Because learning changes everything. ® Manual of Structural Kinesiology R.T. Floyd, EdD, ATC, CSCS Chapter 1 Foundations of Structural Kinesiology Copyright ©2021 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Kinesiology and Body Mechanics 1 • Kinesiology: study of motion or human movement • Anatomic kinesiology: study of human musculoskeletal system and musculotendinous system • Biomechanics: application of mechanical physics to human motion © McGraw Hill 2 Kinesiology and Body Mechanics 2 • Structural kinesiology: study of muscles as they are involved in science of movement • Both skeletal and muscular structures are involved • Bones are different sizes and shapes particularly at the joints, which allow or limit movement • Muscles vary greatly in size, shape, and structure from one part of body to another • More than 600 muscles are found in the human body © McGraw Hill 3 Who needs Kinesiology? • Anatomists • Coaches • Strength and conditioning specialists • Personal trainers • Nurses • Physical educators • Physical therapists • Occupational therapists • Physicians, athletic trainers • Massage therapists and others in health-related fields © McGraw Hill 4 Why Kinesiology? • Should have an adequate knowledge and understanding of all large muscle groups to teach others how to strengthen, improve, and maintain optimal function of the human body • Should not only know how and what to do in relation to conditioning and training but also know why specific exercises are done in conditioning and training of athletes • Through kinesiology and analysis of skills, physical educators can understand and improve specific aspects of physical conditioning • Understanding aspects of exercise physiology is also essential to coaches and physical educators © McGraw Hill 5 Reference and Body Positions 2 Anatomical position • Most widely used and accurate for all aspects of the body • Standing in an upright posture, facing straight ahead, feet parallel and close, with palms facing forward Fundamental position • Is essentially same as anatomical position except arms are at the sides and palms facing the body Courtesy of R.T. Floyd Access the text alternative for slide image © McGraw Hill 6 Reference and Body Positions 3 Fetal position • Lying on either side, spine flexed, head flexed toward chest and extremities flexed and drawn toward torso Hook lying or dorsal recumbent position • Supine with hips flexed approximately 45 degrees and knees flex approximately 90 degrees with feet flat on surface Lateral recumbent or lateral decubitus position • Lying on right or left side, knees and hips may be straight or slightly flexed © McGraw Hill 7 Reference and Body Positions 4 Long sitting position • Sitting with legs extended forward, toes pointed; trunk erect and hands on hips Prone position • Face-downward position of the body; lying on the stomach Short sitting position • Sitting upright with knees flexed and hanging over the edge of the surface Supine position • Face-upward position of the body; lying on the back © McGraw Hill 8 What positions are these people in? © McGraw Hill 9 Reference Lines 1 To further assist in understanding the location of one body part in relation to another • Mid-axillary line • Line running vertically down surface of body passing through apex of axilla (armpit) • Mid-sternal line • Line running vertically down surface of body passing through middle of sternum • Anterior axillary line • Line parallel to mid-axillary line and passing through anterior axillary skinfold ©McGraw-Hill Education./Joe DeGrandis, photographer Access the text alternative for slide image © McGraw Hill 10 Reference Lines 2 To further assist in understanding the location of one body part in relation to another • Posterior axillary line • Line that is parallel to mid- axillary line and passes through posterior axillary skinfold • Mid-clavicular line • Line running vertically down surface of body passing through midpoint of clavicle ©McGraw-Hill Education./Joe DeGrandis, photographer Access the text alternative for slide image • Mid-inguinal point • Point midway between anterior superior iliac spine and pubic symphysis *Inguinal Hernia © McGraw Hill 11 Anatomical Directional Terminology 1 Anterior • In front or in the front part Anteroinferior • In front and below Anterosuperior • In front and above Courtesy of R.T. Floyd Access the text alternative for slide image © McGraw Hill 12 Anatomical Directional Terminology 2 Anterolateral • In front and to the side, especially the outside Anteromedial • In front and toward the inner side or midline Anteroposterior Access the text alternative for slide image • Relating to both front and rear © McGraw Hill 13 Anatomical Directional Terminology 3 Posterior • Behind, in back, or in the rear Posteroinferior • Behind and below; in back and below Posterolateral • Behind and to one side, specifically to the outside Courtesy of R.T. Floyd Access the text alternative for slide image © McGraw Hill 14 Anatomical Directional Terminology 4 Posteromedial • Behind and to the inner side Posterosuperior • Behind and at the upper part Access the text alternative for slide image © McGraw Hill 15 Anatomical Directional Terminology 5 Contralateral • Pertaining or relating to the opposite side Ipsilateral • On the same side Bilateral • Relating to the right and left sides of the body or of a body structure such as the right and left extremities © McGraw Hill 16 Anatomical Directional Terminology 6 Inferior (infra) • Below in relation to another structure; caudal Superior (supra) • Above in relation to another structure; higher, cephalic Courtesy of R.T. Floyd Access the text alternative for slide image © McGraw Hill 17 Anatomical Directional Terminology 7 Inferolateral • Below and to the outside Inferomedial • Below and toward the midline or inside Superolateral • Above and to the outside Access the text alternative for slide image Superomedial • Above and toward the midline or inside © McGraw Hill 18 Anatomical Directional Terminology 8 Caudal • Below in relation to another structure; inferior Cephalic • Above in relation to another structure; higher, superior Rostral • Near, or toward the head, especially the front of the head Caudocephalad • Directionally from tail to head in the long axis of the body © McGraw Hill 19 Anatomical Directional Terminology 9 Cephalocaudal • Directionally from head to tail in the long axis of the body Deep • Beneath or below the surface; used to describe relative depth or location of muscles or tissue Superficial • Near the surface; used to describe relative depth or location of muscles or tissue © McGraw Hill 20 Anatomical Directional Terminology 10 Distal • Situated away from the center or midline of the body, or away from the point of origin Proximal • Nearest the trunk or the point of origin Proximodistal • From the center of the body out towards the distal Courtesy of R.T. Floyd Access the text alternative for slide image © McGraw Hill 21 Anatomical Directional Terminology 11 Lateral • On or to the side; outside, farther from the median or midsagittal plane Medial • Relating to the middle or center; nearer to the medial or midsagittal plane Median • Relating to the middle or center; nearer to the median or midsagittal plane Courtesy of R.T. Floyd Access the text alternative for slide image © McGraw Hill 22 Example Questions: Are the following distal or proximal to the elbow? • Index finger • Shoulder • Forearm Are the following on the medial or lateral side of the body? • Tennis Elbow • Golfer’s Elbow © McGraw Hill 23 Anatomical Directional Terminology 13 Dorsal • Relating to the back; being or located near, on, or toward the back, posterior part, or upper surface of • Also relating to the top of the foot Ventral • Relating to the belly or abdomen, on or toward the front, anterior part of © McGraw Hill 24 Anatomical Directional Terminology 14 Palmar • Relating to the palm or volar aspect of the hand Volar • Relating to palm of the hand or sole of the foot Plantar • Relating to the sole or undersurface of the foot • © McGraw Hill Plantar Fasciitis 25 Anatomical Directional Terminology 15 Fibular • Relating to fibular (lateral) side of knee, leg, ankle, or foot; also referred to as peroneal when specifically referring to the lateral leg Tibial • Relating to tibial (medial) side of knee, leg, ankle, or foot Radial • Relating to radial (lateral) side of forearm or hand Ulnar • Relating to ulnar (medial) side of forearm or hand © McGraw Hill 26 Anatomical Directional Terminology 16 Scapular plane • In line with normal resting position of scapula as it lies on posterior rib cage, movements in scapular plane are in line with scapular which is at angle of 30 to 45 degrees from frontal plane © McGraw Hill 27 Alignment Variation Terminology 1 Retroversion • Abnormal or excessive rotation backward of a structure, such as femoral retroversion Anteversion • Abnormal or excessive rotation forward of a structure, such as femoral anteversion Access the text alternative for slide image © McGraw Hill 28 Alignment Variation Terminology 2 Kyphosis • Increased curving of the spine outward or backward in the sagittal plane Lordosis • Increased curving of the spine inward or forward in the sagittal plane Scoliosis • Lateral curving of the spine © McGraw Hill 29 Alignment Variation Terminology 3 Recurvatum • Bending backward, as in knee hyperextension Valgus • Outward angulation of the distal segment of a bone or joint, as in knock-knees Varus • Inward angulation of the distal segment of a bone or joint, as in bowlegs William E. Prentice Access the text alternative for slide image © McGraw Hill 30 Exercise Examples Squat: -Knee Varus or Valgus? Deadlift: -Spinal kyphosis or lordosis? © McGraw Hill 31 Planes of Motion • Imaginary two-dimensional surface through which a limb or body segment is moved • Motion through a plane revolves around an axis • There is a ninety-degree relationship between a plane of motion and its axis © McGraw Hill 32 Cardinal Planes of Motion 1 3 basic or traditional • In relation to the body, not in relation to the earth Anteroposterior or sagittal plane Lateral or frontal plane Transverse or horizontal plane Access the text alternative for slide image © McGraw Hill 33 Cardinal Planes of Motion 2 Sagittal or anteroposterior plane (A P) • Divides body into equal, bilateral segments • It bisects body into 2 equal symmetrical halves or a right and left half • Example: Sit-up Access the text alternative for slide image © McGraw Hill 34 Cardinal Planes of Motion 3 Frontal, lateral or coronal plane • Divides the body into (front) anterior and (back) posterior halves • Example: Jumping jacks Access the text alternative for slide image © McGraw Hill 35 Cardinal Planes of Motion 4 Transverse, axial or horizontal plane • Divides body into (top) superior and (bottom) inferior halves when the individual is in anatomic position • Example: Spinal rotation to left or right Access the text alternative for slide image © McGraw Hill 36 Diagonal Planes of Motion 1 • Diagonal plane: involves combination of movements from traditional planes and occurs in joints that are capable of movement in two or more planes • Examples: high diagonal, low diagonal and low diagonal Access the text alternative for slide image © McGraw Hill 37 Diagonal Planes of Motion 2 Most obvious at multiaxial joints such as shoulder and hip but can involve biaxial joints High diagonal • Upper limbs at shoulder joints • Overhand skills • Example: Baseball pitch Access the text alternative for slide image © McGraw Hill 38 Diagonal Planes of Motion 3 Low diagonal • Upper limbs at shoulder joints • Underhand skills • Example: Discus thrower Low diagonal • Lower limbs at the hip joints • Examples: Kickers and punters © McGraw Hill 39 Review What PLANE OF MOTION are the following exercises primarily in? 1) Shoulder Press 2) Back Row 3) Resisted Shoulder External Rotation © McGraw Hill 40 Axes of rotation 1 • For movement to occur in a plane, it must turn or rotate about an axis as referred to previously • The axes are named in relation to their orientation © McGraw Hill 41 Axes of rotation 2 Frontal, coronal, lateral, mediolateral or bilateral axis • Has same orientation as frontal plane of motion and runs from side to side perpendicular to sagittal plane of motion • Runs medial/lateral • Commonly includes flexion, extension movements • X-Axis Access the text alternative for slide image © McGraw Hill 42 Axes of rotation 3 Sagittal or anteroposterior axis • Has same orientation as sagittal plane of motion and runs from front to back perpendicular to frontal plane of motion • Runs anterior/posterior • Commonly includes abduction, adduction movements • Z-Axis Access the text alternative for slide image © McGraw Hill 43 Axes of rotation 4 Vertical, long or longitudinal axis • Runs straight down through top of head and is perpendicular to transverse plane of motion • Runs superior/ inferior • Commonly includes internal rotation, external rotation movements • Y-Axis Access the text alternative for slide image © McGraw Hill 44 Axes of rotation 5 Diagonal or oblique axis • Also known as the oblique axis • Runs at a right angle to the diagonal plane Access the text alternative for slide image © McGraw Hill 45 Review What AXIS OF ROTATION are the following exercises primarily in? 1) Shoulder Press 2) Back Row 3) Resisted Shoulder External Rotation © McGraw Hill 46 REVIEW Access the text alternative for slide image © McGraw Hill 47 Body Regions 2 Axial • Cephalic (head) • Cervical (neck) • Trunk Appendicular • Upper limbs • Lower limbs © McGraw Hill 48 Skeletal System Access the text alternative for slide image © McGraw Hill 49 Osteology Adult skeleton 206 bones • Axial skeleton • 80 bones • Appendicular • 126 bones Occasional variations © McGraw Hill 50 Skeletal Functions Protection of heart, lungs, brain, et cetera Support to maintain posture Movement by serving as points of attachment for muscles and acting as levers Mineral storage such as calcium and phosphorus Hemopoiesis: in vertebral bodies, femurs, humerus, ribs and sternum • Process of blood cell formation in the red bone marrow © McGraw Hill 51 Types of Bones 2 Long bones • Composed of a long cylindrical shaft with relatively wide, protruding ends • Shaft contains the medullary canal • Examples: Phalanges, metatarsals, metacarpals, tibia, fibula, femur, radius, ulna and humerus © McGraw Hill 52 Types of Bones 3 Short bones • Small, cubical shaped, solid bones that usually have a proportionally large articular surface in order to articulate with more than one bone • Examples are carpals and tarsals © McGraw Hill 53 Types of Bones 4 Flat bones • Usually have a curved surface and vary from thick where tendons attach to very thin • Examples: ilium, ribs, sternum, clavicle and scapula © McGraw Hill 54 Types of Bones 5 Irregular bones • Include bones throughout entire spine and ischium, pubis and maxilla Sesamoid bones • Small bones embedded within tendon of a musculotendinous unit that provide protection and improve mechanical advantage of musculotendinous units • Patella • 1st metatarsophalangeal Access the text alternative for slide image • 1st metacarpophalangeal • May be bipartite or tripartite © McGraw Hill 55 Typical Bony Features 1 • Diaphysis: long cylindrical shaft • Cortex: hard, dense compact bone forming walls of diaphysis • Periosteum: dense, fibrous membrane covering outer surface of diaphysis Access the text alternative for slide image © McGraw Hill 56 Typical Bony Features 3 • Epiphysis: ends of long bones formed from cancellous (spongy or trabecular) bone • Epiphyseal plate: (growth plate) thin cartilage plate separates diaphysis and epiphyses ©Jim Wehtje/Getty Images Access the text alternative for slide image © McGraw Hill 57 Typical Bony Features 4 Apophysis • Bony process with an independent center of ossification and associated growth plate, which serves as a point of attachment for a ligament or tendon • Close with skeletal maturity but are often inflamed with exercise or forces in adolescence • Particularly tibial tuberosity (Osgood-Schlatter), calcaneus (Sever’s), medial humeral epicondyle (Little League Elbow) and numerous locations on pelvis © McGraw Hill 58 Apophysis-related pathologies Little League Elbow © McGraw Hill Osgood-Schlatter 59 Typical Bony Features 5 Articular (hyaline) cartilage: covering the epiphysis to provide cushioning effect and reduce friction Access the text alternative for slide image © McGraw Hill 60 Bone Growth 3 • Longitudinal growth continues as long as epiphyseal plates are open • Shortly after adolescence, plates disappear and close • Most close by age 18, but some may be present until 25 • Growth in diameter continues throughout life Access the text alternative for slide image © McGraw Hill 61 Bone Growth 5 • Osteoblasts: cells that form new bone • Osteoclasts: cells that resorb old bone Wolff’s law • Bone size and shape are influenced by the direction and magnitude of forces that are habitually applied to them • Bone mass increases over time with increased stress © McGraw Hill 62 Bone Properties 1 Composed of calcium carbonate, calcium phosphate, collagen and water Collagen provides some flexibility and strength in resisting tension -Aging causes progressive loss of collagen and increases brittleness Cortical (Compact) bone: low porosity, 5 to 30% nonmineralized tissue Cancellous: spongy, high porosity, 30 to 90% © McGraw Hill 63 Bone Markings 1 Processes (including elevations and projections) • Processes that form joints • Condyle • Facet • Head © McGraw Hill 64 Bone Markings 2 Processes (elevations and projections) • Processes to which ligaments, muscles or tendons attach • Crest • Epicondyle • Line • Process • Spine (spinous process) • Suture • Trochanter • Tubercle • Tuberosity © McGraw Hill 65 REVIEW What do we see here? © McGraw Hill The pain in this child’s foot is occurring at what normal outgrowth of bone site? 66 Classification of Joints 1 Articulation or arthroses • Connection of bones at a joint usually to allow movement between surfaces of bones Type and range of movements are similar in all humans; but the freedom, range, and vigor of movements are limited by configuration of bones where they fit together, ligaments and muscles © McGraw Hill 67 Table 1.5: Joint Classification by Structure and Function Structural classification: Cartilagenous NA Structural classification: Synovial NA 2) Amphiarthrodial Structural classification: Fibrous Gomphosis Suture Syndesmosis Symphysis Synchondrosis NA 3) Diarthrodial NA NA Arthrodial Condyloidal Enarthrodial Ginglymus Sellar Trochoidal Functional classification 1) Synarthrodial © McGraw Hill 68 Synarthrodial • Immovable joints • Suture such as skull sutures • Gomphosis such as teeth fitting into mandible or maxilla Access the text alternative for slide image © McGraw Hill 69 Amphiarthrodial 1 Slightly movable joints Allow a slight amount of motion to occur • Syndesmosis • Symphysis • Synchondrosis Access the text alternative for slide image © McGraw Hill 70 Amphiarthrodial 2 Syndesmosis • Two bones joined together by a strong ligament or an interosseus membrane that allows minimal movement between the bones • Bones may or may not touch each other at the actual joint • Examples: Coracoclavicular joint, distal tibiofibular joint • © McGraw Hill “Syndesmotic Ankle Sprain” 71 Amphiarthrodial 3 Symphysis • Joint separated by a fibrocartilage pad that allows very slight movement between the bones • Examples: symphysis pubis and intervertebral discs Access the text alternative for slide image © McGraw Hill 72 Amphiarthrodial 4 Synchondrosis • Type of joint separated by hyaline cartilage that allows very slight movement between the bones • Examples: costochondral joints of the ribs with the sternum © McGraw Hill 73 Diarthrodial Joints 1 • Known as synovial joints • Freely movable • Composed of sleevelike joint capsule • Secretes synovial fluid to lubricate joint cavity Access the text alternative for slide image © McGraw Hill 74 Diarthrodial Joints 2 Capsule thickenings form tough, nonelastic ligaments that provide additional support against abnormal movement or joint opening Access the text alternative for slide image © McGraw Hill 75 Diarthrodial Joints 3 Articular or hyaline cartilage covers the articular surface ends of the bones inside the joint cavity • Absorbs shock • Protect the bone Slowly absorbs synovial fluid during joint unloading or distraction Secretes synovial fluid during subsequent weight bearing and compression maintaining and utilizing a joint through its normal range © McGraw Hill 76 Diarthrodial Joints 4 Range of motion are important to sustaining joint health and function Some diarthrodial joints have specialized fibrocartilage disks • Provide additional shock absorption, load distribution and further enhance joint stability • Medial and lateral menisci • Glenoid labrum • Acetabular labrum © McGraw Hill 77 Diarthrodial Joints 5 Diarthrodial joints have motion possible in one or more planes Degrees of freedom: correspond to the cardinal planes of motion • Motion in 1 plane = 1 degree of freedom • Motion in 2 planes = 2 degrees of freedom • Motion in 3 planes = 3 degrees of freedom © McGraw Hill 78 Diarthrodial Joints 6 Six types Each has a different type of bony arrangement • Arthrodial • Condyloid • Ginglymus • Enarthrodial • Trochoid • Sellar © McGraw Hill 79 Diarthrodial Joints 7 Arthrodial (gliding) joints • 2 plane or flat bony surfaces which butt against each other • Little motion possible in any 1 joint articulation • Usually work together in series of articulations © McGraw Hill 80 Diarthrodial Joints 8 Arthrodial (gliding) joints • Example: Vertebral facets in spinal column, intercarpal and intertarsal joints • Motions are flexion, extension, abduction, adduction, diagonal abduction and adduction and rotation, (circumduction) © McGraw Hill 81 Diarthrodial Joints 9 Ginglymus (hinge) joint • A uniaxial articulation • Articular surfaces allow motion in only one plane • Examples: Elbow, knee, talocrural (ankle) © McGraw Hill 82 Diarthrodial Joints 10 Trochoid (pivot, screw) joint • Also uniaxial articulation • Example: Atlantoaxial joint: odontoid which turns in a bony ring, proximal and distal radioulnar joints © McGraw Hill 83 Diarthrodial Joints 11 Condyloid (knuckle joint) • Biaxial ball and socket joint • One bone with an oval concave surface received by another bone with an oval convex surface © McGraw Hill 84 Diarthrodial Joints 12 Condyloid (knuckle joint) • Example: 2nd, 3rd, 4th, and 5th metacarpophalangeal or knuckles joints, wrist articulation between carpals and radius • Flexion, extension, abduction and adduction (circumduction) © McGraw Hill 85 Diarthrodial Joints 13 Enarthrodial • Multiaxial or triaxial ball and socket joint • Bony rounded head fitting into a concave articular surface • Examples: Hip and shoulder joint • Motions are flexion, extension, abduction, adduction, diagonal abduction and adduction, rotation and circumduction © McGraw Hill 86 Diarthrodial Joints 14 Sellar (saddle) joint • Unique triaxial joint • 2 reciprocally concave and convex articular surfaces • Example is 1st carpometacarpal joint at thumb (some include sternoclavicular) • Flexion, extension, adduction and abduction, circumduction and slight rotation © McGraw Hill 87 REVIEW What type of joint is found at: • Shoulder (GHJ) • Elbow • Neck (C1-C2) • Hip • Knee • Ankle (TCJ) • Thumb © McGraw Hill 88 Diarthrodial Joints 15 Access the text alternative for slide image © McGraw Hill 89 Stability and Mobility of Diarthrodial Joints 1 The more mobile a joint, the less stable and vice-versa • Both heredity and developmental factors (Wolff’s Law for bone and Davis’ Law for soft tissue) contribute to variances Davis' Law • Ligaments, muscle and other soft tissue when placed under appropriate tension will adapt over time by lengthening and conversely when maintained in a loose or shorted state over a period of time will gradually shorten © McGraw Hill 90 Stability and Mobility of Diarthrodial Joints 2 5 major factors affect total stability and consequently mobility of a joint • Bones • Cartilage • Ligaments and connective tissue • Muscles • Proprioception and motor control © McGraw Hill 91 Stability and Mobility of Diarthrodial Joints 3 5 factors affecting total joint stability and mobility • Bones • Usually very similar in bilateral comparisons within an individual • Actual anatomical configuration at joint surfaces in terms of depth and shallowness may vary significantly between individual 2 Different Patella in Trochlear Groove © McGraw Hill 92 Stability and Mobility of Diarthrodial Joints 4 5 factors affecting total joint stability and mobility • Cartilage • Structure of both hyaline cartilage and specialized cartilaginous structures (knee menisci, glenoid labrum and acetabular labrum) further assist in joint congruency and stability • Normally the same in bilateral comparisons within but may vary between individuals in size and configuration © McGraw Hill 93 Stability and Mobility of Diarthrodial Joints 5 5 factors affecting total joint stability and mobility • Ligaments and connective tissue • Provide static stability to joints • Variances exist between individuals in degree of restrictiveness of ligamentous tissue • Amount of hypo- or hyperlaxity of an individual is primarily due to proportional amount of elastin versus collagen within joint structures • Individuals with proportionally higher elastin to collagen ratios are hyperlax or "loose-jointed" whereas individuals with proportionally lower ratios are tighter © McGraw Hill 94 Stability and Mobility of Diarthrodial Joints 6 5 factors affecting total joint stability and mobility • Muscles • Provide dynamic stability to joints when actively contracting • Without active tension via a contraction muscles provide minimal static stability • Strength and endurance are significant factors in stabilizing joints • Muscle flexibility may affect the total range of joint motion possible © McGraw Hill 95 Stability and Mobility of Diarthrodial Joints 7 5 factors affecting total joint stability and mobility • Proprioception and motor control • Proprioception: subconscious mechanism by which body is able to regulate posture and movements by responding to stimuli originating in proprioceptors imbedded in joints, tendons, muscles and inner ear • Motor control: process by which body actions and movements are organized and executed © McGraw Hill 96 Stability and Mobility of Diarthrodial Joints 8 5 factors affecting total joint stability and mobility • Proprioception and motor control • To determine the appropriate amount of muscular forces and joint activations needed • Sensory information from environment and body must be integrated and then coordinated in a cooperative manner between central nervous system and musculoskeletal system • Muscle strength and endurance are not very useful in providing joint stability unless activated precisely when needed VIDEO EXAMPLE © McGraw Hill 97 Stability and Mobility of Diarthrodial Joints 9 5 factors affecting total joint stability and mobility • Structural integrity may be affected by acute or chronic injury • Structures adapt over time both positively and negatively to specific biomechanical demands placed upon them • When any above factors are compromised additional demands are placed on remaining structures to provide stability which, in turn, may compromise their integrity, resulting in abnormal mobility • This abnormal mobility (hypermobility or hypomobility) may lead to further pathological conditions such as tendinitis, bursitis, arthritis, internal derangement and joint subluxations © McGraw Hill 98 Open Packed versus Close Packed Joint Positions 1 Any diarthroidal joint may be have more or less stability depending upon the position it is in related to its full range of motion • Close packed joint position • Joints are most stable to translatory movement when in a close-packed position; typically maximal extension for most joints • Minimal joint volume with maximal congruency and area of surface contact between joint surfaces • Ligaments and capsular structures are farthest apart and taut • Joint is mechanically compressed and is at its least distractible point • Examples include full extension of knee, hip and elbow © McGraw Hill 99 Open Packed versus Close Packed Joint Positions 2 • Open or loose packed joint position • Joint positions where the ligaments and capsular structures are in their slackest position • Minimal joint surface contact and congruency with maximal joint volume • Minimal stability; allows maximal distraction of the joint surfaces • For most joints, typically midway between the extremes of a joint’s range of motion • Examples include approximately 70 degrees of elbow flexion, 25 degrees of knee flexion and 30 degrees of flexion and abduction for the hip © McGraw Hill 100 Open Packed versus Close Packed Joint Positions 3 • Some joints permit only flexion and extension • Others permit a wide range of movements, depending largely on the joint structure • Goniometer: used to measure amount of movement in a joint or measure joint angles • Inclinometers may also be used Courtesy of R.T. Floyd © McGraw Hill 101 Range of Motion • Area through which a joint may normally be freely and painlessly moved • Measurable degree of movement potential in a joint or joints • Measured with a goniometer in degrees 0 to 360 © McGraw Hill Courtesy of R.T. Floyd 102 Movements in Joints 1 • Goniometer axis is placed even with axis of rotation at joint line • As joint is moved, goniometer arms are held in place either along or parallel to long axis of bones on either side of joint • Joint angle is then read from goniometer • Normal range of motion for a particular joint varies in people © McGraw Hill Courtesy of R.T. Floyd 103 Movements in Joints 2 Terms are used to describe actual change in position of bones relative to each other Angles between bones change Movement occurs between articular surfaces of joint • “Flexing the knee” results in leg moving closer to thigh • “flexion of the leg” = flexion of the knee © McGraw Hill 104 Movements in Joints 3 Movement terms describe movement occurring throughout the full range of motion or through a very small range • Example 1: flex knee through full range by beginning in full knee extension (zero degrees of knee flexion) and flex it fully so that the heel comes in contact with buttocks, which is approximately 140 degrees of flexion • Example 2: begin with knee in 90 degrees of flexion and then flex it 30 degrees which results in a knee flexion angle of 120 degrees, even though the knee only flexed 30 degrees • In both example 1 and 2 knee is in different degrees of flexion • Example 3: begin with knee in 90 degrees of flexion and extend it 40 degrees, which would result in a flexion angle of 50 degrees • Even though the knee extended, it is still flexed © McGraw Hill 105 Movements in Joints 4 Some movement terms describe motion at several joints throughout body Some terms are relatively specific to a joint or group of joints • Additionally, prefixes may be combined with these terms to emphasize excessive or reduced motion • hyper- or hypo- • Hyperextension is the most commonly used © McGraw Hill 106 Movement Terminology Courtesy of R.T. Floyd (all) Access the text alternative for slide image. © McGraw Hill 107 General 1 Abduction • Lateral movement away from anatomical position in lateral plane • Raising arms or thighs to side horizontally Courtesy of R.T. Floyd © McGraw Hill 108 General 2 Adduction • Movement medially toward and/or across midline of trunk in lateral plane • Lowering arm to side or thigh back to anatomical position Courtesy of R.T. Floyd © McGraw Hill 109 General 3 Flexion • Bending movement that results in a decrease of angle in joint by bringing bones together, usually in sagittal plane • Elbow joint when hand is drawn to shoulder Courtesy of R.T. Floyd © McGraw Hill 110 General 4 Extension • Straightening movement that results in an increase of angle in joint by moving bones apart, usually in sagittal plane • Elbow joint when hand moves away from shoulder Courtesy of R.T. Floyd © McGraw Hill 111 General 5 Circumduction • Circular movement of a limb that delineates an arc or describes a cone • Combination of flexion, extension, abduction, and adduction • When shoulder joint and hip joint move in a circular fashion around a fixed point • Also referred to as circumflexion © McGraw Hill 112 General 6 Diagonal abduction • Movement by a limb through a diagonal plane away from midline of body Diagonal adduction • Movement by a limb through a diagonal plane toward and across midline of body © McGraw Hill 113 General 7 External rotation • Rotary movement around longitudinal axis of a bone away from midline of body • Occurs in transverse plane • a.k.a. rotation laterally, outward rotation and lateral rotation Courtesy of R.T. Floyd © McGraw Hill 114 General 8 Internal rotation • Rotary movement around longitudinal axis of a bone toward midline of body • Occurs in transverse plane • a.k.a. rotation medially, inward rotation and medial rotation Courtesy of R.T. Floyd © McGraw Hill 115 Ankle and Foot (Subtalar and Transverse Tarsal) Eversion • Turning subtalar and transverse tarsal joints outward or laterally in frontal plane • Standing with weight on inner edge of foot Inversion • Turning subtalar and transverse tarsal joints inward or medially in frontal plane • Standing with weight on outer edge of foot © McGraw Hill 116 Ankle (Talocrural) and Foot Dorsal flexion • Flexion movement of ankle that results in top of foot moving toward anterior tibia Plantar flexion • Extension movement of ankle that results in foot moving away from body Courtesy of R.T. Floyd © McGraw Hill 117 Ankle and Foot Pronation • A combination of ankle dorsiflexion, subtalar eversion, and forefoot abduction (toe-out) Supination • A combination of ankle plantar flexion, subtalar inversion and forefoot adduction (toe-in) © McGraw Hill 118 Radioulnar Joint Pronation • Internally rotating radius where it lies diagonally across ulna, resulting in palm-down position of forearm Supination • Externally rotating radius where it lies parallel to ulna, resulting in palm-up position of forearm Courtesy of R.T. Floyd © McGraw Hill 119 Shoulder (Scapulothoracic) Girdle 1 Depression • Inferior movement of shoulder girdle • Returning to normal position from a shoulder shrug Elevation • Superior movement of shoulder girdle • Shrugging the shoulders © McGraw Hill 120 Shoulder (Scapulothoracic) Girdle 2 Protraction • Forward movement of shoulder girdle away from spine • Abduction of the scapula Retraction • Backward movement of shoulder girdle toward spine • Adduction of the scapula © McGraw Hill 121 Shoulder (Scapulothoracic) Girdle 3 Rotation downward • Rotary movement of scapula with inferior angle of scapula moving medially and downward Rotation upward • Rotary movement of scapula with inferior angle of scapula moving laterally and upward © McGraw Hill 122 Shoulder (Glenohumeral) Joint Horizontal abduction • Movement of humerus in horizontal plane away from midline of body • Also known as horizontal extension or transverse abduction Horizontal adduction • Movement of humerus in horizontal plane toward midline of body • Also known as horizontal flexion or transverse adduction Scaption • Movement of the humerus away from the body in the scapular plane • Glenohumeral abduction in a plane 30 to 45 degrees between the sagittal and frontal planes © McGraw Hill 123 Spine Lateral flexion (side bending) • Movement of head and / or trunk laterally away from midline • Abduction of spine Reduction • Return of spinal column to anatomic position from lateral flexion • Adduction of spine © McGraw Hill 124 Wrist and Hand 1 Palmar flexion • Flexion movement of wrist with volar or anterior side of hand moving toward anterior side of forearm Dorsal flexion (dorsiflexion) • Extension movement of wrist in the sagittal plane with dorsal or posterior side of hand moving toward posterior side of forearm © McGraw Hill 125 Wrist and Hand 2 Radial flexion (radial deviation) • Abduction movement at wrist of thumb side of hand toward forearm Ulnar flexion (ulnar deviation) • Adduction movement at wrist of little finger side of hand toward forearm Courtesy of R.T. Floyd © McGraw Hill 126 Wrist and Hand 3 Opposition of the thumb • Diagonal movement of thumb across palmar surface of hand to make contact with the hand and/or fingers Reposition of the thumb • Diagonal movement of the thumb as it returns to the anatomical position from opposition with the hand and/or fingers © McGraw Hill 127 REVIEW Let’s review what motions are occurring in the following activities: • Soccer kick • Softball fast-pitch • Basketball jump shot © McGraw Hill 128 Physiological Movements versus Accessory Motions 1 Physiological movements: flexion, extension, abduction, adduction and rotation • Occur by bones moving through planes of motion about an axis of rotation at joint Osteokinematic motion: resulting motion of bones relative to 3 cardinal planes from these physiological movements © McGraw Hill 129 Physiological Movements versus Accessory Motions 2 • For osteokinematic motions to occur there must be movement between the joint articular surfaces • Arthrokinematics: motion between articular surfaces © McGraw Hill 130 Physiological Movements versus Accessory Motions 3 3 specific types of accessory (arthrokinematic) motion • Spin • Roll • Glide Access the text alternative for slide image © McGraw Hill 131 Physiological Movements versus Accessory Motions 4 • If accessory motion is prevented from occurring, then physiological motion cannot occur to any substantial degree other than by joint compression or distraction • Due to most diarthrodial joints being composed of a concave surface articulating with a convex surface roll and glide must occur together to some degree © McGraw Hill 132 Physiological Movements versus Accessory Motions 5 Example 1: as a person stands from a squatted position the femur must roll forward and simultaneously slide backward on the tibia for the knee to extend • If not for the slide, the femur would roll off the front of the tibia • If not for the roll, the femur would slide off the back of the tibia Access the text alternative for slide image © McGraw Hill 133 Physiological Movements versus Accessory Motions 6 Spin may occur in isolation or in combination with roll and glide As the knee flexes and extends spin occurs to some degree • In Example 1, the femur spins medially or internally rotates as the knee reaches full extension Access the text alternative for slide image © McGraw Hill 134 Physiological Movements versus Accessory Motions 7 • Roll (rock): a SERIES of points on one articular surface contacts with a series of points on another articular surface • Glide (slide) (translation): a SPECIFIC point on one articulating surface comes in contact with a series of points on another surface Access the text alternative for slide image © McGraw Hill 135 Physiological Movements versus Accessory Motions 8 Spin: A single point on one articular surface rotates about a single point on another articular surface • Motion occurs around some stationary longitudinal mechanical axis in either a clockwise or counterclockwise direction Access the text alternative for slide image © McGraw Hill 136 Concave-Convex Rule 1 States that when any convex joint surface moves on a concave surface roll and glide must occur in opposite direction AND that when a concave surface moves on a convex surface roll and glide occur in same direction • Example: Tibiofemoral joint (convex on concave) with tibia (concave) stationary and femur (convex) moves from flexion into extension representing convex movement on a concave surface; femur must slide backward as it rolls forward • When going down from extension to flexion in a squat, femur must roll backward as it slides forward Access the text alternative for slide image © McGraw Hill 137 Concave-Convex Rule 2 • Example: Tibiofemoral joint (concave on convex ) In standing with knee flexed and going into knee extension, femur (convex) is stationary and tibia (concave) moves from flexion to extension; tibia slides forward as it rolls forward • When going from knee extension into knee flexion as in a standing hamstring curl, knee is flexing by tibia sliding and rolling backward on femur Access the text alternative for slide image © McGraw Hill 138 Movement Icons 1 Shoulder girdle Access the text alternative for slide image. © McGraw Hill 139 Movement Icons 2 Glenohumeral Access the text alternative for slide image © McGraw Hill 140 Movement Icons 3 Elbow Radioulnar joints © McGraw Hill 141 Movement Icons 4 Wrist © McGraw Hill 142 Movement Icons 5 Thumb carpometacarpal joint Thumb metacarpophalangeal joint Thumb interphalangeal joint © McGraw Hill 143 Movement Icons 6 2nd, 3rd, 4th, and 5th MCP, P I P, and D I P joints 2nd, 3rd, 4th, and 5th MCP and P I P joints 2nd, 3rd, 4th, and 5th metacarpophalangeal joints 2nd, 3rd, 4th, and 5th P I P joints © McGraw Hill 144 Movement Icons 7 Hip © McGraw Hill 145 Movement Icons 8 Knee © McGraw Hill 146 Movement Icons 9 Ankle Transverse tarsal and subtalar joints © McGraw Hill 147 Movement Icons 10 Great toe metatarsophalangeal and interphalangeal joints 2 to 5th metatarsophalangeal, proximal interphalangeal, and distal interphalangeal joints © McGraw Hill 148 Movement Icons 11 Cervical spine © McGraw Hill 149 Movement Icons 12 Lumbar spine © McGraw Hill 150
