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70 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 3 critical thinking | ANATOMY FOR TOUCH TAKEAWAY: Because you manipulate skin ligaments with every massage stroke, understanding them better can help you be more specifi c with your touch. Between the skin we touch and the muscles we palpate lies a world of tissue and activity that is often under-addressed in our anatomy books, including one extraordinary structure we massage every day called the skin ligaments (retinacula cutis). These are made of connective tissue and part of the fascial system, but unlike most of the other ligaments you know, skin ligaments do not connect bone to bone. These small, fi brous structures create a bridge connecting the skin's dermis to the deep fascia— and you move them with every massage stroke. WHERE DO THEY LIVE? Skin ligaments can be found everywhere within the body's cushiony outermost layer—the subcutis, which is also called the subcutaneous tissue or superficial fascia. The subcutis is the dynamic space situated between the dermis and the deep fascia that stores energy, regulates temperature, exchanges hormones, and circulates lymph. In order for this busy community of cells and f luids to do its job, it requires a stable structural network to live in, which is formed by none other than the skin ligaments. WHAT DO THEY LOOK LIKE? The architecture of the subcutis is immediately visible in the anatomy lab once we go beneath the skin. Our eyes are first drawn to its most striking feature: billowy, bright-yellow fat lobules (Image 1). Looking closer, we can see skin ligaments extending down from the dermis, between the fat lobules, defining their shape and forming a fascial framework that resembles honeycomb or bubble wrap. You've probably seen skin ligaments before, even if you haven't been in an anatomy lab. Have you ever seen cellulite? As much as our culture may lead us to believe cellulite is a pathology, it is nothing more than the visible impression of your skin ligaments and fat lobules on the skin's surface. Skin Ligaments Retinacula Cutis: The Ligament You've Probably Never Heard Of By Nicole Trombley and Rachelle Clauson This cross-section of the skin and subcutis, magnified 40x, highlights the skin ligaments as they root down from the dermis between the fat lobules, providing structure and stability. Image courtesy of Blood vessels Skin ligaments Epidermis Dermis Fat lobule 1 WHAT DO THEY FEEL LIKE? Skin ligaments vary in thickness and density regionally and give structural boundaries to the fatty lobules. Areas that require more stability have shorter, denser, more tightly packed skin ligaments, such as on the palms, soles of the feet, and sacrum. In these areas, the ligaments and lobules can feel like small, squishy, tapioca pearls (1–2 millimeters). Areas that need to accommodate more internal or external movement between the skin and deep fascia have finer, longer, not-so-tightly packed skin ligaments surrounding the fat lobules, such as on the abdomen and thighs. Here, their adaptability makes them less easy to palpate, but you may perceive their soft texture similar to the size and shape of mini marshmallows or candy corn (5–20 millimeters). Authors' note: As hands-on practitioners, we use palpation and touch every day to improve health and wellness. But for many of us, we have no mental map for the things that weren't fully represented in our anatomy book images. How much is typically left out of anatomical drawings? Probably more than you think. We know you massage the whole body, not just muscles, nerves, and bones. So, in this new Anatomy for Touch column, we will write about anatomy that is incredibly relevant to bodywork, but perhaps slightly lesser known, including how it relates to the anatomy you already know, and, most importantly, discussing how it relates to touch.

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