VAN DER WAL: CONNECTIVE TISSUE ARCHITECTURE AND PROPRIOCEPTION
connective tissue in general or of fasciae in particular.On the contrary, one was more or less trained to con-sider fasciae to be connective layers that had to beremoved. This approach is related to the fact that theproper method and procedure of anatomy was and stillis dissection.Although dissection is no longer the main approachin visualizing the anatomy and structure of the humanbody—modern imaging techniques can do so in the liv-ing body—”dissectional thinking” still is the mainmethod of analyzing the body in its anatomy. But in thedays of my training, one had to separate—to “dissect”—and the revealed structures had to be “cleaned” and“cleared” of connective tissue. Connective tissue wassomething resembling a covering or sleeve over andbetween the dissected structures. Therefore it often hadto be removed during the dissection procedure.Most anatomy textbooks today show muscles as dis-crete anatomic structures with the surrounding andenveloping connective tissue layers removed. Whenconnective tissue was met as a layer, a membrane, afascia covering a body structure, organ, or region, itwas given a name derived from the anatomic substratethat the layer covered. Connective tissue anatomy isoften defined as a sub-organization of anatomic struc-tures such as muscles, organs, and so on. Fasciae arethus considered to be “part of” organs and structures.In leading textbooks, fasciae are therefore definedas “masses of connective tissue large enough to bevisible with the unaided eye”
(p. 42) and classifiedas anatomic entities or structures related to organs. Butare fasciae, membranes, sheaths in the body in factdistinct and discrete anatomic structures, or are wedealing with continuity? Is the anatomical view miss-ing something when it allocates parts of this fascialcontinuity to anatomic structures and entities such asbody walls or regions (for example, fascia endo-thoracica or fascia colli media), organs (for example,fascia renalis), or body parts (for example, fascia cru-ris)? In addition, does a topographic perspective onfascia give any clue about the kind of architectural,functional–mechanical relationship being dealt with?Schleip mentions the fascia as “the dense irregularconnective tissue that surrounds and connects everymuscle, even the tiniest myofibril, and every singleorgan of the body forming continuity throughout thebody.”
In this way, fascia is considered an impor-tant integrative element in human posture and move-ment organization (locomotor apparatus) and is oftenreferred to as the “organ of form.”
Does an analyti-cal and “dissectional” approach to anatomy do justiceto this concept?In removing or dissecting the connective tissue inthe form of “layers,” every anatomist observes, butoften overlooks, various degrees of attachment. Some-times a layer of fascia is just loosely connected withthe underlying or neighboring structure or tissue; some-times, it is very tight and interwoven with it, and thefascia really has to be cut away, as is the case with thefascia cruris, for example. In both cases, the conceptof “dissected means discrete” tends to remain, withfascia viewed as distinct from other tissues, except forthose clearly organized in a mechanical
rela-tionship with muscular tissue, as in recognized auxil-iary structures such as tendons and aponeuroses.This methodologic mentality has also lead traditionalanatomy to dissect the musculoskeletal system intodiscrete anatomic structures as represented by bones, joints, and muscles. The present article shows that ar-chitectural and mechanical spatial relationships be-tween the various tissue components of themusculoskeletal system reveal functional units that
the traditional anatomic entities of bones, joints,and muscles.This larger view of
relationships andcoherence is supported by modern neurophysiology. Inthe central nervous system, the traditional anatomicorganization of the musculoskeletal system is only verypoorly represented topologically, if at all. The func-tional and coordinated components of position andmotion are not the muscles (and joints), but movementsand performed actions. Modern task-dependent mod-els as initiated by Loeb
indicate that motor unitsare not necessarily organized in the central nervoussystem with respect to individual motor nuclei, butaccording to behavioral tasks. This organization sug-gests that humans conceptualize a locomotion sys-tem in a
including the coordinatingand regulating nervous system (central as well as pe-ripheral), and discriminate that from the locomotionsystem in the
(locomotor appara-tus), which is represented by the actual musculoskel-etal system.
Continuity and Connectivity—ConnectiveTissue as Matrix
Under the procedural and mental scalpel of theanatomist, the continuity of the connective tissue ascentral matrix of the body has been lost. The pri-mary connective tissue of the body is the embryonicmesoderm. The mesoderm represents the matrix andenvironment within which the organs and structuresof the body have been differentiated and therefore areembedded. The German embryologist Blechschmidttherefore distinguished the mesoderm as germinallayer: an “inner tissue” in opposition to the ectodermand endoderm as “limiting tissues.” In histology, “lim-iting tissue” is commonly called epithelium and isconstituted almost solely of cells, with relatively lit-tle intercellular space. “Inner tissue” could be de-scribed as undifferentiated connective tissue,
and is in principle organized in threecomponents: cells, intercellular space (interstitial sub-stances), and fibers.
Most derivatives of the so-called inner tissue can be identified in histology asconnective tissue, including the head-mesenchyme asderivative from neurodermal tissue.