What is the overhead squat assessment?
Can you perform an overhead squat? Press a barbell or broomstick overhead and perform a squat maintaining your arms lifted above you. This is a highly challenging movement that most people, including athletes, will struggle to perform. Assessment of the mechanics of the overhead squat claims to reveal impairments, imbalances, and movement deviations which warrant correction.
But wait … let’s take a brief pause to think critically about these claims, and what they mean for you and your health.
Is there really an “ideal” way to move?
If the overhead squat assessment — or any movement assessment — can identify movement deviations, this assumes there is an ideal movement pattern from which we can stray.
Historically, the ideal movement pattern for an overhead squat would emphasize several components, which may sound familiar:
- knees pressing out
- hips back with trunk upright and spine straight
- arms by ears with shoulder blades squeezing together
- both sides of the body balanced and symmetrical
This would certainly make for a pretty squat. But if we consider the qualities of an “ideal” movement pattern, the implication (and often the explicit claim) is that this movement pattern is superior and conveys value to the mover: reduced injury risk and improved performance being top of the list as high-value outcomes of achieving a movement pattern that is “ideal.”
But surprisingly, research shows us that many of the common claims about the dangers of movement “impairments” and the benefits of chasing “perfect” form are not supported.
Common movement faults: what the science actually says
Let’s take a critical appraisal of three of the top movement “faults” associated with the overhead squat.
- Knee valgus
When it comes to knees collapsing/caving inward (knee valgus), the primary concern is that it is predictive of future knee injury and is indicative of weak gluteal and hip muscles. However, despite the embeddedness of this message in the fitness industry, this finding has not been substantiated by research.
Knee valgus during squat and jump assessments does not predict future knee injury for athletes. In fact, visual clinical appraisal of knee position during squat assessments and dynamic tasks is unreliable and inaccurate.
As for whether inward movement of the knees means your glutes are weak? Not necessarily. Some research has found that knee valgus during an overhead squat is actually associated with greater hip strength! Other research, including systematic reviews, shows mixed results with some studies finding individuals with knee valgus had weaker hips, some stronger, and some showing no difference.
- Neutral spine myths
Another very common claim regards the dangers of lifting or squatting without maintaining a flat back. Bending of the back during the squat — or losing “neutral spine” — including a “butt wink” (tailbone tucking under) at the bottom of the squat, is regarded as a sign of a weak core and a perilous position threatening the health and safety of your back and spine. However, this seems to be more myth than fact.
There is a lack of evidence that any particular spinal position increases or decreases the risk of developing back pain or injury. In fact, hypervigilance and strict maintenance of a straight back as an attempt to protect the back may be one factor perpetuating low back pain in some individuals. The development of back pain and injury is very complex and cannot be explained by a “weak” core (a verdict which lacks objective thresholds or diagnostic criteria).
Substantiated risk factors for low back pain might not be what you expect, with top factors including smoking, work demands, and a lack of physical activity.
- Asymmetry and injury risk
Our bodies excel at finding ways to move that work well for us, and each body will solve movement puzzles a little differently. Variation is normal, healthy, and unavoidable. Asymmetrical or unbalanced movement is not faulty movement and is not an inherent risk factor for injury.
Once again, research findings are mixed and generally do not support a strong correlation between asymmetry and injury. There is even evidence that asymmetrical movements and increased movement variability can be related to lower incidence of injury in some cases.
Striving for perfect alignment and symmetry is to chase both an undefined prescription and an unsupported strategy for preventing injury.
Your body is anti-fragile: why movement builds resilience
This isn’t to embrace nihilism and say nothing matters when it comes to injury treatment and prevention, or to say that biomechanics or how you move never matters. Rather, it’s to emphasize the complexity of movement, highlight the importance of individual context, and to advocate for you to trust the resilience and intelligence of your body and to move more fearlessly. If a given movement is associated with pain, then it may be worthwhile to evaluate. Otherwise, don’t sweat it!
The way we each move is unique and there is no universally best way to do so. Predicting injury before it happens is not an accurate or evidence-based practice.
Injuries are complex and multifactorial. Your injury risk correlates much more with your body’s preparedness for the task at hand and the capacity of your tissues to recover and adapt over time to the loads placed upon them. All tissue in your body – muscles, yes, but also tendons, ligaments, and bones – respond to the ways in which you use them.
In fact, the human body is an example of what’s known as an “antifragile” system. If you consider a car or a cell phone or just about any other inorganic machine or object, this would be a fragile system. It’s essentially in a constant state of breakdown from the moment it is created. The more the object is used, the more load and stress it takes, the more wear and tear it experiences and the faster it accelerates toward its inevitable arrival at the junk heap.
You, however, are the opposite. The human body is designed to improve with load. We improve with use and actually weaken with disuse. Our bodies adapt to the specifics of the demands placed upon them.
All tissues in the body adapt with proper training and adequate recovery – this includes not only muscles, but tendons, ligaments, bones, and even the discs within our spines.
What actually impacts injury risk?
With that, the factors that impact our injury risk the most are the factors that affect our tissues’ preparedness for and ability to recover from the stress and loading placed upon them. Recovery and adaptation are controlled by factors such as training load and progression (avoiding the pitfall of too much too soon), sleep, nutrition, stress, health conditions, fear of movement, and mental health and well-being.
In a world where we are subject to a constant barrage of endless content it’s easy to feel like you’re never doing enough for yourself. Threats and promises both abound: Can’t complete this mobility challenge? You’re at risk for injury! Perform this exercise to bulletproof your shoulders! This one movement will cure your back pain for good!
While it might sound like a hard truth to say there’s no simple way to predict injury or resolve pain, I hope this message can also provide an opportunity to let yourself off the hook.
If you’re not hurting and you can’t do an overhead squat – don’t worry about it! It doesn’t mean anything about your future risk of injury. If you are hurting and you can’t do an overhead squat – is performing that specific movement important to you? If not, it’s more valuable to focus on restoring the specific patterns of motion and strength that are meaningful for what you want to do.
If you can’t overhead squat, and you want to improve your overhead squat – now is the time to dig into the nitty-gritty and work on the specific mobility, strength, and control required for an overhead squat!
4 key takeaways about movement and injury prevention
- There’s no ideal way to move! Everyone has a different body and moves that body differently, even when performing the same task. There’s no singular perfect form or posture to chase that will prevent injury or be best for everyone. Just because a movement doesn’t look “pretty” doesn’t mean it is harmful.
- You are anti-fragile! Your body will strengthen and adapt to support the unique way that you move, given gradual progressions and adequate recovery. If you are experiencing pain, total rest is not usually the best treatment. Consider temporary modification for load and symptom management, while remaining active.
- Injuries are complex and multifactorial and typically do not have a singular origin or cause. The source of pain and reason for injury is never as simple as tight hamstrings or limited ankle mobility or a weak core. Changes in these variables may or may not be associated with your recovery – it depends!
- There is no cookie-cutter rehab program that will work for everyone, even those with the same or similar injury. If you are struggling with persistent pain or injury, your rehab should be as unique as you are and focus on the distinct patterns of what aggravate and relieve your symptoms, with a focus on returning you to the specific demands of your movement and lifestyle goals.
Get Expert Help Tailored to Your Movement and Goals
Every body moves differently, and there’s no one-size-fits-all approach to preventing pain or improving performance. Our physical therapists can help you build strength, confidence, and resilience with a plan customized to your unique needs. Schedule your PT evaluation today and move fearlessly!
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