Podcast Summary

Better! with Dr. Stephanie

Episode: Avoid Chronic Pain & Injury in Midlife: The Surprising Science of Movement with Henry Abbott
Host: Dr. Stephanie Estima
Guest: Henry Abbott (author of "Ballistic", founder of True Hoop)
Date: September 15, 2025

Overview

This episode dives deep into the biomechanics of injury prevention, especially for women in midlife, and unpacks the latest science behind movement patterns, landing mechanics, joint stability, and "physical literacy." Dr. Stephanie and Henry Abbott discuss how modern research is challenging old dogmas around women’s injury risk, why “stopping” is a secret athletic superpower, and how everyday movement can be harnessed for lifelong joint health, resilience, and wellbeing.

Key Discussion Points & Insights

1. Why Injuries Hit Harder in Midlife (05:00+)

• Aging changes recovery: Injuries in midlife are more significant; recovery is slower compared to youth.
• Women’s shift in fitness: Many listeners are transitioning from cardio-heavy routines to strength, sprinting, and jumping—beneficial for bone density and metabolic health, but requiring new movement skills.
• Biomechanics jargon: Dr. Stephanie gives a heads-up—expect technical terms, but all concepts are explained in lay language.

2. The Modern Science of Injury Prevention (05:25–07:50)

• Data-driven research: Labs like P3 in Santa Barbara are analyzing millions of data points from elite and everyday athletes to correlate movement patterns with future injury risk.
• Two major injury risk factors identified:
  1. Landing mechanics: Landing on the outside of the foot, then letting the foot roll inward (pronation), greatly increases knee injury risk.
     • "In one study of NBA players, 100% of players who had a catastrophic knee injury landed in that manner." – Henry Abbott (06:40)
  2. Femoral rotation: Subtle internal rotation of the thighbone during movements like squats loads the knee’s soft tissue dangerously—a risk factor that is invisible to most observers.

3. Physical (Movement) Literacy & the Problem of One-Size-Fits-All (08:20–11:30)

• Physical literacy is as crucial as academic literacy.
  • Consistent practice—“10,000+ hours”—is why good form develops, not innate talent.
• Women’s biomechanics:
  • Wider hips (greater Q angle) predispose women to different movement patterns but, surprisingly, granular movement data shows Q angle itself isn’t as predictive of catastrophic knee injury as historically believed.
    • "There are more rows in the spreadsheet than Excel permits." – Henry Abbott (05:45)
• Complexity, not simplicity: Human movement is like an orchestra—multifactorial and nuanced rather than explained by a single measurement or risk factor.

4. Individual Differences, Not Universal Rules (16:30–18:20)

• Context matters: Movement recommendations can’t be universal because human bodies operate as integrated, highly individual systems.
• Risk is compounded: For example, excess body weight only increases injury risk if landing mechanics are already poor.

5. Learning & Refining Movement Skills (19:15–22:00)

• Expert eyes matter: Filming yourself or having a knowledgeable coach can reveal hidden compensations or deficits in form that are impossible to sense internally.
• Movement is a language: Learning new movement patterns is challenging and often awkward, like speaking a new language.

6. Hip Mobility vs. Stability: Why Both Matter (24:05–27:39)

• Testing hip stability: Try a wide “X” side plank with raised top leg and arm (all 10 toes facing forward) – holding for 30 seconds equals adequate glute medius strength (24:41).
• Testing hip mobility: Standing “figure four” squat (ankle across knee, hips below 90º) is a practical at-home test.
• Sex differences: Women tend to lack hip stability more often; men are more likely lacking in mobility (but everyone should work both).
  • "Your happy hips ... are going to be both mobile and stable. So you need to work on both." – Henry Abbott (27:36)

7. Internal vs. External Hip Rotation (27:39–30:37)

• Range targets: About a quarter of a circle (25% of the arc) internal/external rotation is desirable.
• Mobility is often limited by tightness: Myofascial release (sometimes extreme, e.g., heavy kettlebell on the quad) temporarily increases mobility before integrating new movement patterns.

8. Ankle & Foot Mechanics: The Forgotten Keys (33:45–43:17)

• Landing mechanics and injury: Sloppy, non-active landings—especially with toes down and subsequent heel slap—can transfer dangerous impact forces straight to the knee and spine.
  • "All the biggest forces they've ever measured ... come from people landing toes down ... then the heel slaps." – Henry Abbott (41:00)
• Active toes-up landing: Dorsiflexed landing (toes up on contact) helps load the Achilles, calves, quads, and glutes, channeling force into tissues designed for it.

9. Training Deceleration – The Athletic “Superpower” (47:09–53:12)

• Stopping (decelerating) is crucial for both athletes and everyday life: NBA players like James Harden excel here, not because of speed, but their elite ability to decelerate safely and maintain vision and control.
• Implications for women: Falls, especially in older women, are often about failing to decelerate and get the foot in front of the center of mass in time.
• Practical drills:
  • Plyometric progressions: Lateral hops, box jumps, kettlebell single-leg transfers.
  • Eccentric overloads (e.g., slow lowering in pull-ups or squats).

10. The Psoas: The Undervalued Muscle (55:44–61:56)

• The psoas links spine, hip, and leg movements.
• Essential for both lateral motion and preventing falls—must be strong and responsive to snap the foot forward and break a fall.
  • "He created a very compelling case for why the psoas muscle is so key for being able to stop." – Dr. Stephanie Estima (AFTER 72:43)
• Soft tissue releases can be (literally) gut-wrenching, but transformative for movement health.
  • "I went through a whole bunch of emotions. I mean, it's weird, right?" – Henry Abbott on psoas release (58:50)

11. The Role of Everyday Movement & “Inefficiency” (62:15–71:00)

• Bodies crave inefficiency: Regular daily “background” movement—stairs, walking back and forth, bending, squatting—is natural, and should be embraced rather than optimized away.
  • "That's not what your body wants to do. Your body wants to just have all these inefficient periods of just wandering around ... that's what your body is designed to do." – Henry Abbott (69:08)
• Physical literacy as play: Adult permission to "play," try new sports, move in new ways is crucial for healthspan and resilience.

Notable Quotes & Memorable Moments

• On movement literacy:

  “Movement is like language ... When you add vocabulary, it doesn’t feel comfortable ... All of the times I’ve learned about how to use my body better, I’m kind of in a cold sweat.” — Henry Abbott (20:00)

• On physical education:

  “The P.E. teacher wasn’t a really philosophical person ... we grew up with the idea that this part of school is kind of dumb. It’s a complicated machine.” — Henry Abbott (18:23)

• On testing hip stability:

  “If you can lock that out for 30 seconds, Marcus Elliott ... is willing to say that ... your hips are stable enough.” — Henry Abbott (24:42)

• On injury mechanisms:

  “Landing on the outside of your foot and then having your foot roll to the inside ... 100% of players who had a catastrophic knee injury landed in that manner.” (06:40)

• On stopping as a superpower:

  “They found that [James Harden] wasn’t really explosive in any direction … but he was great at decelerating. He was elite at stopping. ... It is a superpower in every sport.” — Henry Abbott (47:09)

• On the body’s craving for inefficiency:

  “If we lived in the Stone Age, we would all be walking back and forth to the car 10,000 times.” — Henry Abbott (69:12)

Timestamps for Key Segments

• 00:40 – Episode preview: focus on injury prevention, biomechanics, and aging.
• 05:25 – Henry Abbott introduces movement data science from P3.
• 07:50 – Landing mechanics: injury risk factors.
• 10:14 – How women’s anatomy changes movement demands.
• 12:23 – Q angle and why it may not matter as much as we think.
• 24:42 – Home tests for hip stability and mobility.
• 33:45 – Mechanics of ankle/foot injuries, and why re-injury is common.
• 39:18 – Plyometric progressions: how to (re)build safe landing mechanics.
• 41:00 – The biomechanics of dangerous landings (toes down vs. toes up).
• 47:09 – Deceleration, eccentric loading, and stopping power.
• 55:44 – The importance of the psoas muscle for falling and lateral movement.
• 62:15 – Modern lifestyle, inefficiency, and embracing movement as play.
• 71:04 – Closing remarks and where to find Henry Abbott’s work.

Actionable Takeaways

• Practice both hip mobility (e.g., yoga, figure-four squat) and hip stability (strength training, side plank variations).
• Film your movements or get external feedback—most compensations and technical errors are invisible from the inside.
• Embrace plyometric and eccentric strength work—but progress carefully and pay attention to landing form.
• Don’t be afraid to “nerd out” about your body’s mechanics; understanding detail helps you train smarter, not just harder.
• Be physically inefficient: walk, climb stairs, move frequently and in diverse patterns throughout the day.
• Maintain or cultivate the ability to decelerate and control movement—crucial for injury prevention, especially as we age.

Resources

• Guest’s Website: henryabbott.com
• Book: Ballistic: The New Science of Injury-Free Athletic Performance, by Henry Abbott
• More on NBA & movement science: TrueHoop

“Take your fun impulse of walking the block and being in the fresh air and take it to the max. … What’s the most fun thing you want to do? Let’s go do that thing.”
— Henry Abbott (67:42)

Episode delivered a rich, science-backed, yet practical and motivating roadmap to injury-proofing your body—especially for women approaching or in midlife.