How to stay fit (and injury free): the midlife guide

Times

23-06-2025

By 50, one can feel as if injury is inevitable if one sneezes wrong, never mind stays active. And if we do tweak something by lunging or lifting, our impulse is to do less. We're afraid to let ourselves go. Ballistic and plyometric training — explosive, powerful movements — in particular are a no-no. Jumping, with my knees, back, hips — are you kidding?
The short of it is that in midlife, most of us are brittle and lack bounce. And so it was for Henry Abbott, award-winning journalist and amateur sportsman. British-born but raised in the US, he enjoyed a successful career covering basketball, reporting on the springiest elite athletes of America's NBA. Meanwhile, physiotherapists and doctors couldn't fix his worsening hip and lumbar issues.
Yet Abbott was aware that in recent decades, prevention of injury in professional sport has advanced in leaps and bounds, driven by the pioneering work of the Harvard-trained physician Dr Marcus Elliott, founder of P3, the Peak Performance Project, in Santa Barbara. He believed he could assess and predict an athlete's injury risk by how they moved.
His intuitive, science-based approach irritated conservative coaches who reckoned that every time a player ended their career on a stretcher, 'there's nothing anyone could have done'. But Elliott continued his precision research into biomechanics. Early on, working with the New England Patriots (of the NFL) he reduced their incidence of hamstring injury from about 23 a season to 3.
Abbott's new book, Ballistic — The New Science of Injury-Free Athletic Performance, tells the inspiring story of Elliott and P3, and is a trove of information for anyone who is keen to stay springy and robust. P3's 3D motion-capture of thousands of athletes jumping and moving has given its scientists an invaluable database of evidence as to what can cause injury — and how to prevent it.
The DIY version? Film yourself in slow motion stepping off a high box and you'll acquire decent information about how you land, Abbott says. 'Maybe you'll see your knees cave in; maybe one foot lands before the other; maybe your heels slap down; maybe your pelvis is uneven.' He recommends taking the footage to a trusted personal trainer.
Halfway through writing his book, in agony and desperate, Abbott, 50, acceded to a P3 assessment himself. The instruction enabled him to bounce back to peak fitness and function. He's speaking on Zoom from his home in New Jersey, and flaps three soft-worn sheets of exercises at me, beaming. His regime includes strength training, plyometrics and yoga. 'You're fighting your body's natural inclination to reduce your power and range of motion every year after 25,' he says.
But if you know what to do, it's a battle you can win. Below are some scenarios that many of us have experienced (or are likely to experience) — and advice on how best to support your body in each case.
My knees are stiff and ache when I run. What can I do to offset the pain?
Beyond a common finding — 'You're a bit short of cartilage and, whoops, you're ageing' — P3's research shows that almost every serious knee issue comes from the hips or ankle, Abbott says. 'You're counting on your ankles, knees and hips to attenuate the force of landing. And if they are twisted or rotated, the knee just has to cope with whatever's coming from the ground or the hips. The knee is the unfortunate middle man.'
P3 studied the knees of 380 NBA players over two years and 'found that people who end up with a catastrophic knee injury' — usually an anterior cruciate ligament tear, but also meniscus tears — 'all had a habit of landing on the outside of their foot and rolling to the inside'. This poor landing position is associated with weak soleus and tibialis posterior muscles (below the knee). Strengthen them by standing on one leg and lifting and lowering your foot, for example, or skipping.
The second leading cause of knee injury is what Abbott calls 'dishrag': femoral rotation. 'As you squat, your upper leg bone rotates inwards, like twisting the turkey leg off the carcass. It's from weak hip muscles.' Side planking — with weights and using leg raises — targets the gluteus medius, which is key in stabilising the hips.
I want to play f ive- a-side in midlife. How can I avoid injury?
Abbott cheekily queried whether warm-ups were 'a real thing'. A warmed-up muscle is two to six times less likely to be injured, Elliott told him. But sprints won't prepare your body for football's range of movement. P3's recommended warm-up — for any workout — incorporates rotating, lunging and bouncing. Exercises include a heel walk; lunging and twisting; inching from a plank to a standing position and back again; single-leg Romanian deadlifts; quad stretches; knee hugs; leg swings (sideways and front to back); and 'a bit of lying on the ground, more rotating'. Why save it for sport? 'There have been many days when I wake up feeling 102 years old and then I just do these steps and I feel fine,' Abbott says.
I've joined a netball team. How can I protect my back?
Planning to leave the ground? Whether you jump, run, lunge or leap, land on the balls of your feet — do not land toes down. P3's research-based instruction started with its observation of elite runners. '[Elliott] noticed that everyone running in the Olympics has their feet dorsiflexed — a little bit toes-up,' Abbott says. 'If the force of landing goes into the ball of your foot, with your toes up, this communication happens all through soft tissue — to your Achilles, to your calf, to your quad, to your glutes. With that chain of communication you can take huge forces without injury.'
Whereas if you land with your toes down, 'the next thing is your heel slams down', Abbott says. It exerts huge forces through your body (P3's measured record is nine times a person's body weight: 'Like catching a falling bison'), absorbed by your knees and possibly your lower back. Train so that landing well becomes a habit. 'I do hip bridges with my toes up, just on my heels, or marching movements with a ball over my head and with my toes up,' Abbott says.
My posture is dreadful. What can I do to straighten up?
'Computer back' or kyphosis — where your upper back is curved forward — is the most common problem Elliott sees. In athletes it makes injury more likely, limits lateral explosive power and 'contributes to lower back and hip issues, because as your head goes forward you'd fall over if you didn't compensate in your lower spine', Abbott says. To reverse it, P3 recommends a tricky move called the snap squat press. 'Put a broom across your shoulders and squat, so your hips are level with your knees. Stay in this squat and push the broom up. If you have kyphosis, the broom will hit the back of your head — at first,' Abbott says. (Avoid this by elevating your heels on a rolled-up towel.) 'You're rehearsing the movement that will fix the problem', and will ultimately progress from broom to bar.
I jog in a low shuffle. If bouncing along is better, how do I train?
'So much of life comes down to glutes, it turns out,' Abbott says. 'The shuffle is the lie that you can land safely without using your glutes, so now the forces are going places they aren't supposed to go.' How to train yourself to be springy? If you skip with a rope, it cues the idea that 'I want the force of the ground to travel smoothly and efficiently into my glutes when I land from running or jumping'. After practising himself, Abbott noticed that rather than use his leg muscles to push off the ground, 'I would land with my toes up a little bit, and my legs slightly flexed and the force would go boing, boing, boing into my glute and it took almost no energy. That's the rehearsal for running. That's the springier, safer thing in action.'
Understanding hip flexibility is key
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I have hips like the Tin Man. Does it matter that I can't touch my toes?
'Every single pair of hips P3 has assessed needs help with either mobility or stability, and you should know which group you're in,' Abbott says. 'People with stable hips just love lifting weights and accept that they can't touch their toes, and people who are really good at the half-moon position just keep going to yoga.' Broadly, everyone who does yoga should lift weights and vice versa, he adds. Without both mobility and stability, you could suffer hip pain, hip-related lower back pain, or knee pain.
Abbott suffered incapacitating back pain. His P3 assessment included stepping off a box on to a force plate, which revealed that 'when my right foot came off, my right hip would drop — it's supposed to stay level — and when I hit the ground, I'd have 30 per cent more force on my left side than on my right'. He wasn't absorbing enough force in his hips nor using his glutes, which explained his lumbar problems. Recommended exercises included the stork press: stand on one leg, the other leg pulled up high, knee bent, then hold a heavy weight in your hand on your elevated-leg side. 'You're balancing, trying to keep your hips level, and deploying the glute of the standing leg,' Abbott says. 'Most of what I learnt was in a cold sweat because it was like learning a new language.'
My training is strictly gym-based. I'd love to surf but I'm scared I'll wrench something
We train to prepare ourselves for life. 'Even if you just chase your dog when it gets off the leash, you're going to have to move aggressively,' Abbott says. 'It's weird that we don't jump more.' If you only stick to the elliptical, you do none of that 'complex navigating in space'. 'Humans have the DNA and the musculature and range of motion and the strength capabilities to be pretty darn free moving. That's the goal.' Aim for the joyfulness of 'puppies playing on the beach'.
Abbott's grandmother set a great example: she bodyboarded in Devon. 'She had a wooden board, she'd wear a cap and a frilly, flowery World War Two swimming suit. It was a thrill: the sun and the breeze and cold and the dogs and the puffins.'
I confess that my wildest move is a bear crawl. 'Bear crawl is 100 per cent something that Stone Age humans did all the time,' Abbott says. 'We cooked on the ground — there was so much scrambling around. I don't think it's a coincidence that a lot of super cutting-edge training and therapy looks like Stone Age cooking. We evolved with the muscle set to move in that kind of way.' Whether it's netball, surfing or bear crawls, 'let your intuition be your guide and be playful'.