Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics

Therapeutic Kinesiology Instructor Manual: Ch02 p.6 TK INSTRUCTOR MANUAL: CHAPTER 2 The Skeletal System Chapter manuals include: Objectives Lecture Notes Suggested Classroom and Student Development Activities For other chapter-by-chapter resources, see: Key Term Quizzes Muscle Origin and Insertion Worksheets Muscle OIAs List by Chapter MyTest Test Bank For additional resources see “Teaching Tips and Tools”: 7 research-based learning principles for kinesiology courses in massage 5-step self-directed learning cycle for body mechanics courses Tools that build metacognitive skills: e.g., concept (mind) maps, grading rubrics, and self-assessments inventories OBJECTIVES List the structures and functions of the skeletal system. List the three elements found in connective tissues and the types of connective tissues. Describe how manual therapy can affect the tissue properties of thixotropy and viscosity. Define and contrast the properties elasticity and plasticity. Describe and contrast the two types of bone tissue. Define and describe the process of bone remodeling. List the five types of bone and provide an example of each type. Name and describe two properties of bone and describe how bone fractures. List and describe 13 types of bony landmarks. Describe two types of cartilage and name three connective tissues in the skeletal system. Describe a bursa and its function. Name and describe the three classifications of joints in the body. Describe a synovial joint and list six types of synovial joints with examples of each. Name and contrast the degrees of movement in axial joints with nonaxial joints. Define the line of gravity and the center of gravity. Define joint neutral and describe its relationship to optimal posture. Name and describe five types of mechanical stress. LECTURE NOTES SKELETAL SYSTEM Made up of 206 bones, joints, associated tissues Five major functions Support Protection Storage Blood production Movement Two major parts Axial: The central axis of trunk and head Appendicular: The upper and lower limbs ELEMENTS OF CONNECTIVE TISSUE (CT) Most abundant tissue in the body Types of CT Blood Bone Cartilage CT Proper Loose: Superficial fascia and adipose Dense: Regular and irregular Three building blocks of CT Fibers Collagen Most abundant protein in mammals Most prolific fiber in skeletal system Made of three spiraled collagen molecules Mature fibers have tensile strength of steel Elastin Recticular fibers Cells Examples: red blood cells, osteocytes (bone cells), chondrocytes Fluid: Ground substance, is hydrophilic (“water-loving”) CT can change under stress Agents of change: Movement, postural stresses, deep tissue work CT properties Thixotropy: Responds to variances in temperature by changing from a gel to a sol (liquid) and back again. Viscosity: Time-dependent property of thick fluid substance to resist and dampen pressure. Viscous fluids in the body resist compression and reduce joint friction. Elasticity: Ability to stretch and rebound. Plasticity: Irreversible deformation of tissue that occurs in response to forces that exceed its elastic limit. Piezoelectric effect: Generates electrical potentials. CT in skeletal system Bone CT proper Cartilage Blood Two kinds of bone tissue Compact - Strong, resists bending stress, provides protective outer layer Spongy - Inner layer, loosely arranged lattice, trabeculae along lines of tension Types of bone: Long, short, flat, irregular, sesamoid Bone remodeling Continual regenerative process Osteocytes: Reabsorb old tissue Osteoblasts: Produce new tissue Bone properties Strength Ability to resist fracture under stress Comes from calcium and minerals Elasticity Ability to deform and reform under stress Measured by load bone can withstand Bone fractures Bone fractures when load exceeds mechanical strength Bones always heal stronger after fractures There are many types of fractures Bony landmarks Types of landmarks: condyle, fossa, process, foramen Reasons to learn bony landmarks To verify location of touch To locate muscular attachments To check alignment and symmetry Three types of cartilage Hyaline: Covers articulating surface of bones in synovial joints Elastic: Flexible, found in ears Fibrocartilage: Found in disks Two types of dense connective tissues Regular CT has parallel fibers: Tendons, ligaments, joint capsules Irregular CT has crosshatched fibers: Fascia, periosteum, aponeurosis, Miscellaneous joint structures Bursa: Fluid-filled sacs Found under tendons and around joints Reduces friction between moving tissues Synovial sheaths: Fluid-filled sheaths Encase tendons around joints Protect tendons by allowing them to slide Inflammatory conditions Bursitis: Inflammation of bursa Tendinitis: Inflammation of tendons Tenosynovitis: Inflammation of synovial sheaths JOINT CLASSIFICATIONS Three major classifications Synarthrosis Fibrous joint, immoveable (e.g., sutures) Amphiarthrosis Fibrocartilage joint, semimoveable (e.g., intervertebral) Diarthrosis Synovial, freely moveable Synovial joint structures Joint capsule: Sleeve-like cuff Joint cavity: Enclosed by the capsule Hyaline cartilage: Covers articulating bones Synovial membrane: Lines capsule, secretes fluid Synovial fluid: Fills capsule, nourishes, lubricates, cleans Fibrocartilage disk Only in joints that work under high loads Example: knee, jaw, sc joint Joint surface shapes Ovoid: Convex surface fits into a concave surface (e.g., hip) Sellar: Articulating surface has both convex and concave shapes (e.g., knee) Understanding shapes of joint surfaces improves skills In joint approximation In passive joint motion In assessing active joint motion Six types of synovial joints Ball-and-socket: Most congruent and mobile Examples: hips, shoulders Ellipsoid or condyloid (condyle “knuckle”): Rounded half ball in shallow dish Example: wrists Hinge: Bony cylinder fits into a rounded trough Examples: knees, elbows Plane or gliding: Two slightly curved nearly flat surfaces Example: facet joint Pivot: Rounded end of one bone projects into a ring-like shape of another bone Examples: proximal radioulnar and atlanto-axial Saddle: Two saddle-shaped surfaces in reciprocal, interlocking relationship Examples: base of thumb, sternoclavicular Degrees of motion Nonaxial: 0, gliding Uniaxial: 1, hinge Biaxial: 2, ellipsoid Triaxial (multiaxial): 3 or more, ball-and-socket COG and LOG in optimal posture Center of gravity aligns along line of gravity in optimal posture Headthoraxpelvis (three body masses) stack over each other Five mechanical stresses Compression Tension Shear Torque Bending Loading and lines of force Combined loading: two or more forces Lines of force Pathway along which a force travels Longer the pathway, greater distribution of stress Pathways improve with optimal posture SUGGESTED CLASSROOM AND STUDENT DEVELOPMENT ACTIVITIES PROVIDE AN OVERVIEW OF CLASS Before class, write a short, schematic overview of the class on the board, then go over it at the beginning of class. For example: Today's class covers: Connective tissue Tissues of the skeletal system Joint classifications Skeletal alignment and gravity Activities: Review, lecture and learning activities, recap, and homework EXPLORING TECHNIQUES EXERCISES Tactile Explorations of Viscosity with Corn-Starch (p. 27). Review the connective tissue properties of thixotropy and viscosity, elasticity and plasticity, and the piezoelectric effect (pp. 2627). Discuss how these properties affect tissue responsiveness and quality of touch (speed, pressure, direction). Joint Approximation (p. 37). Use this exercise to study joint shapes and articulation, joint compression, and how lines of force pass through the skeleton. While demonstrating a joint approximation exercise on a joint, make sure to name the joint, identify what type of joint it is, demonstrate its range of movement and identify the number of degrees it can move, and briefly discuss the shape of its articulating surfaces. Axial Compression Test to Assess Lines of Force (p. 43). HANDS-ON EXERCISE: Trace the bones of one major part of the body from one bony landmark to another. BONY LANDMARK EXERCISE: Identify the major types of bony landmarks on a skeleton with sticky notes. There is a list of the major types of bony landmarks on page 31. Have students self-palpate these landmarks as you describe them © 2013 by Education, Inc. Foster, Instructor Resources for Therapeutic Kinesiology