Posts

The Pedant, The choke-hold and the Uninitiated.

RIP – Ennio Morricone

As Anatomists, we should be used to things being named in a way that is not helpful or often misleading. The world of eponyms has left us with literally hundreds of structures in the human body that do not provide us with any information other than who first claimed to identify it, the great vein of Galen, the Fallopian tubes and the angle of Louis to name a few.

It should not surprise us to find the same issues in other professions. Let me introduce you to the figure four choke hold in competition grappling.

There is the first issue of what is the difference between choking and strangling. This is as productive and circular as to whether jam or cream goes onto a scone first. I go with the simple, choking is an internal issue – you can choke on a piece of chicken, whereas a chicken has never strangled anyone. This creates the first issue for the pedant. The uninitiated pedant once experiencing a figure four hold might think ‘this opponent doesn’t know what they are doing. There is a large gap at the front of my throat. This isn’t a choke hold.’ and they will continue to think that right up until the moment they pass out, because the choke hold isn’t designed to choke you.

 

There are a lot of important structures in the neck. There is the airway or trachea. This is held open with C shaped pieces of cartilage so that it does not become compressed as the head moves around. We have the oesophagus which connects the mouth to the stomach. This is a stretchy muscular tube that spends most of its time closed anyway. We also have a lot of blood vessels as you can see in the picture. The two most important are the carotid artery and the jugular vein. They run up each side of the neck taking blood to and from the brain. They can just be seen appearing at the top of the sternocleidomastoid muscle running from the back of the head to the front of the chest (from the sternum to the mastoid process – an example of how things should be named).

 

If we had necks like the Sontaran from Dr Who then this wouldn’t be an issue but we have accepted the vulnerability of exposing all of these structures in a long slender neck for the ability to turn our head around and be aware of what is going on around us.

 

The figure 4 hold works by compressing these vessels, restricting blood flow to the brain and causing people to become unconscious. That is where the discussion should have finished but…a little knowledge can be a dangerous thing and we now have two other debates appearing.

Is it the compression of the jugular vein or the carotid artery that causes the unconsciousness?  Veins are quite flat and easy to squash whereas arteries have springy walls and are better at holding their shape.  The jugular vein is more superficial than the artery so it probably gets squashed first. I would be very suspicious of anyone who claims they can compress one and not the other.  The figure 4 hold is a blunt instrument to an end.

Even more ludicrous then is the discussion around the carotid body.  The carotid body is a small structure that sits just above the bifurcation of the carotid artery.  It has a role in controlling blood pressure through out the body.  Theoretically if the carotid artery were compressed below the carotid body then it would perceive a drop in blood pressure and initiate the process to increase the blood pressure.  If the artery were compressed above the carotid body, it would perceive an increase in blood pressure and initiate steps to reduce it. The outcome in terms on consciousness for the opponent would be the same in both circumstances.  The carotid body is about the size of a pea and, due to anatomical variation, not always in exactly the same place in each person. The pressure is being applied with something varying in size between a forearm and a thigh.  I don’t think I need to point out the ridiculousness of claiming any precision in its application.

 

Arm Bars and exercise origins

I was recently asked why arm bar’s are so effective. These questions usually come from people who have not experienced arm bars – one of the most effective submissions moves in grappling. This time however, I thought about the anatomy of it and the effect this might have had on the exercise world.

An arm bar, correctly applied, usually causes a tap out within a few moments. If you can imagine lying on the ground. Your opponents legs are across your chest and neck, effectively pinning you to the ground. Your arm is extended between their leg and your hand held palm up on their chest. This might already be causing you some physical discomfort depending on the flexibility of your shoulder and the size of your opponent. Now they start to push their hips up. The discomfort escalates as your elbow is forced to hyper extend. You are not getting out of it and most people tap out.

Why does it hurt? Just look at the connective tissue around your elbow.

Every ligament and tendon is filled with receptors that you usually use to help locate them in space. They constantly feed back information to your brain that tells it how much stress it is feeling or how quickly it is accelerating. The brain can calculate which direction things are moving in by comparing the messages from different parts of the body. And it does all of this without you even thinking about it.

Have you ever fallen asleep when you shouldn’t have and woken up with your head jerking back? You probably thought you work up and jerked your head up to appear awake. It happens the other way around. When you fall asleep your head will tip forwards as the muscles relax, due to its weight. This causes the muscles and connective tissue at the back of the neck to suddenly be stretched. That sudden stretching sends a message to the brain ‘We are stretching too quickly, slow it down.’ The body slows that down by contracting the muscles that oppose that stretch. This causes the head to jerk back up and that it what wakes you up. Your body took care of its self whilst you were asleep.

As the muscles and connective tissue start to get stretched in the arm bar the brain gets the same messages. ‘We are being too stretched’ Only the arm is trapped, it can’t do anything to reduce that stretch.

Two bones make up the forearm; the radius and the ulna. The ulna has a large hook like prominence that makes up the point of the elbow. When you straighten your arm, this prominence fits into a hollow at the back of the humerus, the bone of the upper arm. If you continue to extend it then the bone can go no further, it is blocked up the humerus. I’m told it is very unusual to break this prominence off of the ulna by using an arm bar – the usual injury is a dislocated elbow. Either way it is painful.

But what does this have to do with the exercise world?

Have you every gone to a legs, bums and tums class. Endless squats but usually also endless bridges. You lie on the ground, feet close to your butt, and push your hips up as high as you can. A great exercise for the glutes but where do you think it came from? The origins of the bridge can be traced back to ancient Greece and wrestling. The easiest way to get off someone who is on top of you is to push up your hips. The best way to get a submission is to apply an arm bar. The best arm bar will be applied with the highest hips. We might use the exercise now to get a shapely bum but that isn’t why it was developed.

Janet has a PGDip in Anatomical sciences and is currently studying for a PhD looking at different groups beliefs about the body. She represented the UK in TKD and learnt grappling as part of her Budokon belt system.

Ethical Entertainment?

By the end of May, two months into lockdown, new forms of entertainment were needed. Into this arena appeared a company who had made their mark on Dragon’s Den two years previously. They were offering a live post mortem!

I had heard of these events before. They usually tour the country offering dinner and dissection for the same price as a Michelin starred meal. The events usually sell out. In the name of research I watched the recordings of post mortem live.

They use a semi synthetic cadaver. The question of what exactly this was appeared on twitter and was not answered. It appears to be a synthetic human shaped shell into which they place pig intestines for the performance. It was covered in plastic for almost all of the performance causing some people to complain about the glare. I expect it was expensive and they wanted to protect it. If you read a long way down on their web site you do find the mention of pig but there was not one mention of it during the 7 hours of broadcast. In fact they seemed to go out of their way to imply that the figure was human. Several people made comments about the human specimen on twitter which were never corrected and several people even thanked the donor.

The presenters, we were told, were anatomists of national acclaim. I’m not sure what that means. One of them was referred to as Dr xxx PhD. This is confusing in the UK. Is that a medic with a doctorate? He introduced himself as a final year medical student (equally confusing in a year when they accelerated the graduation of final year medics to deal with the pandemic) so the Dr and the PhD are actually the same qualification. The company refuses to release the qualifications of its staff, saying it breaches GDPR.

There was nothing wrong with the anatomy. A few mistakes, but who doesn’t make mistakes in a live broadcast. The ease with which the organs were removed from their host was not realistic and on the one occasion when they did cut into the semi synthetic cadaver not only was it not realistic, it was also impossible to see what they were trying to demonstrate. The skeleton beside them would have been a much better illustration of the spinous processes of the vertebrae.

Comments on twitter asked whether they were actually going to use the human specimen at all and suggested a better title for the programme might have been ‘anatomy lessons with animal parts’.

I am not against dissection as a learning tool. I co founded Anatomy Nights. We have a network of qualified anatomists through out the world who perform heart and brain dissections to educate people. In large letters on our web site is the fact that these are of animal origin. The same statement appears on every presentation and every advertising poster. One of our presenters had a plastinated heart and asked if they could take it along to their event to show people. We asked if they wouldn’t. We don’t want any confusion about the origin of the samples.

Why isn’t this a problem for the Post mortem live people? Their show is advertised with a hearse. They offer a promotional item which is a lunch bag emblazoned with ‘Human organ for transplantation.’ A third of each broadcast was taken up with adverts for their other shows, a live operating theatre experience that appears to start with the car crash. They encouraged people to dissect along side them at home. At one point they referred to this as ‘using the organs you have got from the butcher or the ones you ordered from us.’ these ordered organs were described on their web site as ‘REAL’ (their emphasis).

They aren’t breaking any laws. It’s not illegal to dupe the public. It’s clear from twitter that some of the people thought they were going to see a real human body. Is it ethical to pretend to dissect a human? Is it ethical to portray it as such to make more money? Is it ethical to exploit the more basic curiosity in some people who want to see the inside of a real human? The ethical philosopher Kass has an interesting theory called the ‘Yuck’ theory. It’s self explanatory really but essentially if something make you go ‘Yuck’ then it may be ethical dubious.

I wonder what Kass would think of post mortem live?

The Humble Squat (part 1)

The Humble squat – we all used to be able to do it but how many of us can do it now?

If you go and see any exercise professional worth their salt then you won’t be far into the conversation as to how you can get fitter, before they mention the squat.

So, if it is such a fundamental move and we all used to be able to do it – why can’t we now?

You will see some fancy explanations about the relative weight of a toddler’s head versus their femur length but I’m going to suggest to you there are two main reasons why we can’t squat anymore.

1 – someone invented the toilet seat

2 – misguided belief by the exercise profession that your knee shouldn’t go past 90 degrees.

The explanation of point 1 also covers point 2.

What is the problem with the toilet seat? I’m not talking about the flushing water closet that Thomas Crapper introduced to us in the late 19th century. I am talking about the first Greek or Roman who thought about putting a seat above the latrine pit. Up until that point if someone needed to go to the toilet then they had to squat down. At least once every day every adult squatted right down into what we now call the ‘ass to grass’ pose.

Why squatting is better than sitting? Squatting has a lot of benefits. The first thing it does is line up your rectum. The bottom of the digestive tract is supported in the pelvis by a big sling of muscles that help seal it off by putting a big kink into it. When you squat it becomes a lot easier for this kink to be relaxed as you go to the toilet and for the rectum to be completely emptied. You can find a number of devices on the market now that aim to bring your feet up when you use the toilet. They work on the same principle. The increase in colorectal cancer can be related to the drop in use of the squatting pose (so can the increase in the price of ice creams so watch out for cause and effect in medical claims). Squatting also moves your pelvis around. Opinion is divided on whether SI joints can move and what squatting does to them but you can’t deny that squatting moves the pelvis and the lower back around. The number one cause of days off of work (after mental health) is lower back issues. Maybe if we still moved it around by squatting each day it wouldn’t be such an issue. In our groin we also have a number of large lymphnodes. Squatting compresses these lymphnodes. Some would argue that that helps the lymph fluid to circulate, recirculating that fluid around the body – might help immunity (that’s might help, in the same way that feeling good about your self because you squat each day, might help immunity. It’s impossible to perform double blind trials involving humans and movement or touch so hard scientific facts don’t really exist in this realm).

For a long time in our history we squatted to go to the toilet, some people still do. How can it possibly be wrong for our bodies to perform a function they have done for centuries. It damages some people’s knees to go into full flexion because their knees are not used to it. You should never do any exercise that hurts you but a blanket ban on full flexion of the knee joint is as daft as saying don’t flex and twist your spine at the same time. Excellent advice for ballistic movements in high speed aerobic classes but you trying wiping your ass and not doing that movement.

Blanket anything is not good – everything should be considered and, as always, listen to your body.

During the lockdown I have started a program to get me back to full squat. I haven’t been able to do it for years. I’ll let you know how I get on.

Lockdown Activity

It’s hard to come up with activities to keep you busy during lockdown.

I’ve been doing a number of anatomical felts and I’ve been involved in the Cajal Embroidery project.

I’ll post links as they go live and I might add an art page to the web site but to start with I have added the DNA scarf pattern to the article page.

It is not as hard as it looks!

Lockdown and Corona

The world is not as it was.

Rather than adding to the plethora of mis /information out there I thought I would post you to some resources that my real life / twitterverse friends have created.

The first is from Dr Mike Todorovic.

Mike produces excellent videos and is a SciComm guru.  He has a podcast with his college Dr Matt which is worth listening to.  It’s called Dr Matt and Dr Mike.  It’s all about anatomy and physiology.  It’s fantastic.

Dr Mike has produced a short video about the corona virus which was so good the Australian Nurses have made it one of their recommended videos.

You can access his video here

If you are a returning medic called in to help with the pandemic then the University of Edinburgh have released a free course about critical care for covid patients which can be access here

 

If, like me, then you are just waiting it out at home trying to work from a table and chair that were not designed for 9-5 occupation then Gavin Routledge has a helpful video on his web site that explains how you can help yourself to sit more comfortably.

You can access it here – get your towels and masking tape ready

 

Stay Safe Everyone

Atrophy, Isolation and the identification of Batman’s super power

Atrophy is ‘the gradual decline in effectiveness or vigour due to decrease or neglect.’  It is the ‘use or lose it’ component to fitness.

It is why you should take the stairs rather than the lift and why you shouldn’t use the arms on the arm chair to get up.

Your body is clever.  It is not going to put effort into maintaining something that isn’t being used.

In this time of isolation and staying at home it is important for your body (and mind) that you continue to do something with your body otherwise you will lose the ability to do it.

I don’t think this is too much of an issue as so many fitness people are offering on line options and I see so many people out walking around the park (keeping the appropriate distance) that I am sure the message seems to be getting through.

BUT

people are also watching more films.

I am a Batman person – particularly the Dark Knight trilogy.  (spoiler alert for anyone who hasn’t seen it.  And also Why Not?)

In it Batman is beaten up and thrown into a prison.  There he lies on a bed for what we can assume is days and weeks rather than hours.  He is then diagnosed with a broken back.  They fix this by punching the vertebrae back into line – Not the recommended medical procedure – and then they suspend him from a rope until he can walk.

I get a bit confused by the time line in this film but according to the internet (that most reliable source of information) this is for 80 days.

I had a friend who was recently stuck in bed for 6 weeks – that is 42 days.  When she got out of bed she had problems putting one foot in front of the other; her legs were so weak.

After 80 days they cut him down and he still looks as buff as ever.

Is this the back of someone who has suffered atrophy?  Could he ever have  climbed out of a pit in a death defying escape and saved the world if he had suffered atrophy?  No.  Batman’s super power is that his muscles do not atrophy!

 

We do not have Batman’s super powers so do something to keep your body active during this time of restricted movements.  Dance like no one is watching.

Stay Safe

(Ironically the actor’s previous film showed extreme atrophy and they could have filmed out of sequence and it been a bit more realistic – but hey, Its Batman.  Who want’s realistic?)

Learning by Doing

I bake biscuits.  It started off as a bit of down time and then I realised it could actually be a revision tool.

 

The biscuits might look like a simple picture of a spine but as I iced that I revised all the facts I needed to know about the vertebrae.  It is a bit like haptovisual drawing, it’s impossible to tell by looking at the end product what learning process has taken place.

My institute has an innovative learning week, well it used to.  It was cancelled this year – I think it was something to do with the fact that all our teaching should be innovative, not just that one week.

 

 

Last year I had floated the idea of doing a biscuit workshop and not to be deterred by the fact the event no longer existed, we pressed ahead and did it anyway.

Teaming up with out training kitchen (part of accommodation services where they teach the students to fend for themselves) we ran an afternoon workshop aimed towards medical students.

Come along and learn to bake biscuits and we will decorate them with as close to anatomically correct icing as we can.

That afternoon I experienced one of the best educational experiences I have ever seen.

Two fourth year medics turned up.  They were on their orthopaedic rotation.  The simple cutters were not for them.  They went free style with a knife.  After much debate about the structure of the femur and pelvis they produced two dough shapes.  They had gone backwards and forwards in debate to ensure they captured as many features as they could and they named them all, only resorting to an app for help once.

After baking they decided to hold this femur in place by icing on the ligaments of the hip joint.  It’s not very precise but the discussion between the two of them as to where the ligaments should go and what they were called demonstrated that they were recalling information that they had been taught long ago.

The real cherry on the top of this learning experience was when the chef came over and asked them what on earth it was.  They explained.

He then asked them how a hip replacement operation was performed.

Using their biscuit as a prop, they explained the whole operation to him. the final piece in an exchange of knowledge that had started with him showing them how to use a rolling pin (yep 24 years old and no idea how to use a rolling pin).

I hadn’t expected that demonstration of revision and explanation to occur when we came up with the idea but if there was any doubt that these sort of ideas are worth it that experience has convinced me.

You can provide educational experiences anywhere.

First, Foucault, Fractals, Freedom Fighters, Foam Rolling, Fascia and Feminists

It’s the start of a new year and for me, the start of a PhD.

The first month (just managed to sneak this one under the wire) has been a fascinating start.

I’m going to be looking at different groups beliefs about aspects of the human body, particularly Fascia.  This is social research – a whole different ball game.

Anyone who has looked at social research will know you can’t really move without bumping into Foucault and his thoughts on why things are the way they are so there has been some significant reading in that area.

And then Fractals – this is the mathematical idea of repeating patterns that are found everywhere in nature.  That took some time to get my head around but once you are aware of it you begin to see it everywhere.

That experience is called the Baader Meinhof phenomenon.  The Baader Meinhof group was a militant organisation usually referred to as terrorists.  That doesn’t begin with an F and I think the quote that ‘one man’s terrorist is another man’s freedom fighter’ ties in quite nicely with the idea I am exploring that lots of different groups see the same thing in different way.

This tied in with the feminism strand where I had to read a really interesting book on Emily Davidson, the woman who stepped out onto the race course on Derby day back in 1913.  It’s one of the interesting things of moving towards the humanities; that there are many different ways of looking at the same thing.

Foam rolling? It’s the main connection that the public have with fascia.  Do you foam roll?  What do you think it is doing?

It’s going to be 6 years of wild exploration!

Christmas – the true story

Everybody knows that the true story of Christmas now days is over indulgence.

This could be in the form of presents and spending money you don’t have but it is also in the form of food.

There is a horrendous advert on the bus stop up from my house for one of the major supermarkets.  It shows a spread of food with the tag line ‘Christmas is a time for sharing…unfortunately.’  What a terrible message!

What does your body do when you overindulge?  We probably all know that we get drowsy and feel stuffed, but why?

Food enters our digestive system via the mouth where you chew it all up, mix it up with saliva and it is then pushed to the back of your mouth as a bolus; a nice round ball of food without any sharp edges that can be passed down your oesophagus and into your stomach.

The stomach is usually a small deflated hand sized organ that sits just under your rib cage.  It has a folded layer that allows it to expand as food enters it and it has three payers of muscles that lay in different directions to allow it to churn the food inside with the acid and continue digestion.

After the food has been broken up it passes from the stomach into the small intestine where it has bile added to it to aid with fat digestion.  The nutrients are removed from it as it passes along the 20ft of the small intestine.  Passing the appendix, it enters into the 6 foot of the large intestine where water is absorbed and the remaining waste passes out of the anus when you go to the toilet.

That’s the normal passage of events so what is the difference at Christmas?

It’s the volume of food that you eat and the speed at which you eat it.

The message that goes from the stomach to the brain to say that it is full is based on hormones.  These circulate in the blood to get the message to the brain and so the communication is not as quick as a nervous signal.

We have two hormones that control our appetite, ghrelin and leptin.  Basically ghrelin increases appetite and leptin suppresses it.  As the stomach expands it sends the message to the brain that it is full and leptin is released which should reduce our appetite.  This can take 20 minutes.

On the 25th keep an eye on the clock and see how much food you eat in 20 minutes!

Add to that the fact that there seems to be an increasing problem with leptin resistance.  People who are obese seem to require more leptin to be released before it has any effect.

Why do you feel sleepy?

The blood supply is diverted to the stomach to cope with the digestion of food.  Other systems slow down to accommodate the reduced blood supply.

Can I eat so much I burst?

It’s unlikely but not impossible.  There are some rare clinical cases of people managing to rupture their stomachs through over indulgence.  It’s not going to look like the scene from Monty Python but it’s not going to be pleasant.

Why do I get heart burn? What is heart burn?

The stomach produces a very strong acid.  The lining of the stomach is immune to this acid and protects the organ from its effects.  The oesophagus connects the mouth to the stomach – it is not immune to the effects of this acid.  It is possible for the acid to pass up into the oesophagus through the sphincter (valve) that would normally separate the two.  This is acid reflux and you feel it as a burning sensation as the acid attacks the oesophagus (treat it and if it keeps happening see someone about it)

What should I do?

Cut yourself some slack.  It’s Christmas (or any other holiday).  Be aware that your dinner probably contains around 3 times the amount of calories you need in a day.  You might have had a drink, your will power might be lower and you might feel obliged to eat every dish that Aunt Bessie puts in front of you. Take your time, eat slowly, see if that leptin message is on its way.

 

    Happy Christmas and see you in 2020.