Mar 29, 2013

Friday 5! 5 Ways to Improve Deep Squat Part 2


Part 1 from last Friday is here, where I went over 5 manual therapy treatments to help improve a deep squat from a mobility standpoint. This time is improving it from a stability standpoint.

I know the arguments against looking at deep squat. I know that many adults cannot do it, but like running, and kneeling, squatting is an ADL everyone should be able to perform. When you take into account that recent research shows that something as simple as getting up off of the ground is a predictor of mortality rates in older individuals, it only makes sense to look at a deep squat from a mobility and a stability standpoint.

Many of the reasons why some feels they cannot perform this movement come across as mobility issues. I had a pilates instructor tell me "my hips are so damn tight!" as she flexed forward at her trunk, brought her pelvis posteriorly and flexed her hips to her perceived end range of 80 degrees. Holding her hands and letting me accept the weight, she went down into almost a picture perfect deep squat, because of course she had enough hip and knee flexion. That is one of my favorite SFMA breakouts, and shows it to be a motor control/stability issues when all other the parts are moving well. Here are points of stability you should check on or areas to work to improve overall stability during this functional movement.

1) breathing
  • proper breathing assists the diaphragm to create a pressure inferiorly on the pelvic floor, by letting the dome decrease it's concavity
  • pelvic floor contraction = increased hip and pelvic stability, which in turn should increase the mobility in these areas
  • after getting a patient to find their pelvic tilt that allows them to breathe correctly, teach them to contract on exhale, but continue to exhale, creating a cylinder of core contraction
    • they may be surprised how their "tight" hips gain more mobility - it most likely will not be perfect as this is something that needs to be practiced 

2) Is just another cuing for breathing and this time it's taping!
  • I was taped with this technique at the FMT 2 course by the instructor in the video, Dr. Steven Capobianco
  • after a few hours, my diaphragm was fatigued, and I can breath as I instruct in the short term
  • I found this to be a very effective subtle cue, much like most taping techniques, you lose awareness consciously but subconsciously it still must be working as the CNS is highly perceptive of inputs

3) Rolling patterns

  • If you are not looking at upper and lower body rolling patterns, you are missing out on an easy assessment that many patients with unilateral motor control issues fail
  • after taking the SFMA, this is one of the assessments that I can fall back on when MDT and OMPT is not working, some go here first, but I do what works for me in my approach
  • the premise is to look for movement asymmetries in these patterns and as long as there is enough mobility
    • here is Voight et al article on it, which obviously explains it in much more detail
  • once I find a rolling pattern DN, I'll cue the movement with PNF, using my hands on the upper and lower body, when the patient gets "stuck"
    • I find agonist reversals help very well getting the diagonal to coordinate the movement
  • sometimes even taking them through the movement passively a few times for the patient to get a proprioceptive feel for it helps
  • also cues like "just roll to the side, do not try to get up" also help, as many patients think the upper body rolling pattern should be like a kip up
  • it's just rolling on the ground!
  • here's Charlie doing his thing during his seminar Training = Rehab Rehab = Training - highly recommended course btw!

Here is Joe Heiler's (Sports Rehab Expert) instructing the 4 patterns









4) Hip Stability
  • we all know that looking at hip strength and mobility helps with knee issues, so this is an area I make sure is moving well and coordinates during loading activities
  • a challenging exercise is the anti-rotation single leg stance arm press, really gets the core and glut med firing 
    • stand on the involved side -example right LE
    • cable or band pulling to the left, left LE up in 90/90
  • start with arms holding band/cable against chest and push slowly forward, maintaining stable SL stance
  • it's tougher than it looks/sounds!
  • surprisingly couldn't find a vid on youtube to demonstrate this so I'll have to shoot one when I get back in the office next week
5) scapular/cervical stability
  • had to throw both of these in as well
  • since we are testing overhead deep squat, if someone has limited shoulder mobility, you should check their scapular stability first
  • also cue them on cervical retraction or "packing" the neck
  • getting them to set their scapula and holding their neck in a packed position, gets them more upright, in a better position to breath, and assists their center of gravity from going too posterior
  • in contrast, if the head/neck protract, scapula protract, arms cannot flex enough, sternum drops, thoracic spine and lumbar spine flex too soon, hips get impinged anteriorly, and everything "feels" tight
There are a ton of other manual techniques and exercises/cues you can use to improve this. Also, like I said on my first post, I do not use this as a primary screening movement for sedentary individuals, as most likely they couldn't do it for years. I save the MDT and OMPT/education for them. However, the more you want/need to move in your life and if that's your goal, you're going to have to do a ODS for me before I let you go. One more vid...

Here is the knee motion analysis vid from Gray Cook's IFOMPT Keynote 

Her left knee was the ACL repair/rehab by the PT. This was taken shortly after her discharge and also clearer by the ortho. They didn't look at her DS, and you can see her right knee is clearly not stable. Guess what, that ACL was also ruptured shortly after. Could it have been prevented? Perhaps, they sure could have at least tried to make sure she was symmetrical.

Everyone have a safe and Happy Easter! Meant this to be a short post as I was out all week with the flu... but like my lectures, once you're on a roll...

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