Integrated Anatomy - Holistic Anatomical Language

I have been excited about writing this blog for a while now as I get a chance to really explain why I personally believe the language of Anatomy needs to be changed. 

I decided not to publish the first draft as it read as quite a dry history lesson, even though the people behind the move towards a holistic understanding of anatomy are dynamic, brilliant and captivating! I would encourage you to follow these links if you want to read about some of the people that have helped me develop my thinking in the past few years. (They are ranked in no order - they are simply the 10 people and their books that I turn to almost every day.)

Ida Rolf

Thomas Myers

Ashley Montagu

R. Schultz

Gil Hedley

Julian Baker

C. Davis 

Leon Chaitow

Finando and Finando

F. Alexander

Ida Rolf, however, heads the pack in order of magnitude! The work that she did was ground breaking in relation to the understanding we have today of integrated anatomy. As a Ph.D in bio-chemistry she had a keen grasp of how the cellular structure within us works. After studying many Body-Therapy techniques, including Osteopathy and yoga, she slowly started work on her own approach to movement and body-work therapy: Structural Integration.

 

Structural Integration has fondly been called 'Rolfing' after Ida Rolf's legacy. It is the theory that during our lives, outside factors, emotional issues, internal illnesses and gravity take a tole on the body and it becomes misaligned. Ida Rolf was the first person to really embrace the fact that fascia, the connective tissue that holds us all together, could be seen as an organ in itself and that it could be readjusted to allow the body to realign and heal. Once the body is shown where it can soften and release through Structural Integration and Fascia Release, movement is then allowed new freedom within the person who is being treated as there is less restrictions that is hindering flow. 

Ida Rolf's work with Structural Integration, I believe, led the way for fascia to be looked at in a fully scientific way, which has subsequently led to body-work being researched in-depth into the effect that touch has on the connective tissue, overall health, well-being and improved movement. The idea that until 100 years ago we had missed the largest organ in the body - connective tissue - as a major factor in the anatomy 'systems' is amazing to me. 

Do not be fooled when new-papers tell you that massage has no scientific research. It's simply not true. There is a vast community leading peer reviewed research in the field of massage and body-work. To begin with, just visit the Journal Of Bodywork and Movement Thearpies for a taste! 

Fascia is the founding reason why I believe Anatomy needs to me looked at again with clarity of vision, and why a holistic language needs to be formed within the body-work. If we want positive outcome within our sessions we need to think less of isolated muscles and static terms of movement (i.e arm flexion), and look at how whole movement is formulated; restricted at first and released afterwards. 

Connective tissue also breaks down the argument that was formed throughout the classical view of anatomy. As it flows through all layers, encapsulating every cell, forming sheaths, creating webbed scar tissue and allowing us to be suspended in form whilst gravity pushes us down, I think it is about time we start looking at our bodies with new eyes. 

This is why at Cornerstone Therapies I make sure the people that I help understand that there is more to massage than simply moving muscle. We slowly soften and sink into the layers of the body, intending touch to show the body where it's tight and needs to release, where there are areas that need to move and change, as well as relax and sink back. My work is slow; one stroke can take a few minutes, but the intention is deep and thorough as I want to connect with all layers to make sure that not a single stroke is wasted. I am not interested in singular muscle movement as my intention is to move you to a different place! If I were to only treat one muscle in the back (as if I could!) I can't expect the whole of the back to release as I haven't asked it to change state with the isolated part. 

The language that body-work has needs to change with the knowledge that we have and the technology that we embrace. I long for the day when we can securely and safely store video data from the IPad generation of gadgets as we could then record movement in its whole rather than have tick boxes for movement tests such as flexion and extension - we could see how the form is reacting for the feet to the head in one move! 

Finally, I believe fascia, due to its sliding state, encourages us not to look at people in a static position that is often called the 'Anatomical Position'. Rather, it moves us towards a more realistic view of the natural form, which is living motion, instead of a standing pose. 

In the next blog we will look at movement in a bit more depth and see if we can get body-work and movement singing in harmony. 

A Trip Through Classical Anatomical History

Ancient art can show us a thing or two about the human need to embrace the anatomy that forms us. The Venus Of Willendorf  (pictured left), tells a story of a potter in 24,000BC. Forming this sumptuous, rolling, beautiful statue out of clay with their hands, the potter shows a vast appreciation of the female form, unveiling our eyes to the openness that the body can be admired. With her hands resting on her breasts, in an easy stance, this statue will hopefully be the first step along the way to understanding that the body, the shell that cases our life force, should be softly and easily looked upon. When we look at anatomy, we are looking at ourselves, and so the subject shouldn't be classified simply into the medical field of understanding, or with mental constraint.

We all have a basic right to understand how we function.

If we are going back to 24,000BC to start our search for why anatomy is not just integral to massage therapy, but also for our own understanding of ourselves, I hope you will forgive this less than in-depth blog! But I do believe that art can be a good way of looking at how we understand anatomy in it's Classical Westernized History.

The Greeks followed the Egyptians in the development of medicine. Not only did Hypocrates give us the oath on which Medical Practitioners still swear on today, but Galen performed brain and eye surgery. The Greek's observations of how the body functioned influenced medical thought right up into the middle ages in Europe. But it is the art that we still have around us today that we can gaze on to enhance our understanding of bodies and movement.

Take a look at the Greek and Roman sculptures in any museum and you will see bodies ripple with movement. As they are seen in battle, the worriers are depicted with  tension and anger, whilst the nymphs are refined and gaze into the middle distance. These different poses are great to look at as they tell of muscles, fascia, bones, organs, blood and lymph flowing in harmony to create the human existence. Experience is captured in stone, but the existence of the models who posed for the art is almost palpable. I have never stood looking at these amazing forms and thought about the singular systems that make movement happen; the 10 that are taught to every Massage student in the U.K. All I have ever seen are amazing bodies in flight!

Then we get to the galleries that house the Pre-Renaissance drawing. I love these as they are paintings of exquisite skill, but the hands are often 'wrong'!  If you see sketch books from the famous Painters, they will often be filled with sketches of hands as they are so complicated in the way that they move to express emotion. The truth is that artists didn't know much about what was under the skin, and so they had very little idea about how to draw the mechanics of the hand.

Leonardo Da Vinci's Vitruvian Man 

It was only until we hit the Renaissance that we see art catching up, (and the hands improving!) with anatomy as we know it today. Dissection work was limited to the Medics, and it took a lot for Leonardo DaVinci to get a place within the dissection rooms so that he could make a comprehensive study of the human form. His ideas of anatomy lay in the Greek/Roman ideas that all mammals were the same, just in different proportions. So, when Da Vinci found that he had the Tibia and Fibula (lower leg) of a man but no foot, he got a foot of a bear and drew it underneath the human leg. After 25 years he realized that human anatomy is unique, but due to the lack of human forms that he could draw from he drew a fully formed baby and then surrounded it with the uterus of a cow!

However, Da Vinic demonstrated that the Biceps not only flex the arm, but also supernate the arm, allowing your hand turn down toward the floor. This wasn't recognized for nearly 300 years after his work was put away into private collections.

Leonardo Da Vinci's work is also recognized for looking at the separate systems that we are so fond of today. The skeletal, vascular and muscular systems are all well documented. And I wonder if this is why we still see them in such singular entities today? Was it that his work was so ground breaking, and the work of the medics around him were so ahead of their field that the beauty of anatomy that they did find wasn't questioned until relatively recently?

Connective tissue, the Fascia that is so fashionable today, was the goop that was forgotten about, ignored and thrown away. Only now are we fully realizing that superficial fat is incased in connective tissue that is so important.

Western anatomy, in its classical form is sectioned into systems that we can understand. This is a fantastic building block to see how we move. It's also brilliant for physicians to grapple with as they can become expert in one part of the body. But as Body Workers it's vital to see the body as a whole, a sum of all the parts. I also think that the Medical World would benefit from looking at the body in a more holistic way - embracing how their expertise on one aspect has knock on effects to the rest of the body.

When you see the body depicted in art, start to ask yourself what the body is showing you. Can you see

Michelangelo's David
See where his body is shifted,
tilted and rotated!

where there maybe tension? A shortening in the musculature, a contraction within the stance. Are there parts that are overly long, causing weakness? Now see if there is a connection between them - can you spot that one side is long and weak and the other short and tight? Try and get your eye into seeing how this may change the posture in the statue or painting that you are looking at.

There are many ways to look at anatomy through time. If you are interested, I would recommend getting a bottle of wine and relaxing with and internet rampage for an evening or two! Start looking at a part you are interested in; historically or anatomically based, and go from there. One aspect you could look into is the Arabic texts; ancient manuscripts with intricate drawings of the eyes. Or check out the Greeks and the humors to find out how phlegm and bile were supposed to effect the body.

For me the unanswerable question is at what time, and why, did we start systemizing the body to such a degree that we stopped looking at it as a whole?

If you have the answer, do let me know! I look forward to chatting it over with you via Twitter, or through the Cornerstone Therapies' website.

Until next time, enjoy your own journey into Classical Anatomy  and enjoy the museums!

The Anatomical Exploration Begins!

Thank you for taking the time out to read this posting today. This is the beginning of a journey into the basics of anatomy - an exploration into the subject that all holistic therapists and their clients can stand firm on. Anatomy is our link and our method of communication, which means we should make sure we are talking the same dialect throughout these blog postings.

Why do we need to know about Anatomy? Because we need to move our bodies! 

The journey that we are about to take together will be filled with questions, opinions and beliefs, that all make a rich tapestry in our relationship as we get to know this vast subject. This being the case please do comment on each posting and start a conversation. This is all done to empower you as the client and the receiver of Body-Work so that you can understand the process that your therapist is taking you through. Don't be shy - get in touch!

I work in the U.K and so my view of anatomical learning is very much based on the experiences we have here in England. It would be great to hear from people who have trained in Anatomy across the globe so we can compare and expand that knowledge.

In the U.K Body-Workers are often trained through small private institutes or vocational colleges. Over the past five or so years there have been moves to take Body-Work training into Universities, but at the moment the vast majority of therapists will have studied in a college style environment. This is a fantastic place for people who are not classic academics, (which I am not!), and they are safe places for students to learn rudimentary human anatomy. When therapists leave their basic massage training, they walk into the treatment room knowing the basics of the human body and the systems of:

• Endocrine (Hormones)
• Vascular (Heart and Blood)
• Lymphatic (Immune System)
• Respiratory (Breathing)
• Skin
• Muscular
• Skeletal
• Nervous 
• Reproductive
• The Brain

The way that the systems are taught are in isolation, thus the modules in the class room are broken down into easy sections with little cross linking. The merging of ideas may happen with muscle and skeletal as they are seen as connecting tissue, but many therapists I have spoken to literally had the isolated systems explained. 

Notice that fascia, the connective tissue that I have been very excited about on this blog for the past few years, is not taught at all to new Body-Workers and that is saved for advanced teaching. Further concepts and the art of looking deeper into the systems of the body are taken up by a few Body-Workers here in the U.K who want to further their knowledge.  

I spent a year looking at the muscles and bones in the body, and got very good at Latin in the process, and I do believe that they are great part of the body to study and perfect as at the moment we are in a place where the 'Classical Anatomy', (of which we will look at in the next blog), still rules the roost. Also, clients are happy talking about muscles, their functions, the stretch and contraction. It's a great first step along the journey. 

However, I think we become too comfortable with this simplistic look at the body and there is a need to start looking at our amazing bodies with a wider lens. 

Meridians and the Eastern anatomy and philosophies are not touched upon at college, (or on this blog); it is left to the therapist to decide which path they want to take. Either they take the Clinical and Sports, or the Eastern Medicine route. Personally, I truly believe that it is best to stick to the one that is chosen for a good few years. If it took Leonardo Di-Vinci a lifetime to get to grips with the Classical Anatomy, I am personally not going to try to master both road maps!

On the next part of this Anatomical Journey we are going to talk about the Classical Anatomy, which we work with everyday in the Body-Workers Treatment Room. We will take a quick glimpse at the history of Anatomy and what that knowledge has brought us.

Take good care until next time!

An Anatomical Interlude

Hello, and thank you for waiting for the next episode in the series on the Shoulder Cuff. I have had a

week to ponder on how to present movement for you and describe the relevant anatomy and hit across a stumbling block; Integrated Anatomy needs an introduction!

I am finding that I am often describing movement, trigger point pain and pathologies in terms of muscle and bone, which is great Classical Anatomy fare. However, I no longer believe it is the right was to talk about the way our bodies roam across the planet. We need a more holistic language.

The result has been to create five new videos for you to watch over a cup of coffee and enjoy. They will be posted, along side written blogs, over the next two weeks. The subjects will be:

• An Introduction To The Anatomy Series
• An Introduction To Massage Anatomy In The U.K
• Classical Anatomy - Our History
• Integrated Anatomy - Holistic Anatomical Language
• Movement

If you would like to get in touch, please do! Your ideas and comments are always the inspiration behind the work that I do. Twitter, Google+, Cornerstone Therapies, and the YouTube comments box are all great places to put your ideas forward. 

I look forward to this topical interlude and hope we can work together to rustle some great ideas and move our thinking together along this journey. 

Rotating Shoulders - The Anatomy Blog.

A photo of an illustration depicting
the back muscles. 

There have been a couple of occasions over the past week that have allowed me to revisit a part of the shoulder that can cause a bit of confusions, pain and general bother; The Rotator Cuff.

This part of the shoulder held me in amazed wonder when I worked on a project with two fellow therapists in St Andrews University at the Integral Anatomy week I attended with Gil Hedley in July. During that week a Physiotherapist student also shared his work on the shoulder with me, clearly showing the muscle and fascia relationship within the joint. Over the past weekend I had a great time looking at the text book theory of Painful Arch Syndrome when a colleague asked a couple of questions that I wanted read up on. So this blog comes from quite an intense look at the shoulder area in general!

Clients will often come and visit me with grumpy shoulders and there is a general sense that the shoulder isn't working so well. The range at which they can move their arms can be sticky, pain can be felt when the arm is moved in different directions, or when I ask them to resist pressure on movement. Also, clients can feel as if they are suffering from pain around the wrist, elbow and deep into the upper arm or across the shoulder blade, and after looking their symptoms up on the internet often self prescribe problems such as 'Frozen Shoulder' or 'Carpel Tunnel Syndrome'. In this blog I want to really break the pain that can be felt by the four muscles that make up the Rotator Cuff and see what we do to help lift some of the confusion that it has.

So let's get going! 

The Rotator Cuff is made up of four muscles; Supraspinatus, Infraspinatus, Subscapularis and Teres Minor. All hook into your shoulder blade (Scapula) and into the upper portion of your arm (Humerus). They are all deep muscles, sitting under the topical deltoid and trapezius. 

Supraspinatus gives the head of the Humerus bone stability and also gives you movement of the arm. When you take your arm out to the side, it helps to initiate the movement and then raise it above your head after your deltoid muscle has got you to about 90 degrees. You can find Supraspinatus lying deep in the top of the shoulder blade in it's own little groove called the Supraspinatus Fossa, flowing under a bridge of bone called the Acromium to then attach to the arm. 

Trigger points can often be felt if Supraspinatus gets grumpy and the pain is commonly at the back of the arm near the top (Posterior Deltoid) and then it goes across the shoulder blade (Scapula). It can also go down the back of the arm and can then skip the elbow reappearing in the wrist. 

An example in External Rotation

Infraspinatus lies deep in the dell of the shoulder blade called the Infraspinatus Fossa. It's thin and wide and the main job it has is to externally rotate the arm, as well as stabilize the shoulder joint (Glenohumeral Joint). Because of it's shape, if you are to place your hands over a shoulder blade you are guaranteed to be on it, but your intention has to be deep to the superficial muscles. 

This time the Trigger Points will be felt going down the outside of the upper arm along the humerus and you may also notice them right at the edge of the shoulder blade near the spine (the spine of scapula). Many people report that the pain is worse when they are sleeping on the other side when this muscle gets grumpy as well as pain rearing it's ugly head down the thumb side (radial aspect) of the hand. 

Teres Minor is small and often forgotten about, lying as it does on the side of the shoulder blade, jammed in between it's bigger neighbors. However, it may be little but it is powerful working right along side Infraspinatus when you externally rotate your arm. 

The Trigger Point pathway for Teres Minor is very localized and sits just into the back of the arm and can be a very deep ache. It will often be worse if there are trigger points in the Infraspinatus, so the two not only work together but should also be treated together to enable you to regain ease of movement. 

An example if Internal Rotation 

Subscapularis is one of my favorite muscles! It's tucked away, only peeking out when the arm is moved in certain ways and in massage I find it a very satisfying area to treat. It sits in the front of your shoulder blade and this anterior aspect means that it is sandwiched between  the ribs and the shoulder blade. It's the opposing force to Teres Minor and Infraspinatus, enabling your arm to internally rotate whilst still maintaining the integrity of the shoulder joint. It's not often looked at or treated, so don't be surprised if your Body-Work Therapist takes their time over a few sessions to release it all out for you. 

The Trigger Points spring up around the back of the shoulder blade and the back of the wrist and you may be having problems in taking your arm away from the body (Abduction) as well as external rotation. Unfortunately trigger points can cause such a problem that some clients can experience a subluxation when the head of the humerus comes away from the shoulder joint (Glenohumeral joint). 

There is your anatomy and I hope you have enjoyed it and it's clear for you to understand! I'm sorry that I could get any photos of the muscles, but I am going to work on getting that together for next time so you can see it all in context. 

Next time I'll take you on a tour of movement and I hope that will start to really fit all the dots together for you so that we can start working out how you can work on the area safely at home and what you can expect from your Massage Therapist during your treatments. 

As always with the blogs that I put together for anatomy and massage the information is aimed for clients to understand, not therapists! I want to make it clear that these posting are in no way a diagnostic tool and should not be used as such. If you are in pain and need help, always consult your general medical practitioner. I would also direct you to the blog posting Pain Patterns Explained as it will tell you how I approach soft tissue and the theory of muscle based pain pathways.

No part of these blogs can be used or quoted without written permission from the author.

Reference book used for this blog: 

Trigger Point Therapy for Myofascial Pain; The Practice of Informed Touch. By Finando, Finando. Published by Healing Arts Press, 2005

My Massage And Anatomy

Sardinian beach, my feet and books.

Many of my clients have had a common grumble - I've been away a lot lately.

In June David and I went to Italy for a month of sun with revision and last week I got back after a trip to bonny Scotland at St Andrew's for Gil Hedley's Six Day Intensive Human Anatomy course.

At the weekend I was asked by a client "What is the point of going away to learn more anatomy?". It was a fair question, especially after they have put up with me going off on training courses for the past six years!

I think a lot of people still believe that massage is just a case of rubbing skin with oil or treating muscle tissue with a hit-or-miss effect. In truth the basic massage training is rudimentary when it comes to the atlas of the human body. There is part of me that would argue that a lot of the anatomy that is taught is following principles that have been unchanged for the past 400 years, even though science has shown us that the maps that we rely on need to be revisited and redrawn.

My passion for looking into new parts of our  'inner space' is something that drives me to further my knowledge so that I can bring new delicacies to the treatment room for you. However I am not an Academic, (something that became very clear to me as I was going through my B-Tec Level 6), I am a clinician. On my Twitter Feed last month there was a conversation about the one thing that made a difference to the treatments that therapists offer. My answer was anatomy and there were a few people who said that I was wrong saying, among other things, that it's the therapist's hands, a bit of luck, good teaching and excellent professionalism are the marks of a good therapists. All their answers were correct as well and I would strive to attain them in almost equal measure.

For me, the continued search and application of living anatomy makes me tick and is the thing that I see change my treatment approach time and again. The more I see, the more I realize that I don't know, the more I try to answer the questions that confront me, the more I search. It is an unending relationship that I have between my love for the mystifyingly beautiful, alive and heart led people that I treat on a daily basis and the anatomy of the human form.

Without the Academics and Scientist's passion for research we would still be stumbling around in the dark suffering deaths from Small Pox. Instead we are able to live through so much illness thanks to to the forward march of medicinal information and come out the other side of sickness ready to enjoy and embrace new days, fresh with the feeling that we can go forth and change.

I don't think research should stop with the search to find new medication and I am continually thankful to the research grants and funding that is given to the people who are searching to answer questions about how we are formed.

Massage has always been shrouded in mystery with many people asking 'Does it work?'. The simple answer is 'Let's find out!'.

As for studying Anatomy, I think you should expect nothing less than your massage therapist to know
how to navigate around your body! I will continually seek to develop my understanding of it in all manner of ways, purely because I think the text books can give us a basic layout, but you can't beat learning from the true form.

'Each drawing in an anatomy book is based on an average version of the structure. The sum of these images is a "totally averaged"collection of parts representing no one, no body. Release the need to be, or make someone, that 'no body'. The someone that you are is far beyond average - totally unique. Revel in that! 
The average in principle is unattainable, but you can definitely accomplish being you.'
Gil Hedley

Holidays At Home - One Week To Go

You have planned your holiday at home; tickets are booked, days at home have been planned and lunches with friends are in the diary. You are all set to go! But there are a few finishing touches that you may want to spend some time thinking about and putting into action so that you are all set for your home-based-vacation.

This is a good time to say that from the very beginning that this series has been created for adults on their own, or with partners. I feel children's holidays have a lot of air time and I hope in this series to give the adults some TLC!

Dress To Impress
Your wardrobe is normally set up so that your most used clothes are nearest to you when you open your door. Take an hour to sort out the work and pleasure clothes - popping the work based outfits to the far side of the wardrobe and the bottom draw so that you don't see them through out the holiday. You don't need the visual stimulus and reminders of normal life. You wouldn't see them if you were going away, so why see them when you are on your Holiday at Home? Sort out day and evening outfits so that you can just reach in, grab what you want to wear and enjoy some colour! With your workout guide in the diary you can also place your gym and swim gear into bags so you are all set to go without a fuss. You could also sort out your accessories so that your work based ones get a break and you get to enjoy the others for a bit.

Feed Your Body
Why not put your body on a bit of a holiday? With all your treatments planned, your Personal Trainer booked, your time in the pool organized or the DVD's ordered, why not look after yourself fully by clearing out all the toxic rubbish from the house and filling the cupboards with food that will help you replenish your inner self? This holiday is all about you - getting you to a better place rather than just staying in a rut at home. With a week before your time off, you have a great opportunity to write out a fantastic meal plan, list all the ingredients and order them on line or get them from the store. The extra nice bits can be picked up at the Farmers Markets. It will probably take you a gentle evening to plan this part, but it is well worth it so that you know you are making the most of your vacation for your total body wellness.

Finishing Touches
With just a couple of days to go, make sure the house is in order. You have taken a month to go through it, making sure it is all sorted out so that you don't have to spend your time off doing mundane house-work, so now is the time to really enjoy it! A few ideas are:

• Wash towels and make them fluffy 
• Put fresh candles around the house
• Make sure you have all the nail varnishes, bubble baths etc in the house so you can enjoy them
• Stock up on a couple of new books and fresh magazines
• Make sure the laundry is all done, ironed and put away
• Put all work based stuff in a box and put it neatly under the study table so you don't have to look at it. 

And Enjoy ...

You have worked really hard to get yourself and your home organized so that you can have a real vacation. It takes more time to organize a Holiday At Home than it does to book a pre-packaged deal on the net, so be proud of yourself for doing such a great job! In the week before your time off, enjoy the haircuts, waxing, pedicures and manicures with a spring in your step knowing full well that you are about to enjoy one of the best holidays! It will be one to remember and I can assure you that all the preplanning, excitement and anticipation will all be well worth it. 

I hope that you have enjoyed this blog series and that it has given you some helpful tips and hints about how to make time on your own or with your partner fun whilst you are based in the place you love the most - Your Home. 

Over the next couple of weeks the blog will be offering up some new ideas on anatomy and treatments, so keep a close eye on the up coming posts!

Get in touch with me through the Cornerstone Therapies Website!