by Jenny Wickford
I was privileged to meet physiotherapist Dr Jenny Wickford in 2016 when she attended a dissection with me in Newcastle. Her enthusiasm and sheer passion for her subject, that of treating and studying the human form, has been humbling.
She recently attended the ten day dissection class in St Andrews undertaking some incredible dissection work on the female reproductive system which is her specialist area of treatment.
From Sweden she expresses herself he second language of English in a remarkable way and this piece is a superb tribute to her experience and to her belief in the importance of the dissection process.
There are many who will never understand the relevance of performing dissection to assist the understanding of therapeutic, body based interventions. The idea that everything there is to know is already in many books, persists in the minds of therapists and anatomists alike. There are however many ways to view a body, dead or alive, and by stepping to the side of what we consider ‘normal’ and looking at form in a way that takes us out of our existing and deeply held experiences, we can see new things in a new way.
I am grateful for Jenny’s thoughtful and detailed examination of this subject and hope you will enjoy reading it. You can download the PDF below.
It’s understandable that when someone presents with a specific problem, we want to try and come up with solutions that aim to ‘fix’ it.
Therapy forums on Facebook often feature questions along the lines of, “I have someone coming with –insert name of disease or problem here- are there any things anyone can suggest?”
People then of course suggest things. These suggestions may or may not be helpful, but the motivation and indeed the question itself misses an important aspect of what holistic treatment is all about. The fundamentals of connective tissue, suggests that the connected nature of everything in the body means that the possibilities for cause and effect on a wider scale are limitless.
I am not suggesting that for example the reflexology argument that there are zones in your feet that are related to your organs is one that holds true, just that you can’t chop your feet off and leave them with someone to fix, any more than you can your kidneys. However vaguely they are connected.
Put another way, a human body is not a car.
If tomorrow morning you try and start your car and nothing happens, there is one reason and one reason only that this has occurred. The variables are non-existent and if you reproduced the same fault in any other car the same thing would happen.
My knowledge of mechanics is something akin to zero, but I can be pretty sure that your car malfunctioning has nothing to do with it feeling depressed, unloved or fat.
I can also be reasonably certain that the rust on the side panel, the broken wing mirror and two under inflated tyres have no impact either. Yet this is kind of how we go about trying to treat a human.
Every human has a a history and a wealth of circumstance that will contribute to their current experience. A huge element of the presentation of any injury or illness, particularly chronic ones, will be influenced by patterns of learned behaviour. How much of the pain is fear based? How much of the nausea is responsive? How much of what we are experiencing now has roots from deep in the past?
An understanding of how someone moves might point us towards looking at ankle work for a back pain or addressing the TMJ for a knee issue. Again my implication isn’t that there the teeth have some mystical control over the joints, but that basic load bearing function is at play on a wide scale.
The basic rule of natural treatment, is that the body be treated as a whole, without referral to named disease.
Naming diseases is pretty straightforward and, let’s face it important when it comes to being able to treat life threatening problems. For everything else, the rules change.
Back pain is the classic example. Our human frame experiences back pain on a huge scale, second only to mental illness for work days lost to industry. Yet medicine, for all its ability to conduct hear transplants and brain surgery, remains stumped by a good old fashioned back pain.
The trouble is that the back is subjected to a wide number of influences. Physical work, emotional tension and just general movement. Muscular structures all over the body will affect and change the way we use our back and learned patterns of behaviour and movement will give us postural patterns that will limit our movements.
Our environment and social situation, even our socio economic status will help to define how we sit, move, defecate and sleep and our back will bear the brunt of whatever and however we use it.
Even when we have a specific diagnosis of a bulging disc, this is isn’t a full picture and in many situations is an example of the diagnosis hindering rather than helping; most people with a bulging disc don’t have back pain and most people with back pain don’t have a bulging disc.
So next time someone presents with something you’ve never heard of, take a step back and ask, “what’s the problem?”
The problem with the client isn’t the same as the condition they are suffering and the two shouldn’t be confused.
Twist and Shout!
When we look at or talk about anatomical structures or humans in general, it feels like sometimes that there is a disconnect between us and the rest of nature.
It’s as if the rest of the animal kingdom exists in separation to that of the human species. Certainly we don’t seem to be ‘at one’ with our environment, as countless examples of environmental vandalism bear witness and it feels like we set ourselves aside as different or special in some way.
The human condition strives for a desperate sense of order. Straight lines and linear ideas rule our thinking and understanding and we cut swathes of rod like structures out of surroundings where nothing is ever in a straight line.
Nature abhors a straight line however. In straightness there is weakness and angles that will instigate collapse more readily than support. When we see a tree, a plant, a bush or a bird flying, we are seeing movements of spirals and curves in action.
Humans are no different. A skeleton (as much as a skeleton exists by itself), is a myriad of curves and offset angles with thankfully absolutely no horizontals that would cause us to dislocate our joints.
The structure of the tissues that hold us together, connective issues, are prime examples of non-linear tissues. Collagen is the most common protein in the body and the collagen fibres that form our fascia and much of our connective tissue coiled and spring like, giving our bodies the elastic recoil that allows us to absorb forces and tensions.
Collagen is a triple helix structure. Three thin strands wind themselves together to form a spiral type structure which, when fully formed, is stronger pound for pound than steel rope. These helices don’t follow the line of muscle travelling around the body, but instead criss cross muscle and bone in a myriad of different directions.
Where muscle has a start and an end point, the collagen based fascia doesn’t. Overlapping standard muscle insertions, the fascia invariably carries on from the end of one muscle and into the beginning of another.
This picture shows the adductor longus fascia as it traverses the pubic symphysis and continues in to the fascia of both the rectus abdominus and external oblique. The temptation is to assign function or meaning to this kind of continuity and whilst it can be fun to do, there is little to be gained except to appreciate fascial continuity.
Adductor Longus Fascia overlapping the pubis
This kind of relationship is not unusual in the body and is not just surface tissue either. It dips and dives into the pockets of muscle tissue, creating divisions; ceilings and walls that give the muscle a container in which to operate.
Muscle relies entirely on fascia for its integrity. Without the fascia, the muscle would have no form and no integrity and would be unable to function.
I’d finally decided to do it. After a long time thinking about it and talking about it with my partner, this was it. A 6 day dissection class. With real cadavers.
Ascending the lift, I was apprehensive. I had dissected animals as part of my degree but I had never seen a cadaver, let alone used one as a teaching tool.
In a locker room, with other students, we were all quiet. Some were returners, others were, like me, new to this. After locking our phones and valuables away, and putting on our white coats, we were led into the lab.
As we walked into the lab, it was impossible not to notice all of the 5 shiny humidors that contained our bodies. The lab was large and cold, with specimens persevered in formaldehyde on workbenches.
We sat on stools in a circle, introduced ourselves and were off on an incredible journey.
Once we had discussed what was about to happen, we gloved up and were led over to the humidors, which were now open, revealing linen wrapped forms. The coverings were removed and we were invited to look carefully at each and make a choice as to the one we were drawn to work on. I chose a man – I couldn’t honestly say why. He was an elderly gentleman, well built. He was lying face up. There was a line of stitches in his groin – the closure of the hole to get to the femoral artery to input the embalming fluid. His head was shaved and his arms and legs were freckled.
Now it was crunch time. You think about death abstractly. You know that it is the absence of life. You know that there will be no warmth. You’ve heard about rigor mortis but nothing can prepare you for actually laying your hands on an embalmed cadaver. I was, oddly, surprised by how stiff and cold it was. Note here that I say ‘it’ and not ‘he.’ My initial reaction was that whatever had made this form ‘human’ was no longer there. This thought would change as the dissection progressed.
Having been shown how to use the forceps and scalpel, we were now asked to remove the skin. Yes, you read that correctly, remove the skin. This conjures up pictures of flaying, of Silence of the Lambs but no, it was nothing like that. Skin is attached very firmly to the superficial fascia layer beneath. At one point we had to turn the body over to remove the, much thicker, skin on the back. I now appreciate the term “dead weight.”
Many blunted scalpels later, we could look at our form without his skin – barring his hands, feet and face; the superficial fascia or adipose layer is so thin in some areas, that it takes a degree of skill to dissect it beautifully. The colour was most shocking – yellow – especially when all 5 of the cadavers were placed side by side on their gurneys. But they were still recognisable as male or female, the rounded curves of the women, their breasts and hips given form by this superficial fascial layer.
Day 2 was the removal of this layer. It was soft and oily – a result of the fat cells breaking down as we cut through them with our scalpels. Careful not to cut too deep and hence into the deep fascia underneath, we began to peel back this blanket. One group of more experienced dissectors managed to remove the whole of the superficial layer in one go. They laid it on a gurney next to the body from which it was removed – a woman. Apart from her genitals, she was no longer recognisable as a woman; this covering had given her form and now it was gone.
The layer of deep fascia is one of the most difficult to dissect. It clings to the muscles, wrapping around each, separating them. It is strong, pliable, criss-crossed like a matrix and it is everywhere!
Muscles next; now we were into more familiar territory, but even this was far removed from the conventional anatomy in books like Netter or Grays. Each muscle was wrapped in superficial fascia, but when this was removed, the muscle just came apart in our hands. It made us realise that what we think of as knots in our muscles, couldn’t possibly exist. So what are we doing when we massage or treat someone as a therapist? Bearing in mind the layer of superficial fascia over the top of the muscles, are we actually doing anything to them?
Nothing about this experience is normal, yet it has become routine. On into the viscera; I held the heart in my hands, shone a light through the diaphragm, watched as the teacher used a bag to inflate the lungs, amazed as they ‘pinked up.’ One group removed the brain and the central and peripheral nervous system, laying it out like an ethereal skeleton.
And finally, when our week was done – there was not enough time I can tell you now – we laid everything in a body bag in a coffin and held a moving ceremony where we thanked the donors for what they had allowed us to see and learn. I admit, it was emotional and I shed a few tears. The camaraderie in the room had been fantastic and we had participated in something very few people have had the privilege to do. I would be back!
Fascia Kittens For Everyone!
It’s fair to be said that the only people who really take the fascia thing very seriously are those who are invested in the word or the concept for whatever reason.
Fascial Manipulators, Fascial Releasers, Fascial Roller Manufacturers the list goes on. It’s no surprise that all of these will tell us that whatever it is that they do, has an effect on fascia.
The supporting claims made for the effects on fascia by these modalities and pieces of equipment is accompanied for the most part by a whole raft of scientific bunkum that often lumps fascia into one bundle and addresses it as a single unit or type of tissue, without basic facts getting in the way.
The science side of things often does no better. The bi-annual festival of fascial backslapping that takes place under the banner of the Fascia Research Congress, brings together a wide range of scientists keen to present their latest ideas and theories under one roof.
For the most part the research, to the untrained eye (indeed to even the trained one sometimes) seems either pointless, unintelligible or both, but little matter. Research is being done and the field is being moved forward slowly but surely. Hooray and fascial treatments all round!
The trouble is that from this very early, very inconclusive and often very poor research base, the world of complementary ‘bollocks speak’ is having a field day.
Every other treatment now releases fascia, hydrates fascia, lengthens fascia or does something miraculous to the fascia, which in turn gives you more of whatever it is you want. Flexibility, less pain, tighter buns, eternal life and so on. These days if you want to be sexy, you’d better be working on the fascia. Stretching is so last year darling.
I hold my hands up to jumping on the fascia bandwagon myself, having renamed The Bowen Technique, Bowen ‘Fascial Release’ Technique. The unashamed rebranding was for no better a reason than to at least try and give Bowen a peg on which to hang its hat and move it away from the crazed evangelist guardians intent on suffocating it. But of that another time.
So what does fascial release even mean? To be honest I’m not really sure. The idea that you can in some way change the properties of fascia by applying manual therapy to it is far fetched at best and the pressures required to create change in fascial tissue are, probably, more likely to rip it before it changes. Is Bowen working fascia? Probably but not exclusively and that’s the point. Nothing is.
So what about taping the fascia? Again I have watched YouTube videos, where sensible people demonstrate applying tape, of various colours and let’s not forget price, to bits of the body whilst climbing that this tape will adjust the fascia around the SI joint. Again the likelihood of this being the case is not high.
This all makes for a fairly sad state of affairs and one which often draws snorts of derision from anatomical academics and serious scientists when the F word is mentioned. Fascia, beaten to death on the commercial imperative of the complementary medicine field, desperate to find something of gravitas to justify its own existence, is in danger of becoming something of a laughing stock to the rest of the world. The irony is that an industry that preaches holism and addressing body wide issues, has chosen one bit of (admittedly neglected) connective tissue and obsessed over it.
While I’m beating up on my own doorstep, I’d hate to let the academics off with a pat on the head for being so outrageously smug. Connective tissue in the form of fascias of various kinds, clearly has more of a role to play than just being a container for muscle and much more understanding and good research is needed to understand how it responds.
It’s not all bad of course. There are some serious researchers out there and in the midst of the codswallop and bad science being bandied around, a real interest is being shown in this interface which has been woefully ignored for a long time. If the focus can be shifted to this much needed area of understanding, then I believe that we can probably create a better understanding of body wide function than currently exists.
Wild and outrageous claims need not apply.
A piece of wood is placed on the fire. It burns for a certain length of time and gives off a certain amount of heat or energy.
Simple stuff. Easy to work out how much energy it gives off, based on its size and density. We can therefore estimate the amount of energy that type of wood will give off and work out how much of it we need to heat us up.
We can do this repeatedly with other materials. Grass, cardboard, plastic, you name it. Each of these will give you a reasonably accurate measurement of how much that they will give out. Again simple. Repeat ad-nauseum. It’s all to do with the laws of thermodynamics.
The same piece of wood gets put on the same fire, this time with some cardboard, some grass, a mattress, a few bits of laminate flooring and an old cot from the loft.
How long will the wood burn for and at what temperature? Answers on a postcard. Even here, someone brainy enough would be able to have a reasonable stab at it and probably get close.
The same analogy goes for the way science measures the energetic output of food. Calories. A calorie is a unit of energy. It is not a description of a nutrient, nor is it related to nutritional value, except in the widest sense of the word.
A calorimeter measures the amount of heat (energy) that comes from a certain food. All well and good. But unfortunately our bodies don’t just heat food, but digest it and break it down using a complex process of chemical reactions.
The process of digestion and absorption takes variable lengths of time and is hugely dependent on a wide number of factors. The conditions that we find ourselves in, environmentally, metabolically and so forth, as well as the way in which we talk in other nutrients before and after, will significantly impact the way in which calories are burned, if indeed the word ‘burned’ as a direct comparison to a calorimeter is even appropriate in this context.
The laws of physics in terms of energy in and out, apply only to the extent that in order to measure them accurately, you would need to take in to account the wide variety of additional factors that will influence the energetic exchange.
A recent article by Leo Benedictus in the Guardian, highlighted the nonsensical nature of such direct comparisons. In (fairly) trying to debunk the superfood nonsenses spouted left right and centre, he made the massive error of comparing the calories in an avocado to those of a Mars Bar and those of chia seeds to a Big Mac.
It’s a bit like me affectionately slapping my partner’s bottom being likened to domestic abuse or assault. The comparison is not only erroneous, but potentially damages and undermines the serious and real issue of domestic violence.
The comparisons of widely different food types under one misleading banner creates confusion in already confused and conflicted consumers and erodes the serious issue of obesity and diabetes.
Consumption of sugars through confectionary products and soft drinks, are contributing to a major health crisis in the UK which threatens to undermine our health service and shorten lives through type2 diabetes. Trans fats, found in many fast foods in addition to sugar, cause heart disease in large proportions in the UK.
The consumption of raw food fats such as those found in avocados, aside from the ecological concerns are in no way part of a wide dietary concern. Not all calories are equal and should not, however convenient, be labelled as if they are.
Are calorie measurements helpful?
As with any analytical tool, information is only as good as the use to which it’s put. Used as part of other information and within context, they can be a helpful indicator in certain limited conditions when comparing foods of similar composition. Something that is high in calories is not necessarily unhealthy because it’s high in calories.
Once the calorie gets used as a direct measurement of food across the board, the calorie not only becomes inaccurate but has the capacity to drive unhealthy and obsessive eating patterns.