A day with Tom Myers of Anatomy Trains

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I recently went to a conference where Tom Myers of Anatomy Trains was presenting. I’ve written about him in my posts on tennis elbow, the importance of direction in manual therapy, stretching the IT band and hamstrings. I listened to him for 7 hours, so, I took a ton of notes.

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Background

This was not a personal training / physical therapy / movement oriented conference. It was a massage and spa one. It was very much geared towards spa workers, massage therapists and chiropractors. I loathe some of these people. Let’s start with that.

You can’t preach health…

If you’re unhealthy. There were a ton of students and teachers at this event. There was one group in blue shirts sitting in front of me. Out of 15, I counted 12 who easily were or bordered on being obese. It’s not like you need to be a professional bodybuilder, but when a presenter goes, “Our children’s are losing their bodies” you can’t be shaking your head in agreement when you, yourself, have lost your body.

I know this has been beaten to death on the internet. Especially regarding out of shape trainers. But, this extends beyond how being significantly overweight is generally unhealthy. What doesn’t get enough attention is being obese negatively impacts how you move. I don’t just mean you’re fat so it’s more strenuous to get around. It’s more nuanced than that. I’m going to write a long piece on this someday, but here’s an example.

A common issue in those with shoulder pain is superior glide of the humeral head. The top of the arm travels upwards too much.

I talk about this in more detail in Another example of a postural evaluation. A common pattern associated with superior glide is the person always stands with their arms out to their side -in abduction.

Because of this the deltoid, a humeral abductor, is working more than it should. Hence, pain.

What happens if you’re really overweight, with a ton of that weight around your midsection?

Kind of hard to not have your arms in abduction (out to your side), no?

The person physically cannot let their arms hang straight down like they should.

Get a person with this history to lose some weight and suddenly they have some more room for their arms:

If this person doesn’t lose the weight it’s going to be very hard, if not impossible, to fully alleviate their symptoms. Their body figure is preventing them from moving better. As a massage therapist, or any health professional, someone who is supposed to help people get out of pain, do you understand this? You cannot help some clients who are severely out of shape. And when you aren’t in shape yourself, you’re not compelling your client to change much. In fact, you’re condoning your client’s obesity. You’re not part of the solution; you’re part of the problem.

Now, before you go giving out eating advice…

Overstepping boundaries

This is one of my biggest issues with the alternative / holistic / whatever they call themselves group. They start thinking they can cure everything. For as much shit as they give the mainstream medicine world for being arrogant, the alternative world’s hubris is unparalleled.

One of the presenters even went so far as to say they can change clients attitudes, and attitude trumps aptitude. This was specifically related to helping people heal. Please go tell Steve Jobs, who refused pancreatic surgery for his cancer in favor of 8 months of alternative medicine, his attitude was sufficient. Oh wait, he later realized he should have gotten the surgery, and you can’t talk to him now, because he’s dead.

Until people are consistently getting rid of cancer by eating leaves, admit there’s something you don’t know. That goes for diet, exercise, anything. If you only have experience massaging people, you probably should keep your magic elixir to yourself.

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Myers’ first talk: The Anatomy Trains Myofascial Meridians

I’m going to rattle off a bunch of notes and quotes.

This was my first time seeing Tom present.

He’s energetic, articulate, and carries a good sense of humor. He also goes off on a tangent every 60 seconds. Notice the title of this talk, yet, here’s a list of other things covered:

• Ethics of child birth in the United States
• The proper position of child birth
• The way we handle death
• Did humans actually have an aquatic evolution?
• Cell anatomy
• How cells move through the body
• Urinary tract infections
• Exercise prescription
• Starting a practice
• Existentialism
• Religion
• Culture of Lebanon
• Culture of the United States
• Falsity of magazine covers
• Differences between the Northeast and California
• Surgical removal of the 11th and 12th ribs
• Body image issues
• Constipation
• How to use a chair
• Chiropractors versus massage therapists

That was just in his first talk! There are 7 Anatomy Trains lines / meridians; one meridian and half of another were covered, and I think maybe 20 minutes of the three hour talk was spent on this. As someone who was already familiar with his system, I loved all the tangents and different topics. I’m going to cover a bunch below. However, if I was a student, unfamiliar with Tom, looking to understand this whole “meridians” thing, I can very much see myself leaving thinking, “What the hell did I just listen to? I mean, it was cool, but was I in the right class?” That said, everyone seemed to thoroughly enjoy him as well, so maybe they felt like I did.

A different barometer of your skill level

Besides his classes, Myers gave an opening speech to the conference. After being on stage for maybe 5 minutes he goes, “I’m sorry, I didn’t want to bring this up, but I’ve been having this personal problem. I haven’t gotten much sleep this week.”

I immediately got nervous and thought, “Oh shit, the crazy health industry has gotten him too.” If you’re unaware, there’s a bit of a joke in the fitness world once you hit your 40s or so you lose your mind. Your rationale thinking turns into you saying anything to sell crap, depression, inability to write or work well, etc. If you look around, you’ll notice very few in this world are above 45 or so.

Anyways, Myers is 65, and has been doing this 40 years, this was another good tangent.

“After all these years, I’ve learned there are two signs of your skill level. 1) What you’re able to do on your best day, when you’re zoned in and firing on all cylinders. 2) Your ability on your worst day. How good are you when everything is going wrong? I’ve learned the latter is a better indication than the former.”

Great point.

Women removing their 11th and 12th ribs

It took me a minute to realize what Myers was talking about here. He went from talking about the fascial connection between the diaphragm and ribs to talking about what happens when the bottom ribs are gone. The point being even without the bone (ribs), the diaphragm can still function just fine. Illustrating the diaphragm doesn’t actually connect to bone, but to fascia. Then, in a subtle manner he mentions “waist manipulation.” The idea being models and celebrities will remove their bottom rib or two in the hopes of making their waist smaller. That holy waist to hip ratio us men love so much.

I had absolutely no idea this was even something women considered. After a small amount of looking around it seems this is 1) Not sure to be done or 2) Definitely done, but kept on the down low. Myers has apparently worked with a ton of models, and his trade is touching people’s bodies, so it seems he would know.

I’ll have to ask around the next time I’m on Sunset Boulevard.

Computers

When discussing the impact of the personal computer on our bodies:

“I really hope these machines will get better.”

I think they already have. One of my clients recently asked me for my thoughts on the advent of the smart phones and tablets, and their impact on our bodies. The presumption being “How bad are these things for us?” I’m going to write something more thorough on this, but I think they are a good thing. At least compared to what we’ve had.

It’s a hell of lot easier to stand up, lay down or move around when using an iPad than a laptop. You’re not as confined, it’s easier to swap which hand does the mousing, you don’t have to be in a chair, it’s easier on your wrists, etc. Compared to what we’ve had, it seems like a demonstrable step up.

Chiropractic contradiction

Myers likes to poke fun at a variety of disciplines (including his own). You can tell he has some ill will towards chiropractors.

“Mark my words. In 50 years they’ll be the ones in the back of a conference like this while we’ll be in the front. They’ll be in the back room of the office popping bones for 15 bucks an hour.”

“One of the big issues with chiropractics is nothing sticks when you pop bones. You may help things in the immediate short term, but those bones aren’t going to stay where you pushed them.”

The latter is especially true. However, is this really any different than massage therapy? Chiros push bones around, massage therapists push fascia and muscle around. In either instance, there’s still one huge problem, you have to train the tissue. You can push, pull, rip the ever loving shit out of someone’s body, but if they go right back to all the same habits, nothing is going to change long term.

Tom’s aversion to postural cueing

Going with the above, I was surprised to hear Myers aversion to cueing people, especially posture wise. Other than using manual therapy, he almost made it sound worthless to try to correct how someone stands or sits.  He made it seem he almost prefer you work the fascia manually and then basically hope the work corrects how the person moves.

I was shocked to hear his emphasis on this. Clearly, I disagree here. Furthermore, I’ve heard interviews with Tom where he has explicitly stated, “You have to train the tissue.” That is, do something besides manual therapy.

I wasn’t the only one confused here, before I got to it someone else asked about this. Eventually, Tom got around to saying things like,

“Now, once you’re done with your work then you can give them some small things to work on. Say for instance the person always stands on the inside of their feet. You could teach them to put more weight on the outside of the feet. But you can only give one or two things.”

Well, that’s a different argument. I wrote a whole thing about how much you can give people to think about, as well as increasing people’s adherence, here and here.

So, it seems either Tom didn’t communicate what he meant here well, or maybe some of us misinterpreted what he was saying. I have a feeling it’s more of he disagrees with how people go about trying to correct things, rather than whether or not you need work on it. Because you really cannot expect to work with someone once a week for a few months, have them do nothing on their own, and have anything meaningful happen, especially in the long-term. In that case, you’re really just hoping the manual therapy will stick, and, hope is not a strategy.

Fascia is great and all, but…

I have no doubt Tom has helped move the world to a better understanding of anatomy. I can only see good things coming from switching from a “this muscle, that tendon” approach to “we need consider X and Y, but we also need to look at what’s going on at other areas of the body.” However, I feel people are merely switching from focusing on one type of anatomy to another. Rather than muscles, perhaps fascia. There is still a big thing overriding fascia. In fact, it not only overrides fascia, it overrides tendons, ligaments, nerves, muscle, veins, arteries, everything. That big thing is movement. Yes, fascia is important, but how we move controls fascia. Just like how we move controls our muscles, tendons, and ligaments. I can’t see how obsessing over fascia is much better than obsessing over muscles.

You have to step back and think, “What controls all of this?”

Myers mentions how we’ve had this reductionist mindset for too long. We think too much about muscle X starts here and ends there. But, the superficial front line, also, starts here and ends there. Looking at myofascial meridians may give a bigger picture than looking at a few particular muscles, but meridians are still reductionist.

Let me give an example of the superiority of exercise over manual therapy. Myers used a common example of someone who needs work, a swayback posture:

He mainly discussed the issues at the superficial front and back lines.

The improvements you’re looking for are getting the person to have their hips under them more, less rounding at the thoracic spine, knees bent, etc.

So, you could bit by bit work with your hands on the person, or you could have do something like this:

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In this one motion we’ve bent the knees, gotten the hips more under the body, work on opening the chest up, work on the rounding at the thoracic spine; we’re lengthening what we need to lengthen and tightening what we need to tighten. In one exercise you’re working on what might take you three months to work on in manual therapy.

You could change damn near every aspect of this posture by changing your sleep positioning too. 

Furthermore, this exercise is teaching the person how to move, it’s something the person can do on their own; at home, and the person is exercising. You know, that thing we should all be doing. What’s better? To correct an issue while laying down on a table -being sedentary- or correcting an issue while doing the healthiest thing you can be doing, exercising?

When done properly, manual therapy can be a useful tool. But it’s an indirect, incomplete, less bang for your buck solution.

How we move and the Big C

Myers showed a video going over how cells move throughout the body. To me, the main takeaway from the video was to understand cells don’t just float through our veins and arteries. They can roll from location to location. Think of a velcro ball. It starts stuck to one area, then the cell will change which areas are sticky or not, thus causing the ball to move / roll.

I don’t have the exact video, but this is similar:

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Myers started talking about his mother and how she spends a great deal of her time in a wheelchair. He mentioned since she’s been in the wheelchair she has experienced more and more urinary tract infections. He made one comment that really stuck with me, and I think brings these topics together.

“The doctors keep trying to treat her as if she has this chemical problem. I don’t think it’s a chemical issue. I think it’s a mechanical one. Maybe at this stage it’s, or also is, a chemical issue. But then I’d probably say it started as a mechanical issue.”

This was a profound statement to me. Think of a person constantly in a wheelchair, all hunched over and everything. It makes sense the ability of cells to move throughout the body is going to be changed.

In the above video there is one point when the considerably slow down blood flow by clamping an artery. Notice all the cells bunching up together, then, they unclamp the artery, and everything is flowing smoothly again. Here’s a GIF I made from the video:

As the clamp is held tight you can see the the vein is very dense, almost like a bunch of bricks stacked together. As the clamp is released, the vein looks like a blur is passing through it.

What if, through how we hold ourselves, we’re changing the ability of cells to move? We know when we become overweight we impair blood flow. We call that arteriosclerosis. Whereby things get clogged. Think of a plumbing system. If you keep putting more and more flow into the same size pump, something bad will eventually happen. If you put more into that pipe, but simultaneously clog the pipe with your shedding hair? Bad things happen even quicker.

This is a big reason why after surgery we’ve gone from telling people, “Lay down and rest” to a “Get moving as soon as you can” method. We’ve found keeping people in bed after surgery increases the likelihood of blood clots. It used to be after something like a knee surgery you were laid up for a long time. Now, they try to get you walking immediately. The walking, and movement, helps keep the body’s plumbing flushing things out. Something which is even more important after surgery, because the body will pump a bunch of stuff to the site of surgery, increasing the likelihood of a clog.

The body has another means of clearing out crowded cells: It kills them. The cells, through a process called apoptosis, basically explode.

What do we call the bodies inability to kill cells? Where cells grow uncontrollably? Cancer.

Maybe a cause of cancer isn’t hormone imbalances – a chemical issue- maybe a cause of cancer is inability for the cells to die because of a mechanical problem. Perhaps we’re clamping certain organs through what we do all day. And, after a period of time of this clamping the body can’t handle the amount of cell death it needs to do. The ability and rate of removing the clog is less than the rate of becoming clogged. The amount of hair going down the drain is greater than the ability to remove the hair.

Here’s another way to think about this: A double mastectomy dramatically decreases the risk of getting breast cancer. Using our plumbing analogy: Removing the pipe eliminates the ability of the pipe to get clogged.

There is an interesting area of research discerning cells ability to respond to mechanical force. Example here. 

Gravity is one example of a force.

Think about people, specifically women, in westernized society. We are constantly leaning / hunching over.

What if all that leaning over was changing the cells in the breast(s)? Perhaps in a way crowding the tissue, and eventually, the body goes “We can’t handle this anymore.” Suddenly, one day you have lump on the breast. I’ve talked about the reasoning behind people suddenly having pain, how you can think of it as the body hitting a “threshold.” But, the process behind reaching that threshold has been going on for a while. Maybe there’s something to be said for the body having a similar process with other things, beyond musculoskeletal issues.

Or how about prostate cancer in men? Perhaps sitting provides a “clamp” on the prostate. When we sit we have the force of gravity and the force of the chair.

Looks like a clamp, no?

And what’s between that clamp? The prostate.

Between gravity pushing the bladder down, and the force of the chair pushing the rectum upwards, the prostate could conceivably be clamped between. Restrict the gland, there’s less room in the gland, cells are more likely to get crowded = prostate cancer?

As you’ve likely noticed, I typed a ton of “perhaps” and “maybes” above. Obviously, I’m not an oncologist. I could be completely wrong about all of this. As Myers said about something else, “There’s nothing worse than a beautiful theory destroyed by ugly fact.” But man, isn’t this interesting? What if we could decrease our cancer risk by standing up more often and standing more upright?

For shits and giggles, after I typed this I did a quick google search. My theory may already have some merit, and have been thought of by others. Examples here and here. From a quick search I see a significant difference between what me and some others are saying. Others are making a case for not being sedentary, to get up and exercise more. Exercise and moving more often has been found to help with nearly any and everything. So, this is of course a good idea.

For example, we’re finding coffee is associated with health benefits in nearly everything we study it with. Hell, it’s been found there is a direct relationship between how much coffee people drink and how long they live. We’ve been trying to find why this happens. Is it something with caffeine? The antioxidants? I think it’s much simpler: Coffee makes you move more.

Anyways, the difference in my argument is that I’m not just making a case for exercising more, I’m also making a case for sitting less. It’s not just you should add 30 minutes of exercise to your daily routine after work, it’s that you should also subtract 30 minutes of sitting from your daily routine. Within that, 30 minutes of the bike may very well not be as healthy as 30 minutes on a treadmill. The difference between more and less sitting. Personally, I try to get my clients to do as much of their exercise while not sitting. So, if they ask me whether they should use the bike or elliptical, I vote elliptical.

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Myer’s second talk: Self-care for the long-term

The description for this class was something like staying sane in massage therapy, taking care of your body for a long career, maintaing a practice, etc. A couple of years ago I saw Tom mention he had practiced in 20 different cities. I emailed him for insight as to being able to bounce around like this. He was nice enough to write a thorough blog entry on the topic. I came into this talk with the intention of learning more about this.

Unfortunately, this ended up being geared much more towards the psychology of working in massage therapy. I probably wouldn’t attend this one again. It just wasn’t for me. (Remember, I’m not a massage therapist.) I do have a few notes before closing this up.

Dealing with the emotional toll

This received a lot of emphasis, to which I was surprised.

The general idea here is as a massage therapist you have relationships where people divulge various information to you. Within that, you may be dealing with people with various psychological issues. How do you handle this?

First, I feel like this may have been overblown in the class. I mean, as far as I know, in massage therapy you’re not seeing people that regularly. Most of the people I know go to a massage therapist at most once a month. The way Myers works with people, it’s once a week, but for only three months. After that the person is done or they’re referred.

Is one person really that taxing if you see them that infrequently?

I’ve seen clients at every type of interval. Once, twice, three times a week. Once, twice, three times a month. Whatever. The people you see the least frequent are the easiest to deal with psychologically. We humans tend to connect with people the more we see them / the better we know them. The less frequent you see someone, the less you know them, the less intimate your conversations are.

With that said, I do think this topic has merit. I’ve had people talk to me about everything you could imagine. Divorce, parental issues, child issues, DUIs, alcoholism, drug addiction, their dog dying, break ups, cancer, death, when they got diagnosed with AIDS. I can easily see how one can become overloaded. So, how can you handle this better, should you need to?

The class gave typical answers. Exercise, meditation, vacation, you get the idea.

The problem with these answers isn’t so much they don’t help, it’s they don’t address the cause of the problem: You being overloaded with what you’re talking to people about.

I’ve found a much easier way to help with this: Get your clients to talk to each other rather than you.

In personal training, this is simple. Switch from only one on one to small group training. Introduce a couple of your clients. “Hey Bonnie, this is Sharon, Sharon’s had 3 knee surgeries. Maybe she can talk to you about your upcoming one a bit.” Also, naturally as people are around one another, they talk more. The irony here is as a trainer you’ll suddenly feel a bit more left out. Suddenly your clients talk to one another, and know one another, better than you know them.

I mentioned this to the class, as well as the fact I understand this may not work as smoothly in massage. I said perhaps you could get your clients to run into one another (schedule them at similar times), introduce them through email, whatever. The idea is to build some sense of community with what you’re doing. Myers’ disagreed here. In his opinion, this can work well in personal training, but not massage. I believe his point being massage is too personal. I think he was trying to say you couldn’t reveal certain information about clients to one another.

Funnily enough, a few days after this conference I had a woman come in. She was telling me about her friend who is a quadriplegic, who could really use some extra help, along with some intimate details about the friend. I mentioned to her one of my other clients used to be a caregiver, and even if she couldn’t do the work, she may know someone who could. Immediately this woman goes, “Oh great. Could you ask her, and if she does, could you give her my email?”

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Closing up

Myers also went over some specific massage techniques. Techniques not for the patient, but for the actual therapist, aimed at keeping the therapist healthy. Tom asked the class, “Who here has pain while working in their practice?” Half of the class rose their hands. (That’s a lot of people in pain who are trying to help others get out of pain.) The therapists in the room seemed to really enjoy this. They were able to immediately take some tips and change how they practiced.

Lastly, we did tai chi for 45 minutes. My summation of which is, “Shit got weird.”

At the end of the day, I agreed a ton with Tom, disagreed some, learned new things, and got my mind churning. If you get the chance to see him speak, I highly recommend it.

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You can pick up Myers’ book here: Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists

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