The complicated relationship that we as humans have with fat is one that has lots of strands and interests.
Our cultural referencing tends to create the idea that fat is a bad thing and certainly the link between obesity and poor health is one that has mileage. Obesity in isolation as a health risk tends to do what all these arguments do, which is to set aside accompanying factors.
Being fat is no longer the domain of the wealthy, with fat jolly upper class gentlemen depicted in Dickensian novels as the ruling classes, contrasting with the poor, wraith like creatures of the slums.
Fat has therefore sociological aspects to be considered as well as dietary. The rise of sugar consumption being parallel to that of obesity seems fairly obvious, yet the link remains associative rather than causative.
Nutritional science has little in the way of consensus and there is wide spread disagreement relating to even the most basic ideas of how much and what type of fat should be in our daily diet. Similarly ideas about weight, fat distribution within the body and what type of exercise is best for you, still contradict themselves on a daily basis.
Then there is the ‘burn belly fat,’ websites that scream at you to buy their most scientific finding of utter rubbish. My personal self loathing is my fat wrists and I am therefore under a strict exercise and diet regime aimed at burning the fat at the bottom of my arms.
The terms we use for fat are also something of a misnomer. Superficial fascia is something that could more agreeably used to describe the tissue found directly beneath the skin. There seems to be an idea that this is a tissue that is simply a fatty layer and therefore undesirable wherever it may be.
Adipose, superficial fascia, the pannicular layer are all terms that cover the same tissue. Recent attempts to classify the superficial fascia as having separate layers, with one more defined as distinct from the fascia cutis is interesting.
However the studies undertaken have only looked at the layer around the abdomen and attempts to classify the whole body based on such a small area of study would seem a little ambitious.
In this video of fresh abdominal superficial fascia, you can see that there is a weaving of collagenous like tissue (no samples were taken) through the fatty layer.
This is consistent throughout all the dissections I have been in, with the superficial fascia a continuous structure that running around the whole body. Some areas are of course thicker than others, but the principle is consistent. Even if you were to take all the fat away from this layer, then the fibrous content would remain.
The principle of fat containment within fascia is the same as that of muscle containment within fascia and obeys a basic biological principal: you cannot have cells without something to hold them in place. In the case of both the muscle and the fat, the container is the connective tissue we know as fascia.
In addition we know that adipose itself has a major role to play in the functioning of the body, with the suggestion that adipose might even function as an endocrine organ.
The debate about what to call it, what it does, as well as a clear understanding of how it gets there, genetically as well as environmentally, will no doubt continue for some time to come. In the meantime our battle with the bulge will no doubt continue, profitably for many and miserably for many more.
This weekend saw me revisit some old friends. I say friends because I feel like I know them, even though they don’t have a clue who I am.
In fact you probably know them too as The Rolling Stones. I had been in California last year to see them at an event called Desert Trip, where the combined ages of the performers, who included The Who, Bob Dylan, the aforementioned stones, Paul McCartney and several more reached well above a thousand.
Watching Charlie Watts on the big screen my wife and I quipped about what he was thinking. “Ooh I could murder a cup of tea and a biscuit.” “I hope the missus has recorded Corrie”.
With his silver hair and brilliantly expensive white teeth, he also sat bolt upright at the drums, with a composure and dignity that many of half his age would die for.
Born in 1941 Charlie Watts will be 77 next year and with Ronnie Wood being the baby of the band at 70, you have to ask, how do they do it? Keith Richards has, over the years consumed several times his own weight in recreational drugs and still starts every day with a joint.
The fact that they have survived as long as they have is remarkable, but that they still tour regularly and energetically makes you ask, “what is it that they are doing right.?”
I suspect that the answer lies in the manner in which they live their life and the passion to which do their work. Being multi millionaires doesn’t hurt of course, as money is the key element to longevity the world over.
But watching them all on the stage the other night, it was clear that they all still get a terrific buzz from what they do. The sheer joy that they exude is not something you can fake and from start to finish they did nothing but entertain at full pace.
There aren’t many of us who will have the opportunity to experience the adrenaline rush of playing to 60,000 adoring fans, but perhaps the secret to a long life is to live a life where you experience fulfilment of a passion.
On top of that, not one of them stopped moving for over two hours on stage. Mick Jagger moves as a 74 year old more fluidly than I could hope for at 54 and probably hits his 10,00 step target in one show. Following him on Instagram, he is regularly posting videos of his dance workouts and training and seeing him live you know he’s not faking it.
“When you rest you rust,” my Auntie Joan used to say to me. Until her death at 89 she shouted at squirrels, me and the cat and got out into the garden every day if only to see what the gardener had done wrong.
I live lived to the full is a life lived. Move every day, find a passion. Mick and the boys are living proof of its effects.
The United Kingdom boasts, to my mind, one of the most incredible health services on the planet. Free at the point of delivery, the amount we pay in our National Insurance Contributions isn’t arduous and for most, a year’s payments would barely cover an overnight stay in a hospital let alone any extended treatment.
The pressures on staff and resources that we are currently witnessing, is placing an enormous strain on this, the crown jewel of our country. Various parties have played political football with the NHS over the years and we are at crisis point in many areas.
This is not a political or social comment on the state of the NHS by the way. There are good things and bad things about any system, but I know from visiting other countries, we will miss it when its gone! The strains on the service in the UK combined with certain underlying principles of approach, have prompted many to go in search of private health care, and private health insurance is a growing market.
There is however a third tier to the health system. Unregulated for the most part, yet with millions of adherents and customers and turning over billions of pounds. It is of course complementary medicine. Those with half an ounce of previous experience will know that going to the GP with aches and pains is, quite rightly going to get you with nothing more than advice to take some paracetamol and keep moving about.
The evidence suggests that this isn’t bad advice, but for many, there are longer term issues that they feel only a visit to a non-pmary health care provider will address. The list is endless. Chiropractic, Osteopathy all kinds of massage, Bowen, Reflexology, Cranio Sacral and so forth. One of the largest associations in the UK, the Federation of Holistic Therapists, has over 20,000 members, all of whom one assumes has some degree of work going on from week to week.
The cri de coeur of the medical profession is that there is little or no evidence for these therapies and that they have no credence from a health perspective. Whilst the ‘no evidence’ claim is out dated and tired, much of what is on offer on the high street could be seen as questionable. Yet there is a mountain of evidence relating to hands on and manual therapies, as well as the role that guided movement therapies have for a whole range of issues.
Although CAM therapies are often criticized for being used despite a lack of evidence, hundreds of systematic reviews have, in fact, evaluated specific CAM therapies; of these, some have been well conducted and have shown that the CAM therapy offers a clear benefit. State of Emerging Evidence of CAM
More to the point however is the role that this industry plays as a sticking plaster to the NHS. Imagine a scenario where all therapies were banned tomorrow and anyone with any kind of ache or pain had to report to their GP. A system strained to capacity already would collapse before lunchtime.
Dr Phil Hammond, he of MD in Private Eye, has never been an advocate of Complementary Medicine, but argues the case for this third tier being taken seriously. So are ALL doctors agains CM? While there is a large degree of scepticism from them, there is also an acceptance that therapies play a role in the overall management of patients and their ailments.
The industry is, for the most part unregulated. Chiropractors and Osteopaths being the exception are regulated in the same way as doctors, dentists and pharmacists, being part of the nine health care regulators in the UK alongside the General Medical Council and the HPC, which is the body regulating social care.
The question in this forum is; should Comp Med practitioners have access to educational dissection classes that enhance their knowledge? It seems obvious that any further training or anatomical education is only going to enhance the skill set of these practitioners, as well as by extension, increasing the protection offered to the public.
The die hard, old school academics out there might disagree and there have been many attempts to keep the doors closed to those who they consider unworthy. Ultimately a bonafide interest in anatomy and the human body, based on a daily practice or study should suffice. Those who want to attend my classes are asked to provide a CV and a brief personal statement, explaining why attending a class would be of benefit to their work.
Times are changing and the hope is that eventually we can bring a wider knowledge base to bear across all health disciplines.
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.