The Show Up Fitness Podcast

Overhead Squat Analysis, Text Neck & Posture w/ E3 Rehab DPT Chris Hughen

• Chris Hitchko, CEO Show Up Fitness

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NASM / ACE trainers are gonna want to listen to this podcast with Dr. Hughen from E3 Rehab debunking perfect posture, text neck, FMS and the overhead squat analysis.

The fitness industry has long perpetuated myths about "perfect posture" and ideal movement patterns, creating fear and limiting beliefs that keep people from fully enjoying movement. In this eye-opening conversation with Dr. Chris Hughen of E3 Rehab, we dismantle these misconceptions and explore what the research actually tells us about human movement.

Dr. Hughen shares compelling evidence that challenges common practices like text neck warnings and overhead squat assessments. Despite what many textbooks teach, research consistently shows that static posture doesn't predict pain or injury risk. Your forward head position while texting or "less than perfect" squat form isn't setting you up for inevitable pain—your body is far more resilient than that.

We explore how elite athletes like Usain Bolt and Olympic weightlifter Dmitry Klokov excel despite having movement patterns that would fail standard assessments. This natural variation demonstrates that human bodies find unique, individual solutions to movement challenges rather than conforming to arbitrary standards.

Most importantly, we discuss the psychological impact of movement correction on clients. When trainers constantly point out "flaws" and focus on "fixing" clients, they often create feelings of fragility and fear. Instead, Dr. Hughen advocates for an approach that builds confidence through exploration, guided discovery, and positive reinforcement.

For trainers and fitness enthusiasts alike, this conversation offers a refreshing perspective that celebrates human resilience and adaptability. Rather than chasing perfect form, we should focus on consistency, progressive loading, and help

Want to ask us a question? Email email info@showupfitness.com with the subject line PODCAST QUESTION to get your question answered live on the show!

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Speaker 1:

It's not predictive to me as whether or not someone's at a risk for any type of injury. And then if their goal is to overhead, squat and maybe they are missing some range of motion, well, let's do more of that thing and improve it over time. But it's not something that I perform clinically. Unless someone really values that movement or they have to perform it for the job demands, for whatever reason, or for the sporting demands, then we can have more of a specific approach, but in and of itself it's not a reliable test for any type of risk factor for injury.

Speaker 2:

Welcome to the Show Up Fitness podcast, where great personal trainers are made. We are changing the fitness industry one qualified trainer at a time, with our in-person and online personal training certification. If you want to become an elite personal trainer, head on over to showupfitnesscom. Also, make sure to check out my book how to Become a Successful Personal Trainer. Don't forget to subscribe, rate and review. Have a great day and keep showing up. Howdy everybody. Welcome back to the Show Up Fitness Podcast. Today we are lucky to have Mr Hewitt, doc Hewitt, out of New Mexico podcast host of E3 Rehab. This hunk right here knows a lot about posture and movement and what we're gonna dissect a little bit today, getting into some misconceptions around those things. So thanks for taking your time, doc.

Speaker 1:

Yeah, Chris, I appreciate having me on. I'm excited for this conversation.

Speaker 2:

Great first name and I always love the Chris's.

Speaker 1:

Likewise.

Speaker 2:

So I'm going to read you something right out of a seventh edition. And most trainers enter the industry reading a textbook and within the first couple of chapters we already have a big disclosure that text. Neck is a growing phenomenon that researchers are investigating to identify whether habitual use of cell phones influences neck pain Over time forward. Head posture can lead to dysfunction of the neck area as well as the body. The position of the client's head and neck during exercises to minimize the risk of injury, to help train proper posture and movement patterns. So I know that's like Pandora's box right there, but can we talk a little bit about that? You did a post recently and we got to hear from the pros, such as yourself, because it's easy to stir the bee's nest and just say, oh, this is stupid or whatever. But can we get into the weeds a little bit with what your thoughts are around perfect posture and this test?

Speaker 1:

next stuff yeah, it is a rabbit hole, but for a long time there was this belief and continued belief that's instilled in a lot of humans, whether it's trainers or general population or even physical therapists that there's this quote unquote ideal posture and if you deviate outside of that norm then you're going to be predisposed to pain or that you need to fix these. You know quote unquote maladaptive or incorrect positions and text. Neck is a common example or thing is that thing is that is blamed nowadays of people are spending so much time on their phones that forward headed posture is inherently going to increase their likelihood of neck pain and it's a bad position, or that it's going to increase damage to the neck over time. And the post I made on Instagram a week or two ago was showing a new paper on the topic tracking individuals over time in a typical neck posture position where they're kind of looking down, they have cervical flaxion, they're just looking at their phone and tracked over time to see if these individuals, versus people that were looking with their phones straight up, if they were at an increased risk of neck pain after multiple weeks and months. And these type of studies have been done for low back pain on sitting posture slouched versus more upright positions, positions and what the research continually suggests whether it's for neck positioning, like looking down at your phone or sitting throughout the course of a day that posture in and of itself is not predictive of pain. Whether this is neck posture quote unquote text neck, looking down at your phone this is not an increased risk factor for having pain. And same thing with sitting and slouching and finding comfortable positions. People assume that they have to sit really upright and if they start to slouch, that this is going to be something that leads to back pain, and that's just not the case. So I actually recorded our episode on E3 Rehab that will actually come out in a week or two from now.

Speaker 1:

I don't know when y'all come out with this podcast, but the researcher one of the lead researchers on that paper that I shared on TechSnack dives into this topic, just kind of elaborating on what I'm discussing here. That pain is a messy thing and trying to blame it on one specific static position isn't correct and it puts people into this fearful mindset that sitting or standing or moving in a specific way is inherently bad. And that's not really the case. And if you think about it with something like sitting or looking down at your phone. It's not like someone goes from living a generally normal life and then going from not looking at their phone to now, for hours a day, looking down at their phone.

Speaker 1:

This is something that's typically progressed and exposed to over the course of their life and especially nowadays, as people grow up, most kids will have their phones or they'll have their iPads and they're sitting, they're looking down at their phone.

Speaker 1:

This is built up and exposed and adapted to over time and it's not this one bout. They're introduced to it eight hours a day for the first time ever. So there's also this consideration, for our bodies are super resilient and we adapt to the stressors that we're placed in. And even if that's something like prolonged sitting, looking down, slouching at your phone, that is an indication that we've adapted to it, probably over multiple years and multiple decades. And just because someone has a flare-up of neck pain or back pain, immediately addressing the posture as the main factor. Even though someone's been in this position or been exposed to it over multiple years or decades, it's hard to find that clear link that why are they now having symptoms and why can these symptoms fluctuate, even if they're in the same position later on down the road. So that was a lot, but I'll stop there if you have any follow-ups.

Speaker 2:

No, I love that. That's great and we have our own certification and we're very pro-movement. And I don't know if it was Dr Minkins or someone, but they had a really funny post on that stereotypical skeleton. It's like two degrees forward, four degrees forward and then the last one the head falls off and it's like because you know, we're not that delicate as you're saying here, and I think that can kind of segue into other, maybe static postures or a little slightly dynamic movement screens, like the overhead squat assessment postures, or a little slightly dynamic movement screens like the overhead squat assessment. A lot of these textbooks will have the assessment being something that clients don't do on a regular basis, and then we start out by saying, oh, your sternocleomastoid is overactive and this is underactive and it's very fear-based, and so what are your thoughts on overhead squat assessments and so forth?

Speaker 1:

Yeah, to your point. Some of these assessments one they're arbitrary and a lot of people that are performing them or having them receive the FMAS or an overhead squat they've never been in these positions or they're not exposed to them. So there's novelty to some of these activities that one does it correlate with their ability to do a normal, let's say, bodyweight squat or goblet squat or reach overhead? Generally not, and the research doesn't suggest that if someone has this inability or this quote-unquote, incorrective way to perform an overhead squat, that they're at an increased likelihood of injury. That's just not there. With something like the FMS, they've tracked this over time with certain scores that are inherently what the FMS discusses as predisposing someone to injury or a risk factor. The research just doesn't bear that out with actual athletic endeavors and day-to-day movements. So we know that more of these body weight or arbitrary assessments like an overhead squat really don't mean much in predictive injury. And If you look at someone, there's Dmitry Klokov has a famous picture of him trying to perform a bodyweight overhead squat. He's an extremely famous Olympic weightlifter. He's retired now and there's a comparison of what he and it goes to show that movement is not a static thing and someone's ability to position their body and their joints under load is different with no load versus with load versus with warm up.

Speaker 1:

So taking a snapshot or screenshot of what someone looks like in an overhead squat for one repetition or for multiple reps, one, is it giving you that much information for their general athletic performance? And then, two, if their goal is to overhead squat, what does that look like when they have a bar in their hands? And if they warm up and they have, you know, 10 pounds, 20 pounds, 30 pounds, does that position look better? So it's not predictive to me as whether or not someone's at a risk for any type of injury. And then, if their goal is to overhead squat and maybe they are missing some range of motion, well, let's do more of that thing and improve it over time. But it's not something that I perform clinically. Unless someone really values that movement or they have to perform it for the job demands, for whatever reason, or for the sporting demands, then we can have more of a specific approach, but in and of itself it's not a reliable test for any type of risk factor for injury.

Speaker 2:

It's difficult because, as a new trainer, you know, 15 years ago I went to a gym and the manager was very NASM based and so we had to teach the overhead squat assessment. In my mind I'm going. I've never done this before. I don't see the practical aspect of getting on the floor, of back squatting, front squatting, goblet squats, but I had to do it and a lot of people were very pro overhead squat because it gave them this almost like an illusion, like I am a practitioner, I know what I'm doing, because I'm telling people that, oh, you don't have this perfect squat and this is dysfunctional, and so it gave them maybe this sense of false confidence.

Speaker 2:

And then when I started going away from that gym and started training and open up my own gyms, I'm like I almost felt like I was the outcast because we didn't do that and it just like clients come in and I felt like it was too simple, where it's like okay, you're trying to lose weight, okay, we're going to squat, we're going to hinge, we're going to do unilateral movements, we're going to push, we're going to pull, we're going to do exercise that are appropriate for you regressed or progressed and it worked.

Speaker 2:

And then everyone else is doing all these tests and everything and I'm like, do you really need to do them? And then I'll have whoever it may be, and they're going to say, well, the reason that you have to do this is because we're finding weak points in the system and we need to establish stability, because if you try to build this giant castle on a crappy foundation you're going to get injured and that kind of makes sense. But then, like you're saying, it's not predicated of actually getting hurt in the future. And so what would be your rationale for that practitioner or trainer who pushes back and says, well, the reason that Dimitri couldn't do that is because he was unstable, and if he were to get stable then he's gonna be able to lift so much more.

Speaker 1:

Yeah, I think it's a hard argument to fight against because there's always that pushback of if they were to change this position or if they were to get better at this body weight movement or improve their scoring on this, then who's to say that they can't get better? And you really it's hard to to fight that because there's not a direct experiment that you can do with that individual. So some of it is like it can feel like losing battle having those conversations. But you can also think of, uh, this individual that's at the time, one of the best olympic weightlifters of all time.

Speaker 1:

It's a pretty arrogant statement to say that if they improved their overhead squat with body weight, that they were going to be even better at the thing that they were the best at already. And you could say that for something like usain bolt, where people look at his you know scoliosis and his anterior pelvic tilt and his valgus when he's sprinting like by no means did he have a quote, unquote picture perfect sprinting technique and his biomechanics were different. And there's these arguments that if he was to change his pelvic positioning or his rib cage positioning, that he could be even faster. But one, can we actually make that strong assumption? No, and it just goes to show for someone that's the best at what they do.

Speaker 1:

There's so much natural human variation of how they look and how they move that it's a great thing because we know that we don't have to put someone in this very stripped, rigid box of what their joints should look like in space or how they're able to move People kind of self-regulate and find what is the most adaptive to them. And yes, we can provide some constraints to the system when it is appropriate. But if you look at these freaky athletes that are the best at what they do, you're going to see a lot of variation. Like someone like Usain Bolt, like a Dmitry Klokov, like Michael Phelps. If you look at their static posture, it's not what someone would expect as this perfect in-line assessment, but then you can make the argument that these are adaptive positions and probably beneficial positions and ways that their body has adapted or just how they're built to make them freaky at what they do. So trying to quote, unquote normalize or improve their static postures is a hard thing to justify, especially when they're the best at what they do already.

Speaker 2:

And then you have these hyenas on the sideline who are just waiting to make some clickbait, whether if it's Seedmen or Functional Systems, and Goda already. And then you have these hyenas on the sideline who are just waiting to, you know, make some clickbait, whether if it's you know, seed men or functional systems, and go to oh, this guy blew out his achilles because he didn't have proper form. There's one recently with uh shantae, I believe from the raiders, and they're looking at his e-version of the ankle when he's running like, oh, he's gonna get hurt and it's just unfortunate because when it comes to like I'll use an example like basketball players, like steph curry has a different shot than larry bird and they're still the best in the game. We're not trying to have this perfect shot, it's it works for them, and to try to normalize this perfection. I think it's.

Speaker 2:

It's difficult and it's frustrating because, as a new trainer, you come into the industry and you want to be, and it does make sense to have these squares that you try to put everyone in, but then you realize human bodies are different and I kind of use an analogy, love to hear what you have to say, but when it comes to like form, I kind of use it as like a zero or a one like, okay, let's modify that a little bit. You know, having extreme valgus for a newbie maybe it's not the best, so let's, you know, try to focus on this a little bit. But I it's, either you're fine or okay, let's fix it, I don't go for it. Okay, we need to have perfect form.

Speaker 2:

I've known trainers that literally would spend the first month just trying to perfect a back squat or a pushup and it's like well, are the clients going to get results? Are they coming in, did they literally say. And I love what you said earlier because it depends on the individual. Maybe there is someone that says I'm trying to get better at my overhead squat Great, we can do that. But trying to put them into this square of you have to have perfection almost sets people up for failure.

Speaker 1:

Yeah, one of my mentors, derek Miles, who's with Barbell Medicine he talks about this a lot with trying to achieve this idyllic form as someone that's learning to exercise or resistance train or start a movement in general. You wouldn't expect someone who's learning to write for the first time have perfect writing abilities or for their you know their spelling to be perfect as a young child. And how does someone get better at writing and improving their ability to write and spell correctly? It's doing it over time. And the same thing can go with motor learning and learning new skills. In general. We learn through error and through exposure and repetition and that only comes with experimenting with different positions, self-regulating, rep to rep, maybe getting some feedback, like you said, when things are maybe obviously out of the boundaries or the zones of what we feel comfortable with or what we're trying to accomplish.

Speaker 1:

And the way I view it is as a trainer or as a coach or as a therapist. If I'm performing a movement or I'm having someone perform a movement and I'm wanting them to feel or utilize specific musculature and they're either not subjectively reporting that they're feeling it or the position itself is so obviously adjusted or compensated that I know that they're not really targeting the tissues that I would like. Then maybe I'll provide some constraints to the system, but really early on it's giving them the affordances to move in a variety of ways, explore this and know that over multiple sessions, weeks and months that this will probably clear up on its own. And maybe I give some feedback every now and then, but a lot of times it's I'm not talking a lot. I'm asking what they're feeling, how that goes for them, um, and providing some constraints when appropriate, but a lot of it is.

Speaker 1:

People just need to get reps and exposure and there's this fear that all right, if someone tries a deadlift for the first time and they round their back, that this is going to be ingrained forever or that this is unsafe.

Speaker 1:

But we know from the research that spinal flexion, especially under light loads, but even heavier loads, if it's adapted to over time, it's not inherently an extra risky thing.

Speaker 1:

And so trying to be overly cautious of someone trying to pick up a 10-pound kettlebell or 25-pound kettlebell and do a squat with maybe some butt wink at the end, there's a lot of variation. That's normal and safe and that's not inherently injurious. The risks of an injury with resistance training are exponentially lower than any other kind of organized sport or most other physical activities, that we can feel reassured that even if someone for maybe what we would assume is a better position, even if they're not performing it how we would want them to, they're not really at an increased risk of injury and they can explore and we can provide some adjustments. But we don't have to be overly concerned that on day one rep one or set one that this has to look perfect, because that's an unrealistic expectation and it's not a the most up-date way at looking at motor learning and how someone improves and adjusts to learning a new skill over time. They need to wiggle around, explore and get feedback with their own body over time.

Speaker 2:

I love that and also to piggyback off of that, when you strive for perfection you really don't optimize the load production and so, like if you have a new client and you're just doing body weight, body weight, body weight and, like you said, wiggling through it, trying to produce some force, that's when you really get the good mental aspect from working out. It's like, oh, that felt good to push something almost maximally, whereas if you're just striving for perfect reps, you may leave feeling kind of accomplished but you're like what did I really do? I went to this person. I paid him 150 bucks and we squatted perfectly for 20 reps and they told me that now I have great form, but the aftermath they don't really feel much and the next day they're not sore. As we know, soreness doesn't mean much, but you kind of have to play that game as the trainer to make that person feel like they've accomplished something. So they keep on showing up and doing it over and over again.

Speaker 1:

Yeah, I agree. I think unfortunately, a lot of trainers and physical therapists and coaches end up having their clients leave an initial session or a variety of sessions feeling like they're fragile, that they're moving incorrectly, like they have quote unquote bad posture and they feel less resilient than when they came in, or that they're always on edge that their provider or that their coach or trainer is going to give them negative feedback. And there's already so many barriers for people to engage in exercise and be consistent and feel comfortable in their body. There's so many already walls in place for individuals and I think one of the worst things we can do is create even more negative feedback loops or negative self-perception of someone with how we provide narratives and a story to them. So my whole goal is to provide as much sense of resilience and confidence and motivation as possible to keep that ball rolling of you've sought out our services, you want to improve your health and fitness or these specific things.

Speaker 1:

The worst thing I can do is make you feel like shit on day one and a lot of times there's nothing majorly quote unquote wrong that we need to make that narrative for. It's providing check marks, for this looks exactly what I'd expect it to look or. I'm happy with this right now. Let's keep moving forward. You did great today. How did that feel? A lot of positive self-talk, allowing them to self-reflect on how the session was or how the movement was, but not shifting it, as they're doing something incorrectly, or this looks wrong, or we need to fix X, y and Z, or your glutes are weak All these things that are commonly told to clients or to patients that just make them feel more I don't know poorly about themselves and it's not helpful and it doesn't allow someone to feel confident as they start or continue their journey of health or rehab.

Speaker 2:

That's the whole biopsychosocial model of pain. The mindset is so important. I went in about 15 years ago, had a doc do MRI said I was basically broken. You have a disc protrusion, never squat, deadlift, run again. And I'm just like fuck, I am screwed.

Speaker 2:

And then I went and worked with Dr Benson here at the LA sports spine in LA and he came in and he's like dude, you're, you're, jack, dude. He's like you're, you're good, like do this. And I'm like I can't do that, it's going to hurt me. He says, do it, I'll be back in a couple of minutes. And he just really empowered me Like you're not a little delicate little snowflake, you're fine. And I did it. And he came back and said how do you feel? I'm like actually not that bad. He's like, yeah, progress, let's get stronger.

Speaker 2:

It's like when I have clients that come in and they're you know we have a team physical therapists we work with and so you know, obviously if there's red flags it's gonna be fun to try to get you out of back pain, because it's part of life sometimes but there is hope. You don't have to be. You know moving around thinking that you're this delicate little creature and and so I think that trainers can do a better job. Learning from this is that when you, when you try to assess people and put them into a situation they've never been into before, they're probably going to fail. And I suck at skateboarding and if I get on a skateboard I'm going to fall and I'm going to get hurt a lot, but it's like I've never done that before. How do you get better? You keep on practicing, and when you tell someone that they're fragile and that everything's overactive or your glutes are weaker, your TDA is underactive and we got to fix you because you're weak it's almost setting them up for failure.

Speaker 1:

Yeah, I think people come in, whether it's on the physical therapy side or when they're starting to work with a trainer.

Speaker 1:

They have these stories that they've been told or that they're telling themselves and it's I hear it a lot of I have a bad back, or I have bad knees or bad shoulders, or I have poor posture, and it's a really unfortunate thing for someone to carry with themselves that they are more fragile than they truly are, or that they've been told by their family or by other healthcare providers or by coaches or trainers that this area of your body is bad or that it's incorrect, and that ends up creating this sense of a lot of times they don't either complete fear avoidance or movement avoidance of wanting to load or exercise that area of their body, or that if they do have some level of symptoms in, let's say, their knees and they've been told they have quote unquote bad knees or they have osteoarthritis, or they're quote unquote bone on bone, that they end up becoming more and more deconditioned and sedentary because they ended up removing the value things in their life or exercise because there was this assumption that movement and symptoms with pain equals damage and that I need to protect and protect and protect and then they become more and more sedentary and more and more unhealthy because they're restricting more and more of their lives and that creates a snowball of negative impacts.

Speaker 1:

And trying to unravel that is very messy. But as a trainer or as a physical therapist, combating some of those beliefs in an appropriate manner and building that trust in their own bodies over time and having them show themselves that they can do more than they expected as opposed to one yes, we should instill that verbally, but also it's the person experiencing it themselves that, oh, I can walk for 30 minutes and I'm tolerating this, or I can squat 10 pounds or I can whatever. It is. That exposure over time with that reassurance and that communication is huge and helps people hopefully get out of that long-term story. They've told themselves, or been told that they're doomed for the rest of their life for this XYZ condition.

Speaker 2:

The pain is multifactorial and I think the best thing trainers can do is link up with therapists to learn more. We're really big with hands-on learning weekend seminars. We have a partnership of lifetime when we go to their gyms and and work closely with Equinox as well. We're big fans of Barbell Medicine and Doc Farnsworth has a great weekend seminar that he does. Are there other courses that are hands-on that you're familiar with that you would suggest for new trainers to go and check out?

Speaker 1:

Yeah, you mentioned Barbell Medicine. I think Jordan Feigbaum and Dr Baraki do a great job with discussing these bigger picture topics of health, pain, injury, integration into exercise. That for a newbie, trainer or general population individual looking to learn more about some of these topics in a weekend type seminar. I think they do a phenomenal job. I think they have a seminar coming out in a month or two in San Antonio. I think they may have some pre-recorded lectures but that is probably one of the top places to go. If someone just wants more information on certain topics or certain body regions or injuries, I'll put a selfish plug. E3 Rehab has great YouTube videos for the general population or for trainers or therapists on a lot of these topics around posture, around low back pain, around knee pain and help provide an evidence-based approach to management and to understanding of the research in a digestible way. So I would start kind of those two places 100%.

Speaker 2:

You guys have done a great job of owning the landscape. On YouTube you type in an injury and your guys' name and E3 comes up and it's awesome and it's not too overwhelming and it's way better than a textbook where you're trying to learn it yourself and you don't get to ask questions. All the trainers will say I'm going to get my corrective exercise cert and I'm like you're going to spend 800 bucks and you're't get to ask questions. You know all the trainers will say I'm going to get my corrective exercise cert and I'm like you're gonna spend 800 bucks and you're literally going to tell your clients to foam, roll and stretch and you think that's going to fix them or you need to. You know, add some load in there and you know, get to a class where you can ask questions and network and and do a lot more for yourself from a business standpoint and also better serving your clients.

Speaker 1:

Totally.

Speaker 2:

Where can people find you, Doc?

Speaker 1:

I am available on Instagram, Chris Hewitt. I have my own podcast, like you said, E3 Rehab, but people, if they want to reach out to me just Chris Hewitt, first and last name If someone is interested in working with me or if they have any questions about their own pain or injury, we at E3 Rehab do remote consultations, either one-off calls or we work with people remotely for their pain and rehab and long-term training, modifications and consistency and help people move in the direction that they want. So if they're interested in that E3 Rehab, our website has more information on that, but people can reach out on Instagram if they want to talk to me or ask any follow-up questions.

Speaker 2:

Love to listen to that podcast about Tex-Nec when it comes out and for those trainers that are listening, you'll learn more in one hour consult with Doc here than any of those specializations search. So get yourself into an opportunity to learn more about your own body. But also come maybe with some case examples with some clients and pick their brain and you'll definitely learn a ton. So thank you for your time today, doc.

Speaker 1:

Yeah, thanks, chris.