Dissection of Muscle

water birds chirping water water water water Accepting for the few initial visual references here and in the last sequence to this female form, all of the footage of the deep fascia and muscle layers were shot from a single male form featured in the images you've seen so far here. In this way, I stress the continuities and variations of tissue and texture from place to place and surface to deep that can be found in one given human form. Dean Juand's wonderful book, Job's Body, inspired me years ago with his presentation of the idea that there is really one muscle. My emphasis on muscle as a whole body layer, and perhaps my emphasis on layers in general, is rooted in that initial inspiration and confirmed by lots of laboratory experience. I imagine a whole human form as a marvelous twisty-tied balloon figure like street entertainers make for children.

The fascia and other connective tissues are the conforming surface of this single, fantastic balloon, which is filled either with muscle proteins or the crystal of the bones or the tissue of the organs or nerves. And through the twisting, folding, bending, and shaping movements of development, starting with the embryo, the recognizable human form ultimately emerges balloons within balloons within balloons, all universally related through the connective tissue matrix on in through the cytoskeleton, one muscle, one body. I use the term muscle fluffing to describe the process of differentiating the muscle layer with my hands or a scalpel. This process generates more or less the familiar forms taught in the anatomy courses and represents an opportunity to observe and thoroughly feel into the many relationships which comprise the depths of the muscle layer. For every emotion, every human response, every thought, there is a corresponding whole body signature of tonus throughout the muscle layer.

Each one of us in the human community represents the signatures of joy and sorrow, exhilaration and fear, compassion and love. Through the outwardly visible motions of our muscle layer, our emotional expressions rooted in both cultural and personal habits are patterns traced one way or another by and in our muscle layer. I just gently, I could do this with my finger, but the trap is so thin here, I don't want to break it, so I'm just gently lifting up, lifting my scalpel through the fuzz, lifting along the way here to find its border, creating a creating difference where there is a continuity of surface, I'm creating a difference with my scalpel. So this is some filler tissue actually filling in this triangle over the scapula and we run out of traps, we run out of latissimus dorsi, so that's what this thing I'm lifting up is here. It also has vasculature in it.

It's no less important if we have a half an inch thick fibrous fascial tissue filling in a gap between muscles. The muscles are famous, but the fascia isn't very famous, but golly, if it can't become bound up and require the introduction of movement and freedom of action, range of motion, et cetera, some more of that ephemeral fuzz, the ever present and ever disappearing fuzz that underlies these various muscles, just like this is reminding me of when I was differentiating the superficial fascia and another shot a while back and you can kind of peek underneath in this long arc of tissue and see what's underneath. Here's a tacking down spot, you see? The fuzz isn't thin here, it's very thick, right? It becomes a more durable structure at this point and I have to work my scalp a little bit more firmly to lift up the trapezius muscle at this point coming up towards the spine of the scapula.

It's very thin and then as we trail up along here, it gets thicker and thicker and thicker, so it's quite sturdy at this point and if I'm underneath it, I can really begin to lift up and peek under the trap and see what's under there. Nice. The tissue is not as thick as in the area where it wraps around and attaches to the arm. Do these overlying fibers of the latissimus dorsi where they overlie the inferior margin of the scapula here. See that? The scapula, I'm reaching underneath the lat to touch the scapula. So the lat actually comes all the way up over this inferior most portion of the scapula.

So you can say, wow, does the lat attach to the bottom angle of the scapula? Well, sure, I just had to peel it off there. It was attached to the fascia. It's not that the fibers are attaching to the scapula here of the muscle, but it's tied in to this whole fascia triangle here and then kind of stuck down on it. So there certainly can be limit cycles of motion created in the arm based upon the relationship of the lat to the scapula. You can see my fingers sweeping under here and I'm getting hung up on various fibrous relationships between the back of the lat and the thorax.

So now I'm fluffing the lat from the other side. And it's coming up and up and my fingers are meeting in the middle. That's nice. I was feeling this tug tug here. So that tug tug is a fascial relationship of the latissimus down to the bottom margin of the scapula here.

So we're talking off camera about, maybe there's a vessel in there. I'll have to check as I go through it, maybe a vessel. I'll scratch it and see what happens. Is there a vessel in there? Yeah. There's a little bit of artery in there, a little vein here as we come through.

So the blood vessels of the body are actually tying our musculature together through fascial sheets. The fluffing only happens as a result of breaking through relationships of the vasculature and the nerve tree reaching up from one layer to another, from the inside to the out, from the core to the periphery, from the trunk of the tree to its branches and its limbs and its leaves. It's not just floating there. It's tied in through the fascia. So if you're ever working the musculature, bear in mind that it's not an independent structure, but it's a structure that's in relationship, that's buried in fascia, that's sewn in through the fascia, that's penetrated by vasculature and nervous tissue, which then selves our structuring elements of the body. The bulkiest part of it is this section here on the side.

It's very thin elsewhere. And then it comes back down to a sort of a ribbon as it sweeps and dives and twists. So what a spectacular, broad muscle it is, all the way down the back in this cell. Here's a muscle of the arm sweeping your arm when it reaches out, reaches out from your sacrum, better yet from your feet. If you support the movements of your shoulder girdle and of your hands even from your feet, you can have the support of the earth in your movement.

If you support the movement of your hands from your elbow, you're going to have a sore elbow, maybe even a sore wrist, et cetera. So very nice trap and lat. And if we see the border of the trap here and the posterior border of the sternocleidomastoid here, then what's this window all about? There's a little window in between the two. And of course the deep fascia spans across that window to invest the trapezius muscle and the sternocleidomastoid muscle.

That's actually the first lamina of the deep cervical fascia. So it's in continuity. This tissue here, this deep fascia is in continuity with the fascia lata of the leg. It's in continuity with the deep fascia of the whole body. If you cut through muscle all day, it wouldn't ever dull your scalpel blade because the muscle fibers themselves, those proteins yield.

Well, you look at them and they fall apart. Whereas the deep fascias are so fibrous that they dull the scalpel. In the same way, the skin dulls the scalpel very readily, whereas the superficial fascia does not dull the scalpel. So that's another way to get a sense in terms of the differences between the layers of the body. See, I'm marking out the line of the trapezius as it comes through here while I shave into this little spot.

Anyway, what I was saying is when we're talking, when we're having a layered conception of the body, the fibrous denser layers like the skin and the deep fascia and the bags of the viscera are sort of flat, thin layers, relatively speaking. They don't expand and contract in great degree over the course of a lifetime. Yes, true something might become more fibrous. Whereas the muscles, you can have huge muscles or little ones and that can change over your life as you... I used to do bodybuilding. My muscles were much bigger and I quit bodybuilding.

My muscles got smaller. If I gained a lot of weight in my fatty layer, I could change my shape completely. But it'll be rare that I would change my shape based on the expansion of the thickness of my skin or of my deep fascia. So peeking through this window now, I've gone fairly deep into it and I'm actually uncovering the splenius capitis as it peeks through the window between the line of the sternocleidomastoid and the line of the trapezius muscle. We see the sternocleidomastoid, but again, if I reflect it away in this groove here, I have more grizzly fascia, more fatty layer, more intervention.

Again, what needs the work? What is at issue? Is it this clumping of tissue that inhibits the sliding surfaces from playing against each other in the muscular action or is it the tonicity of the muscles? Maybe it's just the way you feel about the world that day that's getting you down. People often look to the nervous system to try and understand the tonus of musculature and I don't. I actually look to the emotional life and the will because muscle tonus is an ethical question, more so than a physiological one because I can't tell you how many clients lying on your table aren't really all that tense and all of a sudden you find you're actually working their resistance to you and it's about your relationship with them. So you'll have a person who says, oh, work deeper, work deeper and you'll work deeper and you'll work deeper and they'll say, oh, you've almost got it, but not quite and you'll go a little deeper and you'll actually find that you're butting heads with this person.

You're in a contest to see who's stronger. They can provide more resistance than you can provide leverage and sometimes they win, sometimes you win. But if you shifted their relationship, you might be able to talk for five minutes and they'd be soft as butter. It's ultimately their responsibility to let go and not yours to make them let go. You know, Gil, with regard to fascia, with all of the new studies that have been done, just fascia plasticity and the connectiveness of the autonomic nervous system with finding smooth muscle cells in fascia, that now there's, even how you were saying, there's this tone that can occur in the fascia simply because of emotional distress, that if you're emotionally distressed that the actual tone of the fascia becomes more gel-like instead of liquid and that in turn is going to cause that stiffness in the muscle.

So the complaints that clients get for muscle ache really may be more facially related and this gristle, like you call it, rather than muscle at all. Yeah, it's like a question that once you kind of grok the layers, once you get a sense that there are these layers and you establish your own sensibilities and relationship with it, then it gets easier and easier for you when you meet a person, to work with a client, when you work with yourself, to say, you know, what's going on here is about a cloud of tension in this area of my body or it's about maybe it's the fact that I hate, I hate the way my fat lies on this spot and so I have a holding here around that disposition that's actually generating more of it or whatever, in other words, you become capable of interpreting which layer your problem's lying in. It's very arbitrary, the naming of muscles, not insofar as the names aren't descriptive, but there are other ways that they could also be described. That could be equally informative or more informative. Maybe we ought to be required to name every muscle three times and that would get our heads out of the rigidity of the nomenclature.

The attachments of muscles are often not at their ends, but all along the way. So here's another septum. You see this white line? That's the deep fascia having dove down, wraps around and yet it dives down and creates these compartments and I can just, here it's a little easier to tease the flexor digitorum superficialis away from the septum here. It is more of a sliding surface in this instance. I can keep sliding my thumb along and I see here some deep fascia still here.

I have not completely exposed the septum I see. It was similarly colored, I didn't notice it before. Yeah, I have a whole slip of the deep fascia here, which I can tease off. And underlying that, we start to see the tendon of the flexor digitorum superficialis. Again, the tendon of the flexor carpi radialis.

And I'll keep teasing back the septum here with my thumb trace along. This is an easy one to differentiate this time. Unlike here where the muscle fibers were attached into the septum, on this side they yield quite readily and I can spread my musculature apart, differentiate it quite easily. Oh, this is a nerve here. The ulnar nerve.

Here's the ulnar artery with all of these beautiful little tiny arteries feeding the muscle all along the way on either side. Here feeding the flexor digitorum superficialis. Here again. And here feeding the flexor carpi ulnaris. And we've got that median nerve going through there, going through the tunnel on the thumb side.

That's as good a shot as anyone ever needs in a carpal tunnel, huh? Yeah, it's good for my eyes. Oh, the nerve tissue. That's neat. Isn't that pretty?

That's just too pretty. All of that. That's a median nerve. Now I'll sew my way underneath there. Oh, they're not going to believe this.

This is great. The arteries. See? Yeah. And that's the artery.

I'm going to only extend it in three seconds. And here's the deep fascia burrowing its way under. And as I lift it, we can see here incredible fine, thin fibers. Like cotton candy. Just as I pass my finger through it, it's going to disappear.

Yeah, you'll follow me. See, as I lift the fuzz and I pass my finger through it, it disappears and we define out another layer of tissue. You see the back of the rectus femoris here, this incredible tough silvery. It's like a salmon skin. And then beneath it, we see the silvery, fibrous tendinous quality of the vastus intermedialis beneath the rectus femoris here.

When we trim the tissue, then we are differentiating it even more. But I like to just acknowledge it, that it doesn't exist like this. You have to dissect away these intermediate tissues in order to demonstrate the muscles as independent structures. The muscles are not independent structures. The muscles are created structures.

So I'm creating a gracilis here by cutting away that fatty tissue by... See, look at this now. You see my hand passing under here? That's fascia there, right? Now there's the muscle tissue and the fascia that's relating it to the next muscle.

But watch. If I go and take my finger and pass it through here and yank back and forth, right? And then it gets a little tough if I yank too much. Watch your finger. I'm going to use a scalpel now. If I yank too much, I'll tear it because it gets a little delicate.

When you start ripping the fascia, there's nothing to hold the muscle together anymore. And the muscle will rip itself. So you have to be a little more delicate once you've poked your finger. But now, look. Now I've created this thing. It's a fake.

I cut off his blood vessels. I cut off his nerve supply. I cut off the fascia. I round it one way or another. But now I've created the muscle that's in the flashcard book called gracilis.

And the muscle in the flashcard book is drawn just like this. And it has its origin and insertion. It's attaching up here at the pubic bone. And then it's attaching down there at the pes anseris beneath the knee. Okay, so which is it?

I think that the reality of the matter is that it's a tissue balloon. It's a connective tissue balloon filled with certain proteins that are contractile. And it's simply an aspect or a dimension of a much more complex array of balloons. And yet, if we want to talk about it, it's fun to take gracilis apart, in a sense, and define just the muscle tissues. I'll cut here.

And we'll get down to its tendon. See, it comes down to a tendon. Now, look. If you look at it carefully, you have all this muscle tissue here, right? And every one of those muscle cells is surrounded by connective tissue.

Each set of proteins is buried in connective tissue. Now, look at here. It's getting skinnier and skinnier. The muscle proteins are petering out. And what's happening is all that connective tissue that was wrapping those muscle cells are continuing on.

And so what you have here, it's like a water balloon and a water is getting drained out of it. So by the time you get down to here, there's no more. Yeah, it's just a balloon, all empty balloon. And that balloon doesn't really attach. It doesn't attach like it snaps on to your leg.

It doesn't attach in that way. It arises from those tissues. It's in relationship with them. You have to cut them apart. It blends into them.

It melts into them and turns into something else. In a real sense, the muscles are things that are easily differentiated. The mental concepts of the muscles are things that are easily differentiated. And that enables us to say, oh, look, here's a really long one. Or, oh, here's a big one on the inside.

And that gives us the names of the muscles, although it does not represent functional units because anatomical conceptions of musculature are very different than the functional units, which are the motor units. When we see the atlases, when we see the drawings of the artists, they're tending not to draw in the little yellow lines. They're cleaning the tissue up quite perfectly, so you would never have known that there really was a solid relationship of these tissues. It's only by working our hands into the tissue and dividing these relationships that we can begin to differentiate. There can be a tremendous amount of bulk to the muscle layer.

There can be a tremendous amount of bulk to the superficial fascia layer, whereas the skin and the deep fascia are never bulky. They can be extremely fibrous. They can be tough. They can be leathery. They can be strong.

But they're never bulky. Here, I've begun to reflect the muscle tissue, the vastus medialis muscle above the knee. Look at the incredible convergence of tissue textures. The adductor magnus tendon, first cord-like, diffuses into a fibrous sheet and then diminishes in thickness again, blending into the translucent periosteum of the femur. The sacking around the knee is comprised of many layers of fibrous thick fascia, which themselves blend with even thicker ligamentous structures.

The loose aerial or fatty pad softens the relationship of the muscular action relative to the bone and the muscle tissue itself. Tissues within the body are highly differentiated and specialized despite their complete continuity. We can see the slack that builds up in the Achilles tendon and the soleus. And if I dorsiflex the foot, we can see the stretch that comes into the tendon. These fibers that are really running in many directions here, they're coming this way.

They're coming this way. They're coming this way. Really leveraging on the calcaneus. And boy, what incredible effect of awe. That's beautiful.

Look at the way the light's coming on to this. Here I've taken a patch of it out, and here it's still remaining this fibrous tissue. And as I work the calcaneus and loosen the calcaneus, this is a beautiful way to work on the living as well, when you just create multiple vectors of movement. And I can even get my hemostat under it. See, the tendon.

And it's coming around the medial malleolus, malleolus like the hammerhead here. So I'm actually going to slice through this sheathing of the tendon so we can expose it more carefully. Again, the deep fascia has woven itself around the tendon. It's above it. It's below it. It's around it. And then the tendon itself will slide within this sheath, this tendon sheath that's in continuity with the deep fascia.

And here's that filmy layer we've encountered. And I'm differentiating out this filmy layer. The filmy layers are like veils that hide the tissue from us. And in some sense, the somanaut, the person who's exploring inner space and diving into the body, has to muster a certain amount of courage to blast through a veil to see the next level of the form. If you're not willing to pass through the veil, you'll never get to the other side of it.

It's tucked so beautifully, so elegantly. Isn't it awesome? It just slides in there. It's lived there its whole life. And this tendon has never had an independent existence until this very moment.

So I'm going to cut around this way, so I don't want to hurt the gluteus maximus, of course. And we see here actually where the gluteus maximus tissue, the muscle tissue, is rooting into the bone of the femur right here. And then higher up, the gluteus maximus tissues are rooting into this material of the tensor band. So I can continue to differentiate now, having noticed these things. And we can see the biceps femoris dividing at this point.

It sends down a bunch of fibers right into this fibrous septum between the vastus lateralis. Here we have vastus lateralis hanging in its heaviness here. And the septum between vastus lateralis, and we know where this septum came from, it was spun off of the deep fascia. Can you see these beautiful stripes? Look at them going in both directions.

Come in close to this and have a peek. It's quite amazing. So we can see in the particular hamstring of the hamstring group that borders the border of the hamstrings and the quadriceps, the vastus lateralis here and the short head of the biceps here. Short head, long head, short head, the long head goes further. The short head stops short.

That's how it got its name. Attaching down by the fibular head, the short head of the biceps comes on in to this septum of fascia and ultimately to the femur, which this septum of fascia connects to. And here the long head travels all the way up, all the way, all the way. In its midpoint, it's sort of joining up here. We can see how the long head joins up with the next major muscle here, attaching down so they form a common tendon where they attach on to the ischial tuberosity here.

So this muscle, if I follow it down in the other direction along the knee, becomes thinner and thinner and eventually forms a long tendon. It's semitendinosus. It's partly tendinous, this muscle. So that's how it earned its name. And if I take the deep fascia away from semitendinosus, we freshen it up a little bit that way.

You can see that semitendinosus has this tremendously long tendon now that's wrapping around with gracilis and sartorius into the pes ancerus, the goose's foot in the front of the knee. So here my finger is running under the tendon of semitendinosus and I trace the muscle all the way up to where it joins into the fascia of the long head of the biceps femoris and ultimately together they attach here. They root on to the bony ischial tuberosity, the sitz bones. So that's a nice demonstration of three heads of the hamstrings. So we have the short head of the biceps, the long head of the biceps, the semitendinosus with its long tendon reaching around the knee.

You'll notice that intervening deep to the semitendinosus and the biceps femoris muscle is plenty of fatty tissue. And it's a filmy tissue, a filmy fatty tissue. And I can just scrape it away, it's very thin here as this gentleman as we noted when we looked at a superficial fascia was quite a thin fellow, relatively speaking. And we see this beautiful shiny tissue coming out here underneath that film and we can give it a name too. Golly, this is very membranous you might say.

We had one muscle that was semitendinosus and this one is semimembranous. It's semimembranous. See how it has this long flat membrane? We'll call it a membrane for the sake of the naming but otherwise we're usually calling this tough, fibrous, beautiful connective tissue. In this case it's a tendon and that beautiful shiny tendon is coming up and attaching way up here.

I can feel it. So now I'm tracing out the semimembranous through its compartmental division with the adductor group. So there's going to be adductor magis coming through here covered with this tissue. So semimembranous is quite glorious. You always find a fatty layer deep to the hamstrings running over the blood vessels of the thigh, deep near the bone.

So I'm just going to scratch at it a little bit because deep to this beautiful comforting fatty layer here are the great vessels of the leg running posteriorly. So we get behind the knee in the popliteal space and it's very fatty. That's the way it is. It's soft and smooth and wet and fatty. And I'm going to trim away some of this so we can see the vascular structures that underlie this thin fatty layer.

It's not a thick layer. It's just a thin filmy layer. I want to be careful so I can preserve the structures underneath it. So I'm going to scratch at it a little bit and break through that film to reveal not only the pathway of the sciatic nerve but also the artery. Oh, this isn't the artery.

This is the nerve. You're going to just be blown away by this nerve. It's like a garden hose running through here. Do you see this thing? That's a nerve.

Now this is the biggest nerve we run across in this dissection so far, huh? It is. We just keep going and going. Golly, there's a monster, huh? Look at that.

That is unbelievable. Look at that nerve. Holy cow. That is so much bigger in person. It's enormous.

It's like it's a mile long running from way up here and it runs all the way down right over the femur embedded in that yellow fatty layer. So maybe that yellow fatty layer is something we should be trying to get rid of. Maybe that yellow fatty layer is actually keeping your sciatic nerve wet and cozy. I think it is. We come down into the popliteal space here and the sciatic nerve will begin to divide here.

If we look at it as a very shock absorbing, movable area. Nice. Shock absorbing. It kind of keeps it protected. Fatty tissue keeps it protected from the constant strain that's put upon the knee.

Now here we look and we see that the sciatic nerve is dividing. It's going to divide into the tibial nerve and the peroneal nerve. And it does that right here in this popliteal space. So there's our division. So we have this huge monster cable running down here.

Remember your nerves are a wet system. It's chemical. It's also watery and electrical. So here we have this beautiful nerve. And I hope you can all remember this for the rest of your lives because it's just so spectacular.

The sciatic nerve. By example, I've begun to reflect the muscles commonly known as pec major in the deltoid here as a common unit, which I call delto pectoralis. While it is certainly possible to separate them along their shared groove, it's also possible to remove them together as one. That said, I could just as easily divide the pec major itself between the fibers which run from the sternum to the arm and those which run from the clavicle to the arm and name the portions sternobrachialis and clavicle brachialis. The choice to create one muscle here or two or three lay with the anatomist, and the grouping of fibers together under a common name does not by any means prove a common function.

In another example, the common tendon sheath which the pec minor muscle shares with corcobrachialis and the short head of the biceps presents no obvious place for the anatomist to divide it. To cut that tendon in three is utterly arbitrary and completely ignores the continuities of texture in the tissue. I'm happier creating a three-headed muscle, the triceps coracoidius. Similarly, in the leg, there is no obvious place for the anatomist to divide the so-called semitendinosis muscle from the long head of the biceps femoris, which are as equally conjoined along their common tendon as are the short and long heads of the so-called biceps femoris. Following the grain of the tissues, I prefer to reflect those three together and call them the N-shaped muscle of the leg, the nuoid femoris.

An identical arrangement can be seen in the N-shaped muscle of the arm, which we might call the nuoid humerus. Again, the naming of muscles is more rooted in anatomical convenience and historical preferences rather than any precise structural necessities or functional realities. In the leg, the short head of the biceps roots to the femur, just as the coracobrachialis roots to the humerus. The long head of the biceps of the arm matches the semitendinosis of the leg. What could be systematically presented is, in fact, rather arbitrary and sometimes fanciful.

I emphasize this to warn folks against placing any stock in the named muscles as functional units. Use the named muscles as a learning tool to familiarize yourself with the shapes and landscapes of the body. And then go beyond those devices to a deeper understanding of what is actually there in the body. A lot of loose fatty tissue has been removed to create this image. Basically, the buttocks shape is round like this, and that shape is not dependent upon the gluteal muscle line that we've created here.

You see, the fat is actually what gives form to the buttocks more so than the musculature. So these are our landmarks, the ischial tuberosities, the line of the gluteus maximus muscle, the coccyx. Trace your fingers underneath this lateral margin of the gluteus maximus. It's actually possible to fluff it up. In fact, maybe I'll do that right now.

You can see my hand tunneling. See it tunneling under? I'm just tracing my finger along the bone and lifting up gluteus maximus here, because remember, it's attaching into the fascia, not so much the bone at this point. Here we have the gluteus medius fibers filling in the upper part of the crest. See, this is the upper part of the body.

Now we're going down to the legs to give you an orientation. So this is gluteus medius fiber underneath this tough fascia. So if I slide my finger on this side of gluteus maximus, I can actually meet up to where I tunneled through on the other side and fluffed the gluteus maximus at this edge. And I'm cutting through the attachment of the gluteus maximus. I think I got most of it.

To the remnant of the fascia lata here. And away comes gluteus maximus. See how easy that was. That was definitely the way to go. And if I scratch along here, I'll catch the last fibers.

I want to be sure I'm not mucking up my gluteus medius underneath. There we go. That's just a little bit of film. I know I missed a fiber or two there. I'm trying not to lift up the gluteus medius underneath and to truly differentiate my gluteus maximus off of the gluteus medius.

And of course, between every muscle in the body, where they're making sandwiches with each other, we have a filmy fascia. So here's that filmy fascia between the gluteus maximus and the gluteus medius that actually cut into the filmy fascia. Oh, this is great. I'm going to scratch away at the filmy fascia here and free up the gluteus maximus. Now, at this lower edge, by the way, you can see these vessels, these veins coming up to drain the gluteus maximus.

And I can just keep scratching here. At this point, I have to cut the gluteus maximus off of the back of the femur. And it has a strong fibrous attachment here. The gluteal tuberace, wow. Awesome. Oh, nice.

Lucky. Oh, look at that, see? See, if you get on the right plane, you can shave the maximus back and preserve the ligaments underneath. Here we have the last little bit of it along the sacrum on this side. And then she's free.

The gluteus maximus and truly maximum it is. After a little bit of refining, the ligament is covering of the sacrum glints in the light for the first time. The great mass of the gluteus medius and the narrower tendons of obturator internus and the other deep lateral rotators of the hip joints span from the bony prominence of the greater trochanter like the legs of an octopus. Here I demonstrate the successive layers of the gluteal muscles. While maximus slides over the bony trochanter, the medius and minimus arise from its upper surface.

The bony surface of the pelvis is revealed underneath, partly scraped of periosteum from the scratching away of muscle fiber from its broad surface. And then, of course, the sciatic nerve passing beneath the piriformis muscle tissue. I hook my finger underneath the belly of the quadratus femoris and we can see the convergence of the remaining rotator tendons up close. With quadratus femoris reflected, the obturator externus comes into view. Finally, I cut the common tendon shared by four rotators of the hip blending into the bone and they come away together like a quadriceps trochanteris, the four-headed muscle of the big bump.

Even with all of the muscle tissue removed, the very thick and ligamentous sacking of the joint presents a remarkable example of movement-filled transition from one bony balloon to another. You know what that is? That's the posterior surface of the obturator internus. You just lifted it up. You know, you look at this and you say, oh, it's all cut up with a bunch of bones sticking out.

Then you see it's like a pearl inside of a clam. A clam's a little rugged on the outside. You open it up and there's this pearl. Look at that. That is so pretty.

Look at that. I'm not doing this. This is separated on its own. I didn't touch it. You see how it kind of comes apart there?

Little divisions. I'm going to pass it under the greater trochanter. I'm going to drag all these other cut deep lateral rotators with me. Look at that. I'm sneaking everybody through the hole here.

That's where our finger was going before, remember? And now we have the, oh, look at that. So now it's real clear the sacrospinous ligament and the sacrotuberous ligament, and it's real clear how the piriformis goes through the greater sciatic foramen or notch above the sacrospinous ligament where the piriformis was. And the obturator internus comes through the lesser sciatic notch or the lesser sciatic foramen. It's formed by the sacrospinous and the sacrotuberous ligaments.

It's not something you can see on a skeleton but ligaments aren't there usually. I think sometimes it's all just one continuous stream. Well, I know it is, in fact. I lift up the deep fascia over the pec, and we find that really the transition from the pec major to the rectus abdominis is nothing but another tenderness insertion moving into another broad set of fibers. I've been slowly teasing back the anterior rectus sheath and discovering its many layers.

We have the scarphas fascia that was mentioned as an underlayment beneath the superficial fascia. And then we have the deeper layers of the rectus sheath. And in cutting the rectus sheath down to the level of the musculature of the rectus abdominis muscle, I'm in essence cutting the tendon. This is the tendon of the external oblique muscle. The external oblique muscle is here now, and there's an edge here.

And this edge represents the cut tendon of the external oblique. If you can follow that, there are probably ten different ways you could reveal these tissues. I'm doing it this way because, well, it seemed like a good way to go. I'm just noticing this additional layer here. I can find my way now.

You'll see also at this point, because I have severed the tendon of the external oblique, I have in essence created the beginnings of a strip. I've cut the deep fascia of the leg here at the inguinal area, and I've cut the deep fascia at the abdominal area. Now I'm building basically the inguinal ligament. I build the inguinal ligament by taking away all the deep fascia around it, and the tissue here, the abdominal wall scrolls up on itself here to form this tough band of tissue between the pubic bone and the anterior superior iliac spine. And we call that the inguinal ligament, but again, just like the retinacula, there's nothing independent about it until we create it that way.

Ah, I think this gentleman's going to have a muscle called pyramidalis as well, which is sometimes there, sometimes not muscle. I'm down a layer there. See there? I've gotten into the layer of the internal oblique. You can see the fibers of the internal oblique here and here and here. So that could get sticky.

I'm going to lift up here instead and divide the internal from the external. So it looks like at this point, the anterior rectus sheath is receiving contributions from both the internal and the external oblique. It changes as we go down from superior to inferior, exactly which other abdominal muscle is contributing fascia to invest the rectus abdominis. I have a great deal of fuzz here. When filmy fascias are stretched, normally matted down tissues present internal structure as a web.

Like Alice, during her adventure underground, the cannot descends down without necessarily knowing where the bottom is. Here I interchange an actual funnel web of a spider. The analogy is exact with the human tissue here, and we can only marvel at what other vistas lie within our form as yet undiscovered. Before you know it, we're back down to the internal oblique. There we go.

I'm going to wing my way down this border line here. Again, now I'm cutting the tendon of the internal oblique as well. More fuzz behind the rectus abdominis. Here I have to actually cut away some of the vessels that are feeding and stitching the abdominal wall together here and leave them down. As we reveal the posterior rectus sheath behind the rectus abdominis muscle.

The layer by layer approach, while a valuable model for understanding human form from a structural and anatomical perspective, also has important therapeutic applications. Once you have a thorough understanding of each layer, its textures, its qualities, and the manner in which it is related to the surrounding tissues in which it is embedded and embodied, you can touch with a much more clear intention to contact a particular layer. With permission and a clear intention, it is possible to contact every tissue in the body either directly or by leveraging into deep or distant tissues along the vectors of relationship among them. The best place to start is always with yourself. Take the time to become familiar with the layers of your own form, the qualities of sensation which you notice there.

Pay attention to your emotional state as well. Do you love and appreciate the particular area of your body or do you actually dislike it? Is the layer and your sensations there familiar to you or new and surprising? When you invite yourself to a greater sense of awareness and appreciation for the layers of your own body, it becomes possible for you to lead others in positive and healing experiences of their own. Now we can turn our attention for a few moments to the relationship of muscle to bone.

It's an extremely diverse relationship within the human form. Sometimes we need to scrape muscle from bone. Other times it comes in through a cord-like tendon. There is cuff-like material at the major joints of the body here at the humerus much thinner than what we saw at the hip joint. But still, like a fabric, the muscles converge over the bony tissue.

Here we have tendons interwoven with one another in the hand and then we find also that muscle fibers will themselves root onto the tendons of other muscles, as in the case of the lumbricles of the hands and feet. The tibialis anterior is painted on to the surface of the tibia in its full length. Other muscles will root down onto the periosteum of the bone and the transition of periosteum spanning from bone to bone that we call the interosseous membrane. Here we see the tibialis posterior being scraped away from the interosseous membrane spanning the bones of the lower leg and filling in the groove. The human form is packed with muscle tissue.

The muscle layer fills every shape and generates shape in its neighboring balloon bag tissues of bone. The periosteum itself, the around the bone material, is very thin. I can slip my scalpel underneath it, but despite its integrity, its intimate relationship to the surface of the bone and through the surface of the bone clear on into the inner spaces and workings of the bony structure make it nearly impossible to remove it in sheets. It shreds, and yet underneath it the surface of the bone is so beautiful. Here we see the form slowly skeletonized and the periosteum backlit or the interosseous membrane glowing as do the bones in the living.

The following images demonstrate the muscle layer separated away from the body and re-presented as creatures in their own integrity. This kind of presentation enables us to compare tissues from one area of the body to another and to get a sense of different sizes and proportions of the various tissues from one area to another or within a given place, which might not otherwise be possible to observe them in this way. And this gives us further insights into the qualities of the tissues and helps us discover more about them. Also, by plumbing the depths of the tissues themselves, it's an opportunity for me to explore internal relationships and then integrate them. Now we find ourselves having skeletonized the form, bumping up against yet another layer, the organ layer.

It was quite a decision which to present first. If we went through the abdominal structures, we run into the organ layer before meeting the bone. But everywhere else on the body, you have to go through bone to get to the organ layer. The organs are like creatures in a cave. We have to sort of hold hands together as we march into a dark wilderness in order to discover what might lie within there.

It's a whole other world that we'll save the exploration of for the next volume of this series. Also, muscles like the psoas and diaphragm, in my opinion, are actually impossible to understand or appreciate properly out of the context of the viscera. So I've left their presentation aside until an exploration of the viscera has been undertaken. Over the course of the very intense month that I spent working with this form, I found myself on more than one occasion quite literally weeping with joy in the tremendous gratitude I felt for the gift I had received in this gentleman's form. And now, still, my appreciation is deep and I'm grateful that I can share it with you as well.

My pursuit of anatomy as an integral discipline inevitably draws my attention to questions of meaning, purpose, intent, and relationships beyond the apparently physical realms of human form. The sun is really the master gland of our bodies, the moon pulls at the tides undulating along our spinal cords as well as every other fluid body on our planet. The waves of our hearts extend well beyond our immediate physical form, interacting and patterning our surrounding environment in direct accord with our own conscious or unconscious dispositions and generating geopathic zones of fear or love. I sincerely hope you've found this learning experience to be both firmly grounded and upwardly spiraling and I look forward to further explorations with you. Thank you very much.

Thank you. Thank you. Thank you.