Article by Arran Nicholson B.Sc (Hon’s) GSR
I’m going to assume that most of you with some involvement in the sport, health and fitness industry will have spent a fair few hours studying your human anatomy for exams in the past.
You may also have found that no matter how many anatomy books you studied, nothing quite prepares you for real-life. Exams passed and PT diploma certified you are ‘released into the wild’, and to find certain clients don’t quite react the way you expected to certain exercises.
The best way to figure out what is possibly going wrong is to revert back to your anatomy and physiology knowledge. But is what is shown in the majority of anatomy books actually representative of real life, or do we have to look a little deeper (or in some cases more superficially)?
Those of you who have been on courses with me will be rolling your eyes when I say an excellent knowledge of anatomy is the fundamental basis of everything we do as practitioners, PT’s, exercise professionals and sports massage therapists.
The huge variety of anatomy books, posters and interactive apps give great representations of muscle positioning, origins and insertions, however most of them are missing a massive portion of your anatomy.
The fascia is a collagenous connective tissue which covers all of our organs, muscles and bones. Acting like a form of scaffolding, it provides a level of continuity throughout the body, from top to bottom and deep to superficial. Fascial tissue is constantly being replenished by the body throughout our lifetime. It moulds and adapts to the stress we place on it resulting in thin mobile areas, or thicker more fibrous areas being deposited around the body.
It is important to consider it’s formation in every aspect of our anatomy, for example, a tendon doesn’t just stop when it comes into contact with bone at an insertion point, it blends into the periosteum and creates a fluid interaction between the muscles and bones.
The significance of this tissue within the body, cannot be underestimated. It results in an intrinsic interaction between all of the structures in our bodies.
From an exercise perspective, we have to consider the effects this interaction has on movement patterns. If we consider the biceps femoris as an example, our anatomy text books will outline that it originates from the ischial tuberosity and sacrotuberous ligament (long head) and lateral portion of the femur (short head) and stretches down the back of the femur inserting onto the head of the fibula. So if someone has tight hamstrings, stretch them regularly and we’ll solve their problem, easy? Maybe not.
When it comes to ‘real-life’ anatomy we have spare a thought for the blend of fascia from the lateral head gastrocnemius (crossing over the fibular head to attach into the lateral femoral condyle). In that case, flowing through from the Gastrocnemius attachment into the heel, comes the plantarfascia. I would suggest we also need to consider the peroneal muscle group? After all, they attach onto the shaft of the fibula, sharing the same periosteum as the biceps femoris insertion.
At the proximal end, the origin of biceps femoris, the sacrotuberous ligament, blends into the body of the sacrum where it meets the origin of piriformis and the gluteals as well as the lumbosacral fascia further linking up to the latissimus dorsi and erector spinae group.
As you can probably start to picture, these sort of connections begin to make a chain through the body. With this being the case, you may find that those people with “chronically tight hamstrings” might not have a restriction in their hamstrings at all, but a restriction somewhere further along the corresponding chain.
With this in mind, we as PT’s or Sports Massage Therapists have the opportunity to really benefit our client’s wellbeing and function if we can assess their movement well and tailor their sessions to their needs. We can have a direct effect on the fascial system with sports massage techniques, foam rollers, stretching, strength and mobility exercises, the important part is our ability to look outside the box and identify where the restriction is actually coming from.