Okay, let’s get literal for a moment. Solar system, galaxy, universe… What’s the difference (Figure 19-1)? The standard answer is that the solar system consists of the sun and its orbiting planets, along with moons, asteroids, comets, rocks, and dust. Our sun is just one star among the hundreds of billions of stars in our Milky Way galaxy. The universe consists of billions of galaxies.
Figure 19-1.
Then astronomers talk about the most distant reaches of “the observable universe.”1 Are there, indeed, other universes? Copernicus had it simple. He dealt only with the Earth and Sun and a few other planets. His was a pretty simple conceptual universe.
You got it?
Man is not born to solve the problem of the universe, but to find out what he has to do; and to restrain himself within the limits of his comprehension.
Johann Wolfgang von Goethe, 18th-19th century German writer and statesman.
The attitude reflected in Goethe’s quote might also partially explain physicians’ hesitancies to explore the core and find out what’s there and how the different parts of the core interrelate. Just thinking about seemingly endless possibilities can be exhausting. The medical literature reflects these physician hesitancies. You can see this attitude with your own eyes, if you Google key words such as chronic pelvic pain and gynecology.
THE CORE UNIVERSE
Copernicus’s comparatively simple “universe” is the one we shall go with for this book (Figure 19-2). The point here is that the pubic bone sits in the center and its harness or bridle communicates with the brain and other core muscles (see Chapters 6, 7, 8, and 16). The core is vital for optimal musculoskeletal function of the head, neck, and upper and lower extremities.
Figure 19-2. The pubic bone, with its “harness” or “bridle” muscles, at the center of the body’s universe.
THE DIAGNOSIS UNIVERSE
The anatomic region we call the core—nipples to knees—contains a huge number of anatomic and physiological systems known to physicians for centuries. The item left out of physicians’ understanding is the musculoskeletal system. That absence, therefore, calls for a whole new understanding, particularly when one considers how many people in this world have undiagnosed pelvic pain of one sort or the other. Now that we have some handle on some of the causes of these pains, it is time to look at this region as a whole new universe. In the past, physicians and other physical specialists have siloed their knowledge. No specialty has taken on responsibility for all the possible causes and answers. This chapter is a call for appreciating the magnificent number of diagnostic considerations that reside here. Appreciate the beauty of this all. Be aware of all the system’s planets as well as the many comets, meteorites, and rocks that can both help and harm us.
Get on your space suit, wander outside your ship, and take in all the heavenly bodies afloat in varying orbits around the pubic bone and everything else. Be ready to hurl yourself backward to avoid getting hit—by planets, comets, and other asteroids that dart into view. Diagnoses with common themes inhabit each object. See the gastrointestinal planet and the neurologic dust. Occasional wandering comets streak onto the scene. Nomads harboring rare diagnoses may wreak havoc unless we prepare for their possible arrival. Farther out, nebulae appear. Wonder if these clouds of apparent dust are developing concepts or practical knowledge just beginning to coalesce into forms.
Try to name the planets directly in front of us. Let’s find the right appellation for a planet populated by muscular problems and another crawling with disorders of the skeleton. Not surprisingly, those 2 planets rotate closely around each other as they follow what seems to be the same orbit. A planet hovers nearby, full of gastrointestinal issues, and 4 others for genitourinary, neurological, lymphatic, and vascular disorders. Comets flash across the view bearing malignancies, autoimmune processes, and toxins. Distant clouds of stardust contain rapidly developing understandings of how physical training influences the shapes of hips and why brains stop functioning normally when the core muscles are damaged (Figure 19-3).
Figure 19-3. The universe of core diagnoses. Venn planets represent the diagnoses within each system as well as the overlap in diagnoses. DDD = degenerative disc disease, FAI = femoroacetabular impingement, GI = gastrointestinal, GU = genitourinary, GYN = gynecologic, SIJ = sacroiliac joint.
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