Recently, I have heard a lot on the idea of the psoas being able to harbour trapped emotion. Forgive me if my view is a little tongue in cheek but if you’ve watched our webinars, you’ll already understand how I look at things a bit differently.
If muscles were people, then the psoas would be the head of the football team, rugby team or cheer squad. Vacuous and emotionally stunted, whilst looking great. Muscles in general have one thing to do which is contract and relax. They are brilliantly equipped with their own cells and motor units and each muscle is considered an individual organ. What they are not capable of is memory. Although the idea of cellular transference and cellular memory is a thing, muscles themselves are power houses and I don’t believe in any idea of ‘muscle memory.’
Instead, what is clear is that nerves that are myelinated, having laid down fatty schwann cells, will transfer information faster via a process of it jumping over spaces, nodes of Ranvier, created by the myelination of the nerve. This jumping is called saltatory conduction after the Italian saltatore – to jump. Myelination of nerves comes about as a result of learning something. The more you do something the better you get at it, not because the muscles have learned anything, but because the nerve endings that deliver the information from the brain have become finely tuned to the job required, be it playing a trumpet or juggling chainsaws.
The area around the psoas is a hugely loaded area from many respects and the psoas fits in within a chain of other structures to do a job. The central location of this area being around the solar plexus suggests that it would be a central point for emotional responses based around the autonomic nervous system. This is an area that will need to have rapid response in the case of sympathetic nervous system responses, with the pancreas being involved in triggering hormones to release energy and for the digestive system to restrict blood supply and so forth. The psoas just happens to be there.
However, I do feel strongly that as highly emotional beings we don’t primarily respond mentally to our emotional input but instead go to the physical as an initial response. We don’t think angry, we feel angry, we feel sad, we feel stressed and so forth. Our language expresses this perfectly. Our thought processes come along and we start to think our feelings. For most people this is the problem and one of my workshops called Emotional Stiffness, discusses the idea of us being physical and emotional beings before being mental and thinking beings. What does ‘angry’ look like?
It’s not hard for us to look at someone else and say that they look angry, sad or stressed. As well as their behaviour there are physical signals being given that alert us to the emotional and, by extension, mental state of an individual. We use these senses all the time with ourselves and with others without being conscious as to what our physical form is doing to reflect or represent our emotional state. We have trained ourselves into these physical states since early childhood. We know what angry feels like in our body and we know what to do with our body when this feeling arises. As well as the physiological changes that we know about and can measure in the sympathetic nervous system such as heart rate, breathing, blood flow and so forth, we will have learned to adopt a physical position. It’s a go to that will happen every time the emotion, whatever it might be, is triggered. Learned behaviour is a training as sure as weightlifting or yoga is a training and we will lay down connective tissues around our muscles that will support this and allow us to adopt that position when we feel the input that directs the feeling.
If we have spent many years being angry, depressed and so forth, we will also have trained our physical form into an instantly familiar pattern that will reflect our emotional state. In time the physical state becomes inseparable from the emotional state and one potentially drives the other. The cycle is indivisible unless it is recognised. We might spend a lot of time with our therapist, recognising our patterns, understanding our behaviour, recognising our triggers and dealing with our behaviours, but if our physical behavioural patterns are strongly embedded, then just by moving into a certain position could have the potential to move us into the familiar emotional state that we are trying to step away from.
My aim in my workshops is to help people to start to recognise where in their bodies they experience emotional triggers and what happens to their body as a response. It’s a combination of movement and mindfulness that encourages people to assimilate recognise and where possible allow and welcome their feelings as manifesting in a physical form and then to avoid moving into a mental space that then just spirals downwards.
The bottom line is that it’s physiologically implausible to suggest that one muscle or even a collection of muscles for that matter, can ‘store’ memories. What they can do is respond to and easily move into a position that is familiar. Focussing on one muscle or structure is never either useful or correct and the idea of individual muscle function is a contradiction in terms. I believe that building integrated understanding of how we affect and influence our function from a physical, emotional, social and mental perspective and create imbalances in health and ill health, allows us to make much smaller and more manageable steps towards addressing dysfunction or imbalance.
The Saggital Sinus
In mentioning that I was planning a future webinar on spinal cord, dura and meninges, I was contacted with some brilliant questions and thoughts about cerebrospinal fluid and the effect that therapies such as Cranio Sacral Therapy might have. The theory around the techniques suggests that movement of the cranium in clockwise and counter clockwise directions, influences and improves the drainage from the sinuses into the carotid veins. There is a popular understanding that congestion of the CSF can occur secondary to trauma or dental work.
I will admit to knowing not much about the application of the techniques, although I have been on the receiving end of them many times. I have found them to be pleasing and useful especially during a phase when I was experiencing severe headaches. I have also known many people who have had their babies and young children treated with cranial techniques to very good effect.
However my personal feeling is that it is unlikely that the work being done by these therapies is having a direct, mechanical effect on dura or CSF. I just can’t see it. In the fully formed adult head cranial plates don’t move to a degree that can be palpable or affected by the type of pressure usually associated with manual therapy, and neither should they. The sutured plates are there to give a birthing baby the chance to pass through the birth canal without destroying its mother in the process. Once this has been achieved, the necessity for the plates to move isn’t there, and instead the more important role of hardening and fixing to protect the fragile contents of the skull begins.
Unlike the sacrum, the skull also doesn’t need to transmit load or force through it and indeed if the kind of forces generated through the sacrum were applied with any degree of regularity to the skull, brain damage would soon follow. In an infant I do appreciate that this application would have a different perspective.
The incredible thickness of the skull, even at its thinnest area, therefore renders the likelihood of direct effect on the dura or meninges unlikely in my view. However if we are talking about the power of touch to inform every aspect of human behaviour, then all bets are off in terms of what is being achieved.
Putting hands on anywhere, brings an awareness, not just to the localised area being touched, but to all the other areas that are connected to, associated with or affected by the place we are touching. Most of these associations would not be conscious from the client perspective or intellectual from the therapist perspective, in terms of anatomical or theoretical connections established through research or study.
Instead these connections are things like the time we fell off our bike, banged our head and twisted our ankle and spent two hours in the nurses office gagging to the smell of Germolene and feeling nauseous. The resulting associations embedded in this experience become part of our physical, mental and emotional psyche and are impossible to untangle or even identify from either side. The touch that brings all these together even if these realisations are still unconscious, allow a shifting of behaviour and a change of focus of pain or sensation. More information is put in to the existing embedded memory and pattern and more information allows for greater integration of personal experience, good or bad.
There is considerable resistance to the idea that we aren’t actually doing what we think we are doing or what we want to be doing. The clinging to belief, personal conviction, original training and even research papers, sometimes presents barriers to letting go of strongly viewed theories. I will get told many times in no uncertain terms, that I am wrong. That these things do move and that X, Y or Z is happening and that you can feel it under your hands. Well maybe you can, and I for one have no doubt that things happen in sessions that are way beyond what we can reasonably explain using anatomy, physiology or science of any kind. All I can do is present what evidence a donor gives me and what I see. Also logic should prevail to some degree as well. We know that touch is a powerful promoter of change in every aspect and sense: physical, mental, emotional.
The Pterygomandibular raphe. Still a good distance from either of the actual pterygoids.
The jargon and regularly applied phrases such as ‘dural release’ and ideas around working the pterygoid plates come up and it’s hard to find meaning when looking at either how accessible (or inaccessible) any of these structures are in reality, or what ‘release’ might even mean. There’s no doubt that working in these locations will bring proprioceptive awareness to the area, but as to what release actually means is anyone’s guess.
If within this filed we recognise the need to influence fluids, then I would suggest that it is not just CSF that is worthy of our attention, but indeed all the wet bits we possess. Therefore I once again come back to the importance of movement and within the movement, the need to create compression and apply compressive forces within the movement, such as squatting or resistance within and as many ranges of movement as possible. It is these forces, applied regularly and with as much variation as possible that I believe helps effective fluid circulation and is going to be more effective than any physical force that a third party can apply to a body. However the need for an individual to have the ability to create awareness and focus on areas of their body where movement is restricted, painful or where the acquired lifetime patterns of movement and no movement, have introduced limitations that hold us from moving to our fullest potential. This is the unique ability that touch confers,
The right touch, in the right place, with the right story, from a compassionate, caring and insightful therapist is something that no amount of science will ever compete with.
Got together like love and marriage, like horse and carriage, like peanut butter and blue cheese.
I’ve long been interested in what I call ‘virtual relationships’ around the body. Places where things appear together to such an extent that they probably have to have some kind of symbiotic and functional relationship.
I also happen to have a passion for undertaking very detailed and fine dissections where I can spend time seeing how tissues both weave together and separate. It’s not something I generally have a lot of time to do in a class, and any opportunity to spend time alone in a dissecting room will find me undertaking a task on my long list of “I wonder ifs…”
The fibrous pericardium of the heart is generally shown as being continuous with the top of the diaphragm. In open heart surgery (as far as I can ascertain) the pericardium is opened and then not closed up. I presume because it will close itself. I haven’t been able to confirm this with a heart surgeon by the way, so any corrections will be gratefully received. This picture whilst showing the connection of the pericardium to the diaphragm, also happens to show the beauty of the blood vessel network and gossamer nature of this structure.
In any event the linking of the heart to the diaphragm tells us that every time we breath in and out 15-20,000 times a day, our heart rides up and down on our diaphragm, probably contributing to the momentum of heart movement and blood flow. From a geeky perspective I wondered as to the extent of this connection. Could the heart be separated from the diaphragm intact? After a few false starts and some holes in the pericardium, I managed to perfect this dissection which you can see here.
I regularly show how the fascia of the diaphragm is to all intents and purposes, continuous with the fascia of transversus abdominus and that there is also a continuation of the parietal pleura over the diaphragm and incidentally both these pictures don’t make clear that there is another lining over the top of the diaphragm which is parietal pleura. It’s pretty difficult to separate this although I have done it in sections. Perhaps another challenge?
What does it prove? I have yet to postulate any ideas regarding function, just that it is incredibly interesting and does show these two structures as complete and independent of each other from a biological standpoint. Sometimes the applications come after the demonstration possibility. A starting point would be to name the junction. Diaphragmatic pericardial raphe perhaps? Answers on a postcard please!
At a fascia conference in Berlin in November 2018, I was accosted by a lady who pointed at me and accused me of being the man who “doesn’t believe in Anatomy Trains.” Slightly taken aback I pointed out that in the face of evidence, belief is not required. Bring me the evidence and I will not require faith.
Before we go any further, allow me to place a very firm stake in the ground here. I consider Tom Myers to be one of the greatest teachers, orators, therapists and thinkers that we have seen in the last 100 years. Anatomy Trains is a work of absolute genius and one of the most important contributions to the world of body work and anatomy that stands alongside Job’s Body for importance. I for one would not be in the place I am without Tom and his work. I consider him to be a friend and a colleague and someone for whom I have an endless amount of respect and gratitude. I have taught with him back in 2007 where we ran a dissection workshop in St George’s hospital in London and took him on a tour to teach my Bowen people. I like Tom. A lot.
As you might guess, there is a however coming up and you would be right. It’s actually more about how people have taken the AT work on rather than about Tom, but I offer you a quote from the man himself where he explains Anatomy Trains as “imaginary lines of strain in the body.” If we stayed here, with the word imaginary, then I would have no need for my belief system to be questioned and no need to be accused of several counts of Myers heresy. Simply put, Anatomy Trains do not exist. There, I’ve said it. They are imaginary and like many things imaginary, serve an excellent purpose when used to illustrate an idea. Anatomy has needed a model to remind us that there are continuities and connections all over the body that have functional connection and relationships and there is little better in the way of models than the imaginary ATs. Why spoil a good thing?
In the years since I first encountered Tom and the ATs, there has been much dissecting of many cadavers and along the way, the lines have been dissected out and held up as proof that “yes here they are, they do indeed truly exist.” They do not and to suggest they do demeans the originality of the work and its designer. Apart from the basic idea that the lines are physiologically impossible, cutting something out of a dead body just means that you have a sharp knife, a keen eye and a good imagination. My blog on confirmation bias is a reminder that what we seek to verify we probably will, even at the expense of good science, logic and common sense.
John Webster from California is an ice carver (and a pretty good masseur), renowned for his carvings of swans from ice. When asked how he performs such feats he claims it is very simple. “Just take some ice and cut away anything that doesn’t look like a swan.” Anatomy has been creating non-existent structures out of dead bodies for hundreds of years, giving us things like the Iliotibial band and various retinacula, all of which are carvings in the same vein as the ATs and John’s swans. Certainly instructive and interesting and definitely worth doing, as long as you see the nature of the model you are creating.
I do believe however that I have found an actual unicorn in the shoulder blade. No really.
Dissection, from Latin dissecare “to cut to pieces,” is the dismembering of cadavers, and it has a long history.
Greek physicians in the 200s BCE seem to have been the first to medically dissect human bodies. The dismembering of bodies was forbidden in the Roman Empire, so people such as Galen used the corpses of primates. In both Islamic and medieval Christian cultures, it was a strict taboo. Although, the work of individuals such as Ibn al-Nafis in the 1200s shows that human dissection took place regardless.
Modern medicine would not be where it is without this important practice, but it’s not only doctors who benefit from it. Acupuncturists, Osteopaths, and even artists can garner valuable insights – many called Leonardo Da Vinci mad for cutting up cadavers, but had he not done so his artwork would likely be far inferior.
Hands-On Experience Is Irreplaceable
You can spend months watching the cooking channel, but if you don’t pick up a knife and cook, you’ll never be as good as you could be. Human Dissection is a similar concept; Textbooks are a great accompaniment, but they are no substitute for the physical thing.
Arguments have been made that the same results are gained from images of dissected corpses, but there are several reasons why the real thing is better.
As humans, information is generally retained longer if it comes from sensory experience, as opposed to reading. Plus, due to the adrenaline that you’re more than likely to feel, you should have an easier time remembering details.
We’re All Different
An overused quote, but the majority of people do not realize how accurate it is. All humans have the same basic anatomy, but unlike textbooks, a cadaver will show you that vital details can vary wildly.
There are the obvious differences, such as healthiness and gender, but there’s also a host of other differences that make us unique individuals. Some organs might be slightly larger or a different shape depending on the person – some could have discolourations or harmless growths.
You may also end up putting together the fragments of the person’s life. Discolouration of the fingernails and deterioration of lung tissue might indicate a heavy smoker – while severely calloused hands might suggest a life of intense physical labour. It’s easy to begin to care for who the person was when you start to notice these details; Which brings us to our next point.
Dissecting A Human Enhances Respect For The Human Body
In addition to gaining an advanced understanding of human anatomy, dissection also helps people appreciate the value of life. Those who have dissected corpses usually claim that it taught them how great a gift a cadaver is.
Dissecting bodies helps the living continue to live comfortable lives, or simply to continue living. Despite the usefulness provided, many people aren’t comfortable with the idea of their bodies being used after death. Still, someone wouldn’t keep a pair of shoes once they’ve outgrown them, so why would they not donate their body to science?
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I’ve spent most of my adult life convincing myself that what I do works and that my own particular brand of therapeutic intervention has some kind of mechanism that makes people ‘better’, whatever that means.
It stands to reason that I need to have some level of conviction that what I practice, teach, write about and study has some level of efficacy. This conviction however comes with little real evidence to back it up, save for the thousands of other people who have the same conviction. This conviction sometime extends way beyond what we might often think of as a reasonable confidence and is mirrored in the behaviour that we indulge ourselves in all through life.
We tend to surround ourselves with this who agree with us and who confirm our view of the world. Whether it be through religion, culture, politics, therapy or science, we associate and fraternise with those who’s world view closely resembles our own. In science this is called confirmation bias; we tend to confirm as fact what we want to be true.
As I’ve got older and more cynical, it’s hard to separate fact from fiction when it comes to therapeutic intervention, but I still regularly face fierce conviction from those who are utterly convinced that what they do has a clearly defined mechanism of action, even when it is is patently obvious that any such mechanism or at least an understanding of it, is entirely absent.
These people will send me emails that contain pages of research documents that back up their stance and confirm their strongly held belief that what they do is scientifically proven beyond doubt, an excellent demonstration of confirmation bias. Much as the evangelist will use the bible to demonstrate proof of the word of god, anything that might directly contradict or question this view has not been sought out or researched and someone like this is unlikely to have a balanced view.
Whilst understandable, it often makes for uncomfortable conversation. Whilst I totally believe, having had the same experiences, that the most incredible things happen with unerring regularity in treatment rooms all over the world, I have yet to be presented with anything that remotely resembles evidence to support an understanding of how these events actually occur.
Accepting something as part of a faith or a deep belief is one thing, but trying to justify that faith against a world of counter intuitive evidence is going to end badly. Placebo, meaning ‘to please’, is a word often used to bash the therapist by those with a sceptical axe to grind, conveniently ignoring the simple truth that ALL medicine is to some degree placebo by its very nature. You can’t take the doctor out of medicine.
Derren Brown’s ‘Miracle’ available on Netflix, makes for uncomfortable watching for those who might feel that what they do is something more than contextual, yet should be required viewing for anyone who aspires to be a therapist. Does it prove that all healing, or anything without a paper is hocus? No. Brown is a consummate showman and demonstrates the power of hypnotism and mass hysteria in a great show. It would be naive to suggest that what takes place in a treatment room is the same.
Manual therapy has many benefits and the power of touch can and should never be underestimated. But the actual mechanisms by which we change things and how this takes place is very poorly understood, however hotly debated.
Subjects like fascia have become popular and widely bandied around, but are often used by those who have little grasp of the subject to support or justify approaches which have little evidence to validate them. Science and scientists aren’t immune from this self justification as human nature takes over easily, even where deeply held principles of scientific objectivity might be expected to take precedent. It’s hard for anyone to have their work or understanding contradicted.
We are all prejudiced to some degree. We all have deeply held personal beliefs and convictions that will always have the potential to influence even the most guarded of principles. Owning this truth as a starting point for trying to understand our approaches would be a great start.