Overhead Squat Findings in a Recreational Basketball Player With Low Back Pain
Mr. K., 41, is a 1.88-m, 92-kg recreational basketball player with intermittent low back pain for 6 months. He plays twice weekly and sits 9 hours/day. In an overhead squat with a dowel, his arms drift forward at about 60° of knee flexion, his trunk leans 35° from vertical, his heels rise at parallel, and his knees move inward. Ankle dorsiflexion is 10° bilaterally in the weight-bearing lunge test; seated hip internal rotation is 25° on the right and 35° on the left; Thomas test shows 10° right hip extension. He reports anterior right hip pinching at depth but no radicular symptoms. He wants to squat pain-free during pickup games and has 15 minutes before each game for a warm-up. You have only bands, a dowel, and a wedge.
1. Which finding is most likely a primary restriction rather than a compensation, and which two tests would you use to confirm it? Explain your reasoning.
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The most likely primary restriction is ankle dorsiflexion, not the forward arm drift. Ten degrees in the weight-bearing lunge test is substantially limited; when ankle dorsiflexion is restricted, the body commonly compensates by rising onto the heels, leaning the trunk forward, and shifting the center of mass. The forward arm drift can then be a balance compensation rather than a true shoulder or thoracic limitation. The knee valgus may also be a compensation as the athlete attempts to find depth.
Confirm with: (1) a knee-to-wall test measured in centimeters, repeated with a heel lift to see whether symptoms and depth improve; and (2) hip internal rotation and extension reassessed in a position that controls pelvic tilt, because the anterior hip pinch and asymmetric hip internal rotation could reflect a hip joint restriction rather than ankle limitation. If depth and pinch improve with a heel wedge while hip motion is unchanged, the ankle is the priority. If the pinch persists, address hip joint mobility before adding squat volume.
2. Design a 15-minute pre-game warm-up and a twice-weekly 3-week corrective plan that addresses the primary restriction without simply cueing 'chest up'.
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Pre-game, 15 minutes: 3 minutes easy bike or jog; 2 minutes knee-to-wall ankle mobilizations (2 × 10 per side, gentle end-range); 2 minutes calf stretch with the knee straight and bent; 3 minutes goblet or bodyweight squats to a wedge with a dowel overhead, 2 × 8, cueing tripod foot and knee tracking; 3 minutes lateral band walks and single-leg balance; 2 minutes low-intensity shooting or defensive slides.
Twice weekly for 3 weeks: ankle dorsiflexion mobilization (banded or knee-to-wall), 2 × 10 per side; standing calf stretch, 3 × 30 s per side; wedge squat with dowel, 3 × 6, pausing at the depth where the heels stay down; hip hinge and glute activation, 3 × 8. Do not chase depth by cueing 'chest up' if the heels rise; use the wedge and reduce depth until ankle range improves. Re-test knee-to-wall and observe the overhead squat at week 3. Progress by reducing wedge height, not by adding load.