0:05 This is Brent of the Brookbush Institute. In this video, we're going to go over two 0:08 less common signs in the overhead squat 0:10 assessment. We're going to go over a posterior pelvic tilt, as well as an 0:14 inadequate forward lean, and the reason why these two are in the same video is I 0:19 think, once we break down the dysfunction, 0:21 you're going to see these two things are very related. We're also going to take a 0:25 moment to discuss whether that posterior pelvic tilt, seen at the bottom of a deep 0:29 squat, sometimes referred to as a "butt wink" is a dysfunction, or just a sign 0:35 whether we've taken range of motion too far. I'm going to have my friend, Melissa, 0:38 come out. She's going to help me demonstrate. 0:40 Now the posterior pelvic tilt and the inadequate forward lean are two things 0:44 best seen from a lateral view. 0:46 So just to save some time in this video, I'm going to go ahead and have Melissa 0:50 set up so you guys have a lateral view. 0:53 One thing I need to point out is I need you to ignore this heel rise. 0:59 This was not my attempt to do an overhead squat assessment with 1:03 modification. 1:04 This was my attempt to cheat, because Melissa is missing some dorsiflexion. 1:09 The individuals who have this dysfunction generally do not lack 1:13 dorsiflexion, which is one of the reasons why these dysfunctions are so rare. 1:18 Just to get her to demonstrate the compensations we're looking for, 1:22 I had to give her some dorsiflexion back. 1:25 Other than that, we will start the same way we always do. Her second toe is pointing 1:29 forward. Her second toe should be lined up with her ASIS, or her feet underneath 1:34 her hips. 1:35 I'm going to have her reach up to the ceiling as high as she can, and then the 1:39 first thing Melissa is going to actually show us is an inadequate forward lean. 1:45 It's nice and slow. 1:47 These are sometimes referred to as "knee squatters." I think as Melissa does 1:51 this again, you can see her knees just jut straight out. 1:54 Right, her back is somehow maintaining relatively straight, which looks kind of 1:58 odd, right? You can see a lot of load getting transferred into those knees. Now 2:06 she holds the bottom for me, just as a textbook definition here, 2:11 I want you guys to note that tibia-torso angle is not parallel. 2:15 It's the opposite of an excessive forward lean, right? Now instead of 2:20 crossing at the head, these two lines, they're crossing down towards the feet. 2:26 All right, go ahead and come back up. So that's the inadequate forward lean. 2:32 Now that is a sign if we see it without a heel rise. 2:38 I should note that if you were doing a squat with modifications, which included 2:43 heel rise, to try to differentiate whether lower leg dysfunction is 2:46 involved. And you saw the inadequate forward lean, 2:48 that's not a dysfunction. So with heel rise, 2:52 not a dysfunction. Without heel rise, if you see an inadequate forward lean, 2:55 definitely a dysfunction. 2:58 The next thing we're going to talk about is a posterior pelvic tilt. 3:01 So Melissa's got her arms up, and what you'll notice is, all of a sudden, she gets 3:08 that tuck under fairly early in her squat form. Now, I've set her pants up so 3:14 that they're level with her PSIS and ASIS. You can see she's pretty level here when 3:19 she starts, but almost as soon as she dips down into that squat, here PSIS's drop. 3:26 She loses the lordosis in her lumbar spine. 3:33 Let's have you kind of, go down to the bottom there. You might even notice that her, her 3:38 trunk is collapsing. Right? She's actually going into lumbar flexion as she squats. 3:42 We can, we can imagine that's not a very healthy thing to do. Now you might 3:46 see the two things paired. She might go into a posterior pelvic tilt with an 3:51 inadequate forward lean, and I think what you guys will start to note, if you kind 3:55 of use your imagination, think about dysfunction, is there's no forward lean, and 4:00 a lot of force going through the knee. 4:02 Alot of these individuals are people who are past some sort of lumbar 4:10 pathology. 4:11 They're trying to protect their low backs. They almost have a fear of bending 4:15 forward. Thank you, Melissa. 4:16 So let's talk about the, let's talk about the actual dysfunction itself, which 4:23 muscles are overactive, which muscles are underactive. It gets a little 4:27 complicated here, because this is ,this is a tricky one. 4:31 We probably could figure out that our posterior hips are tight somehow. 4:39 But that kind of leads to this idea that our glute max is tight. 4:43 I've mentioned in previous videos, your glute max is not a muscle that gets 4:47 overactive. Never once in my entire career, have I came in to my clinic, to my 4:53 office, and had a patient walk in and go, "you know what Brent, 4:56 my ass is just too tight." You guys can imagine, that doesn't happen. 5:01 These are muscles that tend to get droopy. So it's not that I need to 5:05 stretch my glutes, 5:06 even though they almost appear short in this one. 5:10 This is actually the perfect example of synergistic dominance gone awry. 5:16 Right? Take it up another notch. The muscles that are overactive are all those 5:22 synergists of extension. All those synergists of external rotation. All 5:26 of those muscles that connect into 5:29 the sacrotuberous ligament, have something to do with that deep 5:33 longitudinal subsystem. Your piriformis, biceps femoris, adductor magnus, all go 5:41 in to overdrive, and they all become really, really, overactive trying to find 5:47 a way to not only extend the hip with a glute max that is inhibited, 5:52 but also maybe, pull down that sacrotuberous ligament to stabilize the SI 5:56 joint. 5:57 We also have a big, big, overactivity of our global core muscles. 6:04 You might notice these are also the people who, just bending over like, picking 6:07 up their purse ,or sit down into a chair, or pick up a pencil up off the floor, 6:12 they don't do the drawing-in maneuver, they flat-out brace. These are all the 6:16 muscles involved in bracing--rectus abdominis, external obliques, with like 6:20 bearing down, just to pick up a pen. 6:24 That's not a, that's not a great sign. Now the muscles that are under-active, as we 6:29 have synergistic dominance of your piriformis, biceps femoris, and adductor 6:32 magnus, your glute max and glute med have said, "well if these guys are going to do 6:37 it, 6:37 why would I even get involved?" They just kind of shut down. So we have this little 6:42 careful balance to play. 6:44 Although these muscles are also involved in extension, they're also involved in 6:47 external rotation. 6:49 We still need to get them active without contributing to further over-activity of 6:57 piriformis, biceps femoris, and adductor magnus. You'll see some under-activity, 7:03 some inhibition, of the transverse abdominis and multifidi. 7:09 Again, these are people who are bracing to try to stabilize their lumbar spine. 7:14 Generally speaking, these are not individuals who know how to just draw-in 7:19 and relax, and bend down. Alright, so here is the dysfunction itself. 7:26 The question then becomes, how do we fix it? 7:40 So we just go back to our, our basic model here. 7:45 What am I going to release? Well, I'm going to release all the things that are 7:48 overactive. So my piriformis, biceps femoris, adductor magnus. Getting a little 7:53 bit in arthrokinematic dysfunction, generally these people have a hip that 7:59 has moved anterior and superior, or femoral head that's moved anterior 8:03 superior, relative to the acetabulum, and lumbar facets that are almost 8:11 stuck open. 8:13 So this is going to require some mobilization. You guys got a couple 8:17 of self-administered hip mobilizations. This can be done manually by licensed 8:21 professionals. 8:22 Same thing with these lumbar mobilizations. This can be 8:26 done using, something like an open book, or Mckenzie press-ups, or can be done 8:32 manually if you're a licensed professional. Strengthen, I'm sorry 8:37 lengthen. 8:38 We're going to lengthen the same muscles we release, as always. 8:41 So you guys need to go back if you don't know stretches for the piriformis, biceps 8:44 femoris, and adductor magnus. You need to look those up. 8:47 What are we going to activate? We're going to need some glute max and glute 8:51 med activation, right? So that, that activation circuit, or individual 8:58 exercises to start slowly strengthening the glute max and glute med are all 9:03 going to help in this process. Note, 9:06 you can't just do this, though. If you start to try to do clams and side-lying 9:11 leg raises before you've released your piriformis, biceps femoris, and adductor magnus - all 9:16 you're going to do is start gearing piriformis up, specifically. A clam before 9:22 piriformis release is definitely going to be a piriformis activator. 9:27 Core- lots of quadruped progressions. So, I have all those quadruped 9:32 progressions for you guys. Everything from just the standard quadruped with 9:36 marching of the hands, all the way to that crazy, dynamic quadruped, which we 9:41 saw Melissa sweating on when she did the video. And then this is the tricky 9:46 part. 9:47 How do I get somebody to gain back that eccentric control of hip flexion so 9:54 that they'll start leaning forward. And that's where that deadlift with 9:58 posterior pull of the band comes real handy. So if I put a band pulling this 10:03 way, and then ask him to bend forward, that helps to get that cue in to sit back. 10:11 It also ensures that their glutes stay active as they come back up and thrust 10:18 against that band. So watch that video. 10:20 This exercise- very, very, helpful for somebody who doesn't want to lean 10:26 forward. That band ensures that if they try to stay upright this way and just 10:30 squat with their knees, 10:32 they're going over backwards. Now, the last thing we want to talk about is, is 10:37 that posterior pelvic tilt at the bottom of a deep squat, dysfunction? I'm going to 10:43 have my friend, Melissa, come out. She's going to help me demonstrate what I'm 10:46 talking about. 10:47 Once again, we're using the heel rise just because she lacks some dorsiflexion. 10:50 But if she were to do this deep squat, ass to grass, right, you notice how 10:56 everything tucks under the bottom? Right, and back up. 11:00 Let's go back down again, and back up. 11:05 Good. Thank you, Melissa. 11:10 The question you have to ask yourself before you automatically assume that 11:14 Melissa has a butt wink, and what I need to work on is hip flexion mobility, 11:17 you should probably test hip flexion. So normal hip flexion is a 110 to 11:23 135 degrees. Let's say a 125 11:26 degrees is a normal range of motion. 11:28 If you lie somebody on their back, go over that goniometry video, if you 11:33 don't know hip flexion goniometry. You bring their hip flexion up, 11:37 they have a 125 degrees, you can't say that that's a 11:42 dysfunctional movement pattern. What you can say is you pushed range of motion 11:47 too far for that particular individual. 11:51 Now we do have to throw out there, 11:55 I understand that some individuals in strength sports are going to be required 12:00 to squat "ass to grass." If you're tilting at the bottom of your deep squat, and you 12:11 have normal hip flexion, 12:13 you're going to have to decide whether your sport is worth the risk to your 12:20 orthopedic health, and this is the decision we all have to make in sport. I 12:24 play basketball. 12:26 I know it's very hard on my knees. It can be hard on my neck, which I've had some 12:30 previous injuries with, but I go ahead and keep playing because I know being 12:34 active is definitely healthier than not being active. 12:40 We also have to decide that if this isn't somebody's sport. If you are 12:46 squatting just for general strength or general health and fitness, or 12:51 performance in a field sport, 12:53 you probably want to stop their squat depth before they tuck under, 13:00 because of the potential risk for low back injury. As I said, these individuals 13:07 with posterior pelvic tilts, these individuals with inadequate forward 13:11 leans, most often have a history of either hip or lumbar spine 13:19 pathology, which brings me to my last point. If you try a corrective exercise 13:26 program and you do not get the results you're looking for, 13:31 you need to refer out on this one. It's not a very common sign because it is a 13:36 post-pathology sign in most cases. It is very rare that I come across a posterior 13:45 pelvic tilt or an inadequate forward lean, and that person doesn't have a 13:49 history of injury. So, 13:52 there you go guys. Two less common signs that we do see on the overhead squat 13:57 assessment that you are now aware of - a posterior pelvic tilt, an inadequate 14:01 forward lean. You now know how to differentiate on whether that posterior 14:05 pelvic tilt at the end of a deep squat is dysfunction or not, using hip flexion 14:11 goniometry, and you even know the history that many of these individuals 14:17 will come in with. I hope you enjoyed this video. I look forward to talking to 14:20 you again soon.
