It’s because they didn’t have hernias.

People eventually will have to listen to the physicians and others studying this anatomy, physiology, and pathophysiology, so that they won’t end up in the same situation as the Russian hockey star. Core injuries don’t require mesh. They require precise expertise and know-how.

Right now, that may not be the most popular stance in the surgical world, but how badly should we feel about pointing out something that happens to be right? To a great degree, it is like lecturing at the barbershop convention that people don’t need haircuts. Imagine declaring to the American Hernia Society that these injuries have nothing to do with hernias. It doesn’t work. That happened. That pronouncement did not make this speaker the most popular guy in the room.

But Copernicus didn’t have too many fans either when he said the Earth orbited the Sun. He just had to settle for being correct.

Okay, it’s not quite the same, but you get the picture.

THE WAY IT IS—FIFTEEN CORE PRINCIPLES

By now, you should already appreciate the below-listed principles. Let this list serve as an interval summary. As you read on, implant these principles deep into your psyches. Here are the 15 core principles:

1. Think anatomy. Think in terms of the 4 parts of the core, and know that all 4 parts work together.
   
2. Think about the core’s harness and the harness’s communication with the brain and the bones and muscles.
   
3. Think of the central portion of the core as the axis for stability and athleticism. The pubic bone or an area just above the pubic bone is ordinarily the center of the core. That central focal point may change with injury and make things go off kilter. The hips and pelvis are a huge part of this central anatomy.
   
4. Think of the core as providing power and sense of balance for the upper and lower extremities.
   
5. Think of central core injuries as likely bad, and the more peripheral ones more likely to correct without surgical intervention.
   
6. Think with regard to protecting of the central core structures and building the power muscles and the rest of the peripheral core as protection for the central core.
   
7. Think of the kinetic chain as well as optimal order of sequential movements for developing strategies for improvement and maintenance of core integrity.
   
8. Think about the possibility of multiple sites of injury that might exist at the same time when serious central problems occur. This is a balance thing. To physicians, this concept may, on first glance, seem “non-Oslerian.” In fact, when one considers the entire core as one body part, this concept is very Oslerian.
   
9. Think in terms of correction of central instability as all-important for optimal athletic function and performance.
   
10. Therefore, it follows that correction of central instability often requires a combination of primary repair and correction of compensatory defects.
    
11. Recognize that the systemic organs, blood vessels, nerves, and “everything else” (part 4 of the core) link anatomically to the bones and muscles of the core (eg, femoral vessels may actually affect the range of motion of the hip).
    
12. Think “out of the box” with respect to the possibility that visceral dysfunction affects the musculoskeletal function (eg, bladder irritation, Crohn’s disease, sexual pain, or gastrointestinal dysfunction all may affect athletic performance).
    
13. Keep the bias that fitness, quality of life, and longevity all go together, but also remember that there remains controversy about this connection.
    
14. Don’t think purely of bones and muscles when movement causes pain. In other words, do not miss the “more serious” stuff.
    
15. From our viewpoint, balance, fitness, strength, beauty, and stamina emanate from the core. Those are 5 good reasons to make core health a distinct medical specialty.

Memorize these 15 core principles. They will come in handy as we get back to more clinical stuff.

Okay, okay. You do not have to memorize them. Then, instead, read why we selected the 4 following readings for you.

SELECTED READINGS

Copernicus N. De revolutionibus orbium coelestium (On the Revolutions of the Celestial Spheres). 1543. Dictionary.com. Unabridged. Random House.

Of course, Copernicus’s world-changing book has to be a selected reading. He laid the foundation for modern science when he propounded that his sun-centered model of the universe explained physical reality. Remember, at that time, this was truly heresy. He chose not to publish his book until he was near death.

Kuhn T. The Structure of Scientific Revolutions. 2nd ed. Chicago, IL: University of Chicago Press; 1970.

In this landmark book, Thomas Kuhn destroys the concept that scientists search for truth. He substituted the goal of efficient puzzle-solving for a search for “scientific realism.” “Normal scientific” research occurs within a paradigm. Puzzle-solving merely adds to the scope and precision with which the paradigm can be applied. The scientist, guided by the paradigm, asks questions that can be answered and that have an easily recognizable solution. Thus, the paradigm shapes both the questions and the answers. Normal science, as defined by Kuhn, is cumulative. New knowledge fills a gap of ignorance. But normal science does not permit for advancement by means of revolutionary theories. Inconsistent details threaten a paradigm. When enough inconsistent details concern a topic of central importance, science comes to a halt. Such a crisis requires scientists to reexamine the foundations of their science that they had been taking for granted. Copernicus’s revolutionary new paradigm did just that. Therefore, Copernicus angered most everyone around him.

Cohen IB. Revolution in Science. Cambridge, MA: Harvard University Press; 1985.

In his brilliance, my former professor Bernard Cohen, founder of the Department of History of Science at Harvard University, puts all this revolutionary stuff in perspective. He describes the stages that determine revolutions in science and how Copernicus, Galileo, Newton, and others fit into the overall picture. Alternate paradigms get proposed, usually by scientists who are young or new to the field and thus open-minded. Because different paradigms justify themselves with their own terminology and principles, one must actually jump into the paradigm in order to understand and accept it. Kuhn and Cohen use the word faith to describe the conversion.