Henry Abbott is an award-winning journalist and founder of the Substack TrueHoop. He previously ran ESPN’s 60-person NBA team, guiding it to a National Magazine Award.
This essay draws from his new bookBallistic— a provocative exploration of how we get sports injuries wrong, and what that means for a nation plagued by chronic pain and inactivity.
At the heart of Abbott’s book is a gripping profile of Marcus Elliott, M.D., the Harvard-trained sports scientist who’s flipped physical therapy on its head.
I’ve spent my career as a sportswriter, covering elite players like LeBron James and Anthony Edwards. In that context, I hesitate to call myself an athlete exactly, but I love to move and have done things like run a marathon in under three hours and compete in HYROX events.
Sometimes it hurts. I was born with hip dysplasia, and every decade or so since high school, my back reminds me. I spent the first half of my honeymoon with hips pivoted about 15 degrees left after a spasm. I’ve frequented chiropractors, radiologists, massage therapists, back clinics, orthopedists and physical therapists. I can feel the difference between ibuprofen and acetaminophen.
I’m hardly alone. According to the Centers for Disease Control and Prevention, even before the pandemic 71% of young Americans “would not be able to join the military if they wanted to,” because they’re not fit enough. 12% of Americans have serious difficulty walking or climbing stairs. About 31 million Americans aged 50 or older “get no physical activity beyond that of daily living.” In 1969, half of American kids walked or biked to grade school; in 2009, it was less than 13 percent. In short, we can’t move — and it’s killing us. The World Health Organization says inactivity causes five million deaths a year.
We’ve been through this before. In the 1950s, cigarettes, red meat, mixed drinks and TV-watching inertia were seen as fun parts of a modern lifestyle. That heart attacks claimed lives by the millions was mostly seen as unrelated bad luck. In fact, it was a misunderstanding. Once researchers examined the cardiac epidemic through the lens of the echocardiogram, and it became clear that the crisis followed a decade or so of arterial blood flow slowing through the heart. Now doctors prescribe diet, exercise and medicine for their patients long before they are in severe danger.
Starting after Eisenhower’s heart attack in office in 1955, prevention became standard treatment for heart attacks. Now we prevent them by the million. It’s one of the most successful health interventions of all time; the benefit is measured in millions of life years.
Meet Dr. Marcus Elliott
I just wrote a book, called Ballistic, which tells the life story of a Harvard-educated M.D. who has dedicated his life to preventing sports injuries like we already prevent heart attacks. “The big wins, the big impacts of medical history to this point, they’re all related to prevention,” says Marcus Elliott, M.D.. “Like, all of them.”
Most of us move however we want — or barely at all — until something hurts. “If it gets bad enough, you’ll go to an orthopedic surgeon,” Marcus explains. “They have three options: inject, operate or tell you to just stop doing activities you love.” Our current setup is “a ridiculously bad model,” Marcus says.
After Harvard Medical School, and time at the U.S. Olympic Training Center, the New England Patriots and the Seattle Mariners, Marcus started a clinic in California called P3 Peak Performance Project, which caters to a who’s who of professional athletes. After decades of trying every tool under the sun, the lab has found that injuries communicate themselves through granular movement data — via force plates in the floor and infrared cameras in the ceiling.
We’re used to the idea that “real” medical insight comes from MRIs, x-rays and exam rooms, but those things are as static as the x-rays that were once central to cardiology. You miss a lot when you don’t see how a thing moves. (The morning before he tore his ACL, Derrick Rose’s knee almost certainly would have looked healthy and strong.) Injuries don’t come from lying still in MRI tubes or on doctor’s tables. They come from movement.
Especially from landing. In physics terms, a 90-mph fastball packs about 50 Newtons of force. A professional boxer’s punch around 100. P3 measured one NBA player landing with — and this is not a typo — 11,000 Newtons. Building the strength, mobility and neuroprocessing to handle those forces is not easy, and might be impossible without granular movement data. But it’s also likely the bedrock of sports injury prevention.
When I Became a P3 Client
While I was working on Ballistic, my back took a turn. I’d never planned to become a client of P3 myself — but that changed after weeks of brutal pain. Eventually, I got assessed on the same force plates that have measured NBA stars like James Harden, Giannis Antetokounmpo and Luka Dončić. The report was enlightening:
As I stepped off an 18-inch box, airborne on my way to landing on twin force plates, my pelvis tilted notably to one side.
I landed with 30% more force on the left foot than the right.
I landed on the ground with a force equal to six-and-a-half times my body mass. If I could learn to land on the ball of my foot, and attenuate more force with my hips, they explained, that number could come way down.
An “Owner’s Manual” for Your Own Body
Well-meaning professionals treated my back for years and never knew any of this, because we don’t assess injuries with movement data. Not long into a new regime designed, in part, to teach my right glute to participate more meaningfully in my life, I bounded pain-free from rock to rock, scampering up a riverbed in the hills above Santa Barbara. I look forward to the day when everyone can benefit from a new and better owner’s manual to their own body.
And it’s coming. Some of the lessons Marcus and his P3 team have learned apply broadly to all of us, and I collected them in Ballistic and in many cases had them illustrated by a wonderful artist named John Early.
On the left: a side plank. On the right: the figure four stretch.
John Early
Here’s how to test, for instance, if your hips need help with mobility or stability. If you can lock out a side plank for 30 seconds with your 10 toes pointed forward, and arm and leg elevated, Marcus suggests your hips are stable enough. Similarly, if you can sink deep into a standing figure four, Marcus suggests your hips are probably mobile enough.
You need both mobility and stability to have fully functional hips. But what tends to happen is that people with already-mobile hips go to yoga…and make them even more mobile. Weightlifters have super stable hips, wrapped in muscle, but lack mobility. Instead of doubling down on strengths, we should all spare a minute on our weaknesses. The joke at P3 is that everyone who lifts weights should do yoga, and everyone who does yoga should lift weights.
The Future of Physical Therapy
The solution to the public health disaster of immobility is preventative care that keeps us moving. As we speak, doctors, biomechanists, data scientists, athletic trainers, physical therapists and others are working together to extract cause-and-effect movement lessons from P3’s 134.4 terabytes of movement data, gleaned from thousands of professional athletes.
There are models that can predict about six of every 10 NBA knee injuries — and underlying high-risk movement habits that can be trained away. Researchers have even used movement data to unearth a cause of back pain that has not been discussed in the literature: in NBA players, a habit of landing without flexing hips comes with a 300% increase in games missed to back pain. We’re still in the early days of movement data, but it already has promising implications for hamstring strains, ankle sprains, immobile hips and much more.
Every body is different, but these movement-based assessments offer so much more data for a doctor to help a person stay active and healthy — before they go under the knife.
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