Using the Overhead Squat Assessment
Muscle balance assessment and testing is important as it gives the clinician valuable information about the balance, timing, recruitment, and coordination about the client’s musculature. No one test can give the clinician all necessary information about a client’s dysfunctional movement or muscular impairments, but the overhead squat assessment does provide a larger amount of information than most assessments and is included in the Functional Movement Screen (FMS) and the Selective Functional Movement Assessment.
The overhead squat assessment provides valuable information regarding stability and mobility all throughout the kinetic chain and helps highlight overactive and underactive muscles. The assessment tests for bilateral symmetrical mobility and stability of the hips, knees and ankles, bilateral symmetrical mobility of the shoulders, and extension of the thoracic spine (Nickelston, 2011). The assessment tests total kinetic chain neuromuscular efficiency, functional strength and dynamic flexibility and deviations from proper form resulting from muscular imbalance may cause pain are observable.
The test is performed by the client starting with their feet shoulder-width apart with their arms straight up over head, elbows extended (Nickelston, 2011). The client then should slowly squat as deep as they can without letting the heels leave the ground. The movement should be viewed from an anterior,lateral and posterior angle and the client should perform the movement multiple times. The client should not receive cuing from the instructor as the client will try to correct their movements, and not use their natural, normal movement pattern (Nickelston, 2011). If the client experiences pain during the assessment, it should be stopped, and the site and intensity of the pain should be recorded.
Muscular imbalances, weaknesses and flexibility issues are observable at the feet, the knees, the lumbo-pelvic-hip complex, and the upper body through improper positioning or movement during the exercise. The National Academy of Sports Medicine (NASM) provides a chart about the overhead squat assessment that explains what muscles are overactive, what muscles are underactive, what dysfunctional movement the imbalance produces, and how to correct it. For example, if the arms fall forward during the overhead squat, the client likely has an overactive latissimus dorsi, pectorals, teres major, and coracobrachialis, with an underactive lower and middle trapezius, rhomboids, rotator cuff, and posterior deltoid (NASM, n.d.).
The overhead squat assessment is a very good test. It has shown to be reliable in measuring medial knee displacement and indicating those that may be at risk for knee injury, and the slow movement during the exercise may lead to more accurate readings of results than ballistic tests, such as a jump landing (Post, Olson, Trigsted, Hetzel, & Bell, 2016).
The overhead squat test has also demonstrated validity. Noda and Verscheure (2009) were able to establish a link between goniometric measurements of decreased ankle dorsiflexion and heel lift during the overhead squat, as well as decreased measurement of hip internal rotation and knee shifting during the squat. This is relevant because if there is a restriction at a joint, either due to poor mobility of the joint or the flexibility of the muscles that cross the joint, a movement compensation will occur. The overhead squat assessment has validity in highlighting joint dysfunction.
The overhead squat assessment may also predict how well a client will do on the FMS. Clifton, Grooms, and Onate (2015) performed the overhead squat assessment and entirety of the FMS on 103 collegiate athletes. Athletes who scored less than 2 on the deep squat usually got a composite score of 12 or less, indicating relatively high injury risk due to movement dysfunction, while athletes who got a 2 of higher typically got composite scores of 12 or more, indicating lower injury risk. The overhead squat assessment may be a more feasible option when screening large numbers of athletes, compared to the FMS, due the overhead squat being more time efficient and its high predicative ability of a full FMS (Clifton, Grooms, & Onate, 2015). The overhead squat assessment is a valuable assessment tool.
The overhead squat assessment is based on sound evidence, has been shown to be a reliable and valid assessment and may be able to predict performance on the FMS. It is time efficient and easy to perform for a novice without prior injury. It tells allows clinicians to observe movement dysfunction at the foot, knee, limbo-pelvic-hip complex, and the torso and identify overactive and underactive muscles that produce movement compensations. The overhead squat assessment is a tool I use with new clients to qualify any muscle imbalance, and use periodically to see if the exercise interventions are effective.
Clifton, D. R., Grooms, D. R., & Onate, J. A. (2015). Overhead deep squat performance predicts functional movement screen™ score. International Journal of Sports Physical Therapy, 10(5), 622-627.
NASM. (n.d.). Overhead squat solutions table. Retrieved from https://www.nasm.org/docs/default-source/PDF/overhead_squat_solutions_table-(ces-version)-(pdf-40k).pdf?sfvrsn=2
Nickelston, P. (2011). The overhead squat assessment. Dynamic Chiropractic, 29(2), 40-44.
Noda, T., & Verscheure, S. (2009). Individual goniometric measurements correlated with observations of the deep overhead squat. Athletic Training & Sports Health Care, 1(3), 114-119.
Post, E. G., Olson, M., Trigsted, S., Hetzel, S., & Bell, D. R. (2016). The reliability and discriminative ability of the overhead squat test for observational screening of medial knee displacement. Journal of Sport Rehabilitation, 1-14.