MODULE 1A: ANATOMY

Anatomical position: That of the body standing upright, with the feet at shoulder width and parallel, toes forward. The upper limbs are held out to each side, and the palms of the hands face forward

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 imperative for an 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 program design for group and individual exercises.

Plane: A: Sagittal / Median Plane B: Coronal / Frontal Plane C: Transverse / Horizontal Plane

Definition: Longitudinal line that divides the body / any of its parts into right and left sections

Longitudinal line that divides the body into anterior and posterior parts

Imaginary line that divides the body or any of its parts into superior and inferior

Movement:

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

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

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

• Anterior (or ventral) Describes the front or direction toward the front of the body. The toes are anterior

to the foot.

• Posterior (or dorsal) Describes the back or direction toward the back of the body. The popliteus is

posterior to the patella.

• Superior (or cranial) describes a position above or higher than another part of the body proper.

• Inferior (or caudal) describes a position below or lower than another part of the body proper; near or

toward the tail (in humans, the coccyx, or lowest part of the spinal column). The pelvis is inferior to the

abdomen.

• Lateral describes the side or direction toward the side of the body. The thumb (pollex) is lateral to the

digits.

• Medial describes the middle or direction toward the middle of the body. The hallux is the medial toe.

• Proximal describes a position in a limb that is nearer to the point of attachment or the trunk of the body.

The brachium is proximal to the antebrachium.

• Distal describes a position in a limb that is farther from the point of attachment or the trunk of the body.

• Superficial describes a position closer to the surface of the body. The skin is superficial to the bones.

• Deep describes a position farther from the surface of the body. The brain is deep to the skull.

Directional Terms

TERMS OF MOVEMENT

• Flexion = ↓ angle between two bones

• Extension = ↑ angle between two bones

• Hyperextension = extension past anatomical position

• Abduction = movement away from midline

• Adduction = movement to the midline

• Supination = up- / outward rotation

• Pronation = down- / onward rotation

• Rotation = circular movement along the long

• Medial Rotation = rotational movement towards the midline

• Lateral Rotation = rotational movement away from the midline

• Circumduction = total circular movement

• Eversion = lift lateral side of foot

• Inversion = lift medial side of foot

• Dorsiflexion = toes up

• Plantarflexion = toes down

• Retraction = Backward movement of mandible / scapula

• Protraction = forward movement of mandible / scapula

TABLE OF FREQUENTLY USED TERMS IN ANATOMY

Aditus An entrance or opening.

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.

TABLE OF FREQUENTLY USED TERMS IN ANATOMY

Corpus Means body

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

Crest A projecting ridge or raised surface, especially 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 means a “thread”. This name is given to several thread‐like structures such as the filum terminal, 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 Means 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 unsheathed 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.

BONES

Functions 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 to ten years.

Bone tissue consists of about two thirds mineral components (mostly calcium and salts) which give ridges, and one third organic components which give elasticity. Both components are essential. Without ridges 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 the 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 shape characterized 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 e.g. the patella (knee) or the ball of the big toe.

Structure of 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.

Periosteum It is the membrane which covers the external bone.

The Axial and Appendicular Skeleton:

Axial Skeleton Appendicular Skeleton

− Cranium − Cervical vertebrae − Thoracic vertebrae − Lumbar vertebrae − Sacral vertebrae − Sternum − Ribs − Coccyx

− Scapula − Clavicle − Humerus − Ulna − Radius − Carpals − Metacarpals − Phalanges − Ilium − Ischium − Pubis − Femur − Patella − Tibia − Fibula − Tarsals − Calcaneus − Metatarsals

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 “immovable” 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.

SYNOVIALJOINTS

Most of the joints in the body are synovial joints. These joints are “freely movable” and are 16 characterized 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 e.g. dislocations. Synovial joints are located predominantly in limbs.

Many synovial joints also have ligaments either inside or outside the capsule.

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.

BALL ANDSOCKET JOINTS: Allows a free range of movements i.e. flexion, extension, abduction, adduction and circumduction, such as the shoulder and hip joints.

PIVOT JOINTS: Allows uniaxial rotation. i.e. moving from side to side such as the neck.

PLANEJOINT: Allows short gliding or slipping motions because surface of the bones is flat, such as the vertebral joints.

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

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

TYPES OF JOINTS

BALL AND SOCKET JOINT

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

Found in hips and shoulders

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. (Knee flexion and extension)

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.

TYPES OF JOINTS

CONDYLOID JOINT

Movement = Flexion / Extension /Adduction / Abduction / Circumduction

Found in wrist and lower jaw

The bones can move about

one another in many

directions.

Except condyloid joints

does not rotate.

Some examples of the knowledge application of the Condyloid Joint can be demonstrated by doing the following exercise:

Wrist Flexion Bend the fingers towards the forearm;

Extension Straighten the wrist so that it is on the same plane as the forearm.

Hyperextension Bend the wrist as far back as possible towards the outer part of the forearm. Extend the norm of normal range of motion

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

TYPES OF JOINTS

PLANE OR GLIDINGJOINT

Movement:

These joins can move in many directions and they can rotate and twist.

Intercarpal joints Acromioclavicular joints,

Vertebral transverse and Spinous processes

Ankle and wrist joints

Some examples of Knowledge application of the Plane and Gliding Joint can be demonstrated by doing the following exercise:

− Ankle movement − Flex the wrist

TYPES OF JOINTS

HINGE JOINT

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.

Found in knees, elbows, fingers and toes Carpal and tarsal joints

Some examples of the knowledge application of the Hinge Joint can be demonstrated by doing the following exercise:

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.

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

Single leg hamstring curls

TYPES OF JOINTS

PIVOT JOINT 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

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 Side to side rotation

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 from the hinge joint in the elbow.

SADDLE JOINT

Movement: Flexion / Extension / Adduction / Abduction / Circumduction

Both bones that meet have odd shapes, but they are totally complementary to one another. Each bone has both concavities and convexities.

Found In the thumb

Some examples of knowledge application of the Saddle Joint can be demonstrated by doing the following exercise:

By moving the thumb in different directions Thumb stretches (fine motor movements/mobility)

PLANE JOINT PIVOT JOINT

ANOTHER EXAMPLE OF THE DIFFERENT TYPES OF JOINTS

A plane joint allows bones to slide past each other. Midcarpal and mid-tarsal joints are plain joints.

A pivot joint allows rotation around an axis. Pivot joints are found in the neck and forearm.

HINGE JOINT CONDYLOID JOINT

A condyloid joint is similar to ball and socket but with less movement. The wrist is a condyloid joint.

A hinge joint allows extension and retraction of an appendage. Hinge joints are found in the knees, elbows, fingers, and toes.

SADDLE JOINT BALL AND SOCKET JOINT

A ball and socket joint allow for radial movement in almost any direction. Ball and socket joints are found in the shoulders and hips.

A saddle joint allows movement back and forth and up and down. The only saddle joint in a human body is the thumb.

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, combined in the various joints, to produce an infinite variety, and it is seldom that only one kind of motion is found in any 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 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 vertebrae 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 stabilize and strengthen the joint. Most ligaments do not connect bone to bone or connects to cartilages.

Ligaments have sensory nerve cells which can respond to the speeds, movement and position of a joint. Excessive movement of the joint can lead to strengthening to a point of straining or tearing a ligament, Ligaments however, viscoelastic, they gradually strain when under tension, and return to their original shape when the tension is removed. If ligaments lengthen too much due to joint being dislocated for too long, this will cause the joint to become weakened and thus one becomes more prone to dislocations in the future.

Capsular ligaments are part of the joint capsule that surrounds synovial joints. It is possible to lengthen ligaments over a period through stretching, one must however keep in mind that this may eventually lead to instability in extreme cases.

Ligaments are also membranes folds that can act to support an organ and keep it in place.

Ligaments are rich in nerve supply and thus serve as sensory organs, which is important for reflex mechanism in monitoring the position and movements of the joints.

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, thoracic and lumbar spine. The inferior (lower) nine vertebrae 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 ¼ 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.

In between each of the individual bones there are cartilage disks, known as a intervertebral disk. These intervertebral disks give the spine it’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 change 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.

The spine has natural curvatures giving an “s” 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. The upper most part of the vertebrae is called the CERVICAL vertebrae (7 in total). The vertebrae of the trunk (thorax) is called the Thoracic vertebrae (12 in total). The lower part of the vertebra is called the LUMBAR vertebrae (5 in total). The vertebra that join to the iliac 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.

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

Annulus fibrosus

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 lumbar 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 copes 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‐shaped 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 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.

The cervical vertebrae The thoracic vertebrae

Lateral view of a cervical vertebrae.

Spinous process

Superior view of a cervical vertebrae.

Superior view of a thoracic verterbrae

Transverse pro cess

Body of 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 copes with most of the stress that occurs during movement activities involving running and jumping. So, correct alignment of the spine is absolutely essential.

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.

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.MUSCLES SUPPORTING THE SPINE

ERECTOR SPINAE (MULTIPENNATE)

DESCRIPTION ACTIONS ‐ Closest to the body surface ‐ Positioned posterior ‐ Runs down the length of the vertebral column ‐ Closer to body’s surface (superficial)

‐ Extension of the spine ‐ Lateral flexion of spine

ORIGIN INSERTION

‐ Spinous processes of T9‐ T12 thoracic vertebrae ‐ Medial slope of the dorsal segment of iliac crest

‐ Spinous processes of T1 and T2 thoracic vertebrae ‐ Spinous processes of cervical vertebrae

MULTIFIDUS (MULTIPENNATE)

DESCRIPTION ACTIONS ‐ Positioned posterior ‐ Runs down the length of the spine

‐ Assists with lateral flexion of spine ‐ Assists with extension of spine

ORIGIN INSERTION ‐ Lumbar mammillary processes ‐ Thoracic transverse processes ‐ Articular processes of C4 to C7 ‐ Sacral foramen (S1 to S4) ‐ Sacrospinalis origin aponeurosis

‐ C2 to L5 spinous processes

QUADRATUS LUMBORUM (MULTIPENNATE)

DESCRIPTION ACTIONS ‐ Deeper than erector spinae ‐ Positioned at the side of the lumbar spine between floating ribs and iliac

‐ Together they depress ribs, flex vertebral column, one side acting along produces lateral flexion

ORIGIN INSERTION

‐ Iliac crest

Last and transverse processes of lumbar vertebrae

MUSCLES SUPPORTING THE SPINE ANTERIORALLY AND LATERALLY

RECTUS ABDOMINIS (PARALLEL MUSCLE)

DESCRIPTION ACTIONS These muscles are vertically aligned with straight fibers. Each side divides into 4 sections with tendinous inscription between each section. This divides the “6‐ pack” look for lean individuals

‐ Depresses ribs, flexes vertebral column

ORIGIN INSERTION Superior surface of pubis around symphysis

‐ Inferior surfaces of costal cartilage (ribs 5 – 7) and xiphoid process

EXTERNAL OBLIQUE (FLAT MUSCLE)

DESCRIPTION ACTIONS Superficially broad band of muscles at each side of the trunk with downwards and inwards slanted or oblique fibers

‐ Flexion of spine ‐ Compression of abdomen ‐ Rotation of spine ‐ Lateral flexion of spine

ORIGIN INSERTION Lower eight ribs ‐ Linea alba and iliac crest

‐

INTERNAL OBLIQUE (FLAT MUSCLE)

DESCRIPTION ACTIONS Broad band of muscle running underneath external oblique at both sides of the body with slanted or oblique fibers running upward and inward

‐ Compression of abdomen ‐ Rotation of vertebral column ‐ Compress interval organs.

ORIGIN INSERTION ‐ Iliac crest and adjacent

connective tissue ‐ Lower ribs, xiphoid of sternum and linea alba

TRANSVERSE ABDOMINIS (FLAT MUSCLE)

DESCRIPTION ACTIONS Deepest layer of muscle in the ‐ Compresses the abdominal wall with fibres abdomen, abdominal running horizontally around contents, and gives a the trunk forming a “corset” flatter appearance

‐ Forces expiration; pulls the abdominal wall inwards

ORIGIN INSERTION ‐ Cartilages of lower ribs, iliac crest and adjacent connective tissue

Linea alba Pubic crest

THE SHOULDER GIRDLE AND SHOULDERJOINT Shoulder Joint

The Shoulder joint

Type: synovial ball and socket.

Articulation: head of humerus and glenoid cavity of scapula Glenoid fossa deepened by glenoid labrum, a rim of fibrocartilage.

Articular capsule: thin loose sac that surrounds the joint – extends from margin of glenoid cavity to anatomical neck of humerus.

The Glenohumeral Joint (shoulder ball and socket joint) The Glenohumeral Joint is a ball and socket joint which provides a large proportion of the movement at the shoulder girdle. 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.

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. Flat and triangular irregular bone Situated on the dorsal surface of rib cage, between ribs 2 and 7 2 surfaces – anterior & posterior 3 borders – lateral, medial & superior 3 angles – superior, inferior & lateral 3 processes – acromion, coracoid & spine

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.

Flattened acromial (lateral) end articulates with the scapula Cone‐shaped sternal (medial) end articulates with the sternum Act as braces to hold the scapulae and arms out laterally

Humerus Largest, longest bone of upper limb Articulates superiorly with glenoid cavity of scapula Articulates inferiorly with radius and ulna

The Acromioclavicular Joint The Acromioclavicular Joint (ACJ) is formed by the lateral end of the clavicle articulating with the medial aspect of the anterior acromion. 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 a 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 (anterior, lateral and posterior) • Teres Major • Rotator Cuff (active stabilisation and mobility 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

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 a 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

MUSCLES ACTING TO MOVE SCAPULA Muscles suspend scapula from vertebral column and chest wall

• Trapezius ‐ retract and rotates upward • Rhomboids ‐ retract and rotate downward • Pectoralis minor ‐ depresses the shoulder girdle, draws the scapula inferior and medial towards thorax • Serratus anterior ‐ protracts and rotates upward • Trapezius ‐ Retract and rotates upward

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

MUSCLES THAT SUPPORT THE SHOULDER GIRDLE AND MOVEMENT

TRAPEZIUS (CONVERGENT MUSCLE)

DESCRIPTION ACTIONS Large kite‐shaped muscles ‐ Extends the neck and helps that run from the back of keep the head upright the skull down the back of

the neck, across the upper

‐ Elevates the shoulder girdle ‐ Abducts and adducts the

back to shoulders as well shoulder as between and below ‐ Retracts scapulae scapulae

ORIGIN INSERTION Occipital bone and spinous processes of thoracic vertebrae

‐ Posterior border of the

lateral third of the clavicle ‐ Acromion process ‐ Spine of the scapula ‐ Nuchal ligament ‐ medial superior nuchal line

LEVATOR SCAPULAE (STRAP‐LIKE UNIPENNATE)

DESCRIPTION ACTIONS Strip of muscle that runs vertically at the rear side of the neck between C1 and C4 to the inner border of the scapulae

‐ Elevates scapulae ‐ Tilts glenoid inferiorly by rotating scapulae

ORIGIN INSERTION Posterior tubercles of transverse processes of C1 to C4

Vertebral border of the scapula

SERRATUS ANTERIOR (MULTIPENNATE)

DESCRIPTION ACTIONS ‐ A large flat muscular sheet with fleshy digitations that curves around the sides of the thorax between theribs and the scapulae ‐ Covers the medial axillary wall

‐ Protracts scapulae ‐ Stabilises scapulae ‐ Assists with upward rotation of scapular

ORIGIN INSERTION Anterior and superior margins of ribs 1 ‐ 9

Anterior surface of the vertebral border of the scapula

LATISSIMUS DORSI (SPIRAL MUSCLE)

DESCRIPTION ACTIONS Large triangular muscle ‐ Extension of humerus that spans the right and the ‐ Adduction of humerus left sides of the back and ‐ Assists internal rotation of runs up towards the arm humerus pits ‐ Stabilises the lower

scapular against the ribcage

ORIGIN INSERTION ‐ Spinous processes of Medial intertubercular vertebrae T7 to T12 groove of the humerus ‐ Iliac crest

‐ Thoracolumbar fascia

‐ Inferior angle of scapula

RHOMBOID MINOR (UNIPENNATE STRAP MUSCLE)

DESCRIPTION ACTIONS Short rectangular muscles situated between scapular

Retracts and rotates scapulae upwards

ORIGIN INSERTION Nuchal ligaments and spinous processes of C7 to T1

Medial border of scapula superior to insertion of rhomboid major muscle

RHOMBOID MAJOR (UNIPENNATE STRAP MUSCLE)

DESCRIPTION ACTIONS

Short rectangular muscles situated between scapulae

Retracts and rotates scapulae upwards

ORIGIN INSERTION Spinous processes of T2 to T5

Medial border of scapula inferior to insertion of rhomboid minor

ROTATOR CUFF MUSCLES (GROUP OF 4 MUSCLES THAT ATTACH FROM THE SCAPULA TO THE HEAD OF THE HUMERUS – STABILIZES GLENOHUMERAL JOINT AND ROTATES THE HUMEROUS)

FAMOUS MNEMONIC TO USE: “SITS” SUPRASPINATUS (“S” OF “SITS”) (UNIPENNATE)

DESCRIPTION ACTIONS Short muscle found superior to the spine of the scapula

‐ Abduction of arm ‐ Stabilisation of glenohumeral joint

ORIGIN INSERTION Supraspinous fossa of scapula

Greater tubercle of humerus

INFRASPINATUS (“I” OF “SITS”) (TRIANGULAR MUSCLE)

DESCRIPTION ACTIONS Short muscle found inferior to the spine of the scapula

‐ Lateral rotation of humerus ‐ Stabilisation of glenohumeral joint

ORIGIN INSERTION Infraspinous fossa of the scapula

Greater tubercle of humerus

TERES MINOR (“T” OF “SITS”) (UNIPENNATE)

DESCRIPTION ACTIONS Short muscle found inferior to the infraspinatus on the lateral border of scapula

‐ Lateral rotation of humerus ‐ Stabilisation of

glenohumeral joint ORIGIN INSERTION Lateral border of scapula Greater tubercle of

humerus

SUBSCAPULARIS (“S” OF “SITS”: MULTIPENNATE MUSCLE)

DESCRIPTION ACTIONS Short flat muscle found on the inner fossa of the scapula

‐ Internal/medial rotation of humerus ‐ Stabilisation of glenohumeral joint

ORIGIN INSERTION Subscapular fossa Lesser tubercle of humerus

DELTOIDS GROUP (MULTIPENNATE MUSCLE: INCUDES ANTERIOR, LATERAL, AND POSTERIOR HEADS)

ANTERIOR DELTOID LATERAL DELTOID POSTERIOR DELTOID DESCRIPTION DESCRIPTION DESCRIPTION Short thick muscle that makes up the anterior portion of the deltoids

Short thick muscle that makes up the lateral portion of the deltoids

Short thick muscle that makes up the posterior portion of the deltoids

ACTIONS ACTIONS ACTIONS Flexion of glenohumeral joint Abduction of glenohumeral joint Extension of glenohumeral joint

ORIGIN ORIGIN ORIGIN The anterior border and upper surface of the lateral third of the clavicle

Acromion Spine of the scapula

INSERTION INSERTION INSERTION Deltoid tuberocity of the humerus Deltoid tuberocity of the humerus Deltoid tuberocity of the humerus

TERES MAJOR (NOT PART OF ROTATOR CUFF) (UNIPENNATE)

DESCRIPTION ACTIONS Short muscle found inferior to the infraspinatus on the medial border of scapula

‐ Adduction of the humerus ‐ Assists with medial rotation of the humerus ‐ Helps extend the humerus

ORIGIN INSERTION Posterior aspect of inferior angle of scapula

Medial lip of intertubercular sulcus of the humerus

PECTORALIS MAJOR (CONVERGENT MUSCLE)

DESCRIPTION ACTIONS Large broad band of ‐ Adduction of humerus muscle running on right ‐ Medial rotation of and left sides of sternum humerus ‐ Flexion of

glenohumeral joint

ORIGIN INSERTION ‐ Anterior boarder of Lateral lip of bicipital medial half of clavicle groove of the humerus ‐ Anterior surface of

sternum ‐ 1st to 6th costal cartilages

‐ Aponeurosis of external

oblique muscle

PECTORALIS MINOR (TRIANGULAR MUSCLE)

DESCRIPTION ACTIONS Muscle that lies ‐ Stabilises the scapula

underneath the pectoralis by drawing it inferiorly and

major anteriorly against the thoracic wall ‐ Helps raise ribs with inspiration ORIGIN INSERTION Ribs 3 to 5 near costal Medial border and cartilages superior surface of the coracoid process of the scapula

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

STERNOCLEIDOMASTOID (PARALLEL MUSCLE)

DESCRIPTION ACTIONS Extends from the back of the ear all the way down to the collar bone

‐ Rotation of cervical spine ‐ Flexion of cervical spine ‐ Raises sternum and assists with forced inhalation

ORIGIN INSERTION Manubrium and medial portion of the clavicle

‐ Mastoid process of the temporal bone ‐ Superior nuchal line

LONGUS CAPITIS (UNIPENNATE)

DESCRIPTION ACTIONS

Broad and thick above, narrow below

Flexion of the cervical spine

ORIGIN INSERTION Anterior tubercles of the transverse processes of the third, fourth, fifth, and sixth cervical vertebrae

Basilar part of occipital bone

SPLENIUS CERVICIS (STRAP‐LIKE UNIPENNATE)

DESCRIPTION ACTIONS Deep muscle at the back of the neck

‐ Extension of the head and neck ‐ Lateral flexion of cervical spine ‐ Rotation of cervical spine

ORIGIN INSERTION Spinous processes of T3 to T6

Transverse processes of C1 to C3

SPLENIUS CAPITIS (FUSIFORM)

DESCRIPTION ACTIONS Muscle of the head and neck forming part of the floor of the posterior triangle of the neck

‐ Extension of spine ‐ Rotation of cervical spine ‐ Lateral flexion ofhead

ORIGIN INSERTION ‐ Nuchal ligament ‐ Spinous processes of C7 to T3

Mastoid process of occipital and temporal bone

THE KNEE

The Knee Joint and Movement

Type: modified synovial hinge joint

Articulation: condyles of femur and condyles of tibia

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 those 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 weightbearing 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.

Patella (Kneecap)

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.

Fibula ‐ Although this bone runs parallel to the Tibia, it doesn’t 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

THE HIP (OS COXA) (THE PELVIC GIRDLE)

HIP JOINT Type: synovial ball and socket Articulation: head of femur and cup‐shaped acetabulum of hip bone Acetabular labrum deepens acetabulum Movements Flexion – iliopsoas Extension – Hamstrings (semitendinosus, semimembranosus & biceps femoris); gluteus maximus Abduction – gluteus medius & gluteus minimus Adduction – adductor longus, adductor brevis, adductor magnus, gracilis & pectineus Medial Rotation – gluteus medius & gluteus minimus Lateral Rotation – deep thigh muscles (gemelli, obturators, quadratus femoris, piriformis, gluteus maximus

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 coxae 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 coxae 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 fascia 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 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

MUSCLES OF THE HIP JOINT AND KNEE JOINT HIP FLEXORS PSOAS MAJOR (FUSIFORM)

DESCRIPTION ACTIONS Long fusiform muscle located on the side of the lumbar region, joins iliacus muscle to form iliopsoas (see below)

Flexion of the hip joint

ORIGIN INSERTION ‐ Transverse processes of T12 to L5 ‐ Lateral aspects of discs between T12 to L5

Lesser trochanter of the femur

ILIACUS (CONVERGENT)

DESCRIPTION ACTIONS Flat thick muscle on anterior side of iliac

‐ Flexion of hip joint ‐ Lateral rotation of femur

ORIGIN INSERTION Upper two thirds of the iliac fossa

Base of the lesser trochanter of the femur

ILIOPSOAS (COMBINATION OF PSOAS MAJOR AND ILIACUS)

DESCRIPTION ACTIONS Combination of ‐ Flexion of the hip joint the psoas major and ‐ Lateral rotation of the the iliacus at their inferior ends

femur

ORIGIN INSERTION ‐ Transverse processes of ‐ Lesser trochanter of the T12 to L5 femur ‐ Lateral aspects of discs ‐ Base of the lesser between T12 to L5 trochanter of the femur ‐ Upper two‐thirds of the iliac fossa

PECTINEUS (UNIPENNATE)

DESCRIPTION ACTIONS ‐ Short bank of muscle running from the pubis bone to the top of the femur. ‐ Often grouped as a hip flexor, is also group as an

adductor

‐ Hip flexion ‐ Hip adduction ‐ Internal rotation of the hip

ORIGIN INSERTION Pectineal line of the pubic bone

Pectineal line of the femur

ABDUCTORS AND HIP EXTENSORS

TENSOR FASCIAE LATAE (TFL) – HIP ABDUCTORS (TFL: UNIPENNATE)

DESCRIPTION ACTIONS Hip abductor muscle ‐ Hip flexion

‐ Hip rotation ‐ Hip abduction

ORIGIN INSERTION Anterior iliac crest Lateral condyle of tibia via

iliotibial tract (ITB)

GLUTEAL GROUP (HIP EXTENSORS, ABDUCTORS, AND EXTERNAL ROTATORS)

GLUTEUS MAXIMUS (MULTIPENNATE)

DESCRIPTION ACTIONS Large thick muscle on ‐ External rotation of

the posterior part of the femur ‐ Extension of the hip joint

pelvis forming the ‐ Supports the “buttocks” extended knee through

the iliotibial tract (ITB) hip abduction

ORIGIN INSERTION ‐ Gluteal surface of ilium ‐ Gluteal tuberosity of ‐ Lumbar fascia femur ‐ Posterior surface of ‐ Iliotibial tract (ITB) lower part of sacrum

‐ Sacrotuberous ligament

GLUTEUS MEDIUS (MULTIPENNATE)

DESCRIPTION ACTIONS Large thick muscle on the ‐ Internal/medial posterior part of the rotation of femur with pelvis forming part of the Hip flexion “buttocks” ‐ Extension of the hip joint

ORIGIN INSERTION Gluteal surface of ilium, Greater trochanter of the under gluteus maximus femur

GLUTEUS MINIMUS (MULTIPENNATE)

DESCRIPTION ACTIONS Large thick muscle on the ‐ Anterior fibres posterior part of the rotate thigh inwards pelvis forming part of the ‐ Internal/medial “buttocks” rotation of femur with Hip flexion ORIGIN INSERTION Outer (external) surface Anterior surface of the of ilium between anterior greater trochanter of the and inferior gluteal lines femur

OBTURATOR INTERNUS (UNIPENNATE)

DESCRIPTION ACTIONS Short muscle to help Abducts & laterally laterally rotate femur rotates the extended hip with hip extension and and abducts the flexed abduct femur with hip thigh at the hip, and flexion, as well as to stabilises the hip during steady the femoral head walking in the acetabulum.

ORIGIN INSERTION Ischiopubic ramus Medial aspect of & obturator the greater trochanter membrane

OBTURATOR EXTERNUS (UNIPENNATE)

DESCRIPTION ACTIONS Short muscle to help laterally rotate femur with hip extension and abduct femur with hip flexion, as well as to steady the femoral head in the acetabulum

Hip adduction Assist with latera rotation of the femur at the hip joint

ORIGIN INSERTION Obturator foramen and obturatory membrane

Trochanteric fossa of femur

GEMELLUS SUPERIOR (UNIPENNATE)

DESCRIPTION ACTIONS ‐ External rotator of hip ‐ Accessory to obturator internus

External rotation of hip Assist with lateral rotation

ORIGIN INSERTION Spine of the ischium Obturator internus

tendon

GEMELLUS INFERIOR (UNIPENNATE)

DESCRIPTION ACTIONS

‐ External rotator of hip ‐ Accessory to obturator internus

External rotation of hip

ORIGIN INSERTION Ischial tuberosity Obturator internus

tendon

ADDUCTOR GROUP ADDUCTOR LONGUS (UNIPENNATE)

DESCRIPTION ACTIONS Helps form medial wall of femoral triangle

‐ Adduction of the femur at the hip joint

‐ Flexion of hip joint ‐

ORIGIN INSERTION Pubic body just below the pubic crest

Middle third of linea aspera

ADDUCTOR MAGNUS (TRIANGULAR MUSCLE)

DESCRIPTION ACTIONS

‐ Large triangular muscle situated on the medial thigh ‐ Helps form medial wall of femoral triangle

‐ Adduction of the femur at the hip joint ‐ Flexion of hip (adductor portion) ‐ Extension of hip

ORIGIN INSERTION ‐ Pubis ‐ Tuberosity of the ischium

‐ Linea aspera ‐ Adductor tubercle of the femur

ADDUCTOR BREVIS (TRIANGULAR)

DESCRIPTION ACTIONS Somewhat triangular in form, and arises by a narrow origin from the outer surfaces of the superior and inferior rami of the pubis, between the gracilis and obturator externus

Adduction of the femur at the hip joint

ORIGIN INSERTION Anterior surface of the inferior ramus and body of the pubis

The lesser trochanter and linea aspera of the femur

SARTORIUS

DESCRIPTION ACTIONS ‐ Longest muscle in the human body ‐ Runs down the entire length of the body

‐ Flexion of the femur at the hip joint

‐ Abduction of hip ‐ Lateral rotation of hip ‐ Flexion of the knee

ORIGIN INSERTION Anterior superior spine of the iliac (ASIS)

Anteromedial surface of the upper tibia

QUADRICEPS GROUP (4 MUSCLES MAKE UP THIS GROUP)

RECTUS FEMORIS (BIPENNATE)

DESCRIPTION ACTIONS

Long muscle found at the front of the thigh (anterior compartment of the thigh)

‐ Assists Sartorius and iliopsoas with flexion at the hip ‐ Knee extension

ORIGIN INSERTION Anterior inferior iliac spine and the exterior surface of the bony ridge which forms the groove on the iliac portion of the acetabulum

‐ Quadriceps tendon on the tibial tuberosity via the patellar ligament

VASTUS LATERALIS (UNIPENNATE)

DESCRIPTION ACTIONS Long muscle found laterally on the thigh (anterior compartment of the thigh)

‐ Knee extension ‐ Knee stabilisation

ORIGIN INSERTION ‐ Greater trochanter ‐ Intertrochanteric line ‐ Linea aspera of the femur

Quadriceps tendon on the tibial tuberosity via the patellar ligament

VASTUS INTERMEDIUS (BIPENNATE)

DESCRIPTION ACTIONS Long muscle found anterior compartment of on the thigh

‐ Knee extension ‐ Knee stabilisation

ORIGIN INSERTION Anterolateral femur Quadriceps tendon on the

tibial tuberosity via the patellar ligament

VASTUS MEDIALIS (UNIPENNATE)

DESCRIPTION ACTIONS

Long muscle found medially on the thigh (medial compartment of the thigh)

‐ Knee extension ‐ Knee stabilisation

ORIGIN INSERTION Medial side of femur Quadriceps tendon on the

tibial tuberosity via the patellar ligament

GRACILIS (UNIPENNATE)

DESCRIPTION ACTIONS Superficial muscle on medial side of the thigh

‐ Flexion of hip ‐ Adduction of hip ‐ Medial and internal

rotation of hip

ORIGIN INSERTION Ischiopubic ramus

Tibia

HAMSTRINGS GROUP DESCRIPTION

It is often forgotten by personal trainers that the hamstring muscle crosses two joint sections namely hip and knee (this group can thus extend the hip as well as flex the knee), one must therefore take into account that full range of this muscle must be exercised and stretched ‐ proximal as well as distal ends ‐ in order to obtain peak performance with this specific group

SEMITENDINOSUS (MULTIPENNATE)

SEMIMEMBRANOSUS (MULTIPENNATE)

BICEPS FEMORIS LONG HEAD (MULTIPENNATE)

BICEPS FEMORIS SHORT HEAD (MULTIPENNATE)

DESCRIPTION DESCRIPTION DESCRIPTION DESCRIPTION Found medially on the posterior thigh

Found medially on the posterior thigh underneath the semitendinosus

Found laterally on the posterior thigh

Found laterally on the posterior thigh underneath the long head

ACTIONS ACTIONS ACTIONS ACTIONS ‐ Flexion of the knee ‐ Extension of the hip joint

‐ Flexion of the knee ‐ Extension of the hipjoint

‐ Flexion of the knee ‐ Extension of the hip joint

Flexion of the knee

ORIGIN ORIGIN ORIGIN ORIGIN

Tuberosity of the ischium Tuberosity of the ischium Tuberosity of the ischium

Linea aspera of the femur

INSERTION INSERTION INSERTION INSERTION

Medial condyle of the tibia Medial condyle of the tibia Head of the fibula Head of the fibula

THE ELBOW

The elbow‐joint is a 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 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

Type: synovial hinge joint Articulation: trochlear and capitulum of humerus and trochlear notch of ulna and head of radius

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 for 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.

BICEPS GROUP (GROUP OF 3 MUSCLES) BICEPS BRACHII (FUSIFORM MUSCLE)

DESCRIPTION ACTIONS ‐ Long muscle that runs superiorly along the humerus ‐ Has a long and short head ‐ Has two origins

‐ Elbow flexion ‐ Flexion of glenohumeral joint ‐ Abduction of glenohumeral joint ‐ Supination of radioulnar joint in forearm

ORIGIN INSERTION ‐ Short head: coracoid

process of the scapula ‐ Long head:

supraglenoid tubercle

Radial tuberosity and bicipital aponeurosis into deep fascia on medial part of forearm

BRACHIALIS (UNIPENNATE MUSCLE)

DESCRIPTION ACTIONS

Short muscle on anterior surface of distal humerus

Elbow flexion

ORIGIN INSERTION Distal anterior surface of humerus

Coronoid process and the tuberosity of the ulna

BRACHIORADIALIS (UNIPENNATE MUSCLE)

DESCRIPTION ACTIONS Long muscle that forms part of the forearm

‐ Elbow flexion ‐ Supination of forearm ‐ Assist with pronation of

the forearm

ORIGIN INSERTION Lateral supracondylar ridge of elbow

Distal radius (radial styloid process)

TRICEPS GROUP TRICEPS BRACHII (FUSIFORM MUSCLE)

DESCRIPTION ACTIONS Large muscle of the back of the upper arm

‐ Extends forearm, ‐ Long head extends and adducts arm ‐ Extends shoulder

ORIGIN INSERTION ‐ Long head: infraglenoid tubercle of scapula ‐ Lateral head: above the radial sulcus ‐ Medial head: below the radial sulcus

Olecranon process of ulna

ANCONEUS (TRIANGULAR MUSCLE)

DESCRIPTION ACTIONS ‐ Small muscle on the posterior aspect of the elbow joint ‐ Partially blended in with triceps

‐ Assists in extension of the forearm ‐ Stabilises the elbow during pronation and supination

ORIGIN INSERTION Lateral epicondyle of the humerus, proximally

Lateral surface of the olecranon process and the superior proximal part of the posterior ulna

PRONATOR QUADRATUS (UNIPENNATE)

DESCRIPTION ACTIONS

Square‐shaped muscle on the distal forearm

Pronation of forearm

ORIGIN INSERTION Anterior medial surface of the ulna

Anterior lateral surface of the ulna

SUPINATOR MUSCLE (UNIPENNATE)

DESCRIPTION ACTIONS Broad muscle in the posterior compartment of the forearm

Supination of forearm

ORIGIN INSERTION ‐ Lateral epicondyle of humerus ‐ Supinator crest ofulna ‐ Radial collateral ligament ‐ Annular ligament

Lateral proximal radial shaft

PULMARIS LONGUS (FUSIFORM)

DESCRIPTION ACTIONS

A slender muscle on medial aspect of the elbow

Wrist flexor

ORIGIN INSERTION Medial epicondyle of humerus (common flexor tendon)

Palmar aponeurosis

FLEXOR DIGITORUM SUPERFICIALIS (UNIPENNATE)

DESCRIPTION ACTIONS

Considered to be the deepest part of the superficial layer

Flexor of fingers (primarily at proximal interphalangeal joints)

ORIGIN INSERTION Medial epicondyle of the humerus (common flexor tendon) as well as parts of the radius and ulna

Anterior margins on the bases of the middle phalanges of the four fingers

64

BONES AND JOINTS OF THE FOOT AND ANKLE

ANKLE JOINT Type: synovial hinge joint Articulation: distal tibia and fibula with talus Articular capsule: fibrous capsule, lax anteriorly and posteriorly; completely surrounds joint. Lined by synovial membrane and reinforced by lateral and medial ligaments

Regions of the foot: The foot is the region of the lower limb distal to the ankle Subdivided into ankle, metatarsus & digits The foot has a superior surface (dorsum) and an inferior surface (sole or plantar surface)

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 • Subtalar joint • Talonavicular joint • Metatarso‐phalangeal (MTP) joints.

Joints that move a moderate amount: • Calcaneal Cuboid joint • Cuboid‐metatarsal joint for the fourth and fifth metatarsal. • Naviculocuneiform 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 calcaneus on the underside through the subtalar joint, and helps connect the back part of the foot (hindfoot) to the midfoot via the talonavicular 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 talonavicular 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 subtalar 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 calcaneocuboid joint.

Subtalar Joint The talus rests above the calcaneus 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 talonavicular joint and the calcaneocuboid joint, two joints located near the front of the talus.

Bones of the Mid‐foot: Cuboid, Navicular, Cuneiform (3) 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 calcaneocuboid 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.

Calcaneocuboid Joint The calcaneal‐cuboid joint attaches the heel bone to the cuboid.

Navicular The navicular is located in front of the talus and connects with it through the talonavicular 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 the name suggests, the talonavicular joint connects the talus to the navicular. The curve of the 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 naviculocuneiform 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 tarsometatarsal 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 first metatarsal bone is the bone in the foot just behind the big toe. The first metatarsal bone is the shortest of the metatarsal bones and by far the thickest and strongest of them. 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 predisposing 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 metatarsophalangeal 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 imbalance in the tendons pulling across these small joints of the toes will lead to deformity of the toe such as a claw toe. A list of the joints of the toes can be found below. • Interphalangeal Joint (great toe only) • Proximal Interphalangeal Joint (PIP joint – toes 2‐5) • Distal Interphalangeal 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 sesamoids are part of the flexor hallucis brevis tendon.

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

Movement of the ankle joint • Type of Joint: a hinge joint • Movements ‐ dorsiflexion ‐ plantar flexion

TIBIALIS ANTERIOR (UNIPENNATE)

DESCRIPTION ACTIONS ‐ Long muscle situated anterior to the tibia ‐ Its tendon passes to the medial side of the foot to act on the ankle

Dorsiflexion and innervation of the foot

ORIGIN INSERTION Upper half of lateral condyle of the tibia

Medial cuneiform and first metatarsal bones of the foot

EXTENSORS OF TOES (UNIPENNATE)

EXTENSOR DIGITORUM LONGUS

DESCRIPTION ACTIONS

Long muscle running in ‐ Extension of toes anterior portion of the leg ‐ Dorsiflexion of ankle

ORIGIN INSERTION Anterior lateral condyle of Dorsal surface; middle tibia, anterior shaft of fibula and distal phalanges of and Superior 3⁄4 oflateral four digits interosseous

membrane

EXTENSOR HALLUCIS LONGUS

DESCRIPTION ACTIONS Long muscle running Extends the big toe and deeper in anterior portion assists in dorsiflexion of of the leg the foot at the ankle. Also, is a weak evertor/

invertor ORIGIN INSERTION Arises from the middle Inserts on the dorsal side portion of the fibula on the of the base of anterior surface and the distal phalanx of the the interosseous big toe membrane

GASTROCNEMIUS (FUSIFORM)

DESCRIPTION ACTIONS Muscle of the “Calf” ‐ Plantar flexes foot

‐ Assist with knee flexion

ORIGIN INSERTION Superior to articular surfaces of lateral condyle of femur and medial condyle of femur

Tendo calcaneus (Achilles tendon) into mid‐ posterior calcaneus

SOLEUS (MULTIPENNATE)

DESCRIPTION ACTIONS Muscle running underneath gastrocnemius that acts on the ankle

Plantar flexion

ORIGIN INSERTION Fibula, medial border of tibia (soleal line)

Calcaneus

TIBIALIS POSTERIOR (UNIPENNATE)

DESCRIPTION ACTIONS

‐ Muscle of the leg ‐ The tendon passes into the sole of the foot to act on the ankle joint

Inversion of the foot and plantar flexion of the foot at the ankle

ORIGIN INSERTION Tibia and fibula Navicular and medial

cuneiform bone

FLEXOR DIGITORUM LONGUS (UNIPENNATE)

DESCRIPTION ACTIONS Leg muscle that passes into the plantar aspect

Flexes digits

ORIGIN INSERTION Posterior surface of the body of the tibia

Plantar surface; base of the distal phalanges of the four lesser toes

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 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.

Gender Smoking Muscle mass

MODULE 1B: PHYSIOLOGY

Physiology is the functional basis of understanding human movement and the different functions of the human body. Exercise physiology deals specifically with how the body functions under physical and mental stress.

THE NERVOUS SYSTEM

The nervous system controls movement in the body. The nervous system is a collection of billions of cells forming nerves that are designed as a communication network within the human body. It is a “central command centre” that enables the body to gather information about the internal and external environment and appropriately respond to it. There are three primary/main functions of the nervous system: ‐ Sensory function: The ability of the nervous system to sense changes in either the internal or external environment. ‐ Integrative function: The ability of the nervous system to analyse and interpret information. ‐ Motor function: The neuromuscular systems ability to have to appropriate response to sensory information. It is important to remember that all movement is dictated by the nervous system, so it is important to train the nervous system efficiently to ensure that the correct movement patterns are being developed and executed.

EQUATION FOR MOVEMENT NERVOUS SYSTEM + SKELETAL SYSTEM + MUSCULAR SYSTEM = KINETIC CHAIN

THE ANATOMY OF THE NERVOUS SYSTEM

The Nervous System Types of Neuron The functional unit of the nervous system is known as the neuron. Billions of neurons make up the complicated structure of the nervous system.

The merging of many neurons together forms the nerves of the body.

Neurons are made up of three parts: − Cell body − Axon − Dendrites

The Cell body or Soma contains a nucleus and other organelles such as lysosomes, mitochondria and golgi complex.

The Axon transmits nervous impulses and other neurons or sites, e.g. muscles, organs, spinal cord

The Dendrites are responsible for gathering information from other structures back to the neurons.

There are three main classifications of neurons: − Sensory neurons: Transmits nerve

impulses from the effector sites to the brain or spinal cord.

− Interneuron: Transmits impulses from neuron to neuron.

− Motor neurons: Transmits nerve impulses from the brain and spinal cord to the effector sites.

An example of the way different neurons work synergistically together is seen when a person touches a very hot object.

SENSORY NEURON

MOTOR NEURON

1. DENDRITE A slender, branched projection of a neuron, which conducts the electrical stimulation received from other cells to and from the cell body, or soma, of the neuron from which it projects.

2. CELL BODY (SOMA) The bulbous end of a neuron, containing the nucleus and is where most protein synthesis occurs.

3. NUCLEUS Controls chemical reactions within the cytoplasm and stores information needed for cellular division.

4. AXON A long slender projection of a neuron which conducts electrical impulses away from the neuron's cell body.

5. MYELIN SHEATH An electrically insulating phospholipid layer that surrounds the axons of many neurons, composed of about 80% lipid fat and about 20% protein. It helps prevent the electrical current from leaving the axon and causing a short circuit in the brain.

6. AXON TERMINAL A specialised structure at the end of the axon that is used to release neurotransmitters and communicate with target neurons.

Central and peripheral nervous system:

The central and peripheral nervous system is composed of 2 (two) separate divisions.

1. The central nervous system: The brain and the spinal cord make up the central nervous system. The brain and the spinal cord interpret information.

2. The peripheral nervous system: The peripheral nervous system consists of 12 cranial nerves and 31 pairs of spinal nerves and sensory receptors. They serve two main functions:

i) They are the connection for the nervous system to activate and receive information to things such as the muscles. ii) They send information from our muscles back to the brain. So, they are constantly updating information from the body.

Sensory receptors Sensory receptors are structures that are found throughout the body. They transform environmental information (sound, heat, taste, light) to the brain via the spinal cord to produce an appropriate response.

Sensory receptors can be divided into four main categories: − Mechanoreceptors: Touch and pressure − Nociceptors: Pain − Chemoreceptors: Taste and smell − Photoreceptors: Light and darkness −

We as fitness professionals concentrate mainly on mechanoreceptors. They are responsible for sensing distortion in the tissue. They are located in the muscles, tendons, joints, and ligaments. They sense stretch, compressions, traction, or tension in the tissue, which is then transmitted to the Central Nervous System (CNS).

MUSCLE PHYSIOLOGY

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Muscle Spindles The muscle spindle is a peripheral receptor located in the muscle belly of skeletal muscles. Each spindle consists of intrafusal fibers, sensory nerve endings, and gamma motor neuron endings. They are responsible for conveying information to the central nervous system about the absolute muscle length and changes in muscle length. Spindles play an important role in motor control and are used to help regulate muscle length during movement.

Muscle spindles are the major sensory organs of the muscles. They sit parallel to the muscle fibers. The muscle spindle is there to control change of length in the muscle, i.e. when the muscle is stretched, so is the spindle. When the muscle is about to be “over‐stretched” the muscle spindle will send a message to the brain and the spindle will then contract the muscle. So, the muscle spindles prevent the muscles from being “over stretched” and injured.

Golgi Tendon Organs

Golgi Tendon Organs (GTO) are located at a point where the muscle and the tendon meet (musculotendinous junction). They are sensitive to rate of change in the muscles. When activated, the GTOs will relax the muscle to prevent the muscle from being placed under excessive stress and getting injured.

Joint Receptors Joint receptors are found in and around the joint. They respond to pressure, acceleration, and deceleration of the joint. The joint receptor’s job is to warn the joint against extreme and harmful positions to prevent injury.

The human nervous system includes three general types of neurons:

1. Sensory neurons 2. Interneurons

3. Motor neurons

Sensory neurons have long axons and transmit nerve impulses from sensory receptors all over the body to the CNS. Sensory neurons are specialised to detect stimuli from the environment, such as light, sound, taste, or pressure. Millions of sensory receptors detect changes, called stimuli, which occur inside and outside the body. They monitor such things as temperature, light, and sound from the external environment. Inside the body, the internal environment, receptors detect variations in pressure, pH, carbon dioxide concentration, and the levels of various electrolytes. All of this gathered information is called sensory input. Sensory input is converted into electrical signals called nerve impulses that are transmitted to the brain. There the signals are brought together to create sensations, to produce thoughts, or to add to memory; decisions are made each moment based on the sensory input. This is integration.

Interneurons (also called connector neurons or relay neurons) are usually much smaller cells, with many

interconnections. Detection of a stimulus triggers the sensory neuron to transmit a message to the central nervous system. There, the message is relayed to interneurons that integrate the information and generate instructions about how to respond. Instructions are sent back to the peripheral nervous system as messages along motor neurons.

Motor neurons also have long axons and transmit nerve impulses from the CNS to effectors (muscles and

glands) all over the body. The motor neurons then stimulate muscles to contract or relax to make the appropriate responses. They also stimulate glands to release hormones. Based on the sensory input and integration, the nervous system responds by sending signals to muscles, causing them to contract, or to glands, causing them to produce secretions. Muscles and glands are called effectors because they cause an effect in response to directions from the nervous system. This is the motor output or motor function.

The three types of neurons are arranged in circuits and networks, the simplest of which is the Reflex Arc.

Explanation of the three main functions of the nervous system

Our nervous system is able to pass a message from a sensory neuron, through several interneurons, to a motor neuron within several milliseconds. Though this seems very fast, some sensory inputs (such as pain) require an even more rapid response.

In a simple reflex arc, such as the knee jerk, a stimulus is detected by a receptor cell, which synapses with a

sensory neuron. The sensory neuron carries the impulse from site of the stimulus to the central nervous system (the brain or spinal cord), where it synapses with an interneuron. The interneuron synapses with a motor neuron, which carries the nerve impulse out to an effector, such as a muscle, which responds by contracting.

If we touch a hot stove, for instance, it is beneficial for us to pull back as quickly as possible. How does the nervous system handle this reflex response? When responding to input that requires a very fast response, our nervous system allows sensory neurons to relay information through only one interneuron, or to connect directly to motor neurons. By reducing the number of interneurons required for signal processing, reflex responses are able to occur more quickly than other responses.

The Organisation of the Human Nervous System

The human nervous system is far more complex than a simple reflex arc, although the same stages still apply. The organisation of the human nervous system is shown in the diagram (see next page):

It is easy to forget that much of the human nervous system is concerned with routine, involuntary jobs, such as homeostasis, digestion, posture, breathing, etc. This is the job of the autonomic nervous system, and its motor functions are split into two divisions, with anatomically distinct neurons. Most body organs are innervated by two separate sets of motor neurons; one from the sympathetic system and one from the parasympathetic system.

These neurons have opposite (or antagonistic) effects. In general, the sympathetic system stimulates the “fight or flight” responses to threatening situations, while the parasympathetic system relaxes the body. The details are listed in this table:

ORGAN SYMPATHETIC SYSTEM PARASYMPATHETIC SYSTEM

Eyes Dilates pupils Constricts pupils

Tear glands No effect Stimulates tear secretion

Salivary glands Inhibits saliva production Stimulates saliva production

Lungs Dilates bronchi Constricts bronchi

Heart Speeds up heart rate Slows down heart rate

Gut Inhibits peristalsis Stimulates peristalsis

Liver Stimulates glucose production Stimulates bile production

Bladder Inhibits urination Stimulates urination

Another view and explanation of the Central and Peripheral Nervous System

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 because 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:

‐ Fascia: 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 sarcolemma. 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. Tropomyosin 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 excitation contraction‐ 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 fibre 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.

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

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

The Sliding filament theory:

MUSCLE TYPES

CARDIAC MUSCLE – Referred 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 involuntarily.

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.

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MUSCLE TERMINOLOGY AND DEFINITION

MUSCLE TERMS DEFINITION

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

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.

MUSCLE TERMS DEFINITION

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 plyometric 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 (Plyometric) Loading Loading the muscle while it is lengthening; sometimes called negatives.

Plyometric 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.

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.

A.Basic Muscle Physiology and the Effects of Strength Training B. Muscles consist of individual 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.

C. 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.

D. 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.

E. Strength training improves the body’s ability to recruit motor units - muscle learning - which increases strength even

before muscle size increases.

I. Benefits of Muscular Strength and Endurance

Enhanced muscular strength and endurance can lead to improvements in the areas of performance, injury prevention, body composition, 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 to 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 increase 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.

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).

II. Assessing Muscular Strength and Endurance

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.

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).

III. 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. 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).

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.

They develop strength only at a specific point in the joint range of motion.

1. 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).

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. 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.

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.

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 weight 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.

2. Comparison Static and Dynamic Exercise 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. 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

o Muscles will get stronger if you make them work against a resistance. o 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. o 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. IV. Applying the FITT Principle: Selecting Exercises and Putting Together a Program

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

A. Frequency of Exercise

For general fitness the ACSM recommends 2 ‐ 3 nonconsecutive days per week for weight training

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.

To build strength rapidly, lift weights as heavy as 80% of your maximum capacity. For endurance, choose 40–60% of your maximum.

Rather than continually assessing maximum capacity, base weight on the number of repetitions you can perform with a given resistance.

C. Time of Exercise: Repetitions and Sets

1. To improve fitness, you must perform enough repetitions to fatigue your muscles.

A heavy weight and a low number of repetitions (1 ‐ 5) builds strength.

A light weight and a high number of repetitions (15 ‐ 20) builds endurance.

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.

Exercise scientists have not identified the optimal number of sets for increasing strength.

For general fitness, 1 set is sufficient. Most serious weight trainers perform 3 or more sets of each exercise.

The rest period allows the muscles to work at high enough intensity in the next set to increase fitness.

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. 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.

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.

Effects of exercise on muscles:

Short Term: • Capillary dilation • Increased pliability

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

THE CARDIOVASCULAR SYSTEM

The primary functions of the heart are to:

− Regulate blood supply − Generate blood pressure − Rooting of the blood − Ensure one‐way blood flow

ANATOMY OF THE HEART Your heart has 4 chambers. The upper chambers are called the left and right atria, and the lower chambers are called the left and right ventricles. A wall of muscle called the septum separates the left and right atria and the left and right ventricles. The left ventricle is the largest and strongest chamber in your heart. The left ventricle's chamber walls are only about a half‐inch thick, but they have enough force to push blood through the aortic valve and into your body.

• Atria • Thin‐walled • Expandable outer auricle • Separated internally by the interatrial septum • Coronary sulcus (atrioventricular groove) encircles the junction of the atria and

ventricles

• Ventricles • Separated by the interventricular septum • Anterior and posterior interventricular grooves (sulci) mark the position of the

septum externally • Coronary sulcus and interventricular grooves contain blood vessels

Right atrium Superior vena cava – receives blood from head, neck, upper limbs and chest Inferior vena cava – receives blood from trunk, viscera and lower limbs Coronary sinus – receives blood from cardiac veins Fossa ovalis – before birth this is an opening through interatrial septum (foramen ovale), connects the

atria and bypasses the lungs; foramen seals off at birth forming the fossa ovalis Pectinate muscles – prominent muscular ridges on anterior wall and auricle

Right ventricle

Right atrioventricular valve – opening from right atrium to right ventricle

Also called the tricuspid valve (has 3 cusps) Prevents backflow

Chordae tendineae – tendinous cords attached to papillary muscles Trabeculae carneae – muscular ridges on internal surface of both ventricles Contain part of the conducting system (moderator band)

• Left atrium • Receives blood from the lungs through the left and right pulmonary veins • Blood from left atrium passes to left ventricle through the left atrioventricular valve

• also called bicuspid or mitral valve

• Left ventricle • Holds same volume as right ventricle • Is larger; muscle thicker and more powerful • Papillary muscles and chordae tendineae like right ventricle, but no moderator band

STRUCTURE OF THE HEART The wall of the heart consists of 3 (three) distinct layers: inner endocardium, middle myocardium, outer epicardium. The heart is composed of 4 hollow chambers. The chambers are delineated into two interdependent (but separate) pumps on either side. These two pumps are separated by the interatrial septum and interventricular septum. Each side of the heart has two chambers, an atrium and a ventricle.

1. The Atria: smaller chambers that are superiorly located on either side of the heart. The right atrium gathers deoxygenated blood returning from the upper and lower extremities to the heart and the left atrium gathers reoxygenated blood coming to the heart from the lungs.

2. Ventricles: The inferior chamber of the heart that receives blood from its corresponding atrium and in turn forces the blood into the arteries. The right ventricle receives deoxygenated blood from the right atrium and pumps to the lungs to be saturated with incoming oxygen. The left ventricle receives reoxygenated blood from the left atrium and pumps it to the entire body via the aorta.

The chambers of the heart are all separate from each other. Major veins and arteries via valves prevent a back flow or spillage of blood back into the chambers. These valves include the atrioventricular valves and semilunar valves. The tricuspid valve separates the atrium and ventricle on the right side and the bicuspid on the left side.

3. Septa: Between the right side and the left side of the heart are septa dividing the heart into two functional pumps (interventricular septum).

THE HUMAN HEART AND CIRCULATION

THE FUNCTION OF THE HEART Ventricle contraction pushes the blood from the heart to the body. The amount of blood that is pumped out with each contraction is called the stroke volume (SV). The average adult SV is 75 ‐ 80ml per beat. The heart rate (HR) refers to the rate the heart pumps blood into the body. The average person’s heart rate is 70 ‐ 80 beats per minute (BPM). The stroke volume and heart rate combined (SV and BPM) is collectively termed as cardio output. It is almost impossible to gauge a client’s SV but it is possible to gauge BPM. In cardio activity, it is recommended to monitor the client’s heart rate.

TERMINOLOGY ACTION AVERAGE MEASUREMENT

Stroke Volume The amount of blood that is pumped out with each contraction of the ventricle

For an adult approximately 75 ‐ 80ml per beat

Heart Rate The rate the heart pumps For an adult approximately 70 ‐ 80 BPM

Cardiac Output The combination of how many times the heart beats per minute and how much blood is being pumped out with each beat

BLOOD A cardiac system that is functioning correctly transports and delivers blood efficiently throughout the body. Blood acts as a medium to deliver and collect essential products to and from the tissues of the body. Blood constitutes to about 8% of total body weight and is much heavier and thicker than water. The average person holds 5 liters of blood in their body at any given time. Blood is a vital support mechanism as it provides protection, transportation and regulation of the kinetic chain.

Transportation, regulation and protection Blood transports oxygen and exports all waste products from the tissues. It is also a transporter of hormones, which are essential for various organs and tissues of the body. Nutrients from our food are transported throughout our body through blood. Blood regulates body temperature as a result of its water content and its path to flow. Blood travels close to the skin so it can give off heat or cool the body depending on the environment. Blood is also essential for the regulation of PH levels and water content of the body’s cells.

Through its ability to clot, blood protects us from blood loss when we are hurt or in an accident. Foreign toxins that can harm the body are also fought against with the protection of blood. Ironically blood can also spread disease or sickness through the same mechanism.

SUPPORT MECHANISMS OF BLOOD

MECHANISM FUNCTION

TRANSPORTATION Transports oxygen and nutrients to tissues Transports waste products from tissues Transports hormones to organs and tissues carries heat throughout the body

REGULATION Regulates body temperature and acid balance of the body

PROTECTION Protects the body from excessive bleeding by clotting Contains specialised immune cells to help fight disease and sickness

THE CARDIAC CYCLE The period from the end of one contraction to the end of the next is called the cardiac cycle. The cycle has two phases:

Systole (period of contraction) Diastole (relaxation)

Each cycle is initiated by the spontaneous generation of an action potential in the SA‐node (sinoatrial node). This action potential is carried throughout the atria to the AV‐node; then spread to the purkinje fibres. These fibres move up to the AV bundle and into the ventricles. At the apex the blood travels into the purkinje fibres.

During an average lifetime the heart beats approximately 2, 5 billion times and pumps out about 300 million liters of blood. The heart is very sensitive to the changing needs of the body and cardiac output can vary from as little as 5041ml (during rest) per minute to as much as 35 liters of blood per minute during peak exercise.

BLOOD VESSELS

Blood vessels consist of arteries, capillaries and veins.

Arteries: Carry blood away from the heart at a very high pressure. Most carry oxygenated blood. The aorta of the heart is the largest artery.

Capillaries: Microscopic tubes, which form a network through the arterioles and discharge blood into the smallest tributaries of veins.

Veins: Brings blood towards the heart under low pressure. The blood flow is aided by:

Pressure from the contracting muscles Fall in pressure in the thorax during inspiration Drawing venous blood into the thorax as air Valves in the veins that prevent back flow

LYMPH VESSELS

Lymph vessels are fine tubes containing a clear fluid called lymph. Lymph provides the mechanism for the exchange of substances between the tissue and the blood. Lymph nodes are firm gland‐like structures which act as filters for lymph and phagocytes carried in it.

Human Heart Facts

The heart is one of the most important organs in the human body, continuously pumping blood around our body through blood vessels.

Your heart is located in your chest and

is well protected by your ribcage.

The study of the human heart and its various disorders is known as cardiology.

The heart is made up of four

chambers, the left atrium, right atrium, left ventricle and right ventricle.

There are four valves in the human

heart, they ensure that blood only goes one way, either in or out.

Blood that leaves the heart is carried

through arteries. The main artery leaving the left ventricle is the aorta while the main artery leaving the right ventricle is the pulmonary artery.

Blood going towards the heart is carried through veins. Blood coming from the lungs to the left atrium is

carried through the pulmonary veins while blood coming from the body to the right atrium is carried through the superior vena cava and inferior vena cava.

You might have felt your own heart beating, this is known as the cardiac cycle. When your heart contracts it

makes the chambers smaller and pushes blood into the blood vessels. After your heart relaxes again the chambers get bigger and are filled with blood coming back into the heart.

Impulses going through your heart makes the muscle cells contract.

You might have watched television shows or movies where a patient in a hospital is attached to an electrocardiogram (ECG). You might recognise it as the machine with a line moving across a screen that occasionally spikes (or remains flat when a patient is dying). This machine can measure the electricity going through a patient’s heart. A doctor can use the information to know when a patient is having heart rhythm problems or even a heart attack.

Heart attacks cause scar tissue to form among normal heart tissue, which can lead to further heart problems or

even heart failure.

The Heart Valves

The left and right coronary arteries can be called epicardial coronary arteries as they run on the surface of the heart. In healthy hearts, the coronary arteries are capable of autoregulation to maintain coronary blood flow at levels appropriate to the needs of the heart muscle. These vessels are commonly affected by atherosclerosis and can become blocked, causing angina or a heart attack.

The left coronary artery supplies blood to the left side of the heart, the left atrium and ventricle, and the interventricular septum. The circumflex artery arises from the left coronary artery and follows the coronary sulcus to the left. Eventually, it will fuse with the small branches of the right coronary artery. The larger anterior, also known as the left anterior descending artery (LAD), is the second major branch arising from the left coronary artery. It follows the anterior interventricular sulcus around the pulmonary trunk. Along the way it gives rise to numerous smaller branches that interconnect with the branches of the posterior interventricular artery, forming anastomoses. An anastomosis is an area where vessels unite to form interconnections that normally allow blood to circulate to a region even if there may be partial blockage in another branch. The anastomoses in the heart are very small. Therefore, this ability is somewhat restricted in the heart, so a coronary artery blockage often results in myocardial infarction causing death of the cells supplied by the particular vessel.

The right coronary artery proceeds along the coronary sulcus and distributes blood to the right atrium, portions of both ventricles, and the heart conduction system. Normally, one or more marginal arteries arise from the right coronary artery inferior to the right atrium. The marginal arteries supply blood to the superficial portions of the right ventricle. On the posterior surface of the heart, the right coronary artery gives rise to the posterior interventricular artery, also known as the posterior descending artery. It runs along the posterior portion of the interventricular sulcus toward the apex of the heart, giving rise to branches that supply the interventricular septum and portions of both ventricles.

RESPIRATORY SYSTEM

There respiratory system is often referred to as the pulmonary system. The fore most importance of this system is to provide and ensure proper and correct cellular function. It collects oxygen from the external environment and transports it to the blood stream. It works hand‐in‐hand with the cardiovascular system. The respiratory pump and the respiratory passageway have to work harmoniously together for all of the above to be accomplished.

ANATOMY OF THE RESPIRATORY SYSTEM

Breathing is the process of moving air in and out of the lungs:

Inhalation: The process of actively contracting inspiratory muscles to move the air into the lungs Expiration: The process of actively or passively relaxing the inspiratory muscles to move the air out of the lungs

Inspiration occurs in two forms:

Normal/resting state breathing: uses primary respiratory muscles, i.e. diaphragm and external intercostals Heavy breathing ‐ uses secondary respiratory muscles i.e. scalene and pectoralis minor

Expiration occurs in two forms:

Active/passive: the result of relaxing of inspiratory muscles Heavy/forced: Expiratory muscles compress the thoracic activity and force the air out of the lungs

The respiratory pump is located in the thoracic cavity (chest and abdomen). It is composed of skeletal structures and soft tissue (bones, muscles and pleural membranes). These systems work together with the nervous system for proper breathing/ respiratory mechanics to occur. The skeleton provides attachments and protection for the muscles of the thorax. They are also flexible enough to allow for proper inspiration and expiration to occur.

STRUCTURE OF THE RESPIRATORY PUMP

BONES Sternum, Ribs, Vertebrae MUSCLES Diaphragm, External Intercostals, Scalene, Sternocleidomastoid, Pectoralis

Minor INSPIRATION Diaphragm, External Intercostals, Scalene, Sternocleidomastoid, Pectoralis

Minor EXPIRATION Intercostals, Abdominals

BREATHING AND RESPIRATORY PASSAGEWAYS

Air must have passageways to move in and out of the lungs correctly. These passageways are divided up into two categories:

The conductive passageways: Consist of the structures that oxygen travels through before it enters the respiratory passageway. The structures enable the oxygen to be: − Purified, humidified and warmed or cooled to meet the body’s temperature. They consist of a nasal

cavity; oral cavity; pharynx; larynx; trachea; right and left pulmonary bronchi; bronchioles.

The respiratory passageways: Gathers the channeled air coming from the conductive passageways. At the bottom of the bronchioles sit the alveoli, which consist of clusters of alveolar sacs. This is where the oxygen and carbon dioxide are transported in and out of the blood stream (diffusion). At birth humans possess and estimated 24 million alveoli. It can increase to approximately 300 million at the age of 8 and remains constant though to the age of 30 where it gradually declines.

THE CARDIORESPIRATORY SYSTEM / CARDIO‐PULMONARY SYSTEM

Combined the cardiovascular system and the respiratory system makeup the cardiorespiratory system. Together they forma vital support system to provide the system with oxygen and then removing waste products so that the body can function correctly. Oxygen is inhaled through the nose and mouth where it is conducted through the trachea and then down through the bronchi where it eventually meets the lungs and alveolar sacs. Deoxygenated blood is then pumped from the right ventricle of the heart through to the pulmonary arteries. Capillaries surround the alveolar sacs and as oxygen fills the sacs, it spreads across the capillary membranes into the blood. Oxygenated blood then returns to the left atrium of the heart through the pulmonary veins where it is pumped into the left ventricle and then pumped through the aorta to the rest of the body. When the cells of the body are using oxygen, they also produce an oxygen waste product called carbon dioxide. It is transported from the tissue back to the cardiovascular system and back to the lungs in deoxygenated blood. The pulmonary capillaries transport the carbon dioxide into the alveolar sacs and releases it out of the body through exhalation.

OXYGEN CONSUMPTION

The cardiovascular and respiratory systems work harmoniously to spread oxygen throughout the body and to remove CO2 (Carbon Dioxide). The body’s ability to use oxygen effectively is solely dependent on the respiratory system’s ability to collect oxygen and, the cardiovascular system to transport the oxygen. The utilization of oxygen in the body is called oxygen consumption or oxygen uptake.

LUNG VOLUMES AND CAPACITIES

Tidal volume (TV): The volume of air inspired or expired during normal breathing (men: 4600ml and women: 3600ml)

Inspiratory reserve volume (IRV): Additional air that can be forcibly inhaled after normal inspiration (about 3100ml)

Expiratory reserve volume (ERV): Additional air that can be forcibly exhaled after normal exhalation (about 1200ml)

Residual volume (RV): Amount of air remaining in the lungs after expiratory reserve volumes have been expired (about 1200ml)

Total lung capacity (TLC): about 6000ml Vital Capacity (VC): Total amount of air that can be expired after fully inhaling (about 4800ml) Inspiratory Capacity (IC): Maximum amount of air that can be inspired (about 3600ml) Functional Residual Capacity (FRC): Amount of air remaining in the lungs after normal

expiration (about 2400ml)

MECHANICS OF BREATHING

The action of breathing in and out is due to changes of pressure within the thorax, in comparison with the outside. This action is also known as external respiration. When we inhale the intercostal muscles (between the ribs) and diaphragm contract to expand the chest cavity.

The diaphragm flattens and moves downwards, and the intercostal muscles move the rib cage upwards and out. This increase in size decreases the internal air pressure and so air from the outside (at a now higher pressure that inside the thorax) rushes into the lungs to equalise the pressures.

When we exhale the diaphragm and intercostal muscles relax and return to their resting positions. This reduces the size of the thoracic cavity, thereby increasing the pressure and forcing air out of the lungs.

The primary functions of your lungs are to transport oxygen from the air you breathe into your bloodstream while taking away carbon dioxide, which is released into the air when you breathe out.

Most vertebrate animals (animals with spines) have two lungs.

Your left and right lungs aren’t exactly the same. The lung on the left side of your body is divided

into two lobes while the lung on your right side is divided into three. The left lung is also slightly smaller, allowing room for your heart.

Can you live without one lung? Yes you can, it limits your physical ability but doesn’t stop you from living a relatively normal life. Many people around the world live with just one lung.

People who have a large lung capacity can send oxygen around their body faster. You can increase

your lung capacity with regular exercise.

When resting, the average adult breathes around 12 ‐ 20 times a minute.

An average person breathes in around 11000 liters of air every day.

The study of lung diseases is known as pulmonology.

As well as other parts of your body and your general health, smoking is bad for your lungs. Smoking can cause lung cancer among other lung‐affecting diseases.

Asthma is a common disease that affects the lungs. Asthma attacks happen when your airways

narrow after being irritated. The narrow airways make it hard for you to breathe in air.

Pneumonia is a dangerous disease that makes it harder for your lungs to absorb oxygen from the air you breathe.

Other lung diseases include emphysema, tuberculosis and bronchitis.

Estimates of the total surface area of lungs vary from 50 ‐ 75 square meters; roughly the same

area as one side of a tennis court

LUNG ANATOMY

• Light, soft, spongy • Conical in shape, apex, base, costal surface, medial surface, and hilum • Various impressions on lungs • Right lung

• Three lobes; superior, middle and inferior • Oblique and horizontal fissure

• Left Lung • Two lobes; superior and inferior, also lingula and cardiac notch, oblique fissure

PLEURA

• Thin, double‐layered serous membrane • Parietal pleura on thoracic wall and superior face of diaphragm • Visceral pleura on

external lung surface • Pleural fluid fills the

slit‐like pleural cavity • Provides lubrication and

surface tension

POWER ENERGY SYSTEMS

Cellular respiration produces energy by breaking down carbohydrates, fat, and protein to synthesise energy phosphates. Phosphate bonds are where energy is stored and then released when the bonds are broken. Muscle cells use it to power the myofilaments, which interact in the sliding filament mechanism.

Aerobic energy system (oxygen dependent)

Aerobic refers to the production of energy with the presence of oxygen. One of the main characteristics of the aerobic energy system is the ability to use carbohydrate, fat, and protein to produce ATP (Adenosine triphosphate). ATP is acellular structure that supplies energy for many biomechanical processes by undergoing enzymatic hydrolysis.

ATP is the most common of these high‐energy phosphates and is the energy currency of the myofilaments. ATP is synthesised from ADP (Adenosine di‐phosphate) which is continually recycled within the muscle cells. Only a small amount of ATP can be stored in the muscle cells.

ATP can be produced both by the aerobic (oxygen dependent) and anaerobic (oxygen independent) systems. Exercise intensity and duration with power/energy system is used for example, low and moderate intensity exercise utilizes large muscle groups over an extended time use oxygen to produce ATP such as, long distance running or cycling. To utilize the aerobic energy system, the working muscle, heart, and lungs have to be harmoniously working together.

The following physiological responses occur when muscles demand oxygen:

Breathing rate increases Breathing depth increases Heart rate increases There becomes an increased oxygen capacity in the blood Increased amount of SV of blood pumped into the blood

Anaerobic energy systems (oxygen independent)

Anaerobic energy does not require oxygen. Anaerobic ATP production in the absence of oxygen as follows: − The lactate system supplies immediate energy by breaking down fuel − The phosphagen system relies on the energy reserves in the muscles for instant energy

This energy system provides power for primary high intensity, short duration bouts of exercise. E.g. short sprinting events or power lifting. This system is activated at the onset of the activity because of its ability to produce energy rapidly compared to other energy systems.

The Aerobic System: Utilises a process known as glycolysis to produce less ATP than is produced in the aerobic system. Muscle glycogen is rapidly broken down into pyruvate during high intensity activities. Without adequate oxygen in the muscles, working pyruvate is converted into lactate. Lactate is NOT a waste product but rather a metabolite in anaerobic metabolism. Lactic acid is produced when there is an excess of lactate in the muscles. It eventually spills into the blood and combines with proton,which is produced under excessive conditions. Lactic acid does NOT cause DOMS (Delayed Onset Muscle Soreness) but rather temporary and localized fatigue. In summary ‐ the lactate system provides intense and rapid supply of ATP in anaerobic activity.

The Lactate/Glycolytic system: Utilises a process known as glycolysis to produce less ATP than is produced in the aerobic system. Muscle glycogen is rapidly broken down into pyruvate during high intensity activities. Without adequate oxygen in the muscles, working pyruvate is converted into lactate. Lactate is NOT a waste product but rather a metabolite in anaerobic metabolism.

The Phosphate System: The phosphagen system is an alternative to the anaerobic system, which utilises the immediately available stores of ATP in the body for intense and dynamic bursts of energy such as power lifting. ATP is stored as phosphate creatine (PC) and can produce enormous amounts of energy for approximately 10 seconds. (For activity lasting longer than 10 seconds, the lactate system takes over).

DYSFUNCTIONAL BREATHING

If there is a dysfunction in the cardiorespiratory system, it can impact negatively on the kinetic chain. Alterations in breathing patterns could ultimately disturb this process. Dysfunctional breathing is very much associated with stress or anxiety. The following scenarios could occur through dysfunctional breathing:

Breathing becomes shallower, thus overuse of the secondary respiratory muscles such as the

the upper trapezius, levator scapula and scalenes more than the diaphragm. These muscles are connected to the cervical and cranial portions of the body and increased, or overuse could cause headaches, light‐headedness dizziness and in some cases shortness of breath.

Can lead to altered carbon dioxide and oxygen blood content that stimulates various sensors Inadequate oxygen and carbon dioxide retention can create fatigue and sore muscles Inadequate joint motion of the spine and ribcage Increased blood pressure

MUSCLE FIBRE TYPES

(TYPE 1) SLOW‐TWITCH FIBRES ‐ are used during endurance activities as they tire slowly. Slow twitch fibres generate low tension for extended periods of time such as the abdominals and calves. They have a higher number of capillaries, mitochondria (which transform energy into food and then into ATP) which allows for improved delivery of oxygen. Type I muscles are often referred to as “red fibres” as they contain myoglobin which is similar to red pigment found in blood.

(TYPE 2) FAST‐TWITCH FIBRES ‐ generate fast action for short time periods. They fatigue quickly. Examples of sports where fast‐twitch fibres are recruited arethe100m sprint and long jump. They generally contain fewer capillaries, mitochondria, and myoglobin. They have a lower oxidative capacity and are often referred to as “white fibres”.

INTERMEDIATE FIBRES ‐ have potential function to be either slow twitch or fast twitch. It is determined by the type of activity as these types of fibres are highly adaptable.

MUSCLES AS MOVERS

Muscles provide the body with a variety of functions. The muscle movements are categorised as follows: AGONIST, ANTAGONIST, SYNERGIST, and STABILIZER.

AGONIST Prime mover causing movement of a joint

ANTAGONIST Muscle working against the prime mover as a force couple to produce movement

SYNERGIST Helps perform the same set of joint motion as the agonists

STABILIZER A muscle that contracts with no significant movement to maintain a posture or fixate a joint

THE ENDOCRINE SYSTEM

Although we rarely think about them, the glands of the endocrine system and the hormones they release influence almost every cell, organ, and function of our bodies. The endocrine system is instrumental in regulating mood, growth and development, tissue function, and metabolism, as well as sexual function and reproductive processes. In general, the endocrine system is in charge of body processes that happen slowly, such as cell growth. Faster processes like breathing and body movement are controlled by the nervous system. But even though the nervous system and endocrine system are separate systems, they often work together to help the body function properly.

About the Endocrine System The foundations of the endocrine system are the hormones and glands. As the body's chemical messengers, hormones transfer information and instructions from one set of cells to another. Although many different hormones circulate throughout the bloodstream, each one affects only the cells that

are genetically programmed to receive and respond to its message. Hormone levels can be influenced by factors such as stress, infection, and changes in the balance of fluid and minerals in blood. A gland is a group of cells that produces and secretes, or gives off, chemicals. A gland selects and removes materials from the blood, processes them, and secretes the finished chemical product for use some wherein the body. Some types of glands release their secretions in specific areas. For instance, exocrine glands, such as the sweat and salivary glands, release secretions in the skin or inside of the mouth. Endocrine glands, on the other hand, release more than 20 major hormones directly into the bloodstream where they can be transported to cells in other parts of the body.

Parts of the Endocrine System The major glands that make up the human endocrine system are the hypothalamus, pituitary, thyroid, parathyroids, adrenals, pineal body, and the reproductive glands, which include the ovaries and testes. The pancreas is also part of this hormone‐ secreting system, even though it is also associated with the digestive system because it also produces and secretes digestive enzymes. Although the endocrine glands are the body's main hormone producers, some non‐endocrine organs‐such as the brain, heart, lungs, kidneys, liver, thymus, skin, and placenta ‐ also produce and release hormones.

The Hypothalamus The hypothalamus, a collection of specialised cells that is located in the lower central part of the brain, is the primary link between the endocrine and nervous systems. Nerve cells in the hypothalamus control the pituitary gland by producing chemicals that either stimulate or suppress hormone secretions from the pituitary.

Although it is no bigger than a pea, the pituitary gland, located at the base of the brain just beneath the hypothalamus, is considered the most important part of the endocrine system. It's often called the “mastergland” because it makes hormones that control several other endocrine glands. The production and secretion of pituitary hormones can be influenced by factors such as emotions and seasonal changes. To accomplish this, the hypothalamus relays information sensed by the brain (such as environmental temperature, light exposure patterns, and feelings) to the pituitary gland.

The Pituitary Gland

The tiny pituitary gland is divided into two parts: the anterior lobe and the posterior lobe. The anterior lobe regulates the activity of the thyroid, adrenals, and reproductive glands. Among the hormones it produces are:

Growth hormone ‐ which stimulates the growth of bone and other body tissues and plays a role in the body’s handling of nutrients and minerals Prolactin ‐ which activates milk production in women who are breastfeeding Thyrotropin ‐ which stimulates the thyroid gland to produce thyroid hormones Corticotropin ‐ which stimulates the adrenal gland to produce certain hormones

The pituitary also secretes endorphins, chemicals that act on the nervous system to reduce sensitivity to pain. In addition, the pituitary secretes hormones that signal the ovaries and testes to make sex hormones. The pituitary gland also controls ovulation and the menstrual cycle in women. The posterior lobe of the pituitary release’s antidiuretic hormone, which helps control body water balance through its effect on the kidneys and urine output; and oxytocin, which triggers the contractions of the uterus that occur during labor.

The Thyroid and Parathyroid

The thyroid, located in the front part of the lower neck, is shaped like a bow tie or butterfly and produces the thyroid hormones thyroxine and triiodothyronine. These hormones control the rate at which cells burn fuels from food to produce energy. As the level of thyroid hormones increases in the bloodstream, so does the speed at which chemical reactions occur in the body. Thyroid hormones also play a key role in bone growth and the development of the brain and nervous system in children. The production and release of thyroid hormones is controlled by thyrotropin, which is secreted by the pituitary gland. Attached to the thyroid are four tiny glands that function together called the parathyroid. They

release parathyroid hormone, which regulates the level of calcium in the blood with the help of calcitonin, which is produced in the thyroid.

The Adrenal Glands

The body has two triangular adrenal glands, one on top of each kidney. The adrenal glands have two parts, each of which produces a set of hormones and has a different function. The outer part, the adrenal cortex, produces hormones called corticosteroids that influence or regulate salt and water balance in the body, the body’s response to stress, metabolism, the immune system, and sexual development and function. The inner part, the adrenal medulla, produces catecholamines, such as epinephrine. Also called adrenaline, epinephrine increases blood pressure and heart rate when the body experiences stress. (Epinephrine injections are often used to counteract a severe allergic reaction).

The Pineal Gland and Gonads

The pineal body, also called the pineal gland, is located in the middle of the brain. It secretes melatonin, a hormone that may help regulate the wake‐sleep cycle. The gonads are the main source of sex hormones. In males, they are located in the scrotum. Male gonads, or testes, secrete hormones called androgens, the most important of which is testosterone. These hormones regulate body changes associated with sexual development, including enlargement of the penis, the growth spurt that occurs during puberty, and the appearance of other male secondary sex characteristics such as deepening of the voice, growth of facial and pubic hair, and the increase in muscle growth and strength. Working with hormones from the pituitary gland, testosterone also supports the production of sperm by the testes.

The female gonads, the ovaries, are located in the pelvis. They produce eggs and secrete the female hormones estrogen and progesterone. Estrogen is involved in the development of female sexual features such as breast growth, the accumulation of bodyfat around the hips and thighs, and the growth spurt that occurs during puberty. Both estrogen and progesterone are also involved in pregnancy and the regulation of the menstrual cycle.

The Pancreas

The pancreas produces (in addition to others) two important hormones, insulin and glucagon. They work together to maintain a steady level of glucose, or sugar, in the blood and to keep the body supplied with fuel to produce and maintain stores of energy.

What does the Endocrine System Do?

Once a hormone is secreted, it travels from the endocrine gland through the bloodstream to target cells designed to receive its message. Along the way to the target cells, special proteins bind to some of the hormones. The special proteins act as carriers that control the amount of hormone that is available to interact with and affect the target cells.

Also, the target cells have receptors that latch onto only specific hormones, and each hormone has its own receptor, so that each hormone will communicate only with specific target cells that possess receptors for that hormone. When the hormone reaches its target cell, it locks onto the cell's specific receptors and these hormone‐receptor combinations transmit chemical instructions to the inner workings of the cell.

When hormone levels reach a certain normal or necessary amount, further secretion is controlled by important body mechanisms to maintain that level of hormone in the blood. This regulation of hormone secretion may involve the hormone itself or another substance in the blood related to the hormone.

For example, if the thyroid gland has secreted adequate amounts of thyroid hormones into the blood, the pituitary gland senses the normal levels of thyroid hormone in the bloodstream and adjusts its release of thyrotropin, the pituitary hormone that stimulates the thyroid gland to produce thyroid hormones. Another example is parathyroid hormone, which increases the level of calcium in the blood. When the blood calcium level rises, the Parathyroid glands sense the change and decrease their secretion of parathyroid hormone. This turnoff process is called a negative feedback system.

Problems with the Endocrine System

Too much or too little of any hormone can be harmful to the body. For example, if the pituitary gland produces too much growth hormone, a child may grow excessively tall. If it produces too little, a child may be abnormally short. Controlling the production of or replacing specific hormones can treat many endocrine disorders in children and adolescents, some of which include:

Adrenal Insufficiency

This condition is characterized by decreased function of the adrenal cortex and the consequent under production of adrenal corticosteroid hormones. The symptoms of adrenal insufficiency may include weakness, fatigue, abdominal pain, nausea, dehydration, and skin changes. Doctors treat adrenal insufficiency by giving replacement corticosteroid hormones.

Cushing Syndrome

Excessive amounts of glucocorticoid hormones in the body can lead to Cushing syndrome. In children, it most often results when a child takes large doses of synthetic corticosteroid drugs (such as prednisone) to treat autoimmune diseases such as lupus. If the condition is due to a tumor in the pituitary gland that produces excessive amounts of corticotropin and stimulates the adrenals to overproduce corticosteroids, it's known as Cushing disease. Symptoms may take years to develop and include obesity, growth failure, muscle weakness, easy bruising of the skin, acne, high blood pressure, and psychological changes. Depending on the specific cause, doctors may treat this condition with surgery, radiation therapy, chemotherapy, or drugs that block the production of hormones.

Type 1 Diabetes When the pancreas fails to produce enough insulin, type 1 diabetes (previously known as juvenile diabetes) occurs. Symptoms include excessive thirst, hunger, urination, and weight loss. In children and teens, the condition is usually an autoimmune disorder in which specific immune system cells and antibodies produced by the immune system attack and destroy the cells of the pancreas that produce insulin. The disease can cause long‐term complications including kidney problems, nerve damage, blindness, and early coronary heart disease and stroke. To control their blood sugar levels and reduce the risk of developing diabetes complications, kids with this condition need regular injections of insulin.

Type 2 Diabetes

Unlike type 1 diabetes, in which the body can't produce normal amounts of insulin, in type 2 diabetes the body is unable to respond to insulin normally. Children and teens with the condition tend to be overweight, and it is believed that excess body fat plays a role in the insulin resistance that characterises the disease. In fact, the rising prevalence of this type of diabetes in kids has paralleled the dramatically increasing rates of obesity among kids in recent years. The symptoms and possible complications of type 2 diabetes are basically the same as those of type 1. Some kids and teens can control their blood sugar level with dietary changes, exercise, and oral medications, but many will need to take insulin injections like patients with type 1 diabetes.

Gestational Diabetes ‐ Due to an increase in body mass when pregnant (fast increase in body mass) or due to the baby being big.

Gestational diabetes is not type 3 diabetes. Gestational diabetes usually occurs during pregnancy.

Growth Hormone Problems Too much growth hormone in children who are still growing will make their bones and other body parts grow excessively, resulting in gigantism. This rare condition is usually caused by a pituitary tumor and can be treated by removing the tumor. In contrast, when the pituitary gland fails to produce adequate amounts of growth hormone, a child's growth in height is impaired. Hypoglycemia (low blood sugar) may also occur in kids with growth hormone deficiency, particularly in infants and young children with the condition.

Hyperthyroidism

Hyperthyroidism is a condition in which the levels of thyroid hormones in the blood are excessively high. Symptoms may include weight loss, nervousness, tremors, excessive sweating, increased heart rate and blood pressure, protruding eyes, and a swelling in the neck from an enlarged thyroid gland

(goiter). In kids the condition is usually caused by Graves' disease, an autoimmune disorder in which specific antibodies produced by the immune system stimulate the thyroid gland to become overactive. The disease may be controlled with medications or by removal or destruction of the thyroid gland through surgery or radiation treatments.

Hypothyroidism

Hypothyroidism is a condition in which the levels of thyroid hormones in the blood are abnormally low. Thyroid hormone deficiency slows body processes and may lead to fatigue, a slow heart rate, dry skin, weight gain, constipation, and, in kids, slowing of growth and delayed puberty. Hashimoto's thyroiditis, which results from an autoimmune process that damages the thyroid and blocks thyroid hormone production, is the most common cause of hypothyroidism in kids. Infants can also be born with an absent or underdeveloped thyroid gland, resulting in hypothyroidism. It can be treated with oral thyroid hormone replacement.

Your endocrine system consists of glands that release hormones that control physiological functions in your body. Exercise boosts the number of hormones circulating in your body and strengthens receptor sites on target organ cells. Your endocrine response to exercise can improve organ function, physical appearance and your state of mind. Vigorous exercise, in particular, might improve endocrine function.

Metabolic Rate

Exercise, particularly heavy weightlifting, stimulates the release of luteinizing hormone from your anterior pituitary gland, and the luteinizing hormone triggers testosterone production. Exercise that involves intense bursts of energy also stimulates the release of thyroxine from your thyroid gland. Exercise can help you control or reduce your weight because testosterone and thyroxine speed up your metabolism.

Blood Sugar/ Blood Glucose levels

Insulin is a hormone that regulates your glucose, or blood sugar, by transporting it to muscles and tissues that use glucose for energy. Excessive insulin in your blood reduces your sensitivity to insulin and can lead to diabetes. More glucose stays in the blood when insulin sensitivity goes down, and high blood glucose can cause nausea, vomiting, shortness of breath, organ failure, and circulation problems and can lead to coma if left untreated. Exercise might increase your insulin sensitivity by reducing blood concentrations of insulin. Blood insulin levels begin decreasing after 10 minutes of aerobic exercise, and weight training might increase your sensitivity to insulin at rest.

Blood Flow The adrenal medulla releases epinephrine during exercise and increases epinephrine levels at higher exercise intensities. Epinephrine increases the amount of blood that your heart pumps. Epinephrine also enhances your ability to use muscles during exercise by widening blood vessels, which lets your muscles get more oxygen‐rich blood. Thyroxine secretions during exercise increase the amount of blood in your body by about 30%, and these secretions might remain elevated for around five hours.

Psychological Effects

The effects of exercise on your endocrine system might positively affect your mental state. Exercise‐induced testosterone might increase confidence and libido. Conversely, low testosterone levels might inhibit your motivation, self‐confidence, concentration and memory. Your pituitary gland might produce a five‐fold increase in blood endorphin levels after 30 minutes of exercise. Endorphins block your sensitivity to pain and can reduce tension or anxiety by inducing a sense of euphoria.

MODULE 2: BIOMECHANICS Biomechanics is the study that uses principles of physics to show how forces interact with a human body. This includes muscle actions, anatomical locations, anatomical terminology, description of joint movement, planes of motion, force couples, leverage forces, the force‐velocity relationship.

1. BIOMECHANICS

Biomechanics uses the principles of mechanics for solving problems related to the structure and function of living organisms. Biomechanics – Science involving the study of biological systems from a mechanical perspective. - Application of mechanical principles in the study of living organisms.

Mechanics – the branch of physics involving analysis of the actions of forces, to study the anatomical and functional aspects of living organisms. Statics and Dynamics are two major subbranches of mechanics. Statics is the study of systems that are in a state of constant motion, that is either at rest (with no motion) or moving with a constant velocity. Dynamics is the study of systems in which acceleration is present. Kinematics and Kinetics are further subdivisions of biomechanical study. Kinetics is the description of motion, including the pattern and speed of movement sequencing by the body segments that often translates to the degree of coordination and individual displays. Kinematics describes the appearance of motion. Kinetics is the study of forces associated with motion.

2. KINEMATIC CONCEPTS FOR ANALYZING HUMAN MOTION

FORMS OF MOTION

Linear motion – Involves uniform motion of the system of interest, with all system parts moving in the same direction at the same speed. Linear motion is also referred to translation. Angular motion – Angular motion is rotation around a central imaginary line known as the axis of rotation., which is oriented perpendicular to the plane in which the rotation occurs. General motion – Most human movement activities are categorized as general motion. When translation and rotation are combined, the resulting movement is general motion. Mechanical systems – Before determining the nature of a movement, the mechanical system of interest must be defined. In many circumstances, the entire human body is chosen as the system to be analysed.

TOOLS FOR MEASURING KINEMATIC QUANTITIES

- Video

- Film

- Reflecting joint markers

- Goniometer

- Electro-goniometer

- Accelerometer

3. KINEMATIC CONCEPTS FOR ANALYZING HUMAN MOTION

BASIC CONSEPTS RELATED TO KINETICS 1. Inertia – Resistance to action or to change

2. Mass (m) – quantity of matter composing a body

3. Force (F) – Push or pull acting on a body

F = ma Force = mass x distance

Force = Newton 4. Center of Gravity – Or Center of mass. Is the point around which the body’s weight is equally balanced, no

matter how the body is positioned

5. Weight – The amount of gravitational force exerted on a body

6. Pressure (p) – forced distributed over a given area

7. Volume – Amount of space that is occupied

8. Density – Mass per unit of volume

9. Torque – The rotary effect created by an eccentric force

TORQUE = FORCE (NEWTONS) x PERPENDICULAR DISTANCE TO THE PIVOT (METERS or CENTIMETERS)

MECHANICAL LOADS ON THE HUMAN BODY Compression – Pressing or squeezing force Tension – Pulling or stretching Shear – Force directed parallel to a surface

MUSCLE ACTIONS

CONCENTRIC

Muscle exerts force, shortens and overcomes resistance (positive contraction). A concentric muscle contraction is a type of muscle activation that increases tension on a muscle as it shortens. Concentric contractions are the most common types of muscle activation athletes perform in a gym when lifting weights.

Exercises That Cause Concentric Contractions Common exercises that causes concentric contractions include the lifting phase of a bicep curl, a squat or a pull up. Running up hill or climbing stairs also causes the quadriceps to contract concentrically. Concentric contractions are common to many sports in which you need to generate a lot of power or explosive force.

Also Known As: Muscle shortening

ECCENTRIC

Muscle exerts force, lengthens and is overcome with resistance. An eccentric muscle contraction is a type of muscle activation that increases tension on a muscle as it lengthens. Eccentric contractions typically occur when a muscle opposes a stronger force, which causes the muscle to lengthen as it contracts.

Exercises That Cause Eccentric Contractions Common exercises that cause an eccentric contraction include going down stairs, running downhill, lowering weights and the downward motion of squats, push‐ups or pull ups. Eccentric contractions are common to many sports in which you need controlled or resisted types of movements. Eccentric contractions are associated with the onset of delayed muscle soreness. Eccentric muscle contractions also appear to be associated with greater muscle strengthening than when using concentric contractions

ISOMETRIC

Muscle exerts force, but does not lengthen, i.e. the tension developed by the muscle is equal to the load against which it is acting.

For optimal muscle function, muscles need to develop moving and holding strength. Isometric action is mainly a function of tonic stabilisers. Muscle action that produces movement occurs in phasic mobilises. Isometric exercise is a type of muscle workout in which you perform isometric muscle contraction. An isometric muscle contraction occurs when your muscle exerts force without changing its length. In other words, when you do an isometric muscle contraction, your joint doesn't move. Unlike concentric (when the muscle shortens as it works) and eccentric (when the muscle lengthens when it works) types of contractions, isometric muscle contraction neither lengthens nor shortens the muscle fibers.

Pros and Cons of Isometric Muscle Contraction There are pros and cons to doing isometric exercise. On the one hand, it is convenient. Isometric exercise requires no special equipment and very little time. But because the muscle fibers don't move during an isometric contraction, you won't get strong all the way throughout the muscle's range of motion. Strength gains are limited to specific spots related to the position you're in when you do the exercise.

Perhaps most important is that for people with high blood pressure (hypertension), isometric exercise is not a good idea. Isometric exercise tends to increase your blood pressure.

Isometric muscle contraction may be useful when you're immobilized and/or healing, and you need to reduce your level of activity. If moving a part of your body would damage your joint in some way, your physical therapist or doctor may start you with isometrics. Isometrics are also used to help people who have been very inactive to get their muscle groups firing again. Examples: It's possible to strengthen the muscles at the back of your neck with isometric exercise: Start with your head and neck in vertical alignment with your trunk. Interlace your fingers and place your clasped hands behind your head. They should be placed at the bottom of your skull where it starts to curve down. With your hands, pull your head forward, but resist that force by pulling back with your head. NOTE: If you have neck pain or an injury, be sure to talk to your health care provider before doing this isometric exercise.

The central nervous system (CNS) constantly processes sensory information processed by movement. The information comes from special sensors: MUSCLE ‐ MUSCLE SPINDLE JOINTS ‐ SENSORS IN THE CAPSULE TENDONS ‐ GOLGI TENDON ORGANS

ANATOMICAL LOCATIONS

Movements are explained and described in relation to a standard anatomical position in which the body is standing upright, feet parallel, arms hanging to the side and palms facing forward.

A. Sagittal 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.

Anatomical Reference Axes

1. Mediolateral Axis – Imaginary line around which the sagittal plane rotation occurs

2. Anteroposterior Axis – Imaginary line around which frontal plane rotation occurs

3. Longitudinal Axis

Anatomical Reference Planes Cardinal Plane – Three imaginary perpendicular reference planes that divide the body in half by mass

Sagittal – Also known as anteroposterior (AP) plane, that divide the body into medial and lateral segments

Movements: Flexion, Extension, Hyperextension, Dorsiflexion, Plantarflexion Frontal – Also known as Coronal plane, that divide the body in anterior and posterior segments

Movements: Abduction, Adduction, Lateral flexion (Left and Right), Elevation, Depression, Ulnar deviation, Radial deviation, Eversion, Inversion, Medial and Lateral Rotation

Transverse – Divide the body into superior and inferior segments

Movements: Pronation, Supination, Horizontal Abduction and Adduction, Circumduction

ANATOMICAL TERMINOLOGY

Medial plane Towards the midline of the body

Sagittal plane Any plane parallel to the medial plane. (Movements can be seen from the side)

Anterior Facing forward or located at the front

Posterior Behind or towards the back

Proximal Towards the center of the body

Distal Away from the center of the body

Superior of cephalic Above or towards the head

Inferior or Caudal Below or towards the feet

Prone Lying face down on chest

Transverse plane Divides the body into superior and inferior (upper and lower) parts. Movements can be seen from the top or bottom

VIEW ORIENTATION AND ANATOMICAL PLANES

1. Superior

2. Medial

3.

Posterior

4. Lateral

5. Anterior

6. Dorsal

7. Palmar

8. Proximal

9. Distal

10. Dorsal

11. Plantar

12. Inferior

DESCRIPTION OF JOINT MOVEMENT

FLEXION

Decreasing the angle between 2 bones in the sagital plane, e.g. flexion of the hip

EXTENTION Movements in a sagittal plane that take part of the body backwards from the anatomical

Position e.g. Extension of the Neck

HYPEREXTENTION Extension beyond the normal range of movements, e.g. Lumbar spine extension.

ABDUCTION

Moving the body away from the medial plane, e.g. abduction of hip or side splits on the reformer.

ADDUCTION

Bringing the body part back towards or beyond the midline, e.g. hip adduction or crossover press on electric chair.

LATERAL FLEXION Movements of the trunk or neck in the frontal plane away from the medial plane, e.g. the mermaid.

LATERAL ROTATION

A movement in a transverse plane which takes a body part outward, e.g. lateral rotation of the hips (original PILATES stance).

MEDIAL ROTATION

A movement in the transverse plane which takes a body part inward, e.g. medial rotation of the shoulder.

SUPINATION Refers to the forearm when the palms face forward. It can also refer to the arch of the foot turning outwards.

PRONATION Refers to the forearm when the palms of the hand face downwards/backwards. It can also refer to the arch of the foot being flush with the ground (flat footed)

EVERSION Turning the sole of the foot outwards.

INVERSION Turning the sole of the foot inwards.

DORSIFLEXION Bringing the toes upwards towards the chin.

PLANTERFLEXION

Pointing of the toes

ANKLE SPINATION

A combination of inversion, plantarflexion and forefoot adduction

CIRCUMDUCTION A sequential movement describing a cone

ROTATION Circular motion of the body. A sequential movement describing a cone.

RETRACTION Backwards movement of the mandible or scapula.

PROTRACTION Forward movement of the scapula.

ELEVATION Raising a body part.

DEPRESSION Lowering of a body part.

Muscular force Muscular force can be described as a force that results in an acceleration or deceleration of a second object. They are characterised by magnitude (how much) and direction (which way they are moving)

Length‐tension relationship Length‐tension relationship can be described as the length at which the muscles can produce the greatest force. There is an optimal muscle length at which actin and myosin filaments in the sarcomere have the greatest degree of overlap. This results in the muscle producing maximum force out of the muscle at length. However, if the muscle lengths are altered as a result of misaligned joints or poor posture, they will not be able to produce sufficient force to allow for optimal movement.

Force‐velocity curve The force‐velocity curve can be described as the ability of the muscles to produce force with increased velocity. As the muscle contracts concentrically, the ability to produce force decreases. The opposite theory is applied to eccentric muscle action, as the velocity of the muscle increases, the ability of the force increases.

Force‐coupled relationship The forced‐couple relationship can be described as the muscle groups moving together to produce movement around a joint. Muscles in a forced‐couple produce force and pull on the bone/bones that they are connected to. This is because each muscle has a different attachment site that pulls at different angles and as a result creates different forces on the joint. All muscle movement produced must involve all muscle actions and functions to ensure correct joint movement. So, all muscles working together for the production of correct movement are described as to be working in a forced‐coupled‐relationship.

Muscular leverage The amount of force that the kinetic muscle can produce is not solely dependent on motor recruitment or muscle size, but also, on the leverage of the muscles and the bones. The joints of the body are our levers which are moved and manipulated by force of the muscles. The movement around the joint axes are described as rotary motion. The turning effect around a joint referred to as torque.

The neuromuscular system is responsible for manipulating force. The amount of leverage of the kinetic chain will depend on the leverage of the muscle in relation to the resistance. The difference between the distance that the weight is from the centre of the joint and the muscle attachment and the direction the muscle pulls will determine the muscle efficiency that will be able to manipulate the movement. The muscle attachment sites or the line of pull of the muscles generates cannot be altered. The simplest way to alter the amount of force that a joint generates is to move the resistance. I.e. the closer the weight is to the joint the less force (torque) it creates and, the further the weight is from the joint, the more force it creates. RANGE OF MOTION EXERCISES (ROM)

Range of motion refers to the distance and direction a joint can move to its full potential. Each specific joint has a normal range of motion that is expressed in degrees after being measured with a goniometer (i.e., an instrument that measures angles from axis of the joint).

Limited range of motion refers to a joint that has a reduction in its ability to move. The reduced motion may be a mechanical problem with the specific joint or it may be caused by diseases such as osteoarthritis, rheumatoid arthritis, or other types of arthritis. Pain, swelling, and stiffness associated with arthritis can limit the range of motion of a joint and impair function and the ability to perform usual daily activities.

Range‐of‐Motion Exercises Physical therapy can help to improve joint function by focusing on range‐of‐motion exercises. The goal of these exercises is to gently increase range of motion while decreasing pain, swelling, and stiffness. There are three types of range‐of‐motion exercises: • Active range‐of‐motion ‐ patient exercises without any assistance • Active assistive range‐of‐motion ‐ patient requires some help from therapist to do the exercises • Passive range‐of‐motion ‐ therapist or equipment moves patient through range of motion (no effort from patient)

Normal Range of Motion for Each Joint It's important to know the normal range of motion for each joint. After physical examination, if it is determined that you have limited or abnormal range of motion in one or more joints, you can put together a treatment plan with your doctor. You can be reassessed for range of motion to determine if the treatment is effective. Patients who have joint surgery must also go through extensive rehabilitation to get back to normal range of motion in the affected joint.

Components affecting range of motion (ROM) Sex Age Race Shape of the bone and cartilage Muscle power and tone Muscle bulk Ligaments and joint capsule laxity Extensibility of the skin and subcutaneous tissue

Stationary arm: Placed parallel with the longitudinal axis of the fixed part Movable arm: Along the longitudinal axis of the movable segment Axis of rotation(pin): At the intersection of the stationary & movable arms

Range of motion values Shoulder flexion 0 ‐180°

Shoulder extension 0 ‐ 60°

Hip flexion 0 ‐ 120°

Hip extension 0 – 30°

Knee Extension 135 – 0

Knee Flexion 0 ‐ 135°

Examples of prime mover exercises ‐ AGONIST

Examples of prime mover exercises

LEG EXTENTION Quadriceps ‐ Vastus lateralis, Rectus femoris, Vastus medialis, Sartorius Knee Joint

LEG CURL Hamstrings ‐ Biceps femoris, Semitendinosus, Semimembranosus Knee Joint

PUSH UP Pectorals ‐Pectoralis Major, Pectoralis Minor Deltoids ‐Supraspinatus, Infraspinatus, Subscapularis Minor Triceps ‐Triceps Brachii Elbow joint

LAT PULL DOWN Back muscles ‐Trapezius, Rhomboids, Latissimus Dorsi, Posterior deltoid Biceps ‐Brachialis, Biceps Brachii, Brachioradialis Shoulder & Elbow Joint

SEATED DUMBBELL SHOULDER PRESS Deltoids ‐Supraspinatus, Infraspinatus, Subscapularis Triceps ‐Triceps Brachii

LEG PRESS Quadriceps ‐Vastus Lateralis, Rectus Femoris, Vastus Medialis Hamstrings ‐Biceps femoris, Semitendinosus, Semimembranosus

Shoulder & Elbow Joint Hip & Knee Joint

STANDING CALF RAISE Calves ‐Brachialis, Biceps brachii, Brachioradialis Elbow joint

STANDING TRICEPS PUSH DOWN ‐Triceps Brachii Elbow joint

STANDING BICEP DUMBBELL CURL Biceps ‐Brachialis, biceps Brachii, Brachioradialis Elbow joint

ABDOMINAL CRUNCH Abdominals ‐Rectus abdominis, Transversus abdominis, External oblique, Internal oblique Spine

BIOMECHANICAL ANALYSIS OF MOVEMENT The below are examples of biomechanical analysis of the following movements.

Sprinting The leg action in running is one that takes place in a sagittal plane about a transverse axis. The actions are concerned with three joints the hip, knee and ankle. During the time the foot is in contact with the floor, the drive of the leg is achieved through contractions of muscles causing movement at all three joints.

The leg action in running is one that takes place in a sagittal plane about a transverse axis. The actions are concerned with three joints lower limb the hip, knee and ankle. During the time the foot is in contact with the floor, the drive of the leg is achieved through contractions of muscles causing movement at all three joints. At the hip, a ball and socket joint are formed by the femur and pelvic girdle, (asetabelum of the os coxa), there is a powerful extension and hyperextension, brought about by the action of the muscles of the hamstrings group (biceps femoris, semitendinosus and semimembranosus) and the gluteal muscles (gluteus maximus and minimus). At the knee, a hinge joint formed from the tibia and femur, there is extension, mainly as a result of the action of the quadriceps group of muscles (rectus femoris, vastus medialis, vastus lateralis and vastus inter‐medialis). At the ankle, a hinge joint formed by the tibia and calcaneus, there is plantar flexion, brought about principally by the action of the gastrocnemius. During the recovery Phase; at the hip, the hip flexors, which in this movement include the iliopsoas, cause flexion. At the knee, the hamstring group produces flexion. At the ankle, the tibialis anterior causes dorsiflexion

Throwing

In overarm throwing, there are two phases, the preparatory phase, and the throwing phase, both involving actions at the shoulder, and the elbow, Taking the arm back in preparation involves extension at the elbow. The elbow is a hinge joint formed by the humerus and olecranon process of the ulna. Extension is produced by the actions of the triceps brachii muscle. At the ball and socket joint formed between the humerus and the scapula, there is horizontal hyperextension of the shoulder caused by the action of the posterior deltoid, assisted by the latissimus dorsi. The throwing phase involves flexion of the elbow due to the action of the biceps brachii and horizontal flexion at the shoulder, caused by the action of the pectoralis major and the anterior deltoids.

Racket strokes

The preparatory phase is similar to that of throwing. Taking the arm back in preparation involves supination of the forearm and extension at the elbow. The forearm involves a pivot joint formed between the radius and ulna. The elbow is a hinge joint formed by the humerus and ulna. Supination is produced by the action of the supinator muscle. Extension is produced by the actions of the triceps brachii muscle. At the ball and socket joint formed between the humerus and the scapula, there is horizontal hyperextension of the shoulder caused by the action of the posterior deltoid muscle, assisted by the latissimus dorsi. These actions are mainly occurring in the transverse plane around a longitudinal axis. The striking phase is based on movements that occur at the wrist, elbow, shoulder and trunk rotation. At the wrist there is

rotation (pronation) caused by the action of the pronator teres.

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oblique muscles.

Squat

Press up/Push up The press up also involves control of descent against gravity and hence

the prime movers. The main two joints involved in the movement are the elbow

and extension in the upward movement. The main agonist is the triceps brachii

concentrically during extension. These

around a transverse axis.

a wide‐arm push up ‐ is that of horizontal

around a longitudinal axis.

Gravity demands that muscles work by both shortening during

Thus, in the upward phase of a squat, there is extension at the hip

group (rectus femoris, vastus medialis, vastus lateralis and vastus & sartorius

In the downward phase, the same muscles groups work, but this

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Example of how to conduct an anatomical analysis of movement Muscles and joints involved in a pushup

Pushups are a body‐weight exercise that works the chest, shoulder, triceps and abdominal muscles. Pushups can enhance any fitness program, whether your goals are to build muscular strength or endurance. There are many variations on this classic exercise, with or without additional equipment, that are used to either change the difficulty or challenge the muscles in a different way. The basic mechanics require a series of movement at multiple joints to raise and lower the body.

Setup A standard pushup begins in plank position: In a prone position (face down) on a mat, supporting yourself on your toes and with your hands out slightly wider than your shoulders. You should maintain a straight line through your shoulders, hips and back, making sure you do not dip or arch the lower back. Steadying yourself in this position requires isometric muscle action from the deltoid muscle group in your shoulders and abdominals throughout the exercise. Isometric muscle action occurs when no movement is associated with a contraction. (Isometric muscle contraction – muscle length stays the same)

Descending Phase The pushup motion begins with an inhale as you bend your elbows to lower your body toward the floor. Bending your elbow is known as elbow flexion. In prone position, you are working with gravity as the elbow flexes in order to control yourself on the way down. This motion requires an eccentric contraction from the triceps. Once your elbows are flexed at 90 degrees, you begin to horizontally adduct the shoulder blades, squeezing them together, to finish the move.

Ascending Phase From the "down" position, concentric muscle action is required to lift yourself back up against gravity. Your pectoralis major is the main mover in this phase of a pushup as you abduct your shoulder blades. Elbow extension is caused by the triceps to push you back to starting position. A 2005 study from the "Journal of Strength and Conditioning Research" found that the pectoralis major and triceps brachii were responsible for lifting 40 percent of the body's total weight in a normal pushup.

Variations According to a 1990 study in the journal "Biomedical Sciences Instrumentation," the distance between your hands, the positioning of your hands relative to your shoulders, your relation to gravity, the positioning of your feet and your speed all affect the load on all muscles involved in a pushup, including the main movers and the static supporters. For example, modifying a pushup by performing it on your knees reduces the amount of weight being lowered and lifted, which reduces the total load on the muscles.

What muscles do the pushup work? The muscles of your upper torso. The muscles of your upper torso include the following: • Pectoral muscles (pectoralis major and pectoralis minor) • Deltoid (anterior, lateral and posterior) muscles (the muscles in the shoulder) • Muscles of the upper arm (biceps brachii and triceps brachii muscles) • Muscles of the upper back (latissimus dorsi, rhomboids (major and minor) and trapezius). Each of these muscle groups are responsible for either flexion, extension, pushing or pulling.

The following muscle groups are trained when doing push‐ups: • Pectoral muscles • Triceps brachii (back of the arm) • Biceps brachii (front of the arm) • Front and rear heads of the deltoids • Rhomboids (major and minor) and trapezius • Latissimus dorsi • Serratus anterior

Sports biomechanics is the science that deals with an athlete’s movement while also considering the internal and external forces that are in effect while performing any desired movement.

Sport biomechanics studies the effects of forces on sport performance. Using laws and principles grounded in physics that apply to human movement, athletes and coaches can make sound decisions to develop efficient sport techniques.

When coaches understand how forces work in sports and how athletes can leverage these forces, they have a clear advantage over those who lack these tools. Coaches with a command of both mental training tools and sports training principles can make amazing things happen on the field.