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Overhead Squat Assessment 17 - Deciding Which Dysfunction to Address First
The Overhead Squat Assessment 17 is a comprehensive guide to help clinicians decide which dysfunctions are causing specific movement impairments or pain syndromes in their patients. This assessment looks at the hip, trunk and shoulder musculature, as well as shoulder mechanics and general flexibility throughout the body. By studying the pattern of movement, strength and flexibility, clinicians can determine the root cause of the movement dysfunction and an appropriate treatment plan. The Overhead Squat Assessment 17 is a valuable tool
Transcript
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This is Brent and in this video I'm going to
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address a question that I get quite
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often. So in previous videos we've addressed individual signs, and then we
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took individual signs and realize that we almost never get a template where we
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get one box checked off. We started looking at patterns right these
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compensation patterns which are clusters of signs and how to address those, but
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what you've inevitably started to see is that even that isn't enough. Most of the
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individuals who come in and see us have not just a couple of signs or a pattern of
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signs, they have a couple of compensation patterns, they have little bits of
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upper-body dysfunction with lower leg dysfunction, or they have lower leg
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dysfunction with a little bit of lumbo-pelvic hip complex dysfunction.
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All of these things are happening together which then makes us wonder well
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which one should you address first, or how should you address all of these
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different dysfunctions. So here's the answer to the questions according to me.
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Here's the rubric that i use, here's the filter that i use to help my decision
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making process. Number one, I go after one compensation pattern at a time. To me the
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execution, the success of your program, is dependent on the completeness of your
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strategy. Now if I'm going to go after something like let's say lower leg
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dysfunction completely, I don't have time to go over lumbo-pelvic hip complex and
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upper body dysfunction completely as well. Each one of those things takes a
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significant amount of time, and if you're training as a personal trainer, or you're
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an ATC who is also responsible for a strength and conditioning program you
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know you have an even more limited amount of time. So first things first I
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go after one compensation pattern at a time, I address it completely. When I have
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that compensation pattern under control I reduce it to as little as I can. For
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example in lower leg dysfunction maybe somebody gets reduced down to calf
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release, calf stretch, anterior tibialis activation and that's all that remains,
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and then I can move on to the next dysfunction. Now how I decide which
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dysfunction I go after is based on this, first things first I'm going to go after
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what i call obstructive dysfunction. What I mean by obstructive is it is
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dysfunction that is getting in the way of them doing something they love, or
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something they need to do. So I understand that there may be worse
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dysfunctions in their body, but like let's say this is a power lifter, I have
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them do a overhead squat and I watch their knees kiss, we know this
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wouldn't be a very good thing for a power lifter. This isn't going to
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contribute to their performance very well, but they've come in to see me
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because after their bench press, after their chest work, after their upper body
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work they get shoulder pain, guess which dysfunction I'm going after first. I'm
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going to go after upper body dysfunction, because I need to address the thing
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that's actually getting in their way now. Even some of you I know are already
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thinking but knees bow in could be contributing to right shoulder pain, it
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could, there is a theoretical model, there there is the kinetic chain checkpoints
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we could go through to talk about how, let's say knee cave in on one side leads
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to anterior and automate rotation leads to sacral dysfunction, leads to
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latissimus dorsi tightness, leads to right shoulder. We can go over that, but
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the truth of the matter is is there some sort of upper body dysfunction present.
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We need to fix that first, and if we're successful hopefully this client or
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patient will let us address the rest of their kinetic chain so we get great
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long-term outcomes. So make sure you go after what needs to be gone after first.
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You have to set up a priority list. Second, asymmetrical dysfunction. We
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actually do not have research that says tightness a lack of mobility leads to
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injury. Now some of that has to do with faults in some of the research itself,
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but there is research to indicate that asymmetrical dysfunction will cause
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injury, and I do believe that nothing leads to injury faster than asymmetry
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right to left in the human body. If somebody had an overhead squat both arms
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fell forward to here, but I saw one right foot flattened and turn out, I don't care
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how bad the upper body dysfunction is providing it's not causing them pain or
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obstructing what they love to do, if i see the asymmetry on their right leg i'm
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going to go after that first. Very important that I get to that before it
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gets to them and causes injury. So somebody comes in, why are you here, is
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there anything you can't do, okay maybe there's nothing
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that they can't do, they're coming in to see me because of general health and
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wellness. Okay do I see anything asymmetrical, i'm going to go after that.
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If I don't see anything asymmetrical I'm going to go down to the next thing on my
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list, which is what is their worst dysfunction. This actually doesn't happen
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very often, but let's say somebody has a little bit of arms fall forward but
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their feet flattened, turn way out, knees bow in, I have to go after that. I got to go
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after that. I'm going to go after the worst dysfunction first. This will
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probably maintain for a little while, it's probably not setting them up too
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bad for injury, let's take care of the thing that you know when we see it we go
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oh we need to, we need to address that before once again it gets at them. Last,
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let's say somebody has all of the dysfunctions nothing is in particular
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bothering them, or they have a whole slew of things bothering them; the right ankle
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bothers them, their left knee, they get a little low back pain from time to time,
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left shoulder. Alright how am I going to address this issue, well providing I
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don't have one thing that's more obstructive than another, I don't have a
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huge asymmetry present, there isn't a worse dysfunction, i'm going to start
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from the bottom up. So i'm going to start at the ankle because I know that if I
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correct the ankle I will get good progress
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from ankle to ankle to, or lower leg let's say to lower leg to lumbo-pelvic
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hip complex dysfunction. That'll stay pretty good, and then I can go to upper
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body dysfunction, what does not work out. Well if I start with upper body
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dysfunction and this person has feet turn out, feet flattened every time they
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take a step, little bits when they walk are going to do this, which is going to
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tighten back up their latissimus dorsi as a lumbar extensor, and put them
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right back into the upper body dysfunction I just tried to correct, and
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in essence everything stacks on your feet. Alright so just to recap this guy's
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address what needs to be addressed first, not from your point of view but from
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your patient or clients point of view, that's priority number one. Second
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asymmetry probably the best indicator we have of potential injury. Third go after
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the worst thing you see, and then last and this is probably the one that will
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stick is you stay with a patient, or stay with a client over months and years and
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they keep coming back to you for different things, start from the bottom
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up, continue to keep corrective exercise in their program with this in mind, so
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that you keep them stacked on a stable foundation. I hope this helps your
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decision making process. I hope this and all of the previous videos makes your
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assessment skills much much more refined, much more skill than they were before. I
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look forward to talking to you guys soon.
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Overhead Squat Assessment 17 - Deciding Which Dysfunction to Address First
Overhead Squat Assessment 1: Introduction
Overhead Squat Assessment 3 - Five Steps for Solving for Dysfunction
Overhead Squat Assessment 2 - Signs of Dysfunction
Overhead Squat Assessment 12 - Sign Clusters: Lower Leg Dysfunction
Overhead Squat Assessment 13 - Sign Clusters: Upper Body Dysfunction
Overhead Squat Assessment 6 - Knees Bow In Breakdown
Overhead Squat Assessment 11 - Shoulders Elevate