Name: Overhead Squat Assessment 16 - Sign Clusters: Posterior Pelvic Tilt ("Butt Wink") and Inadequate Forward Lean Breakdown
Uploaded: 2023-04-26T01:02:18.000Z
Duration: 14 min 31 s

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https://stream.mux.com/o6nhnfZ9nz5YCrb2MIUV005N003iUiwbgLf7dJ0201j4K9A.m3u8

Learn how to identify and analyze posterior pelvic tilt (commonly referred to as ‘butt wink’) and an inadequate forward lean 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 lumbopelvic mechanics, interpreting compensatory movement patterns, and understanding how deficits in mobility, stability, and motor control contribute to altered squat mechanics. Develop the skills needed to accurately assess these dysfunctions, inform corrective exercise and manual therapy strategies, and improve overhead squat technique and performance. Perfect for clinicians, fitness professionals, and rehabilitation clients seeking to enhance movement assessment accuracy, optimize lumbopelvic-hip complex function, and reduce injury risk.

Introduction to Overhead Squat Signs

Exploring Inadequate Forward Lean in the Squat

Understanding Posterior Pelvic Tilt and Its Implications

Muscular Imbalances Related to Hip Dysfunction

Strategies for Addressing Dysfunctional Patterns

Assessing the Impact of Deep Squat Techniques

Conclusion: Recognizing Signs and Their Implications for Health

Overhead Squat Assessment 16 - Sign Clusters: Posterior Pelvic Tilt ("Butt Wink") and Inadequate Forward Lean Breakdown

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

 - Analysis of the maladaptive changes in muscle activity and length results in identical tables for 

 ; the only difference being the likely inclusion of restricted lumbar extension in those exhibiting a 

 originates from the lumbo-pelvic hip complex. This is likely the most commonly expressed sign in those with Sacroiliac Joint Dysfunction (SIJD

 . Analysis of SIJD results in the observation that one innominate is rotated relatively anterior, and the other innominate rotated relatively posteriorly (a relative 

 ). This is most often the side opposite the shift, i.e. the side of 

 (restricted lumbar extension and hip flexion) with optimal or excessive dorsiflexion.

 results in or is the result of - over-activity of hip external rotators (

 ). These over-active muscles invest in the sacrotuberous ligament. Increased tension in the sacrotuberous ligament would restrict anterior rotation (nutation) of the sacrum, resulting in a relative 

 is likely the "hallmark sign" of Sacroiliac Joint Dysfunction (SIJD) (a variation of 

 only infers unilateral dysfunction or dysfunction that is more pronounced on one side of the body. An 

 that is unilateral or more pronounced on one side. Further, 

 over-activity results in tibia on foot eversion, and a 

 over-activity forcing lumbar extension. It is of particular importance that the OHSA with Modification is used to determine the origin of dysfunction before developing an intervention when a patient/client exhibits signs of Sacroiliac Joint Dysfunction (SIJD).

Interpreting Results (Differential Reasoning)

 is likely driven by an inability to adequately dorsiflex, and the resulting compensation pattern being an adaptation to achieve functional range "around" this limitation. Adding a heel rise, places the ankle in relative plantar flexion to begin the assessment. This increases the amount of available dorsiflexion range of motion during the OHSA. By removing this potential restriction from the OHSA, the ankle is "removed" from the assessment.

 noted during the OHSA is not present during the OHSA with Heel Rise, 

 we may assume that dysfunction originates at the ankle and 

 (Correct by addressing the side exhibiting more 

 noted during the OHSA is still present during the OHSA with Heel Rise, 

 we may assume that the dysfunction originates from 

 noted during the OHSA improves but is still present during the OHSA with Heel Rise, 

 we may assume that the dysfunction originates from both 

 and SIJ dysfunction (Correct by addressing both the side exhibiting more 

 and using the SIJD corrective strategy discussed below).

Arms Down (Hands on Hips) Rationale: If the 

 is short/over-active it may contribute to lumbar extension, an 

Excessive lordosis (Anterior pelvic tilt)

 over-activity may originate from either dysfunction. By placing the hands on the hips (

 are placed in a "shortened" position that reduces their capacity to contribute to the OHSA and the observed dysfunction.

 is not present during the OHSA but is present during the OHSA with Arms Down, 

 we may assume that dysfunction originates from SIJD (Correct by addressing SIJD)

 is present during the OHSA and gets worse during the OHSA with Arms Down, 

 we may assume that dysfunction originates from 

OHSA with Modification: Arms Down - relative to SIJ and the sign 

 is present during the OHSA, but not present during the OHSA with Arms Down, 

 is present during the OHSA, and still present during the OHSA with Arms Down, 

 is present during the OHSA and improves but is still present during the OHSA with Arms Down, 

 we may assume that dysfunction originates from both 

 (Correct by addressing both the side exhibiting more 

Note: It has been our clinical experience that although it is possible that unilateral 

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 14 - Sign Clusters: Lumbo Pelvic Hip Complex Dysfunction

Overhead Squat Assessment 13 - Sign Clusters: Upper Body Dysfunction

Overhead Squat Assessment 12 - Sign Clusters: Lower Leg Dysfunction

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