Core Commitment Curriculum
I am well acquainted with the ravages of being out of shape and overweight. After all, I am the repairman for the human spine, and I have lived through it somewhat myself. I see obese patients with diabetes, peripheral neuropathy, peripheral vascular disease, coronary artery disease, cerebrovascular disease, severe osteoarthritis among many other manifestations. But as far as the spinal biomechanics go, osteoarthritis is only part of the picture. One of the biggest problems that go hand in hand with being overweight is being out of shape: Specifically having poor abdominal muscular strength and low back muscles. This results in a weaker stabilizing force, which allows for more small injuries, or the occasional big one. Biomechanically, the worst thing you can do to your spine is to bend, lift, and twist all at the same time, especially to pick up a weight that is heavier than anticipated. This can result in excessive stress being placed on the disk itself.
But even the small daily wear and tear can take a toll on the spine just as it does on the knees, the hips and the ankles: the more weight you carry on your frame, the more stress is placed on the spine itself and the weaker those spinal stabilizing muscles are, more likely you are to be injured at any given time. The abdominal and back muscles that provide the stability to the spine especially the lumbar spine are known as the core. The strong core is critical to long term stability of the spine.
Your core (according to Webster’s) is that which is the “basic, essential, or enduring part” of you. So that also includes:
1.Your general physical core:
- the stabilizers of the hips, head and neck, chest; other the muscular regions and stabilizing elements of the body, not to mention the cardiovascular organs.
2.Your mind, internal and external emotional support mechanisms; your psychological core.
- Resilience, stability, socialisation, size of your support network; these also are part of your psychological core.
Do you have a family that is supportive of you when you need help? Do you think the world is out to get you, or are difficulties thrown in your way simply an opportunity for you to shine, excel and take advantage of a new opportunity? Positivity you carry with you as well as the positivity your friends and family, coworkers and practitioners give off, are all part of your mental and emotional core; these may require stabilization at times as well.
Looking at my own pictures over time, I decided if that person does not want to wind up on somebody else’s OR table to fix his back (or worse, to fix a coronary artery problem that might develop later in life), then it is about time that I rebalance my priorities and put taking care of myself as one of them. It is not just about the weight although, the weight is clearly a problem.
Think about whether any of these apply to you:
- I do not like the way I feel; my bigger belly makes it actually harder for me to have flexibility.
- I do not like the way I look, I want to feel better about myself.
- I want to be in better shape.
I understand what my patients are going through because I am now going through it myself. To help my patients as well as myself, I have developed a new program called the Core Commitment Curriculum (see below). It is not enough to fix a back when it is broken or damaged, because without a commitment to change in the way the back and the person is treated, the biomechanics of the back will fall back into the old habits that led to the damage in the first place.
While you might think that repeat customers would be good for business, I generally prefer to fix my patients once and for good. I don’t just like happy patients, I love happy patients. I want all of my patients to be satisfied with their treatment and to go out and say “Dr. Jenkins did not just fix my back, he helped me change my life and now my back is not a problem”. But they can’t say it if I don’t do it, and so I have now refined a formal process for collaborating with the 3 pillars of the stakeholders in each of my patient’s lives:
- themselves (first and foremost)
- their social and professional support groups (friends, family, work, etc.)
- their practitioners (physicians, therapists, chiropractors, herbalists; anyone who is involved in their medical, mental or social care).
For example, it is really hard to quit smoking, but nigh-impossible if the person you are living with is also still smoking. Losing weight and getting in shape has the same social baggage. If everyone else in your household wants to keep eating lots of fried food and drinking lots of soda, beer or other things to excess, it would be very hard for you to learn moderation and proper dietary balance. Our very society and social networks often inadvertently work against this. How many loving family members wanted to make sure that you got enough food to eat, but to the point where they put more food on your plate than you need?
The biggest dietary change I could recommend is not a diet per se, but wisdom and insight: eat slowly because your brain has about a 10-15 minutes lag between when your stomach is full and when your appetite registers that your stomach is full. Do not go back for seconds until you waited at least 15 minutes and you are still hungry; and most importantly while it seems obvious to say, but in reality it is not: stop eating when you feel full, no matter how good that desert, piece of steak, or whatever tempts your palate that is sitting on your plate or on the desert cart.
The journey of 1000 miles starts with a single step, but requires the sum of many small steps. Each of these small steps needs to be done; if at any time you stop moving forward, you won’t get your goal. Getting back in shape I anticipate will take me 6 months to a year, and I am not even looking to lose 50 pounds or more like many of my patients. I can only imagine what my patients who have those 50, 75, 100 plus pound obesities have to deal with. The depression that goes with obesity is widely known, but what is often not addressed is the nihilism (nothing will help) that often goes along with that. It is a learned helplessness that is often reinforced by social cues and the lack of support of family members who may themselves be suffering from the same lack of self esteem or support.
That is why it is so important to get family and friends on board when you set a new goal. They can help you (or at the very least try to get them to agree not to hurt you). I will give you updates as to my progress as we achieve them together. There are many out there who do not have the struggles that I am currently having. I used to have a metabolism where I could eat 2 full meals at a time and not gain weight. That was 35 years ago; those days are long gone. But, I have friends who still do: boy, are they lucky. I hope they appreciate that. The rest of us struggle, but the struggle is worth it because it helps to define who we are, and that we do not give in just because it is hard.
Core – Mind and body in balance – the core of our being
Commitment – more than just compliance, but belief (supported by evidence)
Curriculum – constant process of improvement of ourselves and our goals
1.Spinal alignment and protection
Optimization of any medical conditions
Strength and flexibility
Life changes (work, home, commuting) environment
Balance between work and rest
Managing issues like depression, anxiety, self esteem.
- Do you want to get better and stay better
- Compliance just leads to getting better but then worse again
- Are you willing to be honest with yourself, or do you need someone else to be the “bad cop”?
- What are the current conditions that lead to resistance to commitment?
- What are the traits we have that lead to resistance to commitment?
- What support do we need to ensure commitment leads to change?
- proof of compliance/commitment
- Evidence for the recommendations
- Short term plan
- Long term plan
It has been said that the journey of a 1000 miles begins with a single step. Never has that been more true than with weight loss. It is easy to say “lose 50 pounds”. It is a lot harder just to lose the first 10, let alone the last 10. But since it has also been said that you never achieve any of the goals you do not set for yourself and there is a 100% correlation between not trying and not succeeding, we have to start somewhere. “If all you ever do is all you’ve ever done, all you’ll ever get is all you’ve ever gotten”.
I want to be in a different place, and not follow the same upward trajectory in my weight, and downward trajectory in my physical fitness. I hope you find these guidelines helpful.
You are not alone, and together we can get through this.
Arthur L. Jenkins III, MD
YouTube – NYCSpine
This blog does not constitute medical advice. For you to receive medical advice, you would need to have a two-way relationship with a physician who can examine you, not just exchange emails or comments with.
*I do not make any money to give any endorsements for any product.
At some point as I collate all of the products that I do believe in, I may very well utilize a web portal to facilitate people getting the items and products they need; at that time, I will disclose any interest that I have, but for now, I have no conflicts to disclose and only recommend those products that I truly have used, recommend, and believe in.