In orthopedics, the core comprises a specific group of muscles in the trunk/pelvis. (Others use core generally to mean trunk.) Core muscle strength is beneficial. Just as arm, chest, and foot strength are beneficial! Core muscles are not exemplary. They’re no more our “foundation” than our foot muscles or those running the length of our spine.
Many erroneously treat orthopedic low back pathology by strengthening the core. Assuming core muscle strength can be accurately assessed, if one or more of them is weak, the question is why. Muscles become weak (and painful) from pulls/tears. However, these are very rare when it comes to the large muscles of the core. (Tears follow a consistent, predictable pattern, too, which should make them obvious to an attentive clinician.) Pain can create weakness, but absent a clear tear, the pain usually originates from something other than the muscle.
The number one reason any muscle is weak (the large majority of cases) is because its electricity from nerves has been inhibited – either at the spine or extremity joints. It’s a joint problem. Therefore, in most cases strengthening a weak muscle (or entire group!) is simply attacking a symptom, which won’t fully resolve the problem. -- Laura
Treating symptoms (and signs) alone will not fix a problem. Yet I consistently see people consistently attacking their symptoms. In many cases this has even been advised by a healthcare professional. Examples of signs and symptoms include: pain, tightness, achiness, weakness, clicking, locking, numbness, stiffness, buckling or giving way, tingling, and imbalance.
The question is always: what is causing this/what is the diagnosis? Why does your back hurt? Why is your foot numb? Why is your knee giving out? Why is your calf tight? Why does your shoulder ache? Why is your quadriceps or grip weak? Why can’t you balance on your left? Why is your pelvis rotated? Why is your neck stiff?
There are many diagnoses that create each of these symptoms, such as nerve impingement (at the spine or in the extremities), misaligned joints, torn structures such as muscles, and dysfunctional tendons. Very often the cause is located away from the symptoms. And even these causes have causes - which need to be addressed, like changing sitting posture to prevent nerves from being pinched in the spine. An expert diagnosis from a professional who understands all the possible diagnoses and then finds and treats the cause is warranted. -- Laura
Joint derangements are about 80% of all orthopedic problems. Derangements are when a joint isn't sitting properly, leading to pain, stiffness, tightness, and so on. They are usually rapidly reversible! Unfortunately, people are often given structural diagnoses instead (here, it's an AC sprain) or told they have a muscle or tendon problem.
Since joint derangements comprise the LARGE majority of orthopedic problems, McKenzie experts are trained to look for them first. If a joint derangement is found, we use repeated movements to restore joint alignment. This patient had shoulder pain and limited movement following a car accident. One movement fixes her symptoms (bringing her arm across her body) - and one movement worsens her symptoms (bringing her arm back away from her body). McKenzie experts are trained to find WHICH movement is best for you and use that one movement as the treatment approach. -- Laura
Mechanical pain isn’t a new concept - it’s the most common kind of pain. Besides pain, tightness, numbness, clicking/locking, and tingling are also possible symptoms. The bad news is usually mechanical problems are diagnosed incorrectly as structural problems (eg torn meniscus). The good news is almost all are fixable - if you find a clinician who can diagnose and treat them, like a McKenzie expert.
Mechanical problems are those that, simply, can be fixed with movement. Examples include pinched nerves, dysfunctional tendons, pulled muscles, and frozen shoulders. However, the biggest subset of mechanical problems is joint derangements. Derangements (misalignments) are when something (somehow!) obstructs the joint, such as a fat pad; a herniated/bulging disc; a bone fragment; or a piece of meniscus, labrum, or cartilage. Treatment for muscles/tendons involves tissue remodeling movement; joint derangements require specific movements to restore proper alignment.
Outside of mechanical problems there are structural, chemical/inflammatory, and nervous system problems, among others. Most healthcare providers and patients conclude that symptoms are from a structural issue because of unreliable orthopedic tests and MRIs. Orthopedic tests are false positives in the presence of mechanical derangements and MRIs consistently show abnormalities that are irrelevant. An expert mechanical exam is needed. -- Laura
I always write about not basing orthopedic treatment on imaging findings. We should also not base our treatment on clinical findings that appear to be structural without repeatedly moving the spine and/or extremity. Clinical orthopedic tests for the shoulder have been proven to be unreliable (for example, tests for rotator cuff tears, labral tears, impingement, or tendinopathy). McKenzie clinicians move your spine and extremities, looking for immediate cause and effect. Here, while it looks like the patient has a shoulder problem, when the McKenzie clinician moves her thoracic spine, it resolves. -- Laura
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