Name: Overhead Squat Assessment 6 - Knees Bow In Breakdown
Uploaded: 2023-04-26T01:02:30.000Z
Duration: 5 min 31 s

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https://stream.mux.com/RwdQ1Rc6hbz202XTIwlEtQUREi3KUzGufm1YKvWzjhAw.m3u8

Learn how to identify and interpret knees bow in dysfunction 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 assessing frontal plane knee alignment, recognizing compensatory movement patterns, and understanding how mobility and stability impairments of the foot, ankle, hip, and lumbopelvic-hip complex contribute to dynamic knee valgus. Develop the skills needed to accurately assess this deviation, inform corrective exercise and manual therapy strategies, and improve squat mechanics and movement efficiency. Perfect for clinicians, fitness professionals, and rehabilitation clients seeking to enhance movement assessment accuracy, optimize lower-extremity alignment, and reduce injury risk.

Introduction to Overhead Squat Assessment

Understanding Knees Bowing In Dysfunction

Identifying Signs of Dysfunction During Squats

Joint Actions Correlating with Knees Bowing In

Muscle Groups Influencing Knee Positioning

Implementing Corrective Strategies for Performance Enhancement

Overhead Squat Assessment 6 - Knees Bow In Breakdown

This is Brent coming at you with another overhead squat assessment video. In this video we're going to go over the sign knees bow in. So I'm going to have my friend Mike Tierney come out. Mike Tierney is going to demonstrate this dysfunction for us. Just a couple little things to watch out for, I think you guys kind of know what this sign is supposed to look like. I'm going to set him up so the second toes pointing forward, feet underneath his hips. He's going to go ahead and throw his hands up, perfect and what you guys are watching for, is does this patella track over a second or third toe, or does it start to bow in towards this big toe, or maybe even closer than that. Actually Mike let me have you do us a little favor here, can you tuck these shorts into your compression shorts. It is helpful to be able to see somebody's kneecaps, you can have somebody roll with their pants if you have to. Alright so let's go ahead and go knees bow in, and this is pretty typical you can see Mike's knees starting to kind of track in this way, just medial to his big toe, alright good. A sign that's a little less obvious but I know you've all seen it before, maybe you've wondered what to do with it, is the wobbly knee thing right. Can you show us that Mike. This isn't his natural dysfunction, natural compensation pattern, so he's going to act for us a little bit, good back up. That wobbling knee thing is usually, usually knees bow in waiting to happen. So if you guys are cleaning up somebody's dysfunction, you happen to notice that, it might be worth throwing in some of those corrective techniques for knees bow in to try to solve that, before it becomes, let's go ahead and go back to the first sign knees bow in, before it becomes this. The only other thing I want you guys to watch out for is occasionally what ends up happening, is the only time somebody's knees bow in, and you can go ahead and go back up, the only time somebody's knees bow in, is at the hardest part of the movement, which is that turn around between eccentric and concentric. In other words they bounced into adduction at the bottom. Can you show us what that looks like, good. So you guys can see in this part of dysfunction, if this is how they're going to show it, that you're going to have to watch all the way through their squat pattern. Don't just look at them going down and go, oh yeah knees you're fine, and then move on to the next sign. You need to watch the knees through an entire rep, to ensure that you don't have knees wobble, the knees don't bow in on the eccentric phase, they also don't bow in in that amortisation phase of the turn around from eccentric to concentric. Thank you Mike. Now breaking that down, now we just have to figure out what joint actions are occurring, what joint actions correlate with knees bow in. And I know a lot of you guys have probably been taught adduction, and while adduction is not wrong, you're going to see the adductors come back up in our graph, there are a couple joint actions that correlate better. So if knees bow in if we thought of it is, my tibia are trying to turn out, while my femurs are trying to bow in right. So this whole this bowing in, and this bowing out is actually collapsing the knee inward. That has a much better correlation with what muscles are short, and what muscles are long. So what I want you guys to memorize for now and start to try to think about, is knees bow in equals tibial external rotation, and femoral internal rotation. Now in the feet turn out video you guys saw who the tibial external rotators are, so that's going to be TFL, VL, ITB complex we talked about a little bit, the biceps femoris short head, all right so that short head does not actually cross the hip, and then lateral gastroc will also rotate my tibia outward. My femoral internal rotators some of these muscles you guys are going to recognize because they're very nasty, they like to get really tight, they like to get really short right. You have TFL, you have TFL's nasty cousin, the glute min, and then your anterior adductors. I know at some point every one of you has released or stretched one of those three muscles. Now on the flip side we got to go back to our tibial internal rotators, and our femoral external rotators. Now before I kind of talk to you guys when we did that feet turn out video, the tibial internal rotators are activated as a group, so we'll leave that tibial internal rotators, even though that's the semis, and the gracilis, and the popliteus. The medial gastroc is going to be activated with our post tib. Now I'm not saying that my post tib crosses my knee and contributes to this dysfunction, what I am saying is the exercises that we use for post tib would include medial gastroc activity, so we're going to use that as a little cheat. And then of course our femoral external rotators guys, the muscles that love to get underactive, but the muscles we love to work and try to hypertrophy, and try to get strong which of course are our glute complex, being the glute max in the glute medius. I hope seeing the signs of dysfunction, noting some of the details and dysfunction. The breakdown and the discussion of how we would create exercise from this graph, helps you create more powerful corrective strategies, including rehab and performance enhancement. I look forward to hearing about your outcomes. Thank you.

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Overhead Squat Assessment: Signs of Dysfunction

The effects of movement dysfunction (reduced eccentric hip abduction strength, glute medius and maximus weakness, valgus knee, knee bow in, and greater trunk displacement), have on knee pain, knee injury, ACL (ligament) tears, patellofemoral pain syndrome (PFPS), and pathology. The reliability, validity, and application of assessment and intervention on knee bow in and lower extremity dysfunction (feet flatten and feet turn out) on preventing hip, knee, and ankle pain. 

Does Movement Impairment Precede Knee Pain and Injury?

 to indicate the objective of the assessment or the signs you are attempting to identify. We do not want the client/patient attempting to "fix" their alignment.

Ask your patient/client to stand with feet hip-width apart.

Because a patient/client may assume a range of comfortable foot positions, it may be necessary to cue and manually adjust foot position so that the OHSA is started with the ideal foot position (or as close to the ideal foot position as can be achieved).

Ask your patient/client to reach "straight up over their head" with "elbows locked".

Ask your patient to "sit down" and "stand up" as many times as necessary to assess for the "signs of dysfunction".

 For those who do not know how to squat or may be at risk of falls, this can be done with a chair, and thought of as a "sit-to-stand transfer assessment".

 For advanced exercises and athletes who may "know what a squat should look like", it may be helpful to have them close their eyes, reducing visual input and their ability to self-correct

 It is tempting to start noting every "deviation" based on a personal frame-of-reference of squat form. The only signs that have been correlated with dysfunction and successful intervention are the signs discussed below. Adding additional signs to the assessment, however well-intentioned, may serve to invalidate the assessment, reduce assessment reliability, or reduce the relative efficacy of the implied interventions.

As mentioned above, this assessment is designed to highlight deviations from ideal motion with the intent of informing intervention selection. It may be helpful to review the definition (discussed above) of 

Evidence-based Ideal Posture/Alignment Definition:

 A mean range of segment alignment (bone, joint, muscle, nerve) that is absent of signs correlated with dysfunction, pain, or an increased risk of injury.

The ideal alignment described here is similar to what may be anticipated during a static postural assessment or gait assessment. However, additional details have been added to aid in differentiating between ideal motion and the deviations discussed below.

 Ideal alignment includes feet parallel (2nd metatarsal and toe pointing forward), hip width, and the medial longitudinal arch maintained. That is, the 2nd metatarsals (center of the foot) are parallel, in alignment with the hip joints which are inferior to the anterior superior iliac spine (ASIS), and significant inferior motion of the navicular tubercle is not observed.

Although the neck of the femur extends the greater trochanter laterally and gives the appearance that the hip joints extend to the lateral thigh, the hip joints are only about 7" apart (6). This is about the same width as the ASIS, and the hip joints are in fact, just inferior and in near alignment with the ASIS. Because the hip joints cannot be palpated, the ASIS are used as the reference for hip width.

 The knees should maintain alignment with the hip joint and ankle joint. If optimal foot position is maintained, the anterior and posterior motion of the patella during the squat should align with the 2nd and 3rd metatarsals.

 Ideal alignment includes an optimal lumbar curve, ASIS just inferior to the level of the posterior superior iliac spine (PSIS) (within 2 cm), and the right and left iliac crest level.

During the lateral view of the OHSA, the intersection of the mid-axillary line, and a line between the ASIS and PSIS should be near 90º.

 The tibia and the mid-axillary line should maintain near-parallel alignment during a squat.

 Ideal alignment includes depression and retraction of the scapula. Shoulder flexion should be achieved via upward rotation and posterior tipping of the scapula.

 Ideal alignment is maintaining the arms in alignment with the torso with elbows at terminal extension. That is, 180º of shoulder flexion should be maintained.

Overhead Squat Assessment 6 - Knees Bow In Breakdown

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

Overhead Squat Assessment 11 - Shoulders Elevate

Overhead Squat Assessment 10 - Arms Fall

Overhead Squat Assessment 9 - Anterior Pelvic Tilt (Excessive Lordosis)

Anterior Pelvic Tilt Break Down (Workshop Snippet)

Overhead Squat Assessment 8 - Excessive Forward Lean

Overhead Squat Assessment 7 - Knees Bow Out

Overhead Squat Assessment 5 - Feet Turn Out Breakdown

"Feet Turn Out" Breakdown

Overhead Squat Assessment 4 - Feet Flat Breakdown

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