What's Wrong with Dumbing Down Anatomy

The human body is an incredible, living, adaptive, self-communicating, always evolving machine that surpasses even our most advanced technological wonders.  Unfortunately, this is not how standard anatomy classes are taught.  With in the medical educational system we are taught more about separate parts rather than totally integrated systems. Essentially we tend to compartmentalize everything as if they were somehow not part of a complete system. Essentially our education system "Dumbs Down" the human body to make it easier to teach students. (Drawing of the upper extremity by Michelangelo).  

My specialization is the treatment of musculoskeletal conditions. Over 20 years ago when I first began my practice, I also looked at the body from this very limited perspective. Fortunately for my patients, my perspective has changed radically. 

You could say that three fundamental areas of knowledge have given me a personal epiphany on how our entire body works as one synergetic interconnected system. These are the myofascial system, the body's kinetic web, and  the concept of tensegrity.

About The Myofascial System

The prefix 'Myo’' refers to muscle, whereas  ‘fascia’ refers to the connective tissue that permeates the entire human body. Fascia is everywhere in the body, weaving through, and connecting every component of the body. Fascia forms a seamless web of connective tissue, which connects, holds, and infuses the tendons, organs, muscles, tissues, and skeletal structures.

To get a better understanding of how interconnected we really are, it is essential that we first understand the significance of fascia.  New discoveries over the last few decades have shown that fascia plays a very important role beyond that of simply serving as a packing material around muscles and organs. Fascia is intimately involved in controlling both the movement patterns and the neurological control mechanisms of the entire body. It is an integral component of a body-wide signalling system. Interestingly, it has been shown that fascia is full of neurological receptors (even more so than muscle tissue). This is rather astounding, especially when of realizes that most physicians do not consider how fascia plays such a key role.

Consider the image to the right, this is a dissection of the elbow (proximal lateral elbow region). What  makes this dissection unique is that the muscles are dissected away from the body instead of the fascia. The strands you see show the convergence of this connective tissue to link all the structures surrounding the lateral elbow (lateral epicondlye).   This is a great example of how convergence of multiple strands of connective tissue can form a interconnected functional matrix.  If we did the same type of dissection technique in other areas of the body (shoulders, hips, knees etc.) we would discover a very similar pattern. Multiple stands of connective tissue, in complete continuity, with no visible separation from each other.

Text book anatomy looks nothing like this. The anatomist's scalpel has removed all the fascia leaving the impression of  individual muscles, all by themselves, each performing their own separate actions. Standard anatomy is actaully an anatomical fantasy, and a rather dumbed-down one at that!


Image from "The Architecture of the Connective Tissue in the Musculoskeletal System—An Often Overlooked Functional Parameter as to Proprioception in the Locomotor Apparatus - Jaap van der Wal, MD, PhD University Maastricht, Faculty of Health, Medicine and Life Sciences, Department of Anatomy and Embryology, Maastricht, Netherlands 

Muscle Contraction - How Things Really Work

Standard texts for anatomy and biomechanics teach us that motion is created by the contraction of muscles. These muscles have tendons at each end that insert directly into bone. When a muscle contracts, the two ends of the muscle (origin and insertion) are pulled towards each other to create motion.

Although this description is quite true, it is also a reductionist perspective about what is really happening in the body. Let me explain how an understanding of fascia can help us develop a new, more holistic perspective about how the body performs its actions. This will give us a better understanding about why looking at the bigger anatomical picture can help us to better resolve many complex musculoskeletal conditions. 

First, consider the fact that the muscle fibers actually originate from, and insert into, both the surrounding fascial fibers as well as the bone. These fascial fibers, in turn, insert into multiple regions of other bones, and even into other adjacent muscles. These additional points of contact provide muscles the ability to generate force in multiple directions (a three-dimensional model of movement).

Learning about these multiple points of fascial attachment – all working across three-dimensions – completely changed my understanding of the biomechanics of muscle action, and also provides me with a much more functional understanding of muscle contraction. Now, when I look at, and analyze muscle contraction, I realize that only certain sections of the muscle contract to perform an action (not the entire muscle).

In actuality, groups of muscles usually work together as functional units to execute any action. For example, some muscles may act as the primary movers (agonists) to perform an action, while other muscles act as antagonists; while yet others act as synergists and others as stabilizers. In all these activities fascia is the key component that allows these muscles to work together as functional units by aiding in coordinating their actions across multiple joints.

Depending on the degree of motion, and the amount of force that is needed, each muscle will then contract very specific areas of the muscle, rather than the entire muscle. These very specific motions are largely coordinated by the neurological receptors embedded in the fascia, and are not controlled by the brain alone.

The Kinetic Web 

Your body is made up of a remarkable series of kinetically linked systems which, when working efficiently, store and release impressive amounts of energy without injury!

Essentially, each body acts as a single large three-dimensional Kinetic Web, in which force or tension from one area directly affects multiple structures in both localized areas, and structures far from the site of tension.

The Kinetic Web can be thought of as a linked series of kinetic chains. Each kinetic chain is made up of individual links (the various components of your musculoskeletal system, nervous system, and cardiovascular system) which are connected to each other to form a three-dimensional Kinetic Web. When you have changes in one area of your body, there will be cascading effects throughout the entire body, and thus multiple structures in your kinetic web will be affected.

Any weak link in this chain not only generates its own set of problems, but also creates problems and compensations somewhere else in the body. For example, when a structure in your hip, groin, or pelvis is injured or restricted, it becomes unable to effectively perform its normal functions such as walking, climbing up stairs, or even being intimate with your significant other.

Kinetic Lines

Kinetic Lines (whole body fascial interconnections) are actual physical structures that have been mapped out and dissected. These are actual physical structures that connect our bodies together. Researchers and clinicians such as Thomas Myers (Anatomy Trains), Luigi, Carla and Antonio Stecco (Fascial Manipulation) have spent decades researching these interconnections.

Think of these Kinetic Lines as vectors for force transmission, they are not only connections, but are also a continuous line of tension. In the case of Thomas Myers, he has mapped out seven primary lines of fascial connection throughout the body. These are the:

• Superficial Back Line (SBL).
• Superficial Front Line (SFL).
•  Lateral Line (LL).
• Spiral Line (SL).
• Arm Lines.
• Functional Lines.
• Deep Front Line (DFL).

Other researches have mapped out slightly different connections, but the general concepts remain very similar.  For example let us consider the Superficial Back Line (SBL). 

Click image to view a video of the dissection of the Superficial Back Line (SBL).  As you view this video, consider how the fascia on the bottom of the foot connects directly into the calf muscles, hamstrings, low back, into the neck, and even to the top of the head. In fact, they are all inter-connected and inter-dependant.

Most standard anatomy texts are just starting to acknowledge the importance of these connections

Tensegrity – Tension Plus Integrity

A key concept in understanding your body as an interconnected kinetic web is known as ‘Tensegrity’. Tensegrity is a structural principle that describes the integrity of a structure based on the balance of tensional forces rather than just its compressive nature.

First a little history; the term 'Tensegrity' was made popular in the 1960’s by a neo-futuristic architect by the name of Richard Buckminister “Bucky” Fuller (1895-1983). Fuller came up with this term when examining the highly creative sculptures of Kenneth Snelson. Snelson’s sculptural works are composed of both flexible and rigid components. Snelson uses the term ‘floating compression’ instead of ‘tensegrity’ to describe his sculptures.

The geodesic dome is a superb example of an architectural structure that uses the concepts of tensegrity. Due to its structure, the geodesic dome is an incredibly stable building due to all the pressure being distributed throughout the entire framework. I remember my sense of awe and wonder when I saw my first geodesic dome as a child at the 1967 World's Fair in Montreal (The Biosphere). Even then, I and many other, knew that we were looking at something special!

With regards to how tensegrity relates to the human body, I will refer to an analogy used by Thomas Myers of Anatomy Trains. Standard anatomical perspectives teach that our skeleton provides a strong stable framework to support the array of soft tissue structures that are attach to it.  This is a concept of ‘continuous compression’ in which the osseous structure of the body provides structural integrity.

This is the same concept we use when building skyscrapers, where each layer of the building provides support for the next layer, and is built on a strong base of stability (a Linear Model). The problem when applying this concept to our human body is that this is a static model (not reality).  Yes “continuous compression” works well in building construction, but not so well in explaining the structural integrity of dynamic human bodies that are in continual motion. 

Think about this, without the muscles, ligaments, tendons, and connective tissue, the framework (our skeleton) would simply collapse. Thomas Meyers uses the analogy of a sailboat to describe this concept. He compares the mast of the boat to our skeletal system and its rigging to our myofascial system. When the wind catches the sail of a boat it directs an incredible force into the mast, yet the mast does not come toppling down because of the tensional balance of its rigging. When one side of the rigging becomes tight and contracted, while the rigging on the other side of the boat becomes loose and movable. That is, until the wind changes and the sail is then pushing in another direction which requires the line of tension to shift to the other side. This describes a dynamic system where a rigid structure (the mast) can take on dynamic qualities because of it tensional system (its rigging).

In the same way, our skeletal system maintains its integrity due to the balance of tensional forces provided by our myofascial system. We can run, jump, move, take our bodies into a thousand contorted positions, and return to a state of balance all because of this concept of tensegrity.

Tensegrity and Injury Resolution

The greatest thing about understanding how our body is totally connected is the how this information helps resolve even some of the most chronic injuries.  Consider this analogy. 

Consider how a soft pliable ball reacts to compressive forces. An interesting thing occurs when we take a ball that is about seven inches in diameter (like the ones we use for myofascial release of the abdomen), and compress it with our hands. 

When we grasp the ball and squeeze hard, the area that we are squeezing contracts while the rest of the ball expands.  If we then take some type of mechanical device and squeeze even harder until the ball bursts, we would find the area of rupture in the ball is the weakest part of the material. Interestingly, the point of rupture is often located far from the point of applied force.

The same thing occurs in the human body.   Previous injuries, muscle imbalances, lack of exercise, mental stress (anxiety), poor nutrition, and a host of other problems all create weak links in your body’s kinetic chain.  These are areas where the body is most susceptible to injury. When increased stress is applied to the body, the entire body tries to compensate.   If the weakest link cannot withstand this additional stress, then an injury occurs at that link.

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This tells us that we not only have to consider where the body has developed weak links, but we also have to consider the non-symptomatic areas that are creating this increased stress. Often, these are areas where the patient is not even aware that there is any problem.

The Critical Key

Tensegrity is the key to resolving most chronic musculoskeletal injuries. We must “Look local and Look global”. If there is a problem, we must address both local and global areas. Treatments that only address the symptomatic region (the area of pain) are really an equation for failure.

Bottom line, we are so much more than what appears on the two dimensional pages of an anatomy text (the dumbed-down version). We are complex three-dimensional beings that work as one synergistic organism.  Recognizing this gives us the path to true healing, ignoring this leads us down the path to ongoing dysfunction.

Do you want more information about this, and other topics. Our books (e-Books and hard-copy) provide more information about soft-tissue injuries, rehabilitative exercises for injury recovery, and how to apply these tools to activate and restore all the structures of your kinetic chain. 

To purchase our internationally best-selling books, visit www.releaseyourbody.com.  



For information about our clinic in Calgary, Alberta, please go to www.kinetichealth.ca. Or call us at 403-241-3772.



(COPYRIGHT KINETIC HEALTH 2015 – ALL RIGHTS RESERVED)

Understanding Whiplash Injuries - Bio-mechanics & Anatomy

Whiplash Bio-mechanics

The first factor to consider is that Whiplash injuries (hyper-extension, hyper-flexion injuries) occur in an extremely short period of time. Most of these injuries occur in about one-quarter of a second. This means that the occupants of a vehicle which is struck from behind do not have time to react to the accident. Keep this time-frame in mind as we cover some of the actions that occur.

Vehicle Impact

Let us start with the onset of a standard rear-end collision. Let us consider what happens from the perspective of the driver of the vehicle that was hit from behind. On initial impact where the vehicle in the rear hits the car in front; The force of impact begins to move the front vehicle forward. Since the seat of the car is attached to its frame, the driver’s seat moves forward with the car. But the driver is not attached to the frame of the car, and he/she continues to remain in a fixed position; this is due to inertia. Physics defines inertia as “the tendency of a body to resist acceleration.” Keep in mind, all of this is occurring within milliseconds.

Then, within a faction of a second, the car seat is pushed into the driver’s lower and mid back. This rapid forward acceleration also pushes the lower part of the drivers neck forward (lower cervical spine). This has the effect of straightening out the normal curve in the driver’s neck (the lordotic curve) and the curve in the driver’s mid back (the kypotic curve). This creates an abnormal S shaped curve in their cervical spine (neck).

A considerable amount of damage can be done during this phase (vehicle impact).

o Normally, neck motion is the result of multiple vertebral joints, each of which contribute only a few degrees of motion to an action. Therefore movements like neck extension are made up of the summation of multiple vertebra each adding small degrees of motion to produce the total action.

o When the neck is in this abnormal S-shaped position, the joints of the neck (facet joints) are forced past what is consider their normal physiological range-of-motion limit. This excessive motion causes damage to the area around the spinal joints (facet joints). This damage can include: facet capsule ligament tearing, bony impingements, and intra-articular (within the joint) hemorrhages. The degree of joint damage depends on the severity of collision.

Chronic whiplash and whiplash-associated disorders: An evidence-based approach Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P.

Hyper-Extension Phase

This next high-speed, forward motion, jerks the driver’s head back. In many cases the head moves right back over the headrest. This often occurs since most people keep their headrest too low to be effective, or it can occur due to poor head rest design. If the impact of the accident is severe enough, a considerable amount of soft-tissue and joint damage can occur in the front of the neck as the head is thrown back.

Common areas of damage as the head is thrown back:

Joints

o Facet joints are the most commonly injured joints in the neck.

§ These synovial facet joints support weight and control movement between each individual vertebrae.

§ The facet joints are the most common source of chronic pain neck pain after a whiplash injury.

American Academy Orthopedic Surgery 2007; 15:596-606).

Chronic cervical zygapophysial joint pain after whiplash: a placebo-controlled prevalence study. Spine 1996;21(15):1737-1745

Ligaments

o ALL (Anterior Longitudinal Ligament)

§ This ligament runs down the front of the vertebral bodies and prevents excessive extension. Damage to this ligament causes instability in the neck (cervical spine), and can be a cause of chronic neck pain after a whiplash injury. This occurs due to force being transmitted through the posterior spinal structures (facet joints).

Ivancic PC, Pearson AM, Panjabi MM, Ito S. Injury of the anterior longitudinal ligament during whipash simulation. European Spine Journal 2004;13:61-68.

Cholewicki J, Panjabi MM, Nibu K, Macius ME. Spinal ligament transducer based on a hall effect sensor. Journal of Biomechanics 1997;30(3):291-293.

o Facet capsules

§ The facet capsules in the neck are often injured due to the severity of muscle contractions and vertebra motions during whiplash accidents.

An anatomical investigation of the human cervical facet capsule, quantifying muscle insertion area J. Anat. (2001) 198, pp. 455–461

Anterior Muscles and Nerves Injured During Hyper-Extension

o Longus Colli muscle

· This deep muscle runs along the front of your neck between the top vertebra in your neck (C1) and your mid-upper chest (T3) and is commonly injured in whiplash injuries.

· This muscle (Longus Colli) contains a high density of muscle spindlefibers. Muscles that contain a higher level of these fibers are used for fine motor control, muscle tone, and positional sense. Injuries to these muscles affect a broad range of motor functions.

Fiber composition and fiber transformations in neck muscles of patients with dysfunction of the cervical spine. Journal of Orthopaedic Research 1995;13:240-249

o Platysma muscle

· This superficial muscle overlaps the SCM (sternocleidomastoid muscle).This muscle arises from the connective tissue (fascia) on the upper parts of the neck, chest (pectoralis major), and extends out over the shoulder (deltoid) and down over the collar bone (clavicle).

· The Platysma is supplied by the facial nerve (CN-VII). Injury to this muscle can create trigger points which cause a prickling type of feeling across the face and upper chest.

o Scalene muscles

· These are a group of three muscles on the lateral side of the neck (anterior, medial, and posterior scalenes).

· A network of nerves (brachial plexus) and a major artery (subclavian artery) pass through the anterior and medial scalene muscles.

· This is an area that is commonly injured during whiplash accidents and can cause either neurological or vascular problems from the neck, right down to the hands.

o SCM (Sternocleidomastoid) muscle

· This superficial muscle is located on the lateral anterior side of the neck. It is involved in flexion and rotation of the neck

· Two major nerves (lesser occipital nerve and greater auricular nerve) pass by the SCM. Compression of these nerves generate symptoms ofoccipital neuralgia.

· Occipital neuralgia is a medical condition characterized by chronic pain in the upper neck, back of the head, and behind the eyes. This is sometimes known as C2 neuralgia or Arnold’s neuralgia.

· The Spinal Accessory Nerve provides input (motor innervations) to theSCM and Trapezius muscles. Compression of this nerve can result in limited range-of-motion and decreased strength of the SCM andTrapezius muscles. This will affect shoulder and neck strength.

Hyper-Flexion Phase

Next, the car seat springs forward causing the driver’s whole torso to move forward at a high velocity. Physics defines velocity as “rapidity or speed of motion; swiftness.” Keep in mind as your seat moves forward your head is still moving back. This action is similar to the final moment before a spring releases.

Then, almost instantaneously your torso and head are flung forward. This forward motion is so strong that if the driver does not have their seat belt on they could, depending on force of impact, be thrown right out of their seat into the steering wheel or even through the window. This strong forward action causes the driver’s whole spine to flex forward often past their physiological limits. This action can cause a considerable amount of posterior neck, mid-back, shoulder, and even low back damage.

Common areas of damage as the head is thrown forward:

Joints

o Facet joints - These joints are the most commonly injured joints in the neck.

Posterior Ligaments

o Supraspinous ligament - strong fibrous cord, which connects together the spinous processes.

Posterior Muscles and Nerves

o Erector spinae muscles (Iliocostalis, Longissimus, Spinalis).

· Group of back muscles that runs beside the vertebrae in an almost vertical direction.

· These neck extensors are commonly injured during whiplash accidents.

o Rectus Capitis Posterior Minor muscle

· Individuals with chronic neck pain exhibit muscle atrophy of this muscle as seen of MRI. This can be caused by trauma or compression of the first cervical branches of the spinal nerves (C1 dorsal ramus). This compression occurs because of entrapment within the rectus capitis posterior major muscle.

· Atrophy of this muscle and C1 injury causes symptoms such as: suboccipital headaches with radiation of pain behind the eyes, dizziness, and benign positional vertigo (BPV). With BPV you will feel a sudden sensation of movement, or spinning, when you move your head or hold it in certain positions.

NEUROGENIC ATROPHY OF SUBOCCIPITAL MUSCLES AFTER A CERVICAL INJURY: A Case Study American Journal of Physical Medicine & Rehabilitation, Volume 77(6) November/December 1998, pp 545-549 Andary, Michael T. MD; Hallgren, Richard C. PhD; Greenman, Philip E. DO; Rechtien, James J. DO, PhD

o Suboccipital Triangle – This is an area in the neck at the base of the skull surrounded by the following three muscles

· Rectus Capitis Posterior major

· Superior and Inferior obliques

o All of the suboccipital muscles are extremely important as they contain very high levels of muscle spindle fibers. Muscle spindles provide postural information to the central nervous system. Damage to these structure in experimental animals cause gait disturbances and ataxia (an inability to coordinate voluntary muscle movements)

o The Suboccipital nerve supplies input to the muscles of the suboccipital triangle. Compression of this nerve can occur at the superior oblique muscle.

o Semispinalis (Capitis, Cervicis)

· The greater occipital nerve is located directly under the Semispinalis Capitis. Compression of this nerve is one of the causes of cervicogenic headaches, these are referred to as occipital neuralgias.

§ Occipital neuralgia is a medical condition characterized by chronic painin the upper neck, back of the head, and behind the eyes. This is sometimes known as C2 neuralgia or Arnold’s neuralgia.

§ Research has shown that about 85% of patients with whiplash injuries have trigger points in the Semispinalis Capitis muscle.

A Distinct Pattern of Myofascial Findings in Patients After Whiplash Injury Archives of Physical Medicine and Rehabilitation Volume 89, Issue 7, July 2008, Pages 1290-1293

o Splenius (capitis, cervicis)

· This neck extensor is commonly injured in whiplash injuries.

Luo Z, Goldsmith W. Reaction of a human head/neck/torso system to shock. Journal of Biomechanics 1991;24(7):499-510

o Transversospinalis (spinalis cervicis, cervical multifidus, rotatores cervical)

· The spinalis cervicis muscle is not present in everyone (inconsistent muscle). Orginates from a ligament in the lower neck (ligamentum nuchae).

· The is some research showing the cervical multifidus msucle can cause increased loading of the joint capsule surrounding the joint in the neck (collision-induced loading of facet capsular ligaments).

· These deep posterior muscles are often injured during whiplash accidents.

Are cervical multifidus muscles active during whiplash and startle? An initial experimental study Gunter P Siegmund, Jean-Sébastien Blouin, Mark G Carpenter, John R Brault, and J Timothy Inglis BMC Musculoskelet Disord. 2008; 9: 80. Published online 2008 June 5. doi: 10.1186/1471-2474-9-80

o Trapezius (upper fibers)

· The third occipital nerve travels under the trapezius muscle until it pierces this muscle and ends up in the lower part of the head (occiput).Compression of this nerve causes occipital neuralgias.

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)