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Nov 9, 2022

Defining Sports PT and Defeating Burnout with legendary PT Dr. Kelly Starrett

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Dr. Yoni Rosenblatt: So excited to welcome Kelly Starrett to the True Sports Physical Therapy Podcast. Kelly, I have been following your stuff forever. Every once in a while, I feel like I accomplish something that day and my work is done, and then I look up and see what you do in a given day...

[laughter]

Dr. Yoni Rosenblatt: And geez, does that get me rolling. So... If you don't know who the hell Kelly Starrett is, I don't know what you've been watching, but Kelly, give us some background on what you're currently obsessed with, and what got you to where you are now.

Dr. Kelly Starrett: That's a good question. Thank you for having me on, and PT nerd brother and sisters out there, I hear you and see you. I was a professional athlete, a high level paddler. And short story, my whole life was about that. And there's a, through narrative, I think through a lot of my life, which is obsession, like Juliet's... And my wife now currently, was like, she's like, "I think you're stuck in one of those obsessive phases," and I'm like, "What, huh?" And I paddled myself right off the national team with an injury, with a brachial plexus injury. Hand got numb, definitely pinched compressed nervous tissue at the neck, terrible asthma, sympathetic driver. I was taking 30 puffs of my rescue inhaler every day.

Dr. Kelly Starrett: I had to register my inhaler with the IOC. No inter-rotation, all mouth, chest breathing, all unilateral movement, 11 days... 11 sessions a week in the boat, and just led to a neck that didn't turn, or a shoulder that didn't work, and of course, now in retrospect, I'm like, "Well, that was stupid, that's my fault." But that moment when that was taken away from me really began to color, I think, the view, not the view I have currently and today, not as, "Oh, I couldn't do... Be a professional athlete anymore. I want also be a physical therapist and... " But that was the first time when my body didn't allow me to do something. And I couldn't express my role in society, and that was an existential threat. I couldn't do my job. And fast forward to today, and suddenly I'm a classically trained physical therapist. I went to a, what I think was a really, really good school at the right time, when they were just...

Dr. Yoni Rosenblatt: Where did you go school? Where did you go to school?

Dr. Kelly Starrett: I went to Samuel Merritt University in Oakland. And at the time, it was one of the few private institutions that had a very heavy clinical base where all the teachers were working teachers.

Dr. Yoni Rosenblatt: Love it.

Dr. Kelly Starrett: We were attached at the hip to the World Center for PNF, Kaiser Vallejo and then we had incredible instructors from... Who were NDT masters at Herrick, and then all of these heavy Australian manual therapists through Kaiser. And so we laughed, because I just saw one of my friends, a classmate recently, and we were laughing about... 'Cause he's at the VA, that we had the greatest manual skills education ever. Pain theory Maitland, like we got it all. Exercise selection, zero.

Dr. Yoni Rosenblatt: Zero.

Dr. Kelly Starrett: Actually coaching people, zero, actually getting people stronger, zero, but everything else, world class. So I came out of that, and my second year of physio school, I think first semester, second year, I started a gym. I started San Francisco Crossfit, because everyone who's gone to physical therapy school knows there's a bunch of time, and it's easy to do that. So I had a baby.

Dr. Yoni Rosenblatt: So easy.

Dr. Kelly Starrett: I had a baby, and I started a gym, and did all the coaching six days a week before school and after school, and knew that that was what I wanted to do. And I even sat down with my instructor the first day of physio school and was like, my mentor and I was like, "This is what I wanna do." And she kinda read me the Riot Act that, "How dare you have an idea of what you know." And I can understand from her view and lens, what's possible physio today, and what we're seeing and how people are practicing how we've expanded service, and we thought about the problems, that didn't exist. And so she came out, and this is really important, because when we see people coming out of programs, or coaches coaching a certain way, you have to look at their lineage.

Dr. Kelly Starrett: Why do they believe what they believe? Where did they come from? Why did those people adopt those sets of beliefs? And I think, imagine that suddenly we're like, "Hey, we have this diagnostic tool called strength and conditioning, and we don't need these corrective exercises." It's if you don't have a formal language of strength and conditioning, corrective exercises are great, because they really do... Are kind of sub-components. They're great skill transfer exercises for people who don't have a movement language. But if you have a formal language of strength and conditioning, you have regression and progression out the guilt, so you can see why Shirley Sahrmann believed what she believed, and then you're like, "Okay, now let's stand up and see if we can put our arms over our head and squat at the same time."

Dr. Kelly Starrett: Oh, the dead bug is just sort of like an iterative lumbar control for overhead squatting, or doing something in the real world. So fast forward suddenly where I'm in physio school, and my wife and I own a gym, and suddenly I'm confronted with, "Wow, this language that we're speaking in class doesn't really reflect the realities of what's happening in the way people are training, or my own experience as an athlete, or my own experience training and Olympic lifting, and power lifting," and so I really struggled to kind of reconcile those two things. And it seems obvious now, but in 2004, 2005, it was not obvious at all. And the world has changed really almost 20 years pretty dramatically. You couldn't buy a kettlebell in San Francisco back then.

Dr. Kelly Starrett: You had to drive to Santa Cruz to Flanagan Sports, which had... They imported kettlebells, and then you would buy a kettlebell, so it was like a two-hour drive to buy a kettlebell. So now you can buy 'em at Target. Really, I think people forgotten where we were. And so the gym really starts to color my practice as does my experience 'cause we were so attached deeply to Kaiser at the time, Kaiser Vallejo. And I did my six-month rotations at Kaiser, did inpatient and outpatient there. And I saw that patients weren't being evaluated for up towards six to eight weeks. It was taking long people to get evaluated by physio. And then the schedules were so impacted that you'd get a half-hour in two weeks. So that really colored my vision about, "Well, who owns this really? And how effective can a conversation with a physio be in this thing?" And the original Maitland model everyone knows is you saw someone three to five times a week. Man, if I put anyone with anyone three to five times a week, we're really gonna understand. Even the questions that were in the class of Maitland textbook are, "How did you feel in the first 12 hours? How did you feel in the first 24 hours?" You know what I mean?

Dr. Yoni Rosenblatt: It's crazy. It's crazy.

Dr. Kelly Starrett: How did you feel when you left the session? And that stuff is out. And so we really started realizing as people were coming in that there was this movement control component, skill component. And oftentimes the people who were having musculoskeletal pain were still exercising and people who had musculoskeletal pain also lacked complete range of motion. So what people don't understand is that Supple Leopard, coming up on its 10 year anniversary, people are like, "Where are the objective measures?" And the objective measures are normative range of motion. That's like hip flexion. It just happens to be expressed in squatting. And so what we saw was that people didn't... They said they would squat, but then their arch would be collapsed and their knee would be valgus and then they would be overextended and they couldn't breathe.

Dr. Kelly Starrett: So when we really started connecting the dots, what we found was when we improved people's positions in the weight room, they went faster and all of their niggly problems cleaned up, addressed up. And of course, we still had volume issues, etcetera, etcetera, but what we found was if we improved your position, we can improve your performance. And then restoring someone's position if they had pain and injury was a really effective way to get them back. And so suddenly we had this spectrum of, yes, we may need to bias the physiology temporarily, but ultimately it's about can you do these fundamental movements that express the bookmarks of physiologic range? And now we're still trying to do that today.

Dr. Yoni Rosenblatt: Your stream of consciousness is absurd because, do you even remember the question that I asked you at the beginning of that?

Dr. Kelly Starrett: Yeah. Yeah.

Dr. Yoni Rosenblatt: Okay. So that was very impressive. What I think you just described is what sports physical therapy is.

Dr. Kelly Starrett: Yes.

Dr. Yoni Rosenblatt: And you...

Dr. Kelly Starrett: It didn't exist before.

Dr. Yoni Rosenblatt: It didn't exist.

Dr. Kelly Starrett: Sports physical therapy was like, "Oh, I'm gonna do traditional physical therapy on someone who has a tendinopathy on their elbow." That's what it went like, "Oh, you actually do a sport instead of a work?" That's what it used to be. Right?

Dr. Yoni Rosenblatt: Yeah. And so you flip that, and so that's really impressive. And you really did. Two questions in my mind come out of that. First and foremost, why the hell are schools still teaching like they did in '04 with... There is no progression from Sahrmann to under a barbell. I still think it's very hard to get that in the academic setting. Correct me if I'm wrong. Do you still see that when students come towards you?

Dr. Kelly Starrett: What we don't assume is that everyone has a movement language, right? So, I've been fortunate enough to teach on all the continents except Antarctica. And what we see is that everyone knows what a pushup is. And a pushup is short lever shoulder extension and very functional, but actually expresses normative shoulder extension. And it's a universal language. I don't have to explain what a pushup is. I've taught in Russia, I've taught in Korea. I mean, literally, everyone knows what a pushup is. So, one of the problems is that we haven't all agreed on a moving language. And I just think that that's an opportunity to say, "Well, what is the formal diagnostic program in strength and conditioning?" And what we see is even if someone came out of physio school and spoke Pilates, they'd be able to connect that and have a movement language, a diagnostic language.

Dr. Kelly Starrett: The problem is Pilates doesn't get you to the Olympics. It doesn't get you to bootcamp, It doesn't get... Right? Joseph wasn't messing around. And if you understand Pilates, you understand Olympic lifting. If you even had a movement language like yoga, you would still be able to construct what is essential and foundational about standing on one leg or hip flexion. Why is downward dog so seminal for the calves while it's working on dorsiflexion in a long lever position, which is very different than working on dorsiflexion in a squat short lever position. Right?

Dr. Yoni Rosenblatt: And by the way, it's... Yeah. And it's also in a closed-chain position. I think that gets lost, right? I think we totally mix up open and closed chain and if you're not controlling it in closed chain, especially lower extremity, it ain't gonna help you.

Dr. Kelly Starrett: Well, to say that, that may be not as true. It may be if that you are so deconditioned, I can give you some open chain exercises or if I need to babysit a tissue, and I don't mean that in a pejorative way. If I need to get you to move and all you can do, because you can't weight bear, is you move your leg around in space, valuable at the time to highlight physiology. But to your point, what's the goal? The goal is the person needs to walk around, pick stuff up, put over their head, move it through the environment. And that doesn't look very much like my leg is in space free, that my foot is disconnected to the ground.

Dr. Yoni Rosenblatt: And I think you mentioned...

Dr. Kelly Starrett: So I think you're exactly right.

Dr. Yoni Rosenblatt: And you mentioned that time and again the ability to scale, the ability to progress, the ability to regress. There is room in the rehab world for your ankle alphabet, it's not the end-all. And I think that's a struggle that I see with my students coming out is like, "Okay. How do we go from ankle alphabet to whatever the goal is? What are the steps in between? What happens if they can't do an ankle alphabet? How do we scale and progress?" I think that's missing in the current construct. You fill in that hole tremendously.

Dr. Kelly Starrett: So one is that we are starting to see a generation of physios who are teaching like yourself, who are of a strength and conditioning background. So the glacial pace is the break-neck pace. This is how long it takes to change and reform institutions. If you're feeling frustrated as a physio, how are you improving the education of the students coming out? Are you engaged with your local university, or your local program? Are you giving opportunities to say even if like you can't babysit students, or take a student... And again, I don't mean pejorative. If you can't mentor a student for a rotation 'cause your place is inappropriate for that, they can at least come in and lift with you, train with you, be exposed to you. And we did that a lot with UCSF. We had a lot of the UC students come in and just work out with us, train with us, coach with us. We gave them all our resources so that they could go back and better reform from the inside. There are certainly schools that are taking a lot more seriously, but some of this stuff, it does take a minute to change. It just, it takes a second, and if the language is foot alphabets, which what you see is the creeping of what happens when the system isn't set up to have long enough time to teach someone a complicated problem, right? It's sort of like the original Instagram TikTok solution.

Dr. Kelly Starrett: I have 30 minutes with you. Am I really going to be able to talk meaningfully about your lack of sleep, and your stress in your life, and your nutrition choices? Where am I gonna have those behaviors? And then where am I going to be able to say, "Hey, look. At this point, you're doing this. And then now we need to start getting you to step up and control that on either in one leg, or bipedal," and what you end up seeing is, the space for that is actually in a strength and conditioning environment, where I can see someone three to five times a week instead of saying, "Here's the minimum dose to get you out of pain," which is what we've been doing. So we've been disingenuous about what our intentions are, we actually don't get... Once someone's pain-free, we really don't have many rationales. "I'm gonna keep seeing you until you have full dorsal flexion." Boy, that's a great business model that no one's gonna pay for.

Dr. Kelly Starrett: So, and I see that we're only, the way we're gonna get that ankle to work, is we work upstream and improve your hip extension. Oh, by the way, I don't even get paid for that. So let's keep in mind that what... One of the things you said about the ankle alphabet is, I had a... I think picking up marbles with your feet is, for me, the example of the ankle alphabet that's like the thing that drives me the craziest. That's unskilled care. Why are you paying for that? Why are we charging for that? Why isn't that someone has figured that out on their own? And because I really wanna get to the fact that I actually have a ton of education, and I can really manage complex problems in a holistic different way than the average person. But if this is the only thing I'm spending my time doing, I never get to flex that muscle, and that is a problem. So I think we are... And the internet is taking that away from physio for sure. You can just go on to TikTok and be like, "Oh, I'll just rehab my own ACL," because it was all transparent.

Dr. Yoni Rosenblatt: What's up, guys? It's Yoni from True Sports Physical Therapy. We are always looking for awesome sports PTs. Our practice is super unique. We are in network with insurance, but we spend one-on-one time for 45 minutes every single session with our athletes. We are housed in state-of-the-art facilities, high ceilings, big open turf spaces, racks, barbells, weights. It is a performance facility with the world's best sports physical therapists housed within them, and we wanna add to our team and grow our team of awesome sports physical therapists. We offer awesome salaries, great benefits, more importantly, the ideal setup to provide the highest levels of care to the highest levels of athletes. We have awesome continuing education benefits, we have career ladders. We designed this practice to suit both the patient and the athletic patient, as well as the sports PT. So if you're interested in joining an awesome growing company, reach out. You can send us an email at pod@truesportspt.com.

Dr. Yoni Rosenblatt: So those are all really good points. Listening to your story, your origin story, how you went through grad school, you're managing a gym, you throw in a couple kids and a wife, and all the things you're trying to do. That resonates with me, because when I found Kelly Starrett, it was just YouTube, and I was totally done with the profession. I was out. I was working in a clinic that said that they did sports, and they did not. We'll get into that a little bit later. I was promised all these amazing things as a profession, and I'm looking at 30 minutes, maybe one-on-one time. I didn't even have the skillset to really get anyone anywhere. I was walking around the clinic wearing jeans, which drove me nuts, and then there's Kelly Starrett. And he's so passionate about what we can do as professionals, and it totally opened my mind to how I'm gonna coach, how I'm gonna teach, how I'm gonna interact. No longer is the PT the super sterile being, but we're coaches, and we're athletes, and we're teaching other people how to do that, whatever it means. And so that leads to my question, which is, I was so burnt out. You helped me with that. How the hell were you not burnt out, and how do you manage that now?

Dr. Kelly Starrett: Look. One of the things that I just want everyone to hear is that this problem has been solved. Whatever problem you have has been solved in another field already. One of the things that we were promised was this grand interdisciplinary approach, where I got to work with other teams and professionals, and got my mind... That didn't happen at all. And why, because there was just the schedules, to impact... How can you meaningfully even get ahead, or plan ahead, and in Physio School, I was certainly burned out. I was under... You can see that I go from hair to no hair very quickly, right? And...

Dr. Yoni Rosenblatt: Same. Same.

Dr. Kelly Starrett: Yes. [chuckle] And one is, running everything through this filter really helps. Does this decision get me closer to time with my wife and my kids or not? That's the only thing that matters. And I think people are willing to burn themselves to the ground in search of some professional validation, and meanwhile you don't... Your parachute is burning behind you, and your parachute is your family, that's your emergency brakes, your support mechanism, your airbags, everything is there. So you really have to be thinking about how is this decision impacting quality of life, and it's okay, there is a time where Juliet is an attorney, she's a full-time attorney, we have two babies, we're also running two businesses theoretically, MobilityWOD, and the nascent Ready State, and the gym.

Dr. Kelly Starrett: And she's an attorney, and we have two babies, and we were like we were gonna put our heads down and get out of student loan debt. But the issue is that you can work hard at super maximal levels for a while and then you can't. And if you haven't done that, welcome to why we study professional sports and high energy environments because we find that there are a lot of lessons that have been solved. One of the things that Juliet and I have come to realize is that we're actually more stressed now with bigger jobs, we're responsible for a ton of people, we're really are busy. And I don't mean that in... Like we're as busy as everyone else is busy, but as we've gone faster, we've developed a bigger set of brakes, and that's what you have to have, is a set of brakes where you can be on and off and...

Dr. Yoni Rosenblatt: Give me examples of some of those brakes.

Dr. Kelly Starrett: We protect our sleep like it's our job. Like that is the most important aspect of our entire routine, is that we do not mess around with our sleep, and we'd love to watch the next Apple Plus TV show, but we're in bed in the 9:00s. We've slammed our magnesium and we just protect... [chuckle] We protect our sleep like it's our job. We are lucky now that we can afford a sauna, and we spend a lot of time in the sauna, which kind of forces that hard reset. We are at a place now where we've sort of figured out where the margins are, and sometimes... I just came back from a session where I did 11 days straight of travel, teach, work, the whole thing, sometimes it's gonna be out of balance, and I think one of the problems with what we've done is we've set it up so that you're either on the gas and then you're... Instead of... And you're never on the brake, so you need to either be full open or on the brake. And I don't think we're doing a good job of being on the brake necessarily. And then you bring up a really good point about your own experience, is that if you're working in a system where it doesn't feel sustainable, like where you can find...

Dr. Kelly Starrett: When we're racing there was a speed that the boat went that we called the effortless effort speed, and that at that speed, was sort of maximum whole speed at this set amount of energy and we can maintain that and if we wanted to go a little faster, it was twice the energy, and that is an unsustainable pace. So finding sort of the cruising speed of your life matters, but when you realize that you're not at that cruising speed and all the things that you thought you could accomplish, you cannot change that system from within. We've learned that. Buckminster Fuller talks about that, in order... If you see a system that isn't working, the only way to change that system is not from within, but to go out and create an alternative model that makes the other one obsolete.

Dr. Kelly Starrett: And we're seeing that. You, Dani Mattei, Frank Benedetto, like they are starting to see people out there proposing alternative models where you can buy back your time. I'm not saying that you're gonna work any less, but the motivations and the outcomes are gonna be very different, and that means we may be facing a split in our profession where there's this... I'm dealing with very acute care, and I need this baby sitting of tissues and the modulation of managing very acute symptoms, and that looks very much like inpatient PT or very sub-acute surgery, and then we move to phase two physio which is return to sport, and that might be different and we may need professionals here and professionals here. We might need to call that out. Instead of saying, "Well, I see a physical therapist. You mean for bed mobility in this hospital? 'Cause I was on a car accident or because I'm trying to get you to the Olympics." Those are not the same things.

Dr. Yoni Rosenblatt: Yeah, yeah, it is. It's like a totally different profession, and I would say that sports PT it is a different profession, one that I don't think you're given the tools to... Through grad school, and I totally get it. They have to teach you how to do everything, and they teach you...

Dr. Kelly Starrett: And really questions what would you cut out? What do you remove from grad school? I don't, I'm like, you have to add another year. I don't know what you do.

Dr. Yoni Rosenblatt: Either, I think you have to add another year or there are systems like this, there are educational systems like this where you just make your decision which path you're gonna take earlier on, so is it that important for me to learn wound care as a sports PT? Probably not. So let me just make that decision earlier, maybe that's some type of solution. Now, we're gonna get all the way into the clinical stuff, but I wanna know as a business owner...

Dr. Kelly Starrett: By the way I was a wound care intern, I just want you to know.

Dr. Yoni Rosenblatt: Of course, you were.

Dr. Kelly Starrett: I could peel the kiwi in one peel, just so everyone knows. And I literally was just quoting this to a patient of mine who I was like, "Hey, wounds heal in most environments, what are you doing? Why are you bandaging that?" I was like, "Thank you, wound care."

Dr. Yoni Rosenblatt: There you go. Yeah, so you learned. That's probably also where you came into a hyperbaric oxygen, right? [chuckle] Yeah, like there's carry over. So as a business owner myself, I wanted to talk a little bit about business, and I saw you came out with Supple Leopard which was a game changer. And sometimes I wonder, "How the hell did that happen?" So you have this idea, can you just walk me through a couple of the steps and maybe some of the struggles, how do you take an idea from Kelly Starrett's brain, and all of a sudden it's a New York Times best seller, God knows it wasn't overnight. How do you take an idea like that to market?

Dr. Kelly Starrett: Three words. Cocaine.

[laughter]

Dr. Kelly Starrett: No. One is remember, none of this happens in a vacuum. I think that's the key. Is I had this... I was part of the early CrossFit phenomenon, and it needs to be said, and CrossFit means a lot of different things to a lot of people. It's like saying physical therapist, there is the just do as much work as you can as fast as you can, and then there's this higher expression that looks a lot more like sports preparation training, really thoughtful programming. Intensity can be a lot of different things. So I'm on this early phase, we discover CrossFit when there are four CrossFits in the world, maybe three CrossFits in the world, and we became the 21st CrossFit in the world. There are what? 15,000, we're 21. So early on I was like, "Hey, J. Star, I read this little manifesto by this guy named Greg Glassman and I tried one of these workouts and it buried me, 5 pullups, 10 pushups, 15 air squats for 20 minutes." And I got through 12 rounds and was just dizzy and terrible. And I'm a national champion, I'm a good athlete. Juliet is a three time world champion at this point.

Dr. Kelly Starrett: And then I tried the second easiest one, which is some front squats to presses and some pullups, and that's only 45 reps. It seems super reasonable. And I literally, I just find out I'm not very skilled, I'm not very strong and I'm not very fit. What was nice about being in the gym was that suddenly I had to confront what a movement practice looked like. I had to confront what Moshé Feldenkrais had solved, what other people had solved, Pilates, what do... What's essential? And in the programming, how do I represent all the exposure that a person could need in three to five hours a week? So really confronted with that.

Dr. Yoni Rosenblatt: Kelly, I'm gonna cut you off and I'm gonna do something that probably not many people can do. I'm gonna teach you something. Ready? It's Moshé, Moshé Feldenkrais. [chuckle]

Dr. Kelly Starrett: Alright, alright. There you go. My Israeli is probably not very good. I apologize to everyone out there. That's why everyone says Feldenkrais and...

Dr. Yoni Rosenblatt: Feldenkrais.

Dr. Kelly Starrett: Right. Feldenkrais. You just say, but you have to say Ida Ralph. You don't just say Ralph, right?

Dr. Yoni Rosenblatt: Correct.

Dr. Kelly Starrett: It's too confusing. Thank you. Moshé.

Dr. Yoni Rosenblatt: No problem. Go ahead.

Dr. Kelly Starrett: So in that time, again, starting to ask what is essential and my own... Really one of my decent skill sets is pattern recognition. So I start to understand, oh, there's a whole lot of ways to go overhead and that the technique is the same. And that if I have someone who's competent with a barbell, a kettlebell, a dumbbell, upside down, I start to see that the positions and the techniques are the same. Then I start to understand that our traditional models of strength have always been predicated on either adding more volume, another set, or adding more load. And what we weren't really appreciating was that the demands of real sport were that I needed you to be able to express movement control when your heart rate was really high. And that did not exist anywhere in sports PT clinic, in the language. And so we started saying, "Well, this is an easy way where we can start to challenge people's position by making you breathe hard." And then I really started to see that if I put... Made you do 20 reps, boy, you sucked at that. The first five great, 20, terrible, and that if you could do 20 reps, but you couldn't do heavy three, I was like, "Huh, there's something different in your technique," when I asked you to go speed or compete.

Dr. Kelly Starrett: Suddenly what I found was when we could help people become more competent in base movement positions like an air squat and I... Or a squat pattern, where I could suddenly challenge that squat pattern with all of those different variables, chances are I was going to elicit a degradation in your technique or a breakdown in your schema of how to move through the environment. "Now here's the goblet squat. Now put it on your shoulders. Now put it over your head. Now carry it. Now... " And so what we had was really the ultimate truth test where if you were competent, then I could... You would pass all these things. It was just work and it was a different stimulus. But what we found was we had the ultimate diagnostic tool to find out that the stimulus for adaptation was also the diagnostic tool. That if you went fast, you couldn't hide your potential tissue restrictions or lack of skill. And so suddenly I had a model for understanding what was happening and in a way that people weren't talking about.

Dr. Kelly Starrett: So I started teaching it and then that teaching and then we started making videos about it. And at the same time, we were approached because some of the videos that were going off, people were really thirsty for. And what I had was a course I had taught 100 times already, that was a framework for a book. And that's how we got into there, was me being a clinician on the ground floor coaching, trying to solve this movement problem and movement competency problem. But people weren't seeing movement as part of the training equation. And the physical therapists thought I had lost my mind. They didn't understand that it was about biomotor output.

Dr. Yoni Rosenblatt: I didn't think that, I did not think that. So okay, but then when... Okay, yeah, it's a great idea. Who comes to you and says, "Kelly, you gotta write a book." Is that J. Star? She says it? And then...

Dr. Kelly Starrett: No, no, no, for sure not, Julie and I are just keeping our heads above water.

Dr. Yoni Rosenblatt: She's like, "Please don't write a book." So who says write a book?

Dr. Kelly Starrett: Remember that you are in a community and it's crucial to remember that. So Rob Wolf was an early coach and friend of ours and he wrote a book called The Paleo Solution, and it was a New York Times bestseller. And his publisher knew me through Rob and reached out and said, "Hey, we'd like to help you write a book." And that was how that happened. And I think that's one of the things that people ask all the time, "Can I be on your podcast?" I'm like, "I'm not sure that's how it works." Do something really interesting and then people will ask you to be on their podcast. And the same thing happens... Publishing has changed radically in 10 years. You can self-publish and if you have something important to say, you should write it down. 'Cause it really is... It's so easy to cherry pick, and coaches like to do this. They cherry pick a picture that they don't like, has a weird vantage and they... And I'm like, "Well, did you actually read the content around it or did you read the... " That book is so dense and if we ever put another edition out, it'll have another 100 pages including the movement assessment or movement tests.

Dr. Kelly Starrett: I've already restructured the whole book, but at the time, the real question and this... And I think was the really subversive question was, how can we help people take a crack at making themselves feel better, improving their positions? And does that require another professional person in the room? If we can move beyond press and guess and we can start taking a systems approach. But the first order of business in there is movement, and the second order of business is if we can mobilize to change the movement, that's our objective change. And then the truly objective change, not as just your hip range of motion, but if I improve your function, I should improve your biomotor output, your wattage, your poundage. And that was really a different approach.

Dr. Yoni Rosenblatt: It's a super different approach because now you're starting to blend this very clinical side to this performance side. And that's a beautiful gray area where sports PTs I think should live. And I think that really comes out of your book.

Dr. Kelly Starrett: Yeah. Sports PT, performance PTA, performance therapy. I'm not sure what the word is for that. No, I chose mobility. If you've ever used that word, you're welcome.

Dr. Yoni Rosenblatt: Thank you.

Dr. Kelly Starrett: The only people who had used that word was physical therapist. When we mobilize a tissue. That's literally where that comes from.

Dr. Yoni Rosenblatt: Yeah.

Dr. Kelly Starrett: And I specifically chose that over range of motion or flexibility or pliability or any of these abilities. Because I was like, "It doesn't describe what we're trying to talk about here," right?

Dr. Yoni Rosenblatt: Yeah. Yeah. And you did an awesome job of creating that. So thank you for your time. Thank you for your honesty. I look forward to continuing the conversation.

Dr. Kelly Starrett: Any time.

Dr. Yoni Rosenblatt: I bet we'll do this again.

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