It is my belief that the fundamental basis for all orthopedically oriented hands-on manual and movement therapy, whether it is assessment or treatment, is a firm understanding of anatomy. This is true for palpation or orthopedic assessment testing, soft-tissue manipulation massage, stretching, or joint mobilization treatment.
With a firm knowledge of anatomy (structure) we can figure out physiology (function). And once physiology/function is understood, we can then reason through and understand pathophysiology; from there, we can critically think to determine the appropriate assessment and treatment.
It all Stems from Anatomy
Unfortunately, most of us learn anatomy with the intended goal of passing exams, after which we promptly forget much of what was learned as we turn our attention to the more appealing subjects of pathology, assessment, and treatment. This is somewhat understandable. After all, anatomy is little more than a naming game in which we assign names to all the structures of the body. And this process requires memorization, which is not exactly exciting; in fact, it can be quite boring.
Yet, learning anatomy is the dues we must pay in order to truly learn and understand physiology, pathophysiology, assessment, and treatment. In other words, if we first memorize anatomy, then we can figure out all the rest. But if we do not first learn our anatomy, we are doomed to memorize physiology, pathophysiology, assessment, and treatment. Not only is this labor-intensive, it also encourages rote memorization as the approach to our manual/movement therapy practice, which then encourages our tendency toward looking for cookbook recipe treatment techniques. But armed with a fundamental knowledge of anatomy, we are empowered to critically think through the mechanism(s) of our clients’ conditions. This then allows us to creatively apply our hands-on assessment and treatment techniques.
So even though memorizing anatomy might be onerous, once done we are armed with a knowledge and understanding of the structure of the body and a language we can use (kinesiology terminology) to discuss and understand all the function, altered function, assessment, and treatment we will need to know to appropriately treat our clients.
How to Best Learn Anatomy?
How can we best learn anatomy as the basis for our successful manual/movement therapy practices? There are several keys:
Excellent Anatomy Instructor
The best way to learn anatomy is to have an anatomy instructor who can not only clearly explain the anatomy we are learning, but can also make it interesting and applicable by drawing connections to the patterns of how the body is structured. Also helpful is the anatomy teacher who understands manual/movement therapy and can explain how the anatomy knowledge being studied at the moment will relate to hands-on assessment and treatment skills that will be learned later.
Excellent Textbook
Another key is to have a textbook that, like the teacher, both explains the anatomy clearly and also relates it to the applications of the hands-on manual and movement therapy skills that will be used later in practice.
Quality Digital and Other Resources
A third key is to take advantage of all the other resources now available to the student and therapist. This includes video resources that can help make anatomy visual for the manual and movement therapy student/therapist. Another excellent learning tool is to attend an Anatomy in Clay workshop (or other such workshop in which the student makes the muscles of the body in clay and applies them to a miniature skeleton). This adds the component of being kinesthetic, which is so valuable given how many people in the fields of manual and movement therapy are kinesthetically oriented. It also requires being creative as you actually form and create the muscles you apply to the skeleton.
Plastination Cadaver Exhibits
It is also possible to visit plastination cadaver exhibits. These exhibits have the advantage of having cadavers that have been beautifully (and often artfully) dissected and presented. The disadvantages of plastination exhibits are that there is no instructor present for detailed explanations of the cadaveric anatomy, the fascial tissues are often dissected away, and palpation is not possible.
Cadaver Labs
No anatomy learning experience can rival the knowledge one gains by attending a cadaver lab workshop in which the participant can actually see and work with the true three-dimensional form of the human body. There are generally two types of cadaver lab experiences: observational labs and dissection labs.
Observational Cadaver Labs
Both observational and dissection cadaver labs are excellent, but of the two, observational cadaver labs are far easier to attend and require less investment of time and money. In observational labs, participants simply observe the body that has already been dissected by others, often students at the university where the cadaver lab is located. All the better if the participants are allowed to also palpate the dissected structures, because this adds the kinesthetic component so valuable to learning. Observational cadaver labs are usually anywhere from 4–8 hours and can be done in one day.
Dissection Cadaver Labs—The Gold Standard
The gold standard cadaver lab experience is attending a cadaver dissection lab workshop in which participants perform the actual dissection. Of course, this is done under the supervision of experienced instructors who not only know anatomy but also have expertise in guiding the dissection process. By virtue of the time needed to perform the dissection, these labs are much more time intensive and usually require the commitment of five or six days if the entire body is dissected. Consequently, these labs are also costly. However, they are well worth the expense given the knowledge base and increased understanding the student gains from the experience. The beauty of cadaver dissection labs is that the participant is able to actually uncover and discover the structures of the body as the workshop progresses. Further, the time spent allows for reflection, application, and appreciation of the inter-relationships between the structures being dissected.
Fresh-Tissue Dissection Lab—The Platinum Standard
If attending a dissection cadaver lab is the gold standard for learning anatomy, then attending a fresh-tissue (unfixed and unembalmed) dissection lab is the platinum standard. Fresh-tissue cadavers are much more realistic and lifelike than embalmed cadavers, both in their appearance and structural texture, as well as their flexibility. Especially valuable is that full joint range of motion is still present.
Also, because no embalming fluid is used, participants are not exposed to the possible deleterious health effects that embalming fluid might impose. However, it should be stated that the smell of fresh-tissue cadaver labs can become less pleasant as the days proceed during the week.
Diamond Standard
All of these cadaver lab experiences are excellent. But the diamond standard would be if the instructor who leads the cadaver dissection lab workshop has experience in the field of manual and movement therapy. An experienced instructor can apply the anatomic structural knowledge to the hands-on skills in the field of the participants, thereby increasing the appreciation of the anatomy being learned.
For example, if a manual therapy table is located somewhere in the lab, then after a specific muscle, perhaps the quadratus lumborum, has been dissected, the class can have a demonstration of how to palpate and stretch the quadratus lumborum. If there are enough tables, then in addition to watching the demonstration, perhaps all the participants can practice the palpation and stretching skills demonstrated. Marrying together the fundamental underlying anatomy science with the assessment and treatment of hands-on skills would truly be the diamond standard of learning.
The Institute for Anatomical Research
I have been teaching cadaver labs in the world of manual and movement therapy for well over 25 years. And, as written here, I believe strongly in the value of attending cadaver labs to learn anatomy, and from there, to critically think and creatively apply our hands-on skills. For all the time I have been teaching cadaver labs, I have used an excellent cadaver lab at the University of Bridgeport, near where I live in Stamford, Connecticut. But, being part of a university, there have been some limitations with the use of this lab.
However, as coincidence would have it, while attending a five-day fresh-tissue cadaver dissection class taught by Tom Myers in Arizona, a fellow attendee who lives in Asia told me about a cadaver lab in Colorado Springs, Colorado, that is owned and run by a massage therapist! I contacted this lab and was so impressed that I began using their lab to run my cadaver dissection workshops.
The Institute for Anatomical Research was created and is primarily oriented toward the world of massage therapy, and more generally, all manual and movement therapy professionals. What a pleasure to have such as resource in the world of massage therapy; it is truly a gem!
So, without further ado, I would like to introduce our Massage & Bodywork readers to Bonnie Thompson and James Pulciani of The Institute for Anatomical Research. Thompson created and is the director of the lab. Pulciani is the lab’s director of education. The following is an interview with them both.
A Conversation with Bonnie Thompson and James Pulciani of the Institute for Anatomical Research
Can you first tell us a bit about your backgrounds?
Bonnie Thompson: My entrance into manual therapy began in 1986, when I went to massage school in Colorado Springs, graduating in 1987. I began teaching at the school I graduated from immediately after graduation and became increasingly curious about the human body. Then I met Judith Delany and started as an assistant to her seminars before becoming a primary instructor of her workshops. Teaching really pushed me to understand the human body in depth. I also started my private practice and found that the more I understood about anatomy, the more I was able to help clients with their pain and dysfunction.
James Pulciani: I started out with a BA in Education from the University of Colorado in 1991 and received my massage certificate that same year. I went on to study traditional Chinese medicine, graduating in 1997. I published my first textbook, Holistic Bodywork—Blending Modern and Ancient Bodywork Principles, in 2008. Since then, I have written other textbooks. I have been teaching anatomy and physiology for 15 years and I have a private practice in massage therapy and acupuncture.
What motivated you to create The Institute for Anatomical Research?
BT: I met Gil Hedley in 1996 and did a dissection class with him and realized how different yet similar all our bodies are. It was a fascinating, eye-opening experience! Then, after working with cadavers, I realized how good my palpation skills had become. However, access to cadaver labs was very limited so I decided to try and find a lab at the local university, college, or even morgue. But every lab was unavailable because it was open only to current students and staff. So, I decided to open my own cadaver lab. I looked into all the rules for starting a business, especially the unusual business of a cadaver lab. I needed to find a location that would allow a lab and I worked on finding funding. After five years of dreaming and working to make the dream a reality, I was able to open The Institute for Anatomical Research.
JP: I would like to add that I had a similar experience with learning anatomy. I thought I knew anatomy well until I started coming to the lab here. There is such a difference between book learning and having a full sense of anatomy. It was in the lab that I truly began to understand the three-dimensional relationships of the structures of the body. The incredible work that Bonnie has done to create The Institute for Anatomical Research has afforded me the opportunity to hone my anatomy skills and increase my teaching and clinical effectiveness. Now, working with Bonnie, we are looking to afford that opportunity to other therapists and health professionals.
Tell us about The Institute for Anatomical Research.
BT: Our lab is nonprofit and open to all levels of learners. We are here to inspire a deeper understanding of our bodies and how to safely and efficiently perform manual and movement therapies. We are also here to inspire an understanding of, and develop science-based protocols in order to validate what we think we are doing when working with dysfunctional posture, movement, and pain patterns. We create custom classes for observation and/or dissection of cadavers.
Some classes are shorter and explore one region of the body. Other classes are longer and more in-depth and involve whole-body dissections. We are also unique in that people are able to donate their bodies directly to us. This means we have information on the donor, which helps develop an even deeper understanding of why we are finding and seeing some of the things we do during our exploration of the donor body. The fact that we are not associated with a college or university gives us the ability to truly tailor teaching and learning to all levels. We are also open to the lay public, not just health professionals. After all, everyone possesses a body, and having a greater knowledge of that body allows us to make better decisions regarding our health and treatment choices that can inform and improve our lives.
Who works at the lab with you?
BT: Because we are a nonprofit, we are run by a board of directors. Jim Pulciani is our director of education and teaches most of the classes now while I more often work behind the scenes as the administrative director and scheduler. And we have the assistance of a great group of dedicated volunteers who are all as passionate as Jim and myself about the work that needs to be done in order to bring understanding to our quality of life and advance our professions. Allopathic medicine keeps people alive, but I believe that what we do is help people live healthier lives.
What makes your cadaver lab different than other cadaver labs?
BT: Our lab is different primarily because we are independent, so we can create classes independent of a prescribed syllabus. Also, the fact that we can get history on our donors makes the learning we offer even deeper. When you receive a donor from the state anatomical board, there is cause of death and age but nothing more; we try to understand how that person lived so we can see adaptation patterns that were created during their lives and the impact it had on their bodies. Also, because Jim and I are in the world of manual therapy/complementary alternative medicine, we are able to apply the anatomy that participants see to their manual or movement therapy profession.
JP: As therapists, we always see and palpate the body through the skin. We can only guess at what we are feeling underneath. In the lab, we get to see and palpate a body with the outer layers removed. We get to see what we are compressing or, in my case, putting needles into. We can move the muscles and fascia to see how they react. We can often see the depth of scars and other vestiges of injury or surgery. It has greatly changed my practice for the better.
BT: I would like to add that we also host other continuing education instructors in the fields of manual and movement therapies and complementary alternative medicine. They can offer observational cadaver lab workshops, demonstrating the anatomy we have already dissected. Or they can offer dissection cadaver lab workshops, with either embalmed or fresh-tissue cadavers, allowing their participants to perform the actual dissection. We also have a lecture classroom and a manual therapy treatment table for their use. In this way, they can link the fundamental anatomy they have just seen in the cadavers, that underlies their technique, with the lecture and hands-on application of their technique.
What are your goals with The Institute for Anatomical Research?
BT: Going forward, I would love to see The Institute for Anatomical Research become the place where everyone feels they are able to come and learn at whatever level they please. I would like our institute to be the leader in creating an understanding of function and dysfunction, so we can help massage therapists and other manual and movement professionals become more effective at treating people in pain and discomfort. I would like the institute to offer a place to learn at a level beyond what the books teach us. It has been an honor and a privilege to create and run this cadaver lab, and I am gratified that anyone and everyone who wants access to this learning now has the opportunity to do so.
JP: And, as Bonnie said, the lessons we learn in the lab are to be shared with the greater public as well. Everybody can benefit from understanding how the body functions and how it experiences dysfunction. We want to continue our mission of reaching out and helping therapists, and even the general public, learn more about the human body and what we can do to improve our health. We are constantly looking to improve our outreach and educational opportunities. I would like to extend my hand to anyone who would like to join us on this mission.
If someone is interested in contacting you to learn about how they can learn or teach at your lab, how would they do so?
BT: They can contact me through our website,
www.anatomicalresearch.org, or email me directly at bonnie@anatomicalresearch.org.
JP: We look forward to seeing you at our lab, which, by the way, is located right at the foothills of the beautiful Rocky Mountains!