Author: Anatomy Fundamentals

Last week I was at a concert (how on earth is she going to relate this to anatomy?)

Whilst the way in which we hear is fascinating and complex, I actually wanted to talk about public engagement and getting your message across.

We have all heard the message about how you should lift with your legs, keep your back straight and bend at the knees and hips.  It must be one of the most prominent messages about people’s anatomy, and yet, does anyone ever listen to it?

I watched as the young people cleared away the instruments.  This included lifting several heavy percussion instruments onto a stage that was about three foot high.  One of the lifts involved 8 people.

The kid at the left hand end was the only one that I saw keeping a straight back and lifting as instructed. (This is because he has had anatomy forced upon him at home)

Some of the lifting techniques being displayed were truly wince inducing and I’m sure they will be making physical therapists wealthy for a long time to come.

Why are we so bad at taking in messages that are meant to do us good?

It is the eternal battle of public engagement.  Engage without preaching. Make what ever it is fun and relevant.

Anatomy should be so easy to make relevant – we all have it.

As we enter the International Science Festival I wonder if we will be able to get our message across any better than those people who deliver manual handling courses.

I was recently struck by a phrase in BBC’s silent witness.(This is not unusual, I have friends who work in forensics, I am often bombarded with phrases about silent witness, although I note that it is now much clearer that they are an independent lab and not part of the police force.  Do we sub contract out forensic investigations? – I digress)

The phrase was said whilst watching a post mortem when a body is reduced to weights and measures and it was ‘that we are so much more than the sum of our parts’

Never is this more true than in the case of Neuroanatomy.  We take a mass of grey and white cell matter and we divide it into areas, we name things (in fact, being anatomists we name things several times over; is that your putamen or your lentiform nucleus?)

We identify pathways we draw on areas but when it gets down to the fundamentals, we still aren’t sure how it works.

It’s great to get the opportunity to make people stop and wonder about the body that they are living in.

I recently had a conversation with some students about reflex arcs.  They had drawn out a lovely team diagram of a reflex arc showing a hand being pulled away from a flame. They clearly understood it and were finished earlier than the other groups.  How to keep them occupied?

Do you want to draw out the diagram for standing on a LEGO brick?

There was almost an audible tut, a few minutes later they had drawn out exactly the same diagram replacing the hand with a foot.

That’s great! Is that what actually happens?  You walk across the room, stand on a LEGO brick and lift your foot directly up?

‘No, you usually stumble a bit and swear.’

Ok, why do you stumble? What would happen if you just lifted one foot directly up?

‘You would fall over.’

Exactly, so what else has to happen?

‘You must tighten up the muscles down here’, ‘but wait you stumble so you must loose your balance.’  ‘It must go up to the cerebellum!’  ‘But how do you know you’ve lost your balance?’  ‘It must have inputs from the eyes and ears.’  ‘But wait, you swear, it must involve the speech areas.’ ‘Do you need to double check it’s appropriate to swear, do we need a feedback loop in there?’

Their diagram expanded, it drew in things they had learned about weeks before.  It had gone from a simple little loop to a series of pathways that all happen in the blink of an eye and all subconsciously.

We are so much more than the sum of our parts.

How are you doing with your New Year Resolutions?

I have a friend who is doing really well with hers.  Its a bit unusual.  She decided to take up alternate nostril breathing.

As the name suggests this is breathing through alternate nostrils.  Usually the other one is held shut with your fingers.  It’s a yoga technique and you can read a lot about which fingers you should use to shut the other side of your nose and the benefits of the technique.

There is no doubt it works.  No one knows why.  There is no scientific evidence for any of the effects (I’m not sure anyone has really looked).

It claims to calm you down, reduce stress, make you more mindful, stimulate your nervous system and reconnect the two hemispheres of the brain.

I’m not sure about the last two.  The two hemispheres of my brain are connected quite well by the corpus callosum and doing anything stimulates your nervous system – that’s the point of it.

I suspect the other benefits might well be brought about by sitting quietly and thinking about your breathing – whether you are using one or two nostrils.

I ran a workshop on breathing last year.  We didn’t do any fancy exercises, I simply explained how breathing works; what bits are designed to move etc.  The participants managed to reduce their breathing rate from 12-14 breaths a minute down to around 4.  If you understand how things work you can use them more efficiently.

Anyway – she is sticking to it and it is working for her and that is great.

The thing is – the body does it anyway.  Experiments have shown that over the space of about 30 minutes, the body automatically alternates between which nostril is the predominate air intake route.  You’ve probably never noticed it unless you have been lying on your side in bed with a cold.  Eventually it gets easier to breathe.

When you do alternate nostril breathing you must spend sometime breathing through the nostril which isn’t the route of choice at that given moment.

Maybe if the body is doing it anyway there is something in it!

I’ve been looking at comparative anatomy recently for an event next year but my mind went to it again this morning as I pulled on my boots to walk out into the frosty -7 degrees park.

I was wrapped up against the elements but the dogs were essentially barefoot.

Why didn’t their paws get cold?

It turns out that dogs have the same circulatory system in their feet as artic foxes and polar bears, allowing their feet to be a constant temperature down to temperatures of -30 degrees.

Usually veins travel beside arteries.  We have a similar systems in our limbs but in these animals the veins are so close to the arteries that it allows heat to transfer between the two vessels.  The heat of the arteries is used to warm up the blood in the veins so that the dogs core temperature does not drop too low.  The result is that the feet stay at a fairly constant temperature.

This is nature’s answer.

Man’s answer is to invent booties that are strapped around the dogs legs.  Strap them too tight and you may affect the blood flow that is actually keeping the dogs paws warm, defeating the purpose of putting boots on your dog. Almost the definition of ironic.

If you use booties on your dog to stop them licking off the chemicals that are spread all over the pavement then that is a different use, but be careful not to disrupt natures own heat exchanger.

I was recently asked for some advice on a gym exercise by a young rugby player.  He had been at the gym and had been shown an exercise that concentrated on working his inner biceps.

Why?  Why would anyone want to work their inner bicep? and what is it anyway?

The bicep does have two heads (bi – two, cep – head).  They are usually called long and short but arguably one is more medial (closer to the centre line) and hence you could call them inner and outer, I suppose.

We will gloss over the naming and why someone would want to do this because there is a more important point coming up.

The exercises are below.  They consist of holding a bar bell in either a narrow, normal or wide grip and then performing a bicep curl.

I have tried this and I can confirm that the wide grip version does feel like it is doing something to the inside of your arm.  But what?

The elbow joint is a hinge joint.  It is designed to hinge in such a way that your hand comes up to your shoulder.  The ulna bone of the forearm has a large hook like structure at the end of it called the olecranon.  This is the point of the elbow and it fits snuggly on the end of the humerus.  The whole structure is surrounded by many ligaments that stablise the joint.  It is not designed to have any sideways motion.

Try it yourself.  Put your forearm out at 90 degrees and move your hand away or towards your body.  What you will find is that the movement is actually happening at your shoulder joint.  If you take your arm out to the side and then flex your elbow, your hand still comes up to your shoulder – your whole arm has rotated at the shoulder joint.

If we go back to the exercises – the narrow hold one, the humerus rotates in so that when you bring your hands up they are still fairly near your shoulder joint.  The normal spaced grip brings your hands up to your shoulders.

The wide spread grip is another matter.  If you were doing this with dumb bells then it wouldn’t be a problem.  The whole arm would have rotated outwards and when you do the bicep curl the hand would still come up to the shoulder joint.  But this is a barbell!  The hands are fixed in a position wider than the shoulders.  When you do a bicep curl in this position you are forcing the joint, trying to bring the hand up to some distance to the side of the shoulder joint.

It doesn’t like it. It hurts.  You feel tension in all the structures you are trying to pull out of their normal position.  Yes you can feel it up the inside of your bicep, but you aren’t working it – you are torturing it.

If you want to do this exercise (I guess its a bicep curls that also works on your shoulder area and your rotator cuff – if that is important to you) then please do it with dumb bells.

If you have any other strange exercises that need explaining please let me know.

You sometimes get asked some funny questions when you are an anatomist, an exercise professional and a trainee massage therapist.  They usually start with ‘I’ve got this pain here…’ and I love the opportunity to do a bit of detective work and try and identify the issues although I always start my answers with ‘I’m not a medic or a physio but…’

This week’s was a new one.

A friend had developed a pain in the back of their knee after a spin class. We did the usual hamstring test, that was fine. Test the calves, they were fine.  I asked them to point exactly to where it was hurting and then put on those x ray specs that have been honed through years of dissection and text book study.  Then you get that sinking feeling when they point to an area where you cant think of what is below the skin.  Its a fossa; a gap full of fat, blood vessels etc.  Your mind cant help moving towards the fascia and the concept that everything can affect everything else.

Then is struck me – what exactly had they done?  Could they rotate their tibia against resistance?  No they couldn’t.

They had not adjusted the saddle on their spin bike and had spent an hour in a class repeatedly going from full locked out extension of the knee to bent.  What muscle is that going to exhaust?

Our good friend popliteus.  Its only role in life is to unlock the knee.  When you full straighten your leg your femur actually rotates medially and locks into place.  To unlock it you need to rotate it laterally a little bit to start with.  If you spend a long time doing this then its going to start aching.

Its usually bought on by a direct blow to the knee or repeated use, a common running injury.  It would appear that it can be a spinning injury too.  Take the time and adjust your saddle.

I have just returned from a conference down in London where I was lucky enough to take part in a wax modelling session where we produced a model of a face.  This started from the skull and built up each individual muscle.  Some of the muscles you can’t see in the picture and obviously you wouldn’t be able to see any of them once a skin layer was applied but their existence beneath the surface makes the face what it is.

It is this attention to detail which often defines a line between artists.  If you know what is under the surface then the contours of the skin become natural.  It is the driving force behind all of the art and anatomy courses that are run.

I have always been fascinated by the ecorche figures.  Those statues that show all of the musculature, the most famous being that of St Bartholomew holding his own skin.  I have always thought that the knowledge of the artists to produce such works must have been immense.

At Edinburgh College of Art there is a cast ‘Smugglerius’. An ecorche in the ‘Dying Gaul’ pose.  Every muscle can be seen, it is a great study guide and I have always been impressed by it.

Until last week.

Last week I discovered that whilst it was produced by Agostino Carlini, he had the help of William Hunter and a large amount of plaster of Paris.

Smugglerius was produced ‘from life’ by posing the executed criminal James Langar and casting him.   The statue has always been referred to as Smugglerius but Joan Smith and Jeanne Cannizzo (Scotsman 30th January 2010) did an excellent piece of detective work which strongly suggests that the identity of the man is a thief, James Langar.  Even if the identity is wrong they did identify that William Hunter skinned an executed criminal and then Carlini cast him in plaster.

This raises all sorts of moral questions as to how the bodies of the dead are treated without their permission and we need to remember that it an object that ‘speaks of the time it was done.’

The fact that every muscle can be seen is maybe not so suprising now that I am aware of its history but it got me thinking about the artist’s need to represent things as they actually are.

I have another project bubbling in the background which has me looking at the other side of the coin from convicted criminals (don’t ask – its a long story which I hope will reach fruition in about 4 years time).  I’ve been looking at statues of things that have legs or arms as well as wings.  It appears anatomy isn’t so important in this realm.

It has been pointed out to me (and to be fair I had realised it myself) that everything that has arms / legs and wings is actually mythical, be it dragons, Pegasus, the winged lions in St Mark’s Square or the numerous pictures of angels.

Whilst one area of art was so obsessed with the human body that they took casts from dead bodies, the other area of art was quite happy to just stick some wings on things with no thought as to how they would actually work.

I have in the back of my mind a hankering to work out what a body of an angel with actual working wings would look like but I imagine it would be the sort of thing that would occupy nightmares rather than visions.

If it is not important that the wings are functional then why are they there?  Are they just a symbol that indicates the ability to fly?  Now days we are happy to accept that Iron Man can fly using technology maybe back in the day we needed an indication that flight was possible without it actually being powered by the body.  This doesn’t seem to hold true for Santa’s reindeer which we are quite happy to suggest fly around the world without the aid of wings.

It’s interesting as to where we are prepared to draw the line between things that need to be correct and places where it doesn’t matter.

My anatomy study goes in cycles.  During term time I am busy with the ATP programme and the Post Graduate Diploma, during the summer I can catch up on the other related courses that I am doing in the background.  I tread a path between the Western medical interpretation of anatomy and other subjects where the detail is not so great, some might say accurate.

This is how I find myself writing a piece for my sports massage course on releasing tension in the neck and upper back and having to relate to acupressure points LI4 and LI11.  At this point I need to reflect on how westernised my anatomy learning is.  I’m very much a ‘need to see it’ sort of person.  If I can see that that blood vessel connects those two points then I can accept it.  Once we get into meridians and invisible lines of energy flow I begin to get very sceptical and have problems retaining the ideas – fundamentally probably because I don’t believe them.

Now Eastern medicine has been around a lot longer than Western medicine and there must be something in it or it would have disappeared by now. I struggle with believing in something I cant see, which is essentially faith.  Did you cure me because of the pressure on the meridians or did you cure me because I believed you were going to?  Very hard to differentiate and I would love to see the scientific paper that distinguishes between the two.

However, I’ve produced a paper that explains how the neck tension is dissipated.  I’ve researched the concept and I can see in the learning objectives what it is that I am meant to be able to understand and I have produced a high merit level paper on it.  Does that make me a fraud?  As the teacher you would look at that paper and think ‘job done’. That student has taken on a complete understanding of how that works, but I haven’t. I am a complete imposter.

Or am I?

I know how it’s meant to work.  Is that fact that I don’t really believe it an issue?  is there a difference between superficial learning and just not really believing what you learn.  If I don’t believe it then have I not understood the argument put forward for it.  Is it just because I can’t see it that I struggle?

This brings me nicely around to my upcoming ATP year where I am studying neuroscience.  Look at the brain and it’s impossible to differentiate some of the things I’m being asked to learn about.  You can’t see them, you have to believe that they are there and there are some things we just don’t know about.

Will I struggle with being able to retain facts about things I can’t see?

The e book version of The Lance Grows Rusty has been out for 23 days.  Kindle sales are trickling in and arrangements to produce the actual book are under way.

Now let’s spread the word and see how many institutes and research departments we can get it into.  

I’ve had feedback from people who have read it who say they enjoyed it and I’ve had a couple of people in Edinburgh attempt to name the people who inspired some aspects of some of the characters.

It’s made enough to buy a pot of restriction enzymes.  Please buy a copy and see if we can get enough to send a student to a U.K. conference.

The language of anatomy can be something that either entices students in to learn more or can act as a really barrier to their engagement. The vast majority of us are no longer taught Latin or Greek in school and so the terms that were maybe in everyday usage a few centuries ago are now archaic and their meaning lost to many. Yet if you know the meaning of these words the anatomical names suddenly make a lot more sense and you can even work out what things might be called.

A recent publication ‘The secret language of anatomy’ looks at some of these phrases and a friend of mine, Kat Sanders, recently got to the final of fame lab talking about the same subject. If you haven’t heard of fame lab then you need to look at this years final. Not only do you get to hear Kat talking about anatomical language you also get to see the rapping epileptic who won it. Outstanding!

The important thing to get across to students is that if the effort is put in to learn the terminology then this can pay dividends.

Anatomy is tested by spot tests. Something I used to hate but now actually love and something that has to be experienced before you can understand just how terrifying they can be. You are placed in front of a specimen with a question or simply an arrow pointing to something and given 30 seconds to answer. A bell rings and you move onto the next one, and the next one and the next one. If you panic at the first one and don’t answer it in time and spend your next 30 seconds worrying about the fact you haven’t answered the first one then you are on a slippery slope to a very low score.

The answer is to keep calm, take your time to work out what you are looking at and then be precise. Last year I was taking one of these tests. It was on the limbs and I was studying the trunk so I wasn’t expecting to score well, I was taking it for the practice of taking spot tests (yes I do try and prepare that much). The bell went and I had infront of me an angiogram. Ok, it says it’s an angiogram so I am looking at blood vessel, probably arteries. I can see the outline of a leg in the x ray and I can see a big letter L in the corner, so I am looking at the blood supply of the left leg. The arrow is pointing to something infront of the bone of the leg so I am going to call it the anterior tibial artery of the left leg. With no knowledge, but an understanding of how anatomists name things I have just scored 2 points.

Some things aren’t so easy. I remember the epiploeic membrane. Could I remember that name? No. Ok, so why is it called epiploic? Pleo is Greek for to float upon. The epiploic membrane sits on top of the intestines like a great sea of mesentery. You can understand why it was named as that. They aren’t all so easy to understand but even some of the weirder ones stick in your mind. Saphenous is Greek for evident or obvious so that vein up the back of your leg is actually called the obvious vein, because you can’t really miss it.

I recently managed to apply this knowledge the other way. Whilst on holiday I read Robert Harris’ new book Conclave. (Very good book – you should read it.). As the title suggests this was about the election of a new pope and there were a lot of use of the word genuflect. I didn’t know what that meant. I did know that the blood vessels around the knee are called genicular arteries and veins so genu could well mean knee. Flec relates to flexion. Was genuflecting the practice of bending ones knee? The little bob that priests give infront of alters. Spot on!

Not only is it possible to apply knowledge of words to work out anatomy names, it’s possible to go the other way. Anatomy is everywhere.