Why is Anatomy Important?
Tommy Boone, PhD, MPH, FASEP, EPC
Some years ago, the study of the relationship between form and function was considered important. College professors impressed upon their students the value of knowing human anatomy and its fundamental relationship to function. No one graduated from college with a degree in Health and Physical Education without passing the “Kinesiology” course. It was “the” course that all students dreaded, but were probably most interested in taking. A major part of the reason they didn’t like the course had to do with the requirement to memorize origins, insertions, and functions of the major muscles of the body.
The idea was simple. If the students could identify the muscles and understand the relationship of individual muscles to each other, the likelihood of understanding human movement and thus sports skills was increased. Every student wanted to know more about the anatomy of sports skills, and so the students seldom ever challenged the professors. Every single muscle was put to memory, which raises an interesting question. “Was it correct to require the students to memorize origins, insertions, and functions?” If the professors were correct, “Why is there so little emphasis on anatomy today? More to the point, why don’t all graduate programs that offer exercise physiology have an anatomy course?” To be even a bit more blunt, why don’t the exercise physiology programs have an anatomy laboratory with cadavers?” Clearly there is no substitute for cadaver dissection in the study of functional anatomy.
Answers to these questions will be explored in this article. The purpose is to understand why
anatomy has become the forgotten course in the graduate curriculum of most exercise physiology programs of study? Perhaps, part of the answer is that most professors (and certainly most students) would argue that memorizing a list of facts, formulae, and bits of anatomy is a waste of time! Memorizing anything is openly said to be meaningless. Memorization is said to have little to no value in real learning. Real thinking is defined as something other than memorization? It is said that memorization is simply unnecessary and often distracts from a higher level of cognitive function. Many educators appear to believe that the statement is true.
However, the single biggest myth in academia is the idea that memorization isn’t important. It is entirely untrue that the power invested in memorization is meaningless or a waste of time. To remember facts of diverse dimensions, a person must have an excellent memory. All students (and their professors for that matter) memorize bits and pieces of different subject matter everyday. Remembering origins, insertions, and functions are as important as remembering physiological calculations to understand oxygen consumption or mean arterial pressure. Is there any more sense of importance in remembering the solution to a cardiac output calculation versus remembering the origin of the pectoralis major. What about recalling the insertion of the muscle or the role it plays in inward rotation? If a person should know the right information about each question, what is the role of recall? In short, being able to recall the “lateral lip of the bicipital groove and the fact that the pectoralis major assists in inward rotation bears directly on one’s ability to remember the information.
It is not clear thinking to believe that exercise physiologists can understand the human body without knowing anatomy? Professors should know that a precise understanding of anatomy is crucial to an accurate leadership role in fitness, health, sports training, and rehabilitation. If they do, and good sense suggests they should, it argues against the fact that they appear disinterested and essentially do nothing to engage students in anatomy discussions. It is as if there might be an attitude that anyone can learn anatomy, but only the select few, perhaps, the exercise physiologists, can learn physiology. Such thinking is incomplete and foolish. It sets the stage for poor judgments and a conflicting message, especially with respect to the realm of athletics and human movement. Such a disconcerting point of view is disruptive and uncharacteristic given the impressive academic degrees most professors have earned.
Yet, today, aside from the status quo of most doctorate programs that offer something approachable to exercise physiology, there are few if any academic programs in exercise physiology that require gross anatomy courses. Imagine the incompleteness of a PhD degree that is centered squarely on the human body and, yet the future professors complete their education without having the hands-on opportunities to dissect cadavers. It is the same inappropriateness in thinking when studying oxygen consumption without having the opportunity to measure it. Exercise physiologists argue strongly for the cutting edge metabolic analyzers and other physiological equipment to identify with “physiology” while the idea of procuring a cadaver for a more thorough trustworthy analysis doesn’t seem to enter their minds. Surely, the importance of knowing structure at the same level of knowing function isn’t that hard to face except for the old battles of separation of one discipline (exercise physiology) from another (physical education). To make matters worse, most exercise physiologists either don’t know or act like they don’t know the differences between being a physiologist and an exercise physiologist. In short, the issue of anatomy is but one of several unanswered questions centered directly on the question, “What is exercise physiology?”
Indeed, there are a lot of such questions and one, in particular, “Why teach anatomy, anatomic terminology, connective tissues, articulations, muscles, and nerves?” Despite the many issues that surround the unanswered questions with the anatomical perspective, it is essential that exercise physiologists recapture the original thinking of human movement as a synthesis of the complex interaction of the skeletal, muscular, and nervous systems, including the biomechanics of movement and the biochemistry of movement. Indeed, an understanding of anatomy is essential to gaining a working knowledge of the human body. All professors understand this point but have allowed their better thinking to be derailed and tabled. To complicate matters, they have also embraced a “specialist” thinking as a rule of thumb of their work expectations. Their fuzzy logic has misled them, and unfortunately has kept them from understanding the criteria or characteristics of a profession.
Exercise physiologists ought to wake up and place an equal emphasis on investigative techniques specific to anatomical human movement. One way to do so is to introduce a human anatomy course at the graduate level. An exercise physiologist with gross anatomy training and dissection experience should teach the course. Cadavers should be procured by the department from local medical schools and stored in the department’s anatomy laboratory. The structural and functional relationships should be integrated with the physiological lectures. Becoming involved with anatomy will help clarify a more professional distinction for the department as well as the profession.
Hence, if exercise physiologists want to help with the emerging profession, they should encourage the teaching of anatomy at all levels of the students’ education. A course in functional anatomy is much more important to an exercise physiology student than another course variation on physiology, chemistry, or biochemistry. There is something wrong with the idea of an exercise physiologist who is conducting research at the muscle fiber level, but who cannot recognize the differences in shoulder flexors and abductors. There is also the troubling notion that students who are required to learn the cellular enzymes for energy production, while failing in the understanding of the nerves to specific muscles. Ultimately, knowledge of basic neuroscience (such as the lateral pectoral nerve innervating the clavicular fibers of the pectoralis major, as in shoulder flexion) allows for a better understanding of everyday human movement than the histologic differences between fiber types.
Anatomy is an essential knowledge for all exercise physiologists. It is time to reflect on the lack of emphasis placed on it. Professors should argue for the teaching of anatomy, and its integration in the practice of exercise physiology. They should teach osteology (to understand the points of origin and insertion), myology (to establish the relationship of muscles of different joints to each other), and neurology (to appreciate the role of the nervous system in function and dysfunction). Joint motions should be analyzed with reference to specific muscles, either as one-joint or two-joint muscles, and how singly and collectively they function to produce the desired action or actions.
The kinesiological (i.e., anatomical) analysis can take on a variety of different forms, including but not limited to, weight lifting, sports skills analysis, fitness and training, and exercise rehabilitation. The joints and the range of motion possible should be understood in terms of the nervous system. Students should know the spinal nerves that innervate the skeletal muscles to fully understand the loss in muscle function when an injury occurs to a specific nerve or related nerves. The nerve-muscle information is critical to a solid science background in any science curriculum that is responsible for developing and/or maintaining the human body, either in preparation of sports, during rehabilitation, or as a function of life-style management.
To this end, exercise physiologists need to have a much greater appreciation of anatomy. The contribution to function can be demonstrated convincingly in several important ways. Logic and reason require a commitment to function, as in the exercise intensity necessary to reach the training threshold to realize the true greatness in one’s genes. Yet, in order to win, the athlete’s mindset must be just right. He must also connect with his muscles to create the right combination of factors. An exercise physiologist trained in functional anatomy is better set to create, alter, and/or reconstruct the knowledge and meaningful experiences to achieve athletic success. The mechanisms of athletic function cannot be fully appreciated without an in-depth understanding of the structure of the human body. It is equal in importance to the science of physiology, and it is inseparable from physiology in that anatomy tends to reflect physiology.
At the College of St. Scholastica, our kinesiology course hasn’t changed. We continue to teach functional (or applied) anatomy throughout the entire semester. A great strength of our anatomy education is the commitment by faculty to the belief that exercise physiologists should know anatomy and physiology, not just physiology. This approach has worked well in several academic settings where students have been taught with and without cadaver dissection.
Since we are comfortable with years of teaching anatomy, since we understand its value to a comprehensive understanding of the human body, and since we believe in supplementing the students’ exercise physiology education with anatomy, we were surprised to find that many exercise physiologists simply are not interested in anatomy. Instead, they are interested in physiology! Exercise physiology laboratories are complete with all kinds of equipment to measure physiological responses at rest and during exercise. This closed-out mentality regarding anatomy is less than flexible thinking that is built solidly on thinking from a generation ago. In other words, “Why Teach Anatomy?”
Equally important, is there something different today with our students? Do they know anatomy well enough that we don’t have to teach it? Or, is it that physiology is more akin to research and, since everyone has been taught to value research, we therefore value physiology over anatomy? This latter point has several interesting implications. Research is important, but so is anatomy. Publications are important, but so is being an educated professional. What to do? First, it is important to come to an understanding of the problem before us. If we are to continue to teach very little anatomy, what will it ultimately mean a decade from now? Second, if we are to value the contribution of anatomy to maintain a robust education, what are we going to do? How do we address this issue? We believe it is necessary to keep anatomy in the exercise physiology curriculum.
While we expect members of ASEP to play an integral role in promoting anatomy, we have decided to begin the process by writing this article and charting the direction of our mission. From the beginning, what do we know? One of the hallmarks of physical education is the kinesiology course (which is anatomy when properly taught). In the past, anatomy was alive, and it was required. No one believes a student could graduate as a physical educator without knowing applied anatomy. The idea itself goes back for many years [1-3].
In time, with the negative thinking about what is physical education, its leaders felt compelled to come up with a different name. Physical education became kinesiology (i.e., the science of movement). From activity to science, physical educators became known as kinesiologists. Of course, the public wasn’t fooled. Regardless of the title, kinesiologist or physical educator, the earlier understanding had not changed. Only the physical educator thought change had come about. Later, physical educators, who believed their rightful title is “kinesiologists” became concerned once again with the public’s perception of their work. This resulted in the title now known as “exercise science” in place of kinesiology. Of course, many other departments, consistent with their institutional inertia, adapted to a variety of other department titles and academic degrees .
In the aftermath of the gross lack of leadership that set up at random the identification of dozens of titles and academic degrees, we have not only exercise science programs but, literally, dozens of other programs without meaningful job opportunities. These programs also have little to no serious emphasis on anatomy. Why? We believe that part of the answer lies in the increased emphasis on biomechanics. Obviously, while the physical educators were in a state of confusion, those with an interest in sports biomechanics wrote their own books and methods of analyzing human motion [5-7]. Their influence has had a significant effect on what was applied anatomy. They introduced a new technological point of view with instant data collection techniques. Obviously, cadavers do not provide instant data, and the “School of Human Performance” or whatever the title might have been, is certainly not set up for cadaver dissection.
Hence, the problem becomes apparent. The luxury of an anatomy education and its application to musculoskeletal and/or health and fitness training programs doesn’t exist without the original intent, understanding, or familiarity with the subject. In other words, the purpose of anatomy was pushed aside for the teaching of biomechanics. This thinking presents a major twist in the physical educator’s position regarding structure. In many ways, it’s hard to understand why this spectacular turn of events was allowed. As a result, the typical kinesiology course in many programs was divided into two areas of study (i.e., anatomy and biomechanics). In other programs of study, the biomechanics course replaced anatomical concepts and, why not? Memorization is bad, right?
While there is an obvious value in the study of biomechanics, it doesn’t answer anatomical questions per se. The ability to think 3-dimensionally about structure is the opportunity to see anatomy in real time, either at rest or during motion. The biomechanics course, on the other hand, requires a significant engagement of technological equipment. In our opinion, this is why anatomy is more applicable to everyday conditions. Therefore, it should be an integral part of our academic programs. The benefits are obvious and have been for many years.
Without an anatomy education, there is little opportunity to understand structure. Similarly, without a physiology education, there is little opportunity to understand function. Hence, this is our point: If there is very little anatomy being taught, then we must not value the anatomical conceptualizations of the human body. This ought to come as a surprise to all of us, but it doesn’t. Zoom in and think about it. Meaning, have you looked closely at what our students are not getting when anatomical concepts and insights are not in the curriculum? In our opinion, there is a significant volume of information that our students should know but are not being taught. Rather, it’s all about physiology. After all, physiology is part of the “exercise physiology” title. There are no academic programs and/or professional titles for the “exercise anatomy” professional.
The idea of studying anatomy at the same intensity as physiology appears to exist in the minds of only a few exercise physiologists. Even more alarming, when anatomy is required, it is our opinion that exercise physiology faculty lack the preparation (or worst yet, care or passion) to teaching anatomy. Of course, in all fairness to exercise physiologists, the question is also being asked of anatomists. Paalman  points out “that the structure of the human form is being emphasized less and less….” Is it enough to teach anatomy with interactive functional anatomy software?
This brings up another interesting question. “Why is there less emphasis on anatomy today than a few years ago?” Is it related to the medicine’s reliance on magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET)? Most patients would expect medical doctors to have a thorough knowledge of anatomy. They would be surprised to find out just how little anatomy education many medical doctors have. They would even be more surprised to learn that the “interactive DVD-Rom Drive” is replacing the anatomy lab.
Our impression is that today’s medical doctors have come to think that the “best education” results from the hot ticket items that are expensive ways to diagnose illnesses and dysfunctions. This isn’t true for all physicians, but it is the truth for many. Rather than walk away from an anatomy education with the ability to visualize 3-dimensional anatomical relationships, new modalities and imaging technologies (including the interactive functional anatomy DVDs) have become a permanent feature in ascertaining the anatomy of a human person. The familiarity with significant real-time hands-on dissection experiences has been put aside for course-specific-assisted instruction (CAI) modules .
We believe that exercise physiologists need anatomy. An exercise physiology curriculum built solely or primarily on a physiology education is not enough. That is, one without the other is no longer acceptable. As college teachers, we recognize our responsibility to the exercise physiology students by not marginalizing their education. Our commitment therefore is to a complete and comprehensive education. The marginalizing of anatomy (i.e., reduction in laboratory hours and/or the rationale for substituting various imaging technologies in place of cadaver dissection) must be corrected. An anatomy education is both a privilege and a duty. It is also a daunting task. It should not be replaced by distance-learning programs or by interactive 3-D animations, regardless of the advertisements that the digital format and quick-search DVD facility will save time and/or costs. Is it true that using either Macintosh or PC computer anatomical software will save time when revising and preparing for lectures and presentations ? No doubt to some degree it will, but the issue is whether it should replace the teacher and, where possible, the actual hands-on opportunity to dissect cadavers.
It behooves us, as exercise physiologists, to use whatever forum we have to embrace, to learn, and to share a new way of thinking about anatomy. It is up to us as ASEP exercise physiologists to realize our power as professionals. We have a history of experiences in anatomy, its benefits, and its application to the human at rest and during exercise. Our first responsibility in the 21st century is to capture the original intent in teaching anatomy to prepare the student. Second, and particularly important to the emerging professional status of exercise physiologists as healthcare professionals, is to integrate anatomy into the otherwise predominately physiology curriculum. Interestingly, this brings us back to the question: “Why teach anatomy?” Ten points bear directly on this issue.1. Much of what exercise physiology is about today and will continue into the future is “fitness” and, in general, physical development. Without anatomical information, it is next to impossible to ensure that the student will engage clients in safe and effective fitness programs. This has already become self-evident with personal trainers with little more than a weekend warrior certification. This overall approach to personal training defined by certifications having nothing to do with an academic degree is meaningless and potentially harmful. We have found that professionals are historically linked to a professional education found on college campuses throughout the United States, not from for-profit organizations. There are many examples that illustrate our point (such as nursing, physical therapy, occupational therapy, dietitian professionals with direct links to college academic programs).2. The vast majority of undergraduates think it is logical to teach anatomy. They are confused when the curriculum doesn’t require them to take an anatomy course. This is a valid concern. It also directly influences the quality of the students’ education upon entering graduate school. Without a detailed knowledge base of human anatomy with specific implications to the public sector, the students are at a distinct disadvantage. And, if anatomy isn’t taught in graduate school, which is a very likely possibility, the exercise physiology student without such prior experiences is, in essence, self-taught when it comes to examples where an anatomical orientation, information, and application could make a difference in the client’s health and fitness.
3. It is our experience that other professionals expect our students to have a formal education on the structure (as well as the function) of the human body. Indeed, when the rationale is presented to get rid of anatomical instruction for more ECG courses or more physiology courses, they are equally as confused as we are. We believe that it is up to the exercise physiology faculty to identify the courses that are necessary for a comprehensive exercise physiology education. The argument to not teach anatomy doesn’t hold water. It is a weak point of view.4. We believe that instruction in anatomy must be part of the doctorate degree. The fact that it isn’t is a significant part of this overall problem. Where are doctorate prepared exercise physiologists learning functional (or gross) anatomy? A strong argument can be made that they are not being taught anatomy. Logically, this is also an important reason why kinesiology has been rendered a back seat position to biomechanics or exercise physiology related courses. There appears to be no organized academic effort to develop educators with a strong emphasis in anatomical knowledge and/or instructional skills. This failure to do so, particularly at the doctorate level, will become increasingly problematic in the future.5. In time, perhaps, not too far in the future, neither faculty nor students may perceive anatomy as an integral part of the exercise physiology students’ education. After all, we believe that we are close to that point of view at the present time. If this is true (i.e., perception becomes truth), students may feel that the study of anatomy is a waste of time . This would be an unfortunate side effect of our failure to teach anatomy, to demonstrate its value, and to encourage its application. In short, it is a failure in faculty responsibility to address with specificity the educational curriculum of exercise physiology. All exercise physiology students should not only have the anatomical knowledge base, but as importantly, the philosophical position of anatomical relevance to the practice of exercise physiology. Again, we believe this view is consistent with faculty perspectives in other healthcare professions.6. It is reasonable to expect exercise physiology faculty to want their students to enter the public sector with specific skills and knowledge that will ensure a safe and effective practice. Anatomy is an important part of this knowledge. While we believe it is in jeopardy in many programs of study, it is possible to regain the traditional hands-on anatomy. Even during our recent advances in technology, we believe there is room for a rigorous lecture based problem solving approach to anatomy. High-tech visuals are great adjuncts to the teacher’s responsibility, but we argue that such alternatives are just that – alternatives to actual teaching! Similarly, we would not expect exercise physiologists to substitute the metabolic cart for actual learning guided by the teacher in everyday classrooms. Virtual experiences that describe anatomy are just that – virtual. They are not real interactions between the students and the teacher. Today’s educators ought to work at understanding this point, particularly with the emphasis on distance learning, take-home tests, and other technologically driven methods that have taken the place of many teachers.7. Where students have had the opportunity to dissect and study cadavers, regardless of the standard arguments of not wanting to touch dead, preserved specimens , more frequently than otherwise, they take from the experience sensitivity and constructive appreciation for hands-on interaction with real world anatomy. Of critical importance is the fact they now understand that anatomy is not consistent with the usual belief of rote memorization of meaningless structural details. This means that anatomy can be taught using well-planned and effective 3-dimensional instructional exercises . There are also a variety of other teaching strategies (such as case-driven inquiry-based analysis and problem-based group work).8. Why teach anatomy? The most obvious answer is because the musculoskeletal system is our very foundation for function. To not understand structure is to set our emerging profession up to fail and, yet this may not be true for other professions who have ranked the musculoskeletal system at the bottom of the body systems for typical anatomy and physiology courses . We are surprised by their ranking that places the nervous system first followed by the cardiovascular system second. Fluid, electrolyte, and acid-base, collectively, was third, the immune system was fourth followed in descending rank by the respiratory system, the endocrine system, and musculoskeletal system. This recent trend to teach less anatomy and, in particular, to minimize discussion of detail (such as origin, insertion, and functions) is a serious academic problem for this reason (among others): “We have been dealing with this dilemma as we redesign our A&P curriculum….This revision was prompted by complaints from our Nursing School that the students were not well-prepared for their pathophysiology class and by a request to bring our courses in line with those at other state institutions so that students could transfer credits more easily.” 9. We believe that anatomy is useful and has value. How else could an exercise physiologist know the specifics of “why” and “why not” to perform certain weight lifting exercises? How about flexibility exercise? Surely, knowledge of anatomy is important and, by knowledge, we mean more than just the identification of osteological landmarks and, yes, more than just the origin or a muscle without truly understanding the implications of the landmarks. Our view is that college teachers must not forget to teach the names of structures but, most importantly, place the greatest emphasis on the “language of anatomy”. By language, we mean the ability to reason through relationships by recalling mental images in a very specific 3-dimensional presentation of actual form and function .
10. Anatomy, when properly taught as a language, communicates human function based on structure. If we were to avoid teaching the musculoskeletal system, we would fail to grasp the link between dysfunction and abnormal structure that results from various diseases, musculoskeletal traumas, or developmental defects. Here, we are defining anatomy as more than origins and insertions and/or specific osteological terms. These are important aspects of learning anatomy but, most importantly, is the language itself. The ability to think visually, to see through layers of skin, fat, fascia, muscle, nerves, and so forth to solve a problem or to recognize a possibility. This anatomical concept (or way of thinking) should be the equivalent of a common thread in how college teachers teach anatomy and in the learning process itself on behalf of the students.
1. Rasch, P.J. & Burke, R.K. (1971). Kinesiology and Applied Anatomy: The Science of Human Movement. Philadelphia, PA: Lea & Febiger.
2. Jensen, C. & Schultz, G.W. (1970). Applied Kinesiology: The Scientific Study of Human
Performance. New York, NY: McGraw-Hill Book Company.
3. Duvall, E.N. (1959). Kinesiology: The Anatomy of Motion. Englewood Cliffs, NJ: Prentice-Hall, Inc.
4. Rademacher, E. & Pittsley, J. (2001). Analysis and Comparison of Colleges and Universities with Degree Titles of Exercise Physiology or Related Titles. Professionalization of Exercise Physiologyonline. Vol 4 No 12 December 2001. [Online]. http://www.css.edu/users/tboone2/asep/MinimalStandards.html
5. Dyson, G.H.G. (1962). The Mechanics of Athletics. England: University of London Press Ltd.
6. Hall, S.J. (1995). Basic Biomechanics. Boston, MA: McGraw-Hill.
7. Hay, J.G. (1985). The Biomechanics of Sports Techniques. Englewood Cliffs, NJ: Prentice-Hall, Inc.
8. Paalman, M.H. (2000). Why Teach Anatomy? Anatomists Respond. The Anatomical Record. 261:1-2.
9. Reidenberg, J.S. & Laitman, J.T. (2002). The New Face of Gross Anatomy. The Anatomical Record. 269:81-88.
10. The Conservative Care Specialists. (2003). Interactive Functional Anatomy – DVD. [Online]. http://www.optp.com
11. Haines, D.E., Hutchins, J.B. & Lynch, J.C. (2002). Medical Neurobiology: Do We Teach Neurobiology in a Format that is Relevant to the Clinical Setting? The Anatomical Record. 269:99-106.
12. Miller, S.A., Perrotti, W., Silverthorn, D.U., Dalley, A. & Rarey, K.E. (2002). From College to Clinic: Reasoning over Memorization is Key for Understanding Anatomy. The Anatomical Record. 269:69-80.
13. Boone, T. (2001). Anatomy: The Forgotten Piece of the Beginning. Professionalization of Exercise Physiologyonline. Vol 4, No 6 [Online]. http://www.css.edu/users/tboone2/asep/ANATOMYandExercisePhysiologists.html
14. Lemons, D.E. & Griswold, J.G. (1998). Defining the Boundaries of Physiological Understanding: The Benchmarks Curriculum Model. Advances in Physiological Education. 275:S35-S45.
15. Boone, T. (1990). Imagery and Teaching: Some Reflections. Journal of Physical Education, Recreation and Dance. 62:45-49.
Note: This chapter was originally published in the Professionalization of Exercise Physiologyonline as: Boone, T. (2001). Anatomy: The forgotten piece of the beginning. Professionalization of Exercise Physiologyonline. Vol 4 No 6 [Online]. http://www.css.edu/users/tboone2/asep/ANATOMYandExercisePhysiologists.html
and Boone, T. (2003). Why teach anatomy? Professionalization of Exercise Physiologyonline. Vol 6 No 3 [Online]. http://www.css.edu/users/tboone2/asep/WhyTeachAnatomy.html
Permission has been granted to republished the article in The ASEP's Study Guide.