Exercise Science Doesn’t Work Without Muscles
A few years back I was in a room with a large group of other Exercise Scientists. Most of them were freshly graduated from their undergraduate degree or had been out for only a few years. All of the ones I spoke with were fantastic people. There were a lot of great practitioners that I would be happy to refer out to.
This particular day we were all attending a functional anatomy workshop. That meant having a case study and exploring the anatomical concerns surrounding that case study and then giving a mini presentation on your findings. One thing became abundantly clear: apart from the facilitators, only two people in that room knew their anatomy well. Myself and another gentleman who definitely knew his anatomy better than me.
People were stressing out over how little knew. They couldn’t name major joints, or describe the actions around those joints, or even allude to the muscles attaching across those joints. As an anatomy teacher at the time, and as someone passionately concerned about other practitioners knowing their anatomical stuff, it concerned me greatly.
Exercise science, and more particularly physiology, as a profession, has been around for a lot longer than many others. It is deeply grounded in research and has been the bringer of the basis of, in my opinion, most of the medical knowledge we have. At the end of the 19th Century and the beginning of the 20th Century, it was exercise physiology that brought us knowledge of the cardiovascular system, cellular respiration and in particular metabolism, respiratory volumes, stress responses, hormonal greatness. Of course, these were not just the domain of exercise physiology but they were certainly brought along in leaps and bounds through it. This is something I am immensely proud of.
The problem, however, is that physiology as a discipline became the focus of exercise physiology as a profession. Now there’s a great reason for that — exercise can help so many things. So many non-infectious conditions can be treated effectively, and many can be cured or completely prevented, through appropriate exercise habits. Cardiovascular diseases (you gotta have heart!), respiratory diseases (breathe in … and out), metabolic diseases (need … more … energy!), hormonal issues (pesky little things), mental health (you mean the brain is part of the body?) … so many things. And these ‘many things’ find themselves affecting certain aspects of the body …
Those aspects are the physiology, the way we function. It’s all it is, physiology, it’s the function of the body parts. It’s how the cells use energy. How they produce more. How hormones are produced to stimulate cellular growth. How nerves get the electrical impulse to move along their length and jump across the chasm to their target. How the gases of the air make their journey from airborne to blood borne. There’s gotta be a movie in there somewhere.
I love physiology! I love it. Always have. You know, I struggled immensely with it at uni, but that’s a story for another day. There’s another area I struggled with more, though. And that’s anatomy, the other love of my life.
I’m told that in an arranged marriage you can really learn to love the other person. I find that the longer I’m married and the more challenges we win together, my love for my wife changes and becomes deeper, more real and different to what it was in the first years. I think that we’re learning to love each other in much the same way an arranged couple would. My love for anatomy is like that.
In the early years, it was all struggle. I could see its beauty and its importance, I even wanted to get to know it, this amazing thing. After all, I’d chosen to do this degree, which was a human anatomy and physiology degree. And every semester we studied regional, gross anatomy and every semester I struggled to remember it all.
I remember the week before my first gross anatomy exam. Never before had I awoken from such vivid dreams — the same dreams, every night — where I had a human bony pelvis in front of me. Sometimes it would magnify itself, focus on the acetabulum and spin around slowly, other times I’d be staring at the gluteal lines, bereft of comprehension, as this bony thing flew toward me like it belonged on the boat with Gene Wilder in Willy Wonka and the Chocolate Factory.
Isn’t it funny how we dream? I dreamt of anatomy, because it filled my thoughts daily, learning, reading, trying desperately to remember the names, the attachments, the names. Those were the sleeping dreams, the ones that came unbidden. Inside of me were the waking dreams, the ones I held to but couldn’t realise. Like how desperately I wanted to remember my anatomy.
I get it. I really do. Anatomy is hard to learn. But exercise physiology as a profession, at least in Australia, has forgotten some very important things. It’s forgotten that physiology — that most important of disciplines — is embedded within a moving body.
I returned to my home town near the end of my degree. My friends had all graduated but I was stuck, 18 months behind schedule and sick of it all. So I had 18 months off uni. I didn’t want to lose all of my learnings about the human body, so I enrolled in the VicFit Certificate of Fitness, in the days when VicFit reigned supreme. I figured that being a gym instructor and eventually a personal trainer would enable me to retain some of my learnings from university.
That one step was the single most defining moment for my career that I can think of. There have been other defining moments but none of them would create the change in me that this one did.
I began working with moving bodies. Moving bodies! Muscles pulling limbs here and there. And people had questions, questions that their physiotherapists and doctors seemed unable to answer. And without answers, I couldn’t progress them safely. So I began doing that thing we all end up doing sooner or later. I began searching for answers and I began to ask different questions. Questions of curiosity.
All of a sudden my anatomy textbook became the second most used book on my bookshelf (the first will become apparent with some of my others writings, I’m sure). I couldn’t put it down. I would study every client’s movement in person and then go home and look up the relevant body parts in my text. I would bring the text to work. Read it at breakfast or at lunch. Sit down when tired and read it. Slowly, gradually, it started to make sense to me. We became friends. And soon, just like those arranged marriages, just like my wife and I, we fell in love. Not the shallow love of having to pass an exam and then forgetting 75% of what you learn. This was the love of partners who’ve gone through many trials and tribulations together. Anatomy, like marriage, is hard work. As a lecturer of mine once said, head and neck anatomy isn’t hard, it’s just that there’s so much it’s like drinking water from a fire hydrant.
Exercise physiologists can gain much from an understanding of the anatomy of movement. And movement doesn’t start with the bones or muscles and certainly not with the fascia. It starts with the central nervous system.
Understanding nerves, understanding their course and distribution, understanding how the central nervous system ordains, orders and modifies movement are all central to understanding the human predicament. And I really mean that last bit. But more, understanding how the nerves move around and through the skin and the muscles, this is key. The body’s primary concern is the safety and thriving of the central nervous system, because without it we don’t have a person. If the nerves are threatened by obstacles in their path, then the nervous system will do all in its power to cease that threat, to lessen it, to remove it, to get you to do the same.
And to understand how it does that, we need to understand the tissues through and around which nerves pass. Skin and its fascia, muscles and their convolutions. Bone and their ligaments.
And what about the physiological adaptations? If a person moves inefficiently, if they move inappropriate to their goals, then the body will compensate. If we’re trying to improve someone’s cardiovascular health by increasing their walking speed, but fail to recognise the movement issues, then we can exacerbate their issues or create new ones. To see their motion, to observe it, is to know your task.
By creating postural efficiency, we establish less effort required to propel this body through space. But if we do not understand the moving parts of the body (by which I mean nerves, muscles, tendons, ligaments, bones and their respective connective tissues — anything that is moved by movement) then we cannot know where to start. We cannot know how to modify their movement so that they can become more efficient, or more effective, at it.
Understanding anatomy is also pivotal to understanding the strange musculoskeletal issues that occur in our body. I am not so much a structuralist in this regard as I once was. I model myself more after Antonio Damasio’s theories on self. These understandings cannot separate the moving body from the internal — in fact they merge the two without apology. But movement as a construct is much the same as movement as reality — complex and requiring a physical mechanism at some point.
So anatomy is pivotal to understanding the body we work with. To treat any case of knee pain, shoulder pain, back ache, or balance issues, is to work with the physical structures as they uniquely present in the case of each individual. And that’s the problem, I think, with the profession. Its beginning to see each case as a bacteria that can be treated with a dose of exercise. But it’s not. It’s a person, in a unique body whose movements are a unique expression of their experience to date, along with all the chemical realities within them. The only way to help someone like that is to know your anatomy.
… anatomy, by the way, is not just muscles or ligament or bones. It is the central nervous system. The self as it emerges. As we understand the anatomy, we understand whether this person needs to do pushups, swimming or Graded Motor Imagery. Is the muscular only? Neurological only? Central nervous system processing only? Or a big, fat, chunky, delicious mixture of everything under the sun?
A few years back I was in a room with a large group of other Exercise Scientists. I hope they’ve since learnt some more anatomy. Anatomy is the home of physiology. It needs to be more than just an overview subject in a degree. It needs to be woven into the fabric of the whole degree and then splattered across the horizon of every PD course you can think of. Like you, I’ve forgotten so much of what I’ve learned. But like you, I now know the importance of the things I use to struggle with and can learn to relearn them again today.