John trained smart: he read the articles, hired a running coach to design his half-marathon training, and arranged it all to wedge in around his busy schedule as a partner at a real estate fund.
When his hips felt tight, he stretched. When his IT band flared up, he whipped out the Theragun, and foam-rolled.
Six weeks before race day, he felt some nagging discomfort in his knee, but he pushed through his tempo run nonetheless.
The next morning, he could barely walk.
And it got worse over the course of the week.
One MRI later: torn meniscus, surgery recommended, race cancelled, and six months of physical therapy ahead.
But the real cost wasn't the lost race. It was the month of terrible sleep, the brain fog during a critical fundraise, and the realization that he'd been managing his own body in a way that he'd never manage his company.
When John first came to see us at A3, we shared good news and bad news. We told him we were pretty sure we could get him back to 100% without surgery. (Turns out, we were right.) BUT, we also told him that, had he come in 18 months earlier, we could have prevented the tear in the first place. His injury was entirely predictable from just our first set of movement and structural balance testing.
Most people treat injuries as random bad luck. Yet they'd never approach their businesses that way. Instead, they model risks, build redundancy into critical systems, and fix small issues before those spiral out of control.
Turns out, a similar approach works in the gym, too: assess measurable imbalances, use those to predict injury risks, and then backcast to training and other changes that can head off the injuries in the first place.
At A3 Health, a data-driven performance company in New York, I've spent years watching high performers make this exact mistake. They bring analytical rigor to every aspect of their lives except the one thing that makes everything else possible: their body.
Why the Old Model Fails: "Get Stronger, Hope for the Best"
Here's the standard advice you'll find online: lift three times a week, do some cardio (don't forget the Zone 2!), "work on mobility," maybe throw in a YouTube "prehab" routine if you have an especially touchy shoulder or knee.
Which, honestly, isn't bad advice. You'll get stronger, improve your cardio, and feel FAR better than if you just sat on your butt and did nothing.
But it's also fundamentally blind.
That generic training approach increases your capacity without reducing (and in many cases exacerbating) your injury risk. It doesn't account for the specific ways you're likely to break:
Maybe your strength is asymmetrical. Your left hamstring is 15% weaker than your right, but it feels totally normal to you.
Maybe your mobility is great in some planes but missing where it actually matters. Your golf backswing is full of wonky cover-ups for reduced t-spine rotation or shoulder internal rotation.
Maybe you've developed compensatory movement patterns that you can't see yourself—one knee tracks inward when you squat, or your lower back does all the work that your glutes should be in your deadlift.
And that's the real gap in the standard model: you're not searching out the weak links that in turn model how you're likely to break.
Most people only get sophisticated feedback after they're already in pain. That's when you finally see an orthopedist, get an MRI, start physical therapy. And here's the frustrating part: a good PT will then run you through tests for joint angles, strength asymmetries, and faulty movement patterns. They'll identify the exact imbalances that caused your injury.
In other words, they do the same kind analysis you needed 18 months ago when you felt "fine."
That's like doing crash investigations after the accident, instead of safety inspections before the part fails. We're being reactive when we should be predictive.
The exercises your physical therapist prescribes post-injury? Those same exercises—or smarter, more real-world applicable ones—would have prevented the injury if you'd done them before it happened.
Intelligent Prehab & Backcasting: Preemptive Physical Therapy
So what's the alternative?
It starts with reframing what "prehab" actually means. Most people think of prehab as those random activation drills you do before your workout—some band pull-aparts, maybe a few glute bridges, whatever your Instagram algorithm served up that morning.
That's not prehab. That's warm-up theater.
Real intelligent prehab is a structured system to identify your most likely future injuries, then build prevention into the center of your training plan—not tacked onto the margins. Think of it as preemptive physical therapy baked into your program from day one.
The key concept here is backcasting—borrowed from scenario planning and strategic forecasting. Instead of looking forwards, start from potential negative outcomes, and then work backwards to figure out what predicts them, and therefore what might prevent them in the first place.
The process for applying that to injury is conceptually simple:
Start with a list of specific potential bad outcomes that you're demographically at risk for (if you're a 50-year-old desk jockey, perhaps that's ACL tear, rotator cuff impingement, lumbar disc herniation, etc.).
Ask: "What patterns and imbalances typically precede each of those injuries?"
Look for those exact patterns in your data right now.
If you find them, you've identified a high-risk failure mode.
Build your training around addressing those high-risk patterns and imbalances to close the gap.
Here's what it looks like in a concrete example: research shows that 70-80% of non-contact ACL tears in recreational athletes share a handful of common precursors—reduced hip internal rotation, weak glute medius, poor single-leg stability, knee valgus collapse under impulse or load.
If you show up with those exact markers, we don't need to wait around to see if you tear your ACL. We already know you might Your job is to fix the pattern before the ligament fails.
You already do this in business. You don't wait for your top engineer to quit before you think about succession planning. You don't wait for your server to crash before you set up backups. You imagine the failure mode, work backward to the warning signs, and solve the problem in advance.
Intelligent prehab applies that same logic to your knees, hips, shoulders, and spine.
The difference between someone who trains for 20 years without major injury and someone who's constantly managing an endless list of tweaks and stretches of time off isn't luck. It's whether they're addressing their specific weak links before those weak links break—or just hoping for the best.
The Intelligent Prehab Loop
So assuming you buy the idea, how does it actually work in practice?
At A3, we break the intelligent prehab process into four steps: Detect → Forecast → Recode → Recalibrate.
Step 1: Detect – Deep Assessment, Not Vibes
The first step is moving beyond "I feel tight" or "my squat looks okay in the mirror."
We need actual data. That means comprehensive testing across three domains:
Mobility screening: Hip internal and external rotation, ankle dorsiflexion, shoulder flexion and rotation, thoracic extension, etc.. Not just "can you touch your toes"—we're mapping specific joint limitations that matter for your training and sport.
Strength balance testing: Left versus right asymmetries (is your right leg 15% stronger?), push versus pull ratios (are you benching twice what you can row?), quad versus hamstring balance, hip versus knee dominance patterns.
Movement pattern analysis: How you actually squat, hinge, lunge, press, and run under load. We're looking for compensations you can't see yourself—knees caving in, lower back taking over for glutes, shoulders hiking up during presses.
Depending on the client and the context, we layer in force plates, motion capture, and wearable sensors for more objective data. But regardless of the tools, the core principle is the same: you need a map of your specific fault lines, not a generic "strengths and weaknesses" printout.
The output of this phase is a detailed profile: here's where you're tight, here's where you're weak, here's where you're compensating, and here's how all of that interacts.
Step 2: Forecast – Backcasting From Failure Modes
Now comes the interesting part: connecting your specific data to likely injuries.
This is where we explicitly backcast. We ask: "Given this pattern—tight hip flexors, limited hip extension, weak glute medius, valgus collapse in single-leg tasks—what injuries has this profile predicted in people like you?"
This is also the step where we bring in our proprietary A3 AI system, to help us juggle—and find patterns in—more extensive amounts of data than even great coaches can keep in their brain at one time.
We built this part of our artificial intelligence system based largely on three main bodies of information:
Historical datasets: What happened to other athletes, executives, and weekend warriors with similar profiles?
Research literature: What does the science say about risk factors for specific injuries?
Pattern recognition: Machine learning models that flag combinations of variables humans might miss (for example, the interaction between limited ankle dorsiflexion and knee valgus in predicting patellar tendinitis).
Now, we can feed a client's detailed data in, and kick a hyper-personalized risk profile out.
Risk profiles aren't about scaring you. You're not 'broken.' But they can tell you that you're facing increased odds of knee pain or IT band issues or elbow tendonitis in the next 12-24 months unless you change the way you move and train.
Step 3: Recode – Training as Preemptive PT
Armed with that profile, an intelligent approach to prehab diverges starkly from the standard model.
Our "prehab" doesn't live in some separate corrective exercise corner of your program. It doesn't happen in a 10-minute pre-workout activation circuit. It becomes the spine of your entire training plan.
That means:
Main lifts chosen to address deficits. If you have a significant left-right strength asymmetry, swap out some of your bilateral barbell squats for split squats, single-leg RDLs, and other unilateral work to close the gap.
Accessory work targeted to your specific deficits. If your glute medius is weak and your hip external rotators are underperforming, load those split squats and SLDLs in a variety of ways to change the force vectors, or supplement with things like curtsy lunges and Copenhagen planks—not just because they're "good exercises," but because they're solving your problem.
Warm-ups matched to your pattern, not random stretches. Similarly, if you show limited hip internal rotation and compensate with lumbar rotation, your warm-up might include specific 90/90 hip internal rotation drills and motor control work—not generic leg swings.
Unlike 'traditional' PT, we aren't sidelining you to just light bands and pink dumbbells; you'll still be training, hard. But you'll be doing so in a smarter way, rebuilding the foundation so you can keep training (and playing) hard for decades to come.
Step 4: Recalibrate – The Feedback Loop
And, finally, we check our work.
This approach doesn't work as a "set it and forget it" protocol. Every 4-8 weeks, you'll need to re-test key metrics:
Has hip internal rotation improved?
Are left-right strength gaps closing?
Has your squat pattern cleaned up on video analysis?
Are the risk markers trending down?
As those numbers improve, the program evolves. You keep knocking out low-hanging risks, while also focusing increasingly on offensive, performance-building work.
The loop is continuous. Assessment → forecast → training prescription → reassessment. It's not a one-time fix; it's an ongoing system of intelligent noise-canceling for injury risk.
Two Red Zones You Probably Have Right Now
Our work at A3—whether through our Outperform Coaching program or in-person at our Reboot Performance Lab—is based entirely on hyper-personalization. Every person, and every person's collection of movement patterns, is unique.
But, after hundreds of clients, we can also say that at least some of those movement patterns show up nearly universally, at least in the highly-successful desk-jockey demographic that makes up most of our client base.
In future posts, we'll circle back to deep-dive those patterns one by one—giving you a set of tests to confirm they apply, and then both a general framework and some specific movement and exercise ideas to bake into your program if they do.
Until then, we'll start by running quickly through two of the most common 'red zones' we see, to give you some immediately actionable food for thought.
Red Zone #1: Desk Warrior Hips
The pattern: Tight hip flexors + weak glutes + weak external rotators
Odds are, you do a pretty impressive amount of sitting: you sit on the way to and from work, you sit at your desk and at meeting, you sit at restaurants and at your dinner table and on your couch. All-in, you're likely sitting for at least 6-8 total hours over the course of your day.
If so, this one almost certainly applies.
What it looks like:
Chronic low back tightness (especially after sitting or first thing in the morning), with occasional low back pain (sometimes acute / 'back going out').
Knees cave inward during squats or lunges, especially with more load / speed.
You feel your quads and lower back way more than your glutes when you deadlift or squat.
Often, knee pain (usually on the opposite side of your dominant hand—if you're a righty, that's left knee) that comes and goes without obvious cause.
What's actually happening: Your hip flexors adaptively shorten from all that sitting. Due to something called 'reciprocal inhibition,' your glute max stops firing, which drags your glute medius and the hip external rotators down in turn. When you try to move, your body finds workarounds: your lower back hyperextends to make up for limited hip extension, your knees collapse inward because your glute med isn't strong enough to stabilize laterally, and your hamstrings and lower back take over to cover for all the work your glutes should be doing.
Why this matters: Your hips are the engine of nearly every athletic movement—running, jumping, squatting, hinging. When they don't work right, everything else breaks down. This pattern is a direct line to non-specific low back pain, hamstring strains, IT band syndrome, patellofemoral issues, and more
The backcasting question: If we assume you're going to develop one of those injuries in the next 18 months, what would we find today? Probably exactly this pattern.
What intelligent prehab looks like:
A quick self-check: try the "couch stretch." (Make sure you get your rear knee and rear foot flush against the wall.) If you can't get to a vertical torso with your other foot flat on the front (and the majority of our incoming clients can't even get that foot up to the ground in first place), you're hit.
If so, your training emphasis shifts:
Main lift focus: Split squats, single-leg RDLs, hip thrusts, step-ups
Accessory work: Lateral band walks, fire hydrants, Copenhagen planks, 90/90 hip stretches
The key: You're not just "doing glute work"—you're specifically targeting the lateral stability and external rotation that's missing
Future deep dive: In our next article, we'll walk through the complete hip assessment protocol and the six sub-variants of this pattern based on which specific hip rotators are involved.
Red Zone #2: Keyboard Shoulders
The pattern: Tight internal rotators + weak external rotators + weak mid-back
You also probably spend a bunch of your day rounded over like a giant prawn, with your hands close together in front of you. You're typing on a keyboard, scrolling on your phone, or shoveling food into your mouth.
What it looks like:
Rounded shoulders and forward head posture (take a side profile photo at your desk—you'll see it)
That "pinchy" feeling at the top of your shoulder during overhead presses or pull-ups
Shoulders hiking up toward your ears when you press
Chronic neck tension or tension headaches at the end of a long work day.
What's actually happening: Your chest, front delts, and internal rotators are locked short and dominant from internal rotation. Your mid and lower traps, rhomboids, and external rotators are weak and inhibited. Your scapulae don't move properly—they wing out or tip forward instead of gliding smoothly. When you try to press or reach overhead, your rotator cuff tendons get pinched between bones because the scapula isn't creating space.
Why this matters: The mid-back and scapular muscles are what stabilize your shoulder complex during any upper body movement. When they're weak or not firing, those tiny rotator cuff tendons take the entire load. That's the classic setup for impingement, tendinopathy, and that nagging "angry shoulder" that makes bench presses or pull-ups miserable.
The backcasting question: If you develop rotator cuff pain in the next year, what pattern would predict it? This one.
What intelligent prehab looks like:
A quick self-check: Try a wall angel (back against wall, try to slide your arms up overhead while keeping your elbows and hands in contact contact with the wall). Then try an Apley scratch—reaching your hands together behind your back with one arm reaching up your back and the other reaching down behind your neck. Can you clasp your hands behind your back? Does one side look or feel way different than the other?
If those reveal issues, your training emphasis shifts:
Main lift rebalancing: Your horizontal pulling volume (rows, face pulls) needs to be at least equal to—if not greater than—your pressing volume
Accessory work: Band pull-aparts, face pulls, YTWs, rotator cuff external rotation work, thoracic extensions over a foam roller
The key: You're not just "strengthening your back"—you're restoring the specific scapular control and external rotation capacity that your posture has stolen
Future deep dive: We'll unpack the full shoulder assessment and rehab protocol in a follow-up article, covering all 17 muscles and 4 joints involved in healthy shoulder mechanics.
AND ONE VERY IMPORTANT CAVEAT: These are high-level patterns, not personalized prescriptions. They're useful as a starting point for self-awareness, but they're not a substitute for actual assessment. Your specifics matters—where exactly you're tight, which muscles are weak, how your compensation patterns interact. That's where the real magic of intelligent prehab happens.
Stop Training Toward Your Next Injury
Here's the bottom line: you're already training. The question is whether you're training toward your next injury or away from it.
Most people wait for catastrophe. They ignore the warning signs—the tightness, the asymmetry, the weird compensations—until something breaks. Then they finally get the sophisticated analysis they should have gotten 18 months earlier.
You don't run your business that way. You model risks. You fix small problems before they become existential ones. You build redundancy into critical systems.
Your body deserves the same analytical rigor.
Intelligent prehab—using backcasting to predict likely injuries from current imbalances, then building training around prevention—isn't complicated. The technology exists. The methodology is proven. The only question is whether you'll apply it before you need it, or after.
The patterns we discussed—desk warrior hips, keyboard shoulders—are a couple of potential starting points. They're useful for self-awareness. But true intelligent prehab requires personalized data: your specific movement patterns, your unique asymmetries, your injury history and training goals.
Generic advice has limits. Specific intervention has power.
If you want to see what intelligent prehab looks like in practice—the full assessment, the backcasting process, the personalized training protocols—that's exactly what we do at A3.
The best time to prevent an injury was 18 months ago. The second-best time is today.
Stop waiting for your body to fail before you intervene.
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Josh Newman is founder and CEO of A3 Health. He has spent nearly three decades founding and scaling companies in technology and high-performance physical fitness, and holds a dual BS in Neuroscience and Computer Science from Yale University
