Throw away Gray's Anatomy - the new World Order of Anatomy Understanding is here, and its Italian

This week has seen a string of tweets out of the World Fascia Congress. Interesting? Relevant?


Even if the assorted tweets & images have not directly influenced your day, the material the Congress discusses certainly does.


How does the new perspective on what lies beneath our skin contribute to your treatment in the clinic? Where is this information coming from, and how do we as clinicians interpret it? We will offer up one example of a particular condition: neck pain, and see what the new information can tell us.

Carla Stecco on stage at Fascial Research Congress 2012

There are effectively seven layers from skin to the muscle, as described eloquently by leading anatomist Carla Stecco from Italy. From careful dissection of fresh cadavers (no plastination or dried out models her so familiar in Universities) Carla has demonstrated these as being:

Fascia being dissected

• Skin
• Derma
• Superficial adipose layer
• superficial fascia- layer of fibroelastic tissue
• Deep adipose layer & retinaculum cutis profundus
• Deep Fascia
• Muscle

The careful dissection clearly is in the DNA, as her father was also a renowned and skilled practitioner, as is her brother Antonio. He also spoke eloquently at the World Fascia Congress in Vancouver on the imaging of fascia, reporting that in patients with neck pain there is:

• Increase in the size of SternoCleidoMastoid fascia
• Increase of Fascia Scalenus Medius
• Increase of the Deep Fascia Thickness - if this is >=0.15cm then there is strong correlation with pain

There is high viscoelasticity within the fascial layers as shown by both of the Steccos, and this is increased in pain states: in effect there is an entanglement of Hyaluronic Acid chains which are more concentrated and aggregated. The fascial tissue therefore become more dense & many massuers & therapists alike will recognise the type of tissue feel this confers to the area.


The good news for physiotherapists & massage therapists alike is that science by way of the Steccos as an example, have now shown that these chain-chain interactions were reversibly disaggregated by an increase in temperature or by alkanization (as a result of hands-on treatment or massage).


Exciting huh?
This suggests that we are able to change neck pain, with our bare hands by having a profound on the layers between skin and muscle, and not just by increasing blood flow either.


This greater understanding of how we can shape our worlds is moving rapidly thanks to the youthful energy of the Italian siblings building on dissection work by the likes of Gil Headley, Tom Myers & Andry Vleeming.

Long may it continue: to help those seeking to get the public better by themselves getting better help.

Previous posts on our blog click Fascia articles back catalogue here

RED ALERT - How colours can have an effect (Team GB take note)

Can colour affect performance? Will it be pertinent to Team GB in the week Stella McCartney delivered the London 2012 Olympic competition clothing range?

A much referenced New Scientist article from 2009 seems to suggest so, from birds through to sexual attraction in humans to the more current interest in sports' performance. Colour appears to act as a subtle primer exerting a direct influence on motivation & behaviour without concious awareness.

New Scientist article by Daniel Elkan (2009)

The interesting facet of this article in a sporting concept is that apparently even in a simple clash of red against blue in martial arts form tae kwon do, then red colours were more likely to have higher scores awarded in close encounters: this in an experiment where clothing was digitally manipulated, with experienced referees making the calls too, not those likely to be influenced by any factors other than the contest itself.

Psychological Science, vol 19, p 769 Sagepub Sign-In for pdf. 

Actually red has been getting sidelined  in Team GB kits for some time-clock the increasing use of blue this century for example in this collection of clothing Team GB Clothing 1948-2012.

So should the plethora of internet forum posters 

& excitable commentators really be seeing red over Stella McCartney's latest designs? 

Or are they feeling blue for good psychological reasons?

What truly colours our judgement?

Hubris or hype?

The Dehydration Myth

Tim Noakes has written widely on the 'Science of Hydration', and the concept he states was developed by the sports' industry and their parent companies in the late eighties.

This blog he has just written is in response to the Readers' Poll in British Journal of Sports Medicine (BJSM), and demonstrates the level of (mis)understanding present in the field.


BJSM Readers' Poll Response

Dr Noakes is a Sports Physician and Exercise Physiologist at the University of Cape Town and Sports' Science Institute of South Africa. He was part of an evidence based review along with Chad Asplund & Francis Connor (see Exercise-Associated Collapse PDF Br J Sports Med 2011;45:1157-1162 ) examining Exercise-associated collapse (EAC) which occurs typically  at the end of endurance running events.


Ultimately a key point on dehydration is made by Noakes in the discussion of exercise-induced weight loss. He reports that heatstroke & all heat illnesses are unrelated to measures of fluid balance: losses encountered include that due to irreversible oxidation of fuels. He also concludes that fluid loss during exercise has only  a marginal effect on core temperature.


All of this means that we simply have to keep our minds open to the evidence, not just the advertising or the hype.

Sports Scentist versus Clinical Specialists -High Performance Battlelines drawn in Aussie Sport

Has the era of High Performance management got out of control? The Australian Football League (AFL) certainly seems to want to rein in some of the team staff looking at preparation & recovery if reports in Melbourne Age newspaper are to be understood. 


The Age newspaper : AFL declares unofficial war on Sports Scientists


The piece certainly ignites a debate on the role of specialists within teams, and the hierarchical structure of organisations in professional sport. 


Ultimately the athlete actually has the final say in whether or not he or she is putting themselves forward to compete, albeit with a bank of advice & information from the professionals. This is not so different from the high performance team offering the coach & management sage advice to the predicted pathways of an injury for example when considering team selection. 


Clearly it is best when all parties in the management can come to a consensus regarding athletes, but this is a thought-provoking article, highlighted by BJSM.


How does it work in your team or organisation?

Recent Knee Injuries in Rugby Six Nations

So shortly the latest round of rugby's European premier competition kicks off-the RBS 6 Nations' Rugby Championship. However, several members of the teams from the last round will not be taking their place in the line-ups as the 4th weekend of fixtures takes place, injured on international duty.


Knee injuries have claimed two of the most exciting players, Conor Murray of Ireland & Maxine Medard of France. One occured in landing without anyone else in contact causing severe bruising to the knee (Murray for Ireland), the other injured in a contact situation with an opponent-his knee and lower limb exposed as a rival for the ball ploughed through getting to the ball first driving Medard off his feet but with his foot temporarily planted in the turf. 
He sustained an ACL injury.


You can watch both here courtesy of the SPACE Clinics You Tube Channel.

Here is the Conor Murray injury-he is the player landing on the turf in an attempt to catch the high ball.

Watch here as the French player planting his foot is injured by the opposing player's shoulder as he dives to the floor.

Now watch it again from behind to see the contact on the lower limb.

So best of luck to all players in the matches today representing their countries, and we wish speedy recoveries to the players in these videos, and anyone injured this weekend.

Size matters: the size of your penis may be related to your fingers...no cock & bull tale this

So size does count then. Fact. The ratio of length of men's finger to finger appears to be linked to the size of the penis: lower the ratio, the longer the penis.


Unusual post this, but the Asian Journal of Andrology clearly has some interesting studies, with this piece on the relationship of the a man's genitalia length when flaccid & stretched to the length of his index finger (termed 2D in the study) to the ring finger (termed 4D).


This Korean Study (Asian J Androl. 2011 Sep;13(5):710-4. doi: 10.1038/aja.2011.75. Epub 2011 Jul 4) by Choi et al indicates that measurements taken on 144 local men attending hospital for urological surgery showed that those with a 2D measurement shorter than 4D demonstrated longer stretched penis length which is well correlated with erect size too.


One of the researchers, Dr Tae Beom Kim of Gachon University has claimed that 'Based on this evidence, we suggest that digit ratio can predict adult penile size'. They intimate that there may be a link to the exposure of estrogen & testosterone in the womb as elevated levels of testosterone during foetal development can be associated with a lower 2D:4D ratio.


In both males & females, lower 2D:4D ratios are also associated with better athletic performance, and individual studies have also linked lower ratios to success in high frequency financial trading success, and even medical school exam performance. On the downside, there appears to be a link to autism and elevated cases of alcoholism in this population.


There requires to be more of a body of work in this area on other ethnic populations as one of the confounding factors would be the essentially purity of the population sample, and whether or not there is any link to the need for urological surgical interventions too. 


SO prenatal exposure may cause it, and the authors conclude that the ratio of digit to digit could give an indication of this exposure as well as the predicted length of an individual. Not bad for a swift and non-invasive method of sizing. And it seems to matter, as men have been saying for years.

Concussions in children can affect memory for up to a year!

Fresh research into head injuries in youths has exposed the problems that can affect kids for months after direct or indirect blows to the head in both team sports & individual pursuits.


Kevin Guskiewicz, a neuroscientist well-known to Space Clinics from the University of North Carolina, states that an average College American Footballer sustains around a thousand subconcussive blows a season-these are contacts that are significant enough to sustain cumulative damage, but not enough in themselves to have an immediate effect or cause symptoms. He describes this as a 'dose response', and states that these multiple blows only tend to show some time afterwards.


American Football accounts for half of youth concussions, but with the gender-discrimination busting Title IX giving girls equal access to sports, it also opened up unprecendented injury risk. No surprise then that girls' football (soccer as it's called in USA) claims 12% of all youth concussion in team sports, basketball 7% & volleyball at 1.1% (that was for you Kenny!).


However solo activities such as biking, ice skating, snowboarding, skateboarding & playground recreation also cause a third of all of the child concussions.

TIME Magazine Health Special Concussion Graphic

So far, so short term. However, more worryingly there can be attention deficits,memory lapses, fatigue, forgetfulness, headaches and possible needs to seek additional help at school for up to a year following concussion! 


A new Ohio study in the Archives of Pediatrics & Adolescent Medicine (Arch Pediatr Adolesc Med. Published online March 5, 2012. doi:10.1001/archpediatrics.2011.1082) demonstrates that functional changes can occur at 3 and 12 months post injury in a population of 8-15 year olds (285 participants divided into a concussive group and an orthopaedic group for comparison). In addition abnormalities in neuro-imaging could also be detected. 80% of the post mild head injury group came from sports of some kind, the remainder from road traffic accidents, falls or other traumas.


Here's some online information in the shape of a TIME Magazine special:TIME Magazine Health Special: Kids and Concussions
To read up on other blog posts on adult sporting concussion then check out our blog here as it contains links to all of the postings we ran last year on the subject: Space Clinics Blog on Sidney Crosby Concussion

Daily Exercise & Blood Sugar Spikes - Links to Chronic Disease

Blood sugar levels spiking after a meal are well known. They are also linked to Type 2 diabetes & the development of heart disease or obesity. But even bouts of inactivity in physically active individuals sees a change that an spiral into chronicity.

A recent Missouri study of participants ( Mikus et al 2012-see below)  fitted with glucose monitoring devices looked at what happened if a group of people who exercised above average (using American Heart Association recommendations for 10,000 steps, or around 5 miles a day) were essentially made sedentary and denied their daily exercise totals  (down to average 4300 steps or 3 minutes of exercise per day). Meanwhile their food intake & meals were exactly the same for the first stage of the test when they spent three standard days of normal exercise.


Throughout the trials, their exercise was tracked, food intake assessed via diaries, & blood sugar tested in 30 minute intervals after eating.


During the inactive days, blood sugar levels were seen to spike after meals by 26%, increasing each successive day leading the researchers to suggest that this would seem to be a direct result of their reduced activity. 


These spikes are often seen in injury states where muscles require less fuel, and draw less of the 'sugar' from the blood: they can also return to normal levels quickly as seen in animal as well as human studies on return to activity.


In prolonged inactivity situations however, this is not the case, whereapon there are physiological conditions clearly occuring causing chronic disease such as those the of the heart, and diabetes.


As the study  indicates, daily physical activity is an important mediator of glycaemic control & can assist in the prevention of pathologies and chronic diseases.


Medicine and Science in Sport & Exercise 2012 Feb;44(2):225-31.