The Overhead Squat Assessment
By Perry Nickelston, DC, FMS, SFMA
The overhead squat is one of the most valuable assessments you can do with your patients. This single movement divulges crucial information about your client's mobility and stability in the kinetic chain. The assessment tests for bilateral symmetrical mobility and stability of the hips, knees and ankles. When combined with the hands held overhead, this test also assesses bilateral symmetrical mobility of the shoulders, as well as extension of the thoracic spine.1
Of course, there are situations in which the client may be in too much pain to complete the task; this will be determined on a case-by-case basis. However, you can always use this as a final clearance evaluation at the end of your prescribed treatment plan. Pain will alter movement patterns and show you many things, as long as you are observant enough to see the signs. The objective of the exercise is to test total kinetic-chain neuromuscular efficiency, integrated functional strength and dynamic flexibility.
Normal Assessment Criteria
Gathering More Information
Was the patient able to complete the movement? Was there any pain? To investigate a little deeper into the dysfunction, you can do various "breakout" squat assessments to gather more information about the possible dysfunction. These breakouts allow you to change dynamics of the movements to see if the pain or dysfunction increases or decreases.
To determine if there may be a thoracic extension and shoulder flexion problem, simply have them interlock their fingers behind the neck and repeat the squat. If the squat improves, then you know there is something dysfunctional in the thoracic spine and shoulder complex. Why do we know this? Because you took the shoulder and trunk out of the movement dynamics and it improved.
To determine if there is a stability motor control issue, have the patient perform an assisted squat. This allows you to look for true symmetrical mobility of the lower body joints without the requirement of dynamic stability. Instruct the patient to grab your hands for support. Have them repeat the full deep squat; if they go all the way down into the squat pattern, elevate the hands above the patient's head and try to let go. If the finding is normal, there is a core stability dysfunction or both.1
To determine if there is a hip and knee issue, have the patient lie supine on a table and bring the knees toward the chest in a non-weight-bearing position. If the patient can show full hip flexion and knee flexion while holding the shins, and ankle dorsiflexion is normal, consider this a weight-bearing motor control issue.
The overhead squat is a universal assessment and gives you so much information about how body mechanics change during movement. During your patient evaluation it is important to isolate the painful and symptomatic area by doing the standard requisite tests, but to get a true measure of function you should include movement patterns. The overhead squat is the foundational movement pattern to evaluate. It is important that you do not try to micro-assess each particular joint during the evaluation. Try to take in the entire picture when watching your patient's movement; if you do not see any dysfunction, then move on to the next evaluation. By assessing your patient's static and dynamic posture, flexibility profiles and movement patterns, you can create a more individualized treatment program.
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