A Book Review/Case Study with Kelly Starrett’s Twelve Standards of Running Readiness
Dr. Kelly Starrett, DPT, is the founder of CrossFit San Francisco where he coaches and treats athletes of all abilities. Kelly also runs MobilityWOD, and is the author of Becoming a Supple Leopard, Ready to Run, and Deskbound.
Like the #FitNerdPhysio I am, I can’t resist anything that has to do with running, reading, or pseudo-scientific experimentation on myself. This past spring, as a sort of “I passed my NeuroAnatomy final and didn’t die” gift to myself, I bought Kelly Starrett’s Ready to Run, and decided to test it out on myself. In Ready to Run, Kelly outlines twelve “standards” – of both lifestyle and movement – that one should meet in order to reduce risk of running injury and increase performance. Studies show that up to 80% of runners have experienced injury at some point. Chances are, you’re one of them. I’m DEFINITELY one of them. Some people love KStar, some people think he’s full of $#!* (disclaimer I think he’s awesome). I say, what does an injured or injury-prone runner have to lose by at least trying this stuff out? Kelly is a Doctor of Physical therapy whose touched a LOT of lives. Running through pain hasn’t really done much to help me in the past…why NOT try this approach? I’m a runner….but am I ACTUALLY ready to run?
DISCLAIMER: I didn’t finish this experiment, and I was never actually ready to run because turns out I had a sizeable hole in my hip labrum. No amount of hip smashing is going to fix that. KStar has said it himself on multiple podcasts: “sometimes you just need surgery!”. But I did gain some insights into the effects of lifestyle and posture on pain and performance and I’m excited to continue the experiment once rehab is complete
Standard 1: Stand with Neutral Feet.
There are really two parts to this standard, one being “stand in a head-to-toe neutral position”, and the more important part being “STAND”. Throughout “Ready to Run”, Kelly hammers home the importance of standing, walking, MOVING more. Most of us sit a ton during the day; As a physical therapy student, I’m in class – sitting – up to 7 hours a day. I then go home and study. Save for my 2 hour workout, I’m actually pretty sedentary. I’m sure you’ve all heard the phrase “sitting is the new smoking”? I don’t quite agree with that, but there IS research to suggest that sedentary behavior is not doing us any favors. In fact, the American College of Sports Medicine identifies “sedentary lifestyle” as one of the main risk factors for cardiovascular disease. Physical inactivity has also been linked to increased blood lipids and poor blood glucose control. Not great for your overall health, it would seem, and there is research that suggests even a daily planned bout of exercise won’t counteract the effects of spending the other 23 hours of your day off your feet. There is absolutely more research that needs to be done on this front, but let me put it this way: there is ZERO research to suggest that standing and moving have detrimental effects on health (I spent like four hours on PubMed trying to find it). So, at the VERY least, evidence suggests that sitting is not fantastic, and non-exercise activity, at worst, has neutral effects. Might as well stand up, right?
Kelly says, “When you have a choice of whether to sit or stand [sometimes standing is not appropriate i.e on a dinner date at a fancy restaurant…], you should stand”. So, I tried it. I used the bar in my kitchen as a makeshift standing desk for all of my at-home study time. I started drinking my morning coffee standing up, and any meals that I ate at home by myself – standing. Whenever class was held in the room with high-low plinth tables, I made it a point to stand at one of them. Eventually I got to the point where the only real time I spent sitting was at dinner with my boyfriend, in classrooms without a standing option, and the hour before bed when I indulge in my favorite tv shows.
How did I feel?
First: THIS IS HARD. If you are not used to standing and moving all day, you are going to be sore – just as you would after doing large amounts of any activity that you’re unaccustomed to. I would recommend two things:
- Introduce standing gradually. If you have the luxury of a high countertop, or adjustable desk, try standing for an hour, then sitting for an hour. Back and forth. Maybe for one week you make the change of standing up to drink your morning coffee. The next week, add in an hour of work while standing. Progress gradually.
- Don’t just stand there….move around! Kelly makes this pretty clear in several podcast interviews as well as in his latest book Deskbound: Standing stationary for hours on end is not much better than sitting for hours on end. Prop your foot up. Shift your weight around. Take walk breaks. Give your body some movement variety
- If you must sit, due to either social pressures, workplace environment, or because your feet hurt, there are good and bad ways to sit. Kelly goes into detail about proper sitting technique in his newest book, Deskbound.
So, after I got past the initial soreness and fatigue…..how did I feel?
Actually kind of awesome. Here’s what I noticed about standing more:
1.More energy, better focus.
If I’m trying to study while reclining on my couch, I’m most likely going to either fall asleep or start browsing Facebook. I found that when I study while standing, I am more energetic, have sharper focus, and can more easily engage with whatever I’m working on. The one piece of research I found to back me up on this was a study from the American Thoracic Society suggesting increased performance on pulmonary function tests in standing postures versus sitting. Bear with me -it’s 100% related, I promise. The author postulated that this was likely due to increased inspiratory volumes in standing. Makes sense, right? It’s a lot harder to breathe when you’re hunched over your laptops. You can try this yourself right now. Once you’ve experienced that, the connection between standing and productivity makes a little more sense – Greater inspiratory volumes = greater oxygen perfusion = more oxygen to your brain = FOCUS FOX!
I’m going to keep this professional, but my fellow runners out there know exactly why I like to have a cup of coffee prior to my workout. This process happens much more quickly when I drink my coffee standing, shifting my weight, and walking. Movement has been shown to improve gut motility. I can take this a step further and say that gut motility, physical activity, and colon cancer risk have all shown to be related. And I’ll leave it at that.
2.Less joint pain.
Over one month of trying to stand up whenever possible, I actually noticed…..less hip pain during my workouts. Can I say that standing alone was the fix? Of course not – not only was I experiment with several of Kelly’s other standards, I was also getting regular physical therapy. Like I said earlier, this is no more than pseudo-science. But at the very least, I can say that standing up more, and standing in neutral (feet, pelvis, and chest) – aka engaging my gluteals, core, and intrinsic foot musculature more often throughout the day – had no detrimental effects on my hip symptoms.
BUT I think this had more than just a null effect – I really do think I benefited from standing more, and here’s why:
I noticed that once I got back in the classroom for summer semester and started sitting for up to 3-4 hours a day, my hips became more painful, both in sitting and during workouts. Yes, I had a labral tear, but I think this goes to show how much of an impact POSITIONING, POSTURE, and MOVEMENT can have on your pain, regardless of medical diagnosis or structural pathology!
This is a good place to talk a little more about the actual first standard of Ready to Run:
“Stand with neutral feet”
Yep. When I first read it I was definitely thinking “um…like how else are you supposed to stand? Why is this a thing?” But then I tried it, and realized that no, actually, my typical standing posture is NOT neutral! I had never noticed before,, but my legs tend to rest in external rotation much of the time. Why? Maybe this feels “natural” to me after almost 18 years of dancing ballet. Maybe my external rotators are tight or hypertonic. Maybe internal rotation causes that characteristic “pinching” symptom of impingement (clinicians often use the FADIR – Flexion ADduction, Internal Rotation test for Femoroacetabular Impingement for a reason!), and so external rotation is my body’s avoidance mechanism. Maybe all of the above!
Whatever the reason, standing with neutral alignment was very difficult for me. Add to that the fact that Kelly’s standard involves not just your feet, but your entire spine. He takes you through a bracing protocol that involves contracting your glutes and drawing your belly button in; basically, a posterior pelvic tilt. This is the same bracing technique that my physical therapist used to teach me how to deadlift. According to Kelly, the “bracing” sequence, by putting your body into a neutral alignment from head to toe, makes it easier to recruit your posterior chain musculature, which is exactly what you need to do to run well! FURTHER – it goes without saying that when you are seated, your glutes are pretty much asleep. The more time out of the day you spend with your body in neutral and your core and posterior chain activated, the easier it will be to keep it that way during your run. As Kelly says, it’s “building your training into your day”.
Overall, how did I feel? Again, pretty awesome! As Kelly says, this takes “constant vigilance”; it was about three weeks before I was standing in neutral alignment without thinking about it. But over time, I noticed less hip pain, both during running and over the course of the rest of my day. Running also felt physiologically easier. Posterior chain activation is something I’d been working on in physical therapy, but the bracing sequence was part of that as well; so while we can’t exactly separate the neutral spine from the posterior chain loading itself, I can definitely say that it had no ill effects.
I will also note that keeping a neutral hip/knee/foot alignment has also been helpful for me while on crutches. My right leg is currently doing all the work for me, and with all the pivoting and hopping that goes on, it’s easy to lose neutral. I’m finding that being more mindful of my foot alignment is helping my right hip cope with the load in a less painful fashion.
Stay tuned! Part 2 is coming soon, talking about Kelly’s second standard: running shoes, footstrike, injury, and a whole lot of research.
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