Abs Are Not the Core

Rehab and fitness professionals get loads of questions about abs, especially if they have 'em. And of course, there are as many opinions about abs as there are fitness people. Since some are asking, here's my own fitness-person-mandatory-abs-write-up.

I'm going to give it all away, right off the bat. Yes here it is, up front and free of charge! Herein lies THE secret to abs, and you don't even have to read the entire writing!

First and foremost, above everything else, you should know that the secret of definition is you.

All of you. Yes, you must get all holistic about it. That's why the "just" plans are always a lie.

Just seven minutes of exercise per day...
Just two pills before major meals...
Just wear these toning shoes while at home or work...
You're eating the wrong yogurt. It's definitely the yogurt.

Okay already. We see them. Your abs.
The truth is that You are so far beyond PTs and trainers and nutritionists and the ripped guys and gals in Facebook ads. Sure, some of us are able to guide and assist in some areas, but please understand that getting any one area "spot on" will not help if you're lacking in other areas.

I'd like to think that abs are a side effect of a generally healthy person who, with much intention, makes an effort to be atypical.

Don't worry. I'm not going to try to go all fitness guru. "Check out my abs, and you should believe everything I, with abs, say." Yechht. I'm not eager to try and impress anyone; at least not with abs. Ask my wife and close friends.

But what's it like to have abs? Well, when you have a firm midsection you always leap out of bed in the morning feeling awesome and you always feel awesome about yourself. You shoot at least 98% from the field in pick-up basketball and you never envy anyone. Everything you cook on the grill comes out roasted to savory perfection, and you never step in dog poo.

Your wife always wants to have sex, like, whenever, and you're way awesome at it and stuff. Your children always make wise decisions and you never snap at them because they obey you like Rodd and Todd Flanders. You're always patient with stressed out, workaholic desk jockeys who ask how many crunches you should be doing and insists that you're lucky.

I have had fairly defined abs since I was about 15. How is it that I'm almost 34 and still have abs? Some of my condition is [1] genetic and [2] environmental. Just some of it. I'm a male built from relatively lean and athletic parents who raised me in a physically active environment.

I don't think anyone should pull the "poor genetics" card as an excuse to give up. I truly believe that just about everyone can get fairly lean. But please, ladies, don't think "lean," "fit," or "healthy" means fashion model scrawny.

Some of my own condition is due to [3] training and nutrition know-how. Since it's my life's work to know something about this stuff and be able to help folks and answer questions, I should probably practice what I preach. Along those lines, keeping fit and pushing to achieve physical performance goals are sort of a [4] hobby of mine, and the aesthetics are a side effect.

Much of it is related to my [5] general temperament and [6] general activity level, having a serious case of ants in the pants. Like, I enjoy pulling my kids all over the place in their wagons and I'll practice bike tricks until my hands are bleeding where time permits. The key is that I'm truly, naturally doing all this activity for fun, not for exercise. This means lots of burnt calories without my mind registering "hey, you're being good and burning lots of calories."

Some of it is due to me [7] being hardheaded and maybe a little spiteful toward people who gripe about being out of shape and guarantee that a few more years will put me in the same place. More than of few of such folks are younger than me, fueling the fire to prove them wrong.

Lastly, some of it comes from me having an [8]everyday midlife crisis, seeing what years of bad decisions looks like. Even scarier is the fallout of freak accidents and unexplained and unearned disease processes. Each day in a PT clinic is a reminder that any given day is only about four weeks away from not having abs.

Okay already. And [9] selfishness, okay? I honestly feel edgy and generally not mentally right if I go more than 3 or 4 days without doing something strenuous. It's a priority to me. I'm healthier physically and especially mentally. I'm a better husband and dad and PT when I get my fix.

Lastly, I include a few core strengthening exercises because weak abs have repeatedly been implicated in low back, knee, and hip injuries.

Surely there are others, but those are ten primary reasons for abs.

Now, far more importantly, are the things not responsible for having abs.

[1] Dieting hard. I don't really eat that clean. Now don't get me wrong, I may eat very clean by some standards, rarely touching anything deep fried. I do attempt to avoid trans fats. But moderate amounts of scrambled eggs and pizza and burgers are absolutely fair game. Sure, that may change as I get older, but it works for now because I (usually) don't overeat for my size and activity level.

I never was an emotional eater. It's nothing that reflects me. That's the point: I never had to deal with that complex issue. If it's an issue for you, don't be misled into thinking that exercise or B complex vitamins are a solution to that problem.

The primary "active" ingredients in my diet are heavy squats, overhead presses, and chin-ups. No, seriously, carrying muscle on your frame is absolutely the best thing that allows you to stay lean without eating like a frail mouse.

Learning what normal portions sizes look like is definitely beneficial. But if you're chronically measuring out 3/4ths cup of brown rice, 1/2 cup of steamed broccoli, and adding it to 1 plain jane chicken breast and a dash of lemon, you're holding on WAY too tightly. If you feel the need to routinely do this, something is drastically wrong elsewhere. It may be hormonal issues from stress and lack of sleep. It may be weekend food or drink binges. It may be too much sedentary work and leisure. Only you know your situation, but if you follow a hyper anal diet and aren't lean enough, you should seriously think of addressing something other than diet.

[2] Supplements are no reason for abs. Acacia Berry is not the cornerstone of rippedness. Neither is cinnamon or Ripped Fuel or any other temporary stimulant. Are you kidding me? The big picture of abs is a fairly complex, long-term process that you can't buy for $39.99. Caffeine has been proven to help the body burn a higher proportion of fat for fuel during exercise and has some other benefits aside from this. Of course it's going to be bad for you if you overdo it.

[3] Exercise selection. The secret to abs is no specific, cutting edge core exercise. The issue is not muscle recruitment. Your abs are probably contracting just fine when you do most of the zillions of exercises you can easily look up on youtube.

How about 5 minute abs? I do only one or two ab exercises, each for about 25 to 50 reps, per week. But I consistently do lots of big heavy leg exercises and farmer walk and sprint and throw my kids and mountain bike around.

Now it's true that core exercises can be done incorrectly. Like all exercises, some ab exercises are unnecessary or just not worth the risk. Abdominal weakness often greatly contributes to lumbar spine dysfunction. But please don't imagine that there's some particular, proprietary movement that will suddenly sharpen your abs and melt the overlying fat away.

[4] Long drawn out cardio (LDOC). I hate LDOC. I think too much of it ultimately eats away muscle and therefore sets your abs up for failure in the long run. I train hard and play hard. I could probably run 8 miles or bike 100 if I had to. I mean, it wouldn't be fun or super fast, but I could do it if I had to.

Sure - you can and should run or bike or cardio twist the night away if you enjoy LDOC. But it's certainly not an essential part of abs. How many ripped distance runners to you know?

Lastly, if abs are not a priority, good for you. Abs are just part of the covering of who we really are; the shell, effected by who we are nonetheless. A self-absorbed fitness freak is no fun for anyone. While abs are overrated and they don't make people happy, nobody should misprioritize their health and wellness.

I personally don't believe that a person can will themselves into transforming who they are. Sooner or later, the body tells the truth. The well balanced person is the core of what others are attracted to. And it's what we have been after all along.

- - - - -

One of my favorite images of all time. But what can we learn from this? Their bodies told the truth, and they both died early due to drastically different issues.

Live well and don't take it for granted - abs or no abs.


The Problem is a Verb

When it comes to muscle and joint aches and pain, patients and health care providers find it challenging to conceive of the problem as anything but a noun.

Herniated disc.
Tennis elbow (or lateral epicondylitis).
Torn meniscus.
Shoulder bursitis.

These are the type of labels we're familiar with. Everyone likes the idea of trying to deal with nouns. But it turns out that the noun is often inaccurate (1,2). At least initially, it's really not that important (3,4). Muscle and joint pain almost always has to do with dysfunctional movement. In other words, the problem is a verb.

Almost all-seeing, but not all-knowing.

Why, exactly, does your shoulder ache after volleyball practice? Is your Achilles tendon on fire because of poor foot structure or hip inflexibility? Will the headache and radiating pain down your arm require surgery or is it likely to respond to more conservative care?

It's more important to answer those kinds of questions than it is to identify exactly what hurts. And you'll need some verbs to find good answers.

Although X-rays and MRIs will give you an inside peek into potential causes of pain associated with injury or "wear and tear," the exact tissue at fault is often uncertain(5). Pictures of anatomical nouns in a rested state show how things look but not how they function. Form and function are obviously linked, but research has proven that looks are deceiving (6, 7, 8, 15).

You better take into account how they function.

The problem with noun diagnosis is that people who are in pain and those who have absolutely no pain often have disastrous looking structure. For example, the top dogs of orthopedic medicine and rehabilitating have knowingly skirted that mystery for decades by using the term"nonspecific low back pain," and have since given that diagnostic label to over 90% of patients with back pain (9,10).

I swear I'm not making this up.

It turns out that identifying the cause of pain is also tricky business elsewhere in the body. Is your partially torn rotator cuff tendon the reason why it hurts to buckle your seat belt? Maybe not. Many people without shoulder issues have partial and full thickness tears(11). I've treated people with full tears who are able to reach and lift overhead just fine after improving the mobility of their scapula and thoracic spine.

Experts agree that joint degeneration is a normal part of aging. Meniscal tears and osteoarthritis in the knee are almost universal (12), yet not everyone needs a knee replacement. Your MRI shows degenerative disc disease and herniations? Well, so do fifty percent of the MRIs of people in their early twenties (13)!

How much degeneration the body can accommodate varies from person to person. But something other than just a structural problem is responsible for causing misery for some people but not others.

The difference is in how they move.

So where are we left in our attempts to describe movement related problems with movement-related terminology? What do patients get when clinicians simply try to be honest about the limits of anatomical (noun) diagnoses?

Lumbar flexion dysfunction.
Scapula upward rotation dyskenesis.
Knee coordination impairment.

We get unsatisfactory professor words. Ugh. In order to be more technically correct, we've become more vague and silly. I've noun-diagnosed this phenomenon in healthcare providers as Well Duh Syndrome.

Imagine the scenarios at the office.

"Doctor it hurts when I bend forward, like, flexing my spine."
"Yeah, it seems to me that you have a pronounced case of lumbar flexion dysfunction."

"Doctor my knee hurts pretty bad. It often just gives out."
"Well I've determined that you have knee coordination impairment."

Before you laugh, remember that you've accepted terms like Restless Legs Syndrome and Halitosis as serious medical terminology. Besides, it's not so much a label, but a response to movement that we're after. That's hard to pin down in just a few words.

These poor (Ravens) fans have been
diagnosed with NFL Cheering Impairment.

The bottom line is that you should never be too intimidated when you hear arthritic this or torn that. Diagnostic imaging is one piece of the puzzle and it really is okay if your doctor didn't order expensive tests right off the bat.

The best thing you can do, at least initially, is to worry less about exactly what's causing the pain. I know that's asking a lot. Instead, seek to find out what, if any, movements and positions cause a change in pain and function.

A case for diagnostic imaging.

Nobody can "fix" arthritis. And I won't try to tell you that MRI and CT Scans are useless and that nobody should ever have surgery. But with the right intervention, changing the details of how your body does it's verbs quite often translates into less pain and more verbs.

- - - - -

1. Borenstein DG, O'Mara JW, Boden SD, Lauerman WC, Jacobson A, Platenberg C, Schellinger D, Wiesel SW. The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. J Bone Joint Surg Am. 2001 Sep;83(9):1306-11.

2. Saal JS. General principles of diagnostic testing as related to painful lumbar spine disorders: a critical appraisal of current diagnostic techniques. Spine. 2002 15;27(22):2538-45.

3. Cook C, Hegedus E, Ramey K. Physical therapy exercise intervention based on classification using the patent response method: a systematic review of the literature. JMPT 2005;13:152-62.

4. Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain. Spine. 1997; 22:1115-1122.

5. Chou R, Rongwei F, Carrino J, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. The Lancet. 2009;373 (9662): 463-472.

6. Michael J. DeFranco, MD, and Bernard R. Bach, Jr, MD. A Comprehensive Review of Partial Anterior Cruciate Ligament Tears. In The Journal of Bone and Joint Surgery. January 2009. Vol. 91A. No. 1. Pp. 198-208.

7. Videman T, Battie MC, Gibbons LE, Maravilla K, Kaprio J. Association between back pain history and lumbar MRI findings. Spine 2003;28(6):582-8.

8. Young S, Aprill C, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. Spine 2003;3(6):460-5.

9. Koes B. Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine 2001;26:2504-2514.

10. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;4(2):S192-300.

11. Sher JS, Uribe JW, Posarda A. Abnormal findings on magnetic resonance images of asymptomatic shoulders. Journal of Bone and Joint Surgery 1995;77(A): 10-15.

12. Englund M, Guermazi A, Gale D. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008;359:1108-1115.

13. Takatalo J, Karppinnen J, Niinimaki J et al. Prevalence of disc degeneration and displacement, annular tears, and modic changes in lumbar MRI scans in young adults. Spine. 2009;34(16):1716-21.

14. Hoangmai H. Pham, Bruce E. Landon, James D. Reschovsky, Beny Wu, & Deborah Schrag. Rapidity and Modality of Imaging for Acute Low Back Pain in Elderly Patients. Archives of Internal Medicine 2009, 169 (10), 972-981

15. Connor PM, Banks DM, Tyson AB, Coumas JS and D’Alessandro DF (2003): Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes. A five-year follow-up study. American Journal of Sports Medicine 31, 5, 724-727.


T-ball Recap

It is finished. The six of us at the Gorinski home suddenly have about 6 to 9 more hours per week of time on our hands.

When you sign up, they don't tell you that you're looking at roughly 90 minute "games," with a half-hour in the car and an hour or more of getting ready beforehand or going to the park afterwards, plus snack and peeing issues.

So below is a quick season highlight video. Well, it's not really a highlight, but rather a few pictures thrown together. I missed a lot of the games and when I did make it, I usually had my hands full settling Goldfish cracker/Gator-Aid fights between Maggie and Ben, helping Owen get his costumes on and off, and trying to coach.

Now don't let the video fool you. T-ball is 99% slow going, and that's no exaggeration. Lessons are learned alright, by players, coaches, and parents alike. Those lessons have little to do with baseball. I reflected on a few of my own lessons at the beginning of this season right here.

These gals and girls are just little. Learning to get your body to do what your brain wants it to do takes at least 18 or 20 years. The helmets are still way too big. Amy and I laughed during a recent 5:30 game, looking out and seeing a dozen five and six year olds tired from the day, all of them taking every opportunity to lay down in the grass when they can and trying to put off a potty break by grabbing their peepers.

In conclusion, Tball is worth it IF the kid wants to play.

So here's something to hopefully remember the season by. Remember this is fun for me:


______ League

- - - - -
Hours after coming into this world, mom dressed me in pinstripes, rested my head in a baseball mitt, and snapped a picture. A day or so later my height and weight was broadcast over Tacoma radio, presumably during small talk as dad stepped to the plate.

Mom competed in rodeos. Still does!

My earliest years overlapped temporally and geographically with a certain Steel City dynasty remembered unto the ages.

- - - - -

"You want to go where everybody knows your name." - Cheers Theme

I stride on the scene playing it cool. But who am I kidding? You had me at hello; even before that. It’s in my blood. I couldn't wait to be here today. I can't play alone. Well, at least not at my age. Without you, the physical activity turns into mundane and inconvenient exercise.

The 9 or 12 guys on the court right now are catalysts in the fuel I run on all week. That's how it works with everyday weekend warriors.

Alley-oops and deep post patterns are some of the best ways for men to connect. Helping a friend back onto the mountain bike he fell off in the pouring rain is intimacy. You want to talk about feelings? Pile-ups, blocks, and line checks during flag football are where five at a time gather over something they can feel.

- - - - -
A League of Extraordinary Gentlemen:
Bart Ben Brandon Brett Bret Bruce Chris Craig Dan Dave Doug Kyle Matt Max Mike Phil Rich Ryan Tim Tim
- - - - -

I love these guys.

They aren’t afraid to shut down the lane. In the fall they flatten me at the line of scrimmage and in the summer they make worn spots in the lawn that I interpret like an inkblot test. They pin me on the post, shove, and hit fade away jumpers in my eye. Their presence increases my physiological capacity and causes my bike to go places not meant for wheeled devices.

What could be better for men such as this? We plan, play, review, and share injuries together. It’s the best of high school glory days with only a fraction of the ego and false hope. The games are more fun and less edgy than official “rec” leagues. There is sweat and blood and a little cursing. There’s almost never anything malicious. In fact, I've found the court and trail and ball field to be some of the least contrived places.

Nobody owns or dominates the League. There’s not a cent on the line. Though many in the League were once pro or college-level athletes, all have paid their dues elsewhere. Now our weekly ceremony is a thing of beauty, like a tribal dance passed down from the ancients.

Mental and physical errors happen all the time. But the bursts of graceful, on-the-mark athleticism, when a man who sat at a desk all day or dealt with hours of tanbark or ill patients, shines in a moment of strength....

...That move you just pulled off?


My brother, I stand in awe of that move.

When our meetings end there is laughter and grace. Everyone wins. We sit around sweaty and with poor posture, sometimes opening up our lives, always celebrating today's victory. Softness and frailty have been held at bay in todays battle, yet nobody wins that war.

I must deal with the fact that our gatherings are numbered. I hang my head and find comfort looking down at the three who blister onto the court/field ahead of me. The seeds are sown, as everyone in this League has been so kind to lend a hand in the next.

I think the point is to find your League. Call it a ministry because you need each other. If you have a functional body, fully receive your gift. Hurry, while there's still time. Your League offers sacred things that the sports page and ESPN can't even approach.

It's definitely not just a game.

- - - - -