AnatomyLinks.com Review
Posted on 12. Aug, 2010 by Anatomy Links in Reviews
By Patrick Ward
When Anatomylinks.com became available I was extremely eager to check it out, as Willem Kramer has been a huge influence on me. After several months of poking around on the website, here is my review!
Who
Willem Kramer is a Dutch trained physical therapist, licensed massage therapist and Certified Strength and Conditioning Specialist. For those that don’t know, it is because of Willem that I attended massage school in the first place. A few years ago Willem was working for the Arizona Diamondbacks as their manual therapist and I happened to be hanging out in the training room watching him work magic on a few players. I was intrigued by what he was doing and started asking him questions about were I could learn the type of soft tissue therapy he does. He told me that I should just go to massage therapy school, get a massage license, and then start putting together ideas on how to treat people based on my knowledge of anatomy. I was sold! Two weeks later I signed up for massage therapy school.
Hopefully more people will hear about Willem in the future, as he is one of the smartest people I have had the opportunity to speak to and learn from. His knowledge of anatomy is top notch and the way he applies this knowledge in his manual therapy approach is very unique. You can hear more from Willem in his interview with Carson Boddicker on the Sports Rehab Expert Podcast.
What
First and foremost, Anatomy links is not the same as Anatomy Trains. Anatomy Trains is a great product and Tom Myers is someone I have a lot of respect for. While Anatomy Trains looks at the fascial system Anatomy Links goes beyond that.
The Anatomy Links approach honors the statement “Everything attaches to everything”. With this in mind, Willem shows us the possible connections for one single structure, which he refers to as an Anatomical Unit. While most people think in terms of muscles, bones, and joints, Willem challenges us to open up our minds and and consider everything else as well: skin, fascia (superficial and deep), tendons, ligaments, nerves, and blood vessels.
I am going to be totally honest when I say it is overwhelming to think like this. I told Willem after the first few weeks of using the site that I felt like a quarterback who’s playbook went from 12 plays to 50 plays overnight. Willem is honest and says that it takes time to consider all of this. At his clinic in the Netherlands, Veel Beter Fysiotherapy, clinicians are asked to sign a minimum of a 3 year contract in order to immerse themselves in the system and take the appropriate amount of time to think about all the possible links.
Willem has a number of examples on his website. Here is one example showing you what the Anatomy Links screen looks like and the information contained in each column:
Most people will watch this video and wonder where to go from here. I know I did! This is where the vast number of possibilities start to come into play. I’ll give a simplified explanation of how I use the information contained in this site by using the above example of the Fibula.
If we determine that the Fibula is something that needs to be treated (perhaps in a situation of ankle sprains, restricted ankle mobility, or problems with the proximal tibiofibular joint) we would type “Fibula” in the search box at the top and get the above page with the column on the far left giving us a detailed anatomy of the structure in question, the Anatomical Unit. In the middle column we see all the things that make up the structure we are looking at – arteries, bones, deep fascia, joint capsules, ligaments, muscles, and nerves. In the case of the fibula, there are 51 structures that are part of this anatomical unit. By selecting one of the tabs in the middle column, the column on the right will give us the structures contained in that specific category. It is in the right column where we look at the links to the Anatomical Unit (in this case the fibula). These are the structures that we want to evaluate and if necessary treat in order to get a favorable response in the Anatomical Unit that is determined to be dysfunctional. Furthermore, rather than limiting ourselves to the right hand column, we can click on each one of the structures in this column making them the new anatomical unit (left column) and creating a new list of connections that need to be evaluated.
Through this system, we may start at the ankle with the distal tibiofibular joint and end up working all the way up to the lumbar spine when our assessment is comprehensive and honors the links found to be dysfunctional. The way that we get to the lumbar spine can be through any one of the links that are affecting the anatomical unit – bones, joints, muscles, skin, fascia, nerves, blood vessels, etc.
If this seems overwhelming, don’t worry…it is! Like I stated earlier, grasping this system in its entirety will not happen overnight. That being said, you can easily begin to use the system and start considering various links to the Anatomical Unit you are trying to affect/treat and as you get better at putting things together and connecting the dots, more options will open up for you.
One way to simplify things is through the “settings” tab at the top right of the page, which allows you to control the structures that show up in the middle column. For example, if you want to start simple and only look at bones and muscles, you can unselect everything else, making only those two structures viewable, and allowing you to build your links from there.
Currently, the Anatomy Links site is complete through the lower extremity. Willem is working on adding in connections for the upper extremity and torso but I am not certain when this will be complete as it is an enormous task to try and put all this stuff into the system.
Why
I cannot recommend the Anatomy Links system enough as it has opened up my mind to different ideas and strategies when working on clients. I find myself thinking about people that I work on and looking through the site and considering new connections that I may not have previously considered.
Many have heard the term Regional Interdependence, which in a nutshell tells us that the pain or dysfunction you are experiencing in one area may be created by or related too dysfunction in a region of the body remote to the location of the current complaint. Anatomy Links takes this concept to the next level tying together all of the systems of the body, not just the musculoskeletal system.
I highly suggest checking out the Anatomy Links site as Willem has several other tutorials explaining how to use the site besides the one posted here. The site also has a blog section were Willem occasionally writes ideas and concepts to consider. Willem’s personal blog also has additional articles that reflect his Anatomy Links thought process.
I hope you take the time to investigate the Anatomy Links site and consider the vast possibilities in your treatment approach. Hopefully we will hear more from Willem Kramer in the future, as I believe that he has a lot to offer the industry.
About the Author:
Patrick Ward holds a Masters Degree in Exercise Science and is the founder of Optimum Sports Performance. He is a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association and a licensed massage therapist. Patrick’s professional experience working with a diverse clientele ranges from training for general health, to rehabilitation, to professional athletes who want to take their abilities to the next level. Patrick has served as a strength and conditioning consultant for various athletes of all ages and status.
Extensor Retinacula Revisited
Posted on 17. Jun, 2010 by Anatomy Links in Theory to Practice
In 2007 Abu-Hijleh, M. F. and Harris, P. F. published a paper on the deep fascia of the distal leg, ankle and dorsal foot. Dissecting 14 limbs they examined arrangement, fiber orientation and collagen content.
Among other findings they list the following.
The deep fascia of the distal leg, ankle and dorsal foot forms a continuous sheet containing thickened bands or retinacula. It is anchored to the subcutaneous surface, the tibia and fibula (both malleoli), the tarsal and metatarsal bones.
The Superior Extensor Retinaculum (SER) seems variable in width and thickness. A clearly defined band as generally illustrated is not found. The observed thin bands, possibly representing the SER, run from the tibia to the fibula, crossing the anterior compartment of the distal leg.
Instead of the familiar Y shape the Inferior Extensor Retinaculum (IER) is observed to have an X shape (9 out of 14) or is formed by a central thick node-like band (5 out of 14). Based on dissection findings Abu-Hijleh suggests a physical connection between the IER and the spring ligament.
Several additional bands are consistently found.
The Extensor Digitorum Brevis Retinaculum (EDBR), a band crossing the belly of the muscle connecting with the IER and fascia over the abductor digiti minimi.
The Proximal Extensor Hallucis Retinaculum (PEHR), a band crossing the distal tendons of the extensor hallucis longus and brevis and the distal tibialis anterior attachment (specifics are not given) at the tarsal/metatarsal level. This band connects with the abductor hallucis (its fascia) and the (dorsal) interosseous fascia of the foot.
The Distal Extensor Hallucis Retinaculum (DEHR), a band crossing the distal tendons of the extensor hallucis longus and brevis at the distal metatarsal level. This band also connects with the abductor hallucis (its fascia), the (dorsal) interosseous fascia of the foot and the DLPF.
The Disto-Lateral Pedal Fascia (DLPF), a band crossing the distal tendons of the extensor digitorum longus and brevis at a distal metatarsal level. This band connects with the abductor digiti minimi (its fascia), the (dorsal) interosseous fascia of the foot and the DEHR.
Malleolar Fascia (MF), oblique transverse bands on the tibial and fibular sides, crossing over the malleoli. Both bands connect with the SER.
In regard to collagen fiber disposition, using polarized light a “crisscrossing or woven mesh pattern” is observed. This pattern is observed in all specimens from the distal lower leg to the dorsum of the foot. Histological sections show collagen fibers with elongated nuclei and confirm the “crisscrossing or woven mesh pattern”.
From Theory to Practice
Based on Abu-Hijleh’s research we can opt to consider the individual thickened bands (retinacula) and fiber orientation when treating the deep fascia of the distal lower leg, ankle, dorsum of the foot and its related organs.
Because of the PEHR and DEHR, abductor hallucis, extensor hallucis longus connections we can, for example, consider the abductor hallucis when addressing a flexor hallucis related problem. And the “crisscrossing or woven mesh pattern” might require us to “aim” our therapy and exercises in more than a single direction.
For first hand details please read:
Abu-Hijleh MF, Harris PF. Deep fascia on the dorsum of the ankle and foot: extensor retinacula revisited. Clin Anat. 2007 Mar;20(2):186-95.
Physical Holism
Posted on 05. Jun, 2010 by Anatomy Links in Theory to Practice
Instead of providing a segmented view, Anatomy Links promotes the body as a whole.
Although segmentation and dissection certainly have their purpose, I believe our often applied sectional approach should take a backseat during our clients’ assessment, treatment and training.
We have to realize that all systems and all their individual parts cannot exist on their own. In other words, our muscles, deep fasciae, bones, nerves, vessels, joint capsules, skin and other organs only endure and function because they inter-connect, because they relate and influence one another. It is because of this that isolated or disconnected parts wither and die.
Without listing every possible scenario and mentioning particulars on inter-organ connections ….
It is important to realize that muscle connects with skin. Because it does, muscle pain, dysfunction or injury projects on connecting skin and vice versa. Consequently, treating connecting skin has a positive influence over muscle and vice versa.
It is important to realize deep fascia connects with muscle. Because it does deep fascia pain, dysfunction or injury projects on connecting muscle and vice versa. Consequently, treating connecting deep fascia has a positive influence over muscle and vice versa.
It is important to realize that veins connect with joint capsule. Because they do vein pain, dysfunction or injury projects on connecting joint capsule and vice versa. Consequently, treating connecting veins has a positive influence over joint capsule and vice versa.
Because of physical inter-organ connections we can approach pain, dysfunction or injury from many different angles. After all, we can treat and exercise all connecting organs to solve dysfunction, alleviate pain and promote recovery.
So, after vigorously studying the nervous, circulatory, musculoskeletal and visceral systems and all their individual parts it might be time to put them all together and see the physical human body for what it is; a singular entity, ONE.
2. A Continuous Exchange
Posted on 05. Jun, 2010 by Anatomy Links in Anatomical Connections
For a better understanding please read “Physical Inter-Organ Connections” before reading this entry.
Either fixed and/or not fixed, all of our organs physically relate to their neighboring organs. Because they do, because they all connect and touch, they constantly exchange influence.
Without end (day and night) our muscles, bones, deep fasciae, nerves and other organs exchange mechanical force [?] and nerve impulses.
Externally and internally originating forces affecting our organs are passed to connecting organs and translated to afferent nerve impulses. Either obscure to us or noticeable, the afferent impulses are answered by efferent impulses, in turn generating obvious or subtle internally originating mechanical forces. The purpose of this continuous give and take between organs is generating motion, maintaining posture, providing joint stability, circulating blood, maintaining homeostasis, and so on.
Although the ongoing exchange pertains to all our body parts, not all of them trade the same kind of influence. Depending on which organs connect and how (fixed or not fixed), they trade only force, or trade force and nerve impulses.
Healthy fixed-connections enable the inter-organ exchange of both force and nerve impulses. In regard to force, all organs with a fixed relationship partake in the force-shuffle. Ligaments and bones, joint capsules and ligament, bones and muscles, muscles and deep fascia; all fixed related organs exchange force. Even nerves, arteries and veins, and the organs they are bound with [?] participate in this ongoing correspondence of physical energy. Unlike all other securely anchored organs, the connecting peripheral nerves and muscles and peripheral nerves and blood vessels, exchange both force and nerve impulses [?]. The hamstring muscles and the sciatic nerve, for example, exchange both. Just like the femoral artery and the femoral nerve.
Healthy not-fixed-connections only exchange force. Unlike the fixed connections, however, they are designed to limit the inter-organ trade of shear and pull. The loose inter-organ bonds are perfectly suited to control the amount of force travelling between relating organs. The connection between the iliotibial band and the vastus lateralis muscle for example, is built to limit their correspondence. The same is true for all other not fixed bonds. The not fixed connections between organs and crossing peripheral nerves and blood vessels are designed to do the same. Also synovial joints, not fixed connections between individual bones, are assembled to control the exchange of force between relating parts.
Food for Thought:
With the previous information in mind, what happens to its fixed relations when an organ goes through a character change, for example a change in tonus, pliability, length, etc?
And, what happens to its fixed relations when an organ passes on an abnormal amount of force or an abnormal number of nerve impulses?
And finally, what happens when a not fixed connection adheres and loses its mobility or range of movement?
1. Physical Inter-Organ Connections
Posted on 10. Feb, 2010 by Anatomy Links in Anatomical Connections
“The toe bone connected to the heel bone, the heel bone connected to the foot bone, the foot bone connected to the leg bone, the leg bone connected to the knee bone, the knee bone …”
Like the song “Dry Bones” by James Weldon Johnson implies, the bodies’ bones connect with one another. What James Johnson did not sing about is that not only bones but all our organs connect. Our arteries, bones, deep fasciae, ligaments, muscles, peripheral nerves, and all other organs physically connect to form the human body.
Although most physical inter-organ connections have unique features based on which organs connect and where the connection is located in the body, we can divide them into two large groups; the physical fixed connections and the physical not fixed connections.
The fixed connections are, like their name implies, tightly anchored. They do not allow – or are not supposed to allow – any movement between connecting parts. To guarantee a strong link, the fixed connections are mainly established through the organ-unique connective tissues that invest and surround them. For example, the epineurium, perineurium and endoneurium of peripheral nerves are continuous with the meninges (the dura, arachnoid, and pia mater) surrounding the CNS. In the periphery, the nerves are anchored to the muscles through the “same” epineurium, perineurium and endoneurium. Bones and muscles also connect with one another. At a muscular attachment site, the bone’s periosteum is continuous with the epitenon and endotenon of the muscular tendon. For extra strength the tendon’s collagen bundles are anchored deep into the (cortical) bone. From a functional perspective, the fixed union – no freedom or slack between connecting parts whatsoever – is a requirement for health and proper function.
Opposed to the fixed links, the not fixed connections are not tightly anchored. They do allow – or are supposed to allow – at least some movement between connecting parts. The not fixed connections are generally established through interposed loose connective tissue. Arteries, veins and peripheral nerves, for example, loosely connect with muscles and the other organs they cross through a thin layer of loose connective tissue. Interposed loose connective tissue also ensures some movement between neighboring muscles. Of all not fixed connections only the bone-bone links (also known as synovial articulations or joints) are not established through loose connective tissue. Unlike other not fixed bonds these joints are established through interposed synovial fluid. From a functional perspective, the “free” or not fixed relationship – a certain degree of kinetic freedom or slack between connecting parts – is a requirement for health and proper function.
Anatomy Links: The Lower Extremity
Posted on 09. Feb, 2010 by Anatomy Links in News
“Anatomy Links: The Lower Extremity” version 1.0.1 is active and available to use.
We’ll keep updating the content, but didn’t want to keep you from using it already.
Enjoy,
The Anatomy Links team.