Friday, August 10, 2012

Hole in the hull!

Lately on Facebook I've had the opportunity to peer into the abyss of determinedly persistent mesodermalist confusion from several angles:

It all started when I read a post by Ravensarsa Travillian, Finding your space: Anatomical reasoning and our relationship to realism. 
In it, she discusses comments made by a currently popular anatomy teacher in manual therapy circles, and deconstructs them.

This statement (from Ravensara's post) was pointed out in a conversation I was having with another manual therapist, a fascia-based reasoner by my reckoning;
"Superficial fascia, on the other hand, is an organ, but only one of its components has an endocrine function, so again, he's using terminology wrong: it's not an endocrine organ, although one of its components has an endocrine function."

What the???? First I kicked myself for having not seen it. Then I thought maybe Ravensara had made a mistake. So I asked her about whence it had come. She kindly supplied the reference. A verifiable source. She even brought in an anatomist from there to clarify. That's just the sort of careful, kind, even, responsive and generous scholar she is. He verified it, although there is still a bit of an open question about whether superficial fascia is an "organ", or just an "organ part".

I thought to myself.. must investigate this statement a bit further. How can a "tissue" be considered an "organ"? Organ part maybe, but "organ"??

I dug around in Gray's Anatomy online. Here's what Gray's says:

"Fascia is a term applied to masses of connective tissue large enough to be visible to the unaided eye. Its structure is highly variable but, in general, collagen fibres in fascia tend to be interwoven and seldom show the compact, parallel orientation seen in tendons and aponeuroses. 
"Superficial fascia is a layer of loose connective tissue of variable thickness that merges with the deep aspect of the dermis; it is thus also known as the hypodermis. It is often adipose, particularly between muscle and skin. It allows increased mobility of skin, and the adipose component contributes to thermal insulation and constitutes a store of energy for metabolic use. Subcutaneous nerves, vessels and lymphatics travel in the superficial fascia"

My bolded italics.
This is depressing news. 
I had no idea that "fascia" meant, or was synonymous with, anything other than some sort of gluey stuff extruded from sparsely located cells, barely metabolically active except for cranking out vast amounts of sticky molecules, a trick that comes in handy in a heterogenous organism which has some parts hugely expensive to maintain (e.g. nervous system, only 2% of the body but requiring 20% of all the fuel), important for keeping an organism from falling apart, and for giving its more active contractile elements a place to anchor.
My idea of superficial fascia was that it was that fine filamentous spider-webby areolar stuff adhering the hypodermis on to the outside of the body, and to the dense fascia that overlies it. I confess, it was my conjecture, based on what I think is logical.

Now here is Gray's, saying it means hypodermis. Something is definitely wrong on the internet. Something might be seriously wrong in anatomy!

It seems to me Gray's is calling all animals in this layer cows, instead of just some animals. I look at this with jaw resting on floor. I really do think it amounts to a taxonomic error on the part of anatomists. I'm calling them on it, right here.
I think the term "fascia" should be left as a description of a particular connective tissue type, not an assemblage of tissue types that obviously comprise an organ, hypodermis, that has a particular function, i.e. thermoregulation, and through which passes indisputable neural structure which can't be classified with fascia no matter how hard you try to stretch it! ( pun intended.)

The world of manual therapy is like a spaceship. And I feel like I just discovered the conceptual hole in the hull.

Because of this one single factual misnomer, countless generations of manual therapists have been sucked out into space, have had their minds snapped shut while simultaneously being made to contemplate the bogus idea that they have magical hands that can somehow overcome the logical purpose of fascia, which is to keep the body from coming apart, all because of a careless slip of taxonomic nomenclature stemming from the dissection habit anatomists have of slicing this blubber layer right off so as to get to viscera etc., useless and hindering as it is in a cadaver specimen, not investigating it from the perspective of how it might respond in a living human when touched from the outside, say by a manual therapist, who clearly cannot get his or her hands past the barrier of the heavily innervated outer dermis (not without introducing infection, at least), or past reflexive motor guarding by spinal cord function via autonomic and somatic motor efferent, and visceral afferent neurons. And it has been replicated, as a meme, as an error, by anatomists, apparently with high fidelity.
So, based on this careless anatomical overlook, manual therapists have been taught, carefully, in a stepwise, apparently anatomically acceptable but logically impossible Argument from Authority, a tissue-based myth that they can manually impact "superficial fascia", from the outside in!

To add further insult, this mistake (according to me at least!) has been allowed to sit there uncriticized, confusing generation after generation. When will the madness stop? It could stop immediately, if anatomists, or whoever is in charge of producing anatomical information, would just correct this one tiny assertion/conflation. It would be a necessary and sufficient hull patch.

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