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Outlive: Key Takeaways for Strength Athletes Part 3 - Stability


Person slipping due to lack of stability

In Part 1 of this series, I highlighted 2 things from the book Outlive: The Science and Art of Longevity by Peter Attia, MD with Bill Gifford, that all strength athletes and enthusiasts should consider as part of their overall training. The 2 takeaways are to:

  1. Incorporate (more) conditioning work

  2. Incorporate (more) stability work

These can be generally applied to all people regardless of their health or strength performance goals. However, it is not uncommon for strength-focused people to skip out on cardio altogether. Common reasons include the myth that cardio respiratory conditioning will detract from your "gains," or that cardio is not conducive to strength outcomes. Another reason might be that cardio just isn't enjoyable for many people, and I totally get that! Part 2 of this series goes into depth on how you can incorporate conditioning work, or more conditioning work, into your regimen to improve health outcomes.


Part 3 here will explore the concept of stability for strength athletes. We will begin by defining "stability" from the author's perspective, and touch on how he implements stability work into his training. Then, we will explore where I diverge from the author's views before finally discussing another concept that I believe to be even more important than stability, the concept of resiliency. In a subsequent post, I will dive into how you can incorporate resiliency concepts into your exercise regimen.


Disclaimers:

  1. I am not a Doctor or Medical Professional. The information provided here is for educational purposes only and does not replace medical advice. Consult your Primary Care Physician or other healthcare professional as needed before implementing any recommendations into your lifestyle.

  2. Any views and opinions expressed are my own and are not affiliated with USA Powerlifting, Barbell Medicine, or the authors of this book.


WHAT IS STABILITY?


In Chapter 13 of Outlive, Dr. Attia offers a technical definition for stability: "...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." On his podcast and website, he also defines stability as "a way that we transmit force from the body to the outside world, and vice versa from the outside world to the body... in the safest manner possible across the muscles which are designed to carry that load… as opposed to seeing the dissipation of force across joints that are not fit to do so."


In Outlive, Attia discusses the importance of stability. He notes many older people tend to exercise less, if at all, because of some chronic condition or injury. Attia asserts stability is essential to movement, especially if we want to repeat that movement for decades. He believes most acute injuries are likely the culmination of a chronic weakness and/or lack of stability that was the root cause. Just like we are trying to avoid the four major icebergs on our voyage of life (see Part 1), Attia believes stability is the key to avoiding other icebergs along our fitness journey. He also contends that certain movement patterns can be dangerous especially when combined with maximal loads, noting that improper technique combined with continuous exposure to heavy loads is what leads to injury, and that the cause of the improper technique is a lack of stability.


In his book, Dr. Attia notes most people are born with the innate ability to move properly, but that our movement aptitude disappears with loss of physical activity and increased sitting associated with the modern lifestyle, i.e. going to school or working in an office. He promotes the concepts of Dynamic Neuromuscular Stabilization (DNS) which is a clinical approach to retraining movement based on human development between 3 months of age and walking. Attia also promotes the concepts of the Postural Restoration Institute (PRI), an organization that focuses on asymmetrical patterns and the influence of polyarticular chains of muscles on the human body. Dr. Attia's framework for exercise includes concepts of DNS and PRI among others, as a cornerstone for developing physical capability.



WHERE WE DIVERGE


I think Dr. Attia's framework for exercise is sound and logical. In fact, we probably agree on most things with regard to strength and movement, we just choose different movement disciplines to focus our energies on. I agree that you should not be pushing yourself to the limits or training harder than last time all of the time; that is just intelligent programming and periodization. I also agree that strength and conditioning is a long-game, a journey of sorts rather than a destination. So, we need to train in a way that allows us to continue the pursuit of physical development for years and decades.


Here's where we diverge... I do not believe any movement pattern is inherently dangerous if it is properly trained and progressively loaded within a reasonable amount of time. Obviously, if you are brand new to weight training and manage to squat an empty barbell on day 1, trying to hit a 2 times bodyweight squat on day 2 is going to increase your risk of injury regardless of technique. When it comes to optimal movement patterns, Dr. Jordan Feigenbaum, founder of Barbell Medicine, prescribes the REP model. He states that technique should be Repeatable, Efficient, and Meet the points of performance of the movement as outlined verbatim below.


Repeatable: The individual should perform the exercise in a way where the ROM, joint angles, velocity, tempo, and overall movement patterns are somewhat similar from rep-to-rep. Individuals move differently from one another and, when the analysis is constrained to a single person, from rep-to-rep. [1, 2, 3] Thus, we accept some rep-to-rep variability, though ROM, joint angles, velocity, and tempo should be fairly similar.


Efficient: The movement strategy used should aim to maximize performance for a given level of energy and effort. In other words, an individual should aim for a technique that minimizes muscular force that does not contribute to completion of the task. Using the deadlift as an example, starting with the bar forward of the lifter’s center of balance (approximately midfoot) requires muscular force production to move the bar back to the position it needs to be in, which costs energy and does not contribute to the bar being lifted.


Points of Performance: The resulting movement strategy adopted by the individual should meet any pre-specified criteria or goals of the exercise, e.g. a particular range of motion, velocity, tempo, muscle group contraction, etc. For barbell sports like Olympic weightlifting and powerlifting, many exercises that are trained have competition-specific criteria that serve as points of performance. For general strength and conditioning, these criteria can be used, though they can just as easily be modified. Determining the intent of an exercise, e.g. what are we trying to train and why, is a concept that might be useful for determining useful points of performance.


In this model Dr. Feigenbaum intentionally avoids specific anatomical relationships as many tasks in the real world require "non-ideal" positions. He further adds that if someone cannot move in a certain or idealized manner, their inability is indicative of their current ability rather than a sign of inherently dangerous movement patterns that will cause injury if not addressed immediately.


PURSUIT OF RESILIENCY

Bryan performing split squat for stability and strength

While stability is certainly an important aspect of physical ability, and while incorporating stability work per Dr. Attia's recommendations may prevent injury, I do think for long term development we need to reframe things from the perspective of resiliency. You cannot avoid injury, even if you do have "perfect" technique. If you plan to become the strongest version of yourself, you need to be able to navigate injuries of various severity. Even more importantly, we need to use sound programming and incorporate prehabilitative work so we can minimize injuries in the first place. Lastly, we need to give our body the "tools" and practice it needs to move in different ways through space with and without external load. So what is Resiliency? According to Oxford Languages, it is

  1. The power or ability of a material to return to its original form, position, etc., after being bent, compressed, or stretched; elasticity.

  2. The ability of a person to adjust to or recover readily from illness, adversity, major life changes, etc.; buoyancy.

Both definitions are useful for the concept of developing athletic resiliency. The first definition can be applied to your body. For example, developing joint resiliency through prehabilitative or rehabilitative exercises. The second definition applies to your mindset; your ability to endure hardship and work through a physical pain, injury, or adversity unrelated to training, is what ultimately allows you to become the strongest version of yourself.


You cannot avoid injury, even if you do have "perfect" technique.

RESILIENCY CONCEPTS


From a physical capability perspective, resiliency involves doing all the things that don't get all the glory, things like prehab or rehab, ab work, cardio, unilateral movements and stabilization work, barefoot training, and much more. Resiliency involves adaptability and giving your body the skills it needs to move in multiple ways, even for the same task, e.g. lifting an object from the ground with a flexed, neutral, or extended spine. It also involves developing the skill to make instantaneous adjustments to your body as it moves through space to avoid obstacles or injury, e.g. preventing a fall or at least minimizing injury by absorbing impact through eccentric loading of your muscles. From a mental perspective, resiliency includes establishing a mastery mindset, and the pursuit of a craft rather than an arbitrary goal. The concepts of resiliency are key components within the 3 pillars of my coaching practice: Movement, Mastery, Craft. In subsequent posts, I will dive into the specifics of how you can incorporate resiliency concepts into your training.


REFERENCES

  1. Bartlett, Roger et al. “Is movement variability important for sports biomechanists?.” Sports biomechanics vol. 6,2 (2007): 224-43. doi:10.1080/14763140701322994

  2. Nordin, Andrew D, and Janet S Dufek. “Load Accommodation Strategies and Movement Variability in Single-Leg Landing.” Journal of applied biomechanics vol. 33,4 (2017): 241-247. doi:10.1123/jab.2016-0097

  3. Aasa, Ulrika et al. “Variability of lumbar spinal alignment among power- and weightlifters during the deadlift and barbell back squat.” Sports biomechanics vol. 21,6 (2022): 701-717. doi:10.1080/14763141.2019.1675751

  4. Outlive: The Science and Art of Longevity by Peter Attia MD with Bill Gifford

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