Name: Overhead Squat Assessment 14 - Sign Clusters: Lumbo Pelvic Hip Complex Dysfunction
Uploaded: 2023-04-26T01:00:03.000Z
Duration: 14 min 16 s

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https://stream.mux.com/kgIepDqr7QXUv46QE6l5A2y01Gm7vTCOj01m4JKYpUisU.m3u8

Learn how to assess lumbo-pelvic-hip complex (LPHC) dysfunction using 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 observing key movement compensations and interpreting signs related to lumbopelvic control, hip mobility, and trunk stability. Develop the skills needed to identify underlying mobility and stability impairments that influence squat mechanics, movement efficiency, and performance. Perfect for clinicians, fitness professionals, and rehabilitation clients seeking to refine movement assessment accuracy, inform corrective exercise  and manual therapy strategies, and optimize functional outcomes while reducing injury risk.

Understanding Lumbo-Pelvic Hip Complex Dysfunction

Demonstrating Dysfunctional Patterns

Assessing Mobility Limitations and Dysfunctional Signs

Identifying Overactivity vs Underactivity in Muscles

Release Techniques and Activation Strategies

Exploring Compensation Mechanisms and Next Steps

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

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

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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?

Predictive Model of Lumbopelvic Hip Complex Dysfunction (LPHCD): Signs of lumbopelvic hip complex dysfunction, muscle, joint, fascia, nervous system, neuromuscular recruitment, subsystem, and core muscle contribution. Exercise selection related to lower cross syndrome, anterior pelvic tilt, posterior pelvic tilt, knee bow in, knee bow out, and forward lean.

Lumbopelvic Hip Complex Dysfunction (LPHCD)

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

Note: Many of the signs above may be related to 

 . The "OHSA with Modification" is used to differentiate between these two compensation patterns.

OHSA with Modification - Heel Rise and Arms Down

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 "modification" (heel rise), carefully noting all "signs" still present.

Note: The "heel rise" should be high enough to resolve 

Ask the patient/client to place their hands on their hips (arms down).

Perform the OHSA again with "modification" (arms down), carefully noting all "signs" still present.

Note: 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.

Overhead Squat Assessment 14 - Sign Clusters: Lumbo Pelvic Hip Complex 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 13 - Sign Clusters: Upper Body Dysfunction

Overhead Squat Assessment 12 - Sign Clusters: Lower Leg Dysfunction

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