Anatomy for Sports Massage by HealthFitnessEducation

Anatomy for Sports Massage Level 3 Student Manual

Contents

Anatomy and Physiology Level 3 Student Manual

Table of Contents Anatomy and Physiology for Sports Massage 1

The Skeletal System

Spine, Posture and Core Stability

The Muscular System

Muscle Actions

Cardio-Respiratory System

The Nervous System

The Endocrine System

8 The Lymphatic System

102

9 The Urinary System

106

10 The Skin

108

Principles of Exercise, Fitness and Health Components of Health and Fitness 12

110

13 Principles of Health and Fitness

116

14 Effects of Exercise and Physical Activity on the Body

123

15 Basic Principles of Nutrition and Healthy Eating

130

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Section 01

The Skeletal System

Anatomy and Physiology for Sports Massage

Section 01

The Skeletal System The skeletal system represents the body’s scaffolding and determines individual stature, body size and shape. Issues with the skeletal system, however caused, can relate to bone or joint integrity, limited or excessive range of movement, inflammation or pain or any combination of these. Massage can help improve joint integrity, posture and range of movement, as well as aid relaxation, stress release and pain relief, thereby increasing and supporting bone and joint health. A thorough understanding of the skeletal system will aid appreciation of the physiological effect massage can have on this system and how this, in turn, may affect the body as a whole.

The Function of the Skeleton The adult skeletal system is composed of 206 individual bones which are each connected via a series of joints to fulfil a variety of functions. These functions include: Movement – perhaps the most obvious of skeletal functions is movement. Via a series of joints (discussed later), the muscular system interacts with the skeletal system to produce movement. This is often why the muscular and skeletal system are referred to as the musculo-skeletal system. The long bones in the arms and legs act as levers, creating large ranges of movement at one end of the limb (furthest away from the body), and relatively small ranges of movement at the other end (nearest to the body). Shape – the skeletal system provides the human body with its unique upright posture and shape. With the skeleton acting almost like scaffolding, the muscular system is able to attach to the skeleton to provide the body with its shape. The skeleton also plays an integral role in determining a person’s ‘body type’ (discussed later). Protection – the skeletal system provides important protection to the vital organs by creating cavities and cages. The ribs create a large cage that protects the cardiorespiratory organs. The pelvis protects the reproductive and digestive organs. The spine protects the spinal cord, and the skull protects the brain. If it were not for the protection given by the skeletal system, the internal organs would inevitably become damaged if the body sustained any external blow or impact. Storage – the skeleton provides a large storage reservoir for minerals, especially much needed calcium 2 © Copyright Health and Fitness Education 2016. All Rights Reserved.

and phosphorus. Calcium is needed by the body to keep the bones and teeth healthy and is also used in many energy releasing reactions. Phosphorus also plays an integral role in these functions, and forms part of the membrane of every cell in the body. Production – Red and white blood cells and platelets are all produced in the bone marrow of the skeletal system. The red blood cells are used for the transportation of oxygen. The white blood cells form a crucial component of the immune system, helping the body fight infection and invasion from bacteria. Platelets perform a crucial role in stopping wounds from bleeding by clumping and clotting blood vessel injuries.

Types of Skeletal Tissue The skeletal system is not a passive structure. It is a living and dynamic biological system formed of various components that are constantly adapting, renewing and remoulding to meet the environmental demands. Different tissue types perform different roles within the skeletal system, many of which overlap.

Connective Tissues Connective tissue in adults comes in many forms; the organisation of its internal cells and fibres form individual and unique characteristics. The function of connective tissue is to link muscles and bones together to create an integrated system capable of producing movement.

Fat Fat is a packing and insulating substance capable of acting as a shock absorber, which is an important function in protecting bones and internal organs. Fat is stored for this purpose under the heel, in the buttocks and in the palm of the hand (subcutaneous). Subcutaneous fat is divided into compartments by fibrous tissue that stiffens in response to the protective demands placed upon it.

Collagen Collagen is the primary structural protein found in connective tissue and plays an integral role binding tissues together. Approximately 25% to 35% of the the body’s protein tissue is made from collagen, which is arranged in 2 different forms:

Iregular - fibres are not arranged in parallel bundles and is most commonly found in the skin.

Anatomy and Physiology for Sports Massage

Regular - fibres are arranged in parallel bundles and can be further divided into white and yellow fibrous tissue.

Fibrous Tissue Fibrous connective tissue is found throughout the body, particularly in the dermis of the skin, muscles, tendons and ligaments. There are 2 types of fibrous tissue, which are each outlined below. White fibrous tissue has perhaps the most regular collagen fibres and is incredibly dense. This density provides considerable strength without compromising its flexibility and elasticity. White fibrous tissue forms ligaments, tendons and the perimysium which is the protective membrane surrounding clusters of muscle fibres. Yellow fibrous tissue has a predominance of elastic (elastin) fibres which allows it to perform the highly specialised function of deforming and reforming. Yellow fibrous tissue is primarily found in the walls of the arteries and a small number of spinal ligaments that assist the spinal muscles in maintaining an erect posture, particularly the ligamentum flavum.

The Skeletal System

Section 01

With increasing age, hyaline cartilage tends to become much harder and rigid (calcified) which limits the amount of shock absorption available. Age also results in a decrease in the absolute number of cells within the cartilage. This, combined with its limited capacity for healing and repair, likely contributes to the aspect of wear and tear.

Fibrocartilage Fibrocartilage contains bundles of fibrous tissue which give it great tensile strength, combined with some elasticity, to enable it to resist considerable pressure and deformation. It is found between the vertebrae of the spine (intervertebral discs), the lip of the ‘glenoid fossa’ in the shoulder joint and the ‘acetabulum’ of the hip joint. Fibrocartilage can also be found in the ‘acromioclavicular’, ‘sternoclavicular’ and ‘pubic symphysis’ joints, which are each discussed in more detail later in this section.

Skeletal Tissues Skeletal tissue is essentially connective tissue with condensed cells and fibres which have been organisationally modified to strengthen them.

Cartilage Cartilage is supplementary to bone and is found where rigidity and strength are required. Although a rigid tissue, cartilage is not as hard or strong as bone. Within the body there are two primary types of cartilage hyaline cartilage and fibrocartilage.

Hyaline (Articular) Cartilage Hyaline cartilage, also known as articular cartiliage, forms the temporary skeleton of the foetus and infant prior to the process of ossification. Its remains can be seen as the articular cartilage in the synovial joints, the epiphyseal growth plates within the bone, and the costal cartilage of the ribs. Its outer surface provides a degree of elasticity that allows shock absorption; its smooth surface permits the free movement of adjacent bones.

Section 01

The Skeletal System

Anatomy and Physiology for Sports Massage

Bone Bone is an extremely hard tissue with a great deal of resilience. It is essentially an interwoven mix of fibrous connective tissue that is saturated with mineral salts. Its connective tissue provides the bone with toughness and elasticity, whilst the mineral salts provide hardness and rigidity. It must also be remembered that the mineral component of bones provides a readily available store of calcium that is continuously exchanged with bodily fluids. Bone is an active living tissue that has 2 distinct forms: • •

Compact Cancellous

Compact bone, sometimes called cortical bone, is the toughest of the 2 bone forms and is laden with minerals, bone cells, blood and lymph. Compact bone accounts for approximately 80% of the skeletal mass and can be found most prominently along the diaphysis of long bones. Compact bone is protected by a dense layer of fibrous tissue known as the periosteum; this structure allows the bone to withstand high levels of stress during movement and impact. Cancellous bone, which is sometimes called spongy or trabecular bone, is found primarily towards the ends of long bones; it can also be observed in the core of the vertebra. The internal architecture of cancellous bone reveals a complex arrangement of boney tissue known as trabeculae. The trabecular arrangement of the cancellous bone resembles that of lattice, running in many different directions to maximise its strength, whilst enabling it to stay light enough to move. The multi-directional arrangement of the cancellous bone is designed to resist compressive, tensile and shearing forces. Both cortical and trabecular bone are illustrated in the image above. The deepest component of a bone is the medullary cavity, which is sometimes simply referred to as the ‘medulla’. The medulla is a hollow structure that is packed with a complex vascular network to enable the transportation of blood cells in and out of the bone. The vast majority of the medulla is populated with bone marrow, although some red bone marrow can be found throughout the trabeculae. Bone marrow is primarily responsible for manufacturing red and white blood cells and can be found in both a red and yellow form. Red bone marrow is most prevalent in infants during the aging process and towards puberty, much of the red marrow is gradually replaced with

Nerves

Bone Marrow

Periosteum Cortical Bone

Medullary Cavity

Trabecular Bone

yellow fat marrow. Yellow marrow is primarily found in the medulla, while red marrow is largely stored in the cancellous bone.

Bone Development The skeleton comprises of 270 bones at birth but as the skeleton matures and some bones start to fuse together, only 206 bones remain in the adult skeleton. Ossification is the term used to define the process of bone growth from infant to adult skeletal tissue. There are significant differences between the composition of adult bone and that of a child. At birth, infant bone is primarily composed of cartilage. Bones are not passive structures and are constantly remodelling themselves through the activity of two cells called ‘osteoblasts’ and ‘osteoclasts’. During ossification the presence and influence of growth hormones, causes calcium to be added to the cartilage and triggers osteoblasts to transform cartilage or fibrous tissue into osteocytes. This results in remodelling of the bone at the ‘epiphyseal growth plates’ (the junction between the epiphysis and the diaphysis components of the bone). During adulthood and when the skeleton has creased growing, these growth plates disappear, causing the epiphysis and diaphysis to fuse. Osteoblasts deposit calcium in bone, making it denser and stronger. Osteoclasts remove calcium from bone, reducing its density and strength. In a growing child or adolescent the activity of osteoblasts is normally greater than that of osteoclasts and most of the adult skeleton is replaced every 10 years. In healthy adults the activity

Anatomy and Physiology for Sports Massage

of the osteoblasts and osteoclasts is relatively constant, ensuring bone maintains its strength. When the activity of osteoclasts exceeds that of osteoblasts, as may happen as we age, bone loses density and becomes prone to fractures. This brittle bone condition, known as ‘osteoporosis’ (literally meaning porous bone) is on the increase, especially in the older, frailer population but also in postmenopausal and early menopausal women. Osteopenia is the pre-cursar condition to osteoporosis and refers to bone density that is lower than the normal peak density but is not low enough to be classified as osteoporosis. Regular exercise or activity, coupled with a balanced diet should result in osteoblast activity exceeding that of osteoclast activity making the bones denser and less prone to osteoporosis and fractures. Osteocytes are mature osteoblast cells that have become ‘trapped’ in the bone matrix or ‘lacunae’ (small pits within the hard part of bone). They make up the majority of living cells in adult bone. As mature cells, they continue to form bone but have a larger role in bone remodelling and repair. They secrete substances through dendrite-like structures that influence the recruitment or inhibition of osteoclasts and osteoblasts and the remodelling of surrounding bone. The level of osteocyte activity and the substances it secretes are in turn influenced by factors such as mechanical stress on the bone, circulating hormones, and the amount of calcium and phosphorous in the bloodstream. Osteoblast and osteoclast activity is primarily regulated by the endocrine system and its hormones. The hormones involved in the controlling bone density are testosterone, oestrogen, calcitonin and parathyroid. When these hormones are low, the bone’s ability to retain calcium is diminished and the subsequent risk of osteoporosis is increased. Exactly how these hormones exert their protective effects remains unclear, but research supports the notion that as people age, their hormone profile changes, which increases their risk of developing osteoporosis-related fractures. It is estimated that one in two women and one in eight men over the age of fifty will experience an osteoporosis related fracture in their lifetime. Some of the more common fracture sites for those who experience this age or activity-related loss of bone mineral density include: •

Hip

•

Wrist

•

Individual vertebra in the spine

The Skeletal System

Section 01

Elderly and post-menopausal women are at a particularly greater risk of developing osteoporosis than their younger counterparts, especially men, because their production of oestrogen is reduced to the extent that it no longer affords sufficient protection to the skeleton. It is therefore crucial that these populations compensate for this hormonal change by partaking regularly in frequent weight bearing exercises that promote an increase or maintenance of bone mass and density.

Osteoporosis Risk Factors Age Bone structure e.g. petite frame Family history Speciic diseases e.g. rheumatoid arthritis Pregnancy (due to hormonal changes) History of fracture as an adult, regardless of cause. Cigarette smoking. Underweight (body fat<17%). White or Asian female. Sedentary lifestyle. Early menopause. History of eating disorders. High protein intake, particularly animal protein. Excess sodium intake. Alcohol abuse. Use of anabolic steroids. Vitamin D deficiency either through poor diet or inadequate exposure to sunlight. High caffeine intake.

Section 01

The Skeletal System

Anatomy and Physiology for Sports Massage

Osteoarthritis Another condition you may commonly see as a massage therapist is osteoarthritis. According to Arthritis Research UK, a third of people in the UK over 45 have sourced treatment for this condition. Osteoarthritis is the degeneration of the articular cartilage, usually due to wear and tear. In this condition, the cartilage becomes thinner and rougher, which makes joint movement painful. To compensate for the loss of bone and cartilage, the body forms new bone mass (osteophytes) on the ends of the bone. The new bone mass changes the structure of the synovial joint, often creating deformity and more pain. There are a number of risk factors associated with osteoarthritis, including: •

Age

•

Gender

•

Family history

•

Being overweight or obese

•

Repetitive work/sporting actions

•

Smoking

Bone Repair The process of bone repair is similar to that of bone growth, in the primary involvement of the osteoblast cells. However, the ‘trigger’ for osteoblast activity is now damage to the periosteum, the connective tissue layer surrounding the bone that protects and nourishes it. The periosteum contains a large blood supply so when bone is damaged bleeding is likely to occur between this membrane and the bone. Osteoblasts then migrate to the blood clot that forms at the site of injury. Through the process of ossification the blood clot becomes calcified and begins to turn into bone. As the repaired bone will be larger than its original size, osteoclasts are released to resorb and remodel any unnecessary bone so that the damaged bone returns, as near as possible, to its original size and shape. This has to happen before the cells mature and become osteocytes.

Classification of Bones There are 4 primary types of bone found in the human body:

Long bones act as levers, and are generally found where a large range of movement is required. They can be recognised by their distinct diaphysis and prominent epiphysis. The femur and humerus are good examples of long bones.

Long Bones Short Bones are located in areas where fine and precise movements are required; these bones have less strength than the long bone. The carpals and tarsals are both good examples of short bones.

Short Bones Flat bones serve as protectors of the vital organs and the attachments for skeletal muscles. The cranium, pelvis, scapula and ribs are all examples of flat bones.

Flat Bones Irregular Bones Irregular Bones are located in the spine and the face, and are typically used to protect the vital organs (viscera) and support surrounding structures. It is the irregular structure of the bones in the face that give each of us our unique facial characteristics. Sesamoid bones are bones that resemble the shape of a sesame seed and are usually embedded within a tendon. Examples include the Patella, those in the hands (first metacarpal) and the feet (first metatarsal).

Irregular Bones

Sesamoid Bones

Anatomy and Physiology for Sports Massage

The Structure of a Long Bone Diaphysis The diaphysis, often referred to as the shaft, is made from compact bone tissue covered with a hard outer layer. Compact bone tissue helps provide strength and support to the skeleton.

Epiphysis The epiphysis is the end of the bone, largely made of a spongy bone tissue called cancellous bone. Cancellous bone tissue fills the bone space in a latticework. The spaces within the latticework help reduce the weight of the bone and allow room for blood vessels and bone marrow. Unfortunately, the lattice structure also reduces the strength of the bone, increasing the risk of fracture.

Periosteum This refers to the hard outer protective casing of the bone and provides attachment sites for the muscles. This is largely composed of dense, compact bone that has much greater tensile strength.

The Skeletal System

Section 01

Articular Cartilage This is a smooth, white glossy tissue that furnishes the ends of the bones and ensures that smooth, fluid and lubricated movement between adjoining (or articular) bones can occur. Cartilage is also able to soak up synovial fluid which helps joints to absorb shock.

Medullary Cavity Within the central component of the long bone is the ‘medullary cavity’ which contains yellow bone marrow. Towards the epiphysis of the bone, the internal structure of the bone changes somewhat to become spongier or ‘cancellous.’ It is within this cancellous bone that red bone marrow is located.

Epiphyseal Plate The epiphyseal plate is a plate of hyaline cartilage that is located towards the ends of the bone between the epiphysis and diaphysis. This structure is found exclusively in children and adolescents and when adulthood is reached, the plate fuses completely and is replaced with an epiphyseal line. This structure is essentially the source of all bone growth during development.

(Outer Casing) Epiphyseal Plate

Epiphysis

Periosteum

Diaphysis

Epiphysis

(Compact Bone)

(Cancellous Bone)

N.B. The marrow of the bone is located deep in the medulla, this is not visible on this illustration on page 4.

Section 03

The Muscular System

Anatomy and Physiology for Sports Massage

Section 03

The Muscular System Introduction Skeletal muscle is going to be a primary medium for the massage therapist and one of the main tissues affected by massage application, particularly for superficial muscles lying directly beneath the skin. Massage can help reduce tension, not only in muscles but also in the fascia that surrounds them, keeping them at an appropriate length and strength for proper function. Massaging across muscle fibres (rather than along them) can help separate them and break up adhesions that may have formed due to minute tears, or injury. Left untreated, these adhesions can start to affect muscle function by decreasing range of motion and causing muscular imbalances. This in turn can affect posture, muscle length and strength, causing additional stress to joints and other structures. Massage therapists therfore need to develop a comprehensive understanding of the structure and function of the muscular system if they are going to be able to provide an effective treatment plan for their clients.

Types of Muscle The human body contains 3 distinct types of muscle tissue that are each structurally and functionally different to each other.

Smooth muscle is an involuntary and non-striated muscle tissue that forms the walls of the blood vessels and many of the body’s organs. This tissue is not under conscious control and cannot contract as fast or as forcefully as skeletal muscles. Smooth muscle tissue is more enduring than other types of muscle tissue, which is crucial to its continuous activation throughout the lifespan of a person. When smooth muscle tissue contracts, it typically causes constriction; when it relaxes, it usually results in dilation. Skeletal Smooth

Cardiac

Cardiac muscle is an involuntary form of muscle tissue that is only found in the walls of the heart; while it does contain some striations, it is largely composed of intercalated discs which act as cross bands, separating the opposite ends of the cardiac muscle cell from the next. These discs help to give the cardiac tissue its structural integrity and allow the rapid transmission of electrical impulses to adjacent muscle cells. Cardiac tissue has a lattice-like appearance that allows lots of muscle cells to fire and contract simultaneously, as seen with each heart beat. Cardiac muscle tissue has virtually no anaerobic capacity and therefore relies exclusively on the coronary arteries to deliver a continual supply of oxygenated blood. Skeletal muscle tissue forms over one-third of total body mass in those with a normal body composition and is formed by large bundles of fibres that give the muscle its striated or striped appearance. These tiny fibres have the ability to shorten to almost half of their resting length. It is the arrangement of these fibres that dictates the speed and force at which the muscle fibre can shorten.

Fibre Arrangement A muscle that packs its fibres parallel to each other in a spindle like shape is called a ‘fusiform’ muscle. This arrangement is thicker in the middle and thinner towards the end, and is usually found where the muscle is required to contract through a larger range and at a greater speed. The fusiform arrangement is incapable of producing force at the same magnitude as the pennate arrangement. A muscle that packs its fibres diagonally, or obliquely, is described as having a ‘pennate’ arrangement – there are three primary types of pennate arrangement which are each illustrated on the following page. A pennate arrangement packs more fibres into a smaller space than a fusiform muscle, making it considerably stronger and capable of generating much more force. This greater level of force does however reduce the speed at which the muscle can contract, especially within a multipennate fibre.

Unipennate

Intercostals, tibialis anterior

Bipennate

Rectus femoris

Multipennate

Deltoids

Fusiform

Biceps femoris, bicep brachi

The Muscular System

Anatomy and Physiology for Sports Massage

Unipennate

Bipennate

Multipennate

Structure of a Skeletal Muscle

Fusiform

Protecting each muscle fibre is a layer of connective tissue known as the ‘endomysium’. The endomysium binds large groups of smaller fibres together which are known as ‘myofibrils’. Each myofibril contains segmented contractile units that are arranged in a parallel sequence, these are called ‘sarcomeres’.

The external wall of the muscle is formed by a thick layer of connective tissue known as the ‘epimysium’, occasionally this may be referred to as the ‘sheath’ or ‘fascia’. The facia, which is made from collagen, binds together at the end of the muscle to form the tendinous attachments that connect the muscles to the bone. It is at these sites where the collagen becomes more dense and regular. For further information about tendons, refer to Section 01. Essentially the role of the epimysium is to bind all of the fibres together and to protect the contractile filaments from impact and trauma.

The sarcomere is formed by two protein filaments called ‘actin’ and ‘myosin’. These filaments, sometimes called ‘myofilaments’, are arranged in an overlapping manner to allow to sarcomere to shorten and lengthen as required. During a muscle contraction, the myosin heads bind with the myosin binding sites located along the actin filament to form a ‘cross bridge’. These heads, which look like a double ended of a golf club, then tilt, detach, reattach and tilt again, until the sarcomere can shorten no more. This is ultimately how muscle fibres contract. For more information on this process, refer to the sliding filament theory on the following page.

Large groups of muscle fibres are bound together within the epimysium by layers of fibrous connective tissue. These bundles of fibres are collectively known as ‘fasiculi’ or individually as ‘fasiculus’. Each fasiculus can hold up to 150 ‘individual muscle fibres’ which are each about the size of a human hair. The fasiculi are protected by another thick layer of connective tissue called the ‘perimysium’. Sarcoplasmic Reticulum

Section 03

Myofibril Epimysium

Muscle Fibre

Myosin

Nucleus

Actin Mitochondrion

Endomysium

Perimysium

Fasciculi

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Anatomy for Sports Massage Level 3 Student Manual