BASKETBALL FEELINGS

'Pain's hangover'

I’ve spent the last few years writing Ballistic, coming out May 6, from W.W. Norton & Co. It’s about Harvard M.D. Marcus Elliott who built a lab, called P3, that aims to prevent sports injuries in the way that echocardiograms prevent heart attacks or vaccines present measles…

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a year ago · 4 likes · 1 comment · Henry Abbott

This part of chapter 10 is about an NBA player who, when landing from a jump, wouldn’t put his left heel down. This is highly unusual.

Except—we all do stuff like that.

“Pain is an amazing teacher,” says Rachel Zoffness, Ph.D., a pain psychologist, Stanford lecturer, and assistant clinical professor at the University of California, San Francisco School of Medicine. The human brain might be the most beautiful and intricate of all creations. But it makes mistakes. Pain, according to Zoffness, is “the brain’s opinion” about the danger you’re in.

Zoffness tells a story first published in the British Medical Journal about a construction worker who jumped off a ledge and—oops!—onto a seven-inch nail. The nail poked out the top of his left boot and popped the balloon of normalcy. At the ER, they administered intravenous fentanyl and midazolam before very carefully sawing away his boot.

Inside, though, they found a perfect left foot. No blood, no wound, no nothing. Surprise! The nail had threaded between toes. The worker’s brain had formed the opinion that the body was damaged, and sent pain signals—not because it felt the nail tearing flesh, but because it saw a nail poking through a boot top.

The brain can project real pain into pristine flesh. It can even project real pain into no flesh at all. Amputees can experience pain, called phantom limb pain, in an absent arm or leg. The homunculus is the brain’s map of the body. One way to treat phantom limb pain is mirror therapy, in which the patient looks in a mirror while completing prescribed movements. Eventually, the homunculus updates with better information about where the body ends.

Click here to read the whole excerpt.

Click here to be bombarded with blurbs about Ballistic from people like David Epstein, Louisa Thomas, and Steve Magness.

Halfway through writing a book about human movement expert Marcus Elliott M.D., I happen across stunning slow-motion high-definition video of a cheetah. It’s a symphony. Long polka-dotted front legs stretch perfect paws out in front. They land, grab, and--smooth as the oar of a skull dipping into the river--pull the ground along. In good time, a back foot arrives impossibly far forward, beneath the neck, touches down, and takes its massive turn hurling the entire 150-pound cat fluidly forward. Cheetahs reportedly travel 20 feet per stride, it looks like more. They say running is ballistic, and voila: The cat flies.

I text the video to Marcus.

“Poetic,” he instantly replies.

Marcus and I have talked often about the best movers on the planet. Sometimes it’d be a story about Anthony Edwards or Zach LaVine, or the foot strike of an Olympic sprinter or rotational force of an MLB second-baseman.

But other times the conversation would drift to those whose survival truly depends on perfect athletic performance: animals. If you study range of motion, power, balance and the like, there’s no way around admiring ospreys, bears, and bobcats. I spent one whole day at the library learning about giant squid and then at least another two obsessing about owls, who are mind-blowing.

For many animals, the trial of survival is weeks of straight-line trudging to the next grassy plain. Cheetahs take the whole grueling drama of survival and compress it to the 20 or 30 seconds they can sprint without overheating. The best movers, I couldn’t help but notice, by and large are predators.

Sports mimic that, in treasuring the cheetah’s power, speed, and Formula One design. But I wonder if the best athletes also carry some of the animal world’s more secretive advantages.

One day, settled with my laptop on our back porch in New Jersey, a great cry emerged from the willow tree. Robins and catbirds raged.

Peeking out from the vine covering the chain link: huge piercing eyes. Prey animals tend to have an eye on each side of the head. Predator eyes face forward. This pair was wildly predatory, so huge, so forward, more moons than eyeballs.

Then it hopped into the open, onto the gravel between the raised beds. As every other bird in town formed a hoard of shrieking paparazzi, the superstar at the center of the action glistened in the sunshine. The most decorative, fluffed, and striped legs in nature. Talons, skin around the eye, and weaponized hook of a beak all in matching gold. Dazzling herringbone down the chest. The bird arrived like a knight in armor, a fashionista in the capitol in The Hunger Games, or a Formula One race car on the starting grid. A killer of a bird, a total F-14.

The bird book later revealed, without question: a peregrine falcon. Not just the fastest bird but the fastest animal.

And at that moment, shockingly not moving at all--eyes locked with safe-cracker stillness into the greenery. It was late spring, the wild vine that owns the chain link fence had erupted in green. The leaves almost totally hid what the paparazzi and I knew was in there: a nest full of baby catbirds.

With one effortless hop, the falcon halved the distance, landing on the lattice leaning on the fence for melon vines to climb. In The Wire, the most fearsome killer, Omar, attacks in broad daylight at a walk, heart rate a tick above napping. The peregrine’s expression was simple: let’s kill and go home.

It was time. The falcon leapt--clean and savage--leathery adult talon snatching tender pink infant.

The catbird parents had their moment to dive bomb. But the brilliant falcon didn’t land. In nature’s alley-oop, the falcon snagged a catbird baby without touching the fence and kept moving, falling prey-first clean over the fence and six feet down to the neighbor’s lawn. I leapt up from my seat to see what was happening behind the fence, and watched the raptor rest in stillness, crimping off a young life. Down there the parents couldn’t attack from above thanks to the vine and the fence above. Then the falcon took a breath, girded for punishment, swooped up and over the fence, under the gazebo, and off between the houses with lunch in hand, to the fussy hassle of bereft parents.

A friend just sent me a video about how we underrate the eyes in sports. There’s no question. Scientists have examined cheetahs like they’re cars--how fast they accelerate, their mass, and top speed. None of that matters, though, if the big cat misses its prey. There’s a reason the peregrine took a minute or more to locate the baby catbird. Predation is targeting. Only part of the game is ballet, another part is free throws, or darts.

David Epstein’s Sports Gene drops a dozen signs that eyes are wildly underappreciated in sports. If you show most of us a photograph of a volleyball game for 16 thousandths of a second, we see only a flash of light. World-class volleyball setters, though, can tell you where the ball is, and sometimes other stuff like where the picture was taken and who was playing. An ophthalmologist named Louis J. Rosenbaum used nothing but vision tests to successfully predict which baseball prospects would become MLB stars, and found that major league baseball players have, essentially, the best eyesight on the planet. Another test trained two groups of women to catch tennis balls shot from a machine. Those who pre-tested with excellent depth perception quickly improved their catching scores; women with poor depth perception didn’t improve at all. Epstein also describes the work of Harold Klawans, who wrote a book arguing that Michael Jordan couldn’t hit a major league curveball because as he grew up playing basketball, his brain pruned away the neurons he would have needed to pick up the nuances of a hard-flung small baseball.

After the peregrine’s eyes dazzled me, I noticed something new in the cheetah video: As the body is a blur, and the world whips by, the cheetah’s eyes are granite still. Much evolution designed this symphonic system, it’s incredible. The engine, the paws, the range of motion--it’s all for naught unless it delivers the eyes close enough to target a vulnerable patch of high-speed antelope.

“Curiosity,” wrote Victor Hugo, “is gluttony. To see is to devour.”

Humans have some of these skills. Check the face of a longboarder at 50 miles an hour, a big-wave surfer, or anyone about to jump off a cliff. Or, watch Kyrie in traffic. Or Harden.

All this thinking about eyes connected with some other things I learned in writing Ballistic. The massive trove of granular movement data at Marcus Elliott’s P3 lab tells many important stories about how we move. In some cases, there’s a Perry Mason, open-and-shut feeling to the case--landing with your foot or hip just so sends your injury risk skyrocketing.

But their findings about deceleration contain some unsolved mysteries.

P3 struck a deal with Adidas in 2015. About the time James Harden devoured the whole NBA with his scoring prowess, P3 assessed Harden’s movement and found he was no cheetah. He didn’t run especially fast nor jump notably high. So, how did he roast every defender 29 other teams threw at him? Eager to have something to report to the waiting Harden and a group from his shoe company and ad agency, P3’s head of biomechanics, Eric Leidersdorf, noted that while he couldn’t run or jump in any special way, Harden could really stop.

Harden won the MVP the following season; it felt like stopping mattered. Eric’s team explored deeper and, in a nutshell, it remains almost strange how much deceleration correlates with sports success. P3 tests for it and trains it as a matter of course.

As has been discussed in the Wall Street Journal, ESPN, and elsewhere, the power to brake affects athletic success more than anyone thought likely. When they see young players with elite decel numbers--teenaged Luka was once that guy--P3 keeps an eye on them. They do well.

For many years, the Joe Gibbs Racing NASCAR team used P3 to screen candidates to join their record-setting pit crew. The executive who ran the project told me that all things being equal, he would hire the best decelerators. The job is a three-yard arcing sprint from one side of the car to the other. You might think you’d want furious acceleration. But on arrival to the next wheel well, you have to place a tire just so or a gun on lugnuts. It’s no good getting there without the ability to be perfectly precise.

Marcus has a story about a volleyball player who came in with kyphosis, also known as “computer back.” One of the problems with stooping forward is that it keeps you from using the muscles along your spine as designed. P3’s training got the vertebrae of his back stacked properly, and his game blossomed because now, in the air, he could hold his head on the top of a spine with the muscles and bones available to stabilize his eyes. He had always been able to jump, and always had long arms, but only now could see his prey like a peregrine, and racked up kills.

Harden doesn’t merely need to evade a defender, he needs a quiet eye to fixate on the rim. He needs to make the shot. The falcon doesn’t just need to find prey, it needs to place a precise talon while dodging the parents’ many bullets.

My own homespun theory emerges. The cheetah lands with plenty of force, but has clever, strong, and coordinated muscles up and down the body that attenuate that force so as not to rattle the eyes. Not everyone can keep their head still while landing at 70 miles an hour. Does good deceleration come with a cheetah-like ability to keep the eyes still and focused?

Perhaps bodies that are good at braking facilitate still eyes, and therefore brains good at sizing up the world in intense moments.

It’s a cinch to imagine that braking skills might correlate with a better, more clear view of the world. There’s a part of the P3 assessment where you leap off one leg then land on that same leg on a force plate--the point is not how far you jump nor how hard you land, but how soon after touching down you settle into stillness. Those little leaning wiggles that cost points in gymnastics competitions can also lead to injury when the force get big enough. You want to stick the landing.

But also, it strikes me, when you stick the landing, and don’t wiggle around, your eyes get a better read of the world around you. And good landings are trainable. From the quality of the tissue in our feet to the neuromuscular coordination of every muscle up the chain, there’s work that can make it better.

The eyes are in the head, the head is on a stack of vertebrae atop the sacrum. The sacrum sits on the pelvis and hips, and the hips on the femurs, the knees, tibias, ankles, and feet. And the feet sit on the earth. All of that is managed by soft tissues orchestrated by the nervous system. Get those soft tissues strong, stacked, and moving cheetah-smooth, and your eyes might become killers.

I've been covering sports since just after college. Over that time, what I've learned is that almost every elite athlete gets hurt. And when they do, it's always the same story: nobody's fault, couldn't have seen it coming, or my favorite--it was an act of God.

Which is what they used to say about heart attacks, until they learned how the heart actually works. Now we prevent them by the million! So I wrote a book called Ballistic, coming out in May from W.W. Norton & Co., about the people, and the data, who say we could do better.

The story begins when Marcus Elliott tore his ACL at football practice on his 17th birthday. It changed the course of his life. He resolved to study the human body incredibly hard. So hard that he might one day learn to prevent the injuries that ruin sports.

His journey took him Harvard Medical School, the New England Patriots, the Seattle Mariners, and for the last 20 years or so, the lab he founded in Santa Barbara called the Peak Performance Project, or P3. After exploring fields from biochemistry to physiology, Marcus and his team have landed on an incredibly useful dataset: biomechanical movement data. By assessing the physics of how each of us moves, they can see injury risk before the crisis—just as echocardiograms show issues with bloodflow in the heart long before a heart attack.

This is the story of a journey to prevent heart attacks, the most interesting dataset in sports, and increased odds that this new approach will mean all of us can move with joy into old age.

In between the first time I saw a bear and the second time I saw a bear, a lot happened.

I basically wrote a book and I also went through devastation.

Like I had ... my body went to hell. I was basically disabled for a while and then I slowly got better until one beautiful morning I was going for a run in these wooded hills on the border of New Jersey and Pennsylvania and it was sunrise and you could see the light hitting a million treetops.

It was just gorgeous and I'm just feeling so appreciative of the fact that I can move and I kind of swoop up this little rise and then down and we're in an open field surrounded by trees and I'm running down and I'm aware that I'm not alone.

I have a feeling and I kind of look up and sure enough in the shadows across the bottom of the field walks ... a bear.

This one's even taller, bigger arguably than the first one I'd seen. They can get up to 600 pounds. It's something like that.

And I'm running at this corner of the field and he's walking to the same exact spot.

Which seems like: oopsie.

My first hope is that he simply won't notice me. He's looking the direction he's going. Maybe that's that. And as I'm kind of thinking, oh, maybe he'll just move along, he turns his giant bear head.

His eyes laser into my eyes and go straight into my stomach and boil my innards. And the first thought that hits me is he probably knows how I would taste.

And now I'm out of the fiction that he's not going to notice me and into the ...

I have to do the thing you're supposed to do. I have to act big, like I own the joint.

And now that I've gone through it once before and done it all wrong, I'm determined to do it right. And so I'm still running.

This has all happened so fast. I haven't even stopped running yet.

And so I just act like I won the local 5k. I'm just like, “YEAH.” And, you know, act big. I don't know if I yelled, but big expressions. I'm doing everything I can to act like I own the joint.

And I sort of send that message off into the air. And I'm proud of myself on the one hand that I did what I was supposed to do. But then as the message is making its way through the airspace, it also hits me: I don't have anything else to say to the bear.

If this message isn't received as intended, then... I'm just running at a bear.

We're all alone. No one will hear my screams.

And also people are like, oh, you know, bears tend not to hurt people, which is true. Black bears tend not to hurt people. But on the other hand, I looked this up: Jack Russells send people to the hospital all the time and are a hundredth the size. It just seems inarguable that this is dangerous.

Anyway, so the bear, he's looking at me. He receives my message. And he turns back in the direction he was going and ... breaks into a run.

The bear, the wild bear in the wild, ran away from me, which gave me this, like, I had a really deep and profound appreciation of the power of biomechanics from how it prevents injuries and had healed my own injuries.

But now I had this other X factor, which is it seems to express something. This being big and proud and upright and biomechanically sound seemed to send a nonverbal message across species in a way that mattered. And that's pretty cool.

Marcus Elliott, M.D. runs the Peak Performance Project, perhaps the most sophisticated movement lab in the world. “Who,” I asked him, “is the most beautiful jumper you have ever seen?” Marcus’s team at P3 has assessed nearly a thousand NBA players, and several thousand other elite athletes.

“My first thought” Marcus responded, “is Andrew Wiggins.” One of Andrew’s parents played in the NBA, the other held a Canadian record in the 400 meters. Perhaps the most famous moment in P3’s history is a short video of Wiggins, pre-draft, jumping insanely high against a wall-sized P3 logo. 

But many others have jumped higher at P3. “The thing about him,” says Marcus, “why he was such a beautiful jumper, is that he could do everything. He could jump off one leg, two legs, left leg, right leg. He could jump really high off no steps, or a single closing step, dropping vertically off a box right next to the vertec.” The vertec is the vertical-jump measuring device you’ve probably seen in highlights--a tall pole with a row of fingers near the top, which leapers swipe at. In grainy video of Wiggins’ standing jump test, about ten people are lined up in the background, just watching.

“He didn't care, he had the right tool for every job. Mechanically it was just really clean. No inefficiencies in his jumping. That’s the hallmark of the best: no extraneous movement. Like in engineering, all the force into this pulley or this lever causes an action. No rotational movement, no lateral movement, just boom boom boom. Just go.”

Although it’s a revered part of the scouting process, vertical as measured at the draft combine—this has been studied various ways—has literally nothing to do with success in the NBA. (One way to succeed at that test, the data shows, is to be short. Another is to cheat: the test measures the highest point you can touch while jumping, and then subtracts your standing reach. Every inch you don’t touch in the standing reach adds to your vertical; the common technique is simply not to extend your shoulder all the way when they measure the standing reach.)

But P3 researches jumping all the same, because takeoff and landing are biomechanical earthquakes. If you want to reduce injuries in NBA players, you want to tidy up that engineering. And as athletes get them dialed in, no extraneous movement, no lateral movement, just boom boom boom they do tend to fly. A big vertical jump might not mean much about NBA performance, but an improvement might mean something nice about biomechanics.

The most beautiful jumper question pinged around P3, where people often use the words “Anthony Edwards” as a synonym for elite movement. On the day I asked a couple of years ago, I learned some NFL players have eye-popping data, especially Matt Breida and Bud Dupree. The Seahawk DK Metcalf tore up social media with clips—some real, some faked—of a leaping catch at NBA All-Star Weekend. Overseas basketball player Jacob Wiley got a vote, as did a couple of NASCAR tire changers from P3’s orbit: Adam Riley and Kevon Jackson. Basketball players who made the list include Zach LaVine, Jeremy Evans, Rodney Williams, young Dennis Smith Jr., and pre-injury Alec Burks. (One of P3’s then-biomechanists, Trent, evidently likes jumps that end with a shot, and nominated Salim Stoudamire, Jimmer Fredette, and J.R. Smith.) P3 trainer Jack notes that “Ant Simons hit the same height as Scottie Barnes. He’s six inches shorter, and made it look super easy.” Scoot Henderson, points out Eric Leidersdorf, P3’s head of biomechanics, “moves how you’re supposed to move.”

Once in a while the ability to fly really matters in an NBA game. With about 100 seconds left in a tied 2016 NBA Finals game, Stephen Curry fired a fastbreak bounce pass to his Warriors teammate Andre Iguodala. The two Warriors had a single Cavalier to beat: the 6-6 J.R. Smith. Iguodala had Smith’s exact height, the ball, and a plan. He leapt off his left foot, bringing the ball to his right–a textbook middle-school layup in the making. The inartful predictability triggered Smith, who leapt into a cloud of confidence. Not today, Andre. 

But it was a trap, a killdeer luring a hawk away from the babies by faking injury. Iguodala looked vulnerable for the millisecond it took Smith to orbit. Then he narrowed his shoulders, hung in the air, added a second palm to the ball, and snuck it as far out in front of his chest as his long arms would allow. Smith had filed his flight path to the right; Iguodala’s trick had created a window through which he could sneak a highlight. When Smith finally cleared airspace, Iguodala resumed his textbook layup form. Iguodala extended his right arm and gently released the ball with just a foot to drift to the glass backboard and then tidily placed it into both the net and stories Iguodala would one day tell his grandkids. 

@nba“BLOCKED BY JAMES” 🗣️ On June 19, 2016 #LeBronJames ran down for this HUGE chasedown block! 🤯 #NBA #NBAHistory #LeBron #basketball

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LeBron descended into the play from heaven or the mesozoic or a Chinook helicopter and blocked the living hell out of Iguodala’s shot. Only in slow-motion did it become clear that when Curry fired that pass to the streaking Iguodala, LeBron trailed Curry; the fourth-closest player to the hoop. But the king had the focus of a fox and the movement of a Zeus. As Smith and Iguodala concocted their dogfight, LeBron took one of the best steps in sports, planted a left foot, and put his right hand into the apex of Iguodala’s plans. LeBron’s Cavaliers won the game by a whisper and the championship in seven. 

Perhaps there has never been an athlete like LeBron--somehow at once among the NBA’s heaviest, strongest, fastest … and highest jumping. Perhaps there’s nothing to learn about how LeBron did that, other than eat your Wheaties and pray.

Or maybe there’s a whiff of something in LeBron’s badassery that can be ours. Just maybe there’s something to learn from the way the ball of his foot strikes the floor, his hips sink toward the hardwood, or his ankle aligns under his center of mass that we can extract and model. Maybe in the symphony of the best movements in history there are examinable and exportable traits. There is certainly a place, on a sleepy block of Santa Barbara’s Funk Zone, where they’re more than a decade into dissecting the living crap out of the NBA’s best jumpers. 

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I was riding my mountain bike and I was trying to catch up with my friends.

I'm going extra fast. And through the woods, there was a clearing and some sunlight over on the side. And there was a couple standing over there in their backyard. He was dressed for work and she was in her bathrobe. And they were waving their arms and yelling, maybe at me.

But I was kind of far away and there was some brush. And so I just pretended that they weren't yelling at me and kept pedaling.

And then I got closer, the path kind of opened up and then we're only like 50 yards apart and it was pretty clear they were yelling at me.

So I stopped and I yelled, what?

And then they both yelled back at the same time and it was very hard to make out any of the words until he stopped and she said her last two words, which hung in the air and made my hair stand on end, which were “young male.”

Which was interesting.

Just after she said that, it rose between us: a beautiful, young, apparently male, black bear. I'd never seen one in the wild before. I took a snapshot of its face in my memory, and you can perfectly see, it has like Rottweiler coloring and a dog-like mouth with those little pointy-up teeth. But on a bear, those pointy-up teeth point up so much more.

And he almost seemed like he was smiling. He was just kind of jogging right at me. Super chill. Just seemed calm and happy.

We're in New Jersey, which means it's almost certainly a black bear. And the playbook for that is to stand still, get big, act like you own the joint, be loud, and assume that the bear won't bother you.

I knew that's what I knew I should do. And that's not what I did.

Instead, I just got super chicken and I turned and I pedaled as fast as I could, like a little kid, running from a monster, which is basically what I felt like.

I've gone 55 miles an hour on a road bike before. And I had in my head that I know a bear can run twice as fast as Usain Bolt, but I was like, “I got a bike.” Maybe I can really get out of here.

But the trail happened to be kind of uphill and knotty, rooty, just not fast. And so I'm peddling my brains out and kind of have to be honest that I'm not going very fast. That's even before we got to the switchbacks where it's open. There are no trees or anything, but the trail winds back and forth and back and forth. And it's uphill, so you're going slower. And I'm pretty sure that if the bear just walked up the middle, if he missed me on the first pass, like, don't worry buddy, here I come.

I would circle back and you could just eat me then.

But I made it through the switchbacks and I made it to this little gravel parking lot where my friends were waiting on their bikes. And I blurted out my big bear news.

And then the bear appeared from the woods and ambled across the road a little lower down. Thankfully, instead of following me, he had been following the stream. And we finished our ride, the last like half hour of the ride going, “hey bear, hey bear, hey bear,” at every corner.

But what haunted me on the drive home was that I was writing a book about biomechanics. And I was pretty aware of like the feeling that I had, the shape of my body on the bike once I was terrified was almost fetal position, right? I just got real small and it made it hard to breathe and my heart rate was pounding and I was just stressed.

Meanwhile, the bear was walking around like a billionaire, like he owned the joint, right? He didn't have a care in the world.

And it struck me that this had not just been like a kind of alpha/beta thing. It had been a biomechanical thing. These things had biomechanical ramifications.

And that was kind of interesting. And it mattered a lot the second time I saw a bear.

Which is a story for next time.

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Legendary NBA coach Phil Jackson won his tenth NBA title at about 10:30 p.m. on June 14, 2009. A couple of hours later, his blue suit jacket still a little champagne-sticky, the Lakers’ sixty-three-year-old leader exited Orlando’s Amway Arena in a phalanx of his adult children.

I happened to be a few steps behind. What I remember most aren’t the hats with the Roman numeral ten—X—his kids wore, nor their joyous expressions. Instead, it’s the pained look on Phil’s face. The greatest coach in the history of the game waddled the endless arena hallway with surgically fused vertebrae, balloon stents in his arteries, and none of his original hips or knees. The family shuffled at Phil’s pace. After playing for twelve NBA seasons and coaching for twenty-three, Phil could barely walk.

He’s hardly alone. According to the Centers for Disease Control and Prevention, even before the pandemic 71 percent of young Americans “would not be able to join the military if they wanted to,” because they’re not fit enough. Twelve percent of Americans have serious difficulty walking or climbing stairs. About 31 million Americans age fifty 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 American College of Sports Medicine submitted a report to the US Secretary of Health and Human Services called Exercise Is Medicine, which notes that physical activity improves bone health, cognitive function, heart disease, stroke, many cancers, dementia, sleep, anxiety, depression, multiple sclerosis, hypertension, quality of life, and mortality. The World Health

Organization says inactivity causes five million deaths a year.

Talk to your doctor, they say, before starting an exercise program. With immobility the fourth-leading cause of global death, who do you talk to before not exercising? Joining a gym or going for a run seems, by comparison, safe and healthy. But, we all understand, along the way, something might hurt. From 2008 to 2018, the rate of Americans seeking medical help for injuries (at least, those not caused by car accidents) climbed in almost every age group, gender, and subcategory.

We can be bloody-minded about how we move, pushing our bodies like drill sergeants. Trainers describe a trend: People tend to do what they did in high school. Put on thirty extra pounds in the pandemic?

You might dig out those decades-old soccer cleats, join a league, and expect to race through the midfield like the old days. NBA players do the same thing: Hip starts hurting three years into your professional career? The first thought for many is to bring back the weight-lifting routine they had when they were seventeen, when they hammer dunked on everybody and felt amazing.

But that high-schooler had a certain lung capacity, hip range of motion, and glute strength, not to mention the spine of someone who hadn’t yet spent decades working on a laptop. Dead-sprinting the left wing of a soccer field, or cutting through the lane to catch a lob on the basketball court, wasn’t much to ask of a teenaged body with bounce, wind, and muscle to spare.

It’s common sense that if you park a car for twenty years, you might need to take it to a mechanic before hitting the open road. The same is true of our bodies. But we’re more complicated, needing more than an oil change and four new tires. How do you maintain an athletic body?

Reliable answers to that question can be so maddeningly elusive that they seem not to exist at all. Injuries feel inevitable to weekend joggers and professional athletes alike. Bad backs, trick knees, degraded hips—who doesn’t have at least one body concern and a grab bag of theories about stretching, yoga, massage, physical therapy, cupping, weight lifting, or whatever else feels right? But when it comes to evidence-based sports injury prevention, there’s just not a lot to go on. If you want a solution to move and feel better, you probably feel like I did for most of my life: a little lost.

In my decades as an athlete, I have suffered plenty of injuries, and I hated every one of them—because I love to move. In high school I ran track and cross-country, raced on skis, and played a little soccer. In the decades since, I’ve biked across states, run all kinds of marathons, and taken a thousand or so hard workout classes. And along the way, I’ve had wildly frustrating experiences, doctor-hopping, looking for relief from hip muscles in revolt, Achilles tendinitis, and a whopper of a lumbar crisis.

That pain felt like a personal failing, until I noticed identical things happening to the best athletes in the world. For the last quarter century, I’ve worked as a journalist covering the free-moving sport of basketball.

The NBA boasts some of the world’s most extraordinary, highest-paid athletes. But even as data made the game more exciting and sent viewership soaring, the athletes worth hundreds of millions spent more and more time on the bench.

I’ll never forget the day that a physical therapist recommended that, before sitting down on a chair, in deference to my hips, I first put down a pad shaped like a wedge of cheese. I hesitated. Was this really how I’d roll into restaurants for the rest of my life? The next day I spotted something hilarious during a Laker game: As LeBron James checked out of the game, a trainer slipped an identical cheese wedge onto his seat.

The NBA devours athletic bodies. I grew up in Oregon, where Bill Walton won the 1977 NBA championship—then sued the Portland Trail Blazers for mismanaging his injuries. He missed three of the next four seasons. Larry Bird missed almost two hundred games, then retired prematurely. Citing the toll on his body, Michael Jordan sat out almost four seasons because he was hurt, playing baseball, or retired. Kobe Bryant, Dwyane Wade, Shaquille O’Neal, and Stephen Curry each sat out hundreds of games

In the mid-1990s, Grant Hill got more All-Star fan votes than Jordan, then suffered a brutal string of injuries that he attributes to “archaic” training methods. Ankle surgery blossomed into a staph infection that nearly killed him; Hill was never more than a role player after that. Over the course of his career, Hill missed more than six seasons’ worth of regular-season games. (In a league where a typical career lasts three years, Hill sat in street clothes for two NBA careers.)

Once upon a time, baseball’s Cal Ripken Jr. played 2,632 consecutive games and lulled sports fans into believing that a human can be athletically elite and stable over the long term. Since then, players have become measurably bigger, stronger, and faster. But these increases seemed to reduce their longevity, mental health, and robustness. For all we have learned about cutting-edge performance, we seem to have learned very little about preventing injury. Sports are still lousy with meatheaded “rub some dirt on it” thinking that seamlessly transitions into “next man up” when it all goes awry.

Like race cars, NBA players are in the garage often and sometimes badly wrecked. One expert casually told me that the NBA has a 100 percent injury rate. “Every game you don’t get hurt,” he said, “is a game closer to your next injury.” Many of the league’s would-be superstars never reach their would-be primes: Anfernee Hardaway drew comparisons to Magic Johnson, but knee injuries meant he played in his last All-Star Game at age twenty-six. Other than a five-game comeback in 2010, Yao Ming stopped playing at age twenty-eight. We may never know what Zion Williamson could have been. A dozen big-name players, including Giannis Antetokounmpo, Jimmy Butler, and Kawhi Leonard missed games in the 2024 playoffs.

Magnetic resonance imaging and surgical techniques march forward; surgeries to repair a torn Achilles or anterior cruciate ligament have improved. Doctors have incredible new insights into what happens after an injury has occurred, but that doesn’t lead to fewer injuries in the first place. The crisis continues.

At the 2014 MIT Sloan Sports Analytics Conference, I was a last-minute invitee to a private-room dinner hosted by former Goldman Sachs executive Dave Heller, then one of the investors who ran the Philadelphia 76ers. A few dozen people ate around a ring of tables as Heller steered the conversation like Oprah. The conference is about how big data can improve sports decision-making.

By 2014, wearable devices, sleep studies, and player tracking data had started a conversation that we continued, around Heller’s table, about player health. I said something about making sure the league doesn’t “break Derrick Rose.” Rose was the Chicago Bulls’ next great guard after Jordan. Rose wasn’t a great shooter, nor was he especially tall, but he had won an MVP award doing things that made fans (and even sportswriters) love basketball, heroically taking on bigger defenders in the paint and launching himself to score in spectacular ways.

The Bulls star was, at the time, rehabbing a torn left ACL. Somewhere off to my right, a white man in a suit piped up. He had the slick smugness of Kieran Culkin in Succession. I never learned his name, but I’ll never forget that he said, “What do I care if I break Derrick Rose? I’ll get another one.”

It was outrageous, racist, and, upon reflection, not far from everyday NBA thinking. The Bulls did break Derrick Rose, and they did get another one. High-scoring guard Zach LaVine, measured as one of the finest athletes in league history, tore his ACL, too.

To better understand why all these players were getting hurt, I began a side project researching the science of injuries, reading studies, interviewing doctors, and attending conferences. Meanwhile, the problem had grown personal. At Heller’s dinner, I had been sitting awkwardly to avoid shooting pain. A few months earlier, I had tweaked something while running a half-marathon.

Now, stepping off curbs, kicking balls, sleeping, sprinting, coughing, and sneezing—almost every ordinary, everyday action infused my body with thunderous jolts of pain. A few weeks after that dinner at Sloan, I was introduced as the head of a sixty-person division of ESPN covering the NBA in digital and print media. Just as sitting was becoming an emotional trial, I would spend long hours in conference rooms, behind the steering wheel, crammed into airplane seats, and hunched over in front of a computer. My kids mocked me ruthlessly for it, but out of desperation, I became the guy stretching his hamstrings in the boarding area.

I might have felt bad for Phil Jackson at the 2009 Finals in Orlando; but by the 2014 Finals in Miami, I felt like Phil Jackson. As the Miami Heat battled the Spurs, I battled a tricky hip and a trickier back. I slept poorly and stopped running. When I finally got an MRI in the middle of the Finals, I hated the feeling of slipping on surgical booties before climbing into the MRI tube; I just wasn’t ready to be frail and medicalized.

What I hated even more was the radiologist’s grave tone as he called to tell me about a torn muscle in my pelvic floor, a torn labrum in my hip, a worrisome lower-back problem with a complex name, and (after I asked, joking, “Is there anything else?”) pelvic bones that rubbed together in front, known as osteitis pubis. None was fatal to me as a person; each might be fatal to me as an athlete. I was recommended for back surgery, pelvic floor surgery, physical therapy, and whatever other medicalized hell might follow.

When you’re hurt, a lot of the professional advice comes from the three horsemen of the free-movement apocalypse: radiology, surgery, and pharma. They circle injured athletes like vultures, eager to feast, it feels, on the carcass of your athletic life. They put you on a table or in a tube and tell you to lie still. Sometimes they cut you open and repair something, and then recommend milquetoast baby steps that fall well short of a full return to movement. The current regime might get you back to driving a car and sitting at a desk, but no one seems to care whether or not you get back to the bouncy movements that make life so fun. Had a flubbed half step in a half-marathon really ruined the second half of my life?

Knowing that research shows that back surgery comes with massive risks (and, probably, more surgical booties), I never considered it. But I could feel the vibrancy slip from my life. The Bulls might be able to get another Derrick Rose, but Derrick and I would keep our injured selves forever. I thought of all the friends and family mired in the aftermath of big injuries, and swore I would do whatever work was necessary to keep moving. But what was that work?

I got interested in the injury epidemic because I cared about the NBA and its players. As I tasted my own athletic fragility, it became clear how quietly and constantly athletic dreams shatter. The degree to which the world shrugs at that carnage feels dangerous. Was there a way to avoid the three horsemen? Could someone show me how to prevent injury in the first place?

After years of researching this question, I found myself in Santa Barbara, where I visited the Peak Performance Project and met Marcus Elliott, MD. At P3 (as everyone calls it), Marcus and his team had developed a method that not only could have predicted Derrick Rose’s injury, but might have prevented it from happening in the first place. You meet a lot of people in the world of sports who “have a method,” but Marcus had something better: he had data.

Marcus tore his ACL at high school football practice in 1982. For months, Marcus mourned his college football dreams, but he emerged with a life plan that drives him still. To paraphrase the main character in Andy Weir’s The Martian, Marcus made it his mission to science the shit out of sports injuries. He studied under globally known physiologists, surgeons, and exercise scientists on his way to a medical degree at Harvard. Marcus devised a program to prevent hamstring injuries among the New England Patriots; then the Seattle Mariners made him Major League Baseball’s first director of sports science.

With each passing year, Marcus’s mission clarified. “The big wins, the big impacts of medical history to this point, they’re all related to prevention,” says Marcus. “Like, all of them.”

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