Avoid Injuries and Increase Physical Fitness | Doug Kechijian

Kechijian's personal schedule keeps strength training at once per week because he layers tennis, martial arts, and walking on top of the dedicated sessions — each contributing to one of the three qualities even if not labeled as training. The total weekly stimulus is higher than the session count implies. For someone with no incidental physical activity, he recommends bumping to two strength days. The key principle is that all three qualities need a minimum maintenance dose: 'Your body is amazing in its ability to not adapt — it's so efficient it will drop whatever you don't give it an impetus to maintain.'

Kechijian notes his own sprint sessions take longer than expected because the warm-up is extensive — he cannot just go all-out immediately given his age and history. For neurologically-demanding work like this, the rest interval is also longer than most expect: a true 5-second maximal effort on the bike requires closer to 55 seconds of genuine rest, not just a brief pause. The sprint protocol generalizes to any modality — ski erg, sled push, explosive med ball throws — when the lower body is temporarily unavailable. The nervous system benefit (maintaining rapid motor unit recruitment) is partially systemic: even upper-body explosive work keeps the body in the habit of fast neural firing.

Kechijian uses the financial reserve analogy: a bank account with just enough to cover daily expenses — no buffer — means any unexpected demand tips into deficit. Joints work the same way. A runner whose only activity is running operates their joints at near-100% capacity during every run; an unusual step, a sudden direction change, or an off-day posture has no cushion. 10 minutes of daily end-range work creates that cushion without requiring gym equipment or significant time. He notes that even Tai Chi and slow movement classes count, and that full-range-of-motion strength training can serve double duty as mobility work for joints it crosses.

Kechijian performs RFESS with over 100 lb in each hand plus a weight vest and says his legs are 'getting smoked' — this is not a light substitute but a fully intensity-capable loading pattern. He also notes that machines have been unfairly demonized: a leg press that produces no spinal discomfort is not a lesser exercise than a back squat if the goal is leg hypertrophy and the individual has a bad back. 'Why would you accept the spinal cost when you can achieve the same leg stimulus without it?' The belt squat on a flywheel device allows even higher loads without any spinal compression because the resistance is applied at the hips.

Kechijian's early career mistake was treating patients like colleagues — delivering abstract theory and detailed information rather than a simplified, personalized plan. He now uses the military mission-planning model: what is the objective, what is the safest path, what risks are acceptable given the stakes? For a patient who wants to keep playing competitive tennis despite knowing it carries some long-term risk, the right answer is not to tell them to stop — it is to help them do it with better mechanics and more robust supporting conditioning.

Kechijian explicitly rejects the current standard-of-care for elderly fall prevention — foam pad standing and slow static balance drills — as a 'misguided paradigm.' Falls are unpredictable by definition; preparation requires dynamic reactive training, not predictable controlled conditions. He has used the weighted sled with elderly patients who he did not consider safe for ground sprinting, having them 'push the weighted sled and run as fast as they could with it — it slows them down enough to make it safe, plus they're holding on so they're not going to fall.' The result is a scaled version of the same explosive quality.

Kechijian: 'I've got my whole freaking life to keep repeating it. I don't even like saying do something this many days a week because that's not like life — life gets in the way. Typically in about seven days I'm gonna hit these things, but if I don't do it in seven days I just hit it maybe in nine days.' This maps directly onto behavioral change research: perfectionism after a missed session is the primary driver of program abandonment. The cycle approach normalizes the miss and redirects energy to the next hit.

The bandwidth metaphor recurs throughout the episode: just as a car needs more than first gear even if you never drive on the highway, a body needs the ability to move at the extreme ends of the speed/intensity spectrum even if daily life rarely demands it. Zone-2 training lowers the metabolic floor so the same tasks feel easier; max-intensity training raises the ceiling so that truly high-output moments — sprinting for safety, reacting to a fall, a demanding sport day — are not operating at 100% of capacity. HIIT sits in the middle and does improve that zone, but the returns plateau quickly and the two extremes are never trained. The practical consequence: someone who only does HIIT for years has a reasonably trained middle zone but remains fragile at both ends.

Kechijian's protocol on the bike: sprint all-out for 5–8 seconds every minute on the minute, stopping when peak wattage decreases by ~3% from your best effort of the day. He notes that for pure top-end speed the stimulus is intensity, not volume: after a thorough warm-up, 2–4 high-quality sprints may be the entire workout. He explicitly rejects the idea that fall prevention in elderly people is served by standing on foam pads, calling that paradigm misguided because falls are unpredictable — you train for the ability to right yourself rapidly, not for static balance under controlled conditions.

The reserve metaphor: living your life uses exactly as much joint range as you need to live your life — no buffer. Like a bank account with just enough to cover daily expenses, any unexpected demand (a fall, an unusual movement) tips into deficit. The practical prescription is 10 minutes of daily end-range work: contracting muscles at the end of range, not just passive static stretching. This gives the joint a reason to maintain the structure that supports it. Kechijian is also skeptical of the biomechanical determinism crowd, but equally skeptical of movement optimists who say form doesn't matter; the answer is foundational standards that are age-adjusted but never zero.

The most important clinical implication: an over-cautious PT who avoids all high-stress loading before clearing an athlete is not producing a safe outcome — they are deferring the risk to the strength coach or sport coach who eventually loads that athlete. The locus of the risk just moves. Kechijian's protocol: identify the mission (what does this patient need to be able to do?), triage interventions by risk/reward, and take an explicitly calculated level of risk rather than hiding behind over-caution. This is why he starts every evaluation with 'why are you here and how can I help you' — mission definition before protocol selection.

The practical takeaway for providers: bombarding patients with abstract theory treats them like colleagues rather than patients, and is the wrong mode. The practical takeaway for individuals: if the information landscape feels paralyzing, the correct move is to pick the simplest version of the behavior and start — a 45-minute walk while pushing a stroller counts as zone-2 stimulus. The accountability function of trainers is underappreciated: many clients pay not for information but for the social contract that ensures they show up.

His retrospective analysis: 'I was being a dumbass about my training when I was young — chasing arbitrary numbers, ego lifting, meeting certain milestones with no real mission.' He now does rear-foot-elevated split squats with 100 lb dumbbells per hand rather than back squats, uses belt squats (flywheel) to load legs without spinal compression, and performs heavy carries from a rack rather than deadlifts from the floor. Machines are no longer demonized in his view — for longevity they are valuable because the limiting factor is the target musculature rather than spinal stability.