[Juliet Starrett] (0:00 - 0:16)
Everybody is so focused on longevity and long-term health. One of the messages that we got wrong in fitness was telling people that you could train for one hour, check the box, and then sit for the rest of the day. That's not how humans are designed.

Humans are designed to move and move a lot.

[Angela Foster] (0:17 - 0:21)
What are some things that you think we should make sure we're doing every week?

[Juliet Starrett] (0:21 - 0:30)
Sitting on the floor for 30 minutes a day. I would definitely say women over 40 should be hanging from a bar as often as possible to maintain their shoulder mobility and strength.

[Angela Foster] (0:30 - 0:33)
How we can support and protect against back pain.

[Juliet Starrett] (0:34 - 0:53)
Oftentimes, low back pain isn't really being caused by the low back. There's two things. First of all, missing key hip extension can be a driver of low back pain.

The second thing, when it comes to low back pain. Is there one thing that you want everyone to know? I hope everybody starts sitting on the floor after this.

Their hips will thank them.

[Angela Foster] (0:53 - 1:27)
Juliette, I'm so excited to have you here today. You are, well, we were just talking, both of us actually, former lawyers. You are New York Times bestselling author, CEO.

You are literally kicking ass in every field. I haven't had anyone on yet to come and talk about exercise and mobility in quite this way. So I think a really good place for us to dive straight in is you talk about the distinction between exercise.

I think everyone knows that they need to be exercising, but there is a clear distinction between exercise and mobility. How would you qualify that?

[Juliet Starrett] (1:28 - 6:09)
Yeah, and thank you for saying that. And first of all, thank you so much for having me. And I love meeting another retired lawyer.

So thank you so much, as we talked about. And I think you're right. I think one of the greatest things that has happened in the last 20 years in our health and fitness space is that people really have gotten the message that exercise is so critical.

And in many cases, they are doing it in whatever that means to them, whether that's strength training or play or sports or whatever, it seems like people have really gotten that message. But what has been lagging, I would say, is people's appreciation that if they wanna do the things they wanna do with their body and do those things, especially as they age, they do need to pay attention to, and unfortunately do a little bit of work on their mobility. And here's how I just, I think I'll go ahead and define mobility if I could.

Mobility is the ability to move freely through your environment, do the things you wanna do physically without your body and not be in pain. And the pain piece I think is really interesting as people age, because Kelly, my husband and co-founder and I go around the world and talk to audiences. And one of the things we love to do in large groups of people is say, hey, how many people in here are not in pain?

And we'll have crowds of 200 people and like 25% of the people will raise their hand saying they're not in pain. So we always find that so interesting. And so, and I think people in our audience see it is that you realise that most people are dealing with some kind of pain.

And that's not usually catastrophic pain that requires them to be in the doctor's office or in the emergency room, but just sort of like nagging little aches and pains and challenges with their musculoskeletal system. And their ankle hurts, their knee feels tweaked, their shoulder's hurting. And those things often also happen to those of us who love to exercise.

In fact, that's a common part of exercising. And so the way that we like to think about mobility is imagine an extra wide hallway. Like when you go to the hospital or doc, like hospitals have like double wide hallways.

When you're 22, your mobility is like a double wide hallway in a hospital. You can do, you can pick up new sports and learn new skills and learn activities. And you can probably stay up at the pub until 4 a.m. and still get up at 7 a.m. and get to your class. And you aren't gonna tweak your shoulder. You're gonna be able to do that. But as we age, that hallway starts to narrow from a mobility standpoint.

And unfortunately at the very end of that narrowing hallway, if we don't put a little love and attention into our movement and mobility, we are gonna lose a lot of that. And in fact, in America, I don't know what the data is in the UK, but the number one reason people end up in a nursing home is they can't get up and down off the ground anymore. They lose the ability to get up and down off the ground.

And so nobody's really motivated. Nobody in their 30s, 40s, 50s is that motivated by some scary potential future that they might not get up and down off the ground. But what does motivate people now is that many of us are dealing with aches and pains and tweaks.

And more importantly, we wanna be able to keep doing the exercise we love. And if we wanna be able to keep doing the exercise we love and do it well, we need to pay a little bit of attention to our mobility. And one little point I'll make is that one of the ways I see it most prominently in my own life, I'm 52.

When I was 25, everybody I knew like went jogging. Like we all ran. Like jogging was like an activity that everybody did.

And then as I've aged, it's now like 10% of my friends can still jog as a form of exercise. Because most people have switched to cycling or biking because they can't run anymore because they tweak their knee or it hurts their low back or they have some kind of physical issue that has prevented them from being able to like run as a form of exercise. So to me, I see that as one obvious example of this sort of narrowing hallway where our movement choice has gotten limited by the simple fact that we haven't paid attention to our native range of motion and our mobility.

[Angela Foster] (6:09 - 7:29)
And I think it's interesting what you're saying there about getting up and down off the floor, right? Because I remember when my kids were really young and I was sitting, you know, in my early thirties, sitting on the floor with them, playing, you know, playing cars, Lego, things like this and looking at my parents and actually visibly seeing the difference, right? In my own mobility and their grandparents.

But then I think what happens is your kids start to grow up, they get older. So now you're doing less of that, right? You don't actually have a reason to be on the floor.

And then there can be this huge gap until like, I don't know, 20, 30 years later, you then become a grandparent and you realise, I've lost this. So unless you're doing things that require you, for example, like gardeners have a pretty good mobility quite often, right? Because they're crouching and squatting and doing these things.

I found that for me, one of the things like working in has been to not allow myself to take the easy route. Do you know what I mean? So for example, if you were picking something up off the floor or sweeping like something on the floor, then actually bending down in the toddler squat.

And I think because it was actually via Ben Greenfield that I got into yours and Kelly's content quite early. And I think just like working mobility into your everyday has definitely helped me. Do you find that people who do that tend to be more mobile for longer?

[Juliet Starrett] (7:29 - 13:27)
Yes, I couldn't. And thank you for saying that. I feel like it's a lot.

So I think everybody thinks that mobility is just like sitting on the ground with like a foam roller on your calf or something. But it's so much more than that. And there's so many ways to fit it into your everyday life.

I love that you make that conscious choice to like pop into a full squat in order to like pick something you dropped off the ground. That's amazing. You know, one of the things I do and it's actually in our book, Built to Move, is we have this test in our book called the Old Man Balance Test, which was actually developed by our friend, Chris Hinshaw.

But it's a way of putting on your shoes and socks in the morning where you stand on one leg and you grab your sock and put your sock and your shoe on while standing on one leg. And then you switch sides and do that. You know, while I'm brushing my teeth, I practise standing on one leg.

We have all of these little balance tools around our house and at our standing desks at work that we use. And then the thing that we do that we advocate that everybody do, and honestly, if people take not one thing away from this podcast, but this, it is reintroducing sitting on the floor into your life. We recommend that people just practise sitting on the floor for 30 minutes a day.

We went and did a presentation at this fancy club in San Francisco called the Olympic Club. And it's like this very fancy, very expensive club to join. And it tends to be people that are 40 and over because those are the people who have the income to be able to afford to go to this club.

And we do a presentation there and Kelly and I, and it's sort of those plastic folding chairs kind of thing. So we tell everyone, hey, just fold up your chair and put it to the side and let's just sit on the ground. And I mean, it was amazing to watch Angela.

Like people could not sit comfortably. They couldn't sit in a cross-legged position. By the end of our 45 minute talk, certain people just had to be laying down because sitting was so uncomfortable.

And if you contrast that to when we're in, you know, kids and in school, we're getting up and down off the ground hundreds of times a day. It's the skill that we take for granted. And what I know, and again, I don't know what the UK data is, but what I know the data is in the United States.

And that is that Americans are watching three hours of television a day on average. And so what we say is, hey, take 30 minutes of your television watching time. Or if you happen to be someone who works from home or, you know, has a moment where you can just sit down for 30 minutes on the ground, usually that's at home in your living room in front of the TV.

It is this amazing and sneaky mobility practise that is so good for your hips. It's so good for your low back. Like anyone who's suffering from low back pain, it will be uncomfortable when you start doing it.

When we prescribe sitting on the floor for 30 minutes to people who haven't done it in a while, they're pretty shocked that they can't really sit crisscross. But the goal in that 30 minutes is to find a position, be willing to change positions. You know, if you have to have a leg out or if you need to sit on a little bit of a cushion or a pillow, cross your legs, sit 90-90, which is sort of like a hurdler stance, kneel.

You know, we have so many people who report like how much better they feel just from a musculoskeletal standpoint. And also how much better they feel when they actually go out to do their sport or however it is they like to train because they've sort of unlocked this, you know, we call it rewilding our hips in our book, Built to Move. But, you know, one of the people we follow is this amazing author, Katie Bowman.

And she, do you know Katie? Yeah, and she talks about how we, in the same way that we are advised to sort of eat the rainbow from a fruit and vegetable standpoint, we've all heard that term. You know, Katie Bowman talks about how we need to think about that in terms of our movement.

We can't, most of us do like three things. Like we get on our Peloton and we sit on our Peloton and go sort of in this linear thing. And then we like walk to our office and then sit in our office.

And we really don't have very much sort of, we don't have a very expanded movement diet. And one of the things Katie and we recommend is this simple act of sitting on the floor for 30 minutes. And in many ways it feels sort of passive because you can do it while you're doing something else you're already doing like watching TV or working on your laptop or wherever you finally find the chance.

And I just wanna call out what you said about your parents is we had a good friend of ours on our podcast and he and his wife had just had a young child. It was six months old and both of their mothers. So his mother and his mother-in-law came to visit and his mother-in-law was more active.

In fact, she was a gardener and his own mother had really kind of let her health and fitness go and definitely her mobility. And he said it was such a contrast in terms of how they could interact with their grandchild because his mother-in-law was sitting on the floor and playing with the baby and was able to pick up the baby from the floor and stand up and was just so much more able to be interactive with her grandchild. And he was so upset by watching his own mom who really couldn't have that interaction with her grandchild.

She could be sort of handed the baby or grab the baby out of a high chair, but just such a striking difference in just someone who paid a bit of attention to this key skill in life, which is your mobility and someone who didn't and how that manifested itself in their sixties in terms of being able to play with their grandchild.

[Angela Foster] (13:27 - 13:50)
I love that because there's no way sort of, unless you're actively doing it, tracking it in between, but then all of a sudden you realise I've lost this. So sitting on the floor, right? If people want to do this in the evening for 30 minutes, they don't have to sit in one position.

What you're saying is Neil, I mean, that actually does a really nice quad stretch, moving around different positions, cross-legged for a bit and just building up their tolerance or is the idea to be in multiple positions?

[Juliet Starrett] (13:50 - 14:46)
Yeah, the idea is to be in multiple positions. Every one of those positions is great. And especially for people who haven't, who sort of lost this skill of floor sitting, it will, you will feel stiff and uncomfortable at first.

So you will have to, I mean, people who haven't been sitting on the floor will have to move. They won't be able to sit in one position for more than like three to five minutes. But we actually think that's great because there's tonnes of value from long sitting just with your legs out in front of you, you know, that hurdler, we call that 90-90 cross-legged kneeling.

So I think the best practise is to be okay, sort of listen to your brain's cue of like, I'm ready to move now, I'm ready to switch positions and do that. And also, you know, be cool. Like when you, if you haven't been sitting on the floor for a while, it's okay if you lean your back against the back of your couch or sit on a little bit of a pillow and just sort of ease your way into this practise that for many of us, we haven't done on the regular since we were little kids in school.

[Angela Foster] (14:46 - 15:25)
I love this. I love the kind of working it in. For me, you know, when I got a standing desk, so this desk goes up and down, that made a really big difference.

It just took pressure off my spine. And then when I'm recording right now, I'm seated so I have a stool. So it's really unstable because it has a kind of cone bottom and I had to build up my tolerance to sit on it.

And then I was like, oh, because you're kind of fidgety naturally on a stool, then I'll bring like my feet up like this so then I can completely stretch out. Do you know what I mean? And see, can I get my heel right into my groyne area?

So it's like, just as I'm working or talking, you can do so much of this stuff. Because I think sometimes otherwise, if we think like, I must set aside 20 minutes a day to do my mobility. For me, that's just never gonna happen.

[Juliet Starrett] (15:25 - 19:50)
You're never gonna do it. Yeah, I mean, you're never gonna do that. And I love what you said about the standing desk.

You know, Kelly and I wrote a book way back in 2015 called, Deskbound, which honestly I think was before it's time. The reason we wrote that book is we were, at the time we were running a physical, we owned a physical therapy clinic and we're running a brick and mortar gym in San Francisco. And what we saw in our physical therapy clinic and in our gym classes, were a lot of people that seem to just be suffering from musculoskeletal pains, aches, tweaks from working out really hard, but then like sitting for 12 hours a day.

And so they had a lot of neck pain, shoulder pain, especially low back pain, anything related to the hips. So we started recommending that people stand more at work and incorporate standing and more walking into their lives. And again, just sort of expanding their daily movement diet, so to speak.

And one of the things that I think we got, I don't know if we got it wrong because we certainly did not overly advocate the standing desk, but people actually were funny. Kelly and I would be in an airport in the years following the release of that book and people would see us and be like, I see you guys are sitting, like kind of catching us in the act of sitting. And what we said in the book and what we've always said is that we are not anti-sitting.

Like, as you said, I'm actually sitting right now. What we are fans of is this expanded movement diet and we're against sitting in a single position for long periods of time. And what I love about what you said about the standing desk and why I prefer standing desks is that we see that people just fidget and move more at a standing desk.

They're more likely to get up and take a little five minute walk from a standing desk. What you're doing, I think, is called perching where you're sort of sitting on the edge of a stool with your legs down, which is much more akin to standing than it is to sitting. So it's a better position mechanically for your body.

We, of course, recommend that everyone have a stool at their standing desk because, you know, the goal is to be moving into different positions. So if I had a hidden camera on me as I work over a workday, you'll see that I spend, you know, maybe an hour, an hour and a half standing at my standing desk. But of course I have a place to put my foot like you do.

I will sit for part of the day. I will, if I'm working at home, I'll sit on the ground for part of the day. But what you don't see me ever doing is sitting for like four continuous hours in a row in a single position.

I'm always figuring out how I can move, change positions, think about my next position, change my workspace. And then for people who, you know, and I get it, there are some people who have jobs where they have to sit, like if you drive a bus or, you know, you're a police officer, that constant movement can be more challenging. But in those cases, then I recommend people say, okay, set an alarm every 20 minutes or 30 minutes and stand up and do a few air squats or, you know, walk around your office a little bit or just sort of schedule in more movement.

It's interesting because there was actually a study that showed that for typical office workers, that many metrics of health for smokers were better than often many office workers because smokers, because nobody can smoke inside anymore, were actually getting up out of their chair four or five times a day, walking outside, going outside somewhere, so moving their body, smoking, which is obviously bad, I'm not advocating for that, but then walking back. And so they saw these metrics of health in many ways were better absent the smoking because those people are actually getting up and moving all the time. So I, again, I love the standing desk.

I love how you've approached this, which is figuring out ways to set up your environment with a standing desk in a way that cues you and encourages you to move a lot throughout the day versus like saying, okay, Angela, you have this limited amount of time in life and now I'm expecting you to go to a one-hour mobility class. Nobody's gonna do that. But there are a billion ways you can fit it into your life and pay attention to it.

And I feel like you are the best student ever. I mean, with this like squatting to pick up things off the ground and using your standing desk the way you're using it, like this is the way and it doesn't need to be fancy.

[Angela Foster] (19:50 - 20:23)
It definitely doesn't, I agree. And I think for people listening to this, the thing I've noticed the most is the energy, the blood flow, the like concentration is better. As you say, also like just even being on the stool now, like I'm more fidgety, I just move more, right?

Which is better for me. And I've noticed that I don't get the same back pain, neck pain, lower back pain, not so much really anymore either. That's one thing actually, a question on lower back that came up from my, I've got a few questions from my community and one was around lower back and how to support that.

I wonder if we could go there a little bit.

[Juliet Starrett] (20:24 - 20:27)
Sure, yeah. I mean, it's a huge issue, huge issue for many people.

[Angela Foster] (20:28 - 21:20)
Yeah, huge issue. And I think that as I've noticed that as we get older, when I think about training in the gym, this affects our exercise, just you can feel more vulnerable to back pain after things like deadlifts or squats than you were before. And definitely something I've noticed, and I was actually having a discussion with one of my clients about this earlier, sometimes actually using a machine, if you really, really wanna load your glute muscles or something like that can be better because you're sort of inhibited to a degree by going that heavy by things that will hold you back like grip strength, or for example, how much load you can take on your back if you've had, I had a couple of prolapse discs. So I'd love to understand from you how we can support and protect against back pain and whether we should have any concerns about loading our spine. I hear it's very good for bone density with things like deadlifts.

[Juliet Starrett] (21:20 - 27:14)
So I'll start with this sort of strength and conditioning piece and loading the spine. And I am, of course, a huge fan of strength training. I think it's one of the greatest things that have happened in the last 10 years in fitness, especially that more and more women are strength training.

I really believe we need to actually load in order to build our bone density and create muscle mass. But I think we have too much, sort of binary thinking in the health and fitness space and strength and conditioning is no exception where everybody gets on there like this one way to do things. You've got a progressive load or you, people get stuck on these ideas in strength and conditioning.

But interestingly, ACSM just came out after 30 years, just updated its position on strength training. And this is a U.S. sort of strength and conditioning governing body. And they just updated their sort of guidance on strength training.

And what they found in this huge review of the literature is that there are many roads to roam when it comes to building strength and bone density. There's not one way to do it. So I, for one, have a long tradition of athletics and I owned a CrossFit gym for 20 years.

I'm very comfortable with more complex weightlifting movements like deadlifting and clean and jerking and some of the Olympic lifting movements like snatching and the more speed power movements. But what the ACSM came out and said is like, hey, there's actually no difference if you wanna use a machine versus free weights, if you wanna do more CrossFit style training versus like five by five traditional, progressive overload training that there are a lot of ways to build bone density and get strong. So I'll start by just saying that for anyone who feels, because I have a couple of friends who have very tweaky low back, and because your low back is connected to your nervous system, it can make you feel very, it's different from knee pain.

You can kind of work through knee pain, but if you have back pain and are loading your back, there's a sense, as you mentioned, a sense of vulnerability that's like no other. So I am definitely a fan of moving someone like that into more machine type work, leg press or using the sort of technology we have to stabilise the spine, eliminate that sense of vulnerability and still get that adaptation of strength on our muscles and our bones. So we'll start with that.

The second thing is when it comes to low back pain, there's two things. First of all, going back to what we started with, sitting on the floor for 30 minutes a day is already going to be a big changer for low back pain for people, because oftentimes low back pain isn't really being caused by the low back. It's actually, of course, because we are a system of systems, we have muscles that are crossing our joints in multiple ways.

And so one of the things we see, and it's become a joke in my family because my husband Kelly is obsessed with this, and that is something called hip extension. It's your ability to put your knee truly behind your butt. This is something we see in running and walking.

It is a fundamental skill and one that many of us have lost because we are sitting all the time or most of our days in hip flexion. So missing key hip extension is it can be a driver of low back pain. And we have something in our book, our book Built to Move called The Couch Test.

You can also find it on the internet if you just type in couch stretch and starrette, you'll find this, tonnes of videos about how to do this. Go ahead and try to do, if you're someone who struggles with low back pain, go ahead and try to test yourself on this couch test, couch stretch. And if I'm a betting woman, I'd say that most people who are struggling with low back pain are also missing a tonne of hip extension.

So this may be, in addition to sitting on the floor, an area where you need to give your body a little more love and attention and sort of counteract all the sitting and hip flexion we're doing in life. And the other thing I would add to this is that my husband, Kelly, who's a physical therapist and a very well-known one, people often travel from far to see him. Low back pain is one of the things that he sees people for.

And the first question he asks people who have low back, first two questions he asks them is how much do they move? How much do they walk? And how's their sleep?

So because I know you have a very health conscious audience, I think sometimes it's easy to disconnect pain from movement or sleep. But one of the things that happens with poor sleep is we become more sensitised to pain. And so sleep is definitely a factor in low back pain.

And also movement. We often are exercising for one hour a day and then sitting for the rest of our day. Not you with your amazing standing desk and fidgeting practise.

But total movement really does matter. And so Kelly would really initially before he put his hands on anyone with low back pain would sort of get a sense of how's your sleep? How much walking are you doing a day?

Are you getting enough total movement? And then he would look at their hip extension, probably prescribe them to do the couch stretch on the very regular and have them sit on the floor. Those would be the most basic things that I would suggest people look at.

And then figure out ways to continue to load that feel safe and protected while you're in that vulnerable state.

[Angela Foster] (27:15 - 28:07)
Well, link to that couch stretch. That's really interesting. Do you know what I find interesting as well?

And I'd love to see if you agree with this is, I think in order to move throughout your day, right? Is this concept we had of like, oh, I've been to the gym, therefore I don't need to move is actually don't leave everything on the gym floor because your body has this kind of, don't spend the whole budget is what I would say. Because your body has this sort of budget that it tracks internally of how much you've moved and how many overall calories you're burning.

And so if I do, and don't get me wrong, I have very heavy leg days, but what inevitably happens is that I just notice I'm naturally then moving less and that can then contribute to pain. So for me, certainly as a midlife woman, and I'm 50 now, I found that actually kind of spreading things across the week. So I have hard days, I have easy days and I leave a bit in the tank for some movement has made a massive difference to me being kind of relatively pain-free.

[Juliet Starrett] (28:08 - 30:15)
Yeah, I mean, we saw that for years, we owned a CrossFit gym and we saw people just come in and smash themselves in workouts and then be totally exactly like you, like unable to move. In fact, sometimes unable to even come back the next day to train because they blew themselves out so much the day before. So I agree, I think we have sort of like these sort of, I don't know if it's like fixed number of like energy nuggets, so to speak as humans.

And we do need to figure out how to spread those out. And there is tonnes of research and data to show because everybody is so focused on longevity and long-term health, that total daily movement is really important. And we got, I think one of the messages that we got wrong in fitness was telling people that one hour, you could train for one hour, check the box and then sit for the rest of the day.

That's not how humans are designed. Humans are designed to move and move a lot. I don't know what it's like for you in London, but in the US, it's like the only place where we see people getting enough movement are people who live in like downtown, in Manhattan or in the middle of a big city.

And these are people who are sort of forced to walk as part of their daily living. But at most places in the US, it's like people train for an hour and then they get in their cars and they sit for the rest of the day. So I think you're right.

I think we wanna, we do need to train hard. We do need to breathe hard, but we also need to save up enough energy to make sure that we're walking enough throughout the day, that we're getting enough total movement, that we actually have this psychological energy to say at the end of the day, I'm gonna sit on the floor for 30 minutes versus be a blob here on the couch, right? So part of it is this sort of psychological energy that we all need to tap into because we all have so much going on in our lives.

And so I agree with you. I think we need to train hard and we also do not need to smash ourselves to the point where we can't train the next day and can't get enough total movement.

[Angela Foster] (30:15 - 30:42)
Yeah, such a good point. And when we look at perimenopausal women, this is often when women start to experience more joint pain as estrogens kind of fluctuating and then dropping, they're seeing more inflammation. You know, some conversation with someone earlier today about how she was feeling like her knee feels like you can almost hear the crunching.

It's almost like- Right, yes. What's going on with our joints and our health and our mobility during that peri to postmenopausal transition?

[Juliet Starrett] (30:43 - 34:33)
Yeah, so there, and I can probably send a link to this so you can include it in your show notes, but my favourite piece of work on this, and it is dense, is Dr. Vonda Wright was involved in a really important paper called the Musculoskeletal Syndrome of Menopause. And it's insane to me because, as I mentioned, we owned a gym and a physical therapy clinic for nearly 20 years. And it was, this was not something that we all really knew about and talked about.

And our physical therapists weren't really that familiar with it. And, you know, thankfully there's just been this huge surge of information and support and resources around perimenopause and menopause in the last five years, which is like, yes, it makes me so excited. And one of the downstream impacts of perimenopause and menopause is musculoskeletal pain and injury.

And that's where I would double down and say, this group of people may need to spend a little more attention on their mobility. Because, you know, certainly there's now much more access to hormone replacement therapy, but that's not gonna be a perfect solve for the musculoskeletal syndrome of menopause. And not everybody can take that or has access to that.

And so, you know, one of the things I see most commonly in women in perimenopause and menopause is shoulder issues, right? There's so many women I know who have frozen shoulders, shoulder issues. It's like one of the first things I see pop up in perimenopause and menopause.

And this is a side point I'll make because I think we have all gotten into strength and conditioning. And as I said, there are many ways to roam. But one of the ways that I look at strength and conditioning programmes in terms of whether or not they are, you know, sort of good, better, best in terms of best is does your movement practise and strength and conditioning programme require you to touch all of your normal ranges of motion?

Does your strength and conditioning programme, for example, require you on the regular to put your arm over your head or your arm behind your body? Or does it require you to touch things like hip extension? And so again, I think that's not something people usually think about.

They just think about a strength programme like I'm here to build my muscles and my bones and they disconnect movement from their strength and conditioning practise. And one of the best ways to avoid or ameliorate the musculoskeletal syndrome of menopause is to be involved in a strength and conditioning programme that actually asks you in by way of various strength and conditioning movements to touch all of your native ranges of motion so that you continue to have access to those and are less likely to feel aches, pains, tweaks, losses of range of motion. And it really can make a difference because, you know, again, nobody really wants to do a one hour mobility class, but people are already exercising.

They've carved out that time. So I think people should ask themselves like, does my strength and conditioning programme ask me to put my hip into extension, hip extension? Does it ask me to hang from a bar?

To me, all women over 40 should be hanging from a bar as often as possible to maintain their shoulder mobility and strength. Does it ask me to challenge my ankle range of motion and all of this sort of native shapes of the body? And to me, that's one simple way to retain access to those positions and try to avoid as many of the musculoskeletal challenges of perimenopause and menopause.

[Angela Foster] (34:33 - 37:07)
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Thank you, Julia. I think one of the things that I was thinking about when you were saying that is when I had disc problems in my neck, a physiotherapist was saying to me, well, just don't do anything over the neck. And it was actually the worst piece of advice because what happened was it got worse, right?

It just got worse because if you're not using it, it gets worse and worse. So then when I started working on like strengthening my upper back, you know, some of the postural muscles that help and then doing overhead movements, as you were saying, hanging from a bar, but then lifting at first just my arms overhead, right? And then away and doing higher ups and improving the blood flow and doing lateral raises and things.

I got stronger and stronger. My neck pain went away. And now, you know, I can do very heavy overhead stuff.

But when I actually limited the movement, what happened was it was just getting a whole lot worse. Yeah. And you feel that the movement is continuing is really important.

[Juliet Starrett] (37:07 - 39:07)
It's so important. And, you know, of course, it's always striking this balance because, you know, injuries can be so different. And I do understand, you know, I sometimes think doctors get the short end of the stick because, you know, they often tell people, like, don't do that.

And I understand where they're coming from. They're like, hey, if you're doing a thing that's causing you pain, don't do that thing, right? Like the logic is clear.

But again, for most of us, it's more complicated than that. I couldn't agree more. I think there are so many ways, even around musculoskeletal pain that you can find ways to move and strengthen and sort of build a scaffolding around your skeleton in the form of muscle that actually can do things like improve neck pain or improve low back pain.

And so again, it's always striking a balance because you don't want to overdo it and further tweak something. And you want to protect, you know, your spine and your neck and all of your tissues. And at the same time, I agree telling people not to move is the worst piece of advice.

Like, I can't tell you how many people we've had in our clinic who have been told by someone like, well, just don't move. And that's not, to me, that is not, there's always a way you can move. There's, you know, we became experts in three limb training at our gym because we always said, I don't care if you have a cast on one leg or, you know, your arm is in a cast or you just had shoulder surgery, like still come to the gym.

You know, if you just had shoulder surgery, you can sit on a bike. You know, we love these things called assault bikes. They're those bikes where they have like the arms and the legs.

And we tell everyone like, look, if you've had a surgery of any kind, like buy one of those or find a gym that has one because you can three limb train. You can die on the assault bike, three limb training. So yeah, I'm never a fan of the stop moving advice.

There are so many ways to move and keep moving even amid physical challenges. And I love how you, you know, took this sort of neck pain and realised actually if I build up my strength overhead that I can actually eliminate that and get strong. It's amazing.

[Angela Foster] (39:07 - 39:39)
Thank you. I think it was just getting so much worse. I was like the not moving it, you know, not loading it, wasn't working.

What was really interesting there when you were talking about this three limbed leg movement is I saw some research around where they were getting people to do, I can't remember if it was a leg extension or what exercise it was, but it was only on one limb. So they weren't doing both legs, but then they saw hypertrophy in both legs. So there's kind of some systemic benefits as well, right?

By exercising and doing what you can, you're getting systemic benefits across the body. I love that. With injury, which should continue, right?

[Juliet Starrett] (39:39 - 40:52)
Yeah, I mean, I love that. And I agree with that, exactly. There's a systemic benefit and, you know, people get really, I think, unnecessarily worried in strength and conditioning about like imbalances, right?

Like we have a woman in our, we run a strength and conditioning programme called the Starrett System. And we have a woman who's struggling with a shoulder injury right now. And she really wants, she can lift, you know, a heavy dumbbell overhead with her left arm, but not really with her right arm, you know?

And so what we've said is, okay, you should still move your shoulder, but you don't want to do it at speed and you want to limit the load. And she was really worried about creating this imbalance. Like I'm going to have this really jacked left arm and my right arm is going to become atrophied and weird.

And, you know, first of all, humans naturally have imbalances, right? Like we're all right-handed or left-handed. We bias certain sides.

We really have not seen in, you know, like thousands of patients and people we've worked with in our gyms of like some sort of supposed imbalance really causing problems for people. What does cause problems is not moving. So it is, in our view, always better to move with what you've got than worry about some future imbalance that might be created by training with three limbs or lifting heavier on one arm, that kind of thing.

[Angela Foster] (40:53 - 41:12)
Interesting. You mentioned a moment ago about every woman should spend some time doing a dead hang. What are the, if we think about someone going to the gym or even if they've got things at home, right?

Maybe they've got the hanging bars in the garden for the kids. What are some like five or six things that you think we should make sure we're doing every week?

[Juliet Starrett] (41:13 - 43:42)
Man, okay. So sitting on the floor, I would say that. I'm gonna start this.

Yeah, I'm like sitting on the floor for 30 minutes a day. I would definitely say incorporating some hanging into your life. And let me qualify that because a lot of people can't hang right away.

I mean, the best case scenario is trying to be able to do some pull-ups or a pull-up, but often people can't do that. There's so many ways to scale hanging. You can even hang off of a pull-up bar, but have your feet on the ground and still have the offsetting like 90% of your weight and still be getting into that full overhead hanging position will do wonders for your shoulders.

And I'm a total fan of those door-mounted pull-up bars, having one in your house, because if it just means that you're gonna walk through it and every time you walk through it, you're like, okay, I'm just gonna hang for 10 seconds. I love that. But yeah, I would incorporate hanging.

I would either practise the actual couch stretch or I would make sure that your strength and conditioning programme includes things that involve hip extension, like a Bulgarian split squat or a split squat isometric, making sure that you are practising having your knee behind your butt. I would include that. I am such a fan of walking.

I'm a fan of walking 8,000 steps a day. I think there is a study that showed that walking 8,000 steps a day reduced your all-cause mortality by 51%, which is a number I'll take, like it's a yes for me on that. So I'm all for walking.

And then I don't know if I've gotten it, but I think thinking about, this isn't one thing, but I love what you've done is thinking about the small ways that you can add in and expand your movement diet in your day without going to another fitness class. Is that having a really awesome standing desk set up so that you're fidgeting and moving more? Is it making those kinds of choices, like you said, to squat down when you drop something off the ground or put your shoes on on one foot or stand on one foot while you're brushing your teeth?

So that's not really one thing. I think that's sort of like a broad thing of like, think about the micro ways where you can add in movement and sneaky mobility practises into your life that don't involve you doing something more. So those would be the things I would say.

[Angela Foster] (43:42 - 44:04)
Thank you. I love those, Julia. And what you're saying there about, standing on one foot and putting your sock on as well, it gives you a ready check of how is my balance instead of you getting to older age and then you're falling and you don't have good balance because you know day-to-day is my balance good.

And if you're doing it every day, you'll maintain it. Like it makes such a difference and it's an easy thing. You're gonna put your socks on anyway if it's not summer.

[Juliet Starrett] (44:04 - 44:19)
That's why I love it. It's like, I'm putting my shoes on today anyway. I may as well gamify it and see if I can do it on one foot, you know?

And there's, you know, you can do it next to your bed or next to a wall. So you make sure if you get a little, you know, have something to catch yourself. But I love that practise.

[Angela Foster] (44:19 - 44:59)
I do it every day. Thank you. And from a mobility perspective, if we're looking at kind of, I guess whether there's anything specific, like a routine that you think we should run.

I mean, it must be different for everyone because I noticed with my husband, I'm sure he's not gonna be saying this, like he foam rolls. I should, but I rarely foam roll. I just find that maybe because I'm working this stuff in, I just don't feel as tight.

Whereas I think he's, you know, commuting to London. He maybe spends more time at his desk and thinks he has to do that. Should we all have a sort of regular mobility practise or something in the, are there benefits to us doing that?

Or is it more on an ad hoc basis?

[Juliet Starrett] (44:59 - 47:34)
Yeah, I mean, honestly, we, you know, we've been running, we have an app called Mobility Coach where we have these daily follow along videos. And in my ideal world, if I could wave a wand and have everybody do a 10 minute follow along mobility video a day, I think we would have far less musculoskeletal pain and injury out there. And people would be able to do much more.

I also understand that it is, you know, we are all maxed. We have so many things we have to do. It's really hard to add that in.

I would say though, for people who are struggling with any kind of musculoskeletal pain or recovering from injury, it's a must. I think, you know, there, you know, if you have noticed that you've lost key ranges of motion or you are struggling with pain or injury, a really good mobility practise can help. Doesn't need to be head to toe all the time.

You know, head to toe would be nice, but it can be just a matter of, you know, you are aware that your hips are stiff and you're gonna sit on the floor for 30 minutes, but then maybe you're also going to, you know, smash your quads with a foam roller, or you're going to put a ball into your low back because, hey, you're already on the floor and you struggle with low back pain, or your T-spine's really stiff, so you're gonna spend some time working on your T-spine. So I do think we've found that people don't often wanna do a mobility practise until they need to.

And then once they need to, they fall in love with it and realise it's something they wanna keep doing. And usually the need to is pain that cause, that brings them to it. So, you know, again, I wish I could get every 28 year old to care and wanna do 10 minutes of mobility every single day.

And I wish I could tell them that their future self would thank them, but it's hard to get people to care. So yeah, I mean, I think in an ideal world, people would spend 10 minutes a day working on their mobility. It does not need to be an hour.

It does not need to be a whole class. It does not need to be head to toe. It can just be, you know, saying, hey, this part of my body feels a little stiff and sore, or I noticed when I was doing my overhead press, I didn't feel like I could achieve the position as well.

So tonight I'm gonna spend 10 minutes working on my shoulders. Again, I think we would all be experiencing a lot less musculoskeletal pain and be less prone to injury in our sports and activities if we did that. And, you know, 10 minutes a night is enough and add that to, you know, if you're already sitting on the floor for 30 minutes and you just so happen to have a little basket of mobility tools on the ground, you're way more likely to do it.

[Angela Foster] (47:34 - 48:02)
Yeah, that's the thing. If you're on the floor anyway. Last question for you, because I know everyone is obsessed with, how can I improve my HRV and my sleep metrics?

Do you see a correlation? I know you talk quite a bit about sleep. Do you see any correlation between people's flexibility and mobility and loosening off that stress that's stored in the body and their nervous system health and their sleep metrics and HRV?

Well, yes and no.

[Juliet Starrett] (48:02 - 50:45)
Yes, I do see that total amount of sleep and life stress can have a direct correlation to things like low back pain for the reason I mentioned earlier that, you know, poor sleep makes us more sensitised to pain. So if we have had a night of poor sleep, we are gonna feel our pain more than we do than after a night of great sleep. So just as a thing right there.

What I don't like about heart rate variability, now I have been, you know, Kelly and I run a programme called the Starrett System where we coach, we have a strength and conditioning and longevity programme for people over 40. What I don't like about heart rate variability, it has become this metric in my view that is just plain a source of stress for people. And we do not need more stress in our lives.

It does not seem to be a metric that a lot of people have been able to make a huge meaningful impact in improving. Seems to be largely driven by genetics. I think the way to look at heart rate variability is what is mine?

I shouldn't compare it to my friends. And then maybe you can look at your own trends. So if your average heart rate variability is only 30, you don't need to freak out and hire 27 longevity coaches and think you're gonna die for sure.

What you need to say is, all right, my average heart rate variability is on the lower side. I need to take note when my heart rate variability drops to 15 or way out of norm, but I don't need to obsess over it. So I see a lot of, they've actually created a term now called orthosomnia, which is you have an unhealthy relationship with like sleep and sleep tracking.

So I feel like heart rate variability in my experience has become one of those metrics. I think a way better metric to track is your resting heart rate. You can tell from your resting heart rate, usually whether you're gonna get sick, or whether you went to the pub the night before and drank a bunch of drinks or ate too late.

So I think that's a way better metric to track if you're gonna track. But I am starting to see more and more people who are having an unhealthy relationship with sleep because of their tracking. So I think that's a balance we have to strike.

I think there's tonnes of great information to learn. In our programme, what we recommend is that people lay in bed for eight hours, don't look at their phone, and don't worry about tracking. You know, total amount of sleep and laying in bed, even if part of that laying is just resting is so good for the body and for the nervous system.

So huge, I couldn't agree more that sleep is so critical and I think we do have to make sure we're not obsessing over it and creating disordered thinking and behaviour around our sleep, which I see a lot in my own clients.

[Angela Foster] (50:46 - 51:21)
Because I think people can become so obsessed, can't they, with trying to improve their metrics and comparing HRV with other people as well. I love the work that they've done over at Weep recently, where they looked at the coefficient variation of HRV across seven days. Because it's like, and also thinking about, as you said there, Julia, you know, it's almost like, what's my genetic potential?

What is a really good HRV for me and how can I get closer to that? And am I kind of spiky and not managing it? Because if it's more stable of seven days, you're managing that load, right, with the recovery is more useful than trying to compete with, if yours is 30, your friend who's got one of 120.

[Juliet Starrett] (51:22 - 52:12)
Right, yeah, and I saw that whoop data too and I thought that was so valuable, right? It is, it's sort of like, okay, can you try to keep your heart rate variability as stable as you can? And, you know, that's a way better way to track it.

It's just based on you, just looking at comparing you versus you, your own where you are and seeing if you can stabilise that. And same, I would say the same is true with resting heart rate. I think that's another great one to look at if you're a tracker.

And then, you know, I think also if you find yourself obsessing over it or stressing or waking up and looking at your scores on your whoop or your aura or your Garmin or whatever, and you feel all stressed about it, it's probably time to cast your tracking device away for a while. You know, we're good friends with Andy Galpin who has, he's a great guy, researcher.

[Angela Foster] (52:12 - 52:14)
Oh, yeah, he's been on the podcast.

[Juliet Starrett] (52:14 - 53:10)
Yeah, and he has a company called Absolute Rest, which is cool, you know, they help analyse and help people improve their sleep. But one of the things they do is they say, okay, yeah, we're fans of tracking, but we're not fans of you getting to see your data. So if you go work with Andy Galpin and his team at Absolute Rest, you track your sleep, but the data is hidden from you.

They see the data, you don't see the data because they have found that the more you see your data, the more you're like, oh, getting all stressed and worried about how you don't match up. And oh my God, like my heart rate variability was 12 today, like how will I function at my job and all of this orthosomnia, as they call it. And so again, I really struggle because I love to track, I have an Oura ring, I have a Garmin, I'm tracking everything all the time, I'm a fan.

And at the same time, I see it can really work at cross purposes for some people.

[Angela Foster] (53:11 - 53:18)
Yeah, if you become too obsessed with it. Is there anything that I haven't asked you? Is there one thing that you want everyone to know that I haven't asked?

[Juliet Starrett] (53:19 - 53:26)
I don't think so, I don't think so. I hope everybody starts sitting on the floor after this, their hips will thank them.

[Angela Foster] (53:26 - 53:40)
I'm definitely gonna be sitting on the floor after our conversation, 100%. Thank you so much, this has been really good fun. There's just so much in this.

Where can people connect with you, Juliette, and all the wonderful work that you and Kelly are doing and putting out to the world?

[Juliet Starrett] (53:40 - 54:11)
Sure, yeah, we are at thereadystate.com on the internet. Our Instagram is at thereadystate. I also have my side mini Instagram called at Juliette Starrett.

We have a podcast also called thereadystate. And the thing that we're most excited about, professionally, is our programme called The Starrett System, where we teach people over 40 how to eat well and strength train and move a lot and figure out how to just make it easy for them to fit it into their life. So that's what we're excited about.

[Angela Foster] (54:12 - 54:16)
Amazing, we will link to all of that in the description. Thank you so much for coming on.

[Juliet Starrett] (54:16 - 54:19)
Thank you so much, Angela. Thank you so much for having me.

Most women in perimenopause are training hard, eating well, and still dealing with joint pain, stiffness, and injuries that never fully heal. Juliet Starrett, New York Times bestselling author and co-founder of The Ready State, joins me to reveal why the joint pain and stiffness so many women write off as ageing is actually a specific syndrome nobody warned you about. 

We get into what 30 minutes of floor sitting a day can do for your hips and low back, why most exercise routines are silently narrowing your range of motion, and the five weekly movement non-negotiables Juliet recommends for every woman over 40.

WHAT YOU'LL LEARN

• Why perimenopause triggers joint pain, frozen shoulder, and mobility loss

• How 30 minutes of floor sitting a day rewires your hips and reduces pain• Best movement habits for women over 40

• How strength training may be stealing your flexibility over time • How to train through injury without making it worse

• The HRV myth debunked and what to track instead