June 15, 2013
[00:00] Introduction/Kelly Starrett
[05:05] How Kelly Got into This
[12:32] Movement Dysfunction
[21:01] Stabilizing Your Spine While Standing
[34:21] Shin Splints
[42:14] Super Tight Hips
[46:49] Chronic Sacroiliac Joint Mobility
[54:04] End of Podcast
Ben: Hey, folks. It's Ben Greenfield, and I'm holding a book in my hands right now. It's a big, heavy book. It's called, amazingly, “Becoming a Supple Leopard”. If you're a regular podcast listener or you follow the Facebook page, you've probably heard me mention this before as one of the books that I'm recommending for this year. It's a book about mobility. Technically, the byline is “The Ultimate Guide to Resolving Pain, Preventing Injury, and Optimizing Athletic Performance”. And this book is like a cookbook for fixing problems in your body. It rocks. It's two written by Dr. Kelly Starrett. He's a coach, he's a physical therapist, he's the genius mastermind behind a website called mobilitywod.com. And among other things, he's actually right here on the call with us today. Kelly, what's up?
Kelly: Hey. How's it going, man?
Ben: It's going well. I'm very excited to get you on to talk about this book. I just mentioned to you that over at the Ben Greenfield Facebook page, I let people know that I was going to be interviewing you in a couple hours and asked them if they had any nagging aches or pains, or mobility issues that they wanted to ask you about and got like, looks like over 50 responses now. So, obviously, this is a topic near and dear to people's heart.
Kelly: Well, I'll tell you, I mean I think you just nailed it on the intro that one hand is that this book is literally the Betty Crocker cookbook. I mean, we need a reference. It's our right as humans to be able to perform the basic maintenance on ourselves. We have been told forever, “Okay, you got to exercise. Check. Got it. I got it. Eat better. Check. Got it.” And then we're like, “Okay. Now the exercises come along. We're all squatting, we're all deadlifting, we're all swinging kettlebells. Got it.” But the problem is, still, we still need a template to reconcile all the old athletic injuries we had, all the compromises we made before we got religion, the fact that I travel. I have a Y chromosome last time I checked. That makes me stiff. If I sit, I fly, I'm going to be compromised. And then guess what? It turns out that if you're exposing yourself to four ranges of motion and the motor control to do that, which is what every good strength and conditioning system is now.
Whether you're following Ido Portal, or Erwan Le Corre , or you're a Crossfitter like I am, at some point, we're going to ask you to be able to put your arms over your head and adopt all the shapes that need to be there, and if you don't have that range, working harder in that failed range or incomplete range is the reason why you're janked up in the first place. That's why your shoulder hurts. So, what we've got to do, and to the point that people are raising their hands and saying, “Hey, I've got a problem,” that's the common is that I am imperfect in my humanship because I sit, and I move imperfectly, and I wasn't gymnastics ballet Olympic lifter as a child. I came to it late in life after I learned to heel strike. I'm the guy who used to have knee pain running. I could sprint. But when I was doing that crazy ass heel striking uphill, I had horrible knee pain. It took me 18 months to learn how to run again. We are skilled, skilled animals. This is the recipe book to it sort of resolve the mechanics and make sure that you understand how those mechanics influence your positions so that you can become skilled again.
Ben: Yeah. And you had me at Betty Crocker. Do you actually wear a red sweater and the hair up in a bun kind of…
Kelly: That's actually all I'm wearing right now. It's funny you mention it.
Ben: Just curious. For you, Kelly, I've spent a lot of time in physical therapist offices and kind of doing the whole rigamarole with, whatever, standing on air pillows, and getting ultrasound, and all that jazz, but how'd you come to develop…
Kelly: Was that clockwise ultrasound or counterclockwise ultrasound? ‘Cause it matters.
Ben: I don't remember. I just remember lots of gel, lots of fun gels smeared all over the place. So, how'd you develop your unique flavor of physical therapy and what it is you do with mobilitywod.com and with kind of the tools that you put in this book? I mean, you don't see stuff like Voodoo flossing, and lacrosse balls, and rubbing your backside against a barbell as typical things that physical therapists are talking about. How'd you kind of come into this?
Kelly: Here's the first thing we should all get out there: I am never operating on assumption that people are making bad decisions. People are working at the limits of their understanding. We are in an epoch right now where we have gymnasts talking to powerlifters, talking to Olympic lifters, talking to, everyone's in the same room. And because we're living in a time where people are sharing information so readily, we're starting able to connect the dots more effectively. It's not an accident that, I've known Robb Wolf for 10 years. It's not an accident now that I'm good friends with, these things happen. So, all of the best practices are sort of bubbling up, and then we have this podcast and way to talk about it. And so, what ended up happening is that I used to be a professional athlete, and I paddled, so, my hand went numb, and got the cortisone, and then went to the PT, and stretched my neck, and still had a weakness in my hand, and couldn't turn my neck, and I stopping racing. And when I looked around, I was like, “That was the common.” I did everything. I trained twice a day, 300 days a year. And then of course, what a disaster I was. I mean, it was obvious that I made that problem myself.
I had this epiphany. I was like, “I need to go to a good manual therapy school.” Physio school, my school was one of the best in the country. It's an Australian approach to thinking about musculoskeletal problems. The problem is is that the training there is all still based on understanding the pathology even though we say it doesn't. “It's movement, dah-dah-dah. The treatments are based on movement.” But no one is actually teaching movement. They actually didn't teach us to squat and deadlift in school. And what I really had was this dissociation between all of this advanced pathology, very, very technical biomechanics, heavy duty anatomy and physi, and then, all of a sudden, this is not how Olympians train. This is not how the best tactical athletes in the world train. There's some disconnect. And when I started, I remember that moment where I literally was working in a brilliant sports orthopedic clinic, I just read Louie's book, and I was like, “Oh, I wonder if I could box squat more effectively these guys with miniscus transplants. That would minimize shear.” And I was like, “Oh.” I started to make associations. And then this guy came in and he was an MMA fighter, pretty good MMA fighter, and we we're treating him for his shoulder. And all of a sudden, I was like, he was talking about his guard, and I was like, “You know, I have this technique called hip quadrant.” And I was like, “Let me just whip this on you.” And I whipped on his hip quadrant, like I used the mobilization for non-painful tissue, used immobilization for an asymptomatic, he was functional, he was a high level professional MMA guy, and all of a sudden improved his position with this mobilization.
And I remember being like, “Ho-lee hell.” And now I started going after the problems because they weren't full. I could see where I suddenly was understanding and integrating, “Oh, I can see what problems Shirley Sahrmann was trying to solve, or the masters of [0:08:10] ______ , or what Cook is trying to see,” where you could start to see those problems, but they still weren't connecting them to the practices of the university strength and conditioning system, the university strength and conditioning model. Like at some point, we still have to squat heavy if you're going to play in the NFL. And when we hear things like, “Well, just don't lift more than 200 pounds over your head,” I'm like, “What's that based on?” So, at some point, what we see is the physios were figuring out, “Hey, look. We can get you asymptomatic, good. That means I've chased your pain away. Yes or no.” But as we all know, many of us are missing cardinal ranges of motion, we don't have any problems, there's no pain, I still may even have a gold medal. I may be the best in the world, but still not at my full athletic or human potential.
And so, when I started to sort flipping it on its head and then realizing also the tools that I was given to mobilize or send people home as a therapist, we're all like, it was like TheraBand and some air squats. And I was like, “Look. That's about creating the lowest level of neuromuscular connection again ever. That doesn't change the tissues.” Well, maybe you were taught to roll back and forth on a piece of foam roller, and I don't mean to be crass here, but have you ever tried foam rolling? It doesn't work at all. What a waste of your time. And the reason is you have the quads of an athlete, you have the quads of a runner, you're of the quads of an executive person who is trying to train hard and has to sit on an airplane, and we needed a set of tools that actually could change people's biomechanics, and that's when I started to translate to all my manual skills, everything that I felt like I could do to a person with my ninja manual therapy skills, I translated and invented and created the tools in the book. And that's why, “They're like, ‘What is this?' Well, this is me trying to be my own physio self.” I think there's, honestly, there's like two things you can't really do very well by yourself. And that's getting on your first cervical vertebra. It's really hard to do that by yourself. You can do it, but it's hard. And the second thing is to reach into your own butt and grab your coccyx and pop it out if you fall on it. Other than that…
Ben: I'm not even sure if that's legal in all 50 states.
Kelly: Right. Well, by yourself, it's not legal. But if you pay someone for it, it's professional. So, the issue is we should be able to do those things clearly seeing having a physio that you love for 10 years that's your bro, she deadlifts next to you, having a chiropractic position that you love to help you get ahead or act as a catalyst for your own change, that makes perfect sense. Because sometimes, your genius may be in nutrition, your genius may be in marketing, and you can't understand all the intricate nuances that I obsess about, you don't have to. You should have a basic working model of how your body functions and you should be able to solve this thing. ‘Cause what's happening is that we're literally, I see bright athletes who are like, “Hey, why do I have knee pain?” I'm like, “Oh. Any one of these 10 things,” it's like 10 elephants gathered in this tiny room with us, “do you think that's the problem?” Any one of these things can cause your problem. You've got 10. And so what the problem is that athletes haven't, we haven't empowered people to really figure out what's going on and then just give them basic templates. Are you moving correctly? Yes or no? And can you optimize that movement by proving your biomechanics?
Now, when you go in to see your physician and a.) you're not on fire and b.) you're like, “Hey. I think major hip capsule's tight. I know that my pectineus and medial chain's short. I'm having a hard time 'cause my hip is stiff 'cause I sit all day. And my right ankle's a little janked 'cause I sprained and it’s numbed. And what do you think the problem is?” And people are like, “Oh! Thank god!” And what's happening is that we're seeing an enlightened people, people who are really ready to take the mantle of responsibility on it for their own care and mechanics. And what's great is if I go after the performance, if I get people to obsess about the thing that matters, not your pain. I really don't give a crap about your pain 'cause your pain is going to correct yourself when you move better and when we get you focused on output, wattage, poundage, reps, time. That's the expression of function. And when those things go up, then, by the way, you're going to be safer, you're going to be mechanically more efficient, et cetera, et cetera. Two birds with one stone.
Ben: Yeah. Cool. I like it. You talk in the book about what causes 2% of movement dysfunction versus what causes 98% of movement dysfunction. Can you talk about that a little bit?
Kelly: Yeah! So, when I started to think about, like “what are the things that I'm seeing in my clinic”, what are the things I'm seeing in my gym”, 'cause I'm a user. I mean I still am the strength and conditioning guy. I just PR-ed on my clean this morning. This is what we're doing, is that if I take catastrophe, I was working with our friend, Jenny LaBaw, this weekend. She was riding her bike, got hit by an urban camper on a bike. She broke her foot. You just can't, that happens. My guys parachute at night, downwind, break their ankle on a stump. You can't account for that. A big fat lion is going to roll into your knee once in a while. Check. So we take catastrophe, that's about 1%, and it’s five points a little higher, and then we take pathology. That's not back pain, that's a kidney infection. There's something going on with you. And this is why every single person, the revolution right now that's happening is that the strength coach and the training partner are the new model for the primary care provider in the world.
So, your training partner is the person who's screening you for movement dysfunction and sort of also is looking like, “Dude, you haven't slept much. Your nutrition is crap. I'm noticing you don't drink any water. Bro, this is a recipe for disaster.” And all my coaches can ask, “Night sweats, dizziness, fever, vomiting, nausea, unaccounted for weight loss, weight gain, changes in your bladder or bowel function, that's pathological.” So when something is going on, and let me give you a case. Down south, one our friends, one of my wife's really good friends, their mom lived with her, was taking care, and she had this back pain that no one could get a hold of. And I was like, “Hey, guys. You've taken a crack at it? Guess what? She needs to go to the hospital.” Because most of it's musculoskeletal. But if it's not and it's throbbing all night long, you kick in, and guess what? She had bone tumors from cancer in her spine. And we were able to catch that because these people are aware that this doesn't look and smell like gamut of pain. Something's up. You're losing some weight and something's going on, and we're not trying to lose weight. So, those are the two categories. Catastrophe pathology. Once we account for that, that…
Ben: And that's like the 2% that you say?
Kelly: That's the 2%. And it's rare, but I have literally diagnosed as far as a person can diagnose who's not licensed to diagnose. On the phone, three cases of Lyme disease. “Hey. You know what? Sounds like something that's sketchy going on.” And it turned out to be Lyme disease. We can do that. “What's going on? Oh, you're not sleeping?” “Oh, I am sleeping.” “Oh, your nutrition's good.” So, we take that off. Then when I really put the other two big categories in that 98%, one is what I just call “over tension”. And you can do this little test. Bring your hand to your face. Is there any resistance as you bring your hand to your face? No! Can you imagine how weird it would be if there was resistance in your elbows if you brought your right hands to your face? Well, it turns out people have freakish amounts of resistance in their hips, in their ankles, in their internal rotation, they just don't know it. And so, this first kind of big category of problem is like what I call “over tension”. The system is just too stiff. Your quads get stiff. And when your rectus femoris gets stiff, guess what? It doesn't stretch. Why? It's beef jerky! And so the only way we're going to change that is to crush up that beef jerky to get it sliding again. Right? That's why we do so much mashing and this side-to-side rolling as we try to undo this kind of beef jerky tissues.
The second piece now is to understand that if I am running with my handbrake on, I will work out the solutions to movement because, remember, the brain exists to move the organism through the environment. That's the only reason you have a nervous system. And you're set up for survival. So, your body, and the case in point for this is kids with damaged motor control systems have a diagnosis of cerebral palsy. That's what it means. They're totally cognitively intact, they just have a part of their brain that's damaged that caused them to have decreased motor control. But those kids can walk just fine. What do they do? The foot is collapsed, the foot is turned out. Knee is valgus, hanging on that LCL, ACL. Hip is impinged, ankle destroyed, back overextended. Boom. That's classic cerebral palsy gait, comma, this kid's walked fine. Until what? They wear out their hip, wear out their knee. So, you're designed to keep going. The problem is that we've sort of kind of fallen into this category of, “Okay, you're getting the job done and it doesn't hurt. It must be right.” Versus, “What's the physiology of a human being,” which, by the way, is not debatable. We know what the stable position for the shoulder is. Period. We know what the stable position for the ankle is. Period.
And so, when you're moving around your stiffness problems or you just don't have the control because you're walking like a duck, why? ‘Cause always walk like a duck and didn't know, then one of those issues, that's what I call the open circuit. And it's the open circuit, 'cause the body works best in a way to contraction from trunk to periphery, from core to [0:17:41] ______. There's not a person on the earth who probably disputes that now. That's the definition of functional movement. But what often happens is that I don't generate these positions of stability before I generate positions of force. I generate positions of force from these unstable positions. So, instead of closing the circuit down and then being bad ass, what ends up happening is the circuit is sort of left open and floppy, and then my body is left to find sort of this secondary stability, which is kind of that douchebag shoulder, that shoulders forward, or knee coming in. Those are the positions that people, “Oh, I know what that is! That's how I tore my labrum of my hip.” “That's how I tore my ACL.” “That's how I blew off my Achilles.” “Oh! No wonder I'm…” Okay. So, when we land in those large area forces or receive forces in those bad positions in the open circuit, that's where we see a lot of catastrophic injury like torn labrum, destroyed rotator cuff, herniated discs, et cetera, et cetera.
Ben: Right, right. Douchebag shoulder being a medical term, right?
Kelly: it's a technical term. It's a technical term for douchey-ness in a shoulder. A douchey quality. And it's hard, I'm telling you. What people don't realize is that most of what's happened now is that we're sitting a lot, which is just type one error, can't sit. You've got to be able to lean. Like right now, I'm on like an Ikea platform and I have a stool next to me. And I can lean, and stand, and put my foot up, change direction. But the sitting forces you to round. We don't load the actual skeleton in these rounded positions, and yet we do all the time. So, if you're flexed and then the shoulders come forward, and then guess what? Practice doesn't make perfect, practice makes permanent. And your body starts to adapt to that. So, now I've got adaptively short in those positions. I'm texting in this broken head position, my thoracic spine's rounded. I can't do that and, “By the way, you're still a great athlete.” We get that. But what you're doing is your shoulders are working in the optimal position, so, you're leaving in performance on the table. And that's really where this goes.
What people don't understand is that exercise is sort of the exaggerated reality of posture. Right? That's why we kind of take these basic shapes and then we exaggerate them under load, high respiratory demand and metabolic demand. You test the robustness of your sort of fundamental organizational skills as a human. And one of those organizational skills is this hang archetype. So, if you've ever done any cleans or internal rotation for a snatch, that's basically the same position you'd be in in standing. But all of a sudden, you just default to this internally rotated collapsed mass, and then we're really surprised why your shoulders hurt.
Ben: Got it. And for folks listening in, we're going to take this to the trenches here in a second, and I want to address some of the issues you wrote into the Facebook page about. But before we do that, there's other thing that I wanted to ask you about, Kelly, and that's this whole concept of bracing and spinal stabilization. And the reason I want to ask you this in particular is because we get a lot of people who are doing things now like moving to standing work stations and trying to spend more time on their feet because they've heard that it's metabolically favorable, et cetera. But I personally see a lot of crappy posture in people who are maintaining those positions, and I want to hear from you about this whole concept about bracing. Like what could people do when they're standing there to stabilize their spine, and breathe properly, and all that?
Kelly: The real bottom line here is that, you just nailed it. So, people are working at the limits of their understanding. They're like, “Oh. Stand up? Got it?” But then I'm like, “Dude, my back aches. I feel like crap when I stand.” And we're like, “By the way, standing's another skill, no one taught you how to stand correctly.” In yoga, they call it tadasana. And I don't know if you speak Sanskrit and how that relates to my cleaning position, but I don't. I'm not a Skrit-head. What the problem is, we solve these problems for as long as there have been people. I mean that's really the bottom line. I'll use the example of Musashi. He wrote “The Book of the Five Rings”. He's the famous Japanese swordsman who pioneered fighting with two swords. And in his book, “The Book of the Five Rings”, he says, “Your combat stance is your everyday stance.” So, when you break that down, what we're really saying is that a deadlift setup at the top, where I'm in that zombie position or like I'm standing top like when I've just swung the kettlebell, that position where my feet are straight, I'm creating a little bit of torque, I'm screwing my feet into the ground, my butt is squeezed, rib cage organized, head it neutral, that's the same position as me standing. It's just an exaggerated position 'cause I'm under load.
So, he said, “Between where your short sword goes, your belly needs to be firm.” And what happens is it's one of those open circuits where, “Hey. If I am not conscious or I haven't learned to be a gymnast and have my trunk totally organized. I haven't figured out how to create this right tension.” The Japanese call it “hara”. And you're like, “Hara? What does that mean? How do I deadlift out of hara? I don't get it.” The problem is we've used this kind of precious language about this bracing transversus abdominis. It's just crap. This is how the spine is stable, and there are three mechanisms for stabilizing your spine. The first is you've got to have your feet straight underneath your lungs. So, feet are straight. And you can test this, why we like the foot straight when you run and jump and land is that if you're feet are turned out, then your hip function turns of, and what's happened is we've negated one of the mechanisms for stabilizing your spine.
So, before we even talk about breathing or any of that, it's important to understand that when your body's in a bad position, it just functionally doesn't work very well. I call it positional inhibition. In a bad position, poof, you're inhibited. Right? If you're in a good position, things turn on. When you're in a bad position, things turn off. So, if you're dumpy with your pelvis and that anterior pelvic tilt people kind of understand now, guess what? Your lower abs don't work very well. Your abdominal musculature is just in a crappy position. You can test this for yourself. Dump your pelvis, try to flex your abs. Now squeeze your butt and make your abs tight. You're like, “Oh, my abs turned on. They got stronger.” No. They got to a better position and they work more functionally. So, feet straight is the first piece.
Second, if you squeeze your butt, your pelvis is probably going to organize itself into a straight down position. Now, don't get me wrong. You don't walk around squeezing your butt like 10 out of 10 all day long. But notice that if you squeeze your butt and your pelvis changed position, you are cruising around in a bad position. You were standing in a disorganized, overextended lower spine position. So, what's nice about this is that I don't have to worry about you over squeezing or over tilting because your butt is your butt. It's designed by God over evolutionary terms for you in two and a half million years. And so, if you squeeze your butt, your pelvis comes into a good position, now you can take a big breath in your belly and exhale and try to pull your belly button to your sphincter. You should be able to draw and stiffen. We're not hollowing, we're not sucking, we're not vacuuming. We're trying to create stiffness in the trunk. That stiffness is the second piece. So, your butt set the position of your hips and it sets the lumbar relationship and I can make my abs come on, 'cause I can't get my abs on into a better position unless my pelvis is in a good position.
And then the third thing, so I'm not just kind of balanced over these hip bones, is that I screw my feet into the ground a little bit. And what you'll see is that most people have been told, “Weight on your heels! Weight on your heels! Weight on your heels!” So, they actually weight their heels all the time. And if your weight is on your heels all the time and not centered over your feet, or you've been standing like a duck all the time and your weight is not balanced over the center of your feet, which is right in front of, your center of mass is right in front of your malleolus, right in your ankle bone, is that only can you really center your feet if your feet are straight. And so, now, I can screw my feet into the ground a little bit, I create a little bit of torque. This torque at the hip capsule makes the pelvis stable. I don't have to do everything with my butt. Now I can use the passive winding of my legs. And remember, you're designed to do this. This is why you don't have any hinge joints in your body. They're all rotary hinge joints. For example, if you lay on your back, what do your feet do? They flop out to the side, right?
Ben: Right, right.
Kelly: Well, I have talked to more people who are like, “Hey. Can you fix that?” I'm like, “You don't want me to fix that.” Because when your feet fall out to the side, what you're really doing is you're unwinding the tension in the fascia, in the connective tissue of your legs. When your feet are straight, there's already this passive torque, passive winding up of the connective tissue that makes the system stable passively. That's one of the reasons why you've got to stand with your feet straight, 'cause it automatically makes this whole chain system more stable. So, now, you're organized. Right? So, I've got my feet straight, I've got my butt squeezed 20%, I've got my abs on a little bit, kind of two out of 10 is my moniker. You've got to have your abs on just a little bit.
Now the question is how much stiffness do I need to maintain that position. So, I'm doing standing meditation, that's great. But if I'm fighting against my own tight structures, I'm going to have to work a little bit harder. So, if my hip is short and I end up defaulting to that overextended position again, well, chances are I'm going to have to work a little bit harder. As I become efficient, stabilizing is a really easy background. Now, what's great is that, think about this: your body is designed to have a single motor pattern predominantly for everything that you do. It's really, really simple. It's really efficient. And imagine that if this motor pattern of standing is basically the same motor pattern as a deadlifting setup. The difference is when I deadlift, I'm going to be 10 out of 10 stiff. Or when I'm on top of my squat, I'm going to be 10 out of 10. But standing, two out of 10. So, all I have to do is figure out through skill how much stiffness, i.e. how much butt squeeze, how much belly tightness, how much torque I have to create to be able to maintain this position.
And the problem is that we don't teach anyone this scale model. We say, “Oh. If you're a runner, just do some air squats.” Even our kids, even my children learned to deadlift. Why are they learning to deadlift? I have to introduce a little load, and I'm talking about 15 or 20 pounds, so they can figure out how to create torque and stability against that load so that they can have that understanding of movement fluency in standing, and walking, and running, which is why we put all of our endurance athletes under load and why boot camp is incomplete thinking because the problem with boot camp is that there are not enough loads. Even Erwan Le Corre of MovNat is saying, “Hey! You got to learn to pick up this rock!” And why? By lifting the rock or lifting the log, it teaches them skilled movement principles that I can then scale up and down.
So, if I'm just standing, one of the nice things is that, “Boy, standing meditation's brutal. I'm designed to move, so my next position is my best position.” So, as soon as I stand there and put my foot up on something, like at a bar, and I'm not saying that the listeners of this podcast have never went drinking before, but chances, they have, and they've probably noticed that there's a bar at the bottom of the bar. Right? Someone figured out that if you put your foot up on there, you took a lot of the extension load out of your back. “Ohhh!” And that meant that you were able to stand. And I'll tell you what, everyone can do this test in real time. All I want you to do is go for a run, do some kettlebell swings, and then do some pullups. Those are three pretty extension-driven movements. Immediately after, go to the bar and stand there, and see how cold the beer is and see how beautiful the people are.
And what you're going to find is that your back is going to be a little bit tight and you're not going to want to stand there. Then walk over, put your foot up, which takes that load out of your nervous system, takes that extension load out. Instantaneously, your beer will be colder and everyone will be more beautiful. And what you're seeing is we've reduced some of the load, and shear, and work you have to do, you can stand in a more effective position. So, if you're constantly applying the same set of principles to every single movement, every toothbrush, every sort of thing, that becomes the default background movement, pretty soon, you don't ever have to think about being in a good position. You're just there. And so what we've done is that we've people these stand-up desks, we've given people all of these expensive tools, but we still haven't shown them how their body works. And so, what ends up happening is, once again, we're like, “Oh. Put this belt on. Here's this insole for your shoe. Let's dumb it down.” You know why the elliptical is popular? Because your hip never goes into extension. It's basically a little scale model of you being bent over on the desk. You just never have to extend your hip. Brilliant! No skill.
Ben: Have you ever used one of those outdoor elliptical trainers, like the ElliptiGO? You seen those before?
Kelly: I have seen them, and I have no comment.
Ben: Alright. We won't touch that one. I go back forth to the grocery store on that thing.
Kelly: Well, here's the deal. What we've done for everyone is to say, “Hey, you need exercise.” Which is fundamentally correct, right? For cardioprotective reasons, to make yourself insulin sensitive, all the reasons that you need to do some cardiovascular anaerobic, aerobic training. Right? Comma, what I'm saying is that there's a skill in that too. Why? Because running is the most dangerous sport in the world. The injury rates on runners so high. It's the most difficult skill that we teach. I'm a huge fan, so your elliptical, kick machine, right? That ElliptiGO is honestly no different than me being on my mountain bike. The difference is that I'm in my mountain bike, my back is protected. I don't have to think. I'm sitting, and I got my arms locked on the thing. It's easy on my joints. It gives me another actually good stimulus for cardiorespiratory capacity, but it's not skilled. I'm not saying being a biker isn't skilled. I mean, the pedal stroke is very technical. But it allows me to go out and breathed very, very hard, very, very little thinking about my mechanics.
And the problem is we have sort of adopted that as the wholesale. It's like, “Hey. I'm exercising, I'm breathing really hard, but why did I still have knee pain?” Well, I didn't expose myself to these full ranges of motion, and I didn't have to have the motor control through that. And at least on the elliptical, let's be honest, you're standing up. You know what I mean? There's a whole bunch of reasons why that makes total sense. But at the bottom line, if you coupled that with also deadlifting and running, you're probably okay.
Ben: Yeah. And no, I completely agree with you. That's one of the reasons, like I'm a triathlete and I've always said that it's a mindless sport because I'm used to ball sports. I played water polo, and I was a collegiate tennis player, and played basketball. And compared to any of those sports, I don't think triathlon is a skill sport. It's an exercise sport.
Kelly: It is an exercise sport. And I'll tell you though, we are fast to poo-poo the triathlons. ‘Cause we're like, “Oh, anyone could do it.” Dude, one, swimming is fundamental skill. Can you swim well? Yes or no? And if you can't, you're a lie. If you're a weightlifter and you suck assuming, you are not a full human being. Everyone should be able to blaze a brutal 5K or 10K. Cold, off the couch, blaze it. That's a fundamental skill. And I'll tell you, cycling, big aerobic piece. I am a Tour de France fan. I work with all these cyclists. We love it. In fact, right now, I'm riding the Leadville 100 Mountain Bike Ride. This is what I'm training for.
Ben: Oh, really? Nice.
Kelly: And my point is I'm like, “Look. You can still have this big aerobic base background. In fact, what we're seeing more and more in sports like Crossfit is that people are realizing, “Hey, I've got to go back to this aerobic pace. I've got to spend some more time developing that third-wave adaptation so that I can come back in to work hard.” And I think people are quick to poo-poo some of that stuff, but I'm like, “Oh, yeah? Well then, just go ahead and run. Show up and show me how skilled you are. You swing kettlebells and you're all doing your Turkish get-ups, but you run like crap. And you're slow.”
Ben: Right. Yeah. So, I want to jump into the trenches here and go after some of the common things that tend to creep up and kind of hear how the cookbook approach in your book, this whole motor control fix, mobilization, just everything that you talk about kind of works when it comes down to just digging into this stuff. So, can I throw a few things that you?
Kelly: Hit me.
Ben: Alright. So, Brian Hanson. He commented, and he used, I believe, six possibly, seven exclamation points. So, we'll start with his. He says, “Shin splints,” and then a big string of exclamation marks. Kelly, go.
Kelly: Here's the problem. The fundamental problem is that running is a skill. And when we typically see shin splints, if he's talking about the anterior shin splint kind, the front, that's a function of heel strike. It only exists in people who heel strike. What I'll tell you is that heel striking is not running. Heel striking is an artifact of shoes. Don't get me wrong. You can run correctly in combat boots. There's either running or not running. But one of the things that we've done for years with people is we've systematically shortened the heel cords. You were born to have your heel on the ground, you're born to be flat, but what we've done is we've slowly canted up. The shoes I'm wearing I have a three mill drop. I love these Reebok Nanos for training, but they still have a three mill differential. And what we're seeing is that people are cruising around one centimeter, one-and-a-half centimeter differential toe-to-heel. They're missing the ankle range of motion, the ankle doesn't have full function. And here's my test: can you get into the bottom position of a pistol, yes or no, without collapsing your ankle? And if that's too difficult for you, squat down butt to ankle with your feet together. If you can't do that, chances are you're missing ankle range of motion and the tissues are stiff.
So, we have this technique that I'm, don't have full range of motion in my heel cords. Why? ‘Cause I'm still. I work around. I'm not climbing trees and squatting all the time. This is why the 10-minute squat test is the first Mobility WOD episode. Can you just take a poo in the woods? Can you go have dinner in Thailand? Can you squat? I mean this is this fundamental archetypal shape. And feet together is one of the things you should be able to do. So, what we see is that people, this guy has a big aerobic engine, he's a monster, and I'm 230 pounds. I mean, if I run poorly, I get immediate feedback. Yet, I ran an Ultra not too long ago, and the idea here is that you have to full range of motion your tissues, you also have to be skilled. And when you go run barefoot, you stop heel striking immediately. And I'm not advocating for barefoot running, and I'm certainly not even advocating for you that you go get a minimalist shoe, except that the shoes we should be wearing all the time should be as flat as possible. And then as you become a more skilled runner, we can start to bring you back down. So, that will get you away from this heel strike, which is just putting a brake on and we can see an impulse force that's of upwards of six times bodyweight through that shin. So, it's amazing that I'm asking my foot to decelerate at 230-pound times six, you can see the math, 330 steps in 400 meters, bam! I run a 5K, and the loading on that is insane. And so, no wonder that blows up the tissue. It's a fundamental kind of problem.
Now, the second issue of that is if he is running in this midfoot striking, and we're making the assumption that his technique is good. Well, then what we're also seeing is that people again don't have the foot strength, or the foot capacity, or the ankle range of motion to be able to do that. And what ends up happening is that they blow up the posterior shin, posterior tip from the inside, and it cooks them. And one of the problems is that people have taken their heel striking capacity, which is considerable, like they can go blaze a 10K, and all of a sudden, they take that big aerobic engine and they put it on these very baby tissues that are working in bad positions and barely holding on, and they just destroy their feet. So, we've got to habituate. And that's why I advocate for walking around barefoot as much as you can. And when that's socially unacceptable, put the minimalist shoe on to make your feet work, start to cultivate your foot position, start to work on the soft tissues of your feet, let's restore the arches, let's give you your full range of motion back in your hips, your anterior hip and your ankles. And guess what? That goes away. It literally does. I mean, you just will never have shin pain ever again.
Ben: Was it you or your website where I saw the recommendation to work on foot mobility with golf balls?
Kelly: We probably use the golf balls and we also love this lacrosse ball. I don't think people realize how stiff their feet are because of the footwear choices were making and the fact that you basically, many of us go out and hammer, and then we sit down, and we stand, and our feet just kind of pool. The feet get stiff. And then we're wearing all these ridiculously soft shoes with arch supports. You know what happens when you, one, is that the arches are not a weight-bearing surface. It's an arch. And have you ever seen an arch in architecture that has a post in the middle of it? No, it's arch. Right? And the arch is designed to be a structure that supports itself. As soon as I put something there, your body stops actively creating support there. You just hinge on the arch. So, now you start to lose it, you stretch your feet out.
We need you to have really, really strong feet. It takes a kid, what, two or three years to start to develop an arch in their foot from just building the intrinsics. No kid heel strikes before the first grade. I even watched this in my own kid. I'm like, “Wow, these kids run beautifully.” And then all of a sudden, like midway through the first grade, kids come back from Christmas and they all start heel striking. We're like, “What the heck?” They're this kids asking for heel strike for Christmas or something. What's happened is they start sitting and they started shortening their heel cords, and they worked it out. The body is the miracle, I'm just like, “Alright. Your hips are short, your ankles are short. They'll start heel striking.” The shoes kind of allow that to happen. It's a disaster.
Ben: Yeah. It's kind of crazy how so many people who experience shin splints, or shoulder pain, or knee pain, whatever, they go after that specific area where they experience the pain, like running an iced dixie cup up and down the front of the leg and stuff, when what you're saying is look at your feet. And I think that it defies logic for a lot of people to go away from the body part that hurts and start there.
Kelly: Where the rat, it's right. I mean, you just nailed it. I mean, where the rats get in is not where they chew. That's a fundamental truth. The other thing is that, I think it was Ida Rolf. The Rolfer, structural integration genius, she was like, “Hey, where you think it is? It ain't.” That's one of the kind of fundamental maxims is that we force people, and this is part of the language of the book is saying, “Hey, look. I know you're having shin splints and it hurts there. You've got to resolve that soft tissue injury there. We can compress it, we can make sure that it's less stiff, but we've got to figure out why.” And what we do in physical therapy, they have this radical concept, they're like, “You clear joints and mechanics upstream and downstream of it.” If you have knee pain, the knee isn't fully normal until you have full ankle function. The knee isn't fully normal until you have full hip function. No one ever does that. No one ever actually restores full function in the hip and the ankle. They just have enough function.
Remember, physio is about being functional. It's about getting you out of injury. If you thought that your insurance is going to pay for you to have full capacity and motor control to your tissues, that's what coaching is. Our job in physical therapy in the acute stuff is to get you functional and pain free. Functional means that you can wipe your butt, do you bra, brush your teeth. Optimal means that you are a fully skilled human being, and that's going to take some work. And that's part of what we've got to do is give people a mindset that, “Hey. Look, you're not a piece of meat. This is a fine mechanical machine that requires daily maintenance.” The motto of the book is that you're going to have to take 10 or 15 minutes a day to do some basic work on that. That's non-negotiable. If you don't have 10 minutes a day to work on your hips or your tight feet, you don't deserve to be a human.
Ben: You got time for a couple more quick ones?
Kelly: Oh, yeah. Hit me!
Ben: Okay. Cool. So, Lizzie, and Lizzie's concern is repeated a few times by other people, so I'm going to pick this one. Lizzie says, “Super tight hips where it is tears-to-my-eyes painful to do trigger point therapy on them, like the top of the IT band, et cetera.”
Kelly: Absolutely. And what we are seeing is a lot of trigger points therapy things are really good fine like scalpel. It's like me doing a very, very little piece, and what people, I'm limited by my capacity to take kind of point discrimination pressure, it's very sensitive. People should understand that tissues are normal when they don't hurt. So, you should be able to push on any tissue in your body with pretty extreme prejudice and it shouldn't hurt. And if it hurts, what you're discovering is localized tension around that point. So, tissues are normal. I tell people that they should pain-free and they shouldn't feel stiff. And we teach our athletes what stiffness feels like. Because not to do that is to say, “Hey, by the way, I know you have all this tissue, but you're not allowed to touch yourself.” That's ridiculous.
So, when she gets on there, what she may need is a much broader force. So, we get bigger shear through the tissues. So, that's why we have my Supernova that we have on Rogue Fitness, for example, is a much bigger ball that creates a larger shear forces, sort of disperses some of the pressure. Gives us some of the kind of the benefits of the grip and shear, but by dispersing that. So, that's one aspect. The second aspect, and it may be my own personal bias, but what we know is that why are those tissues stiff in the first place. Well, they may be stiff because you're moving poorly. So, as soon as you start moving more effectively, that stiffness can change. Imagine the definition of madness is that I run like crap, I'm slightly overextended, my hips are tight, I push on something, it hurts, and then run like crap again. Like why is that hurting in the first place?
The second aspect is that I tend to go after the joint capsule first. So, what we know from the research and from the theory out there is that the joint capsules can account for upwards of 50% of the joint range restriction. And that's why we do so much distraction on Mobility WOD and why we use the lacrosse balls, and the Gemini, the new thoracic tool that we have, and why we use all of these bands try to create changes in the joint capsules. Because once I restore the joint capsule function, oftentimes, I don't have to beat up the tissue as much. What ends up happening is that people can go after all the soft tissue, but if you're still missing 50% of your hip function 'cause your hip capsule's tight, that's why that tissue soft. So, know that if you draw your elbow up to your face, like 90 degrees, so your arm was parallel to the ground, and if you kept it there with your arms straight up to the sky and kept it there for eight hours, can you imagine how that system would get? Well, that's you sitting in a chair while flying to the east coast, to the west coast with your hip. I mean, you've got brutally short. Now aggregate that time 10 or 12 hours a day, because you sit at work, you sit at the car, you sit at the table, and then just sort of extrapolate that over 20 or 30 years. You can imagine how stiff those things get. That's why we've got to spend enough time. And look, the hip is the most powerful primary engine of the body.
And so, it's not an accident that we spend a lot of time working on the hip function because it's the chief driver of locomotion and the chief driver of athletic function. So, if your hip function is down, we see this all the time. The head for the USCPT department was like, “Hey, look. Everyone's going after back pain, but no one's looking at their hips.” You're like, “No wonder you're getting so much back dysfunction.” It's like they hip the wagging the dog, tail's wagging the dog. And so, when you're missing hip extension, your leg can't go behind you 'cause your hip is short in the front, it drags your pelvis into overextension, and there's your low back pain. So, we've got to take a systems approach, which is what we do in the book. Are you moving correctly? That's the motor control system. Are you going after the joint capsule? That's joint capsule system. Are you going after the soft tissue? The sliding surface system. And then finally, it's the muscle dynamics. So, if we start taking the systems approach and not just going after sliding surfaces or trigger points, then we start to see a much better outcome because we're treating the body as a systems, as it is. It's a system of systems.
Ben: Cool. Got it. Alright. Let's squeeze one more in. Brock, who actually happens to be the sidekick to the Ben Greenfield Fitness Podcast. It looks like he wrote in, and he, I coach him, so I already know this, but we're going to ask anyway. “Chronic sacroiliac joint mobility issues. If I let up doing my hip routine like lunging hip flexor stretches, bridges, et cetera for even a couple of weeks, it flares up again.”
Kelly: You bet. So, let's break that down. So, he's got pain in his SI region. That's what we can say. We don't know what it is, but he's feeling something in that SI range. So, the key for thinking, let's look at the things that mitigate it. If he spends a lot of time opening the hip in extension, then he opens up the anterior structures of the hip, which includes the rectus femoris, includes the adductors, and the psoas, and the iliacus. So, all the kind of big hip movers in flexion, when he lunges, those things open. When he does the bridges, what's happened is he's reclaiming or forcing his glutes to work a little bit. So, one of the things we know is that when you're short in the anterior hip, or you're stuck flexed a little bit, your but doesn't turn off. I personally never do bridging with my athletes. We don't bridge. I don't have any of my athletes bridge. I think bridging is, for me, is largely a waste of time. Why? Because I go after the problem in the first place, and the problem in the first place is that your anterior hip is tight. And if I open up the structures of the front of your hip, then your butt turns on.
So, what we're seeing is that when athletes are short in the anterior hip, then that causes a gapping or shear force at the SI. And so, what Brock has figured out is that by opening up the front of the hip and reclaiming glute function, which I should be getting, what, 'cause I'm squatting, because I'm deadlifting, because I'm just doing kettlebells. That's how we reclaim glute function and actually resolve soft tissue biomechanical dysfunction, and then I remove the shear of the SI. And what ends up happening otherwise is that those subtle structures inside the pelvis, the psoas touching the spines and inside of the leg, rectus femoris and iliacus, those are the three big drivers, plus the QL in the back, those systems cause me to overextend. That overextension causes a lot of shearing of that SI, and that's the driver for pain. So, when people say, “Hey, I have SI pain,” my first go-to is, “Alright. We're going to smash your quads, specifically your rectus femoris.” We get on a ball and we gut smash you 'til you soften your psoas, get in the iliacus, smash the QL, all of this is on our website. And then, boom, what we see is that that SI pain goes away.
Ben: Yeah. Nice.
Kelly: Once and for all. People don't understand. ‘Cause once you get in that cycle, man, you've got back pain and then your abs turn off, you don't want to generate any force. It's a disaster.
Ben: Right. I like it. And folks, if you're listening in, this is the way the book's written. You just flip to the chapter where your issue is and Kelly lays it out for you. Obviously, this is an audio medium. If you're a picture person, that's where this book comes in quite handy.
Kelly: If you're a picture person, picture me right now like Betty Crocker [0:49:36] ______.
Ben: Betty Crocker with no pants.
Kelly: That's right.
Ben: Alright. As this podcast becomes explicit, in the explicit category. Last thing. You don't talk about food a lot in the book, you don't talk about supplement strategies, things that have to do with connective tissue, stuff like that. I realize you probably had limited time in the actual book itself. But do you ever work with your clients on stuff like that? I mean, do you ever look at their diets, what might be affecting connective tissue, things of that nature?
Kelly: Hundred percent. I mean, if were starting bad materials, it's a disaster. So, one of the biggest things you can do for your health and well-being of your joints is be hydrated. The articular surfaces of all your joints are comprised mainly of water. In fact, when you take glucosamine, the proposed mechanism of glucosamine, which is a salt, is that salt goes into articular surface, it pulls more water in there, and it's fluffier. So, whether you're talking about tissue health, articular cartilage deformations, resistance capacity, whether you have got to be eating a diet rich that minimizes inflammation. You've got to be, you probably don't need to be eating a lot of gluten, honestly. I like [0:50:49] ______ . He's like, “Look. If you're a good athlete and you're eating all your macronutrients, you could probably have a cookie once in a while. It's not going to kill. That's probably honestly not going to kill you. Don't be ridiculous.” But you can't walk around inflamed all the time.
And so, when you guys are more sensitive to milk than other people, you really can't make, and I call that an adaptation error. I take the fish oil, I love the Bulletproof Exec MCT oil stuff, I take a big beefy kind of food-based multivitamin everyday, multivitamins. There's a kind of handful of things like that. The bottom line is one of the things we advocate strongly for is blood testing. You got to go get tested. You got to have someone fractionate your cholesterol and really look in because your blood is really how we measure lifestyle and nutrition. We look seriously at the sleep patterns because we know that if you get one bad night's sleep, you're 30% immunocompromised the next day, your fasting blood glucose will be elevated for the next 24, 48 hours. I mean, you can test that yourself. When I fly back from the east coast teaching, my best blood glucose will be 95, 98. I'm like, “I look pre-diabetic.” Why? Because I didn't sleep very much. So, we absolutely have to have those conversations. But people are just doing that space so well and there's so much good information out there that if you're, kind of our joking motto's like, “We want you to be a vegan without soy.” Soy-free vegan plus grass-fed meat. You can't enough vegetable and you can't pack down enough high-quality proteins, and you get all your good fats in there. And then if you need to throw a cookie in once in a while or some coconut ice cream, boy, there's good options out there for us.
Ben: Cool. Alright. Well, we're running up against time. But folks, if you want to learn how you two can crush your quads like beef jerky, then grab the book. It's called “The Supple Leopard“. I'll put a link to it in the show notes. Check out Kelly's website too, mobilitywod.com. Lots of good stuff on there. he's definitely one of the guys that I follow when it comes to respecting what he puts out, and especially when it comes to fixing stuff that goes wrong in your body. He's a good guy to follow. So, add him to your radar, grab his book. Kelly, thanks for coming on the podcast today.
Kelly: Ah! My pleasure, man. I appreciate it, and happy hunting, you guys!
In today's interview with “Becoming A Supple Leopard” author Kelly Starrett, we discuss everything from fixing shin splints to addressing tight hips, and we cover every aspect of restoring mobility and getting rid of pain in your body.
If you have trouble moving the way you feel like you should move, get sore lots, or just feel like you have “old joints”, this episode is for you. Kelly dishes out tons of useful tips, including…
-What causes 2% of movement dysfunction vs. what causes 98% of movement dysfunction…
-Why bracing and spine stabilization is so important…
-The extreme importance of something called the “one joint rule”…
-How to figure out your personal “motor control fix” and “mobilization” protocol…
-How to crush the beef jerky in your quads…
-And much more…
If you enjoyed this episode, be sure to check out my article on “The 5 Essential Elements of An Endurance Training Program That Most Athletes Neglect – Part 3: Mobility“.