Anatomy by Janus de Lange

MODULE: ANATOMY Anatomy is the structure of the human body. The study of anatomy entails the dissection of muscles and organs. Exercise science requires a fundamental understanding of the human body with less emphasis on the internal organs. It is absolutely imperative for and exercise leader to have an elementary and basic understanding of the human anatomy. Understanding the human body and its functions will enable the exercise leader to be more knowledgeable and effective in their professional responsibilities of programme design for group and individual exercises.

SAGIT

TAL

NAL

CORO

A: Midsagittal plane

Movements of flexion and extension take place in the sagittal plane.

B: Coronal plane

Movements of abduction and adduction (lateral flexion) take place in the coronal plane.

C: Transverse plane

Movements of medial and lateral rotation take place in the transverse plane.

TERMS OF RELATION OR POSITION reference point - horizontal plane

posterior (dorsal) closer to the posterior surface of the body

anterior (ventral) closer to the anterior surface of the body

reference point - frontal or coronal plane

Medial (lying closer to the midline)

Lateral (lying further away from the midline)

reference point - sagittal plane

Proximal closer to the origin of a structure

Distal further away from the origin of a structure

reference point - the origin of a structure

superficial

deep

reference point - surface of body or organ

Inferior (closer to the feet)

Superior (closer to the head)

between two other structures

supine

prone

cephalad

caudad

refers to a hollow structure (external being outside and internal being inside)

face or palm up when lying on back, face or palm down when lying on anterior surface of body toward the head, toward the tail (feet)

internal

external

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intermediate

reference point - along the midsagittal or median plane

Median

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TERMS OF MOVEMENT flexion

extension

increasing angle with frontal plane decreasing angle with frontal plane

posterior (dorsal) closer to the posterior surface of the body

anterior (ventral) closer to the anterior surface of the body

reference point - frontal or coronal plane

flexion

extension

increasing angle with frontal plane decreasing angle with frontal plane

protraction

retraction

moving forward or backward along a surface

elevation

depression

raising or lowering a structure

medial rotation

lateral rotation

movement around an axis of a bone

pronation

supination

placing palm backward or forward (in anatomical position)

circumduction

combined movements of flexion, extension, abduction, adduction

opposition

bringing tips of fingers and thumb together as in picking something up

TABLE OF FREQUENTLY USED TERMS IN ANATOMY Ala

a wing-like process

Alveolus

a deep narrow pit, such as a tooth-socket

Ampulla

used to describe the dilated part of a duct.

Ansa

a loop, usually referring to a nerve

Antrum

a cavity

Aponeurosis

a glistening sheet of fibrous connective tissue from which muscle fibers arise or into which they run

Artery

a blood vessel which conducts blood from the heart

Bone

a special form of connective tissue in which calcium salts are deposited and which provides a framework, or skeleton, for the other tissues of the body.

Bursa

a membranous sac containing a small amount of viscous fluid. A bursa is usually found in tissues where friction develops, such as where a tendon crosses a bony prominence. A bursa may form synovial sheaths to surround tendons as they cross other tendons or bone.

Canal

a tubular and relatively narrow channel, or tunnel, often through a bone. A canaliculus is a smaller canal.

Capsule

a fibrous or membranous envelope surrounding an organ. An articular capsule surrounds each synovial joint, being attached to the bones just beyond the limits of the joint cavity.

Cartilage

a firm white tissue, from which most parts of the bony skeleton are formed and which persists to protect the surfaces of bones and joints.

Caruncle

a small fleshy eminence

Cauda

tail

Cavity

a hollow space (or potential space) within the body or its organs.

Cervix

means neck and is applied to the neck like portion of an organ (e.g. cervix of uterus)

Chiasma

a crossing of fibers in the form of an X. Used primarily to describe nerve fibers.

Commissure

a band of fibers which join corresponding right and left parts of a structure across the median plane.

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an entrance or opening

Aditus

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TABLE OF FREQUENTLY USED TERMS IN ANATOMY Cortex

outer part, or rind, or some organs as distinguished from their inner part, or core usually called a medulla.

Crest

a projecting ridge, especially one which on a bone

Crus

means a leg and is applied to a structure that resembles a leg or stalk

Decussation

same as a chiasma. A crossing of fibers in the form of an X.

Digitation

a finger like process of a muscle

Disc

a flat round structure usually applied to plates of cartilage in joints.

Duct

a tube for the passage of fluid, especially secretions of glands. A ductile is a small duct.

Epithelium

a layer of cells which forms the external surface of the skin, or which lines the cavities of the digestive, respiratory and urogenital organs, serous cavities, inner coats of blood and lymphatic vessels, gland and cavities within the brain. The epithelium of the skin is the epidermis. The epithelium of the digestive, respiratory and urogenital organs is moistened by a film of mucus and is known as the mucous coat. The epithelium lining bloods vessels is known as the endothelium. Serous cavities are lined by epithelium called mesothelium.

Fascia

tissue which lies immediately deep to the skin known as subcutaneous tissue. It usually consists of a layer of connective tissue which contains fat, and of a deep and more fibrous layer which adheres to the surface of the underlying muscle and vessels. These layers are known as superficial and deep fascia respectively. Fascia surrounds every muscle, organ, vessel and nerve in the body.

Fasciculus

a small bundle. A term that is usually applied to collections of nerve fibers.

Filum

literally mean a “thread”. This name is given to several thread-like structures such as the filum terminale, the lower extension of the pia mater of the spinal cord.

Fold

a ridge formed where a membrane doubles back on itself

Folium

mean leaf. The plural “folia” is applied to the folds of the cortex of the cerebellum.

Foramen

a hole, often in a bone or between adjacent bones.

Fossa

a “ditch”, usually referring to a shallow depression or cavity.

Fovea

a small pit or fossa

Frenulum

a small fold of the mucous coat which limits the movement of the structure to which it is attached

Fundus

used to denote the widest part of a hollow organ

Ganglion

a swelling on the course of a nerve. Usually corresponds to a collection of nerve cells.

Genu

mean knee. Geniculum is sometimes applied to a bent part of a structure.

Gyrus

a fold or convolution of the cerebral cortex.

Hilum

a depression or notch where blood vessels enter or leave an organ.

Humor

applied to fluids of the eye

Infundibulum

a funnel-shaped passage

Interdigitate

an interlocking of structures by finger-like processes, as when the fingers of the two hands are interposed.

Invaginate

a process when part of a wall of a structure is pushed inwards to that the structure which invaginates the membrane becomes partly ensheathed by it.

Isthmus

a narrow part of a duct or other passage, or a narrow strip of tissue connecting two wider parts of an organ

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means body

Corpus

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BONES FUNCTION OF THE SKELETON

The skeleton is a mobile framework of bones providing a ridged support for the body. The bones also serve as levers for the action of muscles. The human skeleton consists of 206 bones. At birth bones are made up of cartilage, but, as the baby grows into a child, calcium forms, hardening the cartilage to become bone. Bones that are developed have a compact outer layer and a honeycomb – like inner structure. The bones are complex and remodel themselves according to the stress they are put under. The skeleton renews itself every two years. Bone tissue consists of about two thirds mineral components (mostly calcium and salts) which give ridgety, and one third organic components which give elasticity. Both components are essential. Without ridgety bones would not keep their shape, and without elasticity, they would break and shatter. Bones are the subject of many strains: - Gravitational strain. Bones support the weight of the entire body - They move against resistance (muscle contraction) - They endure external pressure from objects, e.g. lifting boxes or suitcases

FUNCTIONS OF BONES

- Provides attachments for muscles - Protects soft body parts - Stores calcium and other minerals - Synthesis of blood cells - Gives the body shape and form - Joint/articulations and a basis for movement

TYPES OF BONES FLAT BONES - are compressed and thin, and have two compact bone surfaces such as the scapular, sternum and skull. IRREGULAR BONES - are bones that are not of regular categorisation such as vertebrae bones and some hip and skull bones SHORT BONES - cube like bones that are comprised of mostly “spongy bone” such as wrists and ankles. LONG BONES - consists of a shaft and two extremities and are long as opposed to wide. Limb bones - except the bones of the wrist, knee (patella) and ankle - are long bones. Such as the femur and humerus. SESAMOID BONES - can therefore be cartilage covered bone that develop in a tendon. They occur in areas where the tendon is compressed against a body surface. The sesamoid bone can slide on the surface and prevent occlusion of the blood supply during compression eg. the patella (knee) or the ball of the big toe.

STRUCTURE OF THE BONES Cartilage Cartilage covers articulating surfaces of bones (where the joint is found). It is the non- calcified tissue of the skeleton and protects the underlying bone tissue. Joint cartilage (like all cartilage) does not contain blood vessels. It receives nutrients from the synovial fluid and the bone that surrounds it. Cartilage can get damaged by trauma or excessive wear. Rheumatoid arthritis and osteoarthritis are the two main diseases involving damage to the joint cartilage. It causes pain and stiffness of the joint and surrounding muscles. Bone marrow The hollow part of the bone contains bone marrow. The marrow is red in children but becomes yellow in adults as much is replaced by fatty tissue.

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Periosteum It is the membrane which covers the external bone.

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The Axial Sketeton - Cranium - Cervical vertebrae - Throrasic vertebrae - Lumbar vertabra - Sacral vertebrae - Sternum - Ribs - Coccyx

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Appendicular Skeleton - Scapula - Clavicle - Humerus - Ulna - Radius - Carpals - Metacarpals - Phalanges - Ilium - Ishuim Pubis - Femur - Patella - Tibia - Fibula - Tarsals - Calcaneus - Metatarsals

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JOINTS Joints are points of the body where two bones meet. There is often movement between them (but, sometimes not). Joints have two main functions: to allow mobility of the skeletal system AND to provide a protective enclosure for vital organs.

JOINT CLASSIFICATIONS IMMOVABLE JOINTS (FIBROUS) These joints are also called “fixed” or “immoveable” joints, because they do not move. These joints have no joint cavity and are connected via fibrous connective tissue. The skull bones are connected by fibrous joints. CARTILAGINOUS JOINTS These joints also have no joint cavity and the bones are connected tightly to each other with cartilage. These joints only allow a small amount of movement, so are also called “partly” or “slightly moveable” joints. The vertebrae are examples of cartilaginous joints. SYNOVIAL JOINTS Most of the joints in the body are synovial joints. These joints are “freely moveable” and are characterised by being surrounded by an articular capsule which contains the synovial fluid. Synovial fluid lubricates the joints, supplies nutrients to the cartilage and it contains cells that remove microbes and debris within the joint cavity. Because of the larger range of movements of these joints, there is an increased risk of injury eg dislocations. Synovial joints are located predominantly in limbs. Many synovial joints also have ligaments either inside or outside the capsule.

IMMOVABLE JOINTS

CARTILAGINOUS JOINTS

SYNOVIAL JOINTS

The range of movement provided by these joints is determined by: • The closeness of the bones at the point of contact. Closer bones make stronger joints, but movements are more restricted. The looser the fit, the greater the range of movement. However, looser joints are more prone to dislocation. • The flexibility of the connective tissue and the position of the ligaments, muscles and tendons.

TYPES OF SYNOVIAL JOINTS HINGE JOINTS: Allows a singular plane of motion, i.e. flexion and extension, such as the elbow and knee.

CONDYLOID JOINTS: Allows movements in two planes of motion i.e. flexion; extension; adduction or abduction, such as the knuckle joints.

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SADLE JOINTS: Allows movement in two directions such as the thumbs.

PLANE JOINT: Allows short gliding or slipping motions because surfaces of the bones are flat, such as the vertebral joints.

PIVOT: Allows uni – axil rotation, i.e. moving from side to side such as the neck

BALL AND SOCKET: Allows a free range of movement i.e. flexion, extension, abduction, adduction and circumduction. Such a the shoulder and hip joints.

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TYPES OF JOINTS BALL AND SOCKET JOINT Found in hips and shoulders Movement = Flexion / Extension / Adduction Adduction / Internal and External rotation This joint allows for freedom of rotation as well as back and forth movement in any other joint Some examples of the knowledge application of the Ball and Socket Joint can be demonstrated by doing the following: Free rotation in all directions so we can swing our arms around and behind us to swim or throw a ball, raise our arms over our heads to do exercises, or perform the fine back and forth movements to play a violin Knee stirs to perform knee stirs, bend one knee and place your hand against your shin. Then stabilize your supporting side and make five clockwise and five counter-clockwise circles with your bent leg. Switch sides and repeat. Side-lying leg circles strengthen the hip, outer thigh and gluteal muscles. To do them, place your legs at a 45-degree angle. Then bend your supporting leg and extend your top leg. Using your core muscles to stabilize your pelvis, perform five forward and five backward leg circles on each leg.

CONDYLOID JOINT Found in wrist and lower jaw Movement = Flexion / Extension /Adduction / Abdunction / Circumduction The bones can move about one another in many directions EXCEPT rotate. This joint is named for condoyle containing joint. Some examples of the knowledge application of the Condyloid Joint can be demonstrated by doing the following exercise:

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Abduction (radial flexion) with the hand supinated, bend the wrist towards the thumb side; Adduction (Ulnar flexion) with the hand supinated, bend the wrist towards the 5th finger side.

Hyperextension Bend the wrist as far back as possible towards the outer part of the forearm;

Extension straighten the wrist so that it is on the same plane as the forearm;

Wrist Flexion bend the finders towards the forearm;

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PLANE OR GLIDING JOINT Found in wrists and ankles Movement = Intercarpal joints These joints can move in many direction and they can rotate and twist. Some examples of knowledge application of the plane and gliding joint can be demonstrated by doing the following exercise: - Ankle movement - Flex the wrist

HINGE JOINT Found in knees, elbows, fingers and toes Movement = flexion / extension Offer ease of movement but only provide movement in one plane (no twisting no side to side. A good example of a hinge joint is at your elbow, there are two bones in your forearm that interact at the elbow joint. Only the Ulna makes a hinge joint. When you are in the anatomical position and you bend your elbow as if bringing your palm to your shoulder that is the movement of the hinge joint. Some examples of the knowledge application of the Hinge Joint can be demonstrated by doing the following exercises: Swimming Elbow, or arm, flexion is moving your forearm and hand toward your body by bending the elbow joint, while elbow extension is moving in the opposite direction. Push Up, Pull Ups These two exercises involve elbow flexion and extension. For pushups, place your hands on the ground about shoulder-width apart and your feet slightly apart on your toes. Tighten your buttocks as you lower your body toward the ground until your chest and hips almost touch the ground. Keep your elbows close to your body. Exhale and push yourself off the ground, keeping your head in alignment with your spine and hip.

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For pull-ups, grab both hands on a pull-up bar or similar apparatus about shoulder-width apart. Exhale, and pull yourself up until your chin clears over the bar. Lower yourself down until your arms are fully extended. For each exercise, perform three sets of 10 to 12 reps

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PIVOT JOINT This type of joint is in our elbow (for twisting motion and between our first two cervical vertebrae (shaking your head - side to side “NO”). Top of neck Movement = Rotation of one bone around another This joint is one where one bone spins around on another bone, although only one direction of spin has been diagrammed - the spin can go in both directions. Some examples of the knowledge application of the pivot joint can be demonstrated by doing the following exercise: Pivot joints use a twisting motion as the neck turning from side to side and the elbow’s ability to supinate, or turn the hand up, or pronate, turning the hand down. The radius and ulna in the forearm are true pivot joints in that there is no other action they perform. Although these two joints appear to move in other planes, those actions result from proximal joints attached to these bones located closer to the body. The neck’s ability to bend forward and back results from vertebral movement, and the elbow’s ability to move forward and back is from the hinge joint in the elbow.

SADDLE JOINT Found in the thumb Movement = Flexion / Extension / Adduction / Abduction Some examples of knowledge application of the saddle joint can be demonstrated by doing the following exercise:

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- By maneuvering the thumb in different directions - Thumb stretches

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ANOTHER EXAMPLE OF THE DIFFERENT TYPES OF JOINTS

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MOVEMENT ADMITTED IN JOINTS The movements admissible in joints may be divided into four kinds: gliding movement, angular movement, circumduction and rotation. These movements are often, however, more or less combined in the various joints, so as to produce an infinite variety, and it is seldom that only one kind of motion is found in any particular joint. Gliding Movement: Gliding movement is the simplest kind of motion that can take place in a joint, one surface gliding or moving over another without any angular or rotatory movement. It is common to all movable joints; but in some, as in most of the articulations of the carpus and tarsus, it is the only motion permitted. This movement is not confined to plane surfaces, but may exist between any two contiguous surfaces, of whatever form. Angular Movement: Angular movement occurs only between the long bones, and by it the angle between the two bones is increased or diminished. It may take place: (1) forward and backward, constituting flexion and extension; or (2) toward and from the median plane of the body, or, in the case of the fingers or toes, from the middle line of the hand or foot, constituting adduction and abduction. The strictly ginglymoid or hinge-joints exist of flexion and extension only. Abduction and adduction, combined with flexion and extension, are met with in the more movable joints; as in the hip, the shoulder, the wrist, and the carpometacarpal joint of the thumb. Circumduction: Circumduction is that form of motion which takes place between the head of a bone and its articular cavity, when the bone is made to circumscribe a conical space; the base of the cone is described by the distal end of the bone, the apex is in the articular cavity; this kind of motion is best seen in the shoulder and hip-joints. Rotation: Rotation is a form of movement in which a bone moves around a central axis without undergoing any displacement from this axis; the axis of rotation may lie in a separate bone, as in the case of the pivot formed by the odontoid process of the axis vertebrĂŚ around which the atlas turns; or a bone may rotate around its own longitudinal axis, as in the rotation of the humerus at the shoulder-joint; or the axis of rotation may not be quite parallel to the long axis of the bone, as in the movement of the radius on the ulna during pronation and supination of the hand, where it is represented by a line connecting the center of the head of the radius above with the center of the head of the ulna below.

LIGAMENTS Ligaments are dense bundles of collagenous fibres. Mostly they are derived from the outer layer of the joint capsule, however they sometimes do connect nearby a non-articulating bone. The primary function of ligaments is to stabilise and strengthen the joint. Most ligaments do not contract the muscles but rather stretch them.

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Ligaments have sensory nerve cells which are capable of responding to the speed, movement and position of a joint. Excessive movement of the joint can lead to stretching to a point of straining or tearing a ligament.

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MUSCLES Most of all movement of the human body come from a result of muscle contraction. It is made up of fibres. The direction and composition determine the appearance and strength of the muscle. All muscles are held together by fibres and connective tissue which is important to the characteristic of the muscle. A moving muscle is attached to two different types of bones: ORIGIN – bone is fixed in some way. Origin is often the proximal bone. INSERTION – moves as a result of muscle contraction. Insertion is often the distal bone (there may be exceptions though).

THE STRUCTURE OF SKELETAL MUSCLE Skeletal muscle is a collection of many individual muscle fibres that are wrapped around together by connective tissue to form individual bundles. The anatomy of skeletal muscle: - Facia: Connective tissue that covers the entire/whole muscle - Epimysium: Inner layer of connective tissue surrounding the muscle The facia and epimysium help form connective tissue between the muscle and the bone. - Fascicle: Secondary muscle fibre inside the muscle - Perimysium: connective tissue covering the fascicle - Endomysium: connective tissue covering the inner most muscle fibres All connective tissues in muscles play an important role in movement. They allow the forces that are generated by the muscle to be transmitted from the contractile parts of the muscle to the bonds to create movement. Muscle tissue covers the entire length of the muscle to form tendons. Contractile elements of skeletal muscle fibres A single muscle cell is known as a muscle fibre. Under microscope distinct series of light and dark banks can be seen. Muscle fibres are enclosed by a membrane known as the sacolemma. It contains typical cell components such as plasma called sarcoplasm (which is composed of glycogen, fats, minerals and oxygen binding myoglobin) Nuclei and mitochondria (which transforms energy to food). They are unlike other cells because they have structures made up of myofibrils. Myofibrils contain myofilaments which are the contractile components of muscle tissue. Myofilaments are also known as actin and myosin which are thin and thick filaments which form repeating sections within a myofibril. Each one of these sections are known as sarcomere. A sarcomere is the functional unit of the muscle that produces muscular contraction and consists of repeating sections of actin and myosin. Tropomyosin and troponin are two other protein structures that are important for the muscle contraction. Tropomysosin is found in the actin filament and blocks the myosin binding sites located on the actin filament prohibiting myosin from attaching to actin while the muscle is in a relaxed state. Troponin, also located on the actin filament, plays a role in muscle contraction by providing binding sites for both calcium and tropomyosin when the muscle needs to contract. Generating muscle force A muscle generates force in a variety of different methods such as, neural activation, sliding filament theory and excitationcontraction-coupling mechanism. Neural activation Neural activation is made possible by the communication between the nervous system and the muscular system. It makes muscle contraction and stabilization possible. Where a connection is made with the motor neuron and the muscle fibres is called the motor unit. The point where a single neuron meets a single fiber is called the neuromuscular junction. Impulses travel down from the central nervous system into the axon on the neuron. When the impulses reach the end of the axon, chemicals called neurotransmitters are released.

Neurotransmitters send messages between the neurons, nerves and muscle fibres. They fall into receptor sites on the muscle fibre. The neurotransmitter that is required by the neuromuscular system is called acetylcholine (Ach). Ach stimulates the muscle fibres to go through the necessary steps to produce a muscle contraction.

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Excitation-contraction-coupling Excitation-contraction-coupling is the combination of the neural stimulation and the sliding filament theory.

Sliding filament theory The sliding filament theory is the process of how the contraction of the filaments take place within the sacomere. 1. A sacomere shortens as a result of the “Z” lines moving closer together. 2. The “Z” lines pull together as a result of myosin heads attaching to the actin filament and asynchronously pulling the actin filament across the myosin, all resulting in a shortened muscle fibre.

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THE MUSCULAR SYSTEM: ANTERIOR

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THE MUSCULAR SYSTEM: POSTERIOR

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MUSCLE TYPES CARDIAC MUSCLE - refered to as the myocardium and is found in the wall of the heart. It has the same structural and functional characteristics of skeletal and smooth muscle and moves completely involuntary. SKELETAL MUSCLE - 600 muscles in total attach to our skeleton. They are voluntary and can be controlled. Skeletal muscles are striated because of the protein molecules in these muscles and are regularly rearranged giving them a banded appearance. SMOOTH MUSCLE - These are smooth, involuntary muscles which are found in the walls of organs such as the stomach, respiratory passages and the bladder.

MUSCLE TERMINOLOGY AND DEFINITION MUSCLE TERMS

DEFINITION

Myofibrils

Protein structures that make up muscle fibers

Hypertrophy

An increase in the size of a muscle fiber, usually stimulated by muscular overload.

Atrophy

A decrease in the size of muscle fibers.

Hyperplasia

An increase in the number of muscle fibers.

Slow-Twitch Fibers

Red muscle fibers that are fatigue-resistant but have a slow contraction speed and a lower capacity for tension; usually recruited for endurance activities

Fast-Twitch Fibers

White muscle fibers that contract rapidly and forcefully but fatigue quickly; usually recruited for actions requiring strength and power

Power

The ability to exert force rapidly

Motor Unit

A motor nerve (one that initiates movement) connected to one or more muscle fibers.

Muscle Learning

The improvement in the body’s ability to recruit motor units, brought about through strength training.

Tendon

A tough band of fibrous tissue that connects a muscle to a bone or other body part and transmits the force exerted by the muscle

Ligament

A tough band of tissue that connects the ends of bones to other bones or supports organs in place.

Testosterone

The principal male hormone, responsible for the development of secondary sex characteristics and important in increasing muscle size.

Repetition Maximum (Rm)

The maximum amount of resistance that can be moved a specified number of times.

Repetitions

The number of times an exercise is performed during one set.

Static (Isometric) Exercise

Exercise involving a muscle contraction without a change in the length of the muscle.

Dynamic (Isotonic) Exercise

Exercise involving a muscle contraction with a change in the length of the muscle.

Concentric Muscle Contraction

An isotonic contraction in which the muscle gets shorter as it contracts.

Eccentric Muscle Contraction

An isotonic contraction in which the muscle lengthens as it contracts; also called a pliometric contraction.

Constant Resistance Exercise

a type of dynamic exercise that uses a constant load throughout a joint’s entire range of motion

Variable Resistance Exercise

A type of dynamic exercise that uses a changing load, providing a maximum load throughout the joint’s entire range of motion

Eccentric (Pliometric) Loading

Loading the muscle while it is lengthening; sometimes called negatives.

Plyometrics

Rapid stretching of a muscle group that is undergoing eccentric stress (the muscle is exerting force while it lengthens), followed by a rapid concentric contraction.

Speed Loading

Moving a load as rapidly as possible.

Isokinetic

The application of force at a constant speed against an equal force.

Spotter

A person who assists with a weight training exercise done with free weights.

Set

A group of repetitions followed by a rest period

Agonist

A muscle in a state of contraction, opposed by the action of another muscle, its antagonist.

Antagonist

A muscle that opposes the action of another muscle, its agonist.

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A single muscle cell, usually classified according to strength, speed of contraction, and energy source

Muscle Fiber

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In order to be able to apply knowledge of the muscles the following tests can be used to assess muscular strength and endurance. They describe the basics of weight training and provide guidelines for establishing a weight training program. I. Basic Muscle Physiology and the Effects of Strength Training A. Muscles consist of individuals muscle cells, or muscle fibers, connected in bundles. 1. Muscle fibers are made up of smaller units called myofibrils. 2. Strength training causes the size of individual muscle fibers to increase by increasing the number of myofibrils. B. Muscle fibers are classified according to their strength, speed of contraction, and energy source. 1. Slow-twitch fibers are relatively fatigue resistant and do not contract as rapidly or strongly as fast-twitch fibers. 2. Fast-twitch fibers contract more rapidly and forcefully than slow-twitch fibers but fatigue more quickly. C. To exert force, the body recruits one or more motor units to contract. 1. A motor unit is made up of a nerve connected to a number of muscle fibers. 2. When a motor nerve calls on its fibers to contract, all fibers contract to their full capacity. D. Strength training improves the body’s ability to recruit motor units - muscle learning - which increases strength even before muscle size increases. II. Benefits of Muscular Strength and Endurance Enhanced muscular strength and endurance can lead to improvements in the areas of performance, injury prevention, bodycomposition, self-image, lifetime muscle and bone health, and chronic disease prevention. A. Improved Performance of Physical Activities Increased muscular strength and endurance helps with performance of everyday tasks and recreational activities and leads to the enjoyment that accompanies higher levels of achievement. B. Injury Prevention Muscular strength and endurance help protect you from injury in two key ways: • By enabling you t o maintain good posture. • By encouraging proper body mechanics during everyday activities such as walking and lifting. C. Improved Body Composition Muscular strength and endurance exercise increases fat-free mass, which raises metabolism and depletes fat tissue. D. Enhanced Self-Image and Quality of Life Muscular exercise offers the benefit of readily recognizable results: Your body will become noticeably stronger and firmer, and you can easily monitor your progress in terms of amount of weight lifted and number of repetitions. E. Improved Muscle and Bone Health with Aging Strength training can prevent muscle and nerve degeneration brought about by aging and inactivity.

1. After age 30, people begin to lose muscle mass (sarcopenia) , which may reduce ability to perform simple tasks or movements.

2. Aging and inactivity can cause motor nerves to disconnect from the portion of muscle they control and allow muscles to become slower - less able to perform quick, powerful movements.

3. Risk of bone loss, or osteoporosis, can be lessened with strength training, and increases in muscle strength can also help prevent falls.

III. Assessing Muscular Strength and Endurance

F. Prevention and Management of Chronic Disease Regular strength training helps prevent and manage both CVD and diabetes by: • Improving glucose metabolism. • Increasing maximal oxygen consumption. • Reducing blood pressure. • Increasing HDL cholesterol and reducing LDL cholesterol (in some people).

A. Muscular strength is usually assessed by measuring the maximum amount of weight a person can lift one time. This single maximum effort is called a repetition maximum (RM). You can measure 1 RM directly or estimate it by doing multiple repetitions with a submaximal (lighter) weight.

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IV. Creating a Successful Strength Training Program

When muscles are stressed by a greater load than they are used to, they adapt and improve their function.

A. Static Versus Dynamic Strength Training Exercises Weight training exercises are generally classified as static or dynamic.

B. Muscular endurance is usually assessed by counting the maximum number of repetitions of a muscular contraction a person can do (as in a push-up or sit-up test) or the maximum time a muscle contraction can be held (as in a flexed-arm hang).

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Strength training improves the bodyâ&#x20AC;&#x2122;s ability to recruit motor units - muscle learning - which increases strength even before muscle size increases.

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1. Static Exercise (Isometric) In this exercise, the length of the muscle does not change nor does the angle in the joint on which the muscle acts (e.g., pushing against a wall). a. These exercises can be performed with an immobile object (such as a wall) for resistance or simply by tightening a muscle. The contraction should be held for 6 seconds, and 5–10 repetitions should be done. b. They develop strength only at a specific point in the joint range of motion. 2. Dynamic Exercise (Isotonic) In this exercise, the length of the muscle changes (e.g., with weight machines or free weights). Dynamic exercise involves applying force with movement, using either weights or a person’s own body weight (as in push-ups). a. There are two types of Dynamic muscle contractions: (1) A concentric contraction occurs when the muscle applies enough force to overcome resistance and shortens as it contracts. (2) An eccentric contraction occurs when the resistance is greater than the force applied by the muscle and the muscle lengthens as it contracts. b. The two most common isotonic techniques are constant resistance exercise, which uses a constant load (weight) throughout a joint’s entire range of motion, and variable resistance exercise, in which the load is changed to provide maximum load throughout the range of motion. c. A problem with constant resistance exercise with free weights is that, because of differences in leverage, some points in a joint’s range of motion are weaker than others. Variable resistance exercise uses machines that place more stress on muscles at the end of the range of motion, where a person has better leverage and can exert more force. d. Other kinds of isotonic techniques include: (1) Eccentric loading, placing a load on a muscle as it lengthens. (2) Plyometrics, the sudden eccentric loading and stretching of muscles followed by a forceful concentric contraction. This type of exercise is used to develop explosive strength; it also helps build and maintain bone density. (3) Speed loading involves moving a weigh as rapidly as possible in an attempt to approach the speeds used in movements like throwing a softball or sprinting. (4) Isokinetic exercise, exerting force at a constant speed against an equal force exerted by a special strength training machine. 3. Comparison Static and Dynamic Exercise a. Static exercises require no equipment, build strength rapidly, and are useful for rehabilitating joints. However, they have a short, specific range of motion, and so they have to be performed at several different angles for each joint. b. Dynamic exercises can be performed with or without equipment. They are excellent at building endurance and strength throughout a joint’s range of motion. B. Weight Machines versus Free Weights 1. Muscles will get stronger if you make them work against a resistance. 2. Weight machines are preferred by some because they are safe, convenient, and easy to use. They make it easy to isolate and work a specific muscle, and a spotter isn’t always necessary. 3. Free weights require more care, balance, and coordination, but they strengthen the body in ways that are more adaptable to real life and sports. C. Other Training Methods and Types of Equipment This includes resistance bands, exercise (stability) balls, Pilates, and no-equipment calisthenics.

1. For general fitness the ACSM recommends 2 - 3 nonconsecutive days per week for weight training 2. Allow muscles at least 1 day of rest between workouts. B. The amount of weight lifted determines the way the body will adapt and how quickly it will adapt.

A. Frequency of Exercise

Design your program to maximize the fitness benefits but minimize the risk of injury.

V. Applying the FITT Principle: Selecting Exercises and Putting Together a Program

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1. To build strength rapidly, lift weights as heavy as 80% of your maximum capacity. For endurance, choose 40–60% of your maximum. 2. Rather than continually assessing maximum capacity, base weight on the number of repetitions you can perform with a given resistance.

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C. Time of Exercise: Repetitions and Sets 1. To improve fitness, you must perform enough repetitions to fatigue your muscles. a. A heavy weight and a low number of repetitions (1 - 5) builds strength. b. A light weight and a high number of repetitions (15 - 20) builds endurance. c. For general fitness, do 8 - 12 repetitions of each exercise. For older and more frail people (50 - 60 years of age and above), 10 - 15 repetitions with a lighter weight is appropriate. 2. A set is a group of repetitions of an exercise followed by a rest period. a. Exercise scientists have not identified the optimal number of sets for increasing strength. b. For general fitness, 1 set is sufficient. Most serious weight trainers perform 3 or more sets of each exercise. c. The rest period allows the muscles to work at high enough intensity in the next set to increase fitness. d. The length of your rest interval depends on the amount of resistance: If you are training to develop strength and endurance for wellness, rest 1–3 minutes between sets. If you are training to develop maximum strength (and are lifting heavier loads), rest 3–5 minutes between sets. D. Type or Mode of Exercise 1. A complete weight training program works all the major muscle groups, including neck, upper back, shoulders, arms, chest, abdomen, lower back, thighs, buttocks, and calves. 2. Usually, 8 - 10 different exercises are required in order to work all major muscle groups. 3. A balanced program includes exercises for both agonist and antagonist muscle groups. 4. Exercise the large-muscle groups first and then small-muscle groups. E. The Warm-Up and Cool-Down 1. You should do both a general warm-up (such as walking) and a specific warm-up for the exercises you will perform. 2. For cool-down, relax for 5–10 minutes after exercising. F. Making Progress 1. To begin training, choose a weight you can easily move through 8–12 repetitions for 1 set. 2. Gradually add weight and (if you want) sets until you can perform 1–3 sets of 8–12 repetitions for each exercise. 3. As you progress, add weight according to the “two-for-two” rule: When you can perform two additional repetitions with a given weight on two consecutive training sessions, increase the load. 4. You can expect to improve rapidly during the first 6–10 weeks of training; after that, gains come more slowly. 5. After you have achieved the strength and muscularity you want, you can maintain your gains by training 2–3 times per week. G. More Advanced Strength Training Programs

1. If you desire to achieve greater increases in strength, increase the load and the number of sets and decrease the number of reps.

Long Term: • Hypertrophy • Increased metabolic activity • Increased capillarisation • Increase in number of mitochondria • Increase in muscular strength • Increase in muscular endurance

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Short Term: • Capillary dilation • Increased pliability

Effects of exercise on muscles

2. Periodization or cycle training, in which the sets, reps, and intensity of exercise are varied, may be useful for making greater gains in strength.

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Muscles will get stronger if you make them work against a resistance.

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THE VERTEBRAL COLUMN The vertebral column or spine forms a part of the axil skeleton. It extends from the base of the skull to the bottom of the pelvis and measures between 70 - 75cm in the average adult. It consists of 33 irregular bones called vertebrae which progressively increase in size. The smaller being at the top and the larger being at the bottom. There are 24 vertebrae which make up the superior spine. They are individual bones which make up the cervical, thoratic and lumbar spine. The inferior (lower) nine vertebral are fused (before adult hood) and form the sacrum and coccyx. The vertebral foramen is the foramen (opening) formed by the anterior segment (the body), and the posterior part, the vertebral arch. The vertebral foramen begins at cervical vertebrae #1 (atlas) and continues inferior to lumbar vertebrae #5. Within this foramen the spinal cord and associated meninges are housed. The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain (the medulla oblongata specifically). The brain and spinal cord together make up the central nervous system. The spinal cord begins at the Occipital bone and extends down to the space between the first and second lumbar vertebrae; it does not extend the entire length of the vertebral column. It is around 45 cm (18 in) in men and around 43 cm (17 in) long in women. Also, the spinal cord has a varying width, ranging from 1/2 inch thick in the cervical and lumbar regions to 1/4 inch thick in the thoracic area. The enclosing bony vertebral column protects the relatively shorter spinal cord. The spinal cord functions primarily in the transmission of neural signals between the brain and the rest of the body but also contains neural circuits that can independently control numerous reflexes and central pattern generators. The spinal cord has three major functions: A. Serve as a conduit for motor information, which travels down the spinal cord. B. Serve as a conduit for sensory information, which travels up the spinal cord. C. Serve as a center for coordinating certain reflexes.

The vertebra that joins to the iillic bone to make up the pelvis are called the SACRAL vertebrae (5 in total).

The vertebrae that forms the tail bone are called the coccyx and are called the COCCGEAL vertebrae (4 in total) and they are fused together.

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The lower part of the vertebra is called the LUMBER vertebrae (5 in total).

The vertebrae of the trunk (thorax) is called the Thoratic vertebrae (12 in total).

The upper most part of the vertebra is called the CERVICAL vertebrae (7 in total).

The spine has natural curvatures giving an â&#x20AC;&#x153;sâ&#x20AC;? like shape appearance. The degree of the curvatures varies from person to person. It is due to genetics, postural problems, muscle tone or imbalances of the muscles.

In between each of the individual bones there are cartilage disks. These intervertabral disks give the spine itâ&#x20AC;&#x2122;s flexibility and movement. They also absorb some of the impact that is transmitted through the body. There are changes in the disks that occur throughout the day and can account for a minor changes in height. When the spine is rested generally after sleeping, the disks are hydrated and the individual may be taller. When the disks have been carrying the body weight during the day, they are dehydrated and the individual may appear shorter. This would have an effect on postural analysis on the individual, so the assessment is done usually done at the same time of the day.

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FUNCTIONS OF THE VERTEBRA - Support the head - Point of attachment for the ribcage - Point of attachment for the muscles of the shoulder and pelvic girdle - Attachment point for the spine extensors and flexors - Protects the spinal cord - Shock absorption - Movement of the entire body

THE CERVICAL AND THORACIC VERTEBRA

The cervical vertebrae (C1 – C7) are the smallest of the vertebrae. They are not designed to carry weight and can be injured if moved too quickly. The cervical region is the most moveable region of the spine as it does not have ribs attached.” The thoracic vertebrae (T1 – T12) are larger and stronger than the cervical vertebrae, it allows flexion, extension, lateral flexion, and slight rotation. The thoracic vertebrae are the second most moveable part of the spine, with the lumber spine being least moveable.

LUMBAR VERTEBRAE

The lumbar vertebrae (L1 - L5) are the largest and strongest of the vertebrae. Movement of the lumbar spine must be taken and performed with much care. Flexion and extension can be done safely, but movements that attempt to rotate the spine can cause severe damage to the facet joints. The lumbar spine cope with most of the stress that occurs during movement activities involving running and jumping. So, correct alignment of the spine is absolutely essential.

SACRUM

The sacrum is the triangular shape spine and is formed by the fusion of the 5 (five) sacral vertebrae (S1 - S5). It provides a strong foundation for the pelvic girdle. And is joined laterally at each side.

COCCYX

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The coccyx or tailbone is triangular in shape and is formed by joining the second and forth coccygeal vertebrae. The top or superior part of the coccyx joins with the sacrum. The coccyx can be severely damaged when falling and landing directly on it.

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MUSCLES SUPPORTING THE SPINE MUSCLE

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

- Closest to the body surface - Positioned posterior - Runs down the length of the whole vertebral column

Post iliac crest

Angles of ribs, tv processes of all the vertebrae

- Extension of the vertebral column - Lateral flexion of the vertebral column - Stabilises spine during dead lift position - Stabilises spine during squatting movement

- Closer to the body’s surface (superficial) - Positioned at the rear/ posterior - Runs down the length of the entire vertebral column

Sacrum: dorsal surface. Posterior sacro-iliac ligament. Hip bone: posterior superior iliac spine. L1 to L5: mamillary processes. T1 to T12: transverse processes. C4 to C7: articular processes.

C2 to L5: spinous process.

- Closer to the body’s surface (superficial) - Positioned at the rear/ posterior - Runs down the length of the entire vertebral column.

Post iliac crest

- Assists Errector spina in extention - Fixes the 12th ribs during deep inspiration - Lateral flexion of trunk to the same side - Keeps spine stable when carrying heavy loads in one hand - Stabiliser

ERECTOR SPINAE

MULTIFIDUS

QUADRATUS LUMBORUM

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- Positioned at the side and the back of the body - Deeper than the erector spinae

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MUSCLES SUPPORTING THE SPINE ANTERIORALLY AND LATERALLY MUSCLES

DESCRIBTION

ORIGIN

INSERTION

ACTIONS

Two stripes of superficially positioned muscles with vertically aligned straight fibres. Each side divides into 4 sections with tendonous inscription between each section. This divides the “six pack” look for lean and muscular individuals. The muscles are separated centrally and join with the other abdominal muscles

Pubic crest

Cartilage of 5th, 7th ribs and xiphoid

- Flexion of the spine - Lateral flexion of the spine - Compresses the abdomen

Superficially broad band of muscles at each side of the trunk with downwards and inwards slanted or oblique fibres.

Anterior lateral boarders, lower 8 ribs

Anterior half illium, pubic crest and fascia

Flexion of the spine Compresses the abdomen Rotation of the spine Lateral flexion of the spine

Broad band of muscle running underneath the external oblique at both sides of the body with slanted or oblique fibres running upwards and inwards

iliac crest

Cartilage of the last 3-4 ribs

Assists with spinal flexion Compresses the abdomen Rotation of the spine Lateral flexion of the spine Stabiliser

Lateral inguinal ligt, iliac crest, cartilage lower 6 ribs

xiphoid, anterior facia

- Compresses the abdomen and gives a flatter appearance - Supports the abdominal content - Forces expiration – pulls the abdominal wall inwards

RECTUS ABDOMANIS

EXTERNAL OBLIQUE

INTERNAL OBLIQUE

TRANSVERSUS ABDOMINUS

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Deepest layer of muscle in the abdominal wall, with fibres running horizontally around the trunk forming a “corset”.

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THE SHOULDER GIRDLE AND SHOULDER JOINT

The three bones which form the shoulder girdle are the clavicle, the scapula and the humerus. The most important aspect of the shoulder is the large range of movement that it permits, which is central to many activities of daily living. There are three main joints in the shoulder girdle, these are: • Glenohumeral Joint (GHJ) • Acromioclavicular Joint (ACJ) • Sternoclavicular Joint (SCJ) It is also important to consider another “joint” which is important in shoulder movement: • Scapulothoracic Joint

The Scapula (or shoulder blade) This bone is quite complex and is an attachment site for numerous muscles which support movement and stabilisation of the shoulder. It overlies the 2nd – 7th ribs, is tilted forwards by an angle of 30°, and is encased by 17 muscles which provide control and stabilisation against the thoracic wall (the ribcage). This is sometimes referred to as the “Scapulothoracic Joint” although it is not technically an actual joint.

The Clavicle (or collar bone) The clavicle is an S-shaped bone and is the main connection between the upper arm and the rest of the axial skeleton.

The Glenohumeral Joint (shoulder ball and socket joint) Ask someone to point at the shoulder joint, and the chances are they will point at the Glenohumeral Joint (GHJ). The Glenohumeral Joint is a ball and socket joint which provides a large proportion of the movement at the shoulder girdle.

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The head of the humerus articulates (moves) with the glenoid fossa of the scapula - hence the name. The head of the humerus is, however, quite large in comparison to the fossa, resulting in only one third to one half of the head being in contact with the fossa at any one time. The humerus is further supported by the glenoid labrum - a ring of fibrous cartilage which extends the fossa slightly making it wider and deeper (almost like if you have a deeper bowl, you can fit more in it!). Both articulating surfaces are covered with articular cartilage which is a hard, shiny cartilage which protects the bone underneath.

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The Acromioclavicular Joint The Acromioclavicular Joint (ACJ) is formed by the lateral end of the clavicle articulating with the medial aspect of the anterior acromium. The ACJ is important in transmitting forces through the upper limb and shoulder to the axial skeleton. The ACJ has minimal mobility due to its supporting ligaments: • Acromioclavicular Ligament which is composed of strong superior (top) and inferior (bottom) ligaments, and weak anterior (front) and posterior (back) ligaments restricting anterior-posterior (forwards and backwards) movement of the clavicle on the acromion • Coracoclavicular Ligament is composed of the Conoid and Trapezoid ligaments. It forms strong heavy band to prevent vertical movement. MUSCLES ACTING ON THE SHOULDER GIRDLE • Trapezius • Levator Scapulae • Rhomboid Major and Minor • Serratus Anterior • Pectoralis minor • Deltoid • Teres Major • Rotator Cuff (active stabilization of shoulder joint) • Supraspinatus • Infraspinatus • Teres Minor • Subscapularis • Latissimus dorsi • Pectoralis Major STABILITY OF THE SHOULDER GIRDLE Acromioclavicular Joint Ligaments • Acromioclavicular • Coracoclavicular • Conoid • Trapezoid MOVEMENTS OF THE STERNOCLAVICULAR JOINT Types of Movements • Protraction - scapula is retracted causing the sternal end to move forward • Retraction - scapula is protracted causing the sternal end to move backward • Elevation - scapula is depressed causing the sternal end to move upward • Depression - scapula is elevated causing the sternal end to move downward

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MOVEMENTS OF THE SHOULDER JOINT • Flexion - Extension • Abduction /Adduction • Rotation

MUSCLES ACTING TO MOVE SCAPULA Muscles suspend scapula from vertebral column and chest wall • Trapezius - retract and rotates upward • Rhomboids - retract and rotate downward • Upward rotation of the Scapula • Serratus anterior - protracts and rotates upward • Trapezius - Retract and rotates upward

MOVEMENTS OF THE SCAPULA AND STERNOCLAVICULAR JOINT Types of Movement • Elevation - moving the superior border of the scapula and the acromion in an upward direction. • Depression - moving the superior border of the scapula and the acromion in an downward direction. • Upward Rotation - Moving the scapula so that the glenoid cavity faces upward. • Increased the ranges of motion during abduction and/or flexion of the shoulder. • Downward Rotation - moving the scapula so that the glenoid cavity faces inferiorly. • Increases range of motion during extension and / or adduction of the shoulder. • Protraction ( Abduction) - moving the scapula away from the midline • Retraction (Adduction) - moving the scapula toward the midline

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MUSCLES THAT SUPPORT THE SHOULDER GIRDLE AND MOVEMENT MUSCLE

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

Large kite shaped muscles, it runs from the back of the skull down the back of the neck, across the upper back to the shoulders and in between and slightly below the shoulder blades.

C7 and all the throatic vertebral spines

Clavicle, acromion

- Extend the neck and keep the head upright - Elevate the shoulders - Aducts & abducts shoulder girdle and scapulae

Strip of muscle that runs vertically at the rear side of the neck between C1 - C4 to the inner boarder of the scapulae

C1 - C4

Scapulae

- Elevates the scapulae - Lateral flexion of the neck - Assists the trapezius and rhomboids to retract the scapulae

Serratus anterior is a muscle of the scapula, it is a large, flat muscular sheet with fleshy digitations that curves around the side of the thorax between the ribs and the scapula, covering the medial axillary wall.

upper 8 ribs

Scapulae (medial border)

- Stabiliser - Scapulae protractor

Rhomboid major and minor. They short rectangular muscles

Major – T2 – T5 spines Minor – C7 – T1 spines

Major – Scapulae (medial border below spine) Minor – Scapulae (Medial border at spine)

- Stabiliser - Retraction of scapulae - Assists adduction of the arm

Large triangular muscle spans the right and left sides of the lower back and runs upwards towards the armpits.

lower 6 thoratic vertebrae, crests of ilium and sacrum, lower 4 ribs

TRAPEZIUS

LEVATOR SCAPULAE

SERRATUS ANTERIOR

Extension of the arm Adduction of the arm Inwards rotation of the arm Stabilises the lower scapulae against the ribcage

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Humerus (medial intertubercular groove)

LATISSIMUS DORSI

RHOMBOIDS

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MUSCLE

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

Subscapularis: scapulae (inner surface)

Subscapularis: Humerus (lesser tubercle) Supraspinatus: Humerus (greater tubercle) Infraspinatus: Humerus (greater tubercle) Teres minor: Coracoid (scapulae) Teres major: Humerus (greater tubercle)

Subscapularis: - Medial rotation of the arm (inwards) - Stabilising shoulder joint - Assists with flexion, extension, adduction and abduction of the shoulder and arm Supraspinatus: - Assists with initial abduction at the shoulder - Stabilises shoulder and protects from downwards dislocation

ROTATOR CUFF MUSCLES Group of 5 short, broad muscles that attach from the scapulae to the humerus

Supraspinatus: Scapulae (inner surface) Infraspinatus: Scapulae (bellow spine) Teres minor: Scapulae (sub 2/3 lateral margin) Teres major: Scapulae (inferior 3rd lateral margin)

Infraspinatus: - Lateral rotator of arm at shoulder - Lower part of the muscle adducts the arm - Horizontal extension of arm and shoulder - Stabilises the shoulder joint Teres minor: - Lateral rotator of arm at shoulder - Horizontal extension of arm and shoulder - Stabilises the shoulder joint Teres major: - Adduction and medial rotation of humerus - Aids in extension of a flexed arm

SUPRASPINATUS

INFRASPINATUS

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TERES MINOR

TERES MAJOR

SUBSCAPULARIS

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MUSCLE

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

Broad band of muscle forming a “fan” shape. Runs across the front right and left sides of chest

Clavicle, sternum, 1st six costal cartilage (ribs)

Intertubercular groove of the humerus

- Adductor and medial rotator of humerus (arm) - Flexes humerus and extends humerus - Depresses the arm and the shoulder

Thin muscle that lies underneath the pectoralis major Origin: Ribs 3-5 (anterior and lateral) towards the shoulder Insertion: To the top and the front of the scapulae (coracoid)

Ribs 3 to 5.

Scapula: medial border and coracoid process.

Pulls the shoulder girdle forward and downwards.

Short and thick muscles that make up 3 parts of the shoulder: anterior, medial and posterior

Anterior deltoid – anterior lateral clavicle Medial deltoid – scapulae (acromion) Posterior deltoid – Spine of scapulae

Anterior deltoid – mid lateral humerus surface Medial deltoid – mid lateral humerus surface Posterior – mid lateral humerus surface

Anterior deltoid: flexor and medial rotator of humerus Medial deltoid: Shoulder and arm abduction Posterior deltoid: extensor and lateral rotator of humerus active in abduction.

PECTORALIS MAJOR

PECTORALIS MINOR

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DELTOIDS

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THE NECK The neck has a complex tubular region of muscles surrounding the cervical vertebrae. The muscles are arranged in superficial and deep groups. Here we concentrate on the most commonly used muscles.

MUSCLES OF THE NECK MUSCLES

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

Extends from the back of the ear all the way down the collar bone

Sternum (anterior surface manubrium) clavicle

Mastoid process of the temporal bone

Flexion of the neck and rotation

Broad and thick above and narrow bellow

C1 – C6 Insertion: Occipital bone

Occipital bone

Flexes the head on the neck

T3 – T6

Posterior tubercules of the transverse process C1-C3

Neck flexion, lateral flexion and some rotation of the neck

STURNOMASTOID

LONGUS CAPITIS

SPLENIUS CERVICIS

Mastoid processes and the lateral occiput

Extends the head and neck

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Arises from C3 – T3

Splenius capitis is a muscle of the head and neck and forms part of the floor of the posterior triangle of the neck.

SPLENIUS CAPITIS

A narrow tendinous band

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THE HIP AND KNEE The Knee Joint And Movement Our knee is the most complicated and largest joint in our body. It’s also the most vulnerable because it bears enormous weight and pressure loads while providing flexible movement. When we walk, our knees support 1.5 times our body weight; climbing stairs is about 3-4 times our body weight and squatting about 8 times. The knee joint connects the femur, our thigh bone and longest bone in the body, to the tibia, the second longest bone. There are two joints in the knee - the tibiofemoral joint, which joins the tibia to the femur and the patellofemoral joint which joins the kneecap to the femur. These two joints work together to form a modified hinge joint that not only allows the knee to bend and straighten, but also to rotate slightly and from side to side. The knee is part of a chain that includes the pelvis, hip, and upper leg above, and the lower leg, ankle and foot below. All of these work together and depend on each other for function and movement. The knee joint bears most of the weight of the body. When we’re sitting, the tibia and femur barely touch; standing they lock together to form a stable unit. Let’s look at a normal knee joint to understand how the parts (anatomy) work together (function) and how knee problems can occur. Anatomical terms allow us to describe the body clearly and precisely using planes, areas and lines. Instead of your doctor saying “his knee hurts” she can say “his knee hurts in the anterolateral region” and another doctor will know exactly what is meant. Below are some anatomic terms surgeons use as these terms apply to the knee: • Anterior - facing the knee, this is the front of the knee • Posterior - facing the knee, this is the back of the knee, also used to describe the back of the kneecap, that is the side of the kneecap that is next to the femur • Medial - the side of the knee that is closest to the other knee, if you put your knees together, the media side of each knee would touch • Lateral - the side of the knee that is farthest from the other knee (opposite of the medial side) Structures often have their anatomical reference as part of their name, such as the medial meniscus or anterior cruciate ligament. Structures of the Knee The main parts of the knee joint are bones, ligaments, tendons, cartilages and a joint capsule, all of which are made of collagen. Collagen is a fibrous tissue present throughout our body. As we age, collagen breaks down. The adult skeleton is mainly made of bone and a little cartilage in places. Bone and cartilage are both connective tissues, with specialized cells called chondrocytes embedded in a gel-like matrix of collagen and elastin fibers. Cartilage can be hyaline, fibrocartilage and elastic and differ based on the proportions of collagen and elastin. Cartilage is a stiff but flexible tissue that is good with weight bearing which is why it is found in our joints. Cartilage has almost no blood vessels and is very bad at repairing itself. Bone is full of blood vessels and is very good at self repair. It is the high water content that makes cartilage flexible. The Bones Of The Lower Leg Tibia And Fibula The lower legs consist of the Tibia and the Fibula. These two bones run parallel and are connected by an Interosseous Membrane. They also articulate with each other. Tibia (Shin-bone) - The Tibia articulates with the Femur (upper leg) and the Talus (Ankle). This bone carries all the body’s weight. It is the main bone of the lower leg and can be found on the more medial side of the leg.

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Fibula - Although this bone runs parallel to the Tibia, it doesn’t actually carry much weight. Instead, it acts as a stabilizer. It articulates with the Tibia and the Talus. It’s inferior end (Lateral Malleolus) is the bone that sticks out on the outside of the ankle. The Fibula can be found on the lateral side (outside) of the lower leg.

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MUSCLES OF THE HIP JOINT AND KNEE MUSCLE

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

Group of 3 muscles (above) ilacus, psoas major, psoas minor

ilacus – illium (inner surface) sacrum base Psoas major – L1 – L5 (sides of the vertebrae)

ilacus: femur Psoas major: femur

- Hip flexion - Flexion of the spine (psoas major) - External rotation of the femur

GLUTEUS MAXIMUS Large thick band of muscle on both sides of the posterior body forming the buttocks. (Strongest muscle in the body)

GLUTEUS MAXIMUS iliac crest (post quarter) sacrum and coccyx Insertion: Femur

GLUTEUS MAXIMUS Femur

GLUTEUS MAXIMUS - Extension of the hip - Lateral rotation of the hip

THE HIP FLEXOR

ABDUCTOR GROUP

GLUTEUS MEDIUS AND MINIMUS ilium (lateral surface) Insertion: Femur

GLUTEUS MEDIUS AND MINIMUS Femur

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GLUTEUS MEDIUS AND MINIMUS - Abducts the hip - Medial rotation of the hip and femur

GLUTEUS MEDIUS AND MINIMUS Two glute muscles that run underneath the gluteus maximus, but still form the glute.

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MUSCLES

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

Triangular band of 3 muscles of the leg used for adduction Adductor Longus (long) Adductor Magnus (thick) Adductor Brevis (short)

Adductor longus Origin: Pubis, inchial tuberosity

Adductor longus Insertion: Femur (medial)

Adductor longus - Thigh adductor (flexes extended thigh and extends flexed thigh) - Hip flexion - Lateral rotation

Adductor Magnus Ischial tuberosity

Adductor Magnus Insertion: Femur (medial and condyle)

Adductor Magnus - Thigh adductor, aids in extention

Adductor Brevis Origin: Pubis, ischial tuberosity

Adductor Brevis Insertion: Femur (medial)

Adductor Brevis - Thigh adductor - Lateral rotation

Gracilis Long strip of muscle running both sides of the pubis to the Tibia and crossing over the knee. Most superficial muscle of the hip adductors

Gracilis Origin: Pubis, inschium

Gracilis Insertion: Femur (medial)

Gracilis - Adduction of the hip - Internal rotation of the hip - Knee flexion

Short bank of muscle running from the pubis bone to the top of the inner thigh bone. Somtimes grouped as a hip flexor but is most often grouped as an adductor

Pubis (superior)

Femur (upper medial)

- Flexion of the hip - Adduction of the hip - Internal rotation of the hip

ABDUCTOR GROUP

ABDUCTOR LONGUS

ABDUCTOR MAGNUS

ABDUCTOR BREVIS

GRACILIS

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PECTINEUS

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MUSCLES

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

Longest muscle in the human body. Runs down the length of the thigh.

Anterior superior iliac spine

Tibia (Medial surface of the body)

- Hip and knee flexion - Lateral rotation and abduction of the thigh - Medial rotation of the tibia on femur

Large group of 4 muscles spanning the front (anterior) sides of the thigh, crossing over the hip (rectus femoris) and the knee (patella)

Rectus Femoris Straight head Hip bone: anterior inferior iliac spine. Reflected head Hip bone: acetabulum (superior aspect). Capsule of the hip joint.

Rectus Femoris Patella: base (via quadratus femoris tendon).

Rectus Femoris Extends the knee, together with the other muscles that make up quadriceps femoris. Assists in flexion of the hip joint.

Vastus Lateralis Femur: intertrochanteric line, greater trochanter, gluteal tuberosity and the linea aspera.

Vastus Lateralis Patella: base (via quadratus femoris tendon).

Vastus Lateralis It extends the knee joint, together with the other muscles that make up quadriceps femoris.

Vastus intermedius Femur: shaft (anterior and lateral surfaces).

Vastus intermedius Patella (via quadratus femoris tendon).

Vastus intermedius It extends the knee joint, together with the other muscles that make up quadriceps femoris.

Vastus Medialis Femur: linea aspera.

Vastus Medialis Patella: medial edge (also base via quadratus femoris tendon).

Vastus Medialis It extends the knee joint, together with the other muscles that make up quadriceps femoris.

SARTORIUS

QUADRICEPS

RECTUS FEMORIS

VASTUS LATERALIS

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VASTUS MEDIALIS

VASTUS INTERMEDIUS

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MUSCLES

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

The hamstring refers to one of the 3 posterior thigh muscles that make up the borders of the space behind the knee.

Biceps femoris

Ischial tuberosity

Fibula, tibia

Semitendinosus and semimembranosus

Hip extension, flexes the knee, laterally rotates semi flexed knee

Ischial tuberosity

Tibia

BICEPS FEMORIS

Semitendinosus and semimembranosus - Extends the hip - Flexes the knee - Medially rotate a semi flexed knee

PIRIFORMAS A flat pyramidal in shape lying almost parallel with the posterior gluteus medius muscle

Anterior sacrum, superior of the greater sciatic notch

Greater trochanter of the femur

- Lateral rotation of the of the hip - Abduction of the hip

Iliac crest (anterior superior)

iliotibial tract (from iliac crest tibia) lateral condyle

- Flexion of the hip - Inward medial rotation of the hip as it flexes - Horizontal abduction of the hip - Stabilises the pelvis

TENSOR FASCIA LATAE

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Thick muscle embedded in the top of the anterior lateral facia

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THE ELBOW The elbow-joint is a ginglymus or hinge-joint. The trochlea of the humerus is received into the semilunar notch of the ulna, and the capitulum of the humerus articulates with the fovea on the head of the radius. The articular surfaces are connected together by a capsule, which is thickened medially and laterally, and, to a less extent, in front and behind. These thickened portions are usually described as distinct ligaments under the following names: • • • •

The Anterior The Posterior The Ulnar Collateral The Radial Collateral

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Movements The elbow-joint comprises of three different portions: the joint between the ulna and humerus, that between the head of the radius and the humerus, and the proximal radioulnar articulation, described below. All these articular surfaces are enveloped by a common synovial membrane, and the movements of the whole joint should be studied together. The combination of the movements of flexion and extension of the forearm with those of pronation and supination of the hand, which is ensured by the two being performed at the same joint, is essential to the accuracy of the various minute movements of the hand. The portion of the joint between the ulna and humerus is a simple hinge-joint, and allows of movements of flexion and extension only. Owing to the obliquity of the trochlea of the humerus, this movement does not take place in the antero-posterior plane of the body of the humerus. When the forearm is extended and supinated, the axes of the arm and forearm are not in the same line; the arm forms an obtuse angle with the forearm, the hand and forearm being directed lateral-ward. During flexion, however, the forearm and the hand tend to approach the middle line of the body, and thus enable the hand to be easily carried to the face. The accurate adaptation of the trochlea of the humerus, with its prominences and depressions, to the semilunar notch of the ulna, prevents any lateral movement. Flexion is produced by the action of the Biceps brachii and Brachialis, assisted by the Brachioradialis and the muscles arising from the medial condyle of the humerus; extension, by the Triceps brachii and Anconeus, assisted by the Extensors of the wrist, the Extensor digitorum communis, and the Extensor digiti quinti proprius.

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MUSCLES THAT ASSIST THE ELBOW JOINT MUSCLES

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

Long muscle that runs superiorly along the humerus that has a long and a short head and has two points of origin

Long head Scapula: supraglenoid tubercle and superior glenoid rim (the tendon arises within the shoulder joint capsule and is surrounded by a synovial sheath as it passes over the joint). Short head Scapula: coracoid process.

Radius: radial tuberosity.

Supinates the forearm. Flexes the elbow joint, particularly if the forearm is supinated. Flexes the shoulder joint. Helps to hold the head of the humerus within the glenoid cavity.

Humerus: shaft (anterior surface).

Musculocutaneous nerve (C5, 6). Radial nerve (C7).

Flexes the elbow, with the forearm pronated or supinated.

Humerus: lateral supracondylar ridge.

Radius: styloid process.

Flexes the elbow (when the forearm is in neutral position). Supinates the elbow

Long head Scapula: infraglenoid tubercle. Medial head Humerus: shaft (medial surface). Lateral head Humerus: shaft (lateral surface).

Ulna: olecranon.

The three heads acting together powerfully extend the elbow. Acting individually the long head produces weak extension of the shoulder and assists in stabilization of the shoulder joint.

BICEPS BRACHII

BRACHIALIS

BRACHIORADIALIS

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TENSOR BRACHII

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BONES AND JOINTS OF THE FOOT AND ANKLE Regions of the foot: Hind-foot – as the name suggests, the hindfoot is the portion of the foot closest to the center of the body. It begins at the ankle joint and stops at the calcaneal-cuboid joint. Mid-foot – The midfoot begins with the calcaneal-cuboid joint and essentially ends where the metatarsals begin. While it has several more joints than the hind-foot, it still possesses little mobility. Fore-foot – the fore-foot is composed of the metatarsals, and phalanges. The bones that comprise the fore-foot are those that are last to leave the ground during walking. Mobile Joints of the foot and ankle: • Ankle joint • Sub-talar joint • Talo-navicular joint • Metatarso-phalangeal (MTP) joints. Joints that move a moderate amount : • Calcaneal-cuboid joint • Cuboid-metatarsal joint for the fourth and fifth metatarsal. • Navicular-cuneiform joints • Joints of midfoot a.k.a. tarso-metatarsal (TMT) joints or cuneiform-metatarsal joints Talus The talus is something of an odd bone because of its strange shape and the fact that 70% of this bone is covered with hyaline cartilage (joint cartilage). The talus acts as a “ball joint” playing the critical roll of connecting the lower leg to the foot. The talus is covered by so much cartilage because it connects so many different bones. The talus holds the ankle together by connecting to the lower leg with a ball joint, connects to the calcaneous on the underside through the subtalar joint, and helps connect the back part of the foot (hindfoot) to the midfoot via the talo-navicular joint. These series of connections allow the foot to rotate smoothly around the talus, as when you roll your ankle in a circle. Unfortunately, the talus has relatively poor blood supply, which means that injuries to this bone take greater time to heal than might be the case with other bones. Parts of the Talus The talus is generally thought of as having three or four parts: • The talar body including the “dome” of the talus • The talar neck • The talar head The talar body is roughly square in shape and is topped by the dome, connects the talus to the lower leg at the ankle joint. The talar head interacts with the navicular bone to form the talo-navicular joint. The talar neck is located between the body and head of the talus, and remarkable because it is one of the few areas of the talus not covered with cartilage, and is one of the few places that blood can flow to in the talus. Calcaneus (The Heel Bone) The calcaneus is commonly referred to as the heel bone. The calcaneus is the largest bone in the foot, and along with the talus, it makes up the area of the foot known as the hind-foot. The calcaneus is something like an oddly shaped egg; hard cortical bone on the outside covers softer cancellous bone on the inside. There are three protrusions on the top surface of the calcaneus (the posterior, middle, and anterior “facets”) that allow the talus to sit on top of the calcaneus, forming the sub-talar joint. The calcaneus also joins to another bone at the furthest end away from the lower leg toward the toes. At this end, the calcaneus connects to the cuboid bone to form the calcaneal-cuboid joint.

Bones of the Mid-foot: Cuboid, Navicular, Cuneiform (3)

Subtalar Joint The talus rests above the calcaneous to form the subtalar joint. However, the talus does not sit directly on top of the calcaneus. Instead, it rests slightly offset toward the outside of the foot (the side nearest the little toe). This positioning allows the foot to cope with uneven terrain because it allows a little more flexibility from side to side. The subtalar joint doesn’t move independently, it moves along with the talo-navicular joint and the calcaneo-cuboid joint, two joints located near the front of the talus.

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Calcaneo-cuboid Joint The calcaneal-cuboid joint attaches the heel bone to the cuboid.

Cuboid The cuboid bone is the main bone of the mid-foot. It is a square-shaped bone on the outside of the foot, and possesses several places to connect with other bones. The main joint formed with the cuboid is the calcaneo-cuboid joint. Farther along its length, the cuboid also connects with the base of the fourth and fifth metatarsals (the metatarsals of the last two toes). On the inner side, it also connects with one of the lateral cuneiform bones.

Navicular The navicular is located in front of the talus and connects with it through the talo-navicular joint. The navicular is curved on the surface nearest ankle. The side farthest from the ankle joint connects to each of the three cuneiform bones. Like the talus, the navicular has a poor blood supply. On the inner side (closest to the middle of the foot), there is a piece of bone that juts out, which is called the navicular tuberosity. This is the site where the posterior tibial tendon anchors into the bone. Talonavicular Joint As

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the name suggests, the talo-navicular joint connects the talus to the navicular. The curve of the navicular is designed to connect smoothly with the front surface of the talus. This joint allows for the potential to have significant motion between the hindfoot and the midfoot depending on the position the hindfoot is in. Cuneiforms There are three different cuneiform bones present side-by-side in the midfoot. The one located on the inside of the midfoot is called the medial cuneiform. The middle cuneiform is located centrally in the midfoot and to the outside is the lateral cuneiform. All three cuneiforms line up in a row and articulate with the navicular forming the naviculo-cuneiform joint. The structure of the cuneiforms is similar to a roman arch. Each cuneiform connected to the others in order to form a more stable unit. These bones, along with the strong plantar and dorsal ligaments that connect to them, provide a good deal of stability for the midfoot. Bones of the Fore-foot: Metatarsals (5), Phalanges (14), Sesamoid Bones (2) Metatarsals Each foot contains five metatarsals. These are the long bones that lead to the base of each toe. The metatarsals are numbered 1-5 starting on the inside and leading outward (from big toe to smallest). Each metatarsal is a long bone that joins with the midfoot at its base, a joint called the tarsal-metatarsal joint, or Lisfranc joint. In general, the first three metatarsals are more rigidly held in place than the last two, although in some individuals there is increased motion associated with the 1st metatarsal where it joins the midfoot (at the 1st tarso-metatarsal joint) and this increased motion may predispose them to develop a bunion. The long part of the metatarsal bone is known as the metatarsal “shaft”, and the thick end of the bone nearest the toes is known as the metatarsal “head” (the metatarsal neck lies between the shaft and head). The head serves two very important functions: First, the metatarsal heads are the locations were weight bearing takes place. Second, the phalanges connect to the foot at the metatarsal heads at a joint called the metatarsal-phalangeal joint. These joints are very flexible, allowing the metatarsal heads to continuously support the weight of the body as the foot moves from heel to toe. First Metatarsal – The largest of the metatarsals both in terms of length and width. The first metatarsal is the largest of the group both in length and width. Second Metatarsal – The fore-foot is made extremely stable not only by the ligaments connecting the bones, but also because the second metatarsal is recessed into the medial cuneiform in comparison to the others. The second metatarsal may be overly long in some individuals prediposing to 2nd metatarsalgia. Fourth and Fifth Metatarsal – The fourth and fifth metatarsal may have greater range of motion than the others do. Phalanges The phalanges make up the bones of the toes. They are connected to the rest of the foot by the metatarsal-phalangeal joint. The first toe, also known as the great toe due to its relatively large size, is the only one to be comprised of only two phalanges. These are known as the proximal phalanx (closest to the ankle) and the distal phalanx (farthest from the ankle). The four “lesser toes” (toes 2-5) all have three phalanges. The phalanx closest to the ankle is known as the proximal phalanx, this articulates with the “middle” phalanx the proximal interphalangeal joint (PIP joint). The middle phalanx meets the “distal” phalanx at the distal interphalangeal joint. An inbalance in the tendons pulling across these small joints of the toes will lead to deformity of the toe such as a clawtoe. A list of the joints of the toes can be found below. • Inter-Phalangeal Joint (great toe only) • Proximal Inter-Phalangeal Joint (PIP joint – toes 2-5) • Distal Inter-Phalangeal Joint (DIP joint -toes 2-5) Sesamoid Bones A sesamoid bone is a bone that is also part of a tendon. An easy example of such a bone is the kneecap (patella). In the foot there are two sesamoid bones, each of which is located directly underneath the first metatarsal head. These seasmoids are part of the flexor hallucis brevis tendon.

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Movement of the ankle joint • Type of Joint: a hinge joint • Movements - dorsiflexion - plantarflexion

Movement of the Foot The Metatarsophalangeal Joints • Bony Structures • Formed by the heads of the metatarsals and the based of the proximal phalanges • Movements • Extension/flexion • abduction/adduction

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THE PELVIC GIRDLE The pelvic girdle consists of paired hipbones. The pelvis is the section between the legs and the torso that connects the spine (backbone) to the thigh bones. In adults, it is mainly constructed of two hip bones, one on the right and one on the left of the body. The two hip bones are made up of 3 sections, the Ilium, Ischium and Pubis. These sections are fused together during puberty, meaning in childhood they are separate bones. Along with the hip bones is the Sacrum, the upper-middle part of the pelvis, which connects the spine (backbone) to the pelvis. To make this possible, the hip bones are attached to the Sacrum. The gap enclosed by the pelvis is the section of the body underneath the abdomen (stomach) and mainly consists of the reproductive organs (sex organs) and the rectum.the sacrum; each is made up of three bones. The pelvic girdle forms joints between the two pubic bones and between the ilium and sacrum. The interpubic joint is a symphysis type of cartilaginous joint. This strong fibrocartilage structure binds the two os cotae and allows for a small range of motion. The sacroiliac joint is a composite joint that has both a syndesmotic junction and a synovial capsule. The syndesmosis occurs where strong anterior and posterior sacroiliac ligaments bind the os coxa to the sacrum. In addition to these sacroiliac ligaments, iliolumbar, sacrospinous, and sacrotuberous ligaments also stabilize the os coxae on the sacrum. The synovial sacroiliac joint occurs where the lateral alar surface of the sacrum articulates with the ear-shaped auricular surface of the ilium. Originally synovial, with age this joint often forms fibrous adhesions and becomes obliterated later in life, sometimes even ossifying. This joint allows for a small degree of anterior-posterior rotation that accompanies flexion and extension of the trunk. Muscles of the Pelvic girdle Gluteal muscles cover the lateral surfaces of the ilia . The gluteus maximus muscle is the largest and most posterior of the gluteal muscles. Its origin includes parts of the ilium; the sacrum, coccyx, and associated ligaments; and the lumbodorsal fascia. Acting alone, this massive muscle produces extension and lateral rotation at the hip joint. The gluteus maximus shares an insertion with the tensor fasciae latae muscle, which originates on the iliac crest and the anterior superior iliac spine. Together these muscles pull on the iliotibial tract, a band of collagen fibers that extends along the lateral surface of the thigh and inserts on the tibia. This tract provides a lateral brace for the knee that becomes particularly important when you balance on one foot. The gluteus medius and gluteus minimus muscles originate anterior to the origin of the gluteus maximus muscle and insert on the greater trochanter of the femur. The anterior gluteal line on the lateral surface of the ilium marks the boundary between these muscles. The lateral rotators originate at or inferior to the horizontal axis of the acetabulum. There are six lateral rotator muscles in all, of which the piriformis muscle and the obturator muscles are dominant . The adductors originate inferior to the horizontal axis of the acetabulum. This muscle group includes the adductor magnus, adductor brevis, adductor longus, pectineus, and gracilis muscles. All but the adductor magnus originate both anterior and inferior to the joint, so they perform hip flexion as well as adduction. The adductor magnus muscle can produce either adduction and flexion or adduction and extension, depending on the region stimulated. The adductor magnus muscle may also produce medial or lateral rotation at the hip. The other muscles produce medial rotation. These muscles insert on low ridges along the posterior surface of the femur. When an athlete suffers a pulled groin, the problem is a strain--a muscle tear or break--in one of these adductor muscles. The medial surface of the pelvis is dominated by a pair of muscles. The large psoas major muscle originates alongside the inferior thoracic and lumbar vertebrae, and its insertion lies on the lesser trochanter of the femur. Before reaching this insertion, its tendon merges with that of the iliacus muscle, which nestles within the iliac fossa. These two muscles are powerful hip flexors and are often referred to collectively as the iliopsoas muscle Functions of the Pelvic Girdle

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Its primary functions are to bear the weight of the upper body when sitting and standing; transfer that weight from the axial skeleton to the lower appendicular skeleton when standing and walking; and provide attachments for and withstand the forces of the powerful muscles of locomotion and posture. Compared to the shoulder girdle, the pelvic girdle is thus strong and rigid. Its secondary functions are to contain and protect the pelvic and abdominopelvic viscera (inferior parts of the urinary tracts, internal reproductive organs); provide attachment for external reproductive organs and associated muscles and membranes.

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MUSCLES

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

Tibialis anterior is a crural (leg) muscle; its tendon passes to the medial side of the foot to act on the ankle joint.

Tibia: lateral condyle (inferior surface) and shaft (lateral surface). Interosseous membrane.

Medial cuneiform. 1st metatarsal bone: base.

It dorsiflexes the ankle joint. Inverts the foot.

Fibula (anterior surface 1/0 membrane)

Phalanges of toes

Toe extension

Medial head Femur: medial condyle (upper aspect). Lateral head Femur: lateral condyle (lateral aspect).

It receives the tendon of soleus to form the tendo calcaneus, which inserts into the posterior surface of the calcaneus.

Flexes the knee joint. Plantar flexes the ankle joint.

TIBIALIS ANTERIOR

EXTENSORS OF THE TOES

GASTROCNEMUIS

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Gastrocnemius is a crural (leg) muscle that originates from medial and lateral heads and acts on the knee and ankle joints.

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MUSCLES

DESCRIPTION

ORIGIN

INSERTION

ACTIONS

Soleus is a crural (leg) muscle that acts on the ankle joint.

Fibula: head and shaft (posterior surface). Tibia: shaft (medial border) and soleal line.

Calcaneus: posterior surface (via calcaneal tendon with aponeurosis of gastrocnemius).

It plantarflexes the ankle joint.

Interosseous membrane. Tibia: posterior surface of shaft. Fibula: posterior surface of shaft.

Navicular: tuberosity. Medial cuneiform. Calcaneus. Intermediate cuneiform. Metatarsals 2 to 4: bases.

It inverts the foot. Assists in plantar flexion of foot at the ankle joint.

Tibia shaft: posterior surface.

Distal phalanx of the toes 2 to 5.

It plantar flexes the ankle joint and flexes the phalanges of the toes 2 to 5.

SOLEUS

TIBIALIS POSTERIOR Tibialis posterior is a crural (leg) muscle; its tendon passes into the sole of the foot to act on the ankle joint.

FLEXOR DIGITORUM LONGUS

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A crural (leg) muscle, passes into the(plantar aspect) and divides into four tendons for the lateral four toes; it acts on the ankle joint and toesâ&#x20AC;&#x2122; sole of the foot

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FACTORS AFFECTING BONE DENSITY Bone mineral density loss is one of the most common problems people face as they age. This may result in medical conditions such as osteoporosis, a disease that causes a person’s bones to become so fragile they break easily. Bone mineral density can be affected by several factors, such as pre-existing medical conditions, a person’s overall physical health and diet. Medical History A history of medical problems may influence a person’s bone mineral density. According to Marcelle Pick, an OB/GYN nurse practitioner, it is normal for a person to lose some bone density as he or she ages. However, doctors examine patients for progressive bone density loss, which could signal other medical issues. According to a 2007 study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging, older men who suffered from low bone mineral density typically had suffered from other medical issues such as diabetes. Other medical problems that could factor into a person’s bone density include osteoarthritis, prostate cancer, kidney stones and chronic lung disease. The study also shows that there may be a connection between reduced bone mineral density and “a history of maternal or paternal fracture.” Physical Fitness A person’s overall physical health, including levels and intensity of exercise, may influence bone mineral density as well. According to the 2007 study referenced above, an increase in body weight may affect a person’s bone density. But this may, up to a certain point, be a positive factor. Participants in the study who had a 22-pound increase in weight also had bone mineral density levels increase by four percent. The study, which looked at men older than the age of 65, also cited a lack of physical activity as a factor in low bone density. A lack of exercise can reduce bone mineral density in everyone. It is suggested exercising 30 minutes a day, at least three times a week. Bones are most positively affected by weight lifting or incorporating weights in the exercise routine. Diet Diet may play a role in bone mineral density. A well-rounded diet with the appropriate nutrients may help reduce the rate of density loss. Studies show calcium is often associated with strong bones. However, a calcium supplement may not be everything a person needs. Women need at least 20 nutrients that assist in building bone mass. A well-rounded diet, along with additional supplements, can supply this. It is also advised people to avoid certain foods that may create acid, reversing the positive effects of a well-rounded diet. Foods to avoid include sugar and meat. Body fat

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Body fat percentage can be a predictor of bone density or bone health. Individuals who have a sedentary lifestyle and poor nutrition are at risk not only for higher body fat percentage, but also lower bone density. Conversely, extremely low levels of body fat can also contribute to bone loss because of poor nutritional habits. Healthy body fat percentage ranges for women is 14 to 31 percent of total body weight. For men, it is between 6 and 24 percent of total body weight.

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