Name: Overhead Squat Assessment 17 - Deciding Which Dysfunction to Address First
Uploaded: 2023-04-26T01:03:06.000Z
Duration: 8 min 28 s

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https://stream.mux.com/XGW9a72ylmBTGQ02MyBGtoJ02CLjlu6lqYVwpa5eHLwiY.m3u8

Learn how to prioritize and determine which dysfunctions should be addressed first 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 analyzing overhead squat mechanics, comparing compensatory patterns, and identifying the most influential mobility and stability impairments impacting movement quality. Develop clinical decision-making skills to efficiently address imbalances, weaknesses, and faulty motor patterns that may limit performance or increase injury risk. Perfect for clinicians, fitness professionals, and rehabilitation clients seeking to refine movement assessment strategies, improve corrective exercise prioritization, and optimize functional outcomes.

Identifying Dysfunction Patterns

Strategy for Addressing Compensation Patterns

Prioritizing Dysfunction: Obstructive and Asymmetrical Issues

Addressing General Dysfunction and Injury Prevention

Long-Term Client Management and Corrective Exercise

Overhead Squat Assessment 17 - Deciding Which Dysfunction to Address First

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

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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

As mentioned above, the Brookbush Institute recommends the OHSA as the first movement assessment performed. That is, the OHSA should follow a subjective assessment, a physical activity readiness questionnaire, and/or special tests if necessary, but precede additional movement assessments. The OHSA often implies the movement pattern that should be addressed, refining the selection of additional movement assessments for the involved joints.

 For example, a patient/client complains of "low back pain" and exhibits an 

 on the OHSA. An Excessive Forward Lean implies a loss of dorsiflexion and/or hip joint impairment, which may then be assessed using joint-specific assessments (e.g., goniometry, muscle length tests, manual muscle testing, and passive accessory motion examination).

 For example, a patient/client "feels weak during push-off," and a prior assessment by a medical professional noted a decrease in hip internal rotation range of motion (ROM). During the OHSA you identify that the patient exhibits the sign "

 ", implying that a lack of hip internal rotation and "weak push-off" may be correlated with a lower extremity compensation pattern.

 For example, a college athlete continues to get sidelined by nagging soreness in the left ankle, right knee, right hip, lower back, and neck. During the OHSA, you note the individual exhibits an asymmetrical weight shift, excessive forward lean, and arms falling. You start with the 

During an Overhead Squat Assessment (OHSA), most individuals exhibit multiple signs of dysfunction, and often, signs present asymmetrically from right to left. To ensure that the resulting intervention plans are reliable and effective, it is important to develop a systematic approach to selecting which sign you will focus on.

Heuristic for Prioritizing Multiple Assessed Signs

 A sign obstructing the individual from performing activities of daily living, recreation, or sport. This is often the sign most strongly correlated with patients' symptoms or complaints.

 A sign that presents in different magnitudes on the left and right sides.

 Most often, a "worst dysfunction" is hard to determine, but occasionally, a patient/client will present with an "obvious worst.

 If presented with multiple, bilateral dysfunctions (not asymmetrical), it is generally best practice to begin corrective interventions with the foot/ankle complex and progress up the body. 

Clinical experience (and some research) suggests dysfunction "spreads" up from the lower extremity, faster than it "spreads" down from the upper extremity.

Clinical experience suggests it is more effective to address only the number of signs that can be comprehensively addressed during a single session (e.g. release, mobilize, lengthen, activate, integrate, and home exercise). Choosing just 1 or 2 techniques per dysfunction to attempt to address multiple dysfunctions during a single session is unlikely to result in optimal outcomes (e.g., "Jack of all trades and master of none"). If a sign is addressed with an effective intervention strategy, then improvement of that sign should be noted during reassessment, and using the prioritization filter (heuristic) discussed below will imply the "next" most important sign, which can then be addressed comprehensively.

Overhead Squat Assessment 17 - Deciding Which Dysfunction to Address First

Overhead Squat Assessment 3 - Five Steps for Solving for Dysfunction

Overhead Squat Assessment 2 - Signs of Dysfunction

Overhead Squat Assessment 1: Introduction

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