Before diving into anatomical detail, let’s soar up to 30,000 feet and emphasize 7 concepts you should keep in mind as you read further—about the core and how it integrates the rest of the body. You may think of real world of sports stars who illustrate the concepts. Unless a specific name is mentioned, the characters are fictional. Any resemblance to specific individuals is purely coincidental. Many of our patients do exemplify the same themes.
CONCEPT 1: THE BODY’S TRANSMISSION
If you are going to put together a list of the toughest guys in sports history, Franz Beckenbauer (Figure 6-1) must be on the list. The soccer sweeper was the centerpiece of West Germany’s teams for many years, but his performance in the 1970 World Cup semifinal against Italy might be even more impressive than leading his country to the championship 4 years later.
Figure 6-1. Franz Beckenbauer.
Early in the game, Beckenbauer suffered a broken clavicle on a hard tackle by an Italian player. Since West Germany had exhausted its 2 allotted substitutions, “Der Kaiser” stayed in the game, with a sling holding the injured arm close to his body.1 It was unlikely the team’s captain was going to leave such an important contest. Beckenbauer played his customary stout game in the middle of the West German defense for all 120 minutes, but despite his courageous efforts, Italy prevailed, 4-3, in double overtime.
Anyone who has played soccer, whether at the elite or youth levels, understands that while players aren’t able to touch the ball—except on throw-ins or if they are playing goalie—the arms are extremely important for balance and in helping to ward off opponents who are trying to get the ball. To play one-armed, Beckenbauer needed more than just an iron will.
He needed a strong core.
If Beckenbauer hadn’t trained his body’s transmission to its peak efficiency, he never would have endured the marathon game against the Italians, much less played to his usual standard. The strength and flexibility he had built allowed him to excel at the highest level and overcome a substantial setback. No matter how strong his legs were, Beckenbauer wouldn’t have been able to thrive under those circumstances without a core that was operating at its highest levels.
You can ask Mikhail Baryshnikov about that. Generally regarded as the greatest ballet dancer of all time, the Russian genius of dance brought power and athleticism to the graceful discipline, executing leaps that seemed impossible to accomplish. Though slight in frame, Baryshnikov was nonetheless a coiled spring, capable of generating great power with his jumps. (See Figure 6-2.)
Figure 6-2. Modern ballet dancer in a move that Mikhail Baryshnikov made famous. Note the seemingly perfect form, sense of power and balance, and da Vinci/Baryshnikov focal point they call “the center.”
His secret? Practice, of course. But more than anything, Baryshnikov had developed his engine room to the point where its output was at its apex. He displayed the results on stages throughout the world, creating a legend that will never be duplicated.
Baryshnikov has shown that his principles of balance and power generation can be taught. He has become the master teacher. Our Chapters 2 and 7, and the pubic area at the center of the core’s universe, follow unswervingly from some of his teaching.
Baryshnikov could leap, all right, but the Olympic high jumper who approached Dr. Meyers one day was able to soar. Still, he wanted to go higher and had heard about a patient of the doctor’s who had gained some altitude on his jumps after some of his muscles tightened following core surgery to repair an injury. “Do the same for me,” the athlete pleaded. Dr. Meyers was ready, but there was a problem.
There wasn’t anything wrong with him. (See Figure 6-3.)
Figure 6-3.
If surgical repair of the core could produce better results, the jumper wanted in, even if his core was without any blemish. Dr. Meyers laughed, “You have to complain of something in order for me to operate on you.” The high jumper was dismayed and left the building. His knowledge of the core’s importance had grown, but alas, his personal best did not improve.
The high jumper couldn’t be blamed for wanting to heighten his core’s performance ceiling. Repair of injuries often leads to increased results. Many of our athletes have achieved personal bests after surgery. A stronger, more efficient physical transmission will almost always aid athletes and everyday people in their duties.
In other words, if you build it, results will come.
CONCEPT 2: CONTROL OF THE EXTREMITIES
No one can say for certain if there is any direct link between the core muscle injury Chicago Bulls All-Star guard Derrick Rose (Figure 6-4) suffered during the 2012-13 NBA regular season, or the torn ACL that happened during the playoffs and his long-drawn-out return, or any of his other injuries.2–7 There could well be a relationship between the destabilization of the core and the inability of the body to protect the legs, particularly when they are taxed so thoroughly during a basketball game. There could be a relationship between optimal core strength and ideal recovery from ACL reconstruction. Maybe there isn’t.
Figure 6-4. Wonderful basketball star Derrick Rose warming up with the US Olympic team.
“Something’s got to give,” points out BJ Armstrong, Derrick’s agent and former NBA basketball great. “I weighed 175 pounds when I played; these guys nowadays are 210 and the same height. These kids are too strong. It’s fun to watch lateral movement, but the body is not built to do that, at least not for long. Something’s gotta give: the ankle, the hip, the knee?
“The athlete has outgrown the court. They find new ways to create space on the court. Look, for example, at Steph Curry and his ‘stepback deep 3.’ The court is too small. Something has to change for the safety of the kids.”
BJ provided another perceptive insight, which fits precisely with the engine/transmission concept discussed in Chapters 1 and 2: “The basketball player is like a car moving at 75 mph and stopping on a dime and then changes directions beyond what it is designed to do. Other parts of the car become vulnerable.”
Without having gone to medical school, some athletes and agents understand the core pretty darn well. The core is important. Core and extremity injuries are connected.
But since nobody knows for sure whether a core injury leads to an extremity injury, wouldn’t it make sense to protect the extremities as much as possible by building the core and at the same time reducing isolated movement of the extremity?
Just look at what happened to Detroit Tigers pitcher Justin Verlander during the 2013 season. He had been throwing without pain, but his velocity dipped by as much as 10 miles per hour. That’s a significant drop for a power pitcher. Two years after going 24-5 and winning the American League Cy Young Award, Verlander was a pedestrian 13-12 with a 3.46 ERA and 217 strikeouts.8,9 Those last 2 stats were his worst efforts in those categories in the past 5 seasons. After the season, he was found to have torn much of his muscle mass away from the pubic bone. An inverted weighted sit-up dramatically brought the injury to light. Since repair, Justin has regained his power and command, and led the Detroit pitching staff again. In 2017, the Tigers traded him to Houston, which he helped win its first-ever World Series title. Justin’s wonderful work ethic got him through all this.
Two former MLB fastball pitchers we know both suffered core injuries while covering first base on bunt plays. Both had large, protecting contracts and decided against surgery. Both struggled on the mound in the aftermath and came nowhere near approaching their previous speeds or success. Their arms were healthy, but their compromised cores didn’t allow them to air it out like before.
Back in 2003, Roy Oswalt didn’t want to have surgery on his core injury, either. He hurt himself in one of the strangest games in MLB history—a 6-man no-hitter. Oswalt started the game for Houston at Yankee Stadium and pitched a flawless first inning. But a “groin pull” forced him to leave the game after one frame and turn it over to the bullpen, which was remarkable. Houston relievers walked just 3 and struck out 13. Oswalt, meanwhile, didn’t miss a start, despite his injury. He didn’t want to take any time away from his team, and he knew he was due for a potential contract raise after the campaign, so he didn’t want to take any chances. Oswalt finished 10-5 with a 2.97 ERA. After seeing his salary rise from $500,000 to $3.25 million and having his core repaired, Oswalt went 20-10 the next year and led the majors in victories.10
After the injury and prior to the repair, we could see slight limitation to full flexion of the left thigh. Consider Figure 6-5, and imagine Roy’s left foot planted about 18 inches behind where it is. We worried that this would affect pitching mechanics. Even slight alteration in pitching mechanics can have profound injurious effects on the pitching arm. Oswalt heroically pitched with the injury, giving the Astros a chance to make the playoffs. His stride returned to normal after the off-season repair.
Oswalt learned that a compromised core can hamper a pitcher’s ability to deliver the ball at top velocity, no matter how healthy his shoulder and elbow might be.
Figure 6-5. Pitcher Roy Oswalt while with the Phillies. Note his extra-long stride.
And if an athlete has bad feet, that can contribute to trouble with his core. That’s how closely related the area is to everything on the body. Take Grant Hill.11–13 Once considered one of the top 2 or 3 players ever to enter the NBA and heir to Michael Jordan, Hill was sabotaged by a series of foot injuries that forced him to miss sizeable parts of 4 seasons. While he tried to get healthy, he created problems for his core, demonstrating the reciprocal relationship between the extremities and the body’s transmission. Fortunately, Grant underwent repair, and this wonderful player and person had a long and brilliant career.
We can’t always be sure that trouble with one area leads to problems with the other, but the evidence is pretty clear that something’s going on there. Physical therapists talk “kinetic chain.” The key linkage is the core.
CONCEPT 3: INTERACTION WITH THE BRAIN
Star quarterbacks may find themselves on the injury report every week for many seasons, so one might say that their presence on that inventory is largely ceremonial. But, when a wide receiver finds himself on that list after suffering a severe core injury in a preseason game, the presence on that list may not be purely ceremonial.
“Groin injuries” can be substantial, and in one case a couple of seasons ago, that wide receiver chose the heroic route, opting to avoid surgery. He had missed many games the previous seasons for a variety of other injuries. He could not take the risk of missing more games if he could avoid it. It would have been too easy for management to speculate that maybe he was too delicate. Certainly, a prolonged absence would make him seem more fragile and negatively affect his career. He became sick of talking about the injury to the press and just wanted to play.
So, he returned, finally, after a number of weeks…he looked “stiff,” not able to cut and weave like he once had, and he obviously wasn’t able to see the defensive back right in front of him who clocked him. And he was out with a concussion for several more weeks. No doubt, the lack of mobility created a loss of certainty and self-awareness that made him more vulnerable on the field. (See Figure 6-6.)
Figure 6-6. Autographed Sheldon Brown Sports Illustrated cover of him clocking a New Orleans Saints running back.
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