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