Dr. Rhonda Patrick: What does a simple hip mobility test look like to you?

Dr. Kelly Starrett: The question here is: What should the hip be able to do? I say “hip” as in the chain, but that’s the big primary engine. The spine is the first engine, but then we have these big primary engines of the hips and the shoulders.

What’s interesting about that conversation is that if I ask people who are very sophisticated about their running training or their nutrition, “What should the hip be able to do? What’s normal? What’s far from normal? What does every physician agree we should be able to do?” they have no idea. What’s normal hip flexion? Bring your knee to your chest.

This was really where we recognized that one of the problems—or opportunities—we had was to make these range-of-motion tests part of the training, so that the stimulus for adaptation, exercise, was also the diagnostic tool. I can understand what’s going on.

We all should be able to hip squat, hip crease below the knee. That’s a really simple test. If you’re struggling to do that, it tells me a little bit about your readiness today. Again, you could be stiff or have old injuries. There’s no judgment there.

If you stand on one leg, you should be able to pull your other knee up past 90 degrees, and most people would struggle with that. We have a simple test in the last book called the sit-and-rise test, which everyone has heard of now. Lower yourself to the ground, crisscross applesauce, without falling. Then, without putting a knee or hand down, pop back up.

What’s nice about that is that it’s not even a full range-of-motion test. It doesn’t require that much strength, but it’s a good indicator that you may be missing some hip flexion. Being able to fold forward to shift your weight is really the limiter there. If we can begin to create some fence posts—some guidelines—for people to understand what’s more normative or not around their own range of motion, then you can keep an eye on it.

Dr. Rhonda Patrick: And the sit-and-rise test—isn’t there some data on that with associations and longevity?

Dr. Kelly Starrett: Basically, imagine that all these things are proxies. As you’ve talked about, I don’t really care what your grip strength is. I care what you do with that grip strength. But if you’re doing a lot of fun stuff with your grip strength, your grip strength is going to be good. It’s a proxy for all these other things.

That test tells us a lot about your movement choice, your ability to solve movement problems, and your ability to modulate your balance. It may not be that that’s the end-all, be-all. If you put a hand down, you could probably still live to 100. We probably have some aunties in our lives who are over 90 who’ve never done the sit-and-rise test, never done keto, and never gone to a high-intensity exercise class. But there’s something about their lifestyle.

We just got back from Japan. We were sleeping on the ground. In cultures that toilet on the ground, sleep on the ground, and eat on the ground, fall risk in the elderly drops to almost zero. Osteoarthritis in the hips and low back drops to almost zero. There’s something about maybe touching these shapes once in a while. That puts them on the map of the brain. We’re touching and loading those tissues. The brain doesn’t start to pare down some of that movement as irrelevant.

So really, the question is: What should I do every day? Then we can ask the next questions: What are essential movements in strength and conditioning, which is really just a form of movement practice under load?

For example, we have a simple test called the couch stretch. Have you ever done the couch stretch? You put your knee in the corner.

Dr. Rhonda Patrick: I’ve heard about it.

Dr. Kelly Starrett: It’s basically a simple assessment of hip extension. If you were kneeling facing away from the wall, you put your knee in the corner so your foot is going up the wall, and then you bring your other leg up into a high-kneeling position. It’s kind of like a lunge, but your leg is really bent and going up the wall. It’s a short-lever lunge position.

What we’re looking for is: Can you get your back upright without “banana backing,” without just arching? Can you take a breath there? Can you squeeze your butt there? What we often find is that people are so restricted in their quads that they can’t even get into that test position. It also inhibits their ability to squeeze their butt.

Sometimes people are missing hip extension. This is really a simple test of what the tissues should be able to do as we move toward extension—getting that knee behind the butt, like a lunge or a run. The butt gets inhibited because the quads are tight, the pelvis tips over, or for whatever reason the brain is basically saying, “We can’t fire that glute against this resistance.”

We use that as an assessment: Let’s spend some time here with isometrics. We can get your butt practicing that squeeze so your brain says, “In this position, I can do a normal muscular drill. I can get my butt squeezing when the quads are tight.”

That’s a good example of why, a lot of times, people have really stiff hamstrings all the time. They’re always sitting in a bent position, and then the hamstring is doing the work of the butt and the hamstring all the time, instead of the butt doing its job and the hamstring doing its job together.

It’s a good example of how sometimes hamstring pathology could result from working in incomplete positions, where a lot of my physiology is what I call positionally inhibited. The same thing could be true of your shoulder.