Your Practice in 3D: FEELING Anatomy

Learning to recognize anatomy through touch is very different than recognizing it by sight. Nothing is color-coded on your clients’ bodies as they are in your anatomy books. (Wouldn’t that be nice!?) And the boundaries of soft structures are often less obvious in real life than in drawings. Muscles are covered up by skin and buried under networks of squishy fat and fascia. So how do you know what you are palpating? Where does fat and fascia end and muscle begin? What do you look for?

Recognizing anatomy through touch is an essential skill for hands-on therapists and can’t be taught with books alone. We need to know more than what things look like; we need to know what they feel like. A kinesthetic understanding of how tissues feel helps us identify anatomy. It helps us know where we are on the body, what condition our client's tissues are expressing, and how to move through our session. 

Most of us learned anatomy working with bony landmarks – places on the body that are hard, consistent, easy to identify, and give us anchor points to map out the other softer structures. But what if we take it a step further and start to think about what all the tissues feel like under our hands. 

THINKING ABOUT DEPTH

Because we can only physically contact skin in massage, we have to feel through it to perceive the deeper tissues. We can compare this to trying to feel the varied contents of a pillow top innerspring mattress: a soft pillow top over dense sheets of padding, layers of soft filling, and hard support springs. Knowing what components are inside and taking time to consider their different densities, textures, and how they are organized, increases the likelihood we can identify them with our touch when we press. Let’s think about the tissues under our skin – adipose, deep fascia, muscle, and bone – and their differing tissue qualities. Being able to distinguish between these basic categories of tissue with our touch is a great place to start improving our ability to feel anatomy in 3D. 

Adipose “Pillow Top”

The density of tissue can be explained as how tightly or loosely packed together its components are. Just beneath the skin, adipose tissue in the subcutis (one of our favorite tissues to teach about at AnatomySCAPES™) typically feels much less dense than the deep fascia beneath it. This is because the collagen fibers that form adipose tissue’s framework are spread out and separated by soft fat lobules that can conform and adapt their shape when compressed. Completely connected to skin through millions of fine skin ligaments, the squishy adipose tissue is the pillow top layer of the human body. Though skin gets the most direct touch in every massage, soft adipose tissue is full of nerve endings and can sense your touch too! So take your time to feel this sensitive layer.

Deep Fascia “Dense Sheets”

Deep fascia, on the other hand, has collagen fibers that are packed close together, creating firm sheets and sheaths. Deep fascia is not a homogeneous tissue. In some areas it can be thick and easily palpable, in others, it is thinner and less distinct. Sinking beneath the adipose on the limbs, however, you will always palpate deep fascia before you feel muscle. This is why you can’t always feel the edges of muscle as clearly as you see them in the books. Muscle charts leave most of this fascia out of the drawings, so you may not have seen it before! Force transmitting deep fascia wraps the entirety of the limbs like a stocking or a glove, and envelopes groups of muscles into compartments. On the trunk, dense fascial hubs are formed by the convergence of flat tendons including the easily recognizable white rectus sheath and thoracolumbar fascia.

Muscle “Soft Filling”

Force generating muscles weave and layer throughout the body and come in a wide variety of shapes and sizes, from the feather-shaped pennate muscles like the rectus femoris, to the broad, fan-shaped convergent muscles like the pectoralis major. The grain and shape of individual muscles are defined by another group of fasciae called the epimysium, perimysium and endomysium which cause some muscles to have different textures than others. If you consider the toughness of different cuts of meat that you would order in a steakhouse, you get an idea of how the grain of a muscle may affect its texture. Generally, muscle tissue is considered “soft tissue.” But exactly how soft or dense it feels is influenced by several factors including its size, location, level of tone, and overall health. This next level of analysis moves beyond just identifying muscle tissue, to assessing its condition. It’s a big skill but it becomes easier to develop if we first can clearly identify muscle tissue from the other tissues in the body. 

Bone “Hard Support”

Centrally located on the appendages and not too far from the surface on the trunk lies our bony frame. When we apply deep pressure, bone provides the hard object we are pushing against. Knowing the shapes, locations, and depths of bones gives us the opportunity to use them strategically as objects to compress against, shear across, or press between. Of course bone feels more dense than muscle, but if the muscle and fascia are also very dense on a person, it might be tricky to distinguish them from each other. Mistaking bone for “knots” or tight muscles can be a common error in areas like the ribs and vertebrae near the upper shoulders and neck if you aren’t clear on the anatomy. 

WHY WE CARE

Having the essential skill of perceiving anatomy through touch means we are not blindly pressing our way through tissues and ensures we massage the tissues we intend to, in the way we intend to, without causing harm. This can affect how we interact with structures like the IT band on the lateral thigh, which feels quite dense when palpated. A dense fascia lata may be mistaken for tight quadriceps that lie beneath, and using deep pressure may overshoot where the real issue is located. Being able to distinguish between tissues helps you determine what level of depth will be most beneficial for your client.

Thinking about tissue qualities raises your awareness. And awareness changes everything. You begin to feel more … and so will your clients.