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Mosbys Essential Sciences for Therapeutic Massage Chapter 9: Muscles Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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Presentation on theme: "Mosbys Essential Sciences for Therapeutic Massage Chapter 9: Muscles Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved."— Presentation transcript:

1 Mosbys Essential Sciences for Therapeutic Massage Chapter 9: Muscles Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2 2 2 Lesson 9.1 Objectives Describe the functions of muscles.Describe the functions of muscles. List the three types of muscles.List the three types of muscles. Describe the types of skeletal muscle fiber.Describe the types of skeletal muscle fiber.

3 Structure and Function We should look at, and study the body as a whole, in structure and functionWe should look at, and study the body as a whole, in structure and function Physiologically, one muscle does not function independently of othersPhysiologically, one muscle does not function independently of others Three types of muscleThree types of muscle –Skeletal, smooth and cardiac Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.3

4 4 4 Muscles and Force Muscle can change chemical energy (from ATP) into mechanical energyMuscle 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 forceWhen muscle contracts, muscle tissue transforms one form of energy into another and it is able to produce force 2 Types of force2 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) (like pushing against a wall)

5 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.5 5 Muscle Functions 4 major muscle functions4 major muscle functions –Movement production –Joint stabilization –Posture maintenance –Heat generation

6 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.6 6 Functional Characteristics of Muscle Excitability: the ability to receive and respond to a stimulusExcitability: 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 stimulationContractility: the ability to shorten forcibly with adequate stimulation –The ability to contract allows the entire organism to move

7 Functional Characteristics of Muscle Extensibility: the ability to be stretched or extendedExtensibility: 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 stretchedElasticity: 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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.7

8 Support function of muscle tissue The nervous system controls contractionThe nervous system controls contraction –skeletal and smooth muscle – influences the rate of cardiac contraction The endocrine systemThe endocrine system –produces hormones promote repair of muscle tissue The circulatory systemThe circulatory system –delivers nutrients and carries away waste Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.8

9 Functional Characteristics of Muscle The digestive systemThe digestive system –breaks food down –glucose ATP work The digestive, urinary and respiratory systemsThe digestive, urinary and respiratory systems –eliminate waste products from muscle metabolism Lactic acid is the end product of muscle workLactic acid is the end product of muscle work Lactic Acid Broken down through aerobic respiration AKA the Kreb cycle ORLactic Acid Broken down through aerobic respiration AKA the Kreb cycle OR Lactic Acid or sent to the liver to be converted back to glucoseLactic Acid or sent to the liver to be converted back to glucose Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.9

10 10 IsometricIsometric –Tension in the muscle with no change in movement IsotonicIsotonic –Concentric –Eccentric From Greenstein GM: Clinical assessment of neuromusculoskeletal disorders, St. Louis, 1997, Mosby. Muscle Action

11 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.11 From Thibodeau GA, Patton KT: Anatomy and physiology, ed 5, St. Louis, 2003, Mosby. Skeletal Muscle Fibers

12 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.12 From Muscolino JE: Kinesiology: the skeletal system and muscle function, enhanced edition, St. Louis, 2007, Mosby. Striated Muscle

13 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.13 Length and Tension Direct link between tension development and length of the muscleDirect link between tension development and length of the muscle If shortened, or lengthened beyond optimum, tension decreasesIf shortened, or lengthened beyond optimum, tension decreases

14 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.14 From Muscolino JE: Kinesiology: the skeletal system and muscle function, enhanced edition, St. Louis, 2007, Mosby. Innervation

15 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.15 Energy Sources ATPATP Efficient contraction requiresEfficient contraction requires –Glucose –Oxygen: aerobic respiration Anaerobic respiration: no immediate oxygen useAnaerobic respiration: no immediate oxygen use –Produces lactic acid –Leads to oxygen debt

16 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.16 Types of Muscle Fiber Page 258/318Page 258/318 Fast-twitch (white) fiberFast-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) fiberSlow-twitch (red) fiber –Contract more slowly, less intensely (ex. Muscles that maintain posture)(ex. Muscles that maintain posture) Intermediate fibersIntermediate fibers –Combine red and white qualities

17 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.17 Muscle Fatigue Muscle Fatigue is the state of exhaustion produced by strenuous muscular activityMuscle Fatigue is the state of exhaustion produced by strenuous muscular activity Physiologic or psychologic?Physiologic or psychologic? Low levels of ATP cause physiologic MFLow 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 continuingComplete physiologic MF rarely occurs b/c psychological fatigue is what produces the exhausted feeling that stops us from continuing

18 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.18 Adapted from Mathers LH, Chase RA, Dolph J et al: Clinical anatomy principles, St. Louis, 1995, Mosby. Connective Tissue and Muscle FasciaFascia –Involved in nearly all the fundamental processes of the body –Intimately related to muscle

19 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.19 Adapted from Myers T: Anatomy trains: myofascial meridians for manual and movement therapists, London, 2002, Churchill Livingstone. Structure of Muscle Fibers and Coverings

20 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.20 Myofascial Integration: Tensegrity Sheets and lines of fascia create a whole-body network.Sheets and lines of fascia create a whole-body network. Tensegrity: balance of tensile forcesTensegrity: balance of tensile forces –Shows resiliency, becoming more stabile as the load increases Full-body massage addresses the tensegric nature of the bodyFull-body massage addresses the tensegric nature of the body Localized work is directed at the symptom not the cause and is therefore less effectiveLocalized 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

21 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.21 Pathologic Connective Tissue Changes Over time, connective tissueOver time, connective tissue –Thickens –Shortens –Calcifies –Erodes Changes can come from sudden or sustained forcesChanges can come from sudden or sustained forces Ground substance and collagen combine and can cause dysfunction overworked and undernourished muscle trigger point painGround substance and collagen combine and can cause dysfunction overworked and undernourished muscle trigger point pain

22 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.22 Modified from Thibodeau GA, Patton KT: Anatomy and physiology, ed 6, St. Louis, 2007, Mosby. Muscle Attachment Direct attachments (rare)Direct attachments (rare) –Muscles attach to bone or cartilage Indirect attachments (more common)Indirect attachments (more common) –Muscle fascia extends beyond muscle –Attaches to other connective tissue

23 Muscle Attachment OriginOrigin –The attachment that does not move –Usually proximal or medial InsertionInsertion –The attachment that moves –Usually distal or lateral Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.23

24 Muscle Shapes ParallelParallel –Ex. Sartorius ConvergentConvergent –Pectoralis Major PennatePennate –Tendons run the length of the muscle –Unipennate, bipennate, multipennate –Rectus femoris CircularCircular –sphincters Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.24

25 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.25 Lesson 9.2 Objective List the components of myotatic units.List the components of myotatic units. Page 266/328Page 266/328

26 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.26 Myotatic Units Muscles rarely act independentlyMuscles rarely act independently Muscles are part of larger movement patternsMuscles are part of larger movement patterns

27 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.27 Functions and Naming Name of muscle in specific action depends on function:Name of muscle in specific action depends on function: –Mover (agonist) –Antagonist –Fixator (stabilizer) –Neutralizer –Support muscle –Synergist

28 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.28 Receptors Provide information to central nervous systemProvide 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

29 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.29 From Fritz S: Mosbys fundamentals of therapeutic massage, ed 4, St. Louis, 2009, Mosby. Reflex Response

30 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.30 Reflexes Page 268/332Page 268/332 Stretch reflexStretch reflex Tendon reflexTendon reflex Flexor reflex and crossed extensor reflexFlexor reflex and crossed extensor reflex Postural reflexesPostural reflexes

31 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.31 From Thibodeau GA, Patton KT: Anatomy and physiology, ed 5, St. Louis, 2003, Mosby. Cardiac Muscle

32 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.32 From Thibodeau GA, Patton KT: Anatomy and physiology, ed 5, St. Louis, 2003, Mosby. Smooth Muscle

33 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.33 Lesson 9.3 Objectives Identify the attachments, function, synergist, antagonist, and common trigger points of individual muscles.Identify the attachments, function, synergist, antagonist, and common trigger points of individual muscles. Lesson 9.3s muscles: face and head, neck, deep muscles of the back and posterior neck, and muscles of the torso.Lesson 9.3s muscles: face and head, neck, deep muscles of the back and posterior neck, and muscles of the torso.

34 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.34 Muscle Overview I Arranged in layersArranged in layers Most areas of body: three to five layersMost areas of body: three to five layers Deep muscle: closest to boneDeep muscle: closest to bone Superficial muscle: closest to skinSuperficial muscle: closest to skin

35 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.35 Muscle Overview II Many muscles named using such features asMany muscles named using such features as –Location –Function –Shape –Direction of fibers –Number of heads or divisions –Points of attachment –Size of muscle

36 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.36 How to Palpate Muscles When relaxedWhen relaxed –Identify bony landmarks –Trace muscle between attachments –Follow fiber direction –Locate belly of muscle –Have client contract muscle Deep muscles are harder to feelDeep muscles are harder to feel

37 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.37 Muscles of the Face and Head Produce movement for facial expressionsProduce movement for facial expressions Vital for nonverbal communicationVital for nonverbal communication Vary in shape and strengthVary in shape and strength Tend to be fused togetherTend to be fused together Many do not attach to boneMany do not attach to bone

38 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.38 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Lateral View of the Head

39 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.39 Occipitofrontalis Muscles of Facial Expression I

40 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.40 Procerus Corrugator supercilii Muscles of Facial Expression II

41 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.41 Nasalis Muscles of Facial Expression III

42 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.42 Auricularis Auricularis Posterior Ear Muscles I

43 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.43 Auricularis Superior Ear Muscles II

44 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.44 Orbicularis Oculi Eye Muscles

45 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.45 Orbicularis oris Muscles That Move the Mouth I

46 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.46 Depressor anguli oris Risorius Muscles That Move the Mouth II

47 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.47 Zygomaticus major Zygomaticus minor Muscles That Move the Mouth III

48 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.48 Levator labii superiorus Levator labii superioris alaeque nasi Muscles That Move the Mouth IV

49 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.49 Depressor labii inferiorus Levator anguli oris Muscles That Move the Mouth V

50 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.50 Buccinator Muscles That Move the Mouth VI

51 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.51 Platysma Mentalis Muscles That Move the Mouth VII

52 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.52 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Lateral Pterygoid Muscle

53 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.53 MasseterTemporalis Muscles of Mastication I

54 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.54 Lateral (external) pterygoid Medial (internal) pterygoid Muscles of Mastication II

55 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.55 Muscles of the Neck Move the neck at cervical spinal jointsMove the neck at cervical spinal joints Assist in swallowingAssist in swallowing Provide extension of the neckProvide extension of the neck Tension and imbalance are major causes of headaches and arm and shoulder painTension and imbalance are major causes of headaches and arm and shoulder pain

56 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.56 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Neck I

57 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.57 Sternocleidomastoid Muscles of the Neck II

58 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.58 DigastricStylohyoid Suprahyoid Muscles I

59 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.59 Mylohyoid Geniohyoid Suprahyoid Muscles II

60 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.60 Sternohyoid Sternothyroid Infrahyoid Muscles I

61 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.61 Omohyoid Thyrohyoid Infrahyoid Muscles II

62 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.62 Longus colli Longus capitis Posterior Triangle of the Neck

63 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.63 Scalenus anterior Scalenus medius Scalene Group I

64 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.64 Scalenus posterior Scalene Group II

65 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.65 Deep Muscles of the Back and Posterior Neck Responsible for neck and head extension, lateral flexion, and rotationResponsible for neck and head extension, lateral flexion, and rotation Affect trunk movementsAffect trunk movements Play a role in maintaining proper spinal curvePlay a role in maintaining proper spinal curve Complex column extending from sacrum to skullComplex column extending from sacrum to skull

66 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.66 Superficial group of back muscles 66 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Deep Muscles of the Back and Posterior Neck

67 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.67 Intermediate group of back muscles – serratus posterior muscles 67 Deep Muscles of the Back and Posterior Neck From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone.

68 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.68 Deep group of back muscles – erector spinae muscles 68 Deep Muscles of the Back and Posterior Neck From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone.

69 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.69 Deep group of back muscles – transversospinales and segmental muscles 69 Deep Muscles of the Back and Posterior Neck From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone.

70 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.70 Splenius capitis and splenius cervicis Deep Posterior Cervical Muscles

71 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.71 Iliocostalis lumborum, iliocostalis thoracis, and iliocostalis cervicis Vertical Muscles Erector Spinae Group I

72 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.72 Longissimus thoracis, longissimus cervicis, and longissimus capitis Spinalis thoracis, spinalis cervicis, and spinalis capitis Vertical Muscles Erector Spinae Group II

73 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.73 Semispinalis thoracis, semispinalis cervicis, and semispinalis capitis Multifidus Oblique Muscles Transversospinales Group I

74 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.74 Rotatores Intertransversarii lumborum, intertransversarii thoracis, and intertransversarii cervicis Oblique Muscles Transversospinales Group II

75 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.75 Interspinalis lumborum, interspinalis thoracis, and interspinalis cervicis Oblique Muscles Transversospinales Group III

76 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.76 Rectus capitis posterior major Suboccipital Muscles I

77 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.77 Rectus capitis posterior minor Obliquus capitis superior Suboccipital Muscles II

78 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.78 Obliquus capitis inferior Suboccipital Muscles III

79 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.79 Abdominal wall muscles From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Torso, I

80 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.80 Arrangement of structures in vertebral column and back From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Torso, II

81 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.81 Muscles and fascia of the pectoral region From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Torso, III

82 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.82 Diaphragm Muscles of the Thorax and Posterior Abdominal Wall I

83 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.83 Serratus posterior superior Serratus posterior inferior Muscles of the Thorax and Posterior Abdominal Wall II

84 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.84 External intercostals Internal intercostals Muscles of the Thorax and Posterior Abdominal Wall III

85 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.85 Transversus thoracis Innermost Intercostals I

86 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.86 Quadratus lumborum Innermost Intercostals II

87 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.87 Psoas major Psoas minor Innermost Intercostals III

88 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.88 Iliacus Innermost Intercostals IV

89 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.89 Transversus abdominis Muscles of the Anterior and Anterolateral Abdominal Wall I

90 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.90 Internal abdominal oblique External abdominal oblique Muscles of the Anterior and Anterolateral Abdominal Wall II

91 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.91 Rectus abdominis Muscles of the Anterior and Anterolateral Abdominal Wall III

92 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.92 Pyramidalis Cremaster Muscles of the Anterior and Anterolateral Abdominal Wall IV

93 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.93 Sacral and coccygeal plexuses 93 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Pelvic and Perineal Muscles

94 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.94 Coccygeus Levator ani Pelvic and Perineal Muscles I

95 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.95 External sphincter ani Deep transverse perineals Pelvic and Perineal Muscles II

96 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.96 IschiocavernosusBulbospongiosus Pelvic and Perineal Muscles III

97 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.97 Lesson 9.4 Objectives Identify the attachments, function, synergist, antagonist, and common trigger points of individual muscles.Identify the attachments, function, synergist, antagonist, and common trigger points of individual muscles. Lesson 9.4s muscles: gluteal region, anterior and lateral leg, posterior leg, and intrinsic muscles of the foot.Lesson 9.4s muscles: gluteal region, anterior and lateral leg, posterior leg, and intrinsic muscles of the foot.

98 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.98 Some of the most powerful in the bodySome of the most powerful in the body Extend the thigh during forceful extensionExtend the thigh during forceful extension 98 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Gluteal Region Stabilize the iliotibial band and thoracolumbar fasciaStabilize the iliotibial band and thoracolumbar fascia Related to shoulders and arms because of walkingRelated to shoulders and arms because of walking

99 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.99 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Nerves of the Gluteal Region

100 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.100 Gluteus maximus Gluteus medius Muscles of the Gluteal Region I

101 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.101 Gluteus minimus Tensor fasciae latae Muscles of the Gluteal Region II

102 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.102 Piriformis Obturator internus Deep Lateral Rotators of the Thigh at the Hip Joint I

103 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.103 Obturator externus Quadratus femoris Deep Lateral Rotators of the Thigh at the Hip Joint II

104 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.104 Gemellus superior Gemellus inferior Deep Lateral Rotators of the Thigh at the Hip Joint III

105 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.105 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Posterior Thigh

106 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.106 Semimembranosus Semitendinosus Muscles of the Posterior Thigh I

107 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.107 Biceps femoris Muscles of the Posterior Thigh II

108 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.108 Pectineus Muscles of the Medial Thigh I

109 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.109 Adductor brevis Adductor longus Muscles of the Medial Thigh II

110 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.110 Adductor magnus Gracilis Muscles of the Medial Thigh III

111 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.111 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Anterior Thigh

112 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.112 Sartorius Muscles of the Anterior Thigh I

113 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.113 Rectus femoris Vastus lateralis Muscles of the Anterior Thigh II Quadriceps Femoris Group

114 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.114 Vastus medialis Vastus intermedius Muscles of the Anterior Thigh III Quadriceps Femoris Group

115 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.115 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Anterior and Lateral Leg

116 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.116 Tibialis anterior Extensor digitorum longus Anterior Muscles I

117 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.117 Extensor hallucis longus Fibularis (peroneus) tertius Anterior Muscles II

118 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.118 Fibularis (peroneus) longus Fibularis (peroneus) brevis Lateral Muscles

119 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.119 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Posterior Leg

120 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.120 Popliteus Tibialis posterior Muscles of the Posterior Leg I

121 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.121 Flexor digitorum longus Flexor hallucis longus Muscles of the Posterior Leg II

122 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.122 Plantaris Soleus Muscles of the Posterior Leg III

123 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.123 Gastrocnemius Muscles of the Posterior Leg IV

124 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.124 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Intrinsic Muscles of the Foot

125 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.125 Extensor digitorum brevis Dorsal Aspect

126 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.126 Abductor hallucis Flexor digitorum brevis Plantar Aspect: Superficial Layer I

127 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.127 Abductor digiti minimi pedis Plantar Aspect: Superficial Layer II

128 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.128 Quadratus plantae Lumbricales pedis Plantar Aspect: Second Layer

129 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.129 Flexor hallucis brevis Adductor hallucis Plantar Aspect: Third Layer I

130 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.130 Flexor digiti minimi pedis Plantar Aspect: Third Layer II

131 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.131 Interossei plantares Interossei dorsales pedis Plantar Aspect: Fourth Layer

132 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.132 Lesson 9.5 Objectives Identify the attachments, function, synergist, antagonist, and common trigger points of individual muscles.Identify the attachments, function, synergist, antagonist, and common trigger points of individual muscles. Lesson 9.5s muscles: scapular stabilization, musculotendinous (rotator) cuff, and shoulder joint.Lesson 9.5s muscles: scapular stabilization, musculotendinous (rotator) cuff, and shoulder joint.

133 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.133 Muscles of Scapular Stabilization Isometric functionIsometric function –Hold the scapula to the ribcage Move the scapula during concentric and eccentric functionMove the scapula during concentric and eccentric function Act together to elevate or depress the scapulaAct together to elevate or depress the scapula Clavicular movements accompany scapular movementsClavicular movements accompany scapular movements

134 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.134 Trapezius Muscles of Scapular Stabilization I

135 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.135 Rhomboideus major Rhomboideus minor Muscles of Scapular Stabilization II

136 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.136 Levator scapulae Pectoralis minor Muscles of Scapular Stabilization III

137 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.137 Serratus anterior Muscles of Scapular Stabilization IV

138 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.138 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Right Posterior Scapular Region

139 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.139 Muscles of the Musculotendinous (Rotator) Cuff Nine muscles stabilize and move the shoulder jointNine muscles stabilize and move the shoulder joint SITSSITS –Supraspinatus –Infraspinatus –Teres minor –Subscapularis All but subscapularis accessible during massageAll but subscapularis accessible during massage

140 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.140 SupraspinatusInfraspinatus Rotator Cuff Muscles I

141 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.141 Teres minor Subscapularis Rotator Cuff Muscles II

142 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.142 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Shoulder Joint

143 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.143 Deltoid Pectoralis major Muscles of the Shoulder Joint I

144 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.144 Subclavius Latissimus dorsi Muscles of the Shoulder Joint II

145 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.145 Teres major Coracobrachialis Muscles of the Shoulder Joint III

146 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.146 Lesson 9.6 Objectives Identify the attachments, function, synergist, antagonist, and common trigger points of individual muscles.Identify the attachments, function, synergist, antagonist, and common trigger points of individual muscles. Lesson 9.6s muscles: elbow and radioulnar joints, wrist and hand joints, and intrinsic muscles of the hand.Lesson 9.6s muscles: elbow and radioulnar joints, wrist and hand joints, and intrinsic muscles of the hand.

147 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.147 Muscles of the Elbow and Radioulnar Joint Elbow: a hinge jointElbow: a hinge joint –Limited to flexion and extension of the forearm –Posterior: extension –Anterior: flexion Strongest elbow flexor: brachialisStrongest elbow flexor: brachialis

148 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.148 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Biceps Brachii and Brachialis Muscles

149 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.149 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Deep Muscles in Posterior Forearm

150 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.150 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Cross Section of Arm

151 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.151 Biceps brachii Brachialis Muscles of the Elbow and Radioulnar Joint I

152 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.152 Brachioradialis Pronator teres Muscles of the Elbow and Radioulnar Joint II

153 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.153 Supinator Pronator quadratus Muscles of the Elbow and Radioulnar Joint III

154 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.154 Triceps brachii Anconeus Muscles of the Elbow and Radioulnar Joint IV

155 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.155 From Drake RL, Vogel W, Mitchell WM: Grays Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Muscles of the Wrist and Hand Joints

156 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.156 Flexor carpi radialis Palmaris longus Anterior Flexor Group: Superficial Layer I

157 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.157 Flexor carpi ulnaris Anterior Flexor Group: Superficial Layer II

158 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.158 Flexor digitorum superficialis Anterior Flexor Group: Intermediate Layer

159 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.159 Flexor digitorum profundus Flexor pollicis longus Anterior Flexor Group: Deep Layer

160 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.160 Extensor carpi radialis longus Extensor carpi radialis brevis Posterior Extensor Group: Superficial Layer I

161 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.161 Extensor digitorum Extensor digiti minimi Posterior Extensor Group: Superficial Layer II

162 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.162 Extensor carpi ulnaris Posterior Extensor Group: Superficial Layer III

163 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.163 Extensor pollicis brevis Abductor pollicis longus Posterior Extensor Group: Deep Layer I

164 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.164 Extensor pollicis longus Extensor indicis Posterior Extensor Group: Deep Layer II

165 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.165 Opponens pollicis Intrinsic Muscles of the Hand: Thenar Eminence Muscles I

166 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.166 Abductor pollicis brevis Flexor pollicis brevis Intrinsic Muscles of the Hand: Thenar Eminence Muscles II

167 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.167 Opponens digiti minimi Abductor digiti minimi manus Hypothenar Muscles I

168 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.168 Flexor digiti minimi manus Hypothenar Muscles II

169 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.169 Adductor pollicis Interossei palmares Central Compartment Muscles I

170 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.170 Interossei dorsales manus Lumbricales manus Central Compartment Muscles II

171 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.171 Apply knowledge of the muscular system to therapeutic massage application.Apply knowledge of the muscular system to therapeutic massage application. 171 Lesson 9.7 Objective

172 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.172 Mechanisms of Disease, I Causal factors increase muscle tensionCausal factors increase muscle tension Tension leads to localized ischemia and edemaTension leads to localized ischemia and edema Pain resultsPain results Pain leads to spasm; spasm increases painPain leads to spasm; spasm increases pain Inflammation or chronic irritation may resultInflammation or chronic irritation may result Stations in tense tissue report to CNS, which leads to hyperactivityStations in tense tissue report to CNS, which leads to hyperactivity

173 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.173 Mechanisms of Disease, II Macrophages and fibroblasts are activatedMacrophages and fibroblasts are activated Connective tissue production increasesConnective tissue production increases Distortions in one area could create distortions elsewhereDistortions in one area could create distortions elsewhere Chronic hypertension and fibrotic changes may occurChronic hypertension and fibrotic changes may occur Chain reactions occur in myotatic unitsChain reactions occur in myotatic units Sustained tension results in ischemia in tendinous areasSustained tension results in ischemia in tendinous areas

174 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.174 Mechanisms of Disease, III Abnormal biomechanics and bodywide compensatory patterns developAbnormal biomechanics and bodywide compensatory patterns develop Joint restriction and imbalance may occurJoint restriction and imbalance may occur Trigger points developTrigger points develop Generalized fatigue developsGeneralized fatigue develops Sympathetic arousal is heightenedSympathetic arousal is heightened Immune response is inhibitedImmune response is inhibited Massage intervention and medication can helpMassage intervention and medication can help

175 Medications AntibioticsAntibiotics –Treat bacterial infections Steroids and NSAID (non-steroidal anti- inflammatory drugs)Steroids and NSAID (non-steroidal anti- inflammatory drugs) –Help ease inflammation Muscle RelaxantsMuscle Relaxants –Sooth spasms and hypertonic muscles AnalgesicsAnalgesics –Pain relievers AntidepressantsAntidepressants –Help restore sleep Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.175

176 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 planAny 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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.176

177 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.177 Specific Disorders, I Carpal tunnel syndromeCarpal tunnel syndrome –Irritation of the median nerve as it passes through the transverse carpal lig. Pain, tingling, numbness, weaknessPain, tingling, numbness, weakness Thoracic outlet syndromeThoracic outlet syndrome –Impingement of the brachial plexus and blood supply of the arm Shooting pain, weakness, numbness, discoloration of the arm can also occurShooting pain, weakness, numbness, discoloration of the arm can also occur Stress-induced muscle tension and headacheStress-induced muscle tension and headache –Contraction of the muscles puts pressure on the nerves Dull, persistent ache, with a feeling of tightnessDull, persistent ache, with a feeling of tightness Muscle strainMuscle strain –Overstretching or tearing of muscle fibers Repair takes weeks and some muscle fibers may be replaced with fibrous tissueRepair takes weeks and some muscle fibers may be replaced with fibrous tissue

178 Specific Disorders, II ContusionContusion –Bruise or bleeding under the skin, inflammation –Crush injury can result in myoglobin in the blood causing kidney failure Muscle infectionsMuscle infections –Bacterial, viral, parasitic Often produces local or widespread myositisOften produces local or widespread myositis PoliomyelitisPoliomyelitis –Viral infection of the nerves affecting the musculoskeletal sys. Myositis ossificansMyositis ossificans –Inflammation process that produces osseous tissue in the fascicles of muscle. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.178

179 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.179 Specific Disorders, III Tendonitis and tenosynovitisTendonitis and tenosynovitis –Inflammation of tendon/tendon sheath Caused by trauma or overuse, or systemic inflammatory disease (e.g. RA)Caused by trauma or overuse, or systemic inflammatory disease (e.g. RA) Cramps/spasmsCramps/spasms –Painful muscle spasms or involuntary twitches Flaccidity and spasticityFlaccidity and spasticity –Muscle with decreased tone vs. excessive tone ContractureContracture –Chronic shortening of a muscle

180 Specific Disorders, IV Muscular dystrophyMuscular dystrophy –Atrophy of skeletal muscle with no mal-function of the nervous sys. Amyotrophic lateral sclerosisAmyotrophic lateral sclerosis –Lou Gehrigs 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 gravisMyasthenia 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 HerniaHernia –Protrusion of an abdominal organ through the muscular wall Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.180

181 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.181 Specific Disorders, V TorticollisTorticollis –spasm or shortening of SCM WhiplashWhiplash –sudden hyperextension or flexion causing damage to soft tissue of the neck Dupuytrens contractureDupuytrens contracture Rotator cuff tearRotator 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

182 Specific Disorders, VI Shin splintsShin splints –Inflammation or tearing of the muscle from the tibia, usually tibialis anterior, can also result in stress fractures Anterior compartment syndromeAnterior 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 fasciitisPlantar 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) FibromyalgiaFibromyalgia –Aching, fatigue, stiffness, sleep disruption, multiple tender points, headaches, irritable bladder, dysmenorrhea, cold sensitivity, restless leg, Raynauds Phenomenon, numbness, tingling, and weakness Acquired metabolic and toxic myopathiesAcquired metabolic and toxic myopathies –Nutritional and vitamin deficiency, especially protein and vitamin C, D. E, may lead to myopathy

183 Massage and Inflammation Acute phase (first 72 hours) massage is usually contraindicatedAcute phase (first 72 hours) massage is usually contraindicated RICERICE Chronic massage is usually indicatedChronic massage is usually indicated If massage could increase the inflammatory response it is contraindicatedIf massage could increase the inflammatory response it is contraindicated Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.183


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