We dance round in a ring and suppose, but the secret sits in the middle and knows.
—Robert Frost, famous poet.
Ask 100 people about the pubic bone, and after they stop giggling, they’ll no doubt mention something about sex. Or everything about sex. And, when it comes to that, the pubic bone is definitely in play. Man or woman, it has a big role in sexual intercourse (Figure 7-1).
Bull riders look at the thing differently—for good reasons (Figure 7-2).
If you spent 8 seconds (or less) on an angry hunk of bovine nastiness, you would too. The twisting, turning, and bouncing can’t be good for the body, and that pubic bone bears the brunt of the action. Imagine trying to control about 2,000 pounds of snorting cattle that doesn’t want any part of you sitting on its back. It isn’t easy. Even if the rider has a strong core, he/she is exposed to countless opportunities for muscles to tear and bones to break. Those who haven’t built up the area might as well try the merry-go-round.
OBVIOUSLY THE CENTER
Sex, bulls…what else? What other roles does the pubic bone play? Ask a ballet dancer or a futebol jogador, or a hockey goalie, or Leonardo da Vinci for that matter…where is your “center” (Figure 7-3)? They will tell you.
They point to the pubic bone or somewhere slightly above it. Look at what anatomists call the center of the “normal anatomic position” or what evolutionists call the bending point for human progression from a 4-legged animal to early caveperson. Consider the “set” positions of baseball or American football players. What part of the anatomy comes into play most? How does the upper body connect to the lower body? How are the muscles arranged to do this? Isn’t there an obvious symmetry? What anatomic structure provides a more obvious connection point? Is it possible that the pubic bone is the center of the body’s universe (Figure 7-4)?
Not that we need more convincing, but let’s look at what we should already know. The following ancient observations were not simply mythical. Nobody has refuted them. Leonardo da Vinci was not out of his gourd in 1490 when he drew Le proporzioni del corpo umano secondo Vitruvio, the man with the supposed perfect proportions. He used complex mathematical models and a circle and a square to show that the pubic bone and perhaps an area just above it was the center of the body’s universe. He even called it that. He believed literally that man embodied the universe. Da Vinci based his observations on the work of ancient Roman architect Vitruvius. Da Vinci’s square, formed by arms outstretched, represented material existence, and his circle, formed by spread-eagled extremities, represented our spiritual being. It appears that the pubic center covers all the bases! Eerily, da Vinci went further and even used words for this center like “the core.” His Vitruvian man became the symbol for symmetry and balance. I became queasy reading some of the da Vinci translations. I wondered if we were plagiarizing his interpretations, and was relieved when I realized it was way beyond the statute of limitations for da Vinci to sue us.
Now travel ahead to the 20th century. Relatively modern evolutionists reidentified the pubic bone as a crucial anatomic feature in man’s progression from a 4-legged animal to the way we are now. They implied that the older evolutionists already knew this. C. Owen Lovejoy showed that a 3-million-year-old lady named Lucy1,2 could walk and run on 2 legs, with that same bony frontal part at the center of it all, presumably in her first decades of life. Interestingly, Lovejoy and colleagues also saw that the hip sockets formed the levers providing tremendous power that would be channeled through the one and same friendly bony prominence.
So, evolutionists and ancient architects may have known far more about the pubic bone than us modern scholars (Figure 7-5).
Let’s not beat ourselves up too much unnecessarily for being so innocent. How many of us serve as Little League coaches or dance instructors or commit time to teaching other activities? Certainly, we know the pubic bone area is important. We may not say it out loud, but we do. We probably don’t appreciate how much we know. Baryshnikov and other ballet teachers call that anatomic area the same as da Vinci “the center point” for balance and dance. As coaches in baseball, football, soccer, basketball, you name the sport, we teach the “set position” (Figure 7-6). Think about how Coach Mike Krzyzewski teaches the defense in basketball. Bend slightly at the center, be ready for immediate power. A profile of the bony structure of the sprinter’s starting position displays a “ready” position perhaps the best. Plus, we always tell athletes to “play within themselves.” What do we mean by that? Aren’t we advising them to stay in control of their bodies and to maintain their center points? Figure 7-6B should convince you that this starting position is natural.
EXTRAPOLATING VITRUVIAN CONCEPT TO COPERNICUS
For fun, let’s combine the da Vinci pubic center concept with the Copernican controversy concerning the sun at the center of the universe. Could it be that the pubic bone is the center of the body’s universe, with arms, legs, neck, and head orbiting around it (Figure 7-7)? Yes. Now you’ve got it.
MORE ON THE DIFFICULTY STUDYING THIS AREA
This stuff seems so obvious. Then why has this anatomy remained so mysterious to us docs? Why is all this stuff not written down? To keep the mystery in sex? No, medical people don’t obsess on that. The core’s complexity? Maybe that’s part of it. So many muscles and organ systems converge right there. Plus, medical specialists get trapped in their individual organ systems. And except for trauma and the hip, orthopedists generally fear veering into the pelvis. No medical specialty looks at the core as a whole. Could it be that? And put the sex thing on top of that. Maybe we’ve got something here. For whatever reason, important concepts—including the incontrovertible reality that the pubic bone is at or near the center of the core’s universe—have heretofore simply not been articulated in modern times.
Before looking more closely into the anatomy and function of this important center of our body, let us render a couple more remarks about the difficulty studying this area in today’s world.
Clinically, social stigmas spill over in spades to the professional side. With modern-day taboos, the whole “private area” of men and women has become almost off-limits. Detailed physical examinations are almost impossible, except when undertaken by a urologist or gynecologist, who are not ordinarily versed on anatomical problems of the hip. Yet, orthopedists do not ordinarily do pelvic examinations on women. An orthopedic hip surgeon in Vermont did do that a few years ago. Prosecutors charged him with multiple counts of rape.3, VID 1
No doubt, other factors were involved, but the point is that we need to redefine this specialty of the core. We need to establish principles and guidelines. Otherwise, physicians and others, with good or bad intentions, shall continue to make up their own rules. Gynecological, prostatic, and other problems occur in the same anatomic region where the hip also lies. The whole world should peer intently at what health professionals are doing when they care for patients with pelvic problems. We need to create a new field called core medicine.
Social stigmata carry over into the scientific arena, particularly in cadaveric dissection suites. Cadavers provide the answers to how the pubic bone works as the center of the body’s universe. The dissections are not pleasant. But the smells and general disagreeableness of those travails were minor compared to the hoops of social and regulatory taboos we jumped through. It may have been easier to dissect cadavers in ancient Egypt when docs had to let dead people drift for days in the Nile so they could puncture the skin without a knife. The Egyptians would have considered themselves lucky not to have so many people standing around ready to snap cellphone photos of them.
Even educating medical students became difficult. I still dream about all the hairy eyeballs I aroused by my pointing out the pubic anatomy to our medical students at Body Worlds exhibits at the Philadelphia Museum of Art.
As you read further, imagine the difficulties we faced doing our experiments. Nevertheless, the cadaveric dissections were so important. They helped define this body region’s biomechanics. With these, we also developed our MRI techniques. The logistics behind imaging these cadavers in an outpatient center were interesting (Figure 7-8).