81: Fascia, Length-Change, and Language (with John Sharkey)
Episode Transcript
Summary: Is language important? Do muscles actually change length? Does posture matter? Is “fascia” a reductionist idea? Whitney and Til head straight down these rabbit holes (and more) in conversation with clinical anatomist John Sharkey.
Get the full transcript of their conversation on Til or Whitney’s sites:
- Til Luchau’s Advanced-Trainings.com
- Whitney Lowe’s Academy of Clinical Massage
Whitney Lowe:
The Thinking Practitioner Podcast is supported by ABMP, Associated Bodywork and Massage Professionals. ABMP membership gives professional practitioners like you a package, including individual liability insurance, free continuing education, and quick reference apps, online scheduling and payments with Pocket Suite, and much more.
Til Luchau:
ABMP’s CE courses podcast and Massage and Bodywork Magazine always feature expert voices and new perspectives in the profession, including you, Whitney Lowe, myself, Til Luchau. Thinking Practitioner listeners can save on joining ABMP at abmp.com/thinking. Okay, who’s our guest today, Whitney?
Whitney Lowe:
Well, speaking of expert voices, we are very delighted to have Mr. John Sharkey from Dublin, Ireland with us today. And John, thank you so much for taking some time. I’m looking forward to a fascinating discussion, delving into some great stuff with you. So welcome to The Thinking Practitioner Podcast.
John Sharkey:
Well thank you to both. It’s a real privilege. I’m delighted. I’m really thrilled, psyched to be here.
Whitney Lowe:
Good. John, can you take a few minutes to introduce yourself to our audience? Tell them a little bit about what you are doing and what’s your primary focus and work? You’ve been all over the map doing all kinds of things for many years, but I would like our audience to get an appreciation for the depth of the things that you’ve accomplished here.
John Sharkey:
Sure. I mean, I started out in the massage therapy world in 1977, and since that time I’ve gained undergraduate and postgraduate degrees in exercise physiology and in anatomy. In fact, the people who were the early influencers and, for me, these were people who, once they realized that I had an interest in the human body, we didn’t have a health fitness industry in Ireland at that time. It grew. And I always knew that I had an interest in the body. And they said to me, “Well, anatomy and physiology will be the rocks upon which you’re built.” And so I listened to that and that’s why I went and got specific degrees in that area.
And I love all things human body. I’ve had the great privilege of being able to work with colleagues like Professor Carlos Deco and Dr. Robert Schleip. And I work with them on a reasonably regular basis. I mean, they’re just amazing individuals and you can’t help but soak up the information from these guys.
I’m also teaching what we call European neuromuscular therapy. We specialize in the treatment of chronic unresolved pain. And I guess people would also relate the word fascia and fascia science to me. But one of the things I would say is that I find the word fascia a little bit reductionist, and therefore I would like to think that I am more than just fascia.
Whitney Lowe:
All right. So we’ll have to take off on that a little bit. So tell me about that, why fascia is reductionist, the term there?
John Sharkey:
So for somebody to be able to have a meaningful discussion, you need to be able to agree on what it is that you’re talking about. We’ll come back to this word maybe in a couple of minutes time, stretching, because people use the word stretching. Now, I find that when I’m traveling the world, if I’m in Australia or New Zealand or South Africa or in the North Americas, and if I say stretching, people will nod their head, and then what I will do is I might go a little bit further to say, “Can you write down in just a couple of sentences what you mean by stretching?” And then I’ll get people to read out what they’ve written. And honest to goodness, you will find that in a room of 100 people, you will get 30, 40 variations on the theme. And they will be convinced that everybody was thinking the same thing, when in fact, that’s just not the case.
So I think it’s worthwhile to take time out to actually say, well, look, when I’m talking about whatever the topic is, this is what I mean. It’s not what you mean. And people will often say, “Well, no, that’s not quite what I was thinking of. I was thinking…” And that’s great, because now what you do is you reach a consensus and now everybody’s on the same page. And I believe then we can have what I refer to as a conscious experience, because that’s really what actually helps to develop consciousness in us humans, was the gift of language and vocabulary. So fascia, let’s stop and think about some of the words that we relate to fascia. What words do you guys relate to fascia? Any particular words that come to your mind immediately?
Whitney Lowe:
Connective tissue comes to mind immediately.
John Sharkey:
For sure. Connective.
Til Luchau:
Etymologically, we have fascist, to associate.
John Sharkey:
Well, they’re two different etymologies, fascia and fascist. But I mean, you have the words like ubiquitous.
Til Luchau:
Ubiquitous, okay. You’re talking about qualities. I get you. Okay.
John Sharkey:
Yeah, yeah. Forgive me for not being clear enough on that.
Til Luchau:
Binding.
John Sharkey:
Yeah, binding.
Whitney Lowe:
Enveloping.
John Sharkey:
Omnipresent, everywhere. So if fascia is everywhere, how can it be not somewhere? So for me, fascia is a process. It’s not a thing. It’s actually a process. A process in time. It involves things like phase changing. If you think about electrical activity, something that happens slow, like muscle fibers, slow-twitch muscle fibers, they sound like this. If you listen to fast-twitch muscle fibers, they sound like this. So they’re happening. Their activity is occurring at about 400 times faster than a slow-twitch muscle fiber.
Til Luchau:
Were you making a sound? Because I think Zoom got rid of your whatever noises you were making.
John Sharkey:
No way. Really? So I was going, from there.
Til Luchau:
Yeah, it did it again.
Whitney Lowe:
Zoom’s artificial intelligence doesn’t like random sounds and it thinks that they’re not meant to be there.
John Sharkey:
Okay. Let’s just say it was a single shot from a gun fired every maybe one and a half seconds, as opposed to an F16… Or no, what’s a gun? Don’t. I’m not good with guns. A machine gun going boom-boom-boom. I mean, that fast. It’s 400 times faster. So things are happening on a temporal basis in the human body. Temporality is a huge topic for me. Everything is happening on a temporal basis. If you had an immediate injury, and you should never have spaces in the human body, the human body doesn’t allow for space, other than your silent cavities and your urinary bladder. But that fills, and then it empties and it fills. So really, there’s never a space there or there shouldn’t be. And if you did have an occasion where somebody injured themselves and there was an immediate space, how would you fill that space?
Because remember, the body will not allow spaces. So if that’s true, then the body’s going to fill it. How would it fill it? And of course, immediately it’s going to fill it with blood or fluids. You see? That’s what it does. So how does the heel spur come about? You can’t get a heel spur overnight? Heel spurs have to calcify so they take much longer time to fill that space. But then, having said that, generally speaking, that space is occurring over a long period of time.
So as the space is occurring, the body’s filling it and it’s filling it with particular either tissues or liquids. And then those tissues and liquids are going to go through morphological changes. They become sticky and hard and calcified and so on. Can you see? So temporality for me, I love that, it’s a great topic. But we were talking about fascia and I would say that fascia is a process. It’s everywhere. And so for the surgeon, if I’m showing surgeons how to be able to approach retroperitoneal structures on what we would refer to as bloodless planes, then I might be showing them a lateral approach and talking about the various different… Here’s another one.
I might be talking about the various different fasciae that are in the body, but there are no fasciae in the body. There’s only fascia. Fasciae is plural, meaning two. And there are not two fasciae in the human body. There’s only one fascia in the human body, that has folded back on itself to create what we might refer to as some pockets, or it has tripled, so it creates double and triple layers or laminae. But it all came from one original fabric, all the mesenchyme.
Til Luchau:
Fascinating, by the way. Fascinating.
Whitney Lowe:
It’s so rare that we get to talk to somebody who’s got such a vast knowledge of both anatomy and language. We’ll probably have 50 different rabbit holes when we go down here. But I got to ask this question because I’ve wondered this. You mentioned that the letters ae at the end of a Latin name, meaning plural. So what is the plural, for example, in the fascia lata or levator scapulae, for example, since there seem to be just singular structures there, but are they in fact plurals because there’s ae at the end of it?
John Sharkey:
Because again, my brain explodes, but when you say certain things, so one of the first things I got to say is that please remember that everything I tell you could be completely wrong.
Whitney Lowe:
Okay.
Til Luchau:
Thanks for reminding me.
John Sharkey:
Yeah, yeah. I mean, look, it’s John Sharkey, I’m speaking based on my 42 years experience, and it’s what I believe to be true. But having said that, if somebody wants to disagree with me, that doesn’t mean to say that we can’t sit down and have a cup of coffee or a cup of tea or a beer and put our arms around each other and still have a good conversation. We don’t have to fall out just because we don’t agree with each other.
So we are segmented, we are segmental human beings. And we do have right and left sides. And why we have a right and left hemisphere, we don’t know. We don’t know why we have two sides to our brain. That’s just an unanswered question. I’ve discussed this with Iain McGilchrist, who is a famous guy. He has a wonderful book out, very heavy reading. He has two new books out, actually. I don’t know where these guys get the time to read all them research papers that they have, but he has The Master and His Emissary, which is an amazing book.
We have right and left. So you have a right and left rectus abdominis. So it’s not just rectus abdominis, it’s a right rectus abdominis and a left rectus abdominis. And so you have a levator scapula, but I suppose you could say levator scapulae, if you wanted to talk about the right and left together in the one sentence.
Whitney Lowe:
Interesting.
Til Luchau:
And tensor fascia lata would be the left and right, you’re saying? Okay.
John Sharkey:
Well perhaps if you’re talking, but it’s the tensor fascia lata is the-
Til Luchau:
Lata, as a singular. All right. That’s an example. Okay, sure.
John Sharkey:
Yeah. And of course it is continuous because what you find is if you can visualize an embryo, you’re sitting within the womb, you’ll see that the lower limbs have rotated out and they’ve spiraled out, and then they’ve ended up in a particular position. And that position creates specific tensions and compressions. So you’re going to now go into a conversation about genetics versus epigenetics.
So we have a combination of genetics and epigenetics. If things are not where they’re supposed to be, so this argument comes around from time to time where people say to me, alignment and posture are not important. And there are people who have written papers on that, and that’s fantastic. I completely disagree with them. I believe as Ida Rolf used to say, “Put it where it belongs and ask for movement.” And I think she was wise, maybe we could tweak that, but I think she was wise in what she was saying.
Your head needs to be sitting in a particular way on your neck. Your neck needs to be sitting in a particular way on your shoulders. And if not, there’s a consequence for that. There’s a price to pay. So if your lower limbs are in the right position, you will develop an iliotibial band. If they are not in the right position, you will not develop an iliotibial tibial band or you will develop the iliotibial band somewhere else, believe it or not.
Til Luchau:
Really?
John Sharkey:
Yeah. If you’re a horse rider or if you’re treating horse riders, so for those listeners who treat horse riders, you’ll notice that they have iliotibial bands on the medial side of their legs because of the positioning of the feet in the stirrups.
Til Luchau:
Certainly had actors acting like them, yeah.
John Sharkey:
Well, the fascia thickens along the line-
Til Luchau:
Sure, a thickening in that band. Yeah, absolutely. I’m with you.
John Sharkey:
That’s a conversation that’s happening in the human body. It’s not down to genetics. It’s down to epigenetics. It’s down to the influence of the forces operating it. And if you are born and your heart is not in the right place in your thoracic cavity, if it’s not sitting correctly, then there is an opening between the right and left atria. And unfortunately, that opening will not close and you’ll be left with the hole in the heart. And we normally have a small little sticky-out piece of tissue, which we call a limbus. The limbus of the fossa ovalis.
The language is beautiful, isn’t it? The limbus of the fossa ovalis. And so this will not form, this will not close on birth if your heart is just not in the right position. And therefore you’ll be left, as I say, with a hole in the heart. And we’ve several other examples of that around the body. They’re everywhere, actually, these little openings or holes.
Til Luchau:
All right. So you’re unapologetically structuralist. You would say the structure counts, or alignment counts, position matters, as well as postures does. All right.
John Sharkey:
Hugely. And of course the body has the ability to adapt. And as long as you’re functional, that’s fantastic. But this idea that you take an eight-year-old child and you put Harrington rods into their spine to correct the scoliosis, that would not be my approach. I think that’s horrific. Our problem is that it’ll take another 100 years before we have convinced people of an alternative way, another way. Even the word alternative is not a great word, because as soon as you say alternative, people start having certain thoughts in their head because we use the word alternative versus complementary. But yeah, I tend to think that once people can remain functional, then that’s pretty cool.
Til Luchau:
I was listening to Joanne Evanston’s podcast recently and she was interviewing you and she said your nickname was Fascia Man at your university.
John Sharkey:
Yeah. I meet PhDs now all these years later and they say, when they’re introduced to me, or if I’m at an anatomical society meeting, they say, “Oh yeah, you’re Fascia Man.”
Til Luchau:
“You’re the fascia guy.”
John Sharkey:
I have no idea how they still manage to talk about me and how that goes around. It’s just funny. Yeah.
Til Luchau:
Well, she went on to ask something that, while we’re on the subject of is posture important, she said how you feel about having the Mickey taken out of you for your… She said, “Dedication to a lost cause, namely fascia.” I don’t know if you remember that question or not, but it made me curious to hear what you would say to the people who think that fascia is, say, irrelevant or vastly overrated or even a fad that’s passé.
John Sharkey:
Well, there’s a couple of things, by the way, where I was talking in another school just recently, and they were saying things like, “If you want to put the tissue in the bins beneath the cadavers,” and I said, “Look, if you could do me a favor, I’d prefer if you didn’t refer to them as bins. Bins are trash cans. And we would never, ever encourage anybody to say that they were placing human tissue into a bin or a trash can.” And then they said, “Oh, you know.”
Language is important. If you want to encourage people to leave their bodies to science, now I think we need to pay attention to these words. What I get sometimes is a little tap in the back, say, “Oh yeah, John’s interested in fascia. John, have a chat with this person.” And although they’re introducing you to somebody and you kind of think, well, that was great that they helped you to network. It’s the tap on the back that you go, “Did they just tap me on the back?” And you realize that, I’m not quite sure if that’s being disparaging or what it is.
Til Luchau:
A little condescending, perhaps.
John Sharkey:
A little condescending, because maybe they know better. And it’s very hard for somebody to know what they don’t know. It’s very hard for somebody to know that, so if you’ve been encouraged… You see, this is where the focus in anatomy is about where. Where is the superior mesenteric? Of course, everybody loves the vagus nerve. Where is the vagus nerve? My goodness, there’s so much to learn about the vagus nerve. I want to send an applaud out to Professor Porges, as well. What a great character he is. What an incredible guy. And The polyvagal theory. And he has to take a lot of stick over the polyvagal theory.
Til Luchau:
Oh yeah. And about anatomical specificity amongst others. Yeah.
John Sharkey:
Yeah. I mean, one of my tutors was the first human being in space. He was an American. Lots of people think that the first human being in space was a cosmonaut by the name of Yuri Gagarin. But in fact, it was my tutor, Professor David Simons of Travell Simons & Simons. And he was the first human being to go into space. If you don’t believe me, you can go onto the internet and look up Man High Project and you can read all about David and his exploits. And that’s how he met Dr. Janet Travell.
And Dr. Janet Travell, you probably know, she was the first female physician in the White House. She was tending to John F. Kennedy. And she was also, by the way, great at inventing and making things. And she made a specific rocking chair, which is here in Dublin, incidentally, in a restaurant not too far away from me, called Shanahan’s on The Green. And they have that rocking chair up there.
But they were ostracized. They had to take an awful lot of stick of this idea of myofascial trigger points. Hey, there’s another great one, by the way. Why are we not talking about myocardial myofascial trigger points? Why is nobody writing about myocardial myofascial trigger points? Is the heart muscle not a muscle? Mustn’t be. It mustn’t be because nobody has written one iota about myofascial trigger points occurring in the myocardiac tissue, which is just mind boggling.
Whitney Lowe:
Well, that’s an interesting thought. I mean, do you think it’s possible that some of the other symptoms like-
John Sharkey:
Absolutely.
Whitney Lowe:
… heartburn or things like that could actually be myofascial trigger points?
John Sharkey:
Exactly, there are people who are experiencing all of the sensations of some type of cardiac insult, and they don’t have the pathology.
Whitney Lowe:
Interesting.
John Sharkey:
And there’s another great area for people to investigate, fertile ground. Go and investigate it and see if there’s anything there or no, nothing to see here, move on. But my goodness, we talk about every other single muscle in the human body, and we don’t talk about myocardial tissue in terms of myofascial trigger points. And I’m off doing other things. I just can’t be finding the research on those. But I can encourage people. And your podcast, I think this is the first podcast I’ve ever mentioned that. I’ve never mentioned that before to anybody, almost because, first off, I have too many things to talk about. But there it is on your podcast. If there’s anybody out there involved in research, there’s a great area for you.
Whitney Lowe:
That’s a fascinating idea. So now you’ve got me thinking about trigger points in the tongue and where in all these other places that we, muscle tissue that we kind of ignore with potential problems there.
John Sharkey:
Absolutely, Whitney. Well done. That’s brilliant. Now, you see what just happened there? I happened to mention the heart and within just a couple seconds, we’re off. We’re off and we’re rolling. Brilliant. Absolutely fantastic. There’s much to be discovered. There really is.
Whitney Lowe:
I want to ask you a question about something else that I’ve heard you make comments about or mention before, and I don’t understand quite the concept. I’d love for you to explain that a little bit to our listeners, too. When you refer to fascial tuning pegs, tell me a little bit about that, what that is.
John Sharkey:
Okay, so fascial tuning pegs, several years ago I did a research paper with Professor Hong-Jin Sui in Dalian Medical University in China. This is on the myodural bridge, which is the connective tissue, the fascia, the connective tissue from the rectus capitus posterior minor, rectus capitus posterior major. And this relationship, it is continuous with the dura, the tough mother, the dura mater, of your spinal cord. And in fact, what we didn’t include in the paper also, by the way, is that there are specialized little foramen, foramina, through which the connective tissue run through your cranium. They run through your cranium to attach to the dura.
Whitney Lowe:
Wow, okay.
John Sharkey:
Yeah. So we didn’t mention them. And again, nobody has really done a paper on that, that I’ve seen, certainly. So you stop then and you think to yourself, well let’s look at this little muscle in the back of your head. And if you compare it to a quadriceps or a biceps brachi or pectoralis major, and you think to yourself, what is its function? Is it involved in moving us in some way or moving the head? And that’s what we tend to think about muscles.
Well, it turns out that there are specialized, what you may refer to them as fascial structures, in the human body, that when we look at them from a histological viewpoint, we see that they’re completely different to neighboring tissues. So then you have to say to yourself, well, why would they be so different? And I think it’s reasonable to say, well then they must be playing a different role, but what role would they be playing?
And of course, what’s happening with these tissues, they are replete with sensory organs. I mean, replete. If you took one inch of muscle fiber from your gluteus maximus and you were to analyze it for muscle spindles. I’m going to give you old figures, by the way, because these figures are changing constantly. Dr. Robert Schleip with Dr. Carlos Deco combined work with another colleague of theirs who had written about the number of neuro fibers that there are in the human body, sensory neuro fibers in the human body. It’s now into the hundreds of millions, because they used a three dimensional approach. And they also had an average weight of a male and female.
So all of a sudden, our knowledge in terms of these particular specialist sensory organs are just changing. So if you take an inch of muscle fiber in the gluteus maximus, you’re going to have somewhere in the region of 11 muscle spindles. If you take just that little inch of muscle tissue in rectus capitus posterior minor, you’re going to have 11,000.
Whitney Lowe:
Wow.
John Sharkey:
Let’s compare that. 11 to 11,000. Wow. And those figures might have to be multiplied by three. But you ask yourself the question then, what is the… So gluteus maximus doesn’t tell us anything. Gluteus, there’s a term to say, hip, related to hip. Maximus, it’s a big one. So it doesn’t tell us anything. And by the way, contract, what does the word contract mean? It means to shrink. We might talk about that another day. Shrink, is that a good word? Because that’s what it means. It means to shrink.
See, we use these words all the time and we really don’t know what they mean. I remember I met a guy. Dr. Cheto introduced me to a guy, Andrew Biel, years and years and years ago, and he was writing a book at the time. And I said to him, “Let me give you a little gift.” I said, “The word muscles means little mice.” And I think Andrew used that in his book, which is a brilliant book. Is it The Trail Guide?
Til Luchau:
The Trail Guide to the Body. They’re actually one of our sponsors on the show, full disclosure.
John Sharkey:
Wow. What a fantastic book that is. He self-published that and did all the diagrams and I think he got surprised with the number of sales. It’s just brilliant. I recommend his book everywhere I go. I think it’s a beautiful book.
Til Luchau:
Little mice, though, huh?
John Sharkey:
Yeah. So what happened was, again, the listener can’t see us, but if you were to move your fingers and look at how the skin moves on your forearm, the Greeks thought that if you placed a bed sheet or a tablecloth on the ground and you watched a mouse running underneath it, that it made that type of shape, you see? So they called them muscularis.
Whitney Lowe:
Oh wow. That’s fascinating. Yeah.
John Sharkey:
Yeah. I mean, your hip bone, acetabulum, vinegar bowl. So if they turned the pelvis, one side of the pelvis, and if you turned it on its side, it looked like the bowl that they dipped their bread into using a little bit of vinegar and oil vinegarette. So they called it acetabulum. It doesn’t tell you anything about the physiology or metabolism or what is it about.
So if we start to look then at what these tissues are doing, we see that they’re playing very specific roles. So the one thing that gluteus maximus never does is it, I’m going to come back now, but if we have the chance time-wise, I’ll come back and I’ll contradict this, the term that is, nothing in the human body shortens or lengthens. That’s just a complete myth. Nothing in the human body shortens or lengthens.
Whitney Lowe:
Tell us more.
Til Luchau:
Yeah, we’re going to have to dive into that.
John Sharkey:
Well, visually it would be much easier for me to show you, but if it looks like it’s shortening, that’s exactly what it is. It just looks like it’s shortening, but nothing is actually lengthening, right down to the molecular level. You’re just getting things moving relative to each other. But we’ll come back to that in a moment. Gluteus maximus never shortens. You never need to do what people call stretching on gluteus maximus. It’s just-
Til Luchau:
You’re talking about a resting state, a steady state, a permanent state is fairly constant. There’s not great changes in that-
John Sharkey:
It never shortens and it never lengthens.
Til Luchau:
All right, I’m with you.
John Sharkey:
What you might get is you might get hypertonicity, increased tension. And by the way, what do we do if you get an upper trapezius, and it’s tense? Tension is a feeling, tension is a sensation. So what do we do? We stretch it. So people look at the medical world, I’m responsible for training undergrad med students and post-grad specialists and they say, “Oh, you guys only treat the symptoms.” Well, tension is a symptom. And what do we like to do to tension? We like to stretch it. We like to stretch the symptoms. So be careful about finger wagging at other people. At the end of the day, people move their head away from their shoulder and they do this thing called a stretch and, like stretching the hamstrings, it just doesn’t really do anything. They’re stretching it the next day and the next day and the next day.
Til Luchau:
It doesn’t do anything in terms of a permanent deformation or actually changing some physiological length or something like that. Yeah.
John Sharkey:
Thank you. This is the great thing about conversations. Somebody can come in and just tweak what I said to make it that little bit better. And that’s fantastic. We can all offer something there. But let me just finish this real quick. So if we look at rectus capitus posterior minor, really, and remember we have to use hypotheses. We have to say, could I be wrong? Yes I could. But based upon the morphology of the tissue, based upon the neurophysiology of the tissue, placed upon its positioning, et cetera, we can feel confidence that this muscle is about giving feedback to you, to the human body, so that you know where you are in time and space.
Now, if you’ve got forward head posture, then you will not know where you are in time and space. So things that you just take for granted, you will walk towards a doorway and you’ll get to the doorway quicker, before you thought you were going to, or you’ll bang your elbow off things or you’ll bump your toe into things and people who know you will call you awkward. They’ll say, “Oh, John, your boy’s awkward.”
It’s because where you think you are and where you are, are two different things because you have forward head posture. So as manual therapists, our job is to see if we can offer therapeutic intervention to help this head to sit back on the neck in a more appropriate manner. As Ida Rolf would’ve said, “Put it where it belongs and ask for movement.” You were going to say something then. Sorry.
Whitney Lowe:
Yeah, I wanted to get back to the contraction and lengthening thing. So if we talk about just let’s say a discrete muscle tendon unit, something really simple like the biceps in the arm. If you flex your elbow, you are in fact, and correct me anywhere I’m wrong along this thought process here, you are bringing the two ends closer together, right?
John Sharkey:
No, no.
Whitney Lowe:
You’re not?
John Sharkey:
No.
Whitney Lowe:
Okay.
John Sharkey:
It’s real simple.
Whitney Lowe:
Fix me on that.
John Sharkey:
It’s actually real simple. And it would be easier to actually do this if we were on Zoom or if people could see exactly what I’m doing. But if you want to take a particular Sharpie pen, take a little Sharpie pen and you put a dot somewhere on your shoulder somewhere to represent origin of something, and let’s say you pick a point just distal to your elbow and you put a little mark there and you can call that the insertion. And let’s say then what you do is you do that motion that you call a contraction. You’re bending at the elbow joint. If you were to use a soft measuring tape and you hold it in place, you’ll notice that the measuring tape doesn’t actually change.
The measuring tape doesn’t get shorter or doesn’t get longer. So that’s a starting point for us. That’s just a starting point. So the distance between the origin and the insertion never changed. And of course, they couldn’t, other than you had a dislocation or subluxation or the tendon tore off the bone, then something might happen. But that origin insertion distance are not changing.
Whitney Lowe:
So how are you moving a limb? How are you moving a limb if the distance is not changing?
Til Luchau:
I love your premise, by the way. It’s so great to have something that blows people’s mind and they’re going, wait a minute, you’re saying no, you have to turn it around exactly how you think about it. But help me turn it around because I’m not there yet.
John Sharkey:
Oh listen-
Whitney Lowe:
By the way, our listeners can’t see, but Til and I both have smoke coming out of our ears right now. I’m trying to wrap my head around this.
John Sharkey:
We have to remember how have we ended up where we are in terms of anatomy? We could go back several thousand years, but I tend to go back, I know Joanne works with me quite a lot in, so we’re similar in this regard. We tend to go back to René Descartes. So we look at the 17th century, late 1600s. And René Descartes was a horologist. He was a philosopher, fascinated in watches and clocks. And so he thought that he could describe all living motion based upon those mechanics.
Now, long before him we had Morelli, and even before him we had Socrates, and further back if you wish to go. So we’ve got this language that we use in the human body where we talk about, for instance, joints. There are no joints in a human body. Now, if I say there’s no joints in the human body and somebody goes, “What are you talking about? Look at my elbow joint.” You have to understand what the word joint means.
And unfortunately, people have shortened it. It’s actually a pin joint, that’s what it means. And a pin joint means that you get two bars that overlap each other and then you have a pin going between them to hold them together. We don’t have pins going between our bones to hold our bones together. And bone is fascia. Bone is just part of the continuity, it’s part of the continuum. It just happens to be a stiffened, hardened connective tissue, harder than the stuff on your face and harder than this stuff that we call little mice.
It just happens to be a specialization, not spacialization, but specialization. It’s specialists. So if you deposit liver cells into the connective tissue, you’ll get a liver. And if you deposit muscle fibers, you’ll get muscles and so on. Now, I went from the gross part, from the superficial part. We’ll say it was the skin and we talked about a soft measuring tape, and you hold it in place and you’ll notice that the soft measuring tape doesn’t suddenly get smaller or shorter. So that’s telling you that those two points have remained the same.
Til Luchau:
That’s where I don’t get you. By soft, you mean flexible. You don’t mean elastic, you don’t mean it changes its length. You say a measuring tape between the origin and insertion of the biceps, a measurement would not change in elbow flexion.
John Sharkey:
That measurement would not change. But then we have to stop and say, right, okay, well what about the gaster? What about the gaster of the muscle? So gaster, what does that mean? That means muscle belly. What’s the nickname for your stomach? People call it your belly. So if you had some kind of an illness or sickness, you might have gastroenteritis. That’s where that word comes from. So the belly of your muscles are your gasters.
So we look at the gaster and we see, well John, if I do this flexing of my elbow joint, then I see some kind of a shape change there. I see it bundling up. What’s happening there? And that’s really where we’d have to get into the discussion. And unfortunately I’d say that we’re limited in terms of just a conversation where I can’t visually show you something.
But let’s say we go down to the cellular level or even further down into the nuclear level, you’re going to see that nothing shortens. You don’t get either atoms or electrons or protons shortening. All they do is they move around each other, they change. They change relative to each other. And that’s exactly what’s happening. It’s scale free. It’s happening at the nano level and it’s happening at the gross level. Although what you’re seeing is a shape change.
But let me, for you guys, once again, I’ll come back to the Slinky. People can go out and buy a Slinky in a toy store. And if you buy that Slinky and you hold it on either end and you pull it, you’ll see that you’re able to bring your hands apart. And the slinky looks like it’s lengthening, but nothing’s lengthening, although the whole thing is changing.
Til Luchau:
Okay. Now, in your description, your hands are coming apart, is that a distance change in your vocabulary?
John Sharkey:
Absolutely. Sure. I mean, your hands have moved apart, so your hands, they’re no longer closer together. They’re actually-
Til Luchau:
We’re in agreement about that, great.
Whitney Lowe:
Yeah. That’s where I was getting stuck is this idea, like the two attachment points being represented by your hands, each one holding the Slinky, that distance is changing.
John Sharkey:
Absolutely. And look, I mean, we’re got motion, we’ve got movement here. So something’s changing.
Til Luchau:
The angle’s changed.
John Sharkey:
The angle changes. All that sort of stuff is changing. But if you look at the Slinky, for instance, for those people who are just using your imagination, imagine you’re holding a Slinky, you’re holding either end of the Slinky and you’re pulling it. It’s a coiled spring. So what you have in here is what I’d call redundancy. You see? Let me give you another kind of example of it, if I can, and once again, oh gosh, I wish that we were together on Zoom or something, just so that I could give you this kind of a visualization. I’m trying to look for a piece of paper.
So if I have a piece of paper here, let me see. This is something I’m doing tonight so I have millions of notes, but I’ll take this one here. So I have a piece of paper and you see that if I push either end of the piece of paper, it coils into a curl. Can you see that? A U-shape. Yes? So I take a piece of paper. I’m holding it like an A4 page you’d use in your printer at home. Hold it either end, push it towards each other and you’ll get a U-shape.
Til Luchau:
The paper sags, it’s a U. Yep.
John Sharkey:
Yes, it sags. Now, if I fold it in half and I take my nail and you, oh gosh-
Til Luchau:
Put a nice origami crease in there.
John Sharkey:
They might not like that. Now if I push it, you see it moves completely different. Yes?
Til Luchau:
Like a V. Yeah.
John Sharkey:
Now, if I take that piece of paper, and let’s say I do three centimeter folds all the way along the paper. So when I say three centimeter folds, for those people listening, what you’re now trying to do is you’re trying to create an accordion effect. Yes? And now we have an accordion effect. So now what I do is I take the page, I hold it on one end and I lengthen it, and then I shorten it. You see? I lengthen it and I shorten it. Nothing lengthened and nothing shortened. Why? Because this is a piece of paper.
Til Luchau:
The piece of paper hasn’t changed it’s dimensional length at all.
John Sharkey:
Now watch if I stretch it. Are you ready? There we go.
Til Luchau:
Yeah, he’s tearing it apart.
John Sharkey:
Now, that’s lengthening it. And if I take my Slinky and if I just take up the redundancy, it looks like it’s lengthening and shortening. But no one element of this Slinky, lengthened or shortened. Now watch this. I take the Slinky and I really pull, as we say in Ireland, pull the bejesus out of it. Now look what’s happened? Is the slinky damaged? Absolutely.
Til Luchau:
Poor Slinky. The Slinky’s overstretched and isn’t recoiling.
John Sharkey:
It’s not going to go back. You will never get it back. And you can see this written on the abdomens of women who have gone through pregnancy and they even have the correct name for it.
Til Luchau:
And this is plastic deformation of the tissue.
Whitney Lowe:
Stretch marks. Yeah.
Til Luchau:
So let me go back a moment because this is something I have heard for many years, and I want to clarify my misunderstandings about this. In terms of a muscle, when we say a muscle is shortening, this is not what you’re saying is, for example, overlapping of sarcomeres, the contractile units in the muscle that allow the two ends to be brought closer together. Is that correct?
John Sharkey:
You guys have definitely got to have on Dr. Neil Peace from New York University. I’ll send him an email. I’ll introduce you two guys. His new book is out. You can order it at the moment, and I think it’s chapter five, so that you’ll get a whole new explanation of what we used to call the sliding filament theory. That’s just-
Til Luchau:
Not happening, huh?
John Sharkey:
Not happening. And think about it, by the way, once again for the listeners, if you guys place the palms of your hands together and then rub your hands together and say, “Well, what do you feel?” You feel heat. And you feel heat as a consequence of the friction. Mother nature would never construct a living structure based upon friction. The only way you get friction is the breakdown of chemicals in the production of this thing we call energy. Nobody knows what energy is, but we use it as a language of convenience.
So we break down chemicals, we call them adenosine triphosphate, and we produce energy. And when we do so we produce heat. And that’s how the human body produces heat. If you are producing heat by any other means, then that’s pathology. That’s not good. That’s why people who have arthritic issues, et cetera, they’ll tell you that their joints are on fire. Somebody who’s injured themselves and they’ve got inflammation, they’ll tell you that the tissue feels incredibly warm and hot. That’s pathological. So really, if you have heat being produced by friction, imagine that, things rubbing off each other. That’s not a pleasant thought.
Whitney Lowe:
I know we’re getting close to our time limit here, but I want to-
John Sharkey:
I’m really sorry guys.
Whitney Lowe:
Yeah, it’s okay. But I want to try to leave one thing with… Maybe if we can consolidate this into something for our listeners. This whole idea about we feel a person having limited range of motion and we try to increase their range of motion through stretching, massage, soft tissue manipulation, what are we doing and is this a good idea? It’s like, what’s happening here?
John Sharkey:
It can be. I mean, let’s put the word stretching aside for a moment. What you’re doing is you’re trying to return normal physiological range of motion. There is pretension in a human body and there is pre-stress. Let’s use classical, anatomical terms. What happens to a human body on death, almost immediately?
Whitney Lowe:
You have rigor mortis.
John Sharkey:
Okay. So that’s what a myofascial trigger point is. A myofascial trigger point is rigor mortis. It’s a rigor contracture in just a small piece of muscle tissue. There’s no need for ATP, there’s no need for electromagnetic… I beg your pardon. There’s no need for energy, and there’s no need for a nerve input. It can stay that way forever. Isn’t that amazing? And what you’ve got is a rigor contraction.
Now, further out from the sarcomere, you may have an endplate dysfunction and it could involve acetylcholine and all of that. But at the level of the sarcomere, what you have basically is a rigor contraction, which is a form of shortening of the sarcomeres, even though I’m using the word shortening now because it’s convenient for me. But what you’re actually getting is you’re getting rotations and spirals and things are moving relative to each other, and therefore they’re creating what we might refer to as a shortening.
So those people who are stretching, people are trying to return normal physiological or anatomical range of motion because it is short of that range of motion. That’s said, that can be a beautiful thing to do. I would just say be careful not to force your agenda on tissues. You have to have a conversation and that conversation is based upon knowledge and experience.
Whitney Lowe:
Yeah. Okay.
John Sharkey:
Kind of the best I think I could do, Whitney, in the time that we have. I’m really sorry. My other tutor has started class. I know-
Whitney Lowe:
Well basically what this has done is this just made me decide we’re going to have six more episodes to delve into a bunch of this stuff here.
John Sharkey:
Well, Whitney, you and I go back so many years, it’s just great to spend a bit of time with you. And Til, we’ve met each other now on a number of occasions. You guys are doing such great work. I love it.
Whitney Lowe:
Thank you, John.
John Sharkey:
To be involved with you guys and to have a few minutes to spend with you, it’s really been super.
Til Luchau:
Well, and every one of our conversations has been a part in an ongoing whole and to be continued. So thank you, John. Thanks for taking the time.
Whitney Lowe:
I really appreciate it. And thank you again for all of the magnificent work you have done. So can you share a little bit for our listeners, how they can find you, track you down, follow your work, that kind of thing?
John Sharkey:
Okay. So I’m useless when it comes to social media. I know people give out to me about it all the time. But Facebook, come on to Facebook. Facebook only allow you to have so many people. I think it’s 5,000 and that’s full, but they can follow, or JohnSharkeyEvents.com, and they can learn about me there in those two places.
Whitney Lowe:
Okay, wonderful. John, thank you again so much for your time. We really appreciate it. This was a very fascinating discussion and definitely to be continued here.
Til Luchau:
To be continued. If you’ve got to go jump off, we’ve got another minute.
John Sharkey:
Thanks, Til. Brilliant. Yeah, I’m going to jump off and I’ll talk to you again soon, right?
Whitney Lowe:
Okay, that sounds good. Thank you, John.
Til Luchau:
Thanks, John.
John Sharkey:
Thanks to you both. Bye.
Til Luchau:
Yeah.
Whitney Lowe:
So anyway, that was a fascinating discussion with John. He had to zip off our line here, but boy he brought up so many questions and things for me. I mean, what really stuck out for you as being interesting or fascinating sort of things?
Til Luchau:
I really enjoy John’s loquaciousness and his stories and his idea of anatomy. I don’t know if it’s his idea, but his practice of anatomy as a narrative art and historical personified, language-based picture that we can get of anatomy as stories. I really relate to the shared heritage there of being a Rolfer and being that world where it really, for me was my training, my original training was very much in line with what he was describing as position being paramount, and the continuity of different structures being the thing that is foreground rather than taking things apart.
And then the irony of him being such a precise differentiator in his language and ideas, we’re describing something in the terminology in very precise terms. Almost like making distinctions about something that’s not distinct and something that is a whole, by nature. And so trying to communicate the wholeness of that to find distinctions. Anyway, that’s me.
Whitney Lowe:
Yeah, I just found myself at least five or six times saying, whoa, wait a minute here, I got to dig into this dude. What are you talking about? In just a number of things that he brought up feeling like I want to explore this further, like these are many, many rabbit holes that I would want to dive deeper down into. I first met John, I think he and I first met at the very first Fascia Research Congress and that was ’98-ish or so, or somewhere around in 2000. Do you remember when that was?
Til Luchau:
No, I don’t. But I remember it was Harvard.
Whitney Lowe:
Washington. No, Harvard. Yeah, it was Harvard, in Boston. We had just fascinating conversations over the years and I just could sit and listen to him and I’ve got to think he’s one of the people who really pushes my envelope in thinking about things a certain way. So I get a lot out of those discussions. So we’ll have to continue that.
Til Luchau:
Any of those questions you want to bookmark or places that you didn’t get to dive in as much as you would’ve liked?
Whitney Lowe:
Well, I feel like I still didn’t get quite through with this thing about tissues elongating and this thing about positioning movements of the attachment points of bones that I want to revisit this because I’m not quite there yet.
Til Luchau:
Yeah, I think I know what he’s saying. I’m probably doing him a disservice. But I think he’s simply saying that the constituent materials don’t permanently deform.
Whitney Lowe:
Yeah, that’s kind of what I was getting at. And when he was talking about stretching, we’re not really stretching things because if we did actually put the kind of forces on to lengthen at more of a sort of microscopic level of that tissue, then it doesn’t have that degree. But then that calls into question, what about elasticity? I mean, tissues have some degree of elasticity and you can apply certain loads to them before they deform.
Til Luchau:
Yes. He was calling that anatomical range or functional range.
Whitney Lowe:
Yeah, yeah.
Til Luchau:
And the permanent question being the distinguishing word in that conversation. Usually, things are changing length all the time, but do they change their permanent or basic length that they return to in the absence of a motor input or things like that? Yeah.
Whitney Lowe:
Yeah.
Til Luchau:
That’s my guess. That’s what he’s talking about.
Whitney Lowe:
Yeah.
Til Luchau:
And by the way, fascia, at least Paul Ingram says fascia and fascist do share a root. Paul Ingram is, last I read, not a big fan of fascists, so who knows, maybe that might have a bit of tilt in lens there. I’m going to send that to John, that, at least according to Paul, they do share a common root. Although at the end of Paul’s article about fascia and fascist, he says, “I could be wrong about all this,” but who knows?
Whitney Lowe:
It’s kind of like some of those things are probably a little bit of the game of telephone of where’d this come from, kind of thing.
Til Luchau:
There’s that. There’s that. No, great stuff. We had some other things we were going to ask him about. We were going to ask him about bio integrity. For me, it really is the irony, like I mentioned, the irony of being very detailed and yet trying to convey and give people the experience of the whole. That’s what I enjoy. And then his master story. You set up some storyteller, you set up some tension, you set up some narrative tension by basically debunking some fundamentals and then you get to build your case around that new view with your response.
Whitney Lowe:
Right. All right, well, we’ll continue that discussion on a good bit, too. We just wanted to do a sort of momentary wrap up there, after, because there was a lot to take in there.
Til Luchau:
All right. So should I thank our sponsors?
Whitney Lowe:
Yes, indeed, let’s do.
Til Luchau:
He mentioned Andrew Biel. Andrew Biel is the author of Trail Guide to the Body, published by Books of Discovery, which has been part of Massage Therapy Education for over 20 years. Thousands of schools around the world teach with their textbooks, eTextbooks and digital resources. Books of Discovery likes to say learning adventures start here. They see the same spirit here on The Thinking Practitioner podcast and they’re proud to support our work, knowing we share the mission to bring the massage and bodywork community in livening content that advances our profession.
Whitney Lowe:
So check out their collection of eTextbooks and digital learning resources for pathology, kinesiology, anatomy and physiology at booksofdiscovery.com, where thinking practitioner listeners can save 15% by entering the word “thinking” at checkout. So we would like to say a thank you to all of our sponsors and thank you to the listeners for hanging out with us for these fascinating discussions, as well. You can stop by our sites for show notes, transcripts and any extras. You can find that over on my site at Academyofclinicalmassage.com. And Til, where can people find that with you?
Til Luchau:
Advanced-tradings.com. We love to hear from you. It’s great to read the little comments you put in your reviews, but it’s especially great to get your emails. So if you have questions or things you’d like to hear us talk about, email us at info@thethinkingpractitioner or just look for us on social media and message us there under our names. My name continues as Till Luchau. Whitney?
Whitney Lowe:
And you can find that for me under my name, Whitney Lowe on social, as well. And I would like to make a plug here about sending notices to us. We will say some things, probably, on this podcast or some of our guests may say things from time to time that are somewhat controversial and I would just like to let everyone know, please write to us if you don’t agree with something that we’ve said or something really hits a button for you or something like that. I like to know those kinds of things because it really does understand more about what’s happening here. So please feel free.
Whatever your feelings and thoughts, we want to hear from you, so please feel free to do that for us, as well. In addition, you can rate us on Apple Podcasts, as it helps other people find the show. And you can hear us on Spotify, Stitcher, Google Podcast, or wherever else you happen to listen. So please do share the word, tell a friend, and thanks so much for hanging out with us here on The Thinking Practitioner. We will see you on the next time.
Til Luchau:
That makes me think, if somebody didn’t like something we said, can they go gossip to a friend? Can they go tell a friend like, “Oh, these guys-“
Whitney Lowe:
Hey, why not?
Til Luchau:
There’s no such thing as bad publicity, so please go tell a friend, whatever you want to tell them.
Whitney Lowe:
That’s right.
Til Luchau:
It’s great that you’re listening. Thanks very much everybody.
Whitney Lowe:
Okay.
