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.
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 ...
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.
· "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.
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).