summarize "By now it should be clear that it is important to stay in good physical
condition as we age. But now consider another, related question: Why don’t
more people actually pull this off?
A typical seventy-year-old will do less than half as much “moderate to
vigorous” physical activity as she did at age forty—and after age seventy the
decline accelerates. The fit people in their seventies and eighties are the
exception, not the rule.
It is tempting to attribute this to aging itself, the aches and pains that
accumulate in middle age and beyond, not to mention the steady loss of
aerobic capacity and strength. Other factors such as weight gain and poor
sleep can also leave one feeling wiped out. But I think the missing X factor
that explains why so many people just stop moving is something else: injury.
That is, older people tend to exercise less, or not at all, because they simply
can’t. They have hurt themselves in some way, at some point in their lives,
and they just never got back on the horse. So they continued to decline.
This was certainly true of Sophie, my friend Becky’s mother, but I too
could have easily gone down that path. In my twenties, when I was in medical
school and still training hard, lifting weights almost daily, I experienced a
mysterious back injury that required two separate surgeries (one of which was
botched), followed by a long and very difficult recovery. For several months I
was almost unable to function, surviving on large amounts of painkillers. I
couldn’t even brush my teeth without excruciating back pain, and I spent most
of the day just lying on the floor. It got so bad that my mom had to fly out to
Palo Alto and take care of me. The thing is, people think it’s terrible when
someone in their twenties has to go through this (and it is), yet they almost
expect it for someone Sophie’s age.
Sophie and I were not unique: this type of injury and chronic pain is
shockingly widespread. According to the CDC, more than 27 percent of
Americans over the age of forty-five report suffering from chronic pain, and
about 10 to 12 percent say that pain has limited their activities on “most days
or every day” during the previous six months. Most days or every day! Back
pain, in particular, is a huge driver of opioid prescriptions and surgical
procedures that are often of dubious value. It is a leading cause of disability
around the world, and in the United States alone it drains off an estimated
$635 billion-with-a-B per year in medical costs and lost productivity.
As I learned, all the aerobic fitness or strength in the world won’t help you
if you get hurt and have to stop exercising for several months—or forever.
Studies of college-age athletes who experience injury in their careers find that
they report consistently lower quality of life at middle and older ages. Their
injuries continue to affect them not only physically but psychologically as
well, for decades into their lives. During my long ordeal, I came to appreciate
how important our ability to function physically is to our overall well-being.
All of the above, the research and my own experience, support my first
commandment of fitness: First, do thyself no harm.
How do we do this? I think stability is the key ingredient. But it also
requires a change in our mindset. We have to break out of the mentality that
we must crush all our workouts every single time we go to the gym—doing
the most reps, with the heaviest weights, day after day. As I learned, pushing
oneself so hard all the time, without adequate stability, almost inevitably leads
to injury. If you are struggling to get through your workout, then you are
likely resorting to your body’s own “cheats,” your ingrained but potentially
dangerous movement patterns.
Instead, we need to change our approach so that we are focused on doing
things right, cultivating safe, ideal movement patterns that allow our bodies to
work as designed and reduce our risk of injury. Better to work smart than to
work too hard. But as I would see for myself, relearning these movement
patterns is no simple task.
—
Stability is often conflated with “core,” but there is much more to it than
having strong abdominal muscles (which isn’t what “core” means anyway). In
my view, stability is essential to any kind of movement, particularly if our
goal is to be able to keep doing that movement for years or decades. It is the
foundation on which our twin pillars of cardiovascular fitness and strength
must rest. Without it, as we used to say in Canada, you are hosed. Maybe not
immediately, but sooner or later you will likely experience an injury that
limits your movement, kiboshes your daily activities as you age, and possibly
knocks you out of the Centenarian Decathlon for good.
One thing that stability training has taught me is that most “acute”
injuries, such as a torn ACL or a hamstring tear, are rarely sudden. While
their onset may be rapid—instantaneous back or neck or knee pain—there
was likely a chronic weakness or lack of stability at the foundation of the
joint that was the true culprit. This is the real iceberg in the water. The
“acute” injury is just the part you see, the manifestation of the underlying
weakness. So if we are to complete the goals we have set in our own
Centenarian Decathlon, we need to be able to anticipate and avoid any
potential injuries that lie in our path, like icebergs at sea. This means
understanding stability and incorporating it into our routine.
Stability is tricky to define precisely, but we intuitively know what it is. A
technical definition might be: stability is the subconscious ability to harness,
decelerate, or stop force. A stable person can react to internal or external
stimuli to adjust position and muscular tension appropriately without a
tremendous amount of conscious thought.
I like to explain stability using an analogy from my favorite sport, auto
racing. A few years ago I drove to a racetrack in Southern California to spend
a couple of days training with my coach. To warm up, I took a few “sedan
laps” in my street car at the time, a modified BMW M3 coupe with a
powerful 460+ HP engine. After months of creeping along on clogged
Southern California freeways, it was hugely fun to dive into the corners and
fly down the straightaways.
Then I switched to the track car we had rented, basically a stripped-down,
race-worthy version of the popular BMW 325i. Although this vehicle’s engine
produced only about one-third as much power (165 HP) as my street car, my
lap times in it were several seconds faster, which is an eternity in auto racing.
What made the difference? The track car’s 20 percent lighter weight played a
part, but far more important were its tighter chassis and its stickier, racegrade tires. Together, these transmitted more of the engine’s force to the
road, allowing this car to go much faster through the corners. Though my
street car was quicker in the long straights, it was much slower overall
because it could not corner as efficiently. The track car was faster because it
had better stability.
Without stability, my street car’s more powerful engine was not much use.
If I attempted to drive it through the curves as fast as I drove the track car, I’d
end up spinning into the dirt. In the context of the gym, my street car is the
guy with huge muscles who loads the bar with plates but who always seems to
be getting injured (and can’t do much else besides lift weights in the gym).
The track car is the unassuming-looking dude who can deadlift twice his
body weight, hit a fast serve in tennis, and then go run up a mountain the next
day. He doesn’t necessarily look strong. But because he has trained for
stability as well as strength, his muscles can transmit much more force across
his entire body, from his shoulders to his feet, while protecting his vulnerable
back and knee joints. He is like a track-ready race car: strong, fast, stable—
and healthy, because his superior stability allows him to do all these things
while rarely, if ever, getting injured.
Obviously, my street car would be much more comfortable for a long road
trip; no analogy is perfect. But this street car/race car comparison works
because it forces us to consider stability in the dynamic setting.
Unfortunately, the words stable and stability are too often lumped in with
static terms like strong and in balance. A tree is more stable than a sapling. A
Jenga tower cannot stand without stability. But in the exercise context, we’re
not as interested in how rigid something is. Instead, we want to think about
how efficiently and safely force can be transmitted through something.
The key word is safely. When stability is lacking, all that extra force has
to go somewhere. If my street car’s powerful engine is transmitting only part
of its power to the road through the tires, the remainder of that energy is
leaking out, lost to friction and nonproductive motion, primarily. Parts of the
car that should not be moving relative to each other are doing just that. As
fun as it might be to drift a car around a corner, that lost energy is ravaging
the tires and taking a toll on the suspension. Neither will last long. When this
happens in our bodies, this force dissipation (as it’s called) leaks out via the
path of least resistance—typically via joints like knees, elbows, and
shoulders, and/or the spine, any or all of which will give out at some point.
Joint injuries are almost always the result of this kind of energy leak.
In sum, stability lets us create the most force in the safest manner
possible, connecting our body’s different muscle groups with much less risk
of injury to our joints, our soft tissue, and especially our vulnerable spine.
The goal is to be strong, fluid, flexible, and agile as you move through your
world.
In action, stability can be magnificent to behold. Stability lets a skinny
pitcher throw a blazing fastball. Stability allows Kai Lenny to surf towering
waves at Jaws. But stability is also what enables a seventy-five-year-old
woman to continue playing tennis injury-free. Stability is what keeps an
eighty-year-old grandmother from falling when she steps off a curb that is
unexpectedly high. Stability gives a ninety-five-year-old man the confidence
to go walk his beloved dog in the park. It lets us keep doing what we love to
do. And when you don’t have stability, bad things will inevitably happen—as
they did to me, and to Sophie, and to millions of other formerly fit people.
—
My painful lower-back episode was only the beginning of my injury history. I
completed one of my Catalina swims with a torn labrum that was almost
certainly exacerbated by spending four hours a day training in the pool and
ocean, and continuing to do so even after I started feeling pain.
[*1] I still
needed surgery to fix the problem more than fifteen years later. That was the
price I paid for overdoing it in one specific sport. But it took me another
couple of decades to really begin to understand why I had injured my back.
This knowledge came courtesy of Beth Lewis, a former professional
dancer and powerlifter turned trainer and all-around movement genius who
was then based in New York. (I’ve since talked her into moving to Austin.)
We had barely even said hello before she ordered me to take off my shirt and
squat. I obeyed, and she was not impressed. I was crestfallen. I had always
thought of myself as someone who knew what he was doing in the gym. Now
I was being told that I couldn’t even do a simple squat correctly"