000:03:54
lower leg sign we've discussed that, but can also be driven by hip flexion. We're
00:03:5400:03:59
going to need to check this out further. We also see the successive lordosis, do
00:03:5900:04:05
her arms fall, just a little bit right, so we got these three signs coming into
00:04:0500:04:11
play too. So go ahead and stand up. I could have her do a posterior view guys,
00:04:1100:04:15
and you might note that an asymmetrical weight shift can be a lumbo-pelvic hip
00:04:1500:04:19
complex dysfunction sign, but we're going to skip it in this video. I'm going to do
00:04:1900:04:25
a separate video dedicated to the asymmetrical weight shift. So let's have
00:04:2500:04:29
her turn around forward again, we have a couple things that we need to figure out
00:04:2900:04:35
here. She had arms fall forward, which we know can come from over
00:04:3500:04:40
activity in our latissimus dorsi, which we know can also come from either upper
00:04:4000:04:45
body dysfunction or lumbo-pelvic hip complex dysfunction. So how am I going to
00:04:4500:04:50
figure this out? Well I'm going to put her hands on her hips that's going to
00:04:5000:04:58
shorten her lats, lats are now no longer part of this assessment. If her anterior
00:04:5800:05:04
pelvic tilt disappears then I'll know it originated with tight lats coming from
00:05:0400:05:11
upper body dysfunction. If her anterior pelvic tilt stays, then I know it's
00:05:1100:05:15
coming from lumbo-pelvic hip complex dysfunction, because her upper body is no
00:05:1500:05:21
longer part of the assessment. Knees bow in and bow out, same thing. She has
00:05:2100:05:26
knees bow out, how do I figure out if this is eversion on foot our tibial eversion on
00:05:2600:05:32
foot, or femoral external rotation. Well I'm going to take her ankle out of the
00:05:3200:05:38
movement, ankle dysfunction starts with a restriction in dorsiflexion. So
00:05:3800:05:41
if I put her way up in plantarflexion
00:05:4300:05:48
and all of a sudden her knees don't bow out, then I knew that that was coming
00:05:4800:05:52
from lower leg. Right i have taken the ankle out of the dysfunction, now she
00:05:5200:05:57
does this assessment and her knees still bow out, I know it's coming from this
00:05:5700:06:07
segment. You ready, all right let's go, and we have an even more confusing thing
00:06:0700:06:13
happened, which is she still has knees bow out but it got better. So we're gonna
00:06:1300:06:18
use our deductive reasoning a little bit, here would be my guess, she has lower leg
00:06:1800:06:24
dysfunction, but the knees bow out is coming from both her lower leg
00:06:2400:06:29
dysfunction and some dysfunction of the lumbo-pelvic hip complex, so that makes
00:06:2900:06:34
sense. If it had disappeared completely I would know it was lower leg,
00:06:3400:06:39
if it had got no better, or got worse I would know that it was coming
00:06:3900:06:45
from lumbo-pelvic hip. Let's go ahead and turn sideways now.
00:06:4500:06:54
Let's see what happened to all of these signs when I had her hands down
00:06:5400:06:59
and her feet, her heels elevated, and what we'll notice is, is that her excessive
00:06:5900:07:03
forward lean more or less goes away. So i'm going to guess once again that her
00:07:0300:07:07
excessive forward lean was being driven by her lower leg dysfunction, but we
00:07:0700:07:11
still have an excessive lordosis, so that's definitely coming from our
00:07:1100:07:19
lumbo-pelvic hip complex. Alright as well we have her arms down, so my guess
00:07:1900:07:24
would be is that that anterior pelvic tilt isn't even being contributed to by
00:07:2400:07:27
upper body dysfunction, this got no better, all right so I'm going to guess she
00:07:2700:07:32
doesn't have upper body dysfunction. She has a significant amount of lumbopelvic
00:07:3200:07:36
hip complex dysfunction, which we could look at fixing, and as you guys have
00:07:3600:07:41
heard me go through this, she probably has a bit of lower leg dysfunction as
00:07:4100:07:45
well. We're going to concentrate on this in this video, in a future video also
00:07:4500:07:48
kind of describe to you guys how I decide which dysfunction I'm going to go
00:07:4800:07:56
after first. Thank you Melissa. Now this is our cluster of science guys, hopefully
00:07:5600:07:59
you kind of understood the logic of how I got here. Now I know some of you guys
00:07:5900:08:05
are going holy cow that's a lot to fix, but as I had mentioned before in a
00:08:0500:08:10
previous video, a lot of this stuff overlaps. If you guys go to brentbrookbush.com,
00:08:1000:08:14
you go two categories, you look under assessment you look under
00:08:1400:08:19
solutions table, overhead squat assessments, and you started putting
00:08:1900:08:24
these signs on top of each other, you guys would notice that a bunch of the
00:08:2400:08:30
muscles overlap. All of these muscles for like let's say knees bow in and
00:08:3000:08:36
excessive forward lean, a lot of those TFL, gluteus minimis on both sides of the
00:08:3600:08:40
graph, gluteus maximus and gluteus medius is on the other side of the graph
00:08:4000:08:44
of both of these. So once I turn this board over, you're going to see you don't
00:08:4400:08:51
have as much to work on as you thought you did. So here we go, here's the list,
00:08:5100:08:55
here's the list for lumbo-pelvic hip complex dysfunction, and before you freak
00:08:5500:08:58
out about this side of the graph, let me kind
00:08:5800:09:04
break it down for you. All I did was list my hip flexors, my femoral internal
00:09:0400:09:10
rotators, and my lumbar extensors. We'll talk about this in a second. That seems
00:09:1000:09:15
like a lot of muscles to release, but when you really think about it, you can't
00:09:1500:09:20
self-administered release your psoas and iliacus, my manual therapists you can
00:09:2000:09:26
get in there with your hands, great stuff. My personal trainers and people who are
00:09:2600:09:29
watching this just to help themselves, please don't shove things into your
00:09:2900:09:33
abdomen to try to release this. You rectus femoris and Sartorius are both on
00:09:3300:09:36
your anterior thigh, you guys are probably even hitting both of these
00:09:3600:09:41
things, you just didn't know that this one was included to. TFL and glute min
00:09:4100:09:46
same thing. You're TFL's here., your glute min's here. You're probably getting both
00:09:4600:09:48
of them when you do just above your greater trochanter on the side of your
00:09:4800:09:55
hip. You've probably been doing inner thigh. Your lats and erector spinae you do with that
00:09:5500:10:00
thoracic spine foam roll, you might not even have been aware of that. So with
00:10:0000:10:03
your release techniques you're really still only doing the same release
00:10:0300:10:07
techniques, it's only four areas maybe. Same thing with the stretches you're psoas,
00:10:0700:10:12
iliacus, rectus femoris, sartorius, TFL, gluteus minimus, all of those are partly
00:10:1200:10:18
or completely lengthened by a kneeling hip flexor stretch. So you knocked out a
00:10:1800:10:23
whole bunch of things. Your lats and erector spinae are stretched very well,
00:10:2300:10:28
lengthened very well with something like a modified Child's Pose. Same thing on
00:10:2800:10:33
the long side, glute max and glute med are the big ones for this dysfunction
00:10:3300:10:37
that we need to activate. I'm always talking about everybody needs bigger
00:10:3700:10:41
glutes, everybody needs stronger glutes, everybody needs more active glutes. Now
00:10:4100:10:44
you guys start to see why in lower leg dysfunction these guys were weak.
00:10:4400:10:50
Lumbo-pelvic hip complex dysfunction these guys are under active. You could
00:10:5000:10:54
add your semi's to this list, of course semi's on my website is listed under
00:10:5400:11:00
tibial internal rotator activation. I find more use for the semitendinosus
00:11:0000:11:04
activation or tibial internal rotator activation for lower leg dysfunction, but
00:11:0400:11:09
you could add it here. Notice that biceps femoris, piriformis and adductor Magnus have
00:11:0900:11:13
stars by them. They're on the long side of this graph,
00:11:1300:11:18
but they're overactive. They adopt that weird long and overactive relationship.
00:11:1800:11:22
It's most commonly associated with synergistic dominance, since they're
00:11:2200:11:26
overactive we don't want to activate them, and since they're long we don't
00:11:2600:11:30
want to lengthen them. What we can do is release them. We can release them and try
00:11:3000:11:36
to calm down their activity, so that our prime movers have a better chance of
00:11:3600:11:42
becoming as active as they should be. Now as I've mentioned in other videos you
00:11:4200:11:46
have the opportunity when you start looking at bigger patterns to start
00:11:4600:11:51
looking at more research, more theory. You start looking at things like fascia,
00:11:5100:11:57
arthrokinematic dysfunction, synergistic relationships, we can start looking at
00:11:5700:12:03
things like subsystems. You guys notice I have deep longitudinal subsystem on the
00:12:0300:12:09
overactive side of the graph, and then your intrinsic stabilization subsystem
00:12:0900:12:13
which is your TV a and friends, anterior oblique subsystem which is this one
00:12:1300:12:18
right, external obliques rectus abdominis contralateral adductors, and your
00:12:1800:12:23
posterior oblique subsystem your glutes and contralateral lats, they're all on
00:12:2300:12:27
the under active side. So once you guys get past your release, you're lengthening,
00:12:2700:12:32
your individual muscle activations, these are the people you get to have a lot of
00:12:3200:12:37
fun with with their core works. Right you can do all your TVA activations stuff,
00:12:3700:12:41
so that's all the quadrupeds and the quadruped variations. That anterior
00:12:4100:12:45
oblique subsystem, all those chopped patterns are wonderful for this group,
00:12:4500:12:49
and that your posterior oblique subsystem is all those wonderful squat to row, or
00:12:4900:12:53
step up to row, or lunge to row progressions that make for some very
00:12:5300:13:00
tough workouts. Right you guys can also start looking at some fascial stuff, your
00:13:0000:13:04
abdominal fascia, your thoracolumbar fascia. We can start looking at our arthrokinematics,
00:13:0400:13:08
so what is happening to the hip right in that anterior superior
00:13:0800:13:12
glide. We get to do all of this and we start looking at bigger compensation
00:13:1200:13:16
patterns. I want you guys to look up an article for me go to brentbrookbush.com
00:13:1600:13:21
go to postural dysfunction and movement impairment, and go to
00:13:2100:13:26
lumbo-pelvic hip complex dysfunction, and you'll see me tear
00:13:2600:13:31
this stuff apart, give you much much more detail, as well as there's links to
00:13:3100:13:38
sample routines, repertoire of corrective exercises, there's case studies there, as
00:13:3800:13:43
well as the next video we're going to go into, which is our asymmetrical weight
00:13:4300:13:49
shift and sacroiliac joint dysfunction, which is a dysfunction within this
00:13:4900:13:52
dysfunction. I look forward to hearing about the great outcomes that you guys
00:13:5200:13:55
get now that you're able to address this model completely. I think you will get
00:13:5500:14:00
much much better outcomes, much much faster single session type of
00:14:0000:14:05
improvements, that have much better carry over to your next session. Talk to you
00:14:0500:14:07
soon.