Core strength. Everybody that spends time in a fitness center has heard the term. It’s been around a long time. But maybe misunderstood.

What is it? I have my own definition. To me, your core is everything between your knees and your armpits. Your core is the muscles that support your trunk, your pelvis, your hips.

A lot of what Physical Therapists and Athletic Trainers do is work on strength. Lots of exercise. Physical Therapists are really movement experts and have been working on core strength for a long time. A lot of others are now seeing the value in having a strong core. Athletic performance depends on it.

Good personal trainers know all this. They long ago realized that without a solid core, other parts of the body can’t work as well. Think of it this way — your core is the foundation on which your house is built. If you don’t have a strong core, then you don’t have a solid foundation on which everything else works. In other words, without a solid core, your extremities don’t work as well. This is particularly important at the knee and shoulder.

And your core is important when dealing with injuries to your extremities, like at the knee or shoulder. Several years ago, I rehabbed a baseball pitcher after he had shoulder surgery. He was playing at the AAA level and had hopes of making the big leagues. But he hurt his shoulder and had surgery. Then he found his way to my door.

This guy had a golden arm. It had given him a solid college career, a draft position and a seemingly straight climb to the major leagues. He had a great fastball, an effective changeup and he could spot his curveball and slider where he wanted to. He had several minor injuries to his shoulder but he had such a good arm, he could usually pitch through them. But one final injury led him to surgery and to me.

What I found when he got to me was a mess. If you know professional athletes, you know that they are almost universally dedicated to a high level of fitness. That’s what got them to the professional level in the first place. Not this guy. His success was all in his arm.

He had horrible core strength. Could barely perform a sit-up. Failed every one of the tests we do to evaluate core strength. Failed them miserably.

The muscles on the back and front of the chest that are SO important to good shoulder function, particularly in a throwing athlete, were awful. It was a wonder that he had been able to sustain a pro career at all.

Shoulder rehab after surgery is actually pretty straight forward. Depending on the surgical procedure, we focus on motion and build strength accordingly. His shoulder rehab was similarly straight forward. But he could no longer depend on that golden arm to cover other deficiencies.

So he spent that entire summer with me, focusing on fitness levels and core strength. At the end of the summer, he was healthy from a normal, everyday adult male perspective. But not from a professional athlete perspective. The surgery was too much for him to overcome. The damage was done.

He played a couple more years at a lower level but never regained the form that had carried him so far. The performance level required of a professional athlete doesn’t usually allow room for any deficiencies. And the damage done from pitching through injuries, from having deficient core strength was too much.

He’s fine today, he has a normal functioning shoulder and is able to play catch with his kids. And he’s never let his core strength return to those pre-surgical days. If he had just known at 17 what he knows now.

Joe Black, PT, DPT, SCS, ATC is a physical therapist and athletic trainer at Total Rehabilitation and is Manager of Outpatient Rehabilitation for Blount Memorial Hospital. Email to write to him.

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