Medical brain notes 41

  W  ith the recognition of massage as an alternativeor complementary form of therapy, the demands made of the therapist are increasing. Although mas-sage is more involved with the knowledge and use of physical skills and techniques, the knowledge of anatomy, physiology, and pathology is also necessary for the therapist to effectively use those learned mas-sage skills. The therapist is certainly not required to know the field as thoroughly as medical professionals because diagnosis is not involved; however, the ther-apist should have the knowledge to understand how the body functions and how different parts of the body integrate. With this foundation, a therapist should under-stand how various diseases affect specific functions and how to recognize those conditions in which treatment may be detrimental to the client. Thera-pists should also be able to recognize conditions that may be harmful to his or her well-being. In addition, the therapist must have a thorough knowledge of various

  Levels of Organization-an Overview The body is made up of millions of individual units called  cells.  Cells are the smallest living part of the body. The cells, in turn, are made up of  chemi-cals —atoms (e.g., carbon, hydrogen, oxygen, nitro- gen, and phosphorus), molecules, and compounds (proteins, carbohydrates) organized in different ways to form the structures inside the cell. A col-lection of cells having the same function is called  tissue.  For example, a collection of cells that pro-duce contraction is called muscle tissue. Different tissues that are grouped together and perform the same function are called  organs.  For example, the stomach, which helps with food digestion, is made up of muscle tissue that helps move the food, con-nective tissue that binds the muscle tissue, blood vessels and glands, epithelial tissue that lines the inside of the stomach, and nervous tissue that reg-ulates the movement and secretion of glands. Or-gans with the same function are grouped tog

  The Holistic Approach   Although it is easier to teach and learn anatomy and physiology by dividing the body into organs and systems, it has to be understood that the body is complex and highly integrated. Each system is interde-pendent and works together as one—THE BODY. In The Life Application Study Bible,  (Life ApplicationStudy Bible. Tyndale House Publishers, 1997:I Corinthians 12:12-27.) the analogy of the human body is used in a different context; however, it aptly describes the working of the body: “. . . the body is a unit, though it is made up of many parts; and though all its parts are many, they form one body . . . if one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.”   What happens to one tissue affects the whole body and what happens to the body affects all of its parts. It is this holistic concept that alternative/complementary therapy, of which massage is one, adopts. To extend this further, the manipulation of soft tis

  Homeostasis   Traditionally, the body has been divided into many systems, according to specific functions. The ultimate purpose of every system, however, is to maintain a constant cell environment, enabling each cell to live. Fluid surrounds every cell of the body, and all sys-tems are structured to maintain the physical condi-tions and concentrations of dissolved substances in this fluid. The fluid outside the cell is known as the  extracellular fluid  (ECF), and the fluid inside thecell is known as  intracellular fluid  (ICF) (see Figure 1.2). The extracellular fluid inside the blood vessel is known as the  intravascular fluid,  or  plasma.  The fluid outside of the cells and the blood vessels is known as the  interstitial fluid.  Because the intersti-tial fluid surrounds the cells, it is known as the  inter-nal environment;  the condition of constancy in theinternal environment is called  homeostasis.  In short, all systems maintain homeostasis by regulating the volume and composi

  Systems of the Body This book, for convenience, divides the body into the  integumentary, skeletal, muscular, nervous, car-diovascular, lymphatic, respiratory, endocrine, re-productive, digestive,  and  urinary systems  (seeFigure 1.4). At times, the skeletal and muscular are considered together as musculoskeletal system. The integumentary (skin) system  includes theskin and all of its structures, such as sweat glands, nails, and hair. The major function of this system (see Figure 1.4A) is to protect the body from environmen-tal hazards and to maintain core temperature. For an  example of how skin maintains homeostasis, con-sider the effects of an increase in atmospheric temperature.  The skin possesses sensors (nerve recep-tors) that detect temperature change. When a rise in temperature is detected, the network of blood vessels in the skin, aided by the nervous system, dilate and more blood reaches closer to the surface of the body where heat can be removed by conduction. The sweat

  Planes of Reference To study the relationship of one structure to the other or to accurately explain its position, certain standard planes of references are used. Three planes are de scribed here.   The  sagittal plane  runs from front to back, dividing the body into right and left parts. The  coronal  or  frontal plane  runs from left to right, di-viding the body into front and back portions. The  transverse  or  horizontal plane  runs across the body,dividing it into top and bottom portions. These planes help to orient the position of studied structure (see Figure 1.5).

  Anatomic Position Because the body can move in different ways, it is difficult to describe the position of a structure without agreeing on a standard body position. This standard position is called the  anatomic position.  All struc-tures are described in relationship to this position. In the anatomic position, the body is erect, with the feet parallel to each other and flat on the floor; the arms are at the sides of the body, with the palms of the hands turned forward and the fingers pointing straight down. The head and eyes are directed for-ward (see Figure 1.6).

  Directional References In the anatomic position, a structure is described as  superior/cranial  or  cephalic  when it lies toward thehead, or top, and  inferior  or caudal  when it lies to-ward the bottom, or away from the head (Figure 1.6). For example, the tip of the nose is superior to the lips; the chin is inferior to both. A structure lying in front of another is  anterior  or  ventral .  A structure lying behind another is  posterior  or dorsal .  For example, the ear is posterior to the cheek, and the cheek is an-terior to the ear. Those structures lying closer to an imaginary line passing through the middle of the body in the sagit-tal plane are said to be  medial, while those away from the middle are  lateral .  For example, my belly button will always be medial to my widening waist-line. A structure lying away from the surface of the body is considered to be  deep  or  internal,  while a structure closer to the surface is considered  superfi-cial  or  external.  For example

  Body Regions The body is divided into many regions (see Figure 1.7). Knowledge of these regions helps health care professionals identify different areas of the body. Be-cause each region is related to specific internal or-gans, problems in internal organs often present as pain or swelling in these regions. For easy identifica tion, the major body regions are also shown in the photographs. Please refer to Figure 1.7. The major body regions are the  head, neck, trunk, upper ex-tremity,  and  lower extremity. HEAD AND NECK The  head  is divided into the  facial  region, which in-cludes the eyes, nose, and mouth and the  cranial  re-gion—the top and back of the head. The  neck,  also known as the cervical  region, is the area that sup-ports the head. Specific areas of the face are referred to by different terms. The forehead region,  frontal;  eye,  orbital;  ear,  otic;  cheek, buccal,  nose,  nasal;  mouth,  oral;  and chin,  mental. TRUNK The  trunk  refers to the combination of the 

  Body Cavities Although massage is given on the surface of the body, it affects the structures located deep inside the body. If an imaginary cut is made in the sagittal plane to look inside the body, many confined spaces or body cavities containing the organs will be seen (see Figure 1.9). Posteriorly, the brain and the spinal cord lie in the  cranial  and  vertebral,  or  spinal cavities,  respec-tively. The cranial and vertebral cavities are continu-ous with each other. Anteriorly, in the chest, is the  thoracic cavity.  In-side the thoracic cavity, the two lungs lie in the  pleural cavity  and the heart lies in the  pericardial cavity.  The thoracic cavity is separated from the  ab-dominopelvic cavity  below by the diaphragm. This cavity extends from the diaphragm into the pelvis. The abdominopelvic cavity can be divided into the  abdominal  and the  pelvic cavity . The major organsin the abdominal cavity are the liver, gallbladder, stomach, small and large intestines, pancreas, ki

  Levels of Organization There are many ways to view the human body. Each view gives a different perspective on how the makeup of the body and how the body works. It is similar to viewing a flower. We can look at a flower’s colors, with its green calyces and colorful petals, or we can view it’s shape (the shape of it’s petals or how they are arranged) or we can consider the flower’s smell. We can pull the flower apart and view the individual parts. To go further, we can put the flower under a magnifying glass and scrutinize the pollen. If we are really curious, we can take it to a laboratory and an-alyze the flower’s chemical makeup. So many different ways—each giving a different view and perspec-tive.   Similarly, for a full understanding of the human body, we can study it in many ways. Here, we choose to view the organization of the body at the chemical level, cellular level, tissue level and, finally, the systemic level. More time will be spent at the systemic level.

  CHEMICAL LEVEL OF ORGANIZATION Although a therapist seems to work at the systemic level, the benefits of therapy are a result of changes produced at the chemical and cellular levels. Diseases, although they produce symptoms such as pain, fever, and edema, are actually caused by dysfunction at the cellular and chemical levels. Small changes in chemi-cal makeup can have serious effects. For example, in a disease known as sickle cell anemia, the protein in the hemoglobin molecule is slightly different from normal. This small change has drastic effects on the properties of hemoglobin. The hemoglobin in sickle cell anemia, unlike normal hemoglobin, changes into a more solid form in an environment with less oxygen,resulting in red cells that become sickle-shaped and break up easily. The final outcome—less red cells, less oxygen available to the cells—the patient has difficulty performing normal, day-to-day activities. All because of a slight change in the protein structure in hemo-globin.