Staying fit for competition in body and mind

When Marcus Elliott graduated from Harvard Medical School, he embarked on a career with one overriding mission: to extend the playing lives of athletes by utilizing better data and technology. In the decades since, his company, P3, has become a destination for off-season players looking to boost performance and longevity in the professional ranks. For instance, 60% of players on 2021 NBA rosters have been to P3. In the process, P3 has amassed a trove of data on basketball players, football players, and other competitors as it measures the way they move through the basic actions that make up their sport. Elliott can pinpoint precisely how each athlete stacks up against peers, but more important, he can compare their biomechanics—and assess whether they are putting themselves at risk of a career-ending injury. He then prescribes training regimens to address those deficits. Recently, he sat down with Deloitte to talk about building resilience in athletes.

Deloitte: Marcus, thanks very much for joining us today. You’ve spent your career trying to mitigate the risk of injury for professional athletes. Describe the state of play in performance training when you started.

Marcus Elliott (Marcus): The way it worked, and the way it still works in a lot of professional sports, is there’s a coach or a performance specialist who puts a workout up on a whiteboard and then runs 15 NBA players through that same workout. We wanted to create more of a medical model where information would flow in both directions. We didn’t think that we could write an ideal program for a professional athlete unless we knew quite a bit about the athlete.

Deloitte: So, take us through the process when an athlete shows up at your lab.

Marcus: When we assess an athlete, we'll spend an hour and a half to two hours having that athlete do everything necessary to perform in their sport. We assess a whole lot of the best athletes in the world, so when someone shows up, they know that they’re being assessed against the best players in the sport, whether it's the NFL or the NBA or the Olympics. These guys are incredibly competitive. They know we’re going to be measuring them against the best, so they all try really hard. They’re trying to jump high and move fast. We measure those things and we can give them numbers on the performance side. But we’re much more interested in how they do these things: not how high they jump, but rather how they jump, how they land, how they move.

We’ve been doing this for a long time, so we have lot of data, and we’ve connected that data out to the court or field, to the things that matter to the athlete or the team or the league. We can see, for example, that this athlete is one standard deviation outside the mean for a biomechanical movement that’s associated with high risk of knee injury or, on the performance side, is associated with being able to guard the perimeter in the NBA. We know which of these data points are the most significant when it comes to injuries or when it comes to competitive advantage in sports. And we can place these athletes on a scale relative to all their peers to see where their weaknesses are, where the risks are. We use all that information to develop a very targeted training program aimed at specific systems. And then we reassess to see if we actually moved the needle. If all you’re doing is predicting good and bad outcomes, that’s interesting, but it’s much more interesting to actually affect the future.

Deloitte: When you talk about a system, are you talking about a repetitive motion that an athlete makes?

Marcus: We're talking about all the different mechanical pieces that go into executing the movements of your sport. So, it may be a system that allows you to slide laterally. Let’s say you’re a perimeter defender in the NBA. You’ve got to be able to move fast, laterally, in both directions if you’re going to stay in front of somebody. So that’s a system. Another system allows you to jump vertically. Another system allows you to accelerate linearly. These athletes are sort of a summation of all these different physical systems. Our goal is to objectify these systems, to have all this data so we’re not guessing but can make much more reasonable predictions about the future and finally affect the future by reducing risk and improving systems.

Deloitte: What are the biggest career-enders for professional athletes?

Marcus: The idea that chronic or acute injuries are random events—and that there aren’t strong signals—just never made sense to me. It comes down to physics. The physics behind the game dictate whether these guys are able to survive in really harsh environments. Everybody takes note when a player has a giant injury, like a ruptured Achilles, as the basketballer Kevin Durant had. That’s a big, traumatic injury. Everybody watches to see if an athlete in that situation has fallen off when he comes back, if his productivity goes way down.

What most people don't see is that a lack of resilience in professional sports is usually more a matter of these small decrements in the physical systems of performance. Usually, players wash out of the professional leagues because of a death by a thousand cuts. It’s not one traumatic injury. It’s more that you had this bad ankle sprain, and now you can’t finish at the rim off your left leg. That part of your game is taken away. Or imagine you’ve lost some ankle mobility on your left, forcing you to compensate in lateral driving movements, and now you’re not able to create as much lateral force moving to your right. And that means you're not as good a defender on the perimeter moving to your right. A lot of times, it also often means that you’re creating more injury risk due to this compensation.

You have these small pieces of your game that are whittled away to the point where you become a marginal player, and then you get dropped out of the league. And that’s usually how these things work. In our work, because we collect all this granular data on these physical systems, we can see whether a system has gotten a little better, or if it’s a little bit worse, as a new compensation pattern emerges. We can see any perturbation in these systems year to year. We take the guesswork out. The athletes that are able to maintain the same movement patterns—more or less the same physical systems, even if they’re a little bit less powerful, a little less forceful—if they don’t have significant mechanical compensations, they’re the ones who are able to play for a long time.

Deloitte: Are there common characteristics among athletes who are able to have these extended careers?

Marcus: When we collect all these thousands of data points on these athletes, we put all that data into a machine learning algorithm, and it clusters these players based on similarities of physical systems. Let’s take a player like Steph Curry in basketball. That’s a guy who I would predict is going to play for a long time. Steph is in a cluster called kinematic movers. The players in this group don’t jump really high. They’re not players who run really fast. They’re not players who do anything that really stands out physically. They don’t seem exceptional. But it turns out that their superpower is that they don't have any significant holes in their physical systems. They can do everything. They can jump pretty well. They can second jump pretty well. They can move to their left well. They change direction off their left well, they can move to the right well, they can change direction off their right, they can rotate well on either side, and so on. They do everything pretty well. They’re in the 50th to 67th percentile in everything. That ends up being its own superpower.

We think of these players as the Swiss Army Knives of athletes. C. J. McCollum is in that cluster. Trae Young is in that cluster. These are basketball players who are usually undervalued coming out of college because they’re not very flashy and they don’t seem like incredible physical specimens, but they have the right tool for the job in almost any situation, so when a small opportunity presents itself in a game, they have the exact right tool to take advantage.

In our research, the athletes with the longest productive careers are kinematic movers. When those guys lose one physical system, maybe now they don't move as well to their left laterally—they may lose one of their blades—but they have 17 other great blades to reach for. Compare that to someone whose superpower is much more singular, and that power starts getting diminished. That’s a problem. They have one go-to competitive advantage. The players that have a lot of tools, those are the ones that tend to survive the longest. By traditional measures, they’re the most resilient.

Deloitte: Some truly great athletes seem to have another power they can draw on, something psychological or spiritual that gives them the will to eke out victory. How do you deal with that nonphysical element in your work?

Marcus: We know we can’t measure everything that’s important in performance, especially when it comes to the mental and spiritual components. We used to do EEG brain scans on all of our athletes, just like we do biomechanical scans. We actually did brain mapping, but I ended up stopping it after a few years. I didn’t think the available interventions were very compelling. If we saw that athletes had a mental deficit, I didn’t think that using biofeedback was very effective in changing it.

To build mental and spiritual fortitude, we started bringing athletes on what we call misogi challenges. It’s based on an ancient Shinto religious concept. It’s the idea of a purification ritual that usually involves some repetitive process. It teaches you that you can tolerate much more than you thought was possible. We took that concept and really turned it into an intense physical challenge. I had been doing these for a couple of decades before we started bringing athletes along.

I called it a physical challenge, but that’s actually not right. It’s more of a spiritual and psychological challenge that masquerades as a physical challenge. The idea behind it is that by testing your boundaries, by finding out where your edges are, you get this insight that almost always shows you’re able to do much more than you thought possible by getting far out of your comfort zone and risking failure. You’re developing a tolerance for taking on really challenging, difficult, and possibly failure-inducing activities. You learn things about your fortitude, about your potential, that you had no idea existed.

I believe we evolved gene sets that predispose us to these kinds of extreme challenges. It’s the same superhuman effort that gets you over the mountain pass before the first snow comes because you need to settle your tribe in the valley on the other side. Almost anything great that gets done by humans, at the onset of that great thing, there is a high probability of failure. Overweighting the risk of failure stops us from taking on a lot of things that could result in something great. This is certainly true in the world P3 operates in—professional sports—but it’s true in many others as well.

Deloitte: That sounds intriguing. What are some examples of misogi challenges?

Marcus: The misogi challenges are always different, and they’re pretty simple. We have two rules. First, you have to find a challenge that gives you about a 50% chance of making it—if you do everything right. And the second rule is you can’t die. So, if you're doing something where dying is a possibility, you have to mitigate that risk. We did this underwater rock-hauling challenge where a group of us tried to carry these two boulders—82 and 84 pounds—five kilometers underwater. There was a risk of underwater blackout, so we had a dive team out there to keep an eye out in case one of us passed out. We did another misogi where we paddleboarded across 27 miles of open water from an island to shore. The way the winds work, there was a good chance of being blown out to sea, so we had a boat trail us. The concept is simple: You have to find something really hard.

Deloitte: Both of those challenges sound intensely physical. Where’s the psychological and  spiritual element?

Marcus: A misogi looks like a physical challenge, but once you start, you realize it’s very much a challenge above the neck. You don’t have to prepare for one, which takes away all the excuses. Maybe you never carried a rock underwater before. Neither did anyone else. With the rock carry, you had to dive down 10 feet and pick up the rock. It was really heavy, it sort of held you on the bottom, and then you had to carry it as many steps as you could, and then go up and take a breath. And then you had to go down and pick it up again.

When we were 45 minutes in, you just you thought you were done; you really thought you had maybe one or two more carries in you. But then we went another four and a half hours, which is how long it took us to make the five kilometers. In almost every misogi that I've done, I have had this perception that the edge is really close, and it usually turns out that the edge is so much further out than where you thought it was. At maybe 20% or 25% into it, you think you’re finished.

But there’s something that happens when you give yourself over to the process. When we did the underwater rock carry, at just short of an hour, there was this sense that we couldn’t go on anymore. I think that it’s just the planning part of your brain that's trying to do all this work and trying to calculate things that it doesn’t have enough information to calculate because you’re doing something that’s so far outside of anything you’ve ever done before. There’s just not enough data for it. And trying to work that out is really draining. But at some point, when you give yourself over to the process, you're not planning, you’re not thinking 10 steps out. You’re only thinking about what you’re doing right now.

Kyle Korver, the NBA player, did the paddleboard misogi, and that next season, he set an all-time record for most consecutive games making a three-point shot. When he was asked how he did it, he talked about the challenge of paddling almost 30 miles with a big crosswind. He said when he was doing it, he eventually just stopped thinking about even trying to get all the way to land. Instead, he was thinking about the moment: “I’m just going to try to have one perfect stroke and then one more perfect stroke. And the next thing you know, you’re on the other side of the ocean.”

Deloitte: That must build a sense of the possible that’s very empowering.

Marcus: You’re watching yourself do so much more than you ever dreamed you could, and you generalize from there. You start trusting that you can do much more than you thought possible in other situations.