Name: Overhead Squat Assessment 9 - Anterior Pelvic Tilt (Excessive Lordosis)
Uploaded: 2023-04-26T01:02:30.000Z
Duration: 6 min 1 s

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https://stream.mux.com/kyLtvyn8syw754vyfPQ6ROOTYR79RysrxgQCqzBXARs.m3u8

Learn how to identify and interpret an anterior pelvic tilt (excessive lordosis) 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 evaluating lumbopelvic alignment, recognizing compensatory movement patterns, and understanding how mobility and stability impairments of the hip flexors, lumbar extensors, and core contribute to excessive lumbar extension during the squat. Develop the skills needed to accurately assess this deviation, inform corrective exercise and manual therapy strategies, and improve lumbopelvic control and squat mechanics. Perfect for clinicians, fitness professionals, and rehabilitation clients seeking to enhance movement assessment accuracy, optimize lumbopelvic-hip complex function, and reduce injury risk.

Understanding Anterior Pelvic Tilt

Assessment Techniques for Pelvic Alignment

Observing Movement Patterns: Overhead Squat

Muscle Imbalances Related to Anterior Pelvic Tilt

Corrective Strategies for Improving Pelvic Position

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

This is Brent coming at you with yet another overhead squat assessment video. In this video we're going to go over excessive low back arch, or excessive low back rounding, also known as an anterior pelvic tilt. So I'm gonna have my friend Leanne come out. I think this is one of those signs that confuses a lot of individuals, so I'm going to try to give you guys some pointers on how to see this. The first thing I'm going to do is I want a good visual reference of the level of Leanne's pelvis. So I'm going to ask permission to palpate, and what I'm going to try to do is, I'm going to try for my own benefit line Leanne's pants with her ASIS and PSIS, which will then make her waistband a visual reference for level, which should be perpendicular to like the neutral line of your spine. Alright so if I palpate here palpate, palpate, palpate, I feel a bony notch right here, and then this is all soft tissue. So this is her ASIS, i'm going to put her, the front of her pants there. Alright, and then if I palpate around I feel these two bony notches right before I hit her lumbar spine, that'd be her PSIS, and then if I make sure that that line is straight between ASIS and PSIS you guys can see I have a level. Now if that level is let's say within an inch front to back, then her pelvis is probably a neutral position. She probably doesn't have an anterior pelvic tilt, this is one of those signs that often with people who do have it, you can see it even when they're standing, right so can you fake an anterior, there you go. So this would be an anterior pelvic tilt, so you guys can see how this slopes downward.Now in individuals who are just starting to fall into this dysfunctional pattern, we start to see it in their movement pattern, being the overhead squat. So I'm gonna make sure Leanne's second toe is forward, her feet are underneath her hips, she's going to throw her arms up for me, and she's going to go ahead and show me the anterior pelvic tilt, and by showing me I mean show you guys. You guys should notice two things, can you go down, hold that position. I know it's not comfortable. See this excessive rounding in her low back, that's a good sign that she has an anterior pelvic tilt. The other thing you guys might notice is this angle here, right between her pelvis and hip starts to decrease a whole lot, right whereas this angle here, like if I drew a neutral line from her spine, this line isn't perpendicular anymore. I hope you guys can kind of see what I'm looking at. I'm either looking at is the pelvis perpendicular to a neutral line of the spine, or do I see a huge curve in the low back. Thank you Leanne. Now what does that break down to, anterior pelvic tilt equals excessive lumbar extension, an excessive hip flexion. Now we just have to list our muscles, lumbar extensors I know you guys know of the erector spinae, but have you thought about the lats. The lats are a strong lumbar extensor. You need to make sure that if you're trying to correct an anterior pelvic tilt, that your lats are something you include in your release and lengthening techniques. Hip flexors, we've talked about the hip flexors and many dysfunctions already, so this is a group that you should be familiar with. Obviously you can't self-administer release the psoas, but all of the rest of them you can do self-administered release. I know my manual therapists can release the psoas, then of course you're going to want to lengthen them with some lengthening technique. On the flip side guys, we want to activate lumbar flexors, these are the people who need a lot of core work. Lots of rectus abdominis, obliques, and then anytime we get lumbo-pelvic hip dysfunction guys, you can throw in that intrinsic stabilization subsystem, that transversus abdominus as under active. Now the TVA doesn't have a joint action. I don't want you guys to think that it's actually a lumbar flexor, but i can guarantee if somebody has an anterior pelvic tilt, you guys are going to have to do your TVA work, like quadrupeds hip extensors. Now all of my hip extensors are again long, but remember we have that weird agonist glute max shutting down, synergists gearing up. Alright so we got glute max, we need to do lots of activation work. Yes if somebody has an anterior pelvic tilt doing squats isn't going to strengthen their glutes, they're inhibited you need to do something to correct the length problem, and start activating before you start doing multi joint movement patterns. Notice the hamstrings are on the long side of the graph, if my hamstrings are on the long side of the graph, don't stretch them. If they're being pulled long they might feel tight, just like pulling a guitar string long feels tight. But correcting the dysfunction is going to be what returns the hamstrings to normal length and activity. And then of course we have posterior adductors, they act a lot like the hamstrings do. These aren't going to be something i activate, they're not going to be something I stretch. You could release these structures, you could like use a foam roll and try to tone down their activity, but no activation, no stretching. So there you guys go, make sure you don't forget about the lats. You get all your hip flexors, make sure you don't forget about the TVA in your core work, and then of course keep going after that glute max. Nobody got worse performance by having stronger glutes. I will talk with you guys soon. I hope you get great outcomes.

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Overhead Squat Assessment: Signs of Dysfunction

 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 9 - Anterior Pelvic Tilt (Excessive Lordosis)

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

Anterior Pelvic Tilt Break Down (Workshop Snippet)

Overhead Squat Assessment 8 - Excessive Forward Lean

Overhead Squat Assessment 7 - Knees Bow Out

Overhead Squat Assessment 6 - Knees Bow In Breakdown

Overhead Squat Assessment 5 - Feet Turn Out Breakdown

"Feet Turn Out" Breakdown

Overhead Squat Assessment 4 - Feet Flat Breakdown

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