Squats: A Movement Before An Exercise With Aaron Horschig Of Squat University83 Minutes - Aug 29, 2018
If you’ve spent time on Instagram, you may not know Dr. Aaron Horschig DPT by name, but you probably follow his profile.
Dr. Horschig was a pleasure to have on the show. He’s a very knowledgeable, personable doctor and if my family lived in Kansas City MO, I’d send my mother, father and the brother I never had to him for care. His treatment style makes complete sense. Very logically and targeted at reduction of the CAUSE of pain.
Listen to the Dr. Aaron’s podcast interview. We go over a variety of topics that will assist you in exercising, and living a pain-free life for years to come.
Here’s a few of the topics:
- The exercise is not an exercise, it’s movement pattern
- Squat Assessment
- Ultrasound Therapy
- Public Speaking Skill Development
- Full joint range of motion daily
- Self Publication
- Hip Impingement
- The Squat is not just an exercise, it’s a movement first.
- You have to be a “puzzle solver” as a clinician.
- Not using our body as designed can increase injury potential.
- Master movement quality first, then your potential to perform grows.
- The quality of your movement sets you body’s foundation
The Squat Bible (affiliate link)
Dr. Aaron Horschig Bio:
Dr. Aaron Horschig is a physical therapist, strength & conditioning coach, speaker and writer. After graduating with his bachelors in exercise science from Truman State University in 2009, he then went on to receive a doctorate in physical therapy from the University of Missouri in 2012. Aaron now works at Boost Physical Therapy & Sport Performance in Kansas City Missouri.
Past patients have included professional football players from the NFL and CFL, minor league baseball players, European professional basketball players, Olympic weightlifters, numerous NCAA Division I & II athletes, international level youth soccer players, CrossFit athletes and youth athletes in a variety sports.
Aaron’s background includes being involved in the sport of olympic weightlifting as an athlete and coach for over the past decade. His goal is to not only provide the highest quality rehabilitation to athletes who have sustained an injury, but to also help our sports medicine society become proactive in how we approach the athlete – both from a rehabilitation and training perspective.
Sebastian’s Youtube Channel
Attention Docs and Fitness Professionals: Access your client educational products, banners and posters here.
Dr. Sebastian Gonzales is an expert in trouble shooting sports injuries and overuse conditions. This podcast is intended for sports medicine topics to become easier for patients and athletes to understand. Don’t get confused by what your doctor told you in your appointment. If you like in Orange County CA, book an exam with Dr. Gonzales, your Huntington Beach Chiropractor.
... “If you can master movement quality first ... If you can learn how to squat well first, then your potential to perform just rose. It’s like when you\\\\\\\'re building a pyramid; you\\\\\\\'re not going to build the base really tiny and then try to make it really, really wide and then all the way up. A pyramid can only be as tall as it is wide ...”
You’re listening to The Restoring Human Movement Podcast where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery, and now, your host, Dr. Sebastian Gonzales.
Hey everyone, it’s Dr. Sebastian Gonzales again on the mic for The Restoring Human Movement podcast. I’m going to be your host and I want to thank you so much for spending some time today to listen to my show, and hopefully, you will learn some good tips that you can take back to the clinic, or if you\\\\\\\'re lay public, just to apply to your workouts.
Now, that was a real quick clip of the guest I have on today, who you might recognize on Instagram as mainly his handle; his handle is squatuniversity and his name is Dr. Aaron Horschig, who is a physical therapist in Kansas City, Missouri, at this time, so he is going to share a lot of good stuff.
I started following him about a year or so ago and I love his posts--they\\\\\\\'re amazing. He gives away so much great good content and if you go to his website, there’s so much free stuff on there that he literally should be charging for half this stuff. I dare to say that he has one of the best free access sites out there: Squat University. He actually has a paid product as well called The Squat Bible, which you should pick up because it’s pretty cheap for the amount of information that you\\\\\\\'re going to get.
If you\\\\\\\'re a clinician, here’s a couple of things you\\\\\\\'re going to get from this: #1 We are going to go into some of the mechanics of squatting; external flare, proper foot position, and so on. #2 What are the right squats for the different types of people. #3 We are going to go into femoroacetabular impingement, but here’s some interesting things; I feel like when I have on people who ... I don\\\\\\\'t want to say “instafamous” because I think it’s kind of degrading anyways, but instafamous people that we get to hear about some behind the scenes stuff and how they grew their audience. Because realistically, you can have the best content out there and no one is going to find it if you don\\\\\\\'t know how to promote it and relate it to people. So he’s going to share a little bit about some of his experiences with communicating with people on Instagram and how he grew that following, as well as some publication tips should you use a publisher for your books and so on.
Now if you are lay public, an athlete, Weekend Warrior, a barbell athlete (especially CrossFitter, Olympic lifter, or someone who just likes to pick up heavy stuff from the ground) then this is still going to be a lot of great information for you. There are going to be a lot of tips on how to improve your squat mechanics, as well as some central concepts around if something is hurting then maybe we should figure out the reasons why it is hurting and not just stick to passive therapies as we do talk a little bit about ultrasound in here.
Before we go into that, I’m going to lead you into who I am and my life, and I will tell a real quick story and we will go straight into the interview after that.
I don\\\\\\\'t think I’ve ever really spoken about this yet, but one thing that really grinds my gears is Home Depot. I don\\\\\\\'t think Lowe’s does this. Home Depot does this mainly. So you go into a Home Depot, and I don\\\\\\\'t know how it is where you guys all are, but Home Depots where I’m at it’s like there’s 2 doors and it seems like any spot you park, it is never by the spot where you want to go in and get the thing in that aisle. I mean it’s like everywhere, like a cluster.
You\\\\\\\'re destined to be in Home Depot 15 minutes every single time, even if you know exactly what you\\\\\\\'re going to get, so the biggest grief I have with Home Depot is the fact you roll in there, and there’s probably, and I’m not estimating, but there’s about 5 or 6 handicap spots, and they\\\\\\\'re right in the spot where actually you think ... Hmm ... this is the only spot it would seem to make sense to park. You\\\\\\\'re like “Okay, I can respect that, 5 or 6 handicap spots, yeah, but a lot of them are not even full.” It seems like no one ever uses handicap spots.
Second is that you look around and are like, “Oh, here’s a spot right there,” and it has a little Post-It sign next to it and then there’s probably about 5 or 6 more of these and they say Veteran Parking ... and I’m down with the veterans by the way, so veterans thank you for your service, but at the same time, do you guys go to Home Depot that much where you need all the spots? There’s already 12 spots here that we cannot park in.
The third part ... this one really started to kill me ... All of a sudden there’s electric car parking, so there’s like 2 or 3 spots for that, so there’s like 15 spots you can\\\\\\\'t park in where there’s not really any good parking spots really. What the hell? I think at some point we should probably start doing vegan parking too. You know like if you consider the electric cars are the ones that are saving the environment ... I thought it was vegans because of the decreased eating of cows and the transport of stuff to feed the cows and then grain production to feed the cows and the water to produce the grain to feed the cows ... I thought they would be more useful for the environmental protection than electric cars, so let’s just start making vegan parking.
So that’s my thing with Home Depot. I love Home Depot. I love Lowe’s. I love walking around, but at the same time, I’m in a rush and I’m like Dammit! I got to park a hundred yards away because there’s about 15 spots that are not really being used. But I agree with the people using them, I’m not bashing you people, but let’s spread these things out a little bit ... just spread them out a little bit.
Dr. Sebastian Gonzales: Everyone welcome on Dr. Aaron Horschig.
Dr. Aaron Horschig: You got it!
Dr. Sebastian Gonzales: How’s it going?
Dr. Aaron Horschig: Pretty good man, thanks so much for having me on the show.
Dr. Sebastian Gonzales: Yeah, well, I like to look around the back surroundings of people on the other end and I do like this vintage Budweiser Bud Heavy T-shirt you have on.
Dr. Aaron Horschig: Yes, well, I’m from St. Louis, so Anheuser-Busch. You know what? I probably should not be wearing this too much anymore though because of Anheuser sold out to Inbev a couple of years ago, so there’s still a very hard relationship with people from St. Louis with Anheuser now because it’s not locally owned technically anymore.
Dr. Sebastian Gonzales: Oh really? Like they don\\\\\\\'t consider it an “All-American beer” anymore?
Dr. Aaron Horschig: Not really. There’s a lot of people ... I mean obviously a lot of people still drink Bud Light and Budweiser, but there’s a lot of people that were really upset with the way Anheuser-Busch handled that whole deal.
Dr. Sebastian Gonzales:There’s a place down here, Battle’s Point ...
Dr. Aaron Horschig: Yeah, they got some good beers.
Dr. Sebastian Gonzales: Yeah, they got sold out too, but they were like a local brewery too in San Diego and then all of a sudden, they exploded and I think sold for like 100 million or billion or something ridiculous, but I don\\\\\\\'t consider that locally anymore honestly.
Dr. Aaron Horschig: Yeah, well here in Kansas City, we have Boulevard, which they even also sold out recently as well. There’s not many locally, I guess American-owned craft beer. Obviously, there’s a ton, but not as far as the really, really big ones because they\\\\\\\'re starting to sell out as well.
Dr. Sebastian Gonzales: I think you just found a niche market, like forget this whole squat bible thing.
Dr. Aaron Horschig: (Laughs) That’s another untapped potential as I don\\\\\\\'t really talk about beer too much on social media, but that’s another thing ... I love sitting around and having a good beer and talking with people.
Dr. Sebastian Gonzales: I do too. I really think I’ve learned more clinically over beers than I have that I have really paid for.
Dr. Aaron Horschig: (Laughs) Definitely.
Dr. Sebastian Gonzales: So ... can you tell everyone about yourself, how you got into PT, strength conditioning, and why you\\\\\\\'re obsessed with squatting?
Dr. Aaron Horschig: Yeah so, I’ve always been very into the strength conditioning side of things. When I was going through high school, I was always one of those people that didn\\\\\\\'t always have the most talent for the different sports I was in. I mean I excelled; I started in football and baseball when I was in high school, but I never really was that great of a talent to where I knew that Yes! I’m definitely going to college to play sports. But when it came to the off season, I was like, “Oh man, this is my favorite time when you get done with school, go to the weight room, you spend 3 hours there before the weightlifting coach kicks you out. I loved just being in the weight room and just lifting all the time.
So when I went to college, it was probably actually a sign. I tried out for the baseball team at Truman State University, which is a small D2 school, but ended up hurting my elbow in tryouts to the point where I could barely make the throw from right field to second base.
Dr. Sebastian Gonzales: How did you hurt your elbow in tryouts?
Dr. Aaron Horschig: I have no idea. I’m guessing it was one of those things because I played Summer Legion baseball, and we played a lot in the summertime, so I’m guessing it was one of those overuse things that I had been dealing with probably a little bit up to that point. I’m guessing it was just sort of that last little bit and I mean it was one of those things that I’m sure God was just like, “Hey, this is NOT where you\\\\\\\'re supposed to be going.”
If anyone plays baseball and if you can\\\\\\\'t make the throw from right field to second base, man, you\\\\\\\'re a crap outfielder.
Dr. Sebastian Gonzales: They’ll move you to left field won\\\\\\\'t they?
Dr. Aaron Horschig: Exactly. I mean I was devastated obviously because I had played baseball my whole life, but it was one of those things where as soon as I did not make the team ... and this was back like the first year Facebook was a thing and we had groups and that was the big thing is you would scroll through the different groups of your college just to see sort of what people were a part of. I remember scrolling through and seeing the Iron Dogs Olympic Weightlifting Team ... I was like “Oh, this looks pretty cool,” because I had done Olympic weightlifting to a point in high school with a lot of barbell training, specifically cleans, a little jerks. I never really done snatches, but I had gotten into weightlifting up to that point and I had known what Olympic weightlifting was to a point, and this looked like fun, and I still had that competitive side of me that I wasn\\\\\\\'t just ready to be a student, I wanted to be an athlete still.
So I went to one of the first informational meetings, like the week of school starting and I just got hooked and I walked up to the coach, Alex Cook, who is now out east at a different school, but he’s a doctor of exercise physiology, who is an amazing guy, and I was just like “Hey, can I start tomorrow?” and he was like “Yeah” and I actually had a pair of weightlifting shoes from high school. I had actually bought my first pair of weightlifting shoes back then and I just hit the ground running. I have been doing it ever since, now 13 years being in the sport of Olympic weightlifting, so that’s sort of my background coming up with that. I ended up getting my bachelor’s in exercise science and I went to the University of Missouri Mizzou, which is about 1-1/2 hours south of Truman for my doctorate in physical therapist.
While in school, I tried to mold where I wanted to go with my physical therapy practice to work with athletes, so I ended up being able to get one of the first internships or clinical residencies with the University of Missouri strength and conditioning staff, so it was one of the first times to my knowledge where a graduate program had partnered with a strengthening conditioning staff for the actual learning clinical rotation, so not like a post graduate, but actually in the graduate school.
So I was waking up at 4:30 in the morning, getting to the strength conditioning room, meeting with all the coaches just like I was a regular strength conditioning intern, except after the regular practice that we all did, the weight training sessions, I would then pull out a couple people, maybe 5 or 6, that I had as my individual focused care athletes and they were like guys who tore their MCL a year back. They were released by the training staff, but they were not yet 100% so I was able to work with them from a physical therapy point of view to understand that hey, you\\\\\\\'re the sort of transition athlete where you\\\\\\\'re not back to 100%, but you\\\\\\\'re not in pain anymore. I think that is sort of where I excelled also as a physical therapist in my practice because at my current job with physical therapy and sports performance out here in Kansas City, we really try to stress to athletes that my goal during the rehab process is not just to get you to the point where you don\\\\\\\'t have pain and send you on your way and let you try to get back into the sport that you want to do and hopefully things go well.
We have like a 40-yard turf football field out there. We’ve got weights, bungee cords, hurdles, speed bags, different things you’d see in a traditional strength conditioning setting. My goal is to basically make sure that when I release you and I’m “Okay, you\\\\\\\'re good to go,” you’ve done most of the things barring the full contact of football most of the things you should be able to do as an athlete and you should know that you\\\\\\\'re strong and safe to do those things. I should be able to test you at a high level.
I think as a physical therapy profession too often we were the table exercise, hot pack, ultrasound profession, where people come in and their shoulder hurt and we would do a bunch of table exercises, you get a massage, cold pack, ultrasound (which I don\\\\\\\'t even know how to turn on an ultrasound machine anymore and I don\\\\\\\'t even like using it).
Dr. Sebastian Gonzales: Concentric circles, I know that.
Dr. Aaron Horschig: Every day. So you know I think changing that whole thing. We’re seeing so many people from the PT and chiropractic world that have molded and become more practitioners of functional medicine, I guess is a good way to say it, to where Yes, we are going to get you out of pain in the first couple of weeks, hopefully, depending on the type of injury you have, but we’re going to make sure you\\\\\\\'re able to do the things that you\\\\\\\'re supposed to do. You can\\\\\\\'t just do PT on a table and expect that to be the end result because often the same injury that you had or one very similar is going to come back and bite you in the butt, literally depending on the type of injury you have once you go back to your sport. So that’s sort of where I have gone with my practice. Through that and through my application and understanding of strength conditioning, specifically Olympic weightlifting in the past, I have molded that with my physical therapy practice and that has become sort of the “outlet” of Squat University.
I mean why the squat? Because you could pick a thousand exercises, so why the squat? Well, whenever I was coming up my first couple of years practicing as a physical therapist, there was kind of this “a-ha” moment, dejavu moment, that I would get time after time. I was sitting down talking with an athlete and whatever type of injury they have ... most of the time, if you have a postop (someone just out of surgery) you know what caused their injury. You know they had a surgery and there is often a protocol--the first couple of weeks you can only bend your knee this much, blah-blah-blah. Well you don\\\\\\\'t have to do too much digging to find out why the person injured themselves; it’s a pretty straight-forward case.
Well when someone comes to you and they\\\\\\\'re like, “I have knee pain” or “I got hip pain” you then have to be a clinician and puzzle solver to basically find out why the person had pain. Because we’re not just here to treat the symptoms. Anyone can get someone out of pain just by slapping a hot pack on them, or deep tissue work, or my favorite nowadays “Let’s do some Graston technique” and some kinesio tape ...
Dr. Sebastian Gonzales: That’s how you know you\\\\\\\'re a sports doc, okay? (Laughs)
Dr. Aaron Horschig: Exactly. You can get a lot of followers on Instagram using a fancy piece of technology nowadays to get someone out of pain, but the true clinicians--They spend time to try and fix why the problem is there. So during that whole process, I’m like, “Show me your squat. Takes your shoes off and show me a deep bodyweight squat. I don\\\\\\\'t care if you have ankle pain, knee pain, back pain, let me see what your movement quality looks like.” Like 9.9 times out of 10, the athlete ... even if they were squatting 600 pounds prior, even if they were running a 4/4/40, even if they could dunk a basketball, they could perform to their greatest potential of what we now think is possible with athletic performance nowadays, they could not perform a basic bodyweight squat.
On top of that, they could not even perform a simple bodyweight squat with one leg, like a single-leg squat. I think it was almost like time after time, I was seeing athletes of today have rearranged their athletic priorities to such an extent to where they view the squat as an exercise only and no longer a movement pattern, so for that reason, we quit learning how to move well first. We quit the application of the squat, moving well first, and how often do you see someone pop a squat and sit down in a bodyweight squat nowadays? Never.
Dr. Sebastian Gonzales: I tried right before we got on by the way, about 10 seconds without a kettlebell. I was like, “Holy shit, I need a doorway here.”
Dr. Aaron Horschig: Yeah, you know, we look at these other third world countries that does not necessarily use chairs all the time and they\\\\\\\'re able to sit down in a deep bodyweight squat easy. Yet, obviously there’s a lot that goes into it, but what’s the long-term injury rates of back pain, or things like that? Like where these people are using their body through full range of motion like it’s designed to and we’re not holding ourselves back by using chairs, or you know we’re not limiting our movement potential throughout the day. I think that has long-term ramifications, not only injury potential, but also potential performance when you don\\\\\\\'t use your body as it’s designed.
So that’s where Squat University came out of ... it was a combination of physical therapy, combo of strength conditioning principles and sort of mashed into the idea that if you can master movement quality first ... if you can learn how to squat well first, then your potential to perform just rose. It’s like when you\\\\\\\'re building a pyramid ... You are not going to build the base really tiny and then try to make it really, really wide and then all the way up. A pyramid can only be as tall as it is wide.
Well, the quality of your movement, how your squatting, which is obviously relatable to how much mobility you have, how much stability you have, your coordination, the quality of your movements, sets your body’s foundation for how well you can perform and how much potential risk you have for developing an injury down the road. So that’s where the whole idea of Squat University has come out and that has been an outlet for me to try and share and give as much as free information as possible to as many people as possible when it comes down to improving mobility ... Learning how to squat with good technique and how to work with aches and pains of daily injuries.
Dr. Sebastian Gonzales: I definitely have a couple of talking points in there. First of, where did you learn public speaking? Because you go between good storytelling quite a bit in complex topics.
Dr. Aaron Horschig: You know what? It was never something that I really excelled at. I was pretty shy when I was in high school, but I will tell you this, and I don\\\\\\\'t think this is something I’ve shared on other podcasts before which is funny so ...
When I was in college I joined a fraternity. In being a young fraternity member, one of the things I really enjoyed and looked up to some of the guys in this position was the External Vice President. Basically, you go around and you\\\\\\\'re basically the one that runs all the philanthropies; like volleyball tournaments. I mean everybody knows the different things that fraternities do at pageants and stuff like that. Well, I don\\\\\\\'t know if it was because the title they had or the person who was just in there that I looked up to, but I always wanted to be around that type of person. I would be in a lot of their meetings and help them do things. Eventually, I did have that job as I got older in the fraternity as I went through school. Part of that job was to get up and talk in front of sororities and tell them, “Hey guys! Next week we got Sisters in the Sand, our volleyball tournament to raise money for The March of Dimes,” kind of thing.
Let me tell you, as a shy high school boy, to then get up in front of 300 very good looking females and try to talk and articulate your message without ... you know (laughs) ... stumbling all over yourself and looking like a fool, can really make you learn how to articulate your message very well and get over those nerves.
Literally, I’m not even joking, since then, I love getting up in front of people and talking. In doing so, I think that’s also why I have geared towards making videos, talking over them. I recently started my own podcasts and I have enjoyed trying to teach as many people as possible. I think it’s one of the things that if you have practiced it enough times, you get a feel for what you\\\\\\\'re good at and then you just sort of go from there. Some people are not great public speakers and they\\\\\\\'re great at writing or great at this form of content. I think you sort of lean toward what you\\\\\\\'re best at.
Dr. Sebastian Gonzales: Do you remember in your sorority speeches, what type of person you typically looked at and where they were at in the room?
Dr. Aaron Horschig: (Laughs) Usually the girl was also at the time was also the one I was trying to make contact with.
Dr. Sebastian Gonzales: Cool. So back on the clinical part then, so when someone comes in with knee or back pain or whatever, do you feel confident you can make them feel better without actually touching them?
Dr. Aaron Horschig: 100%. Now the thing I like to tell my young clinicians that are doing their clinical rotations is that you need to have as many tools in your toolbox as possible. If you\\\\\\\'re a carpenter and you only have a hammer, everything looks like a nail. But what happens when a screw needs tightening? You need to have a screwdriver.
I think often when we graduate we kind of have this Tonka tool set. You know, you got a little plastic hammer, plastic screwdriver; you have tools, you don\\\\\\\'t have many, and they\\\\\\\'re usually pretty crappy, but then as you grow as a clinician, you\\\\\\\'re like, “Oh, it’s time to upgrade my hammer to a real metal hammer. It’s time to get that new drill.” So you eventually add more tools to your toolbelt and strengthen tools you currently have.
I do think in your perspective of treating people that it should always come down to how their moving in the end. I feel like too often I hear of manual therapists that overdo the manual. Every single person that comes in they have to do a ton of manual and that’s why the person got better.
As much as I think manual therapy is great and it definitely has its application ... and I definitely do manual therapy as well. Yesterday I had someone come in and for 15 minutes, I did mobilizations on his thoracic spine where I was physically doing the manual mobilization. There are times where I do manual scraping technique. I made fun of the Graston technique a couple of minutes ago, but I don\\\\\\\'t use Graston technique because I’m not going to shell out thousands of dollars for a couple of tools that I can do for $125 scrape tool, but I do still do soft tissue mobilization.
I think at the end of the day, it’s our goal no matter who we are to make sure the person we’re working with is able to be treated in a way that A) relates to what they\\\\\\\'re doing outside of the clinic and B) empowers them to take control of the treatment process.
If someone came to me with knee pain and I was the only person that did anything to them, they did not receive any empowerment to fix the injury or know why they had the injury in the first place. They know Dr. Dave was the person that fixed me, so I need to go back to Dr. Dave every single day whenever I have knee pain. Instead of when you come to them and nothing is wrong with doing deep tissue mobilization or maybe patellar mobilizations, depending on what type of knee pain they have ... if I come to them and I’m like, “Look, the reason you had knee pain is because you had poor control of your knee. When you do a single-leg stance activity, you just showed me a single-leg squat that looked like crap. Your knee caved in as soon as you tried to do a single-leg squat. What do you think is happening every time you run? Cut? Or land from a jump? Likely, something is not working correctly in your body as far as coordination to make sure your joints are moving appropriately and your knee is staying in proper alignment with your body.”
That is just like a machine that is not working in alignment with the other gears; eventually, something is going to break down. So while some of the treatment we are going to do today is going to help decrease your symptoms, decrease some stiffness in some areas, realign things that are maybe not moving as well as they should, we are going to do a lot of treatment today that’s going to help you learn how to correct the way in which you are moving, effectively treating why the injury started in the first place. I’m then going to give you 2-3 things that we did today that you can do by yourself at home, good technique doesn\\\\\\\'t hurt, and that’s your homework. You need to start doing that every single day, so having that empowerment of a home exercise program of movement-specific exercises to help that person fix why the problem started in the first place is key.
I would not say I think everyone should be able to treat without touching the person. I think they should have the necessary skills as a clinician to know how to fix them or help someone with manual treatment, but I think where most people miss the boat and I find this largely in young clinicians getting out of school is they like the manual treatment side of things; they like changing things and seeing that it creates an immediate change in their symptoms, so where they go too far down the road, down that rabbit hole, and they don\\\\\\\'t expand their knowledge. The big thing I try to tell people is when you\\\\\\\'re looking at a person’s injury, you don\\\\\\\'t want to view that person’s injury through a microscope. You want to take a step back and you\\\\\\\'re looking through the looking glass of movement. Yes, when someone comes to you with back pain, knee pain, any type of pain, it’s very easy to get tunnel vision to say this is why that person has pain.
For example, if we have a shoulder and someone has rotator cuff impingement that has led to maybe a little bit of fraying of the rotator cuff ... we’ll just say it’s inflamed, whether or not there is a tear or not ... well, obviously we know that person probably needs to do some rotator cuff strengthening to improve how the shoulder blade and rotator cuff is stabilizing the humerus so the golf ball is sitting on the golf tee kind of thing, but in the same sense, if we don\\\\\\\'t understand, take a step back and go Wow! This person has horrible thoracic spine extension. I address that and maybe did some manual therapy and that shoulder is feeling better and I did some strengthening, but I did not address the person as a whole, I think you missed the boat and I think you\\\\\\\'re missing the potential of what you can do as a clinician to help that person really long term ... you know fix the problem so they don\\\\\\\'t have to come back and see you again.
Dr. Sebastian Gonzales: I do like that with you allowing them to establish some control and I actually notice that a lot too from the interns that come in. They see some of the cueing that I do and they think it’s amazing that you can cue them out of a position of discomfort. I’m with you; I dig manual therapy, I do it, I adjust, I do that kind of stuff, but at the same time, I feel like if I do that first, then the person will become dependent and I really don\\\\\\\'t want that.
So a question then is ... and I definitely get these ... when you have someone who is resistant and they\\\\\\\'re coming in with a preconceived notion of they\\\\\\\'re like “I want you to ultrasound me” in concentric circles and they keep asking for that every single time. What kind of conversation do you have with them or do you just realize you may not be the one?
Dr. Aaron Horschig: I think there’s two sides to that picture. I think the big thing is when people come in to me ... and the thing that really “grinds my gears” I guess is physical therapy, at least in the state of Missouri, unfortunately is still a referral source profession. We cannot get direct access for patients in the state of Missouri.
Dr. Sebastian Gonzales: Really? I think in California you can.
Dr. Aaron Horschig: There are 6 states remaining that you cannot go directly to a physical therapist.
Dr. Sebastian Gonzales: Damn.
Dr. Aaron Horschig: You have to go to a chiropractor, or a medical doctor, to get a referral to see a physical therapist because it’s considered a speciality, just the same way you could not just go to see an orthopedic surgeon--usually you need a referral. Hopefully, it’s going to change soon. It’s all up to the lawmakers in Jefferson City, which is our capital.
The thing that really bugs me is whenever an MD sends me a script for someone and it’s like knee pain and on there it just says ultrasound.
Dr. Sebastian Gonzales: Yep (laughs).
Dr. Aaron Horschig: I’m like dude, c’mon.
Dr. Sebastian Gonzales: See ... he just screwed you really.
Dr. Aaron Horschig: Because what happened was the patient then heard from the doctor themselves, the medical doctor, that ultrasound is going to fix their injury. So they come in with a preconceived notion well, my doctor told me that ultrasound is going to fix me. Why are you saying it’s not? Because now I’m getting conflicting messages.
The first thing I always try to say is “I’m a doctor as well. I’m a different type of doctor, a doctor of physical therapy,” and that’s a big thing ... People have no idea that physical therapists are doctors nowadays, or a large majority of them.
So the big thing I try to do is just educate. I’m like ... here’s the deal. Ultrasound is ... this is what people are thinking it is supposed to do. This is actually what is happening and this is what the evidence says ... it’s actually very poor that it’s going to create any lasting change or actually do what it’s meant to do.
And the big thing I try to tell them, and this is another reason why I think a good PT or chiropractor is also a good public speaker ... because you have to convince someone in the educational process of that initial interview to buy in to what you\\\\\\\'re trying to sell them, which is the treatment plan that you\\\\\\\'re going to give them ... and understanding today we’re going to fix why your problem started. So you know what? Can I decrease your pain in the short term with a couple of these little tools? Sure. BUT you’d be right back into see me next week or even worse pain down the road. So we’re going to take the time and fix why your injury started in the first place. So I think that education is the key.
I think the missing factor why people don\\\\\\\'t buy into whatever clinician they\\\\\\\'re going to go see is because the person just don\\\\\\\'t know how to talk to someone; they don\\\\\\\'t know how to relate to someone.
Of all the people that were in my PT school class (we had 40), there was a number of people that didn\\\\\\\'t have the people skills I would say to relate and talk to someone. Also physical therapists and chiropractors, with our medical degrees, we love to talk down to people.
Dr. Sebastian Gonzales: Right ... and you have been in a class with all of these people for like 3 to 4 years and then you don\\\\\\\'t know how to speak to lay public.
Dr. Aaron Horschig: You’ll say, “Well, your shoulder flexion is 10 degrees less than your right, and you\\\\\\\'re acromion process ... “ and they\\\\\\\'re like, “WHAT?” Unless you\\\\\\\'re getting a medical student, they don\\\\\\\'t know what you\\\\\\\'re talking about so you have to convey what you\\\\\\\'re trying to educate them on in a language they understand, so I’m going to use sloppy language that my PT professor would just shake her head at. I’m going to say “the golf ball is going to move on the golf tee and smash into different things in the front side of your shoulder and it’s going to cause pain,” and they\\\\\\\'re like, “Oh! That makes sense,” but if I’m using technical language and jargon, they\\\\\\\'re not going to relate to that, they\\\\\\\'re not going to buy in, and they\\\\\\\'re going to go down the road to the next clinician that’s going to treat their symptom because it feels better right after.
So in the same sense I do think there’s going to be some people, and every clinician is going to get this down the road, where that person is just looking for the quick fix. They\\\\\\\'re looking for the ultrasound, the Graston, looking for this and that’s all they want because they heard that’s all they need. They’ve already came into you with that preconceived notion and you\\\\\\\'re not going to change their mind.
I think it’s one of those things as much as you try, you got to give it your best shot to convince that person and also understand there’s going to be losses. There’s going to be times where you\\\\\\\'re not going to win that person and you need to learn from it and maybe say “should I have done a better job at convincing them?” Because maybe you do need to strengthen your interpersonal skills at talking to someone else, BUT maybe it’s just that person and you can\\\\\\\'t change their mind, and that’s that and you got to move onto the next person and help the next person out.
Dr. Sebastian Gonzales: Yep, I agree. There was one time I told this girl her ankle was broken, but it was sprained because that was the only thing I could think about the tenth time to make her come back because that was the only way I was going to be able to help her ...
Oh, we got a new T-shirt today. Do you dorsiflex?
Dr. Aaron Horschig: Yeah, I had a guy, it’s called Gamba Athletics. He just reached out to me and he was like, “Hey, I’m going to send you a couple of these shirts.” I thought it was pretty funny. There was another one that was like “Be a muscle nerd” and like 4 = distance over time, like where some dude just jacked on the front, it was pretty funny.
Dr. Sebastian Gonzales: I swore a T-shirt that would sell really well was Up, Down, Up, Down, Left, Right, Left, Right, A, B, Select, Start.
Dr. Aaron Horschig: I like that.
Dr. Sebastian Gonzales: Something that is like from a certain era, it’s nostalgic and that’s all you need, like an unsaid thing, yeah we’re the same age.
Dr. Aaron Horschig: Yeah, I saw one the other day and it said: You’ll know that you see a guy that’s between anywhere between the ages of maybe 30 and 38 if you yell into a big room Regulators and someone’s just going to go “Mount up”.
Dr. Sebastian Gonzales: That would be amazing, have you tried that yet?
Dr. Aaron Horschig: Probably in a bar a while ago, but it was definitely something we played all the time in college.
Dr. Sebastian Gonzales: I’m going to try that now. You just gave me a very annoying thing to do.
Dr. Aaron Horschig: Some kids are going to be like What’s that guy doing? Like you\\\\\\\'re too young and won\\\\\\\'t understand.
Dr. Sebastian Gonzales: I actually relistened to a lot of what we talked about, but I know where we stopped. You were talking about how when people write you scripts for ultrasounds.
Dr. Aaron Horschig: Oh yeah, man. I saw the ultrasound machine the other day and I really don\\\\\\\'t think I could turn it on and use it. I remember parameters a little bit. I don\\\\\\\'t know. I think some clinicians they go with the idea that if something is going to bring a patient benefit, even if it’s not backed up by research necessarily, sort of the anecdotal evidence, they’ll go with it. I don\\\\\\\'t know. I really don\\\\\\\'t think ultrasound is one of those things that has much evidence by it and even then it’s one of those things that a passive modality. I know that they have their place; I’m just very against using a lot of passive modalities.
Dr. Sebastian Gonzales: I’m down with you. I don\\\\\\\'t know if you can tell, but I just hit record and we didn\\\\\\\'t say anything offensive, so I will keep it if you\\\\\\\'re good with that.
Dr. Aaron Horschig: Yeah, I’m good with that, definitely.
Dr. Sebastian Gonzales: I guess to everyone who is listening, I screwed up on time zones last time and we had 30 minutes and then we had to stop and this is a week later. He’s got a new T-shirt on and I’m wearing the same one. We both have a coffee refill.
I wanted to ask you about femoroacetabular impingement ... In the chiropractic profession, the schools (I think) do not really address it, and I feel like most people that have some type of pinching in the hip, they tend to go the route of tight hip flexors or some type of stretching technique. So what’s your thought on FAI?
Dr. Aaron Horschig: Definitely so. I think you have to look at FAI in a couple of different aspects. First we have to understand is there an anatomical sort of bias towards having that early impingement just because of the way your body was formed? I think if you have femoral or acetabular retroversion, you\\\\\\\'re going to have a lot more coverage on the front side of the hip. So you\\\\\\\'re going to have that early inclination of hip impingement if you try to squat with that ideal squat stance that so many coaches try to teach, which is that foot that is relatively straightforward, which I think most people should be able to do. BUT if you have femoral or acetabular retroversion, which for all the listeners out there, if you don\\\\\\\'t know how to test for that you will do a Craig’s test, (easy way to do it), but if you have that different type of anatomy that’s outside of that normal textbook, it leads to an early inclination of having that impingement, so that’s one thing to understand straight off the bat is if you have anatomy that’s going to set you up for having an impingement, sometimes just changing your squat stance can be enough to decrease that impingement and take it away.
The next thing we have to understand is the joint capsule. In my research and my experience in treating FAI, I find a lot of people may develop stiffness in different portions of the capsule, particularly the posterior and lateral fibers of the joint capsule. I think the joint capsule can sustain stretches and forces just like our muscles can and can adapt positively or negatively to those and sometimes we find the posterior and lateral capsule fibers when they become stiff are going to lead to that ball of the hip socket and moving a little bit forward and smashing into the front side of the hip joint (early impingement). So we can do different things like banded joint mobilizations to improve the mobility of those. I always love to do a test and retest on those because if you\\\\\\\'re doing a banded joint mobilization either you\\\\\\\'re doing it as a clinician to the patient or the patient is doing it to themselves as you have taught them how to do, so you always need to test after. If you don\\\\\\\'t find any difference, you\\\\\\\'re not doing the right thing for your body or the restriction that you have and you\\\\\\\'re just wasting your time, so that’s another thing.
I think a lot of early clinicians or athletes will see a cool exercise and they’ll go “Oh! I’m gonna try that,” and they do it and it’s not right for their body and they\\\\\\\'re just doing it to do it and it’s not being effective or efficient for their body. So that’s another thing; you’ll always need to test and retest as the most simple method to find out if a corrective exercise is right for your body.
I was talking with Greg Nuckols, who is a really great exercise scientist as far as the ability to understand impuritization and he said something, “There’s research backed and then there’s me searched backed” and I love the idea because just as impuritization with training, one training style may not work for everyone, but it may work for you. The same sort of goes for corrective exercises, particularly at the hip joint because while a lateral joint mobilization may not work for some people, it may be what your body needs to be able to improve the mobility and get over that impingement. So I always like doing that “me search” I guess you could say and play around with it.
Dr. Sebastian Gonzales: I just started listening to that one actually, that was your latest release right?
Dr. Aaron Horschig: Yes it was. Most of my podcasts are like 25-30 minutes long and it’s just me speaking, but I’ve done 2 now with guest interviews and they\\\\\\\'re like 130 minutes because we just keep on talking, so it’s very different, so if people like listening to longer ones, that’s an option.
Dr. Sebastian Gonzales: I have my own thoughts on interviewing versus solo, which do you like better?
Dr. Aaron Horschig: I think it is really where you want to take your program. I don\\\\\\\'t think there’s a right or wrong. I think there’s many really, really good podcasters out there who have just made a name for themselves just interviewing people and interjecting their thoughts here or there. Then there’s some people who just talk. I think you can go about either way and each one can have their upsides. With a lot of mine, I think 90% of them are just me talking. I guess if people didn\\\\\\\'t find the stuff I was talking about interesting they would just tune me out or didn\\\\\\\'t like the way I was talking or using very simplistic terms like “smashing into the front side of the hip capsule.” I know some of my PT professors out there are probably shaking their head the way I described that.
Dr. Sebastian Gonzales: You have, I think, like 105 5-star reviews, so someone likes it.
Dr. Aaron Horschig: Yeah, 100 people like it so far, I guess.
Dr. Sebastian Gonzales: Well, that’s only going to be like 2% of the listeners ever do reviews. Oh, question on with the FAI then, so you said there was adaptation of the lateral capsule or posterior capsule or whatever, what do you think they\\\\\\\'re adapting to?
Dr. Aaron Horschig: I think just the stresses you\\\\\\\'re placing on it throughout the day. It could be the way in which you are lifting. It could be the way the postures you assume throughout your day. I’m sure the seated postures we may have (this is obviously just an assumption) that when you\\\\\\\'re sitting down throughout the day, obviously the forces from the chair that’s pushing up on your body are shifting you forward, which may then adaptively change your posterior capsule fibers to not be in that stretched out position. I don\\\\\\\'t know ... just different things throughout the day.
I guess we could think about it like this too ... just like muscles would adapt to a very straight line way of training, we see very certain types of injuries in track athletes, especially sprinters. All they do is run straight. They don\\\\\\\'t do any lateral work, sometimes. So in that same sense, you\\\\\\\'re having adaptations to the way in which your body is handling stresses throughout the day. I’m sure the same thing can happen to our capsule fibers just like it would our muscles.
So just in my own anecdotal experience training ...
Dr. Sebastian Gonzales: Me search?
Dr. Aaron Horschig: My own me search ... I know that I myself on patients you know we found some great changes when we did do hip joint mobilizations. In going with that also, I think there’s another factor people don\\\\\\\'t realize ... I think you can have stability and strength imbalances around the hip, particularly the glute medius in how the body is then moving as far as the hip mechanics. The glute medius, despite what people have been taught often in medical, PT, or chiropractic schools, the glute medius is not one stiff muscle. There are 3 portions of the glute medius and the posterior fibers of the glute medius have a very important job of centralizing the femur in the hip socket as you\\\\\\\'re going through motion. It’s sort of almost you can compare the glute medius to some of the rotator cuff muscles in the way that it’s main job is to create dynamic stability for the joint during movement.
So if you have an imbalance in the way the glute medius is either firing or if it’s just plain weak, I think you can get early ... I guess we’ll use some scientific words ... they’ll be some early anterior translation of the femur in the socket during hip flexion, so you\\\\\\\'re going to get an early forward movement of the femur in the hip socket as you\\\\\\\'re going into a deep squat.
Different exercises like side planks, side plank clam shells, hip airplanes which is a great exercise. I think Dr. Stuart McGill, the renowned back expert, has shared many times where you\\\\\\\'re dynamically moving in training your glutes to kick on at the right time to provide sufficient stability for the joint and can be great.
I know personally with my own experience, I had a hip impingement that I was working through a couple of months ago and I was trying the traditional things like banded joint mobilizations. There’s a few stretches people like to do that they say hit more of the posterior fibers, I think it’s probably more in the muscles because you need a lot of force to be able to hit the posterior capsule versus the muscle. I was not getting much change with changing up my stance or anything like that. It wasn\\\\\\\'t until I really focused on trying to fire my right glutes that I found there was an imbalance in the way I was coordinating. After going about that phase, that was where I was able to find a really true resolution in my issues.
Dr. Sebastian Gonzales: Actually a couple of things you said there made me think of something. First is that McGill likes suitcase, farmer’s carry, loaded carry, and so on, and we just walk, but obviously, we can do asymmetrical squats and so on, but I kept thinking about ... I have this speaker down the hallway in my office that is obviously off to the side, but if it were on top, maybe I could just put it in the middle and navigate it while I’m doing like a rack carry or something like that. I don\\\\\\\'t know if there’s a use for anything, but I’ve never had it.
Dr. Aaron Horschig: There’s different things you can change up and get different effects from.
Dr. Sebastian Gonzales: Just another thought too and I have done this with quite a few people recently, they’ve been lumbar spine cases, and so I will come in and compress them manually together at the pelvis just to support them and they\\\\\\\'re like “Oh, it all goes away,” so I’m considering the possibility of just like you know when you do a hundred bicep curls and walk out of the gym bent-armed and stuff and can\\\\\\\'t move?
Dr. Aaron Horschig: Yeah.
Dr. Sebastian Gonzales: So can you just do that to that to the glute med and glute max and just everything crossing those hip or SI joints and get them to at least have a change in tone for a little bit of time to make these people’s patterns resolve?
Dr. Aaron Horschig: Yeah ... I mean I think there is definitely the issue of instability at joints, particularly the SI joint and low back. Often we find that certain joints have a propensity or tendency to become unstable and when they\\\\\\\'re unstable, their body is not handling forces correctly, which leads to subsequent stiffness and then pain.
So a lot of times we see the stiffness and see the feelings they\\\\\\\'re having ... the pain, and we try to stretch or create more mobility in an area through manipulation, stretches, or what-not, when often sometimes you just need to create the underlying ability to stabilize certain areas.
I think it’s sort of the joint-by-joint approach. Obviously it’s very simplistic in its nature, but the low back is something that often needs more stability; the hips are something that often needs more mobility. Now obviously, the hip is a crazy joint in that it also needs stability as well to be able to maintain coordination and movement pattern quality. I think when you do to a point to improve the coordination, firing, the strength of certain muscles and you\\\\\\\'re getting them to kick on and work as they should, obviously that brings them to coordination. Understanding coordination and stability is different than pure strength. That’s something a lot of people don\\\\\\\'t understand. Strength is just the ability of a muscle to produce force. How strong the muscle is we can test it, but stability is the ability to limit excessive motion.
So a muscle can be very strong, but not have a very good ability to stabilize. A muscle can be very weak and also not have the ability to stabilize, but we need to go about fixing the issue not by doing strength exercises, but by doing exercises that are going to work on improving stability. That’s why especially at the core, exercises like side plank or exercises where you\\\\\\\'re doing isometric contraction and moving over the type like a bird dog are so helpful at improving stability. There’s actually been research showing exercises that do that type of stability activation do leave that person with a sufficient amount of increased tone afterwards in those muscles. They are basically primed to maintain that minimal amount of stability and tone in their muscles, which is why I always give the recommendation (especially for someone who has had a history of instability in their back or dealing with back pain) to do those core stability exercises prior to them picking up the barbell because it’s going to prime your body to maintain that stability better throughout your workout.
Dr. Sebastian Gonzales: How long does the tone change last, do you know?
Dr. Aaron Horschig: I think it’s variable based on the person, but I think sometimes upwards of an hour.
Dr. Sebastian Gonzales: That’s good. I’m seeing pictures up there, where did you propose at?
Dr. Aaron Horschig: I proposed on the top of the building I was living at in Kansas City. It’s a 12-story building on the plaza, which is sort of our downtown, nicer area; it’s not like “downtown downtown” but there’s a nice shopping center area, restaurants, bars, and stuff, so I lived there for a couple of years. Yeah, got one on the rooftop and rented it out, a bunch of lights.
Dr. Sebastian Gonzales: How did you get the picture taken there?
Dr. Aaron Horschig: I actually hired one of my friend’s sister who is a professional photographer. I hired her to do a little behind-the-scenes photography.
Dr. Sebastian Gonzales: Was she strategically placed behind like a power box?
Dr. Aaron Horschig: Yes. She was hiding in the back and taking some photos.
Dr. Sebastian Gonzales: Is she controlling a drone at the same time or is that pre-drone era?
Dr. Aaron Horschig: Oh gosh, yeah, that’s pre-drone era. I’m sure there were drones out, but it was not accessible to get a drone for something like this.
Dr. Sebastian Gonzales: I saw I think it was a Perform Better years ago, Lee Burton (I don\\\\\\\'t know) but there was an hour-ish where he was saying there’s multiple ways to squat--you can squat feet out, one foot in, one foot back, one foot forward, and so on, I think it was called Squatology but it reminded me of basically variations of squatting or dynamics systems theory. Talk to me about variations of squatting and what’s okay and what’s not okay.
Dr. Aaron Horschig: Yeah, so obviously someone who participates in the sport of weightlifting and then a lot of my content is centered in weightlifting and CrossFit and powerlifting. Obviously the big exercises are back squat, front squat, overhead squat and those are the main lifts that I try to teach about and explain. I think once you have those main lifts out of the way, the idea and ability to have accessory lifts that get you out of the 2-feet down plane of motion always looking straightforward kind of thing, are great at helping clear up asymmetries that can occur in the different stress adaptations that your body can have that can lead to eventual injury.
I’m not huge on saying we’re going to do a lot of main training as a staggered stance or even the Bulgarian split squat is going to be our main lift for the day, or lunges are the main lift for the day. Obviously, because I think strength adaptation you get from a front squat, back squat, and overhead squat, those are your big lifts and those should be the priorities for your strength days for most of the athletes that I’m talking to.
In saying that, I think that the different types of stresses that your body has imposed on them with a Bulgarian split squat with a lateral lunger; things like that are going to get you out of that norm that you\\\\\\\'re so used to and exposes your body to such different types of stresses that it’s so important for long-term longevity in injury risk to decrease injury risk.
I know in my own personal training, I’m not also doing some single-leg squats after my main training, if I’m not doing lateral band walks, things to just stress my body differently than the way ... Think about it, in weightlifting, squats, jerks, pulls, cleans, snatches, you are in the same plane of motion so your body is going to adapt accordingly, so if you don\\\\\\\'t expose to body to especially lateral forces a lot, I think you can over train certain muscles and under train certain muscles. I think when you do it to such an extent that you can expose your body and almost open up weak links that can then invite an injury eventually to the picture.
Dr. Sebastian Gonzales: I’m actually kind of curious with there’s like certain phases of exercise or environmental change or what-not, where like 10 or 20 years later, you see this same injury and you\\\\\\\'re like “Why the hell are there so many back injuries?”
Like with the explosion of all the barbell lifts, I wonder what we’re going to see in about 10 years or so. Do you notice that everyone is doing stretches of different ranges and different planes of movement? Or is that just an anomaly right now?
Dr. Aaron Horschig: I think the big thing is when you\\\\\\\'re having the traditional barbell sports, you just have common patterns of injury. You know your back is often going to be a flexion intolerance type of injury because you\\\\\\\'re having so much weight on your back and often the easiest way for it to break down is rounding forward. You\\\\\\\'re going to have injuries to the knees that occur because of knee wobble, often side to side, or you\\\\\\\'re going to have patellar quad tendinopathy because of over training or that sudden time of “I’ve trained twice a week, but let’s try the Bulgarian method and start training 7 days a week,” and it’s like the patellar or quad tendinopathy is a very common injury.
You know the same sort of thing with upper and lower crossed syndromes; I think you\\\\\\\'re often going to see these similar patterns of injury development in the barbell sports because we do the same exercises day in and day out.
Now sports like CrossFit I think are exposing us to a little bit different or a little bit more variation because of the requirements of running, biking, rowing, and then gymnastics work and stuff like that, so it’s a little bit more of variety to the training compared to Olympic weightlifting and powerlifting. I mean Olympic weightlifting and powerlifters, it’s so common. You just get in the same mode of doing the same exercises and different variations of them over and over again, so I think you see a little bit more patterned injury rates of those sports.
Dr. Sebastian Gonzales: Interesting. I have listened to quite a few of your podcasts already and your content, and the joint-by-joint seems like a big thing for you right?
Dr. Aaron Horschig:Yeah, it is. It’s one of those things as an early clinician, it allowed me to take a step back from the way in which we’re taught in PT school and other medical schools; how to understand the body. So you see knee pain and you\\\\\\\'re looking at the knee and you\\\\\\\'re testing quad strength and you\\\\\\\'re looking at patellar mobility and we’re not even realizing that you need to test ankle mobility, closed chain ankle mobility. I don\\\\\\\'t need to have that person lie on a bed and get out a goniometer and go “Well, you got 5 degrees of open chain dorsiflexion.” That does not tell me how that person is squatting.
We need to understand how to take a step back and I always say some people view through the body through a microscope. With back pain, I want to treat the back and I’m either going to first get them up and say “show me a squat, I want to see how you\\\\\\\'re moving. I want to see your hip mobility.” Because it does not matter how much I fix your back pain, if I never addressed the immobile or unstable hips, that back is always going to break down in the future the next time you do what you were doing before and you\\\\\\\'re going to be in that same cycle of pain again.
So I think the joint-by-joint approach allowed me to take a step back and view the body and I call it the looking glass of movement. I’m going to look first at movement and then I’m going to see the connections of why someone say a pitcher will develop elbow pain, not because of something necessarily of the upper body, but because they\\\\\\\'re missing hip internal rotation onto their left side, so whenever they\\\\\\\'re going into their stride, they\\\\\\\'re unable to fully rotate forward and then they have to compensate by changing their arm pattern in the way in which they\\\\\\\'re moving, so just sort of understanding full-body mechanics.
I know some people have an issue with the joint-by-joint approach in that they think it’s gold in that it’s the only pattern that you think in. The way the joint-by-joint approach works so great is it just gets you out of your normal way in which you view the body. It pauses you to take a step back and view the entire body and from there, go with what you want as far as the different tests you want or find the different exercises that you think are right for that person to define, but it gets you out of your comfort zone and it gets you to take a look at the body in a different way.
Dr. Sebastian Gonzales: What do you thing ... napkin concept do you think ... if you had to develop one right now and change the whole course of therapy, you got anything?
Dr. Aaron Horschig: I don\\\\\\\'t know. I have had many occasions where we were sitting down over a couple of drinks and just jotting stuff down on napkins and things like that, but I say the big things that pop into my head are Thursday mornings where I’m sitting around just answering questions on direct message over on Instagram and just having a couple sips of coffee and then “poof” something will just pop into my head and I will go with it.
Dr. Sebastian Gonzales: You must get a lot of questions on there?
Dr. Aaron Horschig: Man, I’ll tell ya. I could spend hours and hours answering questions on Instagram and I love it because it’s like I’ve been put into a place where I can help others and why would I not try to do as much as I can?
When I first started Squat University back in 2015, I would do a simple thing and I would just say “Who needs help with their squat form? Direct message me.” The first day I got like 40 DMs. I sat there for hours and I messaged every single person back with “Hey, try this test. Alright, that looks good so try this. Alright, this looks awesome and this looks much better in your technique, good job, keep this up,” you know because you don\\\\\\\'t just DM them once. It’s a continual conversation and building a relationship.
Then I would do that a couple of more times and the next time I got 80, then next time I got 100, so on my days off from clinic work, I would sit there on my couch and I would message people for 4 hours straight, doing nothing but creating community and engaging with those who were following my stuff and trying to help people.
It’s gotten to the point where I probably get close to 100 DMs every single day just through Instagram and I try to respond to as many as possible, but it’s so tough. So what I will often do is try to respond to at least like 40 people every single day and try to continue conversations, but what I try to do also is I will use the different platforms and different shows that I have to take one person’s question that is so common and just create a big content series for it.
So if one person messages me and says “My low back is hurting when I’m squatting.” I watch them squat and their back is rounding, I am going to create a piece of content on that. Hey does your back hurt while squatting? Does your back round? Here’s something to try, so that I am able to continuously able to make new content that’s covering different questions so you basically have a never-ending supply of content that you can create, and it never gets stale. I’m never only going to be talking about one thing because I’m trying to continuously create content from those who are asking me for help.
I love jumping in and talking with so many people. I think some people get to the point where they\\\\\\\'re like “so and so reached out to me and they’ve got a million followers” and I’m loving helping out Joe who has 20 followers and does not even have an Instagram picture. It’s because when someone tells you “thank you” for helping me and getting me out of pain, helping me squat with better technique, it does not matter. It’s a great feeling and I love trying to help as many people as possible. When you come to a thing with that approach, things just grow like crazy.
Dr. Sebastian Gonzales: I’m just wondering if you have figured out how to post direct messages to Instagram without your phone, like doing it on a computer? Or like audio dictate it?
Dr. Aaron Horschig: The weird thing is that Instagram is only a mobile-first platform so you can\\\\\\\'t even get into your DMs through the computer.
Dr. Sebastian Gonzales: Man ... you must have nimble fingers right now.
Dr. Aaron Horschig: I’m like a 13-year-old girl in how fast I can type on my phone I guess.
Dr. Sebastian Gonzales: That’s going to be a good quote for this podcast.
Dr. Aaron Horschig: (Laughs) I remember back in the day where they had those phones with keyboards and they would have competitions to see how fast you could type and how many words per minute, so I’ve probably gotten up pretty close to that.
Dr. Sebastian Gonzales: Damn ... I remember they had that thing on Blackberry where it would start to kind of guess what you were going to say like TG5 or whatever was the program.
Dr. Aaron Horschig: That will pop up on Instagram and DM when you\\\\\\\'re typing, at least on my phone--I have an iPhone 8. It will guess different words sometimes what I’m trying to type, which helps sometimes, but sometimes it screws up.
Dr. Sebastian Gonzales: It just keeps trying to capitalize certain things or keep changing it to something I don\\\\\\\'t want to say and I got to go back 3 or 4 times to correct it. You could train your phone, I think, right?
Dr. Aaron Horschig: Actually I think there’s a program where you can go in and be like this is not a shortcut to this or something like that.
Dr. Sebastian Gonzales: Is there anything you have been considering making content-wise that you haven\\\\\\\'t yet that you\\\\\\\'re really excited about?
Dr. Aaron Horschig: I am in the process of writing my second book right now, so my first book The Squat Bible centered on how to fix technique, how to improve your squat, obviously the front part was back squat, front squat, overhead squat, high bar, low bar, what’s the basics of squat technique. Then it was how to break down your body through the joint-by-joint approach to find out if you had limited ankle mobility, here’s how you screen it and here’s how you fix it, and here’s some exercises. So that was the big part with The Squat Bible.
The second part I’m coming through now and writing a lot of content on is you have developed a normal ache and pain of training, you have developed a small injury, no weightlifter, powerlifter, CrossFitter, enthusiastic fitness person ever trains an entire year probably without having some kind of ache or pain in their body. The older you get, the more aches and pains you\\\\\\\'re going to have.
My big thing is the medical industry today unfortunately has gotten to the point where it is so over monetized and so checks and balances that someone who has hip pain either doesn\\\\\\\'t want to go their doctor because they know it’s going to be an $80 copay and their doctor doesn\\\\\\\'t understand weightlifting and is just going to tell them to stop lifting or give them a medication, or they’ll go to a bad physical therapist or bad chiropractor who is going to give them some short-term relief and not fix their underlying cause of what they\\\\\\\'re having, so they\\\\\\\'re frustrated and don\\\\\\\'t know what to do, so my goal with this next book is going to be like here’s what’s going on, here’s how to fix why that problem started so you can return to the stuff you love, so it’s coming from after common aches and pains have already occured, so here’s what you can do.
Dr. Sebastian Gonzales: Nice.
Dr. Aaron Horschig: So, sort of the follow-up to the original which was don\\\\\\\'t hurt yourself, start with good technique, fix your problems before they turn into an injury. The next one is here is the injury, what do you do? Obviously if things are not progressing, when do you need to go see a medical professional.
Dr. Sebastian Gonzales: What are you going to call it? The New Testament?
Dr. Aaron Horschig: (Laughs) Yeah, actually I haven\\\\\\\'t decided yet what it’s going to be called, but yeah, hopefully ... but I still have a couple more chapters to write but we’ll find out.
Dr. Sebastian Gonzales: How thick is The Squat Bible? Can you give me fingers?
Dr. Aaron Horschig: It’s not really thick, maybe not even an inch thick. It’s only 128 pages or something like that. The big thing I’ve heard a lot of people say as far as the reviews of it were “this is a ton of difficult information conveyed simplistically, straight to the point, no BS.” I didn\\\\\\\'t want to give you a 400-page book on how to fix your squat. I want to give you the most important information straight to the point, straight value-packed, fired content that can be practically so you could take away from it that you could read over a week.
I think sometimes, especially in the medical profession, we love to over complicate and give you a 10-page rant when I can easily give you a 1-page simplistic version of that which is going to be just as efficient but that much more practical in understanding for you.
I’m also not writing to the doctor that’s been out for 20 years. I’m writing to the CrossFitter, I’m writing to the fitness enthusiast, I’m writing to the weightlifter, I’m writing to the college kid who is going through exercise science and wants to figure out why they have hip pain, I’m writing to the 28-year-old dad who loves going to CrossFit and his shoulder is starting to hurt; those are the people that I love writing to because those are also the people who love to learn and say “thank you” for it. Whereas a lot of times, we get a lot of the medical professionals and they don\\\\\\\'t enjoy the way you\\\\\\\'re writing simplistically so they automatically tune you out.
Dr. Sebastian Gonzales: Right. Well, you got to write simplistically, like a 5th grade reading level, like your audience is not going to be medically based, so I think it’s perfect.
Dr. Aaron Horschig: Exactly. The thing too that I wanted to do with it is I also did a lot of research and citing my research in the book, so you can go through and each chapter has cited research for it. So if you are an exercise science nerd like myself, or you are a medical practitioner and you pick it up, you could go “Oh! That’s where he got that specific thing he’s talking about in here. It’s in this International Journal of Sports Physical Therapy or American Journal of Medicine article right here.” It’s still based in science. It’s just written in a way that everyone can understand.
Dr. Sebastian Gonzales: I imagine that each CrossFit should have like a library has the checkout section?
Dr. Aaron Horschig: Yeah. That was the big reason I wanted to write for everyone. I loved writing research. I wrote two articles that were published in the International Journal of Sports Physical Therapy and it was awesome getting it done and getting it published. I’m thinking like how many people actually read that? The only other people reading the International Journal of Sports Physical Therapy are nerd physical therapists like myself! Susie, a CrossFitter, Susie, that’s the Olympic weightlifter ... ISN’T reading that journal. So what am I doing to make a change in the world and help other people? The reason we all became medical practitioners is because we want to serve and help other people, so why am I writing necessarily to 10 people in the Journal of the Month Club, not that writing medical journals is not important because yes, you\\\\\\\'re still making a change in that medical community, hopefully.
I just feel like my strength in the way in which I know that I have been given the tools to take the difficult and often complicated medical research and take it and deliver it in a very simplistic way, I feel that’s a strength of mine, so why should I not try to follow that and write to those in effect to hundreds of thousands of people, which is my eventual goal you know to just create a better community out there.
Dr. Sebastian Gonzales: No, I agree. I mean I appreciate the researchers, but also too, there is definitely a good skill set of translational from Latin to common folk that you might as well do ... shit.
Dr. Aaron Horschig: That’s my goal.
Dr. Sebastian Gonzales: One of my friends told me, and I don\\\\\\\'t know where he pulled this number at, but he said “research takes about 10 years to get to the public,” and I’m like, “You got to be shittin’ me?” 10 years ...
Dr. Aaron Horschig: Yeah, it’s crazy. The thing is you take so much time to do the research. You have to sit down and then you have to find all the research that could possibly be related to your research, to create your introduction. I know a lot of researchers and they have like an article that has 80 sources. You know you have to explain how you got to your hypothesis based on where did all the research come in the past, how it all relates, and how your specific question is different than the rest, and it’s just so tedious. Then, you have worked hours, hours, and hours on this paper and send it off to 4 reviewers who sit behind a desk in their ivory tower and then they completely try to rip apart your paper and basically tell you your worthless in all you wrote that you poured your heart into. “This is crap and doesn\\\\\\\'t make sense” and “you better support that better because that doesn\\\\\\\'t make sense” and “have you even thought of this? Because you\\\\\\\'re not smart enough to think of that.” Anyone who has published research knows what I’m talking about. The reviewers tear you apart, as they should, because the goal is to create the best product possible, but I’m just like you know what? I have much more fun spending a couple less hours creating amazing blog posts that has 10 resources because it’s based in science, based in practical application, and I’m just going to publish it for free on WordPress.com and guess what? You can understand, read it, share it with your friends, and if you don\\\\\\\'t like it? Whatever. But if you like it, share with your friends, leave a comment, let me interact with you. You can\\\\\\\'t do that with a published journal.
Dr. Sebastian Gonzales: Too, I read a shit ton of content and I feel like at least when you write your own and publish in WordPress then you can kind of be yourself. You don\\\\\\\'t have to be such a robot behind there you know?
Dr. Aaron Horschig: Yeah, and you can write in a way that people read and understand. If you pick up a journal article, it’s so boring sometimes. After I wrote The Squat Bible I tried to go back and write another article for a journal and halfway through, I was like, “this is dumb, boring,” so you have to write so differently. You can\\\\\\\'t write matter of fact in a journal article because you’ll get torn apart. It’s much more fun to write the way I do now.
Dr. Sebastian Gonzales: Where are you selling The Squat Bible at? Is on Amazon or only on your site?
Dr. Aaron Horschig: Oh no, it’s all over Amazon.com, all over the different world of Amazon, Amazon EU, Amazon.co.uk; it’s all over the world on Amazon sites. It’s obvious that you can find it through my website SquatUniversity.com and then I think I have seen a couple of links for Barnes & Noble books, but I don\\\\\\\'t know if it’s in any Barnes & Noble, but that would be kind of cool to go through and see one day.
I find that most people don\\\\\\\'t go to bookstores anymore; you go online for your books, so ...
Dr. Sebastian Gonzales: Did you use a publisher? Why did you go to hard copy actually?
Dr. Aaron Horschig: Great question. When I was writing my book, obviously most authors you usually try to go to a traditional publisher because that’s all you have known. Well it is very difficult to get your book published nowadays through a traditional publisher. There’s less and less money to be made in publishing hard copies of books and it’s very difficult, so you take your losses. I probably sent my book out to 10-13 different publishers and got denied, denied, denied. I won\\\\\\\'t mention their name. I had a number of publishers who deal primarily in exercise science-based books for the public. I said “You know I’ve got a fairly big audience,” because at the time it was like 90,000 to 100,000 followers on Instagram and she said, “Matter of fact, no one knows who you are and I don\\\\\\\'t think you can sell anything through Instagram.” It was one of those things where I was like ...
Dr. Sebastian Gonzales: I think I can probably guess who this is actually.
Dr. Aaron Horschig: So I was like here we go. Here’s the deal ... I’m so glad I didn\\\\\\\'t go through a traditional publisher because it’s a learning experience. Nowadays, it’s 2018, the gatekeeper that was standing behind the door and saying “Your material cannot get published. We hold the key to delivering public to the people.” Nowadays, anybody can publish a book.
Like 15 years ago if someone was self-published, people would be like, “Eeh, it’s a self-published book.” Nowadays, there’s amazing books that are self-published. Brent Bartholomew he’s the coach who wrote Conscious Coaching and his book is all over. He published through CreateSpace, which is the same website I publish through. The gatekeeper that limited the availability of books to people before is no longer there because of the internet.
I can go direct to consumer, which is I can build my community of people and I can say “Hey, here’s a book. This is a product I have created. Please buy my book.” I think it’s something almost like fuel to the fire when that person said that you can\\\\\\\'t sell anything through Instagram, and I’m like “I have to disagree with you. I have a much larger audience than every single one of your publishers put together because I’m going about doing things the right way.” So many people in the past and this has been the people out there who have been the role models for us as far as in the strengthening, conditioning, fitness, physical therapy, and chiropractic community in the past; they just put out information to then give and take it right back, and all they do is ask and sell, and sell, and sell.
I’m coming about it in a totally different way. I’m like, “You know what? I’m going to provide you straight content to help you and be of value to you.” I put that out there. I put out stuff for 2 years and then I said, “You know what? If you enjoyed the content that I have given out for the past 2 years for 100% free, if you would buy this book for 28 bucks it would mean the world to me. If you don\\\\\\\'t want to buy it ... that’s cool. I’ve written this book. It is a very simplistic and smashed together of all my content so far and it’s all available in 128 pages that can be very helpful to you. If you would buy that for 28 bucks it would mean a lot to me.” People spend $30+ on a caffeine and Kilo shirt to wear around. I mean it will bring you some value for a couple of months but eventually this shirt is going to wear out a little bit. This book is something that can stay on your shelf for a long time and bring you value in a way that it’s going to help fix your technique, decrease your aches and pains, help you reach true athletic potential and can share it with people.
Dr. Sebastian Gonzales: If your book comes with a flat-bill hat, I think it would increase sells.
Dr. Aaron Horschig: (Laughs) If it’s a snapback hat, it will really pop.
Dr. Sebastian Gonzales: I just spoke with Jen Esquer, Doc Jen Fit, and she has had great success with Instagram sales too.
Dr. Aaron Horschig: I think when you go about things the right way in building community and helping people, you\\\\\\\'re going to build an audience and they\\\\\\\'re not going to resent you or turned off when you ask them to buy something. I think too many people in the fitness and medical community, they just go in for the ask and they just try to sell you stuff. They try to sell you a product. They try to sell you this and that. They don\\\\\\\'t provide any value to you that’s going to draw you to want to follow that person.
When Kelly Starette, I guess who was the main kickstarter behind this type of concept in our community; the dude made a video, a helpful video every single day, his Mobility 365 video, every single day for 365 days, and then after that even continued to do a lot of free content.
After watching all that ... how much that helped me. When he came out with a book, I was like “Here’s my money. Take it!” Just because I knew how helpful it was to me, the least I could do was support him and buy a book from him.
I think if you\\\\\\\'re an up and coming person in the fitness community and strength conditioning or in the medical community, provide value FIRST, help others FIRST, and then if you have aspirations to write a book, you don\\\\\\\'t have to sell through a traditional publisher nowadays. It’s a lot of work to self-publish, especially with everything that goes along with it, BUT it’s a possibility.
Dr. Sebastian Gonzales: I definitely do agree with buy and support. Like there’s a couple of doctors around here, like my optometrist. She does not take insurance from me because my insurance is crap and I’m sure yours is too, which I understand that because I’m on the side that I don\\\\\\\'t take insurance either, so I just hand her cash and say, “Whatever your fees are, I will pay it.” It’s like keeping money in the family. If everyone follows you, and they like you, and you\\\\\\\'re part of their family and you give something back to them, like why not support them? Keep money in the family.
Dr. Aaron Horschig: Exactly ... 100% agree.
Dr. Sebastian Gonzales: So is there anything else you would like to cover that I missed?
Dr. Aaron Horschig: Man ... I don\\\\\\\'t know. We covered a lot of stuff in the past 2 weeks.
Dr. Sebastian Gonzales: I know, right? I swear to God the time zone thing, my mission is to stop the time zone from happening like last week. It drives me crazy.
Dr. Aaron Horschig: One day we’ll get there.
Dr. Sebastian Gonzales: I interviewed one guy in Arizona and I forgot Arizona does not have Daylight Savings time and it’s like commonology, and he’s like “Yeah, half the year we have the same time as you,” and I’m like, “Huh ... That makes sense.”
Dr. Aaron Horschig: The hardest thing is when you\\\\\\\'re talking to people overseas and their trying to figure out what time to Skype with you, and I’m like I will be up at 5 in the morning which means they’ll be awake at 8 o’clock at night, and I’m like this is going to be tough to figure out; I’m just waking up, they\\\\\\\'re just going to bed, or vice versa.”
Dr. Sebastian Gonzales: Right on. Thanks for being on. That was good. How can everyone reach you with all your handles, website, just so everyone knows all that.
Dr. Aaron Horschig: Yes, so all across social media @squatuniversity. My main website is www.squatuniversity.com but as far as Instagram, Twitter, Facebook, podcasts--it’s all @squatuniversity. Obviously I have my own person, Dr. Aaron Horschig, on Facebook, and I started my own personal page as well where people can watch and see more amazing content.
Dr. Sebastian Gonzales: And people can be treated by you in person?
Dr. Aaron Horschig: Yes, yes.
Dr. Sebastian Gonzales: Are you touchable?
Dr. Aaron Horschig: Yes (laughs) I’m a real person and touchable. If anyone wants to come through Kansas City, Missouri, I work at Boost Physical Therapy and Sports Performance. We have 6 or 7 locations now across the KC Metro area where we do both speed and agility, physical therapy, that’s a fun location.
Dr. Sebastian Gonzales: Right on. Well, thanks for being on.
Dr. Aaron Horschig: Thank you for having me on, it’s been an honor.
Okay, that was a good interview. Thank you so much Dr. Aaron for being on. You can find him in Kansas City if you need to go or you can go online and go to www.squatuniversity.com and he has ALL of his great content on there. He has a ton of stuff on Instagram obviously, but if you\\\\\\\'re looking to read and go a little bit more than just a small section, go to his website. As you heard, he has The Squat Bible too. I read quite a bit of his content and I think it’s really good. I can tell just by his intention that he really does want to help and he’s not trying to make a bunch of money off everybody and some crap, he’s trying to sell you good stuff that you need if you\\\\\\\'re going to be lifting and moving, and you should consider squatting well. I mean you listened to the whole podcast and you know what’s up.
If you are looking for the show notes on this, go to www.p2sportscare.com and type up Dr. Aaron Horschig or Aaron and he’s probably going to be one of the only Aaron’s I interview for a very long time, especially with the double A Aaron, and there is also going to be a link in your media player as well right here.
If you guys want to hear someone specific in the upcoming podcasts, please let me know. I would love to interview anyone you have as long as they have something useful to say. I don\\\\\\\'t always have something useful to say on the solo podcasts, but I got to fill some time.
Talk to you guys later. Leave people better than how you found them ... and date an Eagle Scout. Talk to ya later.
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