What’s the Core? It Seems Kind of Important

Figure 1-1. Josh Hamilton and a wall. This is the event that produced Josh’s first injury. (Major League Baseball trademarks and copyrights are used with permission of Major League Baseball Properties, Inc, with permission from Josh Hamilton.)

Josh Hamilton had been given a day off, right in the middle of the 2011 World Series. Seems that “groin strain” was bothering him a lot, and Texas manager Ron Washington wanted his slugger to get a little rest. It made sense. The man who had slammed 25 homers during the regular season hadn’t cleared the wall once during the playoffs (Figure 1-1).

Josh and outfield walls did not get along. He repeatedly crashed into them over the course of his career, leading to the speculation that these led to his core muscle avulsions. His first injury was definitely related to such a crash, and he set the All-Star Game Home Run Derby record the year following repair.¹ The second injury had a more occult onset and was on his opposite side.

Hamilton would go deep during the Rangers’ Series loss to St. Louis. Once.

In 17 October games, Hamilton hit just .271, with that lone homer and 13 RBIs. Texas hung in for 7 games against the Cards but couldn’t win the deciding game. As analysts looked back on the Series, Hamilton’s performance in the Fall Classic (.241, 1 HR, 6 RBIs) was looked at as a prime reason for the loss.² Forget that the Rangers’ pitchers gave up 42 runs. Hamilton didn’t deliver, so he was branded a prime culprit.

Less than 2 weeks after the World Series ended, doctors found out exactly why Hamilton had struggled so. He had torn all 3 adductor muscles on one side of his core. It was a huge injury within the very engine room that delivered the power to his swing. This wasn’t some little groin strain. It was a full tear that was in need of repair. Hamilton could have opted for surgery earlier, but there was no way he was going to miss his chance at a world title, especially since the Rangers had lost the year before to San Francisco in 5 games.

Doctors identified precisely the injury and fixed it, and Hamilton rehabbed during the winter months. The following season, Hamilton slugged 9 homers in April and went on to have one of his most productive years, slamming a career-high 43 dingers, knocking in 128 runs and hitting .285 (Figure 1-2).³

Figure 1-2. Josh setting the MLB Home Run Derby record in 2010. (Reprinted with permission from USA Today Sports.)

The moral of the story? The core seems kind of important.

You know Hamilton would say it is. But so would just about any athlete who needs power and energy to thrive. Football players need strong cores to generate the force necessary to overpower opponents. Basketball players need health there to attack the rim. Hockey goalies had better be able to move side to side or the net will be filled with pucks. World-class sprinters (Figure 1-3). Volleyball spikers. The list is long.

Figure 1-3. Tyson Gay fighting for first place in the 100 meters. (Reprinted with permission from Tyson Gay.)

THE CORE AFFECTS US COMMON FOLK

Athletes are not the only ones. Ever bring a couple bags of groceries into the house from the trunk of your car (Figure 1-4)? If you can do that without taking a break halfway, you have built some core strength. Try carrying a teenager’s book bag without a little bit of fuel in the body’s engine room. If you don’t have any, it’s class dismissed. And don’t go picking up that crying toddler without some core development, or you’ll be the one throwing the tantrum.

The core serves elite athletes and everyday folks who have to carry out the tasks that get them through their days. It’s the central part of the body, and it’s responsible for helping everything else function at top levels. Without a sturdy foundation there, the arms, legs, and brain are vulnerable. Confidence is destroyed. Performance lags.

So, what is the core?

Figure 1-4. Carrying groceries requires the core.

THE CORE IS OUR ENGINE AND TRANSMISSION ALL WRAPPED INTO ONE LARGE REGION OF THE BODY

Okay, we got that. So, it’s the engine room and transmission all wrapped into one. We see that. Figures 1-5 and 1-6 show that pretty obviously. But what are we looking at? Tell us more.

Figure 1-5. An automobile engine/transmission.

Figure 1-6. It so happens that the engine/transmission fits inside (A) Josh (Reprinted with permission from USA Today Sports), (B) Tyson (Reprinted with permission from Tyson Gay), (C) our grocery woman, (D) Lionel, and (E) Mia (Reprinted with permission from AP Photo/Don Heupel and Mia Hamm).

Simply put, the core is the body from the nipples to the middle of thigh, and there is an awful lot of stuff in there. Organs, nerves, muscles, and big blood vessels can all be found there. Okay, so the head is kind of important. The core is vital, too. It is amazing that nobody has really paid much attention to it until now, at least not in its complete state. Cardiologists care about the heart. Gastroenterologists worry about the digestive tract. But nobody has been concerned about the whole thing. What’s in there? And, more importantly, how does it all fit together?

That’s what this book is about. It discusses adductors and the rectus abdominis. The psoas and the rectus femoris. The pubic bone and the gluteus maximus. The hip joint. And the back. And then the organs and all that other stuff. The core is all of that, and believe it or not, this whole region of the body fits together. Duh! It’s there. It is part of our body. Well, it is not only there, but the core actually works together and functions as a whole, just like the engine and transmission of a car, yet so much more intricately. We shall be talking about these functions; the relationships between the different parts of the core; development, repair; and rehabilitation; and much more.

THE CORE IS SPICY—SO GET OVER IT

We’re going to use some spicy language here, because there are some spicy things in that core. It isn’t just muscles and joints. There’s sexual stuff, too. Maybe that’s why everybody has been so reticent about all of this? As soon as someone mentions the pubic bone, you can almost hear the giggles, like we were in a junior high health class. Deal with it, folks (Figures 1-7 and 1-8). As you read this book, remember that giggles are okay! This region of the body is fun. Plus, a strong core can help all kinds of athletes.

Figure 1-7. Get over it.

Figure 1-8. The mystery involves both sexes. This picture is shown purely for equal time. Again, get over it!

We said, “Get over it” (ie, get over that the core contains the “private” parts of the body). And we have to, in order to understand the core. That is not simple, and predators are out there, like Larry Nassar, the abominable family medicine guy in charge of US Women Gymnastics whose abusive and criminal actions damaged a collection of girls and young women and eventually landed him in jail, disgraced and never to practice his monstrous tactics again. Good riddance.

We all have to respect the area so much that we keep those creeps away. We need chaperoning. We need a strong, continued dialogue between physician and patient. Between physician and parent. Between everybody. This is imperative, not only to ensure the best possible care but also to ensure nothing like Nassar’s atrocious behavior happens again.

But the elite athletes make the biggest news about the core. Like world-class sprinter Tyson Gay, who floundered on the track for a short while, had his muscle injury fixed, and then beat world champion Usain Bolt in the 100 meters. He later underwent hip surgery and was back winning top events at the age of 35 years.

NFL cornerback Sheldon Brown saw some time as a rookie with the Eagles in 2002, but a core injury limited his effectiveness. After a doctor repaired his problem, Brown became a starter and completed his 11th year as a regular in 2013. The same story with Bills’ safety Jairus Byrd. A severe core injury prevented him from playing the last couple games even though he was still named Rookie of the Year. He had to undergo both muscle and hip surgery, and 4 years later, the Bills had to franchise him in order to keep him. Tight end Jeremy Shockey knows all about what a healthy core can mean. A lot of people thought he was washed up when the Giants let him go after the 2007 campaign. And given Shockey’s—let’s say “enterprising”—personality and approach to the game, plenty of fans would have been happy if that had been the case. But after surgery, he became a key part of the New Orleans Saints’ attack. In Super Bowl XLIV, Shockey caught a key TD pass in the Saints’ victory over Indianapolis.^4–6

IT ALL FITS TOGETHER

One of the big things we’re showing with this book is how the hip, muscles, and vital and giggle organs all work together (Figure 1-9).

Figure 1-9.

Another big thing we expect to do by this book is to eradicate the term “sports hernia” forever from the English language. Or die trying. There is no such thing. Core injuries involve tears, pulls, and strains. They involve disruptions of big bony, muscly joints. They aren’t simple protrusions or bulges. And they aren’t simply hernias to be repaired by mesh. The media gets part of the blame for this. Using the “sports hernia” catch-all term is easy and doesn’t require detailed explanations (Figure 1-10).

We, the medical and health care communities, deserve some responsibility here, too. A huge number of publications perpetuate that term or terms that imply that repairs of hernias will fix that one type of problem.^7–12 The anatomic region seems so complex. This complexity makes us physicians give up trying to understand the problems more, and therefore lends itself to easy-to-say, catch-all phrases—even though we all know the terms have no validity. There’s an awful lot going on in the core, what with all the biomechanics and the big blood vessels and organs in there.