wer will was lebendig’s erkennen und beschreiben, … documents...fascia congress brussels 2012...

10/06/2012Fascia Congress Brussels 2012

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Wer will was Lebendig’s erkennen und beschreiben, sucht erst den Geist herauszutreiben,

dann hat er die Teile in der Hand. Fehlt, leider! nur das geistige Band.

J.W. von Goethe, Faust

Those who want to study life,

first have to throw out (think away) spirit.

Next you have the parts in your hand,

what now fails, is the context of spirit (and wholeness)

THE ARCHITECTURE OF THE FASCIA AS PARAMETER TO

UNDERSTAND IT AS THE ORGAN OF INNERNESS IN

GENERAL AND TO UNDERSTAND ITS FUNCTIONAL

ANATOMY IN LOCOMOTION IN PARTICULAR.

WARNINGTHIS LECTURE IS ABOUT THEORY AND PHILOSOPHY

NOT ABOUT CAUSES AND PRACTICE

2


JAAP VAN DER WAL MD PhD

Why me?

PHILOSOPHICAL AND

METHODOLOGICAL

INTRODUCTION

3


AN APPROACH TO DEFINE

THE SUBSTRATE OF FASCIA

AN

THE ARCHITECTURE OF THE CONNECTIVE

TISSUE IN THE MUSCULOSKELETAL SYSTEM

A TRANS-BORDER APPROACH OF THE SPATIAL ORGANIZATION OF ‘PROPRIOCEPTORS’,PLACED IN THE CONTEXT OF

‘FASCIAL ANATOMY’


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10/06/2012

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AMSTERDAM 2009

THE SECOND INTERNATIONAL FASCIA CONGRESS

MY MAIDEN SPEECH IN THE DOMAIN OF FASCIA RESEARCH

Fascia Congress Brussels 2012

NOT BY BONES, LIGAMENTS AND

MUSCLES ALONE

The Importance of Fascial Architecture for

understanding the locomotion system


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FROM FACTS TO CONCEPTS - INDUCTION –

AND BACK …


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A ‘transborder’ anatomy of fascia

Connective tissue and its functional

organization in the human body

Architecture of connective tissue in the Musculoskeletal

System

Thesubstrate of

proprioceptionin joint regions

1988

…… ON THE WAY BACK I (ALSO) BECAME

EMBRYOLOGIST AND PHENOMENOLOGIST


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PHENOMENOLOGIST

MORPHOLOGY

EMBRYOLOGIST

ANATOMIST

ACTION ACT

GESTURE

MOTION

FORM

JEDES SEIN WIRD UNS NUR DURCH SEIN WERDEN ERKANNT.

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ORGANISM versus CELLULARITY

WHOLENES versusPARTS AND ORGANS


ANATOMY FOR INTEGRITY AND SYNTEGRITY

THINKERS

ANATOMY DESTRUCTS MUCH MORE THAN YOU CARED FOR


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ANATOMY (IS NOT) FOR INTEGRITY AND

SYNTEGRITY THINKERS


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Wer will was Lebendig’s erkennen und beschreiben, sucht erst den Geist herauszutreiben,

dann hat er die Teile in der Hand. Fehlt, leider! nur das geistige Band.

J.W. von Goethe, Faust

Those who want to study life,

first have to throw out (think away) spirit.

Next you have the parts in your hand,

what now fails, is the context of spirit (and wholeness)

ACTION ACT

GESTURE EXPRESSIO

N

MOTION

FORM


11

ANATOMY (FORMS) ON THE MOVE

PHENOMENOLOGIST

MORPHOLOGY

EMBRYOLOGIST

ANATOMIST

../../../Afbeeldingen Waljaap/Walembafb/embanimaties/Cursusanimaties/1 Y_Morfing_totaalontwikkeling.mov


UNDERSTANDING NOT EXPLAINING

HOW MANY FISTS CAN A HUMAN BEING MAKE ?12


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http://www.allvisions.nl/fotovisie/handleidingen/mengen-vuist.jpg

http://www.powerstore.nl/html/vuist.jpg

http://www.powerstore.nl/html/vuist.jpg

UNDERSTANDING VERSUS EXPLANATIONS

I AM NOT A BRAIN, I AM / HAVE A BODY

I AM NOT MOVED BY …. , I MOVE (… my body …)

NOT MY MUSCLES OR BRAIN OR LOCOMOTOR

APARATUS IS / ARE MOVING ME, I MOVE MY

ARMS, MY BODY

ORGANISMS MOVE, NOT APARATUSES

INTEGRITY VERSUS DISSECTION: Anatomy is not

a method alone it became a ‘dissecting and

ana-lytic’ mentality


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STRUCTURE of the lecture


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1. Fascia anatomy is a contradictio in terminis,

architecture is the keyword

2. The “holy locomotion apparatus trinity” (anatomy)

versus the “functional twofoldness” of forces to be

guided (architecture)

3. The architecture of connective tissue (‘fascia’) is

instrumental for as well locomotion as proprioception

4. Fascia AS WELL AS muscle tissue are derivatives and

integral components of the “Meso” and ‘Inner tissue’

5. A transborder matrix organization: “over the woof of

the muscle man, the warp of dynament woman”



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1. Fascia anatomy is a contradictio in terminis,

architecture is the keyword2. The “holy locomotion apparatus trinity” (anatomy) versus the “functional

twofoldness” of forces to be guided (architecture)

3. The architecture of connective tissue (‘fascia’) is instrumental for as well

locomotion as proprioception

4. Fascia AS WELL AS muscle tissue are derivatives and therefore integral

components of the “Meso” and the ‘inner tissue’

5. A transborder matrix organization: “over the woof of the muscle man, the warp of

dynament woman”

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(‘CLASSICAL’) ANATOMY DESTRUCTS MORE IN

YOUR MIND THAN YOU ARE AWARE OF ..!

The ‘anatomist’ cuts, dis-sects,

separates: capsules, ligaments,

fasciae, muscles, bones.

Anatomical figures / images =

“(self) made” structures.

Continuity has gone!

That continuity was ORIGINAL!

It is the continuity of connective tissue, of

mesenchyme, of the fascia, of Meso


WHAT IS IN A NAME?

WARNING! A ‘name’ is very important. Names might obscure facts

and induce views. Think on the so-called ‘gill arches ‘or ‘pharyngeal

arches’ in the human embryo. A name might even narrow your mind!


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MUSCOSKELETAL

SYSTEM????????

The Locomotor

System?

Sensu stricto or

sensu lato?

The Musculo-Skeletal

System?

What about the

Connective Tissue

Skeleton?

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WHAT’S IN A NAME?


IJTMB_Communicating about fascia IJTMB Vol 2 Nr3 (2009)_Huijing et al_Word werkversie.docx

IJTMB_Communicating about fascia IJTMB Vol 2 Nr3 (2009)_Huijing et al_Word werkversie.docx

10/06/2012

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TABLE 1. Recommended use of terms regarding fascial structures

Dense connective tissue

Connective tissue containing closely packed, irregularly arranged (that is, aligned in many directions) collagen fibers.

Non-dense (areolar) connective tissue

Connective tissue containing sparse, irregularly arranged collagen fibers.

Superficial fascia

Enveloping layer directly beneath the skin containing dense and areolar connective tissue and fat.

Deep fascia

Continuous sheet of mostly dense, irregularly arranged connective tissue that limits the changes in shape of underlying tissues. Deep

fasciae may be continuous with epimysium and intermuscular septa and may also contain layers of areolar connective tissue.

Intermuscular septa

A thin layer of closely packed bundles of collagen fibers, possibly with several preferential directions predominating, arranged in

various layers. The septa separate different, usually antagonistic, muscle groups (for example, flexors and extensors), but may not

limit force transmission.

Interosseal membrane

Two bones in a limb segment can be connected by a thin collagen membrane with a structure similar to the intermuscular septa.

Periost

Surrounding each bone and attached to it is a bi-layered collagen membrane similar in structure to the epimysium.

Neurovascular tract

The extramuscular collagen fiber reinforcement of blood and lymph vessels and nerves. This complex structure can be quite stiff. The

diameter and, presumably, the stiffness of neurovascular tracts decrease along limbs from proximal to distal parts. Their stiffness is

related to the angle or angles of the joints that they cross.

Epimysium

A multi-layered, irregularly arranged collagen fiber sheet that envelopes muscles and that may contain layers of both dense and

areolar connective tissue.

Intra- and extramuscular aponeurosis

A multilayered structure with densely laid down bundles of collagen with major preferential directions. The epimysium also covers the

aponeuroses, but is not attached to them. Muscle fibers are attached to intramuscular aponeuroses by their myotendinous junctions.

Perimysium

A dense, multi-layered, irregularly arranged collagen fiber sheet that envelopes muscle fascicles. Adjacent fascicles share a wall of

the tube (like the cells of a honeycomb).

Endomysium

Fine network of irregularly arranged collagen fibers that form a tube enveloping and connecting each muscle fiber. Adjacent muscle

fibers share a wall of the tube (like the cells of a honeycomb).


BUT GIVING NAMES AND DESCRIPTION IS NOT

ENOUGH

In anatomy giving names is associated with location

and localization

It is not only about the WHERE, it also is about HOW


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IF IT IS NO LONGER ABOUT THE PARTS AND ‘WHERE’

BUT ALSO ABOUT THE WHOLE AND ‘HOW’ ….

Tensegrity, integrity is a relationship not an anatomy

We need other ‘elements’ and ‘relationships’

…….. then ARCHITECTURE is the Keyword.


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1. Fascia anatomy is a contradictio in terminis, architecture is the keyword

2. The “holy locomotion apparatus trinity” (anatomy)

versus the “functional twofoldness” of forces to be

guided (architecture)3. The architecture of connective tissue (‘fascia’) is instrumental for as well


4. Fascia AS WELL AS muscle tissue are derivatives and therefore integral



dynament woman”

‘CLEAN ANATOMY’. AWAY WITH THE ‘ENVELOP’


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‘IMPOSSIBLE ANATOMY’ (‘MUSCULOSKELETAL’)


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WHAT ARE THE COMPONENTS OF

A JOINT?

Articulating bones (with cartilage)

Synovia (synovial fluid)

Articular capsule

In principle the capsule does NOT play a mechanical role !!!!

A “joint is a dis-connection”


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WHICH ANATOMICAL ELEMENTS PLAY A

ROLE IN THE TRANSMISSION OF FORCES

ALONG A SYNOVIAL JOINT (STABILITY)

Articulating bones en articular surfaces

Ligaments and other (collagenous)

connective tissue structures

Muscles including their connective tissue

components (tendons, aponeuroses)

3


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WHAT KIND OF FORCES HAVE TO BE GUIDED /

TRANSMITTED IN SYNOVIAL JOINT?

Pressure

forces

Tension /

traction forces

2 PRESSURE FORCES via

articular surfaces and bone

elements

TRACTION/TENSION FORCES

Statically via ligaments and

so on - ‘passively’

Dynamically via muscles -

‘actively’

3?


28

DEFINITION OF A ’MUSCLE’?

MUSCLE =

Sample of muscle fascicles

linked between dense

collagenous connective

tissue elements:

Tendon on the one side,

Aponeurotic plates (fascial

enforcements and septa) on

the other side

DYNAMICAL


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DEFINITION OF A ‘LIGAMENT’?

Ligament = Bundle of dense collagenous connective tissue fibres linked between two bones i.e. the skeletal elements of a synovial joint.

STATIC


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LIGAMENTS AS PASSIVELY FORCE

TRANSMITTING STRUCTURES, MUSCLES AS

‘ACTIVELY’ FORCE TRANSMITTING STRUCTURES

‘CLASSICAL ANATOMY’: COLLATERAL LIGAMENTS AND

MUSCLES AS SEPARATE IN PARALLEL STRUCTURES

10/06/2012

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GLIDING AND LOADING –

2 TIMES FORCE TRANSMISSION

DISTAL: MUSCLE UNITS GLIDING ALONG

EACH OTHER AND UNDERNEATH THE

ANTEBRACHIAL FASCIA (‘SLIDING’)

THE ANTEBRACHIAL FASCIA AS

INSERTING AREA FOR UNDERLYING

MUSCLE FASCICLES (‘TRACTION’)


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33

*

*


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CONSEQUENCES

To the lateral humeral

epicondyl rdCT layers

(and cases) are

converging and inserting

… with in series

muscle fascicles of the

extensor muscles (in a

pennate configuration)


35

CONSEQUENCES

To the lateral humeral

epicondyl rdCT layers

(and cases) are

converging and inserting

… with in series

muscle fascicles of the

extensor muscles (in a

pennate configuration)THE CONCEPT OF THE LATERAL COLLATERAL FORCE TRANSMISSION SYSTEM LCFTS

But like this!

Connective and

muscle tissue

not IN PARALLEL

(like ligaments)

but IN SERIES!

Not in this way!

10/06/2012

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‘OLD’ SITUATION:

- Connective- and muscle tissue

organized in parallel

- ‘Ligaments’ only ‘functional’ in

one particular joint position

‘NEW’ SITUATION:

- Connective and muscular tissue

organized in series

- Ligaments are ‘functional’ in ‘’ every’

joint position

10/06/2012

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‘THE ARTISTS IMPRESSION’: THIS IS NOT HOW ANTEBRACHIAL

MUSCLES ORIGINATE FROM THE SKELETON! PROMETHEUS 2004


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*

*


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NOT THIS

BUT LIKE THIS

M. Supinator

Annular

ligament


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THIS IS NOT HOW AN ANNULAR LIGAMENT

LOOKS LIKE! PROMETHEUS 2004

ANNULAR LIGAMENTS ARE

MADE BY SHARP DISSECTION


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If you cut here, you

make an annular

ligament

Poster by Glaxo about Tennis Elbow

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Slice MRI (in vivo)

THE CONCEPT OF THE LATERAL COLLATERAL

FORCE TRANSMISSION SYSTEM LCFTS


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LCFTS MCFTS

3 D Reconstruction

That is the method

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No intermuscular septa are represented (yellow lines)

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FASCIA

AND / OR

APONEUROSIS?

47

FASCIA AND / OR APONEUROSIS ?


Architecture is a better

functional clou than anatomy!

NOT ONLY WHERE ALSO ‘HOW’



48


2. The “holy locomotion apparatus trinity” (anatomy) versus the “functional


3. The architecture of connective tissue (‘fascia’) is

instrumental for as well locomotion as proprioception4. Fascia AS WELL AS muscle tissue are derivatives and therefore integral



dynament woman”

NOT ONLY

WHERE

ALSO ‘HOW’

THE SUBSTRATE OF PROPRIOCEPTION MECHANO-

RECEPTORS: NERVE ENDINGS, BALLS AND SPINDLES

FNE Free Nerve

Endings(s)

Paciniform

‘lamellated’

Ruffini shaped

Tendon spindle / GTO

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USUAL CONCEPT: JOINT RECEPTORS VERSUS

MUSCLE RECEPTORS ?

Joint receptors for statesthesia en kinesthesia,

muscle receptors for muscle motor control

Joint receptors in CAPSULES / LIGAMENTS:

(Paciniform) Lamellated corpuscles (LC),

Ruffini like Corpuscles(RC), FNE

Muscle receptors in MUSCLES:

Muscle spindles (MS), Golgi Tendon Organs

(GTO) and Free Nerve Endings (FNE)

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SPECTRUM OF MECHANORECEPTIVE SUBSTRATE

At the TRANSITION of muscle tissue to the septa so-called proximal GTO’s are present.

In some muscles those proximal GTO’squantitatively dominate the distal GTO’s (e.g. in ECU, SUP)

Classification? Ruffini corpuscle (joints) of GTO (muscle)?

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The innervation pattern of the proximal antebrachial fascia and supinator septum resembles that of a ‘ligament’ ‘

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Spatial distribution of muscle spindles

and GTOs

Non-evenly distributed over the muscles

Organized according to CT (septum)–muscle– CT

(tendon)–units i.e. to ARCHITECTURE = FORCE

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MUSCLE RECEPTORS

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MUSCLE RECEPTORS

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SUP ~ EI quantitatively : 510 MS / gram versus 510 MS / gram muscle

Yet their spatial organization as to MS are quite different and opposite

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ECR ~ ECU quantitatively:100 MS / gram versus 260 MS / gram muscle

As to the spatial organization of the MS they are quite similar.

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FUNCTIONAL

ARCHITECTURAL

PATTERNS


Muscle spindles follow a non homogenous, eccentrical distribution

pattern

‘Monitor zones’ in line with the architecture of ‘connective tissue –

muscle – connective tissue – units’

Patterns of muscle spindle organization:

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(Quantitative) parameters per muscle are not

sufficient to describe their functional pattern

A NEW CLASSIFICATION?

OR NO CLASSIFICATION?

The whole spectrum of mechanoreceptive

substrate in a joint region is represented by:

MS + GTO + LC + FNE

That is:

Muscle triplet MS, GTO/RC en FNE

combined with

Joint triplet RC, LC en FNE

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A NEW CLASSIFICATION?

OR NO CLASSIFICATION?

Mechanoreceptors do not need to be classified

anatomically as to proprioception (in particular

not as ‘joint receptors’ vs. ‘muscle receptors’)

Besides physiological parameters it is the

context that determines whether a certain

mechanoreceptor is activated or not.

And that context is architectural

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The CT architecture is instrumental in

the process of proprioception

NOT ONLY

WHERE

ALSO ‘HOW’

‘BRAINS KNOW NOTHING ..….’

Does the ‘homunculus

motoricus’ posses

muscles?

And what about the

‘homunculus

sensoricus’?

It is not about anatomy

or muscles it is about

forces and movement >

ARCHITECTURE

63Fascia Congress Brussels 2012



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2. The “holy locomotion apparatus trinity” (anatomy) versus the “functional


3. The architecture of connective tissue (‘fascia’) is instrumental for as well


4. Fascia AS WELL AS muscle tissue are derivatives and

therefore integral components of the “Meso” and the

‘inner tissue’5. A transborder matrix organization: “over the woof of the muscle man, the warp of

dynament woman”

A.T. STILL: MAN IS MIND, MOTION AND MATTER


65

MIND

MOTION

MATTER

ACTION ACT

GESTURE EXPRESSIO

N

MOTION

FORM



HUMAN BEHAVIOR Blechschmidt

The embryo (still) functions in forms

(‚Gestaltung‘).

The gestures of growth represent the

motions and actions.

The ‘Gestaltung’ of the embryo is a

performance in course of time.

66Fascia Congress Brussels 2012

LIMITING TISSUES AND THE INNER TISSUE

Erich Blechschmidt (1904-

1992) introduced the principle

of Limiting tissues versus/and

Inner tissue.

The classical triad Ectoderm,

Mesoderm and Endoderm

should be interpreted as such:

‘meso(derm)’ as the ‘INNER’

(not the viscera)


67

28/10/2009

INNER TISSUE, THE MATRIX TISSUE


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THE QUALITIES OF THE INNER

OR MATRIX TISSUE

As to the connective tissue this leads

to two functional principles:

‘connecting’, binding,

‘disconnecting’, creating room

As extreme examples:

Desmal sutures in the skull

Synovial joints (articulations)

Superimposed on that the

CONTINUITY of the original

mesenchym as the matrix tissue:

“Enveloping Connective tissue skeleton”


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28/10/2009

TENDENCIES IN THE INNER

OR MATRIX TISSUE

• Phenomenologically one could describe two organizing tendencies in the primordial Inner tissue of Mesenchyme:

– Concentration, centering,CONNECTION

– Decentration, peripherizing,DIS-CONNECTION

70


‘FASCIA’ IS AN ORGAN OF INNERNESS ?

The primeval dimension

of the mesenchyme as

the matrix tissue is

CONNECTING and

SHAPING SPACE

Morphologically this is

represented by the

tendencies like

‘compaction’ versus

‘dilation’ (formation of

body cavities)

• It connects

and it shapes

space

• It enables

motion

and

it mediates

71


TWO EXPONENTS OF THE MESO:

BLOOD AND FASCIA

TWO EXPONENTS OF THE MESO:

BLOOD AND FASCIA

• ‘Blood’ is here defined as

the organ of mediation

• Blood as a tissue, blood

as cardiovascular system

• Blood formation and

vessel formation always

go hand in hand

• ‘Blood’ is the PRIMARY

ORGAN

FUNCTION:

BLOOD

MEDIATES,

BLOOD IS

‘EVERYWHERE

AND

NOWHERE’

72

‘BLOOD’ IS AN ORGAN OF INNERNESS ?

Densationsfelder (Verdichtung, d):

Die Entstehung des embryonalen

Skeletts ist bestimmt durch Verlust

an wässriger Grundsubstanz.

Flüssigkeit diffundiert ab, der

Zellverband wird dadurch verdichtet.

METABOLIC FIELDS & KINETICS

ACCORDING TO ERICH BLECHSCMIDT

.

Dilationsfelder (Dehnung, f):

Zonen, in denen Zellen in

bestimmten Hauptrichtungen auf

Zug beansprucht und dabei

gedehnt werden. So dilatierte

Zellen entwickeln sich

gesetzmäßig zu

kontraktionsfähigen Muskelzellen.


ACCORDING TO ERICH BLECHSCMIDT

Retensionsfelder (Straffung, h):

Binnengewebe, das durch

Querdruck beengt und durch einen

senkrecht dazu verlaufenden Zug

gestrafft wird, bekommt

Zugfestigkeit und funktioniert damit

als Halteapparat. Sehnen und

Bänder entstehen in

Retensionsfeldern.

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75


according to ERICH BLECHSCMIDT

Architectural units of

connective and muscular

CONNECTIVE TISSUE IN THE

MUSCULOSKELETAL SYSTEM


76

DISTALLY Muscles with tendons

Muscular units

PROXIMALLY

Septa, walls or

cases of connective

tissue with muscle

parts inserting to

them in series.

Intermuscular

septa

Transmission of

forces occurs here

in a TRANS-

muscular order!

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ARCHITECTURAL ‘UNITS’?

Which means:

transmission of compression forces via bones and joint surfaces

versus

Transmission of tensile forces via muscle and connective tissueUnits of muscle AND connectivetissue (with ligaments as ‘exceptional’)

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ARCHITECTURAL ‘UNITS’?

NOT: OR

But a muscle - connective

tissue -

bone - unit ……

- Call it a ’DYNAMENT’

…… with which you

may ‘construct’ every

structure in the

Locomotor System?

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ARCHITECTURAL UNITS IN THE MUSCULO-

SKELETAL SYSTEM? ‘DYNAMENTS’ ?

Not: OR

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LIGAMENTS * AS ‘EXCEPTIONAL’

AND MEMBRANES AND SO ON

WHAT IF?

If fascia is the adult appearance of the mesenchyme

matrix …

If the mesenchyme matrix on its turn is the

appearance of Meso, of the Inner tissue …

If the two polar tendencies i.e. connection and

disconnection are also represented by the polarity of

contraction and relaxation of the muscular tissue

Maybe that muscle tissue and connective tissue are

two of the same be it dynamically and statically /

structurally?


85

FASCIA MAN

Muscle man, where is

your fascia?

Integrity man, don’t forget

your muscle tissue!


86

FASCIA AS ORGAN OF INNERNESS ?


87

A view

wer will was lebendig’s erkennen und beschreiben, … documents...fascia congress brussels 2012...

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