Mosby’s Essential Sciences for Therapeutic Massage

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

Lesson 9.1 Objectives Describe the functions of muscles.
List the three types of muscles. Describe the types of skeletal muscle fiber. 2 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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) ● How is massage therapy related to static and dynamic force? Massage professionals often seek to transform static force into dynamic force, thereby releasing the energy to achieve therapeutic goals. 4 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4

Muscle Functions 4 major muscle functions Movement production
Joint stabilization Posture maintenance Heat generation ● Because the shoulder has so many movements, it can develop rotator cuff impingement or become dislocated relatively easily. 5 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● What is a stimulus? A stimulus is a change in the internal or external environment. Massage therapy often applies specific stimuli to achieve specific goals. ● Note: Use visuals to help students remember these concepts. 6 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 6

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

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

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

Muscle Action Isometric Isotonic
Tension in the muscle with no change in movement Isotonic Concentric Eccentric ● Isotonic action occurs when tension develops as muscle shortens or lengthens. Concentric describes shortening; eccentric refers to lengthening. ● Note: Relate this to working out. Students may be familiar with “negative reps” in weight training. From Greenstein GM: Clinical assessment of neuromusculoskeletal disorders, St. Louis, 1997, Mosby. 10 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10

Skeletal Muscle Fibers
● What types of tissues make up a skeletal muscle? Muscle fibers (muscle cells), large amounts of connective tissue and nerve fibers, and many blood vessels. ● Note: Compare the wrappings of the muscle with the nerve and bone wrappings. From Thibodeau GA, Patton KT: Anatomy and physiology, ed 5, St. Louis, 2003, Mosby. 11 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11

Striated Muscle ● Sarcomeres are the structural units of contraction in skeletal muscle fibers. ● What happens when a muscle cell contracts? Its individual sarcomeres shorten. ● The two types of filaments found within the myofibril are myosin and actin. Cross-bridges from the myosin attach to active sites on the actin subunits of the filaments; then sliding begins. Each cross-bridge attaches and detaches several times during a contraction, which generates tension and pulls the thin actin filaments toward the center of the sarcomere. From Muscolino JE: Kinesiology: the skeletal system and muscle function, enhanced edition, St. Louis, 2007, Mosby. 12 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 12

Length and Tension Direct link between tension development and length of the muscle If shortened, or lengthened beyond optimum, tension decreases ● An optimum length exists at which a muscle is capable of developing maximal tension. 13 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13

Innervation ● What is a motor point?
A motor point is where a motor neuron enters a muscle. Motor points act like pilot lights in gas furnaces. ● Acupuncture points correspond to motor point locations and the locations of the Golgi tendon organs. Some agreement has been reached that these points correspond to neurovascular bundles in the muscles. This supports the idea of a neurologic and a vascular component of pathologic conditions of these points and the benefits of acupuncture and trigger point methods. From Muscolino JE: Kinesiology: the skeletal system and muscle function, enhanced edition, St. Louis, 2007, Mosby. 14 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 14

Energy Sources ATP Efficient contraction requires
Glucose Oxygen: aerobic respiration Anaerobic respiration: no immediate oxygen use Produces lactic acid Leads to oxygen debt ● The body tries to make up for oxygen debt by breathing more heavily. This helps convert lactic acid. 15 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● Which type of muscle fibers fatigue most quickly? Fast-twitch fibers fatigue more quickly than slow-twitch fibers. 16 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● How does psychologic muscle fatigue work? Psychologic muscle fatigue produces an exhausted feeling that keeps us from continuing a muscular activity, thereby reducing the chance of serious injury. 17 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 17

Connective Tissue and Muscle
Fascia Involved in nearly all the fundamental processes of the body Intimately related to muscle ● If any part of a fascial structure becomes deformed or distorted, adverse effects can occur anywhere in its associated network. ● Massage affects fascia. Adapted from Mathers LH, Chase RA, Dolph J et al: Clinical anatomy principles, St. Louis, 1995, Mosby. 18 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 18

Structure of Muscle Fibers and Coverings
● As you can see, a muscle cannot be separated from its network of connective tissue. Adapted from Myers T: Anatomy trains: myofascial meridians for manual and movement therapists, London, 2002, Churchill Livingstone. 19 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● How did the term “tensegrity” come about? It was coined by the designer R. Buckminster Fuller from the phrase “tension integrity.” The term can be applied to many natural and man-made structures as well as to the body. 20 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● Pathologic and therapeutic viscoplastic changes are not absolutely permanent, since collagen has a limited half-life (300 to 500 days). 21 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● What are some problems with origin and insertion terminology? The terminology can lead to confusion, since the origin and insertion can switch, depending on the action. Modified from Thibodeau GA, Patton KT: Anatomy and physiology, ed 6, St. Louis, 2007, Mosby. 22 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 22

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

Muscle Shapes Parallel Convergent Pennate Circular Ex. Sartorius
Pectoralis Major Pennate Tendons run the length of the muscle Unipennate, bipennate, multipennate Rectus femoris Circular sphincters Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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

Myotatic Units Muscles rarely act independently
Muscles are part of larger movement patterns ● It might help to think of the muscles in a myotatic unit as actors. In one production, one actor might be the star, while in another, he might take a supporting role. 26 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 26

Functions and Naming Name of muscle in specific action depends on function: Mover (agonist) Antagonist Fixator (stabilizer) Neutralizer Support muscle Synergist ● What does the antagonist do? The antagonist usually has the opposite action of the mover, or agonist. It’s usually on the opposite side of the joint from the mover. 27 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● Which reflex responses are most often stimulated? The stretch reflex, tendon reflex, flexor reflex, and crossed extensor reflex. 28 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 28

Reflex Response ● What are reflexes?
Reflexes are automatic responses triggered by changes in the environment. They quickly and predictably restore homeostasis. From Fritz S: Mosby’s fundamentals of therapeutic massage, ed 4, St. Louis, 2009, Mosby. 29 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 29

Reflexes Page 268/332 Stretch reflex Tendon reflex
Flexor reflex and crossed extensor reflex Postural reflexes ● The purpose of posture reflexes is to maintain posture, as well as to keep the eyes in the horizontal plane and oriented forward. 30 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 30

Cardiac Muscle ● What is another named for cardiac muscle?
Striated involuntary muscle. From Thibodeau GA, Patton KT: Anatomy and physiology, ed 5, St. Louis, 2003, Mosby. 31 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 31

Smooth Muscle ● Visceral smooth muscle usually has a rhythmic self-excitation, or self-rhythm, that spreads across the entire tissue. From Thibodeau GA, Patton KT: Anatomy and physiology, ed 5, St. Louis, 2003, Mosby. 32 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● When studying each muscle, pay special attention to referred pain patterns; knowledge of these symptoms can increase the efficacy of massage therapy. 34 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● How does the number of heads affect the naming of a muscle? -ceps refers to heads, and the prefix gives the number. The biceps, triceps, and quadriceps are examples of this. 35 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 35

How to Palpate Muscles When relaxed Deep muscles are harder to feel
Identify bony landmarks Trace muscle between attachments Follow fiber direction Locate belly of muscle Have client contract muscle Deep muscles are harder to feel ● What is the belly of a muscle? The belly is the largest area of a muscle, and is usually near the middle of the muscle. 36 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● Many muscles in the face and head attach to the skin or other muscles. 37 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 37

Lateral View of the Head
● Muscles of the face and head lift our eyebrows, flare our nostrils, and open and close our eyes and mouth. From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 38

Muscles of Facial Expression I
● What is the concentric function of the occipitofrontalis? It draws the scalp anteriorly and posteriorly, elevates the eyebrows, and wrinkles the forehead. Occipitofrontalis 39 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 39

Muscles of Facial Expression II
● What is the concentric function of the procerus? It draws the medial angle of the eyebrow downward and produces transverse wrinkles over the bridge of the nose. ● Corrugator supercilii means “to wrinkle the eyebrows.” Procerus Corrugator supercilii 40 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 40

Muscles of Facial Expression III
● Nasalis means “related to the nose.” Nasalis 41 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 41

Auricularis Posterior
Ear Muscles I ● The next three muscles are concerned with the movement of the ear. ● What is the concentric function of the auricularis? It draws the ear anteriorly and tightens and moves the scalp. The auricularis posterior draws the ear posteriorly. Auricularis Auricularis Posterior 42 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 42

Ear Muscles II Auricularis Superior
● What does the auricularis superior do? It elevates the ear and tightens and moves the scalp. Auricularis Superior 43 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 43

Eye Muscles Orbicularis Oculi
● What is the referred pain pattern of the orbiuclaris oculi? To the nose. Orbicularis Oculi 44 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 44

Muscles That Move the Mouth I
● The next 16 muscles to be studied move the mouth. ● Orbicularis oris means a small disk belonging to the mouth. Orbicularis oris 45 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 45

Muscles That Move the Mouth II
● What does depressor anguli oris mean? To press down the corner belonging to the mouth. ● Risorius means to cause one to laugh. Depressor anguli oris Risorius 46 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 46

Muscles That Move the Mouth III
● What is the concentric function of the zygomaticus major? It elevates and draws the angle of the mouth laterally. ● What does the zygomaticus minor do? It elevates and everts the upper lip. Zygomaticus major Zygomaticus minor 47 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 47

Muscles That Move the Mouth IV
● The levator labii superiorus’s major antagonist is the orbicularis oris. ● What does the levator labii superiorus alaeque nasi do? It elevates and everts the upper lip and flares the nostril. Levator labii superiorus Levator labii superioris alaeque nasi 48 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 48

Muscles That Move the Mouth V
● What is the concentric function of the depressor labii inferioris? It depresses, everts, and draws the lower lip laterally. ● What does levator anguli oris mean? One that raises the corner of the mouth. Depressor labii inferiorus Levator anguli oris 49 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 49

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

Muscles That Move the Mouth VII
● These two muscles are each other’s major antagonists. Platysma Mentalis 51 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 51

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

Muscles of Mastication I
● What does masseter mean? One who chews. ● What is the referred pain pattern of the temporalis? The temporal region, the eyebrow, and the upper teeth. ● These muscles are treated in TMJ syndrome. Masseter Temporalis 53 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 53

Muscles of Mastication II
● How does one palpate the lateral pterygoid? This is done from inside the mouth. ● The referred pain pattern of the medial pterygoid is the back of the throat and ear. ● In TMJ treatment, this inter-oral work is done with gloves on. Lateral (external) pterygoid Medial (internal) pterygoid 54 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● The muscles of the neck often act in sequence with trunk flexors and extensors. Neck muscle problems can therefore occur with low back pain, as well as hamstring and quadricep dysfunction. ● Note: Carefully explain how the muscles of the neck act in sequence with trunk flexors and extensors; students need to understand this concept. 55 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 55

Muscles of the Neck I ● Many of these muscles attach to the upper ribs; they function as accessory breathing muscles. From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone. 56 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 56

Muscles of the Neck II Sternocleidomastoid
● What is the referred pain pattern for the sternocleidomastoid? The head and face, particularly the occipital region, ear, and forehead. Sternocleidomastoid 57 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 57

Suprahyoid Muscles I Digastric Stylohyoid
● What does the digastric do? It elevates the hyoid and depresses the mandible at the TMJ. ● What does stylohyoid mean? Pen and U-shaped. Digastric Stylohyoid 58 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 58

Suprahyoid Muscles II Mylohyoid Geniohyoid
● What is the mylohyloid’s primary concentric function? It elevates the hyloid and depresses the mandible (important during the first stage of swallowing). ● The geniohyoid elevates the hyoid and depresses the mandible at the TMJ. Mylohyoid Geniohyoid 59 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 59

Infrahyoid Muscles I Sternohyoid Sternothyroid
● The sternohyoid plays a part in speech and mastication. ● What is the concentric function of the sternothyroid? It depresses the thyroid cartilage. Sternohyoid Sternothyroid 60 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 60

Infrahyoid Muscles II Omohyoid Thyrohyoid ● What does omohyoid mean?
Shoulder and U-shaped. ● The thyrohyoid depresses the hyoid and elevates the thyroid cartilage. Omohyoid Thyrohyoid 61 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 61

Posterior Triangle of the Neck
● The longus colli and longus capitis are important muscles to consider in whiplash injuries. Longus colli Longus capitis 62 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 62

Scalene Group I Scalenus anterior Scalenus medius
● What is the referred pain pattern of the scalenus anterior? The pectoral region, the rhomboid region, and the entire length of the arm into the hand. ● What is the concentric function of the scalenus medius? Flexion and lateral flexion of the neck at the spinal joints, and elevation of the first rib at the sternocostal and costovertebral joints. Scalenus anterior Scalenus medius 63 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 63

Scalene Group II Scalenus posterior
● What is the isometric function of the scalenus posterior? It stabilizes the cervical spine. Scalenus posterior 64 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● In these areas, massage is most effective when applied with a slow, sustained, broad-based compressive force. 65 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 65

Superficial group of back muscles From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone. 66 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 66

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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 67

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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 68

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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 69

Deep Posterior Cervical Muscles
● What is the referred pain pattern of the splenius capitis and splenius cervicis? To the top of the skull, the eye, and the shoulder. Splenius capitis and splenius cervicis 70 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 70

Vertical Muscles Erector Spinae Group I
Iliocostalis lumborum, iliocostalis thoracis, and iliocostalis cervicis ● What is the isometric function of the iliocostalis lumborum, iliocostalis thoracis, and iliocostalis cervicis? These muscles stabilize the spine and pelvis. 71 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 71

Vertical Muscles Erector Spinae Group II
● Longissimus means “the longest”; the muscles pictured on the left relate to the thorax, neck, and head, respectively. ● What are the referred pain patterns of the spinalis thoracis, spinalis cervicis, and spinalis capitis? The scapular, lumbar, abdominal, and gluteal areas. Longissimus thoracis, longissimus cervicis, and longissimus capitis Spinalis thoracis, spinalis cervicis, and spinalis capitis 72 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 72

Oblique Muscles Transversospinales Group I
● What is the eccentric function of the semispinalis thoracis, semispinalis cervicis, and semispinalis capitis? These muscles engage in flexion and contralateral lateral flexion of the trunk, neck, and head. ● What does multifudus mean? Many split parts. Semispinalis thoracis, semispinalis cervicis, and semispinalis capitis Multifidus 73 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 73

Oblique Muscles Transversospinales Group II
● The referred pain area of the rotatores is local. ● What is the concentric function of the muscles pictured at right? These muscles allow lateral flexion of the trunk and neck at the spinal joints. Intertransversarii lumborum, intertransversarii thoracis, and intertransversarii cervicis Rotatores 74 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 74

Oblique Muscles Transversospinales Group III
● What does interspinalis mean? Interspinalis means between or among the parts of the spine. Interspinalis lumborum, interspinalis thoracis, and interspinalis cervicis 75 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 75

Suboccipital Muscles I
● What is the referred pain pattern of the rectus capitis posterior major? Around the ear on the same-side, sensation of compressed junction of skull and neck, and bandlike headache. Rectus capitis posterior major 76 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 76

Suboccipital Muscles II
● What is the eccentric function of the rectus capitis posterior minor? It restrains flexion of the head. ● What does obliquus mean? Slanting. Rectus capitis posterior minor Obliquus capitis superior 77 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 77

Suboccipital Muscles III
● In its isometric function, the obliquus capitis inferior stabilizes the upper cervical spine. Obliquus capitis inferior 78 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 78

Abdominal wall muscles
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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 79

Arrangement of structures in vertebral column and back
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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 81

Muscles of the Thorax and Posterior Abdominal Wall I
● What is the concentric function of the diaphragm? Inspiration (breathing in). Diaphragm 82 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 82

Muscles of the Thorax and Posterior Abdominal Wall II
● What is the isometric function of both of these muscles? Both the serratus posterior superior and serratus posterior inferior stabilize the ribcage. Serratus posterior superior Serratus posterior inferior 83 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 83

Muscles of the Thorax and Posterior Abdominal Wall III
● Intercostal means “between or among the ribs.” ● Note the angle of the attachment. External intercostals Internal intercostals 84 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 84

Innermost Intercostals I
● What is the referred pain pattern of the transversus thoracis? It spans the intercostal segment, and is especially noticeable with deep breathing or rotational movement. Transversus thoracis 85 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 85

Innermost Intercostals II
● Quadratus means “square-shaped,” and lumborum means “of the loins.” Quadratus lumborum 86 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 86

Innermost Intercostals III
● What is the referred pain pattern of the psoas major? The entire lumbar area into the superior gluteal region, as well as the anterior thigh. It may be associated with menstrual aches and can mimic appendicitis. ● What is the concentric function of the psoas minor? Flexion of the trunk at the spinal joints and posterior tilt of the pelvis at the lumbosacral joint. Psoas major Psoas minor 87 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 87

Innermost Intercostals IV
● What is the referred pain pattern of the iliacus? The hip and groin. Iliacus 88 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 88

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

Muscles of the Anterior and Anterolateral Abdominal Wall II
● The internal and external abdominal obliques are slanted in opposite directions. ● Differentiate between these muscles. The angle of insertion creates the action, similar to intercostals. Internal abdominal oblique External abdominal oblique 90 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 90

Muscles of the Anterior and Anterolateral Abdominal Wall III
● What does rectus abdominis mean? Rectus means “straight,” and abdominis means “of the abdomen.” Rectus abdominis 91 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 91

Muscles of the Anterior and Anterolateral Abdominal Wall IV
● The pyramidalis is a striated muscle, but it is not usually voluntary control. ● Controls tension of the linea alba. ● What is the function of the cremaster? It pulls the testes superiorly, to regulate their temperature. Pyramidalis Cremaster 92 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 93

Pelvic and Perineal Muscles I
● What is the function of the levator ani? It forms the floor of the pelvic cavity, constricts the lower end of the rectum and vagina, and supports and slightly raises the pelvic floor. ● Why do massage therapists need to know this when we don’t “massage” these muscles? Attention to antagonistic and synergistic muscles that are accessed more easily is indicated. ● The coccygeus pulls forward and supports the coccys. Levator ani Coccygeus 94 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 94

Pelvic and Perineal Muscles II
● Transverse means “crossing” or “around”; perineal means “to empty” or “defecate.” ● What is the function of the external sphincter ani? It closes the anal orifice. ● Why do massage therapists need to know this when we don’t “massage” these muscles? These muscles act as antagonists and synergists to other muscles that are more readily accessed. External sphincter ani Deep transverse perineals 95 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 95

Pelvic and Perineal Muscles III
● What does the ischiocavernosus do? It compresses the crus penis, and is believed to play a part in maintaining erection of the penis or clitoris. ● The bulbospongiosus aids in emptying the urethra. Ischiocavernosus Bulbospongiosus 96 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● Many of these muscles display inhibitory patterns to one another. ● Explain reciprocal inhibitor and the specific agonist and antagonist relationship. From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone. 98 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 98

Nerves of the Gluteal Region

Muscles of the Gluteal Region I
● What is the concentric function of the gluteus maximus? It extends and laterally rotates the thigh at the hip joint. It is active primarily during strenuous activity. ● What is the referred pain pattern of the gluteus medius? The low back, posterior crest of the ilium to the sacrum, and to the posterior and lateral areas of the buttock into the upper thigh. Gluteus maximus Gluteus medius 100 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 100

Muscles of the Gluteal Region II
● Gluteus means “buttocks”; minimus means “smallest.” ● What is the isometric function of the tensor fasciae latae? It tenses the iliotibial band, and counterbalances the backward pull of the gluteus maximus. It also stabilizes the pelvis and the knee. Gluteus minimus Tensor fasciae latae 101 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 101

Deep Lateral Rotators of the Thigh at the Hip Joint I
● What does piriformus mean? Pear-shaped. ● What is the concentric function of the obturator internus? Lateral rotation of the thigh at the hip joint and abduction of the thigh at the hip joint if the thigh is first in a position of flexion at the hip joint. Piriformis Obturator internus 102 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 102

Deep Lateral Rotators of the Thigh at the Hip Joint II
● What is the isometric function of the obturator externus? It stabilizes the hip joint. ● What is the referred pain pattern of the quadratus femoris? The sacroiliac region, the entire buttock, and down the posterior thigh to just proximal to the knee joint. Obturator externus Quadratus femoris 103 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 103

Deep Lateral Rotators of the Thigh at the Hip Joint III
● Gemellus means “twin.” ● These muscles share the referred pain pattern of the quadratus femoris. Gemellus superior Gemellus inferior 104 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 104

Muscles of the Posterior Thigh

Muscles of the Posterior Thigh I
● What does semimembranosus mean? Half membrane. ● What is the concentric function of the semitendinosus? Flexion and medial rotation of the leg at the knee, extension of the thigh at the hip, and posterior tilt of the pelvis at the hip. Semimembranosus Semitendinosus 106 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 106

Muscles of the Posterior Thigh II
● What is the referred pain pattern of the biceps femoris? The ischial tuberosity, the back of the knee, and the entire posterior thigh and leg to midcalf. Biceps femoris 107 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 107

Muscles of the Medial Thigh I
● What is the isometric function of the pectineus? It stabilizes the pelvis at the hip joint. Pectineus 108 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 108

Muscles of the Medial Thigh II
● What is the concentric function of the adductor brevis? Adduction and flexion of the thigh at the hip joint and anterior tilt of the pelvis at the hip joint. ● The adductor longus shares the same concentric function. Pain in this muscle appears deep in the groin. Adductor brevis Adductor longus 109 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 109

Muscles of the Medial Thigh III
● What is the referred pain pattern of the adductor magnus? Deep in the groin, into the medial thigh and downward to the knee and leg; it may mimic hamstring tension. ● What does gracilis mean? Slender. Adductor magnus Gracilis 110 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 110

Muscles of the Anterior Thigh

Muscles of the Anterior Thigh I
● What is the referred pain pattern of the sartorius? The entire anterior thigh, with concentration at the knee. Sartorius 112 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 112

Muscles of the Anterior Thigh II Quadriceps Femoris Group
● Together, the rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius are known as the quadriceps femoris group. ● What is the concentric function of the rectus femoris? Extension of the leg at the knee joint, flexion of the thigh at the hip joint, and anterior tilt of the pelvis at the hip joint. Rectus femoris Vastus lateralis 113 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 113

Muscles of the Anterior Thigh III Quadriceps Femoris Group
● What is the referred pain pattern of the vastus intermedius? Entire anterior thigh, with concentration at the knee. Vastus medialis Vastus intermedius 114 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 114

Muscles of the Anterior and Lateral Leg
● The muscles of the leg are primarily important for their actions at the foot. From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone. 115 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 115

Extensor digitorum longus
Anterior Muscles I ● What does tibialis mean? Related to the shinbone. ● What is the concentric function of the extensor digitorum longus? Extension of toes 2 to 5 at the metatarsophalangeal and interphalangeal joints, dorsiflexion of the foot at the ankle joint, and eversion of the foot at the tarsal joints. Tibialis anterior Extensor digitorum longus 116 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 116

Anterior Muscles II Extensor hallucis longus
● Extensor hallucis longus translates to “long one that stretches the big toe.” ● What is the referred pain pattern of the fibularis (peroneus) tertius? Down the leg and into the toes. Extensor hallucis longus Fibularis (peroneus) tertius 117 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 117

Lateral Muscles Fibularis (peroneus) longus
● What is the isometric function of the fibularis (peroneus) longus? It stabilizes the ankle joint. ● What is the referred pain pattern of the fibularis (peroneus) brevis? To the lateral malleolus and the heel. Fibularis (peroneus) longus Fibularis (peroneus) brevis 118 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 118

Muscles of the Posterior Leg

Muscles of the Posterior Leg I
● Popliteus means “hollow of the knee.” ● What is the concentric function of the tibialis posterior? Plantar flexion of the foot at the ankle joint and inversion of the foot at the tarsal joints. Popliteus Tibialis posterior 120 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 120

Muscles of the Posterior Leg II
● What is the eccentric function of the flexor digitorum longus? It allows extension of the toes and allows dorsiflexion and eversion of the foot. ● What does hallucis mean? Related to the big toe. Flexor digitorum longus Flexor hallucis longus 121 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 121

Muscles of the Posterior Leg III
● Plantaris means the sole of the foot. ● What does soleus mean? Sandal, or sole of the foot. Plantaris Soleus 122 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 122

Muscles of the Posterior Leg IV
● What is the referred pain pattern of the gastrocnemius? Down the posterior leg to the heel and the sole of the foot into the plantar surface of the toes. It can be a factor in knee pain as well. Gastrocnemius 123 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 123

Intrinsic Muscles of the Foot
● Intrinsic muscles of the foot are small muscles located wholly within the foot. From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone. 124 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 124

Extensor digitorum brevis
Dorsal Aspect ● What is the referred pain pattern of the extensor digitorum brevis? The entire foot, with areas concentrated at the large toe, the ball of the foot, and the heel. Extensor digitorum brevis 125 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 125

Plantar Aspect: Superficial Layer I
● What is the concentric function of the abductor hallucis? Abduction and flexion of the big toe at the metatarsophalangeal joint. ● What is the eccentric function of the flexor digitorum brevis? It restrains extension of toes 2 to 5. Abductor hallucis Flexor digitorum brevis 126 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 126

Plantar Aspect: Superficial Layer II
● What is the concentric function of the abductor digiti minimi pedis? Abduction and flexion of the little toe at the metatarsophalangeal joint. Abductor digiti minimi pedis 127 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 127

Plantar Aspect: Second Layer
● Both of these muscles are in the second layer of the plantar aspect. ● What is the referred pain pattern of both of these muscles? The entire foot, with areas concentrated at the large toe, the ball of the foot, and the heel. Quadratus plantae Lumbricales pedis 128 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 128

Plantar Aspect: Third Layer I
● What is the concentric function of the flexor hallucis brevis? Flexion of the big toe at the metatarsophalangeal joint. ● What is the eccentric function of the adductor hallucis? It restrains abduction and extension of the big toe. Flexor hallucis brevis Adductor hallucis 129 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 129

Plantar Aspect: Third Layer II
● The flexor digiti minimi pedis flexes the little toe and restrains its extension. Flexor digiti minimi pedis 130 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 130

Plantar Aspect: Fourth Layer
● Which toes are affected by the interossei plantares? Toes 3 to 5. ● What is the concentric function of the interossei dorsales pedis? The abduction of toes 2 to 4 at the metatarsophalangeal joints, the flexion of toes 2 to 4 at the metatarsophalangeal joints and extension of toes 2 to 4 at the proximal and distal interphalangeal joints. Interossei plantares Interossei dorsales pedis 131 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● What common movement consists of scapular elevation? Shrugging the shoulders. 133 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 133

Muscles of Scapular Stabilization I
● What is the referred pain pattern of the trapezius? The neck posterior to the ear and the temple, the subscapular area, and acromial pain. Trapezius 134 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 134

Muscles of Scapular Stabilization II
● What shape do the rhomboideus muscles take? Their name comes from the geometrical term rhombus—they are roughly diamond-shaped. ● What is the referred pain pattern of the rhomboideus muscles? The scapular region. Rhomboideus major Rhomboideus minor 135 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 135

Muscles of Scapular Stabilization III
● What is the concentric function of the levator scapulae? Elevation and retraction (adduction) of the scapula at the scapulocostal joint, and extension, lateral flexion, and ipsilateral rotation of the neck at the spinal joints. ● Pectoralis means “related to the chest”; minor means “smaller.” Levator scapulae Pectoralis minor 136 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 136

Muscles of Scapular Stabilization IV
● What is the isometric function of the serratus anterior? It holds the medial border of the scapula firmly against the thorax, thereby preventing winging of the scapula. Serratus anterior 137 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 137

Right Posterior Scapular Region

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 ● The best position to access these muscles is supine, with pressure applied through the axilla and toward the scapula. ● Note: Discuss eccentric function. 139 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 139

Rotator Cuff Muscles I Supraspinatus Infraspinatus
● What is the concentric function of the supraspinatus? Abduction of the arm at the shoulder joint. ● How about the infraspinatus? Lateral rotation of the arm at the shoulder joint. Supraspinatus Infraspinatus 140 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 140

Rotator Cuff Muscles II
● What is the referred pain pattern of the teres minor? The posterior deltoid region often has a limited range of motion for reaching behind the back. ● The subscapularis is often implicated in “frozen shoulder” syndromes. Teres minor Subscapularis 141 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 141

Muscles of the Shoulder Joint

Muscles of the Shoulder Joint I
● What does deltoid mean? Triangular. ● This muscle functions in three distinct patterns (flexion, abduction, and extension). ● What is the referred pain pattern of the pectoralis major? The chest and breast and down the ulnar aspect of the arm and forearm to the fourth and fifth fingers. Deltoid Pectoralis major 143 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 143

Muscles of the Shoulder Joint II
● The subclavius is often considered with the clavicular part of the pectoralis major. ● What does the name of latissimus dorsi mean? Latissimus means “widest,” and dorsi means “belonging to the back.” Subclavius Latissimus dorsi 144 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 144

Muscles of the Shoulder Joint III
● What is the referred pain pattern of the teres major? The posterior deltoid region and down the dorsal portion of the arm. ● Coracobrachialis means “crow’s beak” and “of the arm.” Teres major Coracobrachialis 145 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● The muscles in this area often operate with flexors of the legs because of the gait. 147 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 147

Biceps Brachii and Brachialis Muscles

Deep Muscles in Posterior Forearm

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

Muscles of the Elbow and Radioulnar Joint I
● What is the concentric function of the biceps brachii? Flexion of the forearm at the elbow joint, supination of the forearm at the radioulnar joints, and flexion of the forearm at the shoulder joint. ● What is the isometric function of the brachialis? It stabilizes the elbow joint. Biceps brachii Brachialis 151 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 151

Muscles of the Elbow and Radioulnar Joint II
● What is the referred pain pattern of the brachioradialis? The wrist and base of the thumb in the web space between the thumb and the index finger and to the lateral epicondyle at the elbow. ● What is the concentric function of the pronator teres? Pronation of the forearm at the radioulnar joints and flexion of the forearm at the elbow joint. Brachioradialis Pronator teres 152 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 152

Muscles of the Elbow and Radioulnar Joint III
● Not surprisingly, the supinator is involved in supination and the restraint of pronation. ● The pronator quadratus is the prime mover of pronation of the forearm. Supinator Pronator quadratus 153 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 153

Muscles of the Elbow and Radioulnar Joint IV
● What is the concentric function of the triceps brachii? Extension of the forearm at the elbow joint; also, the long head adducts and extends the arm at the shoulder joint. ● What is the isometric function of the anconeus? It stabilizes the elbow. Triceps brachii Anconeus 154 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 154

Muscles of the Wrist and Hand Joints
● If all the muscles required for the hands’ strong, intricate movements were located in the hands, they would be too bulky to function. ● Tendons are important for functioning and need to be taken care of with massage therapists’ work in mind. From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone. 155 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 155

Anterior Flexor Group: Superficial Layer I
● What is the concentric function of the flexor carpi radialis? Flexion and radial deviation (abduction) of the hand at the wrist joint, flexion of the forearm at the elbow joint, and pronation of the forearm at the radioulnar joints. ● In its isometric function, the palmaris longus tenses the palmar fascia. Flexor carpi radialis Palmaris longus 156 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 156

Anterior Flexor Group: Superficial Layer II
● What is the eccentric function of the flexor carpi ulnaris? It restrains extension and radial deviation (abduction) of the hand and extension of the forearm. Flexor carpi ulnaris 157 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 157

Anterior Flexor Group: Intermediate Layer
● The flexor digitorum superficialis is involved in flexion of fingers 2 to 5, as well as flexion of the hand. Flexor digitorum superficialis 158 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 158

Anterior Flexor Group: Deep Layer
● What is the isometric function of the flexor digitorum profundis? It stabilizes the wrist and finger joints. ● What is the referred pain pattern of the flexor pollicis longus? Into the wrist, associated fingers, or thumb, and occasionally into the elbow. Flexor digitorum profundus Flexor pollicis longus 159 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 159

Posterior Extensor Group: Superficial Layer I
● What is the concentric function of the extensor carpi radialis longus? Extension and radial deviation (abduction) of the hand at the wrist joint, and flexion of the forearm at the elbow joint. ● The extensor carpi radialis brevis performs similar tasks. Extensor carpi radialis longus Extensor carpi radialis brevis 160 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 160

Posterior Extensor Group: Superficial Layer II
● What is the concentric function of the extensor digitorum? Extension of fingers 2 to 5 at the metacarpophalangeal and proximal and distal interphalangeal joints and extension of the hand at the wrist joint. ● What is the isometric function of the extensor digiti minimi? It stabilizes the little finger. Extensor digitorum Extensor digiti minimi 161 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 161

Posterior Extensor Group: Superficial Layer III
● The major antagonists of the extensor carpi ulnaris are all the flexors of the hand. Extensor carpi ulnaris 162 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 162

Posterior Extensor Group: Deep Layer I
● What is the eccentric function of the extensor pollicis brevis? It restrains flexion and adduction of the thumb, ulnar deviation (adduction) of the hand, and pronation of the forearm. ● In its isometric function, the abductor pollicis longus stabilizes the thumb and the wrist joint. Extensor pollicis brevis Abductor pollicis longus 163 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 163

Posterior Extensor Group: Deep Layer II
● What is the concentric function of the extensor pollicis longus? Extension of the thumb at the carpometacarpal, metacarpophalangeal, and interphalangeal joints. ● Extensor means “one that stretches,” and indicis means “of the index finger.” Extensor pollicis longus Extensor indicis 164 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 164

Intrinsic Muscles of the Hand: Thenar Eminence Muscles I
● The opponens pollicis is involved in the opposition of the thumb. Opponens pollicis 165 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 165

Intrinsic Muscles of the Hand: Thenar Eminence Muscles II
● What is the referred pain pattern of the abductor pollicis brevis? Into the thumb and the wrist. ● The flexor pollicis brevis shares the same referred pain pattern as the abductor. Abductor pollicis brevis Flexor pollicis brevis 166 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 166

Opponens digiti minimi
Hypothenar Muscles I ● What is the eccentric function of the opponens digiti minimi? It restrains reposition of the little finger. ● What is the concentric function of the abductor digiti minimi manus? Abduction of the little finger at the metacarpophalangeal joint. Opponens digiti minimi Abductor digiti minimi manus 167 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 167

Flexor digiti minimi manus
Hypothenar Muscles II ● What is the concentric function of the flexor digiti minimi manus? Flexion of the little finger at the metacarpophalangeal joint. Flexor digiti minimi manus 168 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 168

Central Compartment Muscles I
● What is the referred pain pattern of the adductor pollicis? Into the associated finger, commonly associated with Heberden’s nodes. ● What is the isometric function of the interossei palmares? It stabilizes fingers 2, 4, and 5. Adductor pollicis Interossei palmares 169 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 169

Central Compartment Muscles II
● In its isometric function, the interossei dorsales manus stabilizes fingers 2 to 4. ● Lumbricales means “earthworms.” Interossei dorsales manus Lumbricales manus 170 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 170

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 ● This slide and the next two indicate the fairly predictable sequence of events that occurs when the myofascial system is stressed. 172 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● For review, what are myotatic units? Groups of muscles that function together. 173 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 ● What are trigger points? Hyperirritable loci within taut bands of skeletal muscle. 174 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 174

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

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

Specific Disorders, I Carpal tunnel syndrome Thoracic outlet 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 ● Carpal tunnel syndrome is the irritation of the medial nerve as it passes into the wrist. ● Is massage therapy indicated for contusion? No. 177 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 177

Specific Disorders, II Contusion Muscle infections Poliomyelitis
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. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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 ● How might one ease cramps or spasms? One can manage simple cramps or spasms by pushing the belly of the muscle together. ● Massage is contraindicated for a hernia. 179 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Specific Disorders, V Torticollis Whiplash Dupuytren’s contracture
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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Specific Disorders, VI Shin splints Anterior compartment syndrome
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 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Mosby’s Essential Sciences for Therapeutic Massage

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Mosby’s Essential Sciences for Therapeutic Massage

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