Morning anatomy session

• Jaap van der Wal, a local gross anatomist, opened the day with a renegade fascial anatomy lecture that Gil Hedley would have been proud of. He maintains that connective tissue should also be thought of a disconnective tissue; it connects things and separates things. He used the word ‘dynament’ to describe how muscles attach to ligaments in a series arrangement, as opposed to independently doing their thing. Ligaments should not be thought of as passive stabilizers but actively attached to dynamic structures and continually maintaining active tension. Dissection is the only way to isolate them. He also advances the phrase ‘transmuscular units’ to describe whole functional units which combined amount to the architecture of the locomotive body.
• Various speakers talked about the crural fascia, thoracolumbar fascia and the paratendon.
  • Crural fascia is a three layer system, each layer with collagen fibers aligned at 78° to the other.
  • Thoracolumbar fascia is more a two layer system heavily innervated (? nociceptive, ? segmental), mostly in the outer dense layer, which leads me to think about skin rolling the TLF a bit more in order to lift the dense superficial CT from the loose CT layer below.
  • The paratendon is the layer between the tendon and the sheath and may be filled with areolar CT to help the tendon glide better (as opposed to the paratenon of the Achilles tendon – which I’ve been assured doesn’t even exist).
• Canadian, Peter Purslow gave a fine presentation on fascia and force transmission and showed wonderful photos of the connective tissue of muscle after the muscle protein had been digested with sodium hydroxide. His confirmation that muscle fibers only average 35 mm in length, are laid down in a staggered fashion, and have endomysium between them that stiffly transfers lateral forces explains that when only 10% of the fibers contract at one time, the other 90% also shorten. What an efficient and economic system. How the motor nerves co-ordinate all this is still a mind-blowing mystery he says. Mr Purslow’s background is with the meat industry. More on this some other time.
• The morning was beautifully rounded out by Oz-extraordinaire, Paul Hodges. His topic of fascia, motor control and the effect of pain reinforced the point that ‘core stability’ is still in. Transversus abdominis contraction should precede all movement, followed by the erectors if the movement is flexion etc. etc. Funnily enough he cautioned that over-training may create too much stability, a topic that Chaitow introduced a few years back to explain some of the common pelvic floor complaints that women have who (over) do Pilates.

The second afternoon

• I chose the parallel session covering thoracolumbar fascia (TLF) and pain. We were by now well versed in the anatomy and innervation. Langevin has found a correlation between CT layer variability, LB pain and a higher BMI. Unfortunately her subjects’ average BMIs were 25 or so in the healthy northern Vermont she lives in; I’m sure this is well below the American average. Others talked about shear forces, trigger points, myofascial release and experiments on cats???  Overall this made me think about Hilton’s Law, whereby working on the cutaneous layer will have effects on all the layers underneath.
• Wine and beer helped turn the 27 poster session presentations that followed into some very lively discussions; especially as some presenters had very personal agendas promoting novel products and novel methods.