The 12-Standards of Ready to Run by Dr. Kelly Starrett (A Book Review)

Ready to Run

First things first, if you have any interest in running/movement/playing sports – go read this book! My goal is to summarize the “12 Standards” Dr. Kelly lays out for people in order to prove to themselves that they are “Ready to Run” –  without a high risk of injury that is!  I believe this standardization should be applied to all athletes that need to navigate their bodies through a course, field, or court. Think distance runner, sprinter, soccer, rugby, football, basketball, lacrosse, baseball, or tennis player.  More than just runners will benefit from this book, but it’s the running motion that links all of those athletes together!

It’s an easy read, much smoother than Becoming a Supple Leopard. Less jargon is used which makes it quite accessible for the medical-terminology challenged.  Concepts are explained in enough detail that the reader can start testing, making changes, and re-testing right away. Pictures are plentiful, which always helps!  The anecdotes are compelling and the “no-nonsense” tone is motivating – it makes you want to get off your ass and make some necessary changes in your life!  Take my synopsis for what it is – if you want more knitty-gritty details, then go read the book and start watching some videos on how to pass the standards.

The following are the “12 Standards” Dr. Kelly presents.

1) Neutral Feet
2) Flat Shoes
3) A Supple Thoracic Spine
4) Efficient Squatting Technique
5) Hip Flexion
6) Hip Extension
7) Ankle Range of Motion
8) Warming Up/Cooling Down
9) Compression Socks
10) No Hotspots
11) Hydration
12) Jumping/Landing

Let’s briefly go over each one.  I add some of my own insight to the general principles he lays out in the book, too.

1) Neutral Feet
feet pic

The goal of standing, walking, and running should be to maintain a neutral foot position. This not only includes avoiding hyperpronation and hypersupination, but also avoiding pigeon feet (internal rotation) and duck feet (externally rotation).  Asymmetrical positioning with one foot straight and the other ducked way out into external rotation is a common standing positional error that leads to upstream mechanical faults.  Ground reactive forces don’t get absorbed well in the non-neutral side, and before you know it the knees, hips, and low back are achy.

Common medical practice to correct a positional error is with orthotics.  Realize that when you put a rigid support under your foot you are not creating a system that helps itself over time – you are making it dependent on that support.  Have you ever sprained or broken your ankle?  If you ever wore a cast and then ankle wraps or got taped up with white athletic tape from the trainer then you have seen the aftermath or what rigid supports do to your joints in the ankle/foot.  Rigid supports make them weak and atrophy.  If you want a higher arch then you need to work on activating your intrinsic foot muscles.  The “Janda Short Foot” is the go-to move.

Practice standing, walking, and running with neutral feet.  Practice people watching in public places – see who walks/runs neutral and who has a movement fault.  If you can spot the error in others than you will be more cognizant of your own movements.

Organizing neutral feet is easier if you are in a braced, “midline stable (MLS)” position, as well.  The simple four step activation process to achieve neutral spine position (good posture) is the following:

1)  Engage your glutes (pelvis rotates posteriorly)
2)  Engage your abs (ribs rotate downward)
3)  Move your shoulders back and down (palms should be touching the side of your          legs with thumbs pointing forward)
4)  Tuck you chin backwards (like a turtle retracting its head back into the shell or                double-chin)

2) Flat Shoes

Traditional running shoes have an elevated heel.  They are essentially “high heels” for runners.  No one would be caught dead running in their fancy stilettos unless their ankles had a death-wish.  Even a small elevation change of 20mm between the forefoot and heel can enable poor mechanics to happen.  If you tried to run barefoot you would not strike the ground with your heel.  With heel-cushioned running shoes you can without an immediate consequence.  Heel-striking increases the ground-reactive forces in your body since you are essentially braking with each step, which counteracts the momentum of you trying to propel your body forward!

Flat or “zero drop” shoes will not fix the problem immediately – in fact, they can cause different ailments like strains to the plantar fascia, Achilles, or calf.  Zero-drops will invite change to your mechanics.  Most notably you should lean forward to shift your center of gravity in front of your midline and begin striking the ground with your mid to fore-foot instead of your heel.

3) A Supple Thoracic Spine

Humans spend too much time with their arms in front them for daily tasks.  Computers, cell phones, writing, reading, exam/note-taking, driving, household chores, holding a baby, etc.  Your mid-back is repetitively being forced into the dreaded “hunch-back.”  To prevent yourself from being permanently stuck bent forward, mobilize your thoracic spine in both extension and rotation.  It’s simple, you just need to do it to counter-act all that time spent in t-spine flexion.

Optimal breathing mechanics involve a fully-expanded ribcage and lungs.  When you finish sprints where do you go to get the most oxygen – bent over looking at the ground or hands above head and an upright-posture?  Similarly, just compare the difference of position when throwing a ball.  Hunch forward and throw, then do one with a relaxed mid-line stable position and you be the judge of what is the optimal posture for movement.

4) Efficient Squatting Technique

Most people can’t squat well for two reasons:  mobility or stability limitations.

Mobility:  Ankle and thoracic spine
Stability:  Glutes, intrinsic foot muscles (neutral foot/arch)

You first need to watch yourself or have someone watch you squat to see if you’re making some of the common movement errors.

Squat Movement Errors:

1)  Valgus Knee (collapses medially – above picture on the left)
Correction: Glute activation drills. Create external rotation torque during squat

2)  Collapsed Arch (hyperpronaton of foot)
Correction: Janda Short Foot Exercise, neutral foot positioning, mobilize plantar fascia, ankle, calf)

3)  Excessive Forward Lean (Hips –> Spine angle not parallel to ankle –> knee angle
Correction: Mobilize thoracic-spine extension/rotation, learn how to breath when squatting

4)  Anterior Translation of the Knee (moves forward in front of toes)
Correction: Goblet or TRX squat to move center of gravity behind mid-line. Practice the hip-hinge and the Founder

Once you can squat well, you need to practice squatting more times well.  That is, you need to resist fatigue and poor form from creeping back into your mechanics as you get tired.  The goal is to do a Tabata set, 20 seconds on, 10 seconds rest, repeated for 4 straight minutes.  You need to attain 10 squats in each 20 second interval to pass the test. If you don’t achieve the standard on the first try, get practicing!

5) Hip Flexion

The picture above shows a 90 degree angle of hip flexion.  That is not the standard of range of motion.  You need to be able to balance on one leg with at least 120 degrees of hip flexion for 30 seconds on each leg to pass this standard.

Just because we spend an excessive amount of time sitting doesn’t mean we can attain MLS and stay balanced while expressing full hip range of motion.

If you fail the test then you need to practice it and also work on the posterior chain of the thigh and hip to free up that range of motion.  Target the glutes and hamstrings with foam rolling, mobility bands, and voodoo floss.

6) Hip Extension

Running is a linear motion that many get boxed into.  Despite lateral and backwards movement being available to people, we tend to train down the straight and narrow path. Compound that with the amount of time we spend seated in 90 degrees of flexion and you can see why we have a hip extension limitation epidemic.  The fix?  Limit your time spent sitting to as close to ZERO as possible and do the couch stretch – pictured above. Squeeze the glutes to reciprocally inhibit the hip flexors to get the deepest stretch to the hip flexors and all the gunk in the deep capsule.

7) Ankle Range of Motion

Ankle dorsiflexion (toes fly up to the sky) is often limited  because of the sheer abuse we put it through in steps/day (10K average).  Sports and working out add to that load, as does wearing shoes with an elevated heel pad for a lifetime.  And who hasn’t rolled an ankle before?  There’s a reason why the ankle inversion sprain is the most common sports-related injury – we do a poor job of maintaining ankle health, making it even more susceptible to traumatic injury from athletics.

To test if you have good enough ankle dorsiflexion you need to perform a pistol squat position.  You don’t need to do the full-on single leg squat, just the end shape.  So begin by touching your inner feet together heel to toe, then squat with both legs balancing your body weight, then at the bottom position stick one leg out straight at a 45 degree angle. The squatting leg will be loading the ankle to the max in dorsiflexion.  If your heel raises off the ground or your arch collapses then you do not pass the standard.

Correction:  posterior chain leg mobility (plantar fascia, Achilles, calf), Voodoo Floss ankle, and this ankle mobility band drill

Ankle Plantarflexion (toes plant down to the ground) is overworked in ballerinas from dancing on point and in those who have high standards of fashion and choose high-heels over zero-drops.  For everyone else plantarflexion is a position we rarely spend time stressing.  This standard will burn like crazy for those people.

To test your ankle plantarflexion simply point your toes down and sit on them, tall, elongated spine in a MLS posture.  Hang out for a few minutes – or as long as you can handle.  Increase that time over time.  If you don’t feel enough of a stretch then kick it up a notch and do what the above picture shows – lift yours knees and lean back with the hips still clamped down over the top of the ankle.  Still not enough?  Draw circles with your knee to scour all the nooks and crannies of the anterior ankle.

Correction:  Anterior leg mobility for anterior shins, quads, couch stretch

8) Warming Up/Cooling Down

People get injured when they try to do too much too soon.  Jumping into a run, game, or workout cold is a quick way to tweak a muscle.

The warm-up simply needs to involve non-linear movement in order to prepare your tissues for a 3-dimensional world of movement.  Think arm circles as opposed to punching straight jabs.  This principle applies to all major muscles/joints in your body. Jogging is a good start, but a dynamic stretch in all 3 planes (flexion/extension, lateral flexion, and rotation) will be a more complete awakener for your hips.  A good warm-up will elevate your heart-rate, begin to make you sweat, take your joints through multiple planes of motion, heat your body temperature, and prime your nervous system for explosive or endurance movements, whichever you need.

KStar recommends that you warm-up for a time inversely proportional to the time spent doing your activity/competition.  For example, a sprinter running the 100m should warm-up much more than a marathoner.   The more power and energy expenditure required for the activity, the more “warm” you should be to be ready for it.

Cooling down is similar to the warm-up in tasks performed but opposite in its goals.  You want to slow your heart rate down, help propel metabolic waste products through the lymphatic system, and release tension to overused tissues torched during the activity.  If static stretching were ever recommended, it would be during the cool-down.

9) Compression Socks

Wearing compression socks is an easy, inexpensive, and useful tool for aiding your body’s attempts to flow blood against gravity from your feet and legs back towards your heart. This is important because if you do not clear the metabolic waste then you will feel sore, which will slow you down in future practices and performances.

A car would be poorly designed if the exhaust spewed out of the vents where the AC comes from.  We were not meant to breath in the waste products created by the combustion engine, much like our muscles were not meant to be subjected to lingering metabolic waste accumulation.

When your body gets overworked in specific tissues it also spews out tons of waste products.  It’s rather controversial, but some scholars blame soreness on lactic acid, while others blame Hydrogen ions/increased blood acidity, and others on carbon dioxide build-up, electrolyte depletion, or inflammation due to repetitive microtrauma to the tissues. Whatever causes soreness is neither here nor there – as athletes, all we want to do is eliminate soreness as fast as possible.  If we can help create a pressure gradient and look fancy with some cool socks at the same time then I say sign me up!

If you have to travel for your athletic competition or workout, you most likely sit in a car right after you finish – and forgo moving for far too long!  God forbid you have to drive hundreds or fly thousands of miles and get trapped in a seat for countless hours.  Even if you just travel frequently for work or business, compression socks will help keep your legs fresh.

A more expensive over-the-counter solution to ridding the body of metabolic waste is the Marc Pro – a portable muscle stim unit that doesn’t fatigue the muscles.  It allows you to remain relaxed while it repetitively contracts your muscles, which squeeze around the vein/lymph vessels, surging the metabolic waste and blood back towards your heart like you would move toothpaste by squeezing the bottom of the container.  Waste products get cleared faster, and you end up feeling less sore.

10) No Hotspots

“If you feel pain during or after moving, then what you were doing was not functional movement. If it feels sketchy, it is sketchy.”  ~KStar

There’s a difference between pain as a symptom and pain as an indicator of a “hotspot” aka trigger point, knot, myofascial adhesion, excessive scar tissue formation.  Therapeutic treatment that involves manual release of hotspots WILL CAUSE PAIN/INTENSE DISCOMFORT, but the difference between pain as a symptom should be obvious.  If it’s not obvious – then go seek medical help.  If you roll over an area and you feel no pain or discomfort, well then, don’t waste your time rolling out that tissue.  Would you brush your teeth if you knew they were clean, say, right after you just brushed them?  Focus on the hotspots instead of rolling simply for the sake of rolling.

Most of you know that the foam roller is the toothbrush for the human body, but other tools help do the job as well, sometimes even more so because they can help you access difficult to reach anatomical locations with ease.  Lacrosse balls, golf balls, softballs, baseballs, yoga balls, RockBallz, the Stick,  Tiger Tail, Jade/Guasha tools, and any metallic soft-tissue release instrument – they all have their place.

One new tool that KStar designed and developed is “VooDoo Floss Band Compression,” which has been revolutionary due to its simple application and outstanding results with restoring range of motion to stuck, adhered, laminated tissues.

11) Hydration

You need to ingest half of your body weight in fluid ounces everyday to maintain MINIMALLY ACCEPTABLE hydration levels.  So if you weigh 160 lbs. that’s 80 fl. oz. per day, which is 4 full blender bottles worth.  If you are that size then I would suggest you carry a water bottle with you EVERYWHERE you go, and fill it up 4 times a day at the bare minimum.  Drink fast enough to get all that fluid consumed throughout the day!

This amount does not account for replenishing fluids lost from athletic activity, especially if you sweat a lot or play in a hot/humid environment.  In those cases, up the dose or risk dropping critical performance metrics like VO2 max (maximum volume of oxygen available, which measures peak anaerobic capacity).

Hyponatremia is a condition most commonly seen in endurance runners that over-hydrate but fail to spike their water with a key ingredient – electrolytes!  These minerals are known as “water-magnets” due to their ability to create a concentration gradient in the collecting ducts of the kidneys, which allows water to be absorbed more readily.  Without electrolytes like Magnesium, Calcium, Potassium, and Sodium, a large quantity of water would pass through our system straight into the great white porcelain bowl.  In order to prevent this loss of water retention, simply sprinkle your water with a pinch of iodized salt. There are even flavored droplets out there now, promising to turn those that hate the foul taste of plain water into a nectar of the gods.

Even if your urine is clear, you could be absorbing and retaining more of that water.  Be like a cactus, suck up that water to the best of your ability, and aid your body’s absorption of water with salts!

12) Jumping/Landing

Much like squatting mechanics, if you cannot jump and land with neutral feet, knees, and hips you will likely develop patellar tendonitis or worse, tear your ACL or be susceptible to some other traumatic injury given enough time and opportunity to mess up. It doesn’t matter how strong you are – your tissues can only handle excessive stress until they can’t anymore.  When something finally breaks down you will know and you will wish you prepared better by grooving a fluid, efficient movement pattern instead of a “ticking-time bomb” movement fault.

The jump/land test has 2 parts:

1) Box Jumps:  perform with mechanics similar to good squat form.  The movement is essentially an unloaded, dynamic squat.

Common Errors:
1) Knees forward, shins not vertical
2) Pigeon/Duck feet (too much internal/external rotation)
3) Lack of Midline Stability (hyperflexion of the low back)

2) Jump-Rope:  perform single-leg jump rope hops with each foot 30 times with good form

Common Errors:
1) Lack of Midline Stability (head/shoulders translate/round forward)
2) Landing on heel (should land on forefoot)
3) Pigeon/Duck feet
4) Valgus collapse of knee
5) Collapsed arch of foot

Concluding Remarks

KStar wraps up the book with numerous demonstrations of mobility drills and an entire overview of various mobility techniques, complete with a plethora of pictures!  He then applies those techniques with strategies to attack common running injuries.  You’re going to have to get the book to check those out.  It’s well worth it!

I hope you enjoyed the review as much as I enjoyed reading the book.

Thanks for reading and good luck on your journey towards meeting the 12-Standards 😀

Dr. Chris Baker, D.C. | Sports Chiropractor
ART/Graston/PTR Certified
RockTape Tennis Director

Premiere Spine & Sport
4982 Cherry Ave. San Jose, CA 95118
(408) 448-4445 (office) | (408) 448-4447 (fax)

2 thoughts on “The 12-Standards of Ready to Run by Dr. Kelly Starrett (A Book Review)

  1. Pingback: Ready to Run | El's Reading Room

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