(Physical) Therapist’s Couch

The human body is pretty miraculous. It evolved to allow a nearly infinite number of movements: running, climbing, jumping, swinging, and more.

But you mostly use it for one thing: sitting down. You sit in your car or on the subway, you sit all day at your desk, you sit to eat lunch and dinner, and you sit on your couch to binge-watch Netflix at night.

That disjoint – between how your body was evolved to be used, and how you’re actually using it – causes all kinds of problems.

Here’s just one: when you sit, your hip flexors are in a shortened position. And after enough sitting, your body starts to treat that shortened position as the new normal. So when you stand back up, there’s not enough slack in the system. Your hip flexors are permanently tight.

That’s a problem by itself, since so many athletic movements – from running and jumping, to throwing a ball or throwing a punch – depend on generating powerful hip extension. Tight hip flexors oppose that extension, reducing the power you can create. It’s like driving with the parking brake on.

But the secondary effects are even worse. Let me explain:

Perhaps, in the past, you’ve bought beef to cook for dinner, and had to cut off the silver-skin.

Your muscles have silver-skin, too. It’s called fascia. In your body, your muscles cells are held together in bundles, and the fascia is what does the holding together.

In recent years, however, we’ve begun to realize that fascia also connects one bundle to the next, in running lines of tension. As the song says, your hip bone’s connected to your thigh bone. And, similarly, your hip muscle’s connected to your thigh muscle. Which, in turn, is connected to your calves, ankles and feet in one direction, and to your lower back, thoracic spine, shoulders and arms in the other.

In fact, there’s a single run of fascia that extends from your toes, up through your entire body, to your elbows. And your tight hip flexors are right in the middle of that fascia run.

When hip flexors get tight, they take slack out of the middle of the system, creating a game of ‘crack the whip’ that causes problems all the way up and down that chain. Now, your tight hip flexors start causing foot pain, or knee pain, or a bad back, or a tweaky shoulder.

Normalizing the length of your hip flexors, getting slack back in the system, has huge and far-reaching impacts.  It will make you a better athlete, prevent future injuries, and knock out a slew of nagging pains you’ve been living with too long.

Fortunately, you can make big inroads on fixing your hip flexors with just one simple stretch, popularized by Dr. Kelly Starrett. He calls it the ‘couch stretch’, because he and his family do it at night, on the front of their couch while they watch TV.

Here’s a demo, pulled from Composite’s 14-day Jump Start for new clients. (I cover similar topics as in this post for the first half of the video; if you just want to see the stretch, hop to about the six-minute mark.)

To recap:

  1. Get on your hands and knees in front of a wall (or, if you can’t peel yourself away from the tube, the arm of a couch).
  2. Put your right shin flat vertically against the wall; your knee should be wedged into the corner where the wall and floor meet, and your foot should be pointed so that your instep is against the wall.
  3. If you’re not bendy, this may be a stretch already. If you’re more flexible, you can put your left foot flat on the ground.
  4. Squeeze your butt. In particular, squeeze your right glute, the side with the foot that’s against the wall. This will help stabilize your low back, and correctly position your hips.
  5. While still squeezing your butt, try to lift your upper body upright. Think about making your spine long, extending the straight line between the top of your head and your tailbone. You want to get upright by opening at the hip, and not just by arching your low back.
  6. For bonus points, you can eventually work towards reaching both hands overhead, so long as you can do so with tight abs and glutes and with your back long and straight. In the beginning, however, you’ll probably want to use your hands on the floor or on your forward knee, to help push yourself upright. You can also put a box in front of your body, and push up on that.

Now hold that stretch for two minutes. (That’s how long it takes for the Golgi tendon organ receptors to give up, allowing you to reach your full stretch and make lasting change.) Then switch to the other side, and do two minutes on the other leg.

I strongly, strongly suggest timing yourself, as two minutes is waaaaaay longer than most people tend to hold a stretch by default otherwise. (Side note: interestingly, dentists similarly recommend toothbrushing for two minutes. There, too, without using a timer, most people average brushing for only a third of the recommended time. If you like having teeth, consider deploying your two-minute timer next to the sink while brushing, much as you do while Couch Stretching.)

The most common problems to guard against while doing the Couch Stretch:

  1. Your rear knee isn’t against the wall. Even if it means you can’t get your opposite foot up on the ground, keep your rear knee / shin / foot all the way up against the wall. That takes all the slack out of the system, making the stretch much more effective.
  2. Your forward foot is too close in. Take a big step forward with that foot, so that your forward shin is vertical, too.
  3. You’re over-arching your lower back. Hyper-extending your lumbar spine is a very common (and not very good for you) habit in general; it’s even more common in something like the couch stretch, where it’s easier to bend at your low back than to actually stretch the hip flexors you’re gunning for. Think about making your spine tall, and about keeping your low back flat, even if that means you can’t get as far towards upright.
  4. You’re making a ‘pain face’. Effective stretching isn’t a relaxing experience. Done right, the couch stretch is hard work! At the same time, it’s important not to grimace while doing it (more technically called ‘facial fixing’), which actually undercuts the neurological effectiveness of the stretch. Breathe, go to your happy place, and try to keep your face serene. It’s zen and the art of stretching!

That’s it.

Try it daily for the next two weeks; I suspect you’ll be pleasantly surprised by the huge positive impact.

Keep it Moving

If you’re an average, 180-pound person, all the capillaries in your body – the smallest blood vessels, where oxygen and other nutrients are exchanged with cells – can together hold about 3 gallons of blood.

But blood, like water, is heavy. So you evolved into a evolutionary compromise. Your body only contains about 1.5 gallons of blood at a time; much lighter to carry, but only half of what you need to provide for your whole body at once. Fortunately, your body also evolved a smart system of hemodynamics, a combination of forces that sends that blood to capillaries as it’s needed.

At the front end, your heart pushes oxygen- and nutrient-rich blood through your arteries.

Then the movement of your muscles pulls that blood from your arteries into your capillaries, to feed individual cells.

In other words, while your heart is circulating blood all the time, the oxygen and nutrients only make it to cells when the muscles around them are moving.

That’s one of the major problems with excessive sitting: without movement, your cells are starving.

But that’s just one problem. After 30 minutes of sitting, your metabolism slows down by 90%. A few hours in, you’ve got increased blood triglyceride and insulin levels, and reduced (good) HDL cholesterol and lipoprotein lipase (an enzyme that breaks down fat in your body).

So perhaps it shouldn’t be surprising that people who sit more are sicker and fatter than people who don’t.

What’s more, that’s independent of exercise. Even between people who work out for the same number of hours weekly, a greater number of hours spent sitting each day correlates with an increase in both body mass and all-causes mortality. Studies have tied sitting to huge increases in everything from type 2 diabetes to cardiovascular disease and cancer.

For example, excess daily sitting increases your risk of lung cancer even more than the second-hand-smoke effects of living with a smoker.

All of which is bad news, because we apparently really love to sit. The average desk worker spends 7-8 hours a day sitting at the office, then comes home to sit down for another 5 hours of daily TV.

Fortunately, the solution is simple: get up frequently and move around.

Research has shown that even short breaks (a couple of minutes) at low intensity (walking to the bathroom, or simply standing up) make a huge difference. One study showed that, the greater the number of breaks taken, the lower the waist circumference and BMI, and the better the blood lipids and glucose tolerance.

Of course, once you get into the flow of work, it’s easy to forget just how much you’re sitting. That’s why you need some gentle nudges:

First, several fitness trackers can provide regular reminders to move. You can make sure those alerts are set up on your Apple Watch (more info here), Jawbone (see “Idle Alerts” here) or Garmin Vivosmart (info on the “Move Alert” here).

Second, as most people carry a smart-phone at all times, a simple hourly chime app (like Chime for iPhone and Hourly Chime for Android) can be a suitable reminder. When you hear a ‘ding’, stand up for a minute or so. If you’re feeling saucy, you can set those apps for more frequent reminders – say, every 30 minutes. (These are particularly handy in the evening. If you’re watching TV, for example, you can keep watching, just stand up and move a bit for a minute or two while you do.)

Third, since people are most likely to sit for extended periods of time while working on their computers, it’s also worth adding in an even more insistent reminder on-screen. Breaktime for Mac or Rest for Windows will take over your screen at whatever interval your select, reminding you to stand up, shake it out, go the bathroom, grab a water or coffee, or similarly get that mini-dose of movement it takes to get your body back on track.

This one’s an even smaller habit than most – again, it just requires getting up and moving briefly throughout the day. But it’s also one of the most effective you can implement in your life.

Knock Your Socks Off

As I’ve written about before, the muscles in your feet are extremely important. When they’re engaged, your arch can absorb a huge amount of force, and the muscles further up the kinetic chain – in your legs and hips – work their best, too.

Whereas, when your arch collapses, every step smashes the small muscles and tendons in your feet. Worse, the navicular bone in your heel collapses inward, torquing your shin, and turning off muscles like your glute medius on the side of your hip. It’s a consistent cause of chronic pain in feet, knees, hips, and low-backs.

That’s why I’m a long-standing supporter of going barefoot: it allows you to use your feet (and, in turn, your legs) they way they’re meant to work.

Obviously, if you run along city streets (like I do here in NYC), you probably don’t want to go totally barefoot, should instead opt for some minimalist, zero-drop shoes. (I’m a big fan of Inov-8.) And if you’re working out in a commercial gym, even if you take off your shoes, you probably still want to keep on your socks, to avoid picking up infections like MRSA or ringworm from sweaty floors.

But when you’re padding around the house, you’re in the clear. And while you may already be taking off your shoes at the front door, there’s a big difference between going barefoot, and going sock-clad mostly barefoot.

First, though socks are more forgiving than shoes, they still squeeze your foot, preventing natural toe splay. Second, socks are slippery. Walking depends on friction – between your foot and the ground – to give you something to push against. Imagine walking on ice: with almost no friction between your shoes and the ground, you automatically start to take small, tentative, penguin-like steps, instead of natural human strides. Sure, socks on wood floor (or even carpet) aren’t nearly as slippery as shoes on ice. But they’re still slippery enough to change the way you walk, and to undercut the skill- and muscle-developing point of walking around barefoot in the first place.

So, in short, make a point to walk around your home without shoes – and without socks. It’s the healthiest thing to do.

Hit the Road

Almost exactly a year ago, I blogged about how much I hate running. But also about how, precisely because it’s my biggest athletic weakness, I was focusing on running more, and on running better.

I ran through last summer, and into the fall. But by the time winter rolled around, I scaled back. I still hopped on the treadmill a few times a week to warm up before lifting, and tried to include 400m and 800m repeats in at least one metabolic conditioning session each week. But, all in, I could still count my total weekly mileage on one hand.

Now, warm weather is upon us again. This year, I no longer dread running, could lace up my sneakers and bang out a 10k at a moments notice. But I’d also be lapped on that 10k by many octogenarians. So I’m focusing this summer on not just surviving runs, but on actually doing them fast.

For the second day in a row, Jess and I are off to the Hudson Greenway, to get back in the swing of things with some long, slow distance. After that, it’s weeks of tempo runs and long and short intervals for me. I may still not be winning races, but I can at least move up to the front of the over-80 crowd.

Caveman Cardio

In preparation for an upcoming talk, I’m revising a now five-year-old presentation on “paleo fitness” – what we can learn from our evolutionary ancestors about how to live longer, perform better, and look good naked.

While my thoughts have shifted just a bit on the final third, the first two sections stand up exceedingly well. So, preemptively, I’m posting both of them again here:

Once I finish revising, I’ll re-record a final installment to complete the trifecta.

Don’t Make ’em Like They Used To

In the last week, the politically-minded fitness world has been abuzz with the theory of exercise that Donald Trump shared in a recent New Yorker feature:

There has been considerable speculation about Trump’s physical and mental health, in part because few facts are known. During the campaign, his staff reported that he was six feet three inches tall and weighed two hundred and thirty-six pounds, which is considered overweight but not obese. Trump himself says that he is “not a big sleeper” (“I like three hours, four hours”) and professes a fondness for steak and McDonald’s. Other than golf, he considers exercise misguided, arguing that a person, like a battery, is born with a finite amount of energy.

Like many of Trump’s science-minded proclamations, this one is mind-bogglingly stupid. And it reinforces my long-held belief that massive heart-attack is the likeliest way for 45 to serve out less than a full first term.

But what really caught my eye was a piece about the quote in GQ, which ran through the exercise habits of recent presidents past: Obamas pick-up basketball games, W’s “100 Degree Club” (waiting until the temperature hit 100° before heading for stacks of 7:00 miles), Clinton’s pokier lopes in 90’s jogging suits.

The real kicker, however, is a reference to an episode I think I knew about obliquely, but had largely forgotten:

On the campaign trail in 1912, Teddy Roosevelt stopped in Wisconsin for a campaign rally. There, a crazed assassin (who later claimed to have been egged on by the ghost of William McKinley) sprung from the crowd, and shot Roosevelt in the chest at point-blank range.

The bullet, however, simply got stuck in Roosevelt’s pec muscle. Though doctors wanted to bring him immediately to the hospital, Roosevelt explained that he was not mortally wounded, and would go ahead with the speech. Blood still dripping from the wound, Roosevelt told the gaping crowd, “I have just been shot, but it takes more than that to kill a Bull Moose!”

So, in short, Donald is definitely being a wuss. And Teddy Roosevelt, who I also think of whenever I visit New York’s American Natural History Museum, full of taxidermied fauna he gunned down on hunting trips during his spare time, is undoubtedly the original Most Interesting Man in the World.


This time of year, as the weather turns, and people start thinking about having to appear in public in a bathing suit, there’s a sudden uptick in diets and gym trips. With a sense of deadline looming, they tend to jump in full-throttle.

But here’s the bad news: you didn’t get out of shape in six weeks, and you’re probably not going to become a cover model in that amount of time either. I see a lot of people who don’t want to face that reality, cutting their calorie intake in half, hitting the gym seven days a week. And, for about two weeks, it works like a charm. By the third week, they’re overtrained, nursing a summer cold, and entirely burnt out.

Harvey Penick, the legendary golf coach, liked to say, “when I tell you to take an aspirin, please don’t take the whole bottle.” Just because something is helpful doesn’t mean five times as much is five times as helpful. In fact, overdoing it often has entirely negative effects; an aspirin may cure a headache, but a bottle of it will kill you.

So if you want to kick off a summer fitness push, I think that’s a great idea. You can set reasonable goals, make a plan, and see solid results over the span of the next few months. Or you can take the whole bottle, and set off on an unsustainable beach countdown crash approach, which, after a few weeks, will similarly probably be dead.


When people start getting serious about their fitness, they often start to opt for well-marketed “scientifically designed” food substitutes instead of actual food. They drop simple fish and chicken, for example, in favor of protein drinks and bars.

I’ve written before about one set of problems that causes, as breaking food down and then reassembling it from its constituent components leaves out all kinds of important micro-nutrients.

But problems exist in the opposite direction, too. A number of ‘harmless’ additives used in those reassembled food products are increasingly turning out to be not so harmless after all.

A study recently published in the journal Nature, for example, demonstrated that two widely-used emulsifiers (carboxymethylcellulose and polysorbate-80) threw off the gut microbiome in mice, sufficient to cause inflammation, colitis, obesity, and metabolic syndrome.

As the researchers conclude, “the broad use of emulsifying agents might be contributing to an increased societal incidence of obesity/metabolic syndrome and other chronic inflammatory diseases.”

The solution? Eat real food instead of food products. It’s the simple, healthy choice.


This morning, Eliud Kipchoge ran a marathon in two hours, twenty-five seconds. On the one hand, that fell short of the sub-two-hour goal that he and his Nike support team had been shooting for – a parallel to Roger Bannister breaking the four-minute mile exactly 63 years back. But, on the other hand, it bests the prior world record time by more than two-and-a-half minutes, a nearly superhuman feat.

It’s hard to get a real sense of how crazy a sub-two-hour marathon is. As it’s a consecutive series of twenty-six 4:41 miles, it’s literally just harder than setting your treadmill to 13mph, then running for two hours nonstop. To demonstrate that, Wired put today this great video, which includes (along with some physiological analysis of the feat) a number of members of Wired’s running club trying to see how long they can hold that 13mph. In short, it turns out they can cruise for about a minute before things fall apart. So, just more than 99% of the race to go!

Congrats to Eliud and everyone at Nike. The two-hour barrier may not have fallen today, but it’s only a matter of time.

Fascinatin’ ‘Rithm

One of the goals for Composite over time is to build automated mass-personalization for our clients, whether in prescribing workout programs, or pacing the acquisition of healthy eating habits.

I’ve started to sketch a few of those algorithms out, and the flow-charts I’ve amassed definitely look more than a bit like a prop from A Beautiful Mind.

So I was happy to see this xkcd comic today, which pretty much nails my present mood:

Lump this, I suppose, under “nobody knew fitness could be so complicated.”