Mosby’s Essential Sciences for
Therapeutic Massage
Chapter 9:
Muscles
Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Lesson 9.1 Objectives
• Describe the functions of muscles.
• List the three types of muscles.
• Describe the types of skeletal muscle fiber.
2
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2
Structure and Function
• We should look at, and study the body as a
whole, in structure and function
• Physiologically, one muscle does not function
independently of others
• Three types of muscle
– Skeletal, smooth and cardiac
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3
Muscles and Force
• Muscle can change chemical energy (from
ATP) into mechanical energy
– Energy: the capacity to do work
• When muscle contracts, muscle tissue
transforms one form of energy into another
and it is able to produce force
• 2 Types of force
– Dynamic force: creates movement and change
– Static force: expends energy, but creates no
movement or noticeable change
• (like pushing against a wall)
4
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4
Muscle Functions
• 4 major muscle functions
–
–
–
–
Movement production
Joint stabilization
Posture maintenance
Heat generation
5
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5
Functional Characteristics
of Muscle
• Excitability: the ability to receive and respond
to a stimulus
– Massage stimulates the muscles, which in turn
stimulates the maintenance of homeostasis
• Contractility: the ability to shorten forcibly with
adequate stimulation
– The ability to contract allows the entire organism
to move
6
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6
Functional Characteristics
of Muscle
• Extensibility: the ability to be stretched or
extended
– One group of muscles contracts, while the other
group lengthens
• Elasticity: the ability to recoil and resume the
original resting length after being stretched
– This also includes the ability to remember where
the movement began and to return to that position
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7
Support function of muscle tissue
• The nervous system controls contraction
– skeletal and smooth muscle
– influences the rate of cardiac contraction
• The endocrine system
– produces hormones promote repair of muscle
tissue
• The circulatory system
– delivers nutrients and carries away waste
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8
Functional Characteristics
of Muscle
• The digestive system
– breaks food down
– glucose  ATP  work
• The digestive, urinary and respiratory
systems
– eliminate waste products from muscle metabolism
• Lactic acid is the end product of muscle work
• Lactic Acid  Broken down through aerobic respiration
AKA the Kreb cycle OR
• Lactic Acid  or sent to the liver to be converted back to
glucose
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9
Muscle Action
• Isometric
– Tension in
the muscle
with no
change in
movement
• Isotonic
– Concentric
– Eccentric
From Greenstein GM: Clinical assessment of neuromusculoskeletal disorders, St. Louis,
1997, Mosby.
10
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10
Skeletal Muscle Fibers
From Thibodeau GA, Patton KT: Anatomy and physiology, ed 5, St. Louis, 2003, Mosby.
11
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11
Striated Muscle
From Muscolino JE: Kinesiology: the skeletal system and muscle function, enhanced edition, St. Louis, 2007, Mosby.
12
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12
Length and Tension
• Direct link between
tension development
and length of the
muscle
• If shortened, or
lengthened beyond
optimum, tension
decreases
13
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13
Innervation
From Muscolino JE: Kinesiology: the skeletal system and muscle function, enhanced edition, St. Louis, 2007, Mosby.
14
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14
Energy Sources
• ATP
• Efficient contraction requires
– Glucose
– Oxygen: aerobic respiration
• Anaerobic respiration: no immediate oxygen
use
– Produces lactic acid
– Leads to oxygen debt
15
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15
Types of Muscle Fiber
• Page 258/318
• Fast-twitch (white) fiber
– Contract most rapidly, forcefully
– Fatigue quickly due to lactic acid build-up
– Anaerobic b/c they do not need a lot of O2
• Slow-twitch (red) fiber
– Contract more slowly, less intensely
• (ex. Muscles that maintain posture)
• Intermediate fibers
– Combine red and white qualities
16
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16
Muscle Fatigue
• Muscle Fatigue is the state of exhaustion
produced by strenuous muscular activity
• Physiologic or psychologic?
• Low levels of ATP cause physiologic MF
• Complete physiologic MF rarely occurs b/c
psychological fatigue is what produces the
exhausted feeling that stops us from
continuing
17
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17
Connective Tissue and Muscle
• Fascia
– Involved in nearly all
the fundamental
processes of
the body
– Intimately related to
muscle
Adapted from Mathers LH, Chase RA, Dolph J et al:
Clinical anatomy principles, St. Louis, 1995, Mosby.
18
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18
Structure of
Muscle Fibers
and Coverings
Adapted from Myers T: Anatomy trains: myofascial meridians for manual
and movement therapists, London, 2002, Churchill Livingstone.
19
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19
Myofascial Integration: Tensegrity
• Sheets and lines of fascia create a whole-body
network.
• Tensegrity: balance of tensile forces
– Shows resiliency, becoming more stabile as the
load increases
• Full-body massage addresses the tensegric
nature of the body
• Localized work is directed at the symptom not
the cause and is therefore less effective
– See Figure 9-8 on page 263 in the book.
– Blue book 9-9 pg 325
20
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20
Pathologic Connective
Tissue Changes
• Over time, connective tissue
–
–
–
–
Thickens
Shortens
Calcifies
Erodes
• Changes can come from sudden or sustained
forces
• Ground substance and collagen combine and
can cause dysfunction  overworked and
undernourished muscle  trigger point pain
21
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21
Muscle Attachment
• Direct attachments (rare)
– Muscles attach to bone or
cartilage
• Indirect attachments (more
common)
– Muscle fascia extends
beyond muscle
– Attaches to other connective
tissue
22
Modified from Thibodeau GA, Patton KT:
Anatomy and physiology, ed 6, St. Louis, 2007,
Mosby.
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22
Muscle Attachment
• Origin
– The attachment that does not move
– Usually proximal or medial
• Insertion
– The attachment that moves
– Usually distal or lateral
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23
Muscle Shapes
• Parallel
– Ex. Sartorius
• Convergent
– Pectoralis Major
• Pennate
– Tendons run the length of the muscle
– Unipennate, bipennate, multipennate
– Rectus femoris
• Circular
– sphincters
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24
Lesson 9.2 Objective
• List the components of myotatic units.
• Page 266/328
25
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25
Myotatic Units
• Muscles rarely act independently
• Muscles are part of larger movement patterns
26
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26
Functions and Naming
• Name of muscle in specific action depends
on function:
–
–
–
–
–
–
Mover (agonist)
Antagonist
Fixator (stabilizer)
Neutralizer
Support muscle
Synergist
27
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27
Receptors
• Provide information to central nervous system
– Muscle spindles: respond to sudden, prolonged
stretch
– Tendon organs: respond to tension in muscle
relayed to tendon
– Joint kinesthetic receptors: respond to pressure,
changes in joint movement
Reflexes are automatic responses triggered by
change in the environment
28
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28
Reflex Response
From Fritz S: Mosby’s fundamentals of therapeutic massage, ed 4,
St. Louis, 2009, Mosby.
29
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29
Reflexes
•
•
•
•
•
Page 268/332
Stretch reflex
Tendon reflex
Flexor reflex and crossed extensor reflex
Postural reflexes
30
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30
Cardiac Muscle
From Thibodeau GA, Patton KT: Anatomy and physiology, ed 5, St. Louis, 2003, Mosby.
31
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31
Smooth Muscle
From Thibodeau GA, Patton KT: Anatomy and physiology, ed 5, St. Louis, 2003, Mosby.
32
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32
Lesson 9.3 Objectives
• Identify the attachments, function, synergist,
antagonist, and common trigger points of
individual muscles.
• Lesson 9.3’s muscles: face and head, neck,
deep muscles of the back and posterior neck,
and muscles of the torso.
33
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33
Muscle Overview I
•
•
•
•
Arranged in layers
Most areas of body: three to five layers
Deep muscle: closest to bone
Superficial muscle: closest to skin
34
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34
Muscle Overview II
• Many muscles named using such features as
–
–
–
–
–
–
–
Location
Function
Shape
Direction of fibers
Number of heads or divisions
Points of attachment
Size of muscle
35
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35
How to Palpate Muscles
• When relaxed
–
–
–
–
–
Identify bony landmarks
Trace muscle between attachments
Follow fiber direction
Locate belly of muscle
Have client contract muscle
• Deep muscles are harder to feel
36
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36
Muscles of the Face and Head
•
•
•
•
•
Produce movement for facial expressions
Vital for nonverbal communication
Vary in shape and strength
Tend to be fused together
Many do not attach to bone
37
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37
Lateral View of the Head
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
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38
Muscles of Facial Expression I
Occipitofrontalis
39
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39
Muscles of Facial Expression II
Procerus
40
Corrugator supercilii
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40
Muscles of Facial Expression III
Nasalis
41
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41
Ear Muscles I
Auricularis
42
Auricularis Posterior
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42
Ear Muscles II
Auricularis Superior
43
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43
Eye Muscles
Orbicularis Oculi
44
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44
Muscles That Move the Mouth I
Orbicularis oris
45
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45
Muscles That Move the Mouth II
Depressor anguli oris
46
Risorius
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46
Muscles That Move
the Mouth III
Zygomaticus major
47
Zygomaticus minor
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47
Muscles That Move
the Mouth IV
Levator labii superiorus
48
Levator labii superioris
alaeque nasi
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48
Muscles That Move the Mouth V
Depressor labii inferiorus
49
Levator anguli oris
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49
Muscles That Move
the Mouth VI
Buccinator
50
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50
Muscles That Move
the Mouth VII
Platysma
51
Mentalis
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51
Lateral Pterygoid Muscle
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
52
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52
Muscles of Mastication I
Masseter
53
Temporalis
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53
Muscles of Mastication II
Lateral (external) pterygoid
54
Medial (internal) pterygoid
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54
Muscles of the Neck
•
•
•
•
Move the neck at cervical spinal joints
Assist in swallowing
Provide extension of the neck
Tension and imbalance are major causes of
headaches and arm and shoulder pain
55
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55
Muscles of the
Neck I
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for
students, Edinburgh, 2005, Churchill Livingstone.
56
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56
Muscles of the Neck II
Sternocleidomastoid
57
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57
Suprahyoid Muscles I
Digastric
58
Stylohyoid
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58
Suprahyoid Muscles II
Mylohyoid
59
Geniohyoid
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59
Infrahyoid Muscles I
Sternohyoid
60
Sternothyroid
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60
Infrahyoid Muscles II
Omohyoid
61
Thyrohyoid
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61
Posterior Triangle of the Neck
Longus colli
62
Longus capitis
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62
Scalene Group I
Scalenus anterior
63
Scalenus medius
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63
Scalene Group II
Scalenus posterior
64
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64
Deep Muscles of the Back and
Posterior Neck
• Responsible for neck and head extension,
lateral flexion, and rotation
• Affect trunk movements
• Play a role in maintaining proper spinal curve
• Complex column extending from sacrum to
skull
65
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65
Deep Muscles of the Back and
Posterior Neck
Superficial group of
back muscles
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for
students, Edinburgh, 2005, Churchill Livingstone.
66
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66
Deep Muscles of the Back and
Posterior Neck
Intermediate group of back muscles
– serratus posterior muscles
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for
students, Edinburgh, 2005, Churchill Livingstone.
67
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67
Deep Muscles of the Back and
Posterior Neck
Deep group of back muscles –
erector spinae muscles
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for
students, Edinburgh, 2005, Churchill Livingstone.
68
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68
Deep Muscles of the Back and
Posterior Neck
Deep group of back muscles –
transversospinales and segmental
muscles
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for
students, Edinburgh, 2005, Churchill Livingstone.
69
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69
Deep Posterior Cervical Muscles
Splenius capitis and splenius cervicis
70
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70
Vertical Muscles
Erector Spinae Group I
Iliocostalis lumborum,
iliocostalis thoracis,
and iliocostalis cervicis
71
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71
Vertical Muscles
Erector Spinae Group II
Longissimus thoracis,
longissimus cervicis, and
longissimus capitis
72
Spinalis thoracis, spinalis
cervicis, and spinalis capitis
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72
Oblique Muscles
Transversospinales Group I
Semispinalis thoracis,
semispinalis cervicis, and
semispinalis capitis
73
Multifidus
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73
Oblique Muscles
Transversospinales Group II
Rotatores
74
Intertransversarii lumborum,
intertransversarii thoracis, and
intertransversarii cervicis
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74
Oblique Muscles
Transversospinales Group III
Interspinalis lumborum, interspinalis thoracis,
and interspinalis cervicis
75
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75
Suboccipital Muscles I
Rectus capitis posterior major
76
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76
Suboccipital Muscles II
Rectus capitis posterior minor
77
Obliquus capitis superior
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77
Suboccipital Muscles III
Obliquus capitis inferior
78
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78
Muscles of the Torso, I
Abdominal wall muscles
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
79
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79
Muscles of the Torso, II
Arrangement of
structures in
vertebral
column and
back
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
80
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80
Muscles of the Torso, III
Muscles and
fascia of the
pectoral
region
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
81
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81
Muscles of the Thorax and Posterior
Abdominal Wall I
Diaphragm
82
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82
Muscles of the Thorax and Posterior
Abdominal Wall II
Serratus posterior superior
83
Serratus posterior inferior
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83
Muscles of the Thorax and Posterior
Abdominal Wall III
External intercostals
84
Internal intercostals
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84
Innermost Intercostals I
Transversus thoracis
85
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85
Innermost Intercostals II
Quadratus lumborum
86
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86
Innermost Intercostals III
Psoas major
87
Psoas minor
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87
Innermost Intercostals IV
Iliacus
88
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88
Muscles of the Anterior and
Anterolateral Abdominal Wall I
Transversus abdominis
89
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89
Muscles of the Anterior and
Anterolateral Abdominal Wall II
Internal abdominal oblique
90
External abdominal oblique
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90
Muscles of the Anterior and
Anterolateral Abdominal Wall III
Rectus abdominis
91
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91
Muscles of the Anterior and
Anterolateral Abdominal Wall IV
Pyramidalis
92
Cremaster
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92
Pelvic and Perineal Muscles
From Drake RL, Vogel W,
Mitchell WM: Gray’s
Anatomy for students,
Edinburgh, 2005, Churchill
Livingstone.
Sacral and coccygeal plexuses
93
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93
Pelvic and Perineal Muscles I
Levator ani
94
Coccygeus
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94
Pelvic and Perineal Muscles II
External sphincter ani
95
Deep transverse perineals
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95
Pelvic and Perineal Muscles III
Ischiocavernosus
96
Bulbospongiosus
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96
Lesson 9.4 Objectives
• Identify the attachments, function, synergist,
antagonist, and common trigger points of
individual muscles.
• Lesson 9.4’s muscles: gluteal region, anterior
and lateral leg, posterior leg, and intrinsic
muscles of the foot.
97
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97
Muscles of the Gluteal Region
• Some of the most powerful in the body
• Extend the thigh during forceful extension
• Stabilize the
iliotibial band
and
thoracolumbar
fascia
• Related to
shoulders and
arms because
of walking
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005,
Churchill Livingstone.
98
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98
Nerves of the Gluteal Region
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
99
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99
Muscles of the Gluteal Region I
Gluteus maximus
100
Gluteus medius
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100
Muscles of the Gluteal Region II
Gluteus minimus
101
Tensor fasciae latae
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101
Deep Lateral Rotators of the Thigh at
the Hip Joint I
Piriformis
102
Obturator internus
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102
Deep Lateral Rotators of the Thigh at
the Hip Joint II
Obturator externus
103
Quadratus femoris
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103
Deep Lateral Rotators of the Thigh at
the Hip Joint III
Gemellus superior
104
Gemellus inferior
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104
Muscles of the Posterior Thigh
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
105
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105
Muscles of the Posterior Thigh I
Semimembranosus
106
Semitendinosus
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106
Muscles of the Posterior Thigh II
Biceps femoris
107
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107
Muscles of the Medial Thigh I
Pectineus
108
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108
Muscles of the Medial Thigh II
Adductor brevis
109
Adductor longus
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109
Muscles of the Medial Thigh III
Adductor magnus
110
Gracilis
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110
Muscles of the Anterior Thigh
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
111
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111
Muscles of the Anterior Thigh I
Sartorius
112
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112
Muscles of the Anterior Thigh II
Quadriceps Femoris Group
Rectus femoris
113
Vastus lateralis
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113
Muscles of the Anterior Thigh III
Quadriceps Femoris Group
Vastus medialis
114
Vastus intermedius
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114
Muscles of the Anterior and
Lateral Leg
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
115
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115
Anterior Muscles I
Tibialis anterior
116
Extensor digitorum longus
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116
Anterior Muscles II
Extensor hallucis longus
117
Fibularis (peroneus) tertius
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117
Lateral Muscles
Fibularis (peroneus) longus
118
Fibularis (peroneus) brevis
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118
Muscles of the Posterior Leg
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
119
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119
Muscles of the Posterior Leg I
Popliteus
120
Tibialis posterior
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120
Muscles of the Posterior Leg II
Flexor digitorum longus
121
Flexor hallucis longus
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121
Muscles of the Posterior Leg III
Plantaris
122
Soleus
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122
Muscles of the Posterior Leg IV
Gastrocnemius
123
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123
Intrinsic Muscles of the Foot
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
124
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124
Dorsal Aspect
Extensor digitorum brevis
125
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125
Plantar Aspect: Superficial Layer I
Abductor hallucis
126
Flexor digitorum brevis
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126
Plantar Aspect: Superficial Layer II
Abductor digiti minimi pedis
127
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127
Plantar Aspect: Second Layer
Quadratus plantae
128
Lumbricales pedis
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128
Plantar Aspect: Third Layer I
Flexor hallucis brevis
129
Adductor hallucis
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129
Plantar Aspect: Third Layer II
Flexor digiti minimi pedis
130
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130
Plantar Aspect: Fourth Layer
Interossei plantares
131
Interossei dorsales pedis
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131
Lesson 9.5 Objectives
• Identify the attachments, function, synergist,
antagonist, and common trigger points of
individual muscles.
• Lesson 9.5’s muscles: scapular stabilization,
musculotendinous (rotator) cuff, and shoulder
joint.
132
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132
Muscles of Scapular Stabilization
• Isometric function
– Hold the scapula to the ribcage
• Move the scapula during concentric and
eccentric function
• Act together to elevate or depress the
scapula
• Clavicular movements accompany scapular
movements
133
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133
Muscles of Scapular Stabilization I
Trapezius
134
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134
Muscles of Scapular Stabilization II
Rhomboideus major
135
Rhomboideus minor
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135
Muscles of Scapular Stabilization III
Levator scapulae
136
Pectoralis minor
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136
Muscles of Scapular
Stabilization IV
Serratus anterior
137
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137
Right Posterior Scapular Region
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
138
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138
Muscles of the Musculotendinous
(Rotator) Cuff
• Nine muscles stabilize and move the
shoulder joint
• SITS
–
–
–
–
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
• All but subscapularis accessible during
massage
139
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139
Rotator Cuff Muscles I
Supraspinatus
140
Infraspinatus
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140
Rotator Cuff Muscles II
Teres minor
141
Subscapularis
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141
Muscles of the Shoulder Joint
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
142
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142
Muscles of the Shoulder Joint I
Deltoid
143
Pectoralis major
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143
Muscles of the Shoulder Joint II
Subclavius
144
Latissimus dorsi
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144
Muscles of the Shoulder Joint III
Teres major
145
Coracobrachialis
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145
Lesson 9.6 Objectives
• Identify the attachments, function, synergist,
antagonist, and common trigger points of
individual muscles.
• Lesson 9.6’s muscles: elbow and radioulnar
joints, wrist and hand joints, and intrinsic
muscles of the hand.
146
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146
Muscles of the Elbow and Radioulnar
Joint
• Elbow: a hinge joint
– Limited to flexion and extension of the forearm
– Posterior: extension
– Anterior: flexion
• Strongest elbow flexor: brachialis
147
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147
Biceps Brachii and Brachialis
Muscles
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
148
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148
Deep Muscles in Posterior Forearm
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
149
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149
Cross Section of Arm
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
150
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150
Muscles of the Elbow and Radioulnar
Joint I
Biceps brachii
151
Brachialis
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151
Muscles of the Elbow and Radioulnar
Joint II
Brachioradialis
152
Pronator teres
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152
Muscles of the Elbow and Radioulnar
Joint III
Supinator
153
Pronator quadratus
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153
Muscles of the Elbow and Radioulnar
Joint IV
Triceps brachii
154
Anconeus
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154
Muscles of the Wrist
and Hand Joints
From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.
155
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155
Anterior Flexor Group:
Superficial Layer I
Flexor carpi radialis
156
Palmaris longus
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156
Anterior Flexor Group:
Superficial Layer II
Flexor carpi ulnaris
157
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157
Anterior Flexor Group:
Intermediate Layer
Flexor digitorum superficialis
158
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158
Anterior Flexor Group:
Deep Layer
Flexor digitorum profundus
159
Flexor pollicis longus
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159
Posterior Extensor Group:
Superficial Layer I
Extensor carpi radialis longus
160
Extensor carpi radialis brevis
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160
Posterior Extensor Group:
Superficial Layer II
Extensor digitorum
161
Extensor digiti minimi
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161
Posterior Extensor Group:
Superficial Layer III
Extensor carpi ulnaris
162
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162
Posterior Extensor Group:
Deep Layer I
Extensor pollicis brevis
163
Abductor pollicis longus
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163
Posterior Extensor Group:
Deep Layer II
Extensor pollicis longus
164
Extensor indicis
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164
Intrinsic Muscles of the Hand:
Thenar Eminence Muscles I
Opponens pollicis
165
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165
Intrinsic Muscles of the Hand:
Thenar Eminence Muscles II
Abductor pollicis brevis
166
Flexor pollicis brevis
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166
Hypothenar Muscles I
Opponens digiti minimi
167
Abductor digiti
minimi manus
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167
Hypothenar Muscles II
Flexor digiti minimi manus
168
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168
Central Compartment Muscles I
Adductor pollicis
169
Interossei palmares
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169
Central Compartment Muscles II
Interossei dorsales manus
170
Lumbricales manus
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170
Lesson 9.7 Objective
• Apply knowledge of the muscular system to
therapeutic massage application.
171
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171
Mechanisms of Disease, I
• Causal factors increase muscle tension
• Tension leads to localized ischemia and
edema
• Pain results
• Pain leads to spasm; spasm increases pain
• Inflammation or chronic irritation may result
• Stations in tense tissue report to CNS, which
leads to hyperactivity
172
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172
Mechanisms of Disease, II
• Macrophages and fibroblasts are activated
• Connective tissue production increases
• Distortions in one area could create
distortions elsewhere
• Chronic hypertension and fibrotic changes
may occur
• Chain reactions occur in myotatic units
• Sustained tension results in ischemia in
tendinous areas
173
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173
Mechanisms of Disease, III
• Abnormal biomechanics and bodywide
compensatory patterns develop
• Joint restriction and imbalance may occur
• Trigger points develop
• Generalized fatigue develops
• Sympathetic arousal is heightened
• Immune response is inhibited
• Massage intervention and medication can
help
174
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174
Medications
• Antibiotics
– Treat bacterial infections
• Steroids and NSAID (non-steroidal antiinflammatory drugs)
– Help ease inflammation
• Muscle Relaxants
– Sooth spasms and hypertonic muscles
• Analgesics
– Pain relievers
• Antidepressants
– Help restore sleep
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175
Medications
• Any medication, prescribed, over the counter,
or herbal or homeopathic remedies have an
effect on the client and therefore must be
taken into consideration when developing a
treatment plan
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176
Specific Disorders, I
• Carpal tunnel syndrome
– Irritation of the median nerve as it passes through the transverse
carpal lig.
• Pain, tingling, numbness, weakness
• Thoracic outlet syndrome
– Impingement of the brachial plexus and blood supply of the arm
• Shooting pain, weakness, numbness, discoloration of the arm can also
occur
• Stress-induced muscle tension and headache
– Contraction of the muscles puts pressure on the nerves
• Dull, persistent ache, with a feeling of tightness
• Muscle strain
– Overstretching or tearing of muscle fibers
• Repair takes weeks and some muscle fibers may be replaced with fibrous
tissue
177
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177
Specific Disorders, II
• Contusion
– Bruise or bleeding under the skin, inflammation
– Crush injury can result in myoglobin in the blood causing
kidney failure
• Muscle infections
– Bacterial, viral, parasitic
• Often produces local or widespread myositis
• Poliomyelitis
– Viral infection of the nerves affecting the musculoskeletal
sys.
• Myositis ossificans
– Inflammation process that produces osseous tissue in the
fascicles of muscle.
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178
Specific Disorders, III
• Tendonitis and tenosynovitis
– Inflammation of tendon/tendon sheath
• Caused by trauma or overuse, or systemic inflammatory
disease (e.g. RA)
• Cramps/spasms
– Painful muscle spasms or involuntary twitches
• Flaccidity and spasticity
– Muscle with decreased tone vs. excessive tone
• Contracture
– Chronic shortening of a muscle
179
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179
Specific Disorders, IV
• Muscular dystrophy
– Atrophy of skeletal muscle with no mal-function of the nervous
sys.
• Amyotrophic lateral sclerosis
– Lou Gehrig’s Disease, characterized by tripping, stumbling, and
falling; loss of muscle control and strength in hands and arms;
difficulty speaking, swallowing or breathing; chronic fatigue,
muscle twitching or cramps
• Myasthenia gravis
– Autoimmune disease in which the immune sys. Attacks the
muscle cells at neuromuscular junctions affecting ACH, therefore
nerve impulses are unable to stimulate the muscle fully
• Hernia
– Protrusion of an abdominal organ through the muscular wall
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180
Specific Disorders, V
• Torticollis
– spasm or shortening of SCM
• Whiplash
– sudden hyperextension or flexion causing damage to soft
tissue of the neck
• Dupuytren’s contracture
• Rotator cuff tear
– Overuse or impingement may weaken the muscles of the
rotator cuff can cause partial or complete tears
– Weakness, atrophy, pain or tenderness may occur
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181
Specific Disorders, VI
• Shin splints
– Inflammation or tearing of the muscle from the tibia, usually tibialis
anterior, can also result in stress fractures
• Anterior compartment syndrome
– Any condition that increases pressure in the compartment of the leg can
cut off blood supply and nerve function
– Overuse, repetitive stress and accelerated growth are common factors
• Plantar fasciitis
– Inflammation and slight tearing of the plantar fascia
– Caused by excessive stress to the foot commonly near the attachment to
the clacaneus (stress causes calcium deposits, which can cause bone
spurs)
• Fibromyalgia
– Aching, fatigue, stiffness, sleep disruption, multiple tender points,
headaches, irritable bladder, dysmenorrhea, cold sensitivity, restless leg,
Raynaud’s Phenomenon, numbness, tingling, and weakness
• Acquired metabolic and toxic myopathies
– Nutritional and vitamin deficiency, especially protein and vitamin C, D. E,
may lead to myopathy
Massage and Inflammation
• Acute phase (first 72 hours) massage is
usually contraindicated
• RICE
• Chronic massage is usually indicated
• If massage could increase the inflammatory
response it is contraindicated
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183