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Dear Mark: Can’t Squat, Please Help; Plus, High CRP, No Symptoms, and Glutathione

Posted By Mark Sisson On December 3, 2012 @ 8:00 am In Dear Mark | 55 Comments

In this week’s edition of “Dear Mark [7],” I answer two reader emails that end up being more like three questions. First, I try to help out Alex, who’s having trouble reaching full depth in the Grok squat without falling over backwards. This is a common issue, believe it or not, and luckily there are some pretty simple fixes that people can try. In my response, I explain why he might be toppling over and what he can do to fix it. After that, I answer a question about C-reactive protein, the “inflammation” marker. One reader is feeling great and sitting at an ideal body weight, but a recent blood test in which CRP was elevated has worried her. She wants to know what she can do about it, so I explain why it might be elevated, why it might not be an issue, why it might be one, and what she can do to boost glutathione, which her doctor recommended she increase.

Let’s go:

Hi Mark,

I’m having trouble with the Grok Stretch.

I feel like I’ve read everything I could find about how to do it properly and watched all the videos you have available, but I can’t get down there without falling over.

What I’m wondering is: is my balance issue just one of my muscles and joints needing to be accustomed to the stretch? The reason I’m curious is that you describe it over and over as a “relaxation”, that is, I shouldn’t be contracting my muscles or leaning forward on the balls of my feet. Rather, I should just relax and sit back and be comfortable. My problem is that when I get down into the position where my heels are on the floor and I’ve got my center of mass lined up properly, I can’t not fall over backward. I can hold it for maybe 10 seconds tops, but, when I do that, my muscles are all very tight and it’s clearly not relaxing.

If you have any thoughts, they’d be very much appreciated!



I can think of two things that may be impeding your progress: your calves are tight and you’re trying to maintain a vertical torso. Most people who spend any time wearing shoes with heels (even slightly pronounced ones) probably have tight calves. When your heel is elevated, whether it’s because you’ve raised up on your toes or you’re wearing a shoe [8] with heels, your ankle is in a state of plantarflexion [9], or moving toward an angle greater than 90 degrees. When your ankle is in plantarflexion, your calf is contracted and “shortened.” Calf raises also put your ankle into plantarflexion in order to target and work your calves. If you’re just walking around in some tennis shoes with a half inch or two of heel, your calves are going to languish in mild contraction and, over time, this contraction can be a semi-permanent position for your calves.

When you try to squat with tight calves, you run into problems. You’ll naturally want to shift enough body weight forward to maintain your balance over your feet, but this requires ample amounts of ankle dorsiflexion [10] (angle less than 90 degrees). If your calves are too tight, you won’t be able to dorsiflex your ankle, and your knees won’t be able to travel forward enough to shift a sufficient amount of bodyweight forward to maintain balance. Tight calves force you to keep all the weight on the back half, causing you to fall backward.

Second, you’re probably trying to maintain too vertical a torso. This is understandable, because so many people talk about the need for a neutral spine when squatting, and that gets mixed up with a vertical spine.  Squatting is all about balance, and counter balance. If you’re squatting and want to keep an upright torso, you need full ankle dorsiflexion, particularly if you have tight calves. Otherwise, all the weight will stay in the back, and you’ll fall over. If you ever watch Olympic lifters doing a front squat [11], their backs are only able to stay vertical because they’re able to push their knees far ahead of their toes; this allows them to maintain balance. That takes flexible calves – flexible enough to allow full dorsiflexion at the ankle and a knee forward position. If they tried to keep a vertical torso with tight calves, vertical shins, and knees behind the toes, they would fall over, just like you’re doing. Does that sound familiar? Watch what happens to this guy [12] when he tries to squat – is that you?

Going up onto your toes is a lot easier because it elevates the heel, reduces the need for full ankle dorsiflexion, and makes it easier to maintain and upright torso, which is why most Westerners must default to a toes down, heel up squat. There’s nothing wrong with doing that kind of squat as long as it’s unweighted, but you want to have enough flexibility to sit in a full heels down squat, too.

  • Reduce the time you spend in passive ankle plantarflexion.
  • Start wearing minimalist shoes [13] with a zero-drop heel, or go barefoot [14] more often.
  • When you sit down, try to keep your feet flat on the floor. Too often we point our toes to the ground and elevate our heels.
  • Mobilize your calves.

You’re gonna have to stretch and mobilize your calves [15], particularly if you continue to plantarflex your way through life (hey, sometimes you just wanna wear some nice heels). This is the best calf stretch [16] I’ve found (skip to around 3:00 for the actual stretch, if you’re short on time). Here’s an article [17] describing it, with plenty of helpful pictures. Try the stretch for two minutes for each calf, with knee straight and bent, and see how it affects your squat.

I’d also recommend you practice sitting deep into a full squat while holding onto something in front of you for stability, like a pole as in the picture above. By holding on to the pole, you provide an external counterbalance and eliminate the need for an internal counterbalance. This allows you to really accentuate the ankle dorsiflexion; you can almost pull yourself into it and really stretch those calves and get used to being in a proper squat. Make sure you keep those heels down or you’ll lose the stretch.

Also, a Grok squat [18] stretch doesn’t have to be perfect. Your back probably won’t be totally vertical, and that’s fine. You might lean forward. The lower back might even round! Don’t stress over it. Even the pros let their backs round [19] at the bottom of a bodyweight squat. However, let me make this clear: your lower back should not round on weighted squats.

Dear Mark,

I have been primal for over two years and I feel great. My weight is perfect and so is pretty much everything – that is until I got my blood tests done (by a primal doc!). All results came back in glorious primal fashion except my inflammatory numbers! My CRP was 7.4 (optimally it should be below 1.00). My other inflammation/oxidation numbers were also high. The thing is I have no symptoms. My doctor recommended taking whey because it helps the body produce Glutathione, the body’s master anti-oxidant. The thing is, I dislike taking it. It feels processed and not the whole food I am used to. Is there a better way to get Glutathione into my body? I know supplements aren’t supposed to work that well…and any other ideas to bring down the inflammation? Thank you!


That is an interesting case. Elevated CRP is potentially worrisome, I agree, because it’s a sensitive barometer [20] of any kind of inflammation [21] occurring in the body. You sprain an ankle, CRP goes up. You get an infection, CRP goes up. You run a marathon or do an intense CrossFit WOD, CRP goes up. You get a cold or the flu [22], CRP goes up. You have an autoimmune disease flare-up [23], CRP goes up. It could be multiple sclerosis [24], or chronic stress, or acute stress [25], or sleep apnea [26], or almost anything. So, CRP going up can mean something very bad, or it can simply represent a transient, benign increase [27] in inflammation due to exercise or a single bad night’s sleep. It’s nothing to freak out about, but it’s definitely something to investigate.

Did you have a particularly intense workout prior to the test? CRP levels can be significantly elevated 24 hours after physical exertion, so this may be confounding the results. One study [28] – in marathoners – even found that CRP levels went up 2000%. Other inflammatory markers were also affected.

You may have a variant in the “CRP gene” that predisposes you to higher CRP numbers without any additional base inflammation. Folks with the variants effectively have a CRP set point 64% higher than “normal” folks [29]. So, a 7.4 CRP in one of these people might be equal to a 1.0 CRP in a “normal” person, even though they have the same “level” of inflammation. In fact, a recent study showed that although people with genetically high CRP numbers are theoretically at a greater predicted risk of developing heart disease when you go by the traditional understanding of CRP, those genetic polymorphisms themselves are not associated with increased risk [30]. Their inflammation isn’t necessarily higher; their CRP is just hyper-responsive.

And finally, the blood test [31] you just got was a snapshot in time. Far more troublesome would be an upward trend of CRP, or a perpetually elevated reading. So, get another test done in a few weeks, and maybe a couple more at regular intervals to see if your elevated reading was a trend or just a momentary blip. Judging from your subjective results, I’d lean toward it being an aberration, but that’s just a guess.

As for boosting glutathione, whey protein is a good way to do it [32] because of its cysteine content. Raw whey proteins [33] are even better, and raw egg whites [34] (from trusted sources) can do it, too. Cysteine is an amino acid and a precursor to glutathione synthesis, but whey isn’t the only source. N-acetyl-cysteine, a relatively inexpensive supplement, has also been shown to boost glutathione status [35]. (My Advanced Health Formula [36] and Damage Control Master Formula [37] contain it.) Good sleep matters, too, as melatonin can increase glutathione production [38].

That’s it for today, folks. Thanks for reading and keep the questions coming!

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[7] Dear Mark: http://www.marksdailyapple.com/category/dear-mark/

[8] shoe: http://www.marksdailyapple.com/do-mbt-skechers-shape-ups-reebook-easytones-barefoot-toning-shoes-work/

[9] plantarflexion: https://www.google.com/search?q=plantarflexion&hl=en&safe=off&tbo=d&source=lnms&tbm=isch&sa=X&ei=giC5UO6JNuK2iwKIpoGIBQ&ved=0CAcQ_AUoAA&biw=1872&bih=1079

[10] dorsiflexion: https://www.google.com/search?q=dorsiflexion&hl=en&safe=off&tbo=u&tbm=isch&source=univ&sa=X&ei=8SC5UP-rHKn5igLA_4HYCw&ved=0CDYQsAQ&biw=1872&bih=1079

[11] front squat: http://www.catalystathletics.com/workouts/images/120827-steveFrontSquat.jpg

[12] this guy: http://www.mobilitywod.com/2012/02/tight-ankles-bad-squatting.html

[13] minimalist shoes: http://www.marksdailyapple.com/merrell-new-balance-barefoot-shoes/

[14] barefoot: http://www.marksdailyapple.com/how-to-prepare-for-barefooting/

[15] mobilize your calves: http://www.marksdailyapple.com/how-to-improve-wrist-and-ankle-mobility/#axzz2Dl71iLnJ

[16] best calf stretch: https://www.youtube.com/watch?feature=player_embedded&v=e4cpBBDVGGU

[17] article: http://sanfranciscocrossfit.blogspot.com/2008/11/your-calves-are-tight-bro.html

[18] Grok squat: http://www.marksdailyapple.com/how-to-proper-squat-technique/

[19] pros let their backs round: http://www.crossfitriseabove.com/wp-content/uploads/2012/02/asian_squat.jpg

[20] sensitive barometer: http://www.marksdailyapple.com/how-to-tell-if-youre-inflamed-objective-and-subjective-inflammatory-markers/

[21] inflammation: http://www.marksdailyapple.com/what-is-inflammation/

[22] get a cold or the flu: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1326064/

[23] autoimmune disease flare-up: http://www.ncbi.nlm.nih.gov/pubmed/22684398

[24] multiple sclerosis: http://www.neurology.org/content/65/1/153.abstract

[25] stress: http://www.marksdailyapple.com/hormesis-how-certain-kinds-of-stress-can-actually-be-good-for-you/

[26] sleep apnea: http://www.ncbi.nlm.nih.gov/pubmed/22754038

[27] it can simply represent a transient, benign increase: http://www.marksdailyapple.com/makes-my-blood-boil/

[28] study: http://content.onlinejacc.org/article.aspx?articleid=1136616

[29] 64% higher than “normal” folks: http://www.ncbi.nlm.nih.gov/pubmed/19533498

[30] genetic polymorphisms themselves are not associated with increased risk: http://www.ncbi.nlm.nih.gov/pubmed/18971492

[31] blood test: http://www.marksdailyapple.com/blood-test-markers/

[32] whey protein is a good way to do it: http://www.ncbi.nlm.nih.gov/pubmed/12537959

[33] Raw whey proteins: http://www.marksdailyapple.com/workout-break-raw-milk-banana-breakfast-ketosis-in-breastfeeding-and-bikram-yoga/#axzz2Dl1tzksI

[34] raw egg whites: http://www.westonaprice.org/blogs/2010/09/11/the-biochemical-magic-of-raw-milk-and-other-raw-foods-glutathione/

[35] boost glutathione status: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129149/

[36] Advanced Health Formula: http://primalblueprint.com/products/Advanced-Health-Formula.html

[37] Damage Control Master Formula: http://primalblueprint.com/products/Damage-Control-Master-Formula.html

[38] melatonin can increase glutathione production: http://www.ncbi.nlm.nih.gov/pubmed/16816830

[39] Primal Blueprint Books: http://primalblueprint.com/categories/Store/Books-and-Media/?utm_source=mda_sidebar&utm_medium=banner&utm_campaign=sidebar_like_article_books

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