Anatomy: A Pressing Concern in Exercise Physiology

Although there is an explosion of computer-based human anatomy material available to teach anatomy, cadaveric dissection by students and the integration of knowledge from textbooks and didactic lectures are still the most popular methods of teaching anatomy. The volume of time dedicated to teaching anatomy has steadily decreased over the past several decades. This has resulted in more college graduates with an inadequate understanding of anatomy. Do you want students of exercise physiology to be taught by qualified teachers? If the answer is "yes" -- then you must act now. Commitment to professionalism is imperative.

Knowledge of anatomical structure of the body is basic to understanding musculoskeletal function and how both structure and function are modified by exercise or disease. Ironically, at a time when knowledge of anatomy is increasingly important, exercise physiologists are facing a major crisis in anatomical education. There is a major shortage of academic exercise physiologists willing to teach gross anatomy. Many faculty members are simply not academically prepared to teach anatomy. Yet, the students of exercise physiology need a thorough anatomy education to be credible healthcare professionals. This is true for professionals in physical therapy and athletic training and it is true for exercise physiologists too.

Given the presence of so many educated men and women today, one would expect that there would be a sufficient number of anatomy teachers. Point in fact though, there are too few healthcare professionals with a credible knowledge of and actual hands-on laboratory experiences in anatomy instruction and application to human movement and healthcare. While there are numerous reasons why anatomy is no longer taught in exercise physiology and related degree programs, one in particular is the cost, time, and challenges to maintain a dissection room. Another reason is the unsupportive academic infrastructure. None of these reasons is justified. Anatomy is obviously essential for exercise physiologists as credible healthcare professionals.

Anatomy is the study of the structures of the body. Physiology is the study of the function of the structures. The study of both provides a solid understanding of the body and how to develop it and rehabilitate it. There is a great divergence in exercise physiology departments in teaching exercise physiology in general and anatomy in particular. Exercise physiologists must not be disempowered from anatomy. To not have the power to influence the profession would be an appalling state of affairs. Yet, it is clear that students are graduating without knowing in detail which muscles are responsible for what actions.

“The taboo against desecrating the bodies of the dead goes back many centuries; it was prohibited by both ancient Greek and Roman religions. Cadaver dissection is essential for the acquisition of anatomical language. The first recorded instance of medical dissection of human bodies is in the sixth century BCE, when the Greek philosopher Alcmaeon began his research. In 275 BCE, Herophilus of Chalcedon founded the first school of anatomy at the Museum of Alexandria, in part to encourage his students to overcome their fear of dissecting human bodies” (http://knarf.english.upenn.edu/Contexts/dissect.html). Given the significance of this quote, students, teachers, researchers, and surgeons are still asking questions: Is dissection the only way to learn anatomy? Why don’t they have cadavers to dissect? When teaching anatomy, which is best – cadavers or computers? Can the YouTube help students learn anatomy? Is it better than dissection? Do students have sufficient knowledge of clinical anatomy with just lectures?

Teachers must acknowledge that rote memorization is rather useless when students are not encouraged to visualize the structures. There is a huge volume of detail and integrated content when anatomy is blended with mental pictures. The mind can be taught to scan the origins, insertions, and functions of muscles just as computers can scan and create three-dimensional pictures. The brain does not know the difference between what is real and what is not real. Thus, when you visualize (i.e., see with the mind’s eye) the latissimus dorsi muscle and its origin and insertion, the electrical signals of the thinking-visualization process are essentially the same as seeing it on a cadaver.

The quality of professional development of exercise physiologists is determined by the quality of their professional thinking, which in turn is determined by the quality of their critical thinking - for critical thinking is the driving force behind professionalism. Without critical thinking skills, there is little reason to think of exercise physiologists as healthcare professionals. In fact, it is obvious that all the scientific papers, presentations, and posters by exercise physiologists at national and regional meetings cannot define exercise physiology as a profession. This point is within their understanding if they work at critical thinking as they have taught their students to think scientifically. Yet, many exercise physiologists continue to present their scientific papers without internalizing the concepts and principles essential to the underlying concepts of critical thinking and professionalism in exercise physiology. Despite having the doctorate degree and after teaching years of college and university courses, it is apparent that relatively few professors have the desire to become selfdirected, self-monitored, and self-corrective critical thinkers to guide their students’ path towards a professional understanding of flexibility training.

Flexibility refers to the range of motion of the musculoskeletal system. It is trainable, but only when it is done correctly. Warming-up should not be confused with training for an increase in range of motion. Flexibility is a logical prerequisite to performing athletic skills with ease, efficiency, and safety. If stretching is done on a regular basis, there will be an increase in the range of motion at specific joints. The stretching will help to improve human movement, whether it is athletics or engaging in physical activity, the circulation of blood and oxygen to the active tissues, and the pain and soreness that results from using the muscles. In general, there are four methods to increase and maintain flexibility: (1) static stretching; (2) ballistic (or dynamic) stretching; (3) contract-relax stretching (also called PNF, proprioceptive neuromuscular facilitation); and (4) passive stretching.

Improving flexibility is primarily the result of performing stretching exercises. The right flexibility program will provide the athlete with the knowledge to increase range of motion, maximize efficiency of movement, supplement training, and enhance recovery. A good flexibility program concentrates on muscle groups most likely to experience adaptive shortening. In the majority of the cases, just three flexibility exercises will produce the range of motion required to optimize the musculoskeletal system for almost any sport. Be sure to remember that there are “good, useless, and dangerous” flexibility exercises. The useless and the dangerous exercises must be avoided. An excellent example of the latter point is the hurdler’s stretch exercise during which the position of the knee and leg stretches the medial collateral ligament while putting pressure on the medial meniscus.

Just as the lack of flexibility can lead to muscle and joint injuries and posture issues that influence athletics, health, and wellness, engaging in the common stretching mistakes is a waste of time and a failure to train for an increase in range of motion. It is important to avoid flexibility exercises that are useless. Avoid those that increase the risk of injury, especially the dangerous exercises with questionable value. Only good stretching exercises should be performed by athletes and others. At no time should the joints and muscles be forced into a stretched position. It is always better to engage in a brief, light form of aerobic exercise such as walking or jogging just prior to a commitment to stretching. Also, it is important to recognize the discomfort associated with flexibility training by not over-stretching. When engaged in flexibility training, remember to breathe, to stretch regularly, and to avoid the stretching mistakes.

A good flexibility program requires no more than “three” stretching exercises (sit-straddle-reach stretch, shoulder and chest stretch, and the standing hip flexor stretch) to maximize the range of motion of the muscles that undergo adaptive shortening. Increased flexibility in the anterior chest and shoulder muscles, the low back, adductors, hamstrings, and plantar flexor muscles, and the hip flexors, help an athlete or client to engage in athletics or recreational programs, with an increase in skill performance and movement efficiency with less degree of difficulty as compared to earlier musculoskeletal limitations.

Useless flexibility exercises are done by athletes, trainers, and other practitioners with the intention of increasing their range of motion. Unfortunately, the time taken to stretch the muscles across specific joints is time wasted that could have been used to obtain benefits from the three good flexibility exercises. This outcome is primarily due to the lack of anatomical knowledge as to whether the range of motion of specific exercises actually produces a significant stretch on the muscles. When an exercise cannot place a stretch on the muscles, it is useless and ineffective and should not be part of the flexibility training program.

dangerous flexibility program consists of exercises that place unusual and unnecessary stretch and/or force on muscles, joints, and nerves. Many so-called stretching exercises have the potential to do more harm than good. No one should do an exercise that has the potential to result in degenerative changes in joints and nerves over time. Dangerous flexibility exercises that involve placing the head and neck (such as the plough and shoulder stand bicycling), knees (e.g., the deep knee bends and quadriceps stretch), and low back in an awkward or questionable position should be avoided. It is unfortunate that so little credible information is available to athletes, coaches, and individuals interested in flexibility training. The content in this chapter should help lay a solid foundation for thinking straight about which flexibility exercises should be avoided.

The professional development of exercise physiologists is determined by the quality of their professional thinking, which is in turn determined by the quality of their critical thinking, for critical thinking is the driving force behind professionalism. Without critical thinking, there is little reason to think exercise physiologists are meaningfully interlocked with other healthcare professionals. In fact, it is obvious that all the scientific papers, presentations, and posters by exercise physiologists at national and regional meetings cannot define exercise physiology as a profession. This point is within their understanding if they work at critical thinking as they have taught their students to think scientifically. Yet, many academic exercise physiologists continue to present their scientific papers without internalizing the concepts and principles essential to the professionalism in exercise physiology (i.e., code of ethics, accreditation, and a career specific Board Certification). Despite having the doctorate degree and after teaching years of college and university courses, few professors have the skills to become self-directed, self-monitored, and self-corrective critical thinkers to guide their students’ path towards professionalism.

Exercise physiologists should focus on the professionalization of exercise physiology by supporting the American Society of Exercise Physiologists (ASEP), particularly in regards to their role in prescribing exercise medicine? Secondly, the non-academic community of non-doctorate exercise physiologists must provide a stronger voice for exercise physiology as a healthcare profession. It is important that exercise physiologists should focus on healthcare employment, and they must be taught the exercise physiologists’ code of ethics and professional standards. For the profession of exercise physiology to become equal to physical therapy and other healthcare professions, members must help ensure that professionalism is at the core of the academic curriculum. The exercise prescription must be properly prescribed with specificity to promote positive outcomes and reduce complications. Age-related changes in human organ subsystems can be improved by regular exercise, but only if it is safely administered by ASEP Board Certified Exercise Physiologists.

Is it realistic that academic exercise physiologists teach anatomy in the exercise physiology curriculum? If so, is it necessary that they studied anatomy in their doctorate program? If they did not study anatomy and/or dissect cadavers, is it reasonable to expect them to know anatomy? If it is not reasonable, then, should the exercise physiology doctorate curriculum change to better educate the students of the 21st century? After all, exercise physiologists are healthcare professionals and, therefore, they must have the opportunity to study and dissect cadavers in the same way that other healthcare professionals have. The power of anatomy in identifying the right and the wrong way to lift weights, to increase range of motion, and to develop the motor aspects of physical skills is testament to its importance. This requires exercise physiology educators to take seriously the learning of anatomy as a dynamic basis for solving health and athletic problems.