NOTES FROM A FASCIAL ANATOMY
DISSECTION
by Robert Schleip
Reprint of a posting on the e-mail rolf-forum of
Sept 4-1997
Like 17 others I did the 6-day human anatomy
dissection workshop with Gil Hedley in Denver this August. Several Rolfers had
posted me specific anatomical questions via the e-mail rolf-forum for
exploration in this dissection lab situation. Here are some of my notes in
regards to those questions plus a few other interesting discoveries.
We had 3 very well preserved cadavers, which we named
'Lucy', 'Eve', and Red' (male). They all seemed to have lived at least 65
years. As usual we were not told about their names, profession, cause of death,
or any other personal details.
1) PSOAS FIBERS INTO Q.L.
Liz Gaggini had asked if we could see anything that
could be holding the Psoas lateral beyond a fusion with the iliacus. (She had
described to frequently find a lateral psoas displacement on the concave side
of a scoliotic pattern). In one of the bodies (Lucy) we found a clear fiber
bundle which went from the lesser trochanter into the ventral fascia of the
Quadratus Lumborum about 1 1/2 inch lateral of L3. This bundle
which she had on both sides consisted mainly of
muscular fibers and was about 1 inch broad and 1/4 inch thick. I remember
sharing in the rolf-forum some time ago about Rolfer Herbert Battisti
discovering a similar extra psoas bundle into Q.L.
in a preserved specimen at the anatomical museum in
Munich (Friends, if you ever come to Munich, look it up, it is very obvious and
quite beautiful). Yet in his case those "Battisti fibers" how I
called them were only very thin. In Lucy's case they are
much stronger (kinesiologists would calculate up to
7-8 kg muscular force to them). Liz, I can't tell you anything though about her
spinal curvature.
2.) TEMPORALIS ATTACHEMENTS.
Punito Aisenpreis had asked: "In which layer is
the Fascia Temporalis connecting with the scalp? Is it the Galea (aponeurotica)
or is it deeper on the periost of the scull". My findings in Eve: the
muscular fibers seemed to attach into the periost, whereas the fascia went
clearly into the galea.
Gil Hedley demonstrated to my surprise on Eve how the
inferior attachment of the Temporalis was covering almost the whole lateral and
medial surfaces of the
Coronoid Process of the mandible, not just the
superior tip of it as I had assumed and had seen in "the books".
This convinced me of Gil's suggestion that the
Temporalis can be worked on (direct mechanically) intraorally with finger
pressure towards the medial surface of the coronoid ... which I had never
thought about before.
ATLANTO-OCCIPITAL JUNCTION
Deborah Stucker had asked us to check out "the
patch of fibrous tissue near the top of the spinal column that links the neck
with the dura" inside the scull. Also Bob Brill asked "what kind of
fibrosity was grabbing around the brain stem". I spent at least
an hour exploring the deep myofascial connections betw
occiput, atlas and axis along the posterior side (i.e. not anterior or lateral)
in Eve. To my surprise I found all the 4 suboccipital muscles on each side to
be extremely thin. E.g. the obliquus capit. sup. consisted almost entirely of
white or transparent fascial fibers, with only few
red muscular portions. This suggested to me that they
could have served hardly any significant motor function in Eve for her 10-12
pound head. (Which would fit into V.Janda's suggestion that these muscles
should be seen as "a sensory organ"
instead because of their extremely dense enervation
with muscle spindles). Yet: Gil Hedley told me that he remembers having seen
these muscle to be of finger to thumb thickness in a previous cadaver.
I discussed with several Rolfers if one of my favorite
manipulations, the so called 'A-O Release' would have had any chance to
mechanically disengage the A-O connection. This technique is quite popular in
various variations among cranial osteopaths and
Rolfers: the scull of the supine clients is supported
by both hands, yet with a significant portion of its weight resting onto
several raised fingertips which
are just inferior and close to the occiput. After a
while and with some gentle & sophisticated finger coaxing an opening betw
atlas and occiput can then
often be felt. Yet when looking at Eve we found that
this would have been questionable. The distance between occiput and axis was so
narrow there (read: atlas ring inaccessible) and the several inches of
myofascial layers on top so dense, that I would not believe myself or anyone
else so easily anymore when claiming
to effect and feel a separation movement between
occiput & atlas in that area, ... IF the situation is like in Eve.
Besides my obvious disappointment, I suggest there is
a also consolidation in there: IF in a particular client you can't feel to
reach the atlas with this release technique, maybe it is not because of your
lack of skill or sensitivity ...
4) PIRIFORMIS
Adjo Zorn had asked me to check out if we could find
any Piriformis fibers which go from the gr.troch. in a medial and inferior(!)
direction towards the sacrum. According to Adjo this would fit into a concept
from Hubert Godard that the Piriformis could lift the pelvis upwards in
relation to the femoral head in standing (just like the most inferior fibers of
the obt.int./ext. have recently been shown to do; see e.g. Calais-Germain's
anatomy book). When checking this in two of the bodies, it was unusually easy
to determine the most inferior border of the Piriformis; and it was very clear
that even these most inferior fibers still go from lateral-inferior to
medial-superior, and would therefore still compress the pelvis downwards onto
the femur in contraction. Sorry Adjo ...
5) MUSCLE OF TREITZ
This muscle, which has been emphasized in the visceral
work of J.P.Barral and D.Prat, connects the ascending duodenum towards the
posterior peritoneum. Punito Aisenpreis had asked us to check where this
posterior attachment of the muscle is exactly. This proved to be a very
difficult research! When Gil reached there with his hand in Eve, there was a
whole bunch of stuff attaching the duodenum posteriorly, plus the maximal
extensive distance from the posterior periosteum was only 1-2 inches. We were
able to nail the connecting tissue down to a short bundle of about
2 inches diameter, of which a significant portion was
made up by various vessels plus surrounding tissues. Holding this messy bundle
while lifting the whole guts as much as possible anteriorly, we finally gave up
on any more specific clarifications
... after we had read in Barral's 'Visceral
Manipulation' that the posterior attachment of this muscle is supposed to be at
the left crus of the diaphragm, which seemed to look at least believable to us
in terms of the general direction. Yet no guarantee from us on this.
In discussing this topography with other Rolfers
present, we agreed that it would be pretty impossible to "palpate"
the Treitz muscle from the outside. Same thing by the way about the uterus in
Eve: her uterus and ovaries were placed so far inferiorly & posteriorly
behind the pubes, that we felt if any bodyworker would have claimed to feel one
of those structures in her via palpation from the front, we would question this
now; - and rather suggest that the practitioner has been fumbling with a colon
portion instead. Again: in another person this might be quite different.
6) OTHER QUESTIONS ASKED
There were several other anatomical questions which I
had been given. Yet due to limited time, methodological weaknesses, plus
emotional overwhelm in this intense experience, I don't have any new answers
for them. Sorry Deborah Stucker, Sandy Henn, and Punito Aisenpreis.
Yet we found a few other things:
7) FOOT ARCH SUPPORT
According to classical Rolfing teaching, some of the
lower leg muscles play a substantial (if not the main) role in creating the
arches in the feet. I spent a good deal of time to check this out by
sequentially cutting various myofascial structures plus testing the
rigidity/mobility of the arch in the foot before and after. I did this with
both of Eve's feet, plus one of Lucy's. The results were quite similar. Cutting
the tendon of the Peroneals brought no release (or less than 5%). Same for the
Tibialis Anterior, as well as the socalled Plantar Fascia. Flexor Dig.Long. and
Flex.Hal.Long. together only 10%-15%. Tibialis Posterior approx. 20%. Yet big
& unpleasant surprise for me: the socalled "Long Plantar
Ligament" deep inside plus the powerful oblique head of the Adductor
Halucis attaching to it accounted for at least 50-60% of the intrasegmental
mobility of the foot arches; when cutting these the whole arch just got loose
immediately! My conclusion now for working with high rigid arches: lengthening
the often tight Plantar Fascia, the Tib.Ant. and Peroneals in them might be
almost "a waste of time". Releasing the whole deep flexor compartment
deep inside the lower leg might help "a little". Yet what is needed
is a lengthening of the Long Plantar Ligament plus the oblique head of the
Adductor Halucis very deep inside the foot. I suggest that in order to get
these 2 structures with direct mechanical work it is almost necessary to first
put the more superficial Plantar Fascia into a softer "slack"
condition by passively bending the foot to increase the longitudinal arch as
much as possible and then working through that thick superficial plantar layer
with a lot (?) of deep pressure. (Neuromuscular re-training exercises might
also effect them). For helping to build up higher arches I will now emphasize
strengthening the big toe adductors more. Suggestion: if you haven't seen or
known this Long Plantar Lig. & the Adductor Halucis attaching to it, look
it up in the books. They seem to be of key importance for the foot arches!
8) BODY STRAPS
When we took the skin off Eve, we were suprised to see
two clear horizontal straps (as superficial indentations) in her adipous layer
underneath. One across the mid chest and one in the upper belly. They clearly
fit into Louis Schultz' proposition of fascial 'body straps' in his book
"The Endless Web". We did not check if and how these straps were
created on deeper fascial or muscular layers underneath.
9) SLIDING FASCIAL SHEETS?
Except for the structures inside of the pleura and
peritoneum, I did not find any adjacent fascial planes which felt like they
could allow - or were designed for - a free sliding movement in relation to
each other. Most always fascial planes which were touching each other were
connected with the typical "cotton candy" cross connections, which we
could cut or tear in our dissection.
Maybe some of you liked the very nice scene in the
video "Gravity is the therapist" with Ida Rolf, in which a visual
model shows how two muscles are first glued to another with their fascial
envelopes and cannot slide freely in relation to each other. Then a Rolfer's
hand releases the "adhesions" between them, and - voila - the two
shiny muscles can then freely glide upon each other. My favorite scene on this
video! But I now have some doubts if it is really possible with myofascial
manipulation to change the connections betw adjacent fascial planes such that
they will be "freely gliding" in relation to each other. Our changes
must be due to other changes: the fascial envelope getting softer/wider, the
muscle inside being more able to sidebend, general or specific tonus changes of
the muscle or the fascial envelope, longterm decrease of extra collagen fibers
(e.g. in scar tissue or former local inflammations), etc.
10) QUADRATUS LUMBORUM AND THIRD HOUR WORK.
Gil had shocked me and several other faculty members
already last year with the following: Based on his previous cadaver dissections
he believes that most of what we consider to be "Quadratus lumborum
work" might actually be work on the abdominals. (Kathy Roony made a
similar impressive statement in her Annual Conference presentation this year,
based on a cadaver dissection with Gil). So we looked again for this. Our male
cadaver did in fact have a clear and broad Quadratus lumborum, which one might
have been able to palpate. Yet in the two other cadavers (Lucy & Eve) the
QL was very thin and it looked more likely that it could NOT be distinguished
in palpation from the very strong vertical fibers of the oblique abdominals and
the iliocostalis between the iliac crest and the lower ribs. My conclusion: if
someone claims to palpate the QL, I will now tend to believe that; and if I
can't palpate the QL in some clients that could be accurate too.
11) RANGE LIMITATIONS IN FEMUR ROTATION
I did the classical range of motion tests for hipjoint
mobility in Eve (prone with lower leg bent with the sole of the foot towards
ceiling, rotating that femur externally & internally as much as possible). Lateral
rotation of the femur was possible about 40 degrees, medial about 50. To
determine the limiting factors I then cut sequentially individual
muscles/ligaments which could be involved, and tested again before & after
each cutting. My biggest surprise: cutting the piriformis plus all other deep
hipjoint rotators yielded together only about 5 degrees more medial rotation. Pooh!
I have treated hundreds of clients with limited medial hip rotation range of
motion by leaning into their deep rotators, sometimes for up to 20 minutes. Maybe
all a waste of love??
For the limited lateral rotation, cutting all the
muscles which are thought to be medial rotators did not do a thing. Yet when
cutting the iliofemoral lig. in front, I got 30 degrees more lateral rotation,
plus 30 degrees more medial rotation. The remaining limitations then seemed to
be due to the ischiofemoral ligament plus the joint capsule, since cutting them
finally freed it all. Conclusion? Well I know at least about the iliofem. lig.
that it is very tough. Platzer writes that it is the strongest ligament in the
human body. Plus since it is so deep, I don't think I can lengthen that by
myofasical work. Regular stretching exercises might work to some degree, yet
probably only if done for unusally long times. Maybe I will now tend to accept
that some of my "tight ass men" (with their chronically everted feet
and limited medial rotation range of motion in the hipjoints) will not change
their range of hipjoint rotation ability very much in my sessions.
12) RIGID CRANIAL SUTURES
On the last day we did a horizontal cut through Eve's
scull, so that we had the superior part of the scull as a round bowl in our
hands. The sutures (between the two parietals, plus betw the parietals and the
occiput) seemed surprisingly rigid and unyielding. In squeezing the most
lateral ends of that bony bowl towards each other I needed to press with about
30-40pounds(!) in order to see a tiny movement of about 1millimeter (in terms
of the lateral ends of the bowl approaching each other). And this bending
movement seemed to occur evenly all over the scull, not just in the sagital
suture in the middle. Soaking that top piece of the scull in warm water for
about 1-2 hrs did not change its rigidity. Talking with Gil, he seemed to believe
that the embalming process did not increase that rigidity before, i.e. that her
scull probably had the same inflexibility previous to her death. This made
sense to me, since her individual ribs for example did have the usual
flexibility when tested by bending them, and I also have not heard of any
post-mortem accumulation process of minerals or other hard density material in
the bones. Now, I remember that there used to be (or still is?) a debate in the
somatic field about the mobility of the sutures. Most traditional anatomy books
used to say that these sutures tend to become completely rigid in most adult
people. Yet many craniosacral professionals question that and claim that they
the sutures still move significantly in most adults. If that is true, was Eve
then an unusual exception?? I am sure that some of you cranial experts in our
membership have more accurate data and refined thoughts available on this
debate than I do; - please let me know, since I am now pretty unclear after
this experience.
13) ANOMALIES ARE NORMAL
Besides the lateral psoas band into the middle of the
quadratus lumborum (as reported before) we discovered several other interesting
aberrations. Rebecca Lux found in Lucy that her pect major had an extra attachment
slip into the tendons of the long head & short head of the biceps. Folks,
this was not a tiny flimsy slip, it was pretty broad and clear, definitely able
to exert force in this direction.
Also in Lucy we found a strong and clear fascial
(tendinous) connection from the deltoid which went parallel to the long head of
the triceps to insert onto the scapula.
In Eve we found some clear fibers from the gluteus
minimus that joined the upper piriformis to attach to the front of the sacrum. Wow,
I never thought of the glut. min. to be possibly part of the pelvic floor, or
to be able to tilt the sacrum in relation of the ilium, or to compress the SI
joint!
14) ADDUCTOR MAGNUS MINGLED WITH HAMS & QUADS
This was not new to me, yet I used this lab to verify
it: the adductor magnus has a strong adhesion and connection with the
semimembranosus. I don't think any Rolfer can "differentiate them"
anatomically without a knife. Same for the so called vastoadductor membrane
which connects the long tendinous part of the add.magn. with the vastus med. Conclusion:
when a class student now tells me in the bodyreading that she/he wants to
"differentiate' the adductors from the quads" or hams in a session, I
will continue having some questions about this brave concept in my mind.
15) 'SUPERFICIAL FASCIA' BODYSUIT
Most of you remember Ida Rolf's description of the
"superficial fascia" as a whole body stocking, with often distinct
lines of tension. I am quite sure now that this relates to the first fascial
layer underneath (!) the adipous layer under the skin. In American anatomy
terminology the often thick and yellowish-glibbery adipous layer is called
"superficial fascia" and the one underneath "fascia
profunda". Yet in European terminology (which Ida seemed to follow and I
will do so now too) this mostly white layer just underneath the fat layer is
called 'Fascia superficialis'. At the beginning most of us including myself did
not have the skill yet to carefully dissect this superficial fascia layer
without injuring it a few times. Yet later with our improved scalpel skills
this would have been a possibly very rewarding project (at least in my
fantasy): to make a dissection of the body with just the skin and fat layer
taken off to show Ida's 'body stocking' via the superf. fascia of the whole
body. I am actually quite intrigued now by this fascinating body suit with its
slippery wetsuit (adipous layer) around it.
So I got the following idea/dream: Someone with more
artist talents than myself could make a full body anatomical map of this
superficial fascia layer. Regional maps of it can be found in Sobotta, Platzer,
etc. Put together they could make a very nice drawing, of a mostly white or
silverish body stocking showing the main fiber directions in all the different
areas of this whole body suit. If done by an artist and printed as a body size
anatomical poster it would not only be a beautiful background to our Rolfing
classes, but I am sure that (with the increasing popularity of myofascial
release techniques) several massage schools and other professionals would like
to order such a beautiful chart and put it on their walls too. Maybe with a
Rolf Inst. copyright underneath or other tiny Rolf reference included this
could get Ida Rolf's message of fascial continuity out into our visually
oriented culture.
BTW: I am pretty sure that Ida's 10th session goal of
"horizontalizing" the superficial fascia should not be taken
literally. It probably means arrangingthe fiber directions of this body
stocking into their most appropriate directions (which are often not
horizontal, e.g. from lateral-superior to medial-inferior on the lateral fascia
cruris). A good knowledge/image of the proper directions of this body suit is
therefore of great value to us.
16) IMPRESSIVE HANDS-ON ANATOMY EXPERIENCES:
· To hold a beautiful looking, cut-out kidney in ones
hand with open/closed eyes in standing - while connecting with ones own kidneys
at the same time.
· Touching the slippery falciform & cruciate
ligaments of the liver, or the round & broad ligs of the uterus. Or
reaching behind the sternum to feel the tough sheet of the mediastinum
attaching to its middle.
· Gil had us palpate with closed eyes the dura mater
of the cut open brain while he exerted a lateral pull on both ears of that
scull. The effect inside the scull could be clearly felt, at least when he
pulled with strong (<10 pounds) force.
17) OTHER FEEDBACK
· A Rolfer: "I used to work the lateral side of
the thigh in my sessions as 'fascia' and the lateral side of the lower leg as
'muscle'. But now I know that they are both fascia and will work with them more
similarly."
· One participant said he had to laugh, when looking
at an anatomy book with its neat distinctions. (It became very obvious to all
of us, how these neat distinctions in the books are mostly manmade distinctions
and that the real body has little similarity with it).
· "Ligaments as distinct cords don't exist. They are
usually arbitrarily chosen lines among broader fascial sheet connections"
· One participant on the last day: "I have
more questions than ever before; about anatomy, but also about life and
death".
18) TRANSPERSONAL/SPIRITUAL ASPECTS
For all of us these 6 days have been touching us very
much emotionally. Gil's great style of leading these days included at least an
hour each morning of sharing among the group, which has always been very deep,
personal, and profound. Gil's analogy of "a group of shamans traveling
together through the land of the dead" fitted very well to these
sharings. Questions about death, life and spirit got stirred up in all of us.
Some pieces:
· "I am here to learn more about death, so I
understand more about Life"
· "We are meeting death and what most frightens
us face to face here"
· One participant shared about him being prepared to
maybe loose his wife soon because of cancer; yet expressing after a few days
how this confrontation with death and our 3 cadavers had given a less personal
dimension to this for him. Another participant joined him in sharing how her
husband recently had died in her very arms.
· With my own father having died in May (which was not
unexpected but was still very moving & touching for me, and still is) I felt
this workshop working deep inside of me. A 'shamanic' orchestrated death group
- sitting along a cadaver in a holy cave while doing all kinds of sacred
rituals for example - might not have been more profound for me than these 6
days in the lab.
· Lots of questions in all of us, yet no final
answers: Is the soul separable from the body? If so does it leave the body
immediately at death, or hang around for a few days or even longer? Impressive
experiment by our acupuncturist in the group: on day four when the chest &
belly walls where open and the inner organs exposed, he put a long visible
acupuncture needle into the forehead of the cadavers. Immediately most in the
group (maybe except me) felt a strong energetic shift. Apparently in Chinese
medicine there is a concept that the "essence energy" of a person
still resides in their lungs after death. I have to admit that even in me I had
strange emotional and energetic shifts happening during all those 6 days, which
were intensified whenever my perception was momentarily confused about
"alive" or "dead" basic perceptual categorizations. E.g.
just the very thought that Eve's arm which I was dissecting to maybe start
moving a tiny bit by itself, ... or her eyeballs moving slightly, ... or how my
own hand in front of me will look one day when I am dead, etc, - and my
emotions & perceptions went yoyo. I actually often lost the outer time
& space context orientation during this work, and needed to reorient where
I was and what to do here. Like most others, I needed to take frequent brakes
to go outside and look at the grass and the birds in the blue sky.
· Interesting reflections and discussions whether
energy could still be stored in the fascial net via piezoelectric properties
after death, and whether "postmortem acupuncture" for example could
help to release that. With all my scientific doubts, I have to admit that when
Jeffrey (our inspiring acupuncturist) finally put a needle into Lucy, who had
been "carrying" (or triggering) the most fright in this room,
suddenly the whole room changed, and working became much easier for all of us.
· Most of us had very intense dreams at night. Part of
the morning round was sharing those dreams with each other. (To clarify: no
nightmares or unusual horror scenes came up, as far as I remember. Rather very
strong and meaningful dreams).
· Inspiring insight in the "wisdom of the
heart": Before serving blood to the rest of the body, the heart first
nourishes itself, resourcing itself with the best and freshest blood it has
available. No wonder it can then serve so well, so long and so powerful to
supply the whole rest of the body. Maybe there is something to learn in this
for some of us workoholics out there ...
· There was a general sense of deep personal
appreciation for our 3 donors, who we had named Red, Lucy & Eve. One
participant even announced to be so moved by this experience that she decided
to also donate her body in the future for this use.
FINAL NOTE:
There were hours (specially on the last 2 days) ith an
extremely high level of positive excitement in the room. Loud expressions like "My
God, I can't believe this, this is SO fantastic" often coming from one
table or the other in about 2-3 minute intervals; and I had to constrain myself
not to run from table to table all the time in my drive of not wanting to miss
people's exciting discoveries.
But the lab is also very challenging, emotionally,
esthetically and mentally. 7-hours a day in a formaldehyd-smelling lab with 3
cadavers is a lot! At least for me I can't imagine any Stephen Spielberg horror
movie scene to be more impressive than some of what I experienced there.
Yet I think we all were immensely(!) thankful for this
experience. I don't know of any other place in the world where one can study
3-D fascial anatomy in a lab AND also has room and support to deal with these
most human important issues of life & death & spirit. Excellent
leadership by Gil Hedley, thank you heaps! Great, great closing ritual at the
end! (I rather don't tell you the details, but I thought it was very powerful
and really perfect).
