FUNCTIONAL ANATOMY AND INJURY PREVENTION

Transcription

1 Functinal Anatmy and Injury preventin mdule FUNCTIONAL ANATOMY AND INJURY PREVENTION Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 1 f 216

2 Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 2 f 216

3 Functinal Anatmy and Injury preventin mdule Cntents Page CONTENTS PAGE... 1 OVERVIEW OF MODULE... 6 FUNCTIONAL ANATOMY... 9 THE SHOULDER MUSCLES AROUND THE SHOULDER JOINT INJURIES TO THE SHOULDER SHOULDER DISLOCATION SHOULDER (GLENOHUMERAL) JOINT DISLOCATION PREVENTION SLAP LESION & BANKART LABRAL TEARS ROTATOR CUFF TENDONITIS AND SHOULDER IMPINGEMENT SHOULDER BURSITIS SHOULDER POST REHABILITATION - CONDITIONING EXERCISES FOLLOWING AN INJURY THE ELBOW AND FOREARM MUSCLES AROUND THE ELBOW FUNCTIONAL ANATOMY OF THE WRIST INJURIES ASSOCIATED WITH THE ELBOW AND WRIST JOINT AND ITS ACCOMPANYING MUSCLES LATERAL EPICONDYLITIS OR TENNIS ELBOW TRICEPS STRAIN ELBOW BURSITIS CARPAL TUNNEL SYNDROME WRIST CONDITIONING EXERCISES FUNCTIONAL ANATOMY OF THE SPINE AND THORAX ABDOMINAL REGION INJURIES TO THE SPINE AND THORAX FACET JOINT PAIN (ZYGAPOPHYSEAL JOINT PAIN) SPONDYLOLISTHESIS COCCYX INJURY SCOLIOSIS RIB FRACTURE THORACIC OUTLET SYNDROME LUMBAGO (LOW BACK PAIN) BACK CONDITIONING EXERCISES ACETABULOFEMORAL JOINT (HIP JOINT) OVERVIEW OF MUSCLES AROUND THE HIP INJURIES TO THE STRUCTURE ASSOCIATED TO THE ACETABULOFEMORAL JOINT Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 3 f 216

4 Functinal Anatmy and Injury preventin mdule HAMSTRING (BICEP FEMORIS) STRAIN HAMSTRING TENDINITIS FEMUR STRESS FRACTURE QUADRICEPS (RECTUS FEMORIS) STRAIN ACETABULOFEMORAL (HIP) DISLOCATION PELVIC STRESS FRACTURE PIRIFORMIS SYNDROME FUNCTIONAL ANATOMY OF THE TIBIOFEMORAL JOINT INJURIES TO THE STRUCTURE ASSOCIATED TO THE TIBIOFEMORAL JOINT ANTERIOR CRUCIATE LIGAMENT INJURIES MENISCAL TEAR ILIOTIBIAL BAND SYNDROME PATELLOFEMORAL PAIN SYNDROME KNEE CONDITIONING EXERCISES FUNCTIONAL ANATOMY OF THE TALOCRURAL AND SUBTALAR JOINT INJURIES TO THE STRUCTURE ASSOCIATED TO THE TALOCRURAL AND SUBTALAR JOINTS ACHILLES TENDONITIS AND ACHILLES TENDINOPATHY ACHILLES TENDON RUPTURE MEDIAL TIBIAL STRESS SYNDROME (SHIN SPLINTS) PLANTAR FASCIITIS CONDITIONING EXERCISES FOR THE ANKLE AND FOOT GENERAL INJURY PREVENTION STRATEGIES MANAGEMENT OF SPORTS INJURIES R.I.C.E FOR ACUTE INJURIES FUNCTIONAL REHABILITATION BASICS OF BIOMECHANICS BIOMECHANICS - MOTION FORCE NEWTON S LAWS OF MOTION MOMENTUM LEVERS LEVER CLASSIFICATIONS ONE AND TWO ARM LEVERS RESISTANCE DEVICES CENTRE OF GRAVITY MUSCLE ANALYSIS POSTURE Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 4 f 216

5 Functinal Anatmy and Injury preventin mdule STATIC POSTURE THE WALKING GAIT STANCE PHASE THE SWING PHASE GAIT OBSERVATION AND ASSESSMENT VIDEO GAIT ANALYSIS FUNCTIONAL MOVEMENT SCREENING Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 5 f 216

6 Functinal Anatmy and Injury preventin mdule Overview f Mdule This exercise science and special ppulatins mdules address the all the systems within the bdy, and hw they can becme affected by cnditins. Here is a list f general websites which can prvide the learner with my infrmatin n the tpics thrugh this mdule: General websites: Research Thrugh the mdule, there are many images which d nt cntain infrmatin abut the wner f these images; the majrity f these images withut any reference t an external surce are btained frm the fllwing surce: Activities Thrughut this mdule and the fllwing mdules we have created activities fr yu t cmplete which will help yur learning and understanding f the tpics within each mdule. These activities are nt cmpulsry r marked, hwever we recmmend they are cmpleted t help understand tpics within this mdule. Activity Cmplete the fllwing Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 6 f 216

7 Functinal Anatmy and Injury preventin mdule Vides In additin t curse ntes within this mdule, there are vide which can aid the learner. These vide will be identified as belw and can be access n the ACSF Online Learning Centre within the Diplma f Fitness Sectin. DVD (length) Watch the fllwing DVD segment: [Vide Name] Vide # Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 7 f 216

8 Functinal Anatmy and Injury preventin mdule Intrductin t the exercise science mdule This functinal anatmy and injury preventin mdule breaks dwn the muscular make up f each sectin f the bdy identifying the muscles, their rigin and insertin and their mvements. The Cmpetencies assessed in this mdule Diplma students will be assessed n their curse wrk in multiple lessns t determine verall cmpetence in the fllwing units f cmpetency SISFFIT525A SISFFIT526A Advise n injury preventin and management Deliver prescribed exercise t clients with musculskeletal cnditins. These cmpetencies will be further applied and assessed during practical sessins. In additin, SISFFIT526A is als delivered and assessed during the Exercise Science and Special Cnditins mdule in the alternate term. By the end f this mdule, students will be required t knw: Functinal anatmy f jints and the musculskeletal system Analyse specific jint mvement frm cmplex mvements. The principles f bimechanics t minimise injuries The pathlgy f injury and injury respnse and the phases f healing Cmmn causes f injuries and the rle f exercise in preventin and management Limitatins f Specialised Exercise Trainers in advising n injury management and preventin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 8 f 216

9 Functinal Anatmy and Injury preventin mdule Functinal Anatmy Recap f Mvement Terminlgy Plane Actin Definitin Sagittal Flexin Decreasing the angle between tw bnes Extensin Hyperextensin Drsi flexin Plantar flexin Increasing the angle between tw bnes Increasing the angle between tw bnes beynd anatmical psitin Mving the tp f the ft tward the shin (Ankle nly) Mving the sle f the ft dwnward (Ankle nly) Frntal Abductin Mtin away frm the midline f the bdy (r bdy part) Adductin Elevatin Depressin Inversin Eversin Mtin tward the midline f the bdy (r bdy part) Mving the scapula t a superir psitin Mving the scapula t an inferir psitin Lifting the medial brder f the ft Lifting the lateral brder f the ft Transverse Rtatin Medial r lateral turning abut the vertical axis f bne in the transverse plane Prnatin Supinatin Hrizntal Flexin Hrizntal Extensin Of the frearm, rtating the hand and wrist frm the elbw t the palm dwn psitin r back Of the frearm, rtating the hand and wrist frm the elbw t the palm up psitin r frward. Frm a 90-degree abducted arm psitin, the humerus mves twards midline f the bdy in the transverse plane The return f the humerus frm the hrizntal flexin t 90-degree abductin Multiplanar Circumductin Mtin that describes a cne, cmbines flexin, abductin, extensin and adductin in sequential rder Oppsitin Thumb mvement unique t primates and humans that fllws a semicircle tward the little finger Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 9 f 216

10 Functinal Anatmy and Injury preventin mdule Recap f Directinal Terms Anterir: In frnt f, frnt Psterir: After, behind, fllwing, tward the rear Distal: Prximal: Drsal: Ventral: Superir: Inferir: Lateral: Medial: Away frm, farther frm the rigin Near, clser t the rigin Near the upper surface, tward the back Tward the bttm, tward the belly Abve, ver Belw, under Tward the side, away frm the mid-line Tward the mid-line, middle, away frm the side Illustratin shwing the directinal terms Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 10 f 216

11 Functinal Anatmy and Injury preventin mdule Recap f Anatmical Bdy Planes Sagittal (Medial) Plane- a plane that lies directly n the bdy s midline cutting the bdy in half, right between the eyes. This type f plane, which is included as a sagittal plane, divides the bdy int left and right parts. The Frntal r Crnal plane divides the bdy int anterir and psterir parts. Fr this plane, imagine that yur bdy was cut in half, except this time yur chest and back wuld be separated. Transverse plane r the hrizntal plane divides the bdy int superir and inferir parts. The bdy is divided in such a way that the upper regin arund yur head wuld be separated frm the lwer regin arund yu. Illustratin shwing the Anatmical bdy planes Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 11 f 216

12 Functinal Anatmy and Injury preventin mdule The Shulder The shulder cmplex is made up f multiple bnes, which cmbined tgether t make up 5 different jints (tw can be cnsidered articulatins rather than jints), which cnsists f and can be seen in the diagram belw: Acrmiclavicular jint Sternclavicular jint Glenhumeral jint Suprahumeral articulatin Scapulthracic articulatin Illustratin that identifies the 5 jints f the right shulder cmplex Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 12 f 216

13 Functinal Anatmy and Injury preventin mdule Of these 5 jints r articulatin, the main ne that we are cncerned with when referring t functinal anatmy is the glenhumeral. As mentined in the Exercise Science mdule, the glenhumeral jint is made up frm the head f the humerus and the glenid capsule r cavity. It is a ball-and-scked jint (as shwn in the illustratin belw n the right), which is the mst freely mvable type f jint in the bdy allwing almst all mvement. Illustratin a ball and scket jint Mvement permitted at the glenhumeral jint The fllwing table and illustratins indicate the types f mvement that are permitted at the glenhumeral jint within the shulder: Glenhumeral Jint Mvement Muscles invlved Flexin Extensin Deltid (anterir fibres) Pectralis Majr (upper fibres) Bicep Branchii Cracbrachialis Deltid (psterir fibres) Latissimus drsi Teres majr Infraspinatus Teres minr Pactralis majr (lwer fibres) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 13 f 216

14 Functinal Anatmy and Injury preventin mdule Illustratin Mvement Muscles invlved Abductin Adductin Hrizntal Abductin Hrizntal Adducitn Deltid (all fibres) Supraspinatus Latissimus drsi Teres majr Infraspinatus Teres Minr Pectralis majr (all fibres) Triceps branchii (lng head) Cracbrachialis Deltid (psterir fibres) Infraspinatus Teres minr Deltid (anterir fibres) Pectralis Majr Lateral (external) rtatin Deltid (psterir fibres) Infraspinatus Teres minr Medial (internal) rtatin Deltid (anterir fibres) Latissimus drsi Teres Majr Subscapularis Pactralis majr (all fibres) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 14 f 216

15 Mvement permitted at the Scapulthracic jint (scapula) Functinal Anatmy and Injury preventin mdule The fllwing tables and illustratins indicate the types f mvement permitted at the Scapulthracic jint within the shulder: Scapulthracic Jint Mvement Muscles invlved Elevatin Depressin Trapezius (upper fibres) Rhmbid majr Rhmbid minr Levatr scapula Trapezius (lwer fibres) Serratus anterir (with the rigin fixed) Pectralis minr Abductin (prtractin) Adductin (retractin) Serratus Anterir (with rigin fixed) Trapezius (middle fibres) Rhmbid majr Rhmbid minr Upward rtatin Dwnward rtatin Trapezius (upper and lwer fibres) Rhmbid Majr Rhmbid minr Levatr scapula Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 15 f 216

16 Muscles arund the Shulder jint Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 16 f 216

17 Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 17 f 216

18 Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 18 f 216

19 Functinal Anatmy and Injury preventin mdule The fllwing sectins addresses the individual muscles f the shulder, prviding infrmatin abut their attachment pints, muscle actins and mvement permitted. Deltid The deltid is a runded triangular shulder muscles lcated n the upper regin f the arm and lateral prtin f the shulder that is made up fr three different parts. The illustratin belw shws the deltid muscle frm the anterir and psterir view indicating its shape, the bnes it is attached t and the three different parts that make up the deltid. These parts include: Clavicular part, r anterir prtin Acrmial part, r middle prtin Spinal part, r psterir prtin Illustratin shwing the nterir view f the right deltid Illustratin shwing the psterir view f the right deltid The fllwing table identifies the deltid s rigin, insertin, actin and innervatin: Muscle Origin Insertin Actin Clavicular part f deltid Lateral third f the clavicle Acrmial Part Acrmin Deltid tubersity n the humerus Abductin Spinal part f Scapulae spine deltid Anteversin (mves the arm and shulder frward), internal rtatin, adductin Retrversin (mves the arm and shulder backward), external rtatin, adductin The deltid are an interesting muscle as it acts as its wn antagnist, whilst the anterir part is cntracting the psterir part is relaxing. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 19 f 216

20 Functinal Anatmy and Injury preventin mdule Trapezius The trapezius is the largest upper trs muscle, which, like the deltid, is made up f three different parts, cnsisting f: Descending part, r upper trapezius Transverse part, r middle trapezius Ascending part, r lwer traps The muscle expands frm the base f the skull, t the acrmin and then dwn t the bttm f the thracic spine (T12) where is attaches t the spinius prcess. Each part can cntract and wrk independently and is respnsible fr an individual rle r mvement, which is identified in the table belw. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 20 f 216

21 Functinal Anatmy and Injury preventin mdule Illustratin shwing the psterir view f the Trapezius The fllwing table identifies the rigin, insertin, actins and innervatin f each part f the trapezius: Muscle Origin Insertin Actin Trapezius Descending part: Occipital bne, and the spinus prcesses f all cervical vertebrae via the nuchal ligament Lateral third f the clavicle Draws the scapula bliquely upward and rtates the glenid cavity inferirly (acting with the inferir part f the serratus anterir). Tilts the head t the same side and rtates it t the ppsite side (with the shulder girdle fixed) Transverse part: Brad apneursis at the level f the T1-T4 spinus prcesses Acrmin Draws the scapula medially Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 21 f 216

22 Functinal Anatmy and Injury preventin mdule Ascending part: Spinus prcesses f T5-T12 Scapular spine Draws the scapula medially dwnwards (supprts the rtating actin f the descending part Entire muscle NA NA Steadies the scapula n the thrax Rtatr Cuff The Rtatr cuff muscles are a grup f muscles which extend frm the scapula t the head f the humerus, and are made up f: Supraspinatus named after being lcated superir t the spine f the scapular Infraspinatus named after being lcated inferir t the spine f the scapula Subscapularis named after being lcated underneath the scapular i.e. n the anterir surface Teres minr Alng with their individual actins, the rtatr cuff muscles act as a jint stabiliser securing the head f the humerus int the glenid cavity. Illustratin shwing the psterir view f the rtatr cuff muscles. Illustratin shwing the anterir view f the rtatr cuff muscles. The fllwing table identifies the rtatr cuffs rigin, insertin, actin and innervatin: Muscle Origin Insertin Actin Supraspinatus Supraspinus fssa f the scapula Greater tubersity f the humerus Abductin Infraspinatus Infraspinus fssa f the scapula Greater tubersity f the humerus External rtatin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 22 f 216

23 Functinal Anatmy and Injury preventin mdule Teres minr Lateral brder f the scapula Greater tubersity f the humerus External rtatin, weak adductin Subscapularis Subscapular fssa f the scapula Lesser tubersity f the humerus Internal rtatin Serratus Anterir The Serratus Anterir is a muscle lcated n the lateral surface f the ribs and runs psterirly twards the anterir surface f the scapula, where it is attached n the medial brder. The rigin is shwn n the image belw, but the lcatin f the insertin is nt easily visible due t it being attached t the anterir surface f the scapula. Illustratin shwing the serratus anterir (right side, lateral view) Muscle Origin Insertin Actin Serratus Anterir First thrugh ninth ribs Scapula: 1- superir part (superir angle) 2- Intermediate part (medial brder), 3- inferir part (inferir angle and medial brder) - Entire muscle: draws the scapula laterally frward, elevates the ribs when the shulder girdle is fixed (assists in respiratin) - Inferir part: rtates the scapula and draws its inferir angle laterally frward, (rtates glenid cavity superirly) - Superir part: lwers the raised arm (antagnist t the inferir part) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 23 f 216

24 The Rhmbids (majr and minr) and the Levatr scapulae The Rhmbids (bth majr and minr) lie psterirly t the ribs and are attached between the medial brder f the scapula and the spinus prcesses f the thracic spine. The Rhmbid minr is a lt smaller and lcated superirly t the Rhmbid majr. The Levatr scapulae is lcated superir t the rhmbids and expands between the superir angle f the scapula t the transverse prcesses f the cervical spine. Functinal Anatmy and Injury preventin mdule Illustratin shwing the Levatr Scapule, rhmbideus majr and rhmbideus minr (right side, psterir vew) Muscle Origin Insertin Actin Levatr Scapulae Transverse prcesses f the C1-C4 vertebrae Superir angle f the scapula - Draws the scapula medially upward while mving the inferir angle medially (returns the raised arm t the neutral psitin) - Inclines the neck tward the same side (when the scapula is fixed) Rhmbid Minr Spinus prcesses f the C6 and C7 vertebrae Medial brder f the scapula (abve the scapular spine) - Steadies the scapula - Draws the scapula medially upward (returns the raised arm t the neutral psitin) Rhmbid Majr Spinus prcesses f the T1-T4 vertebrae Medial brder f the scapula (belw the scapula spine) - Steadies the scapula - Draws the scapula medially upward (returns the raised arm t the neutral psitin) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 24 f 216

25 The Pectralis Majr and Cracbrachialis muscles Functinal Anatmy and Injury preventin mdule Lcate anterirly t the ribs; the Pectralis majr is the biggest muscle in the chest regin. It is cmpsed f three different parts, which include: Clavicular part Sternal and cstal (sterncstal) part Abdminal part Like the deltid, the Pectralis majr acts as an antagnist t itself, with the upper and lwer fibres perfrming ppsing actins at the shulder jint. The Cracbrachialis muscle is a small tubular muscle lcated in the anterir prtin f the armpit and lies deep t the Pectralis majr. The Image belw indicates the parts f the Pectralis muscle, the Cracbrachialis and surrunding bny landmarks. Illustratin shwing the anterir view f the right pectralis majr and cracbrachialis Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 25 f 216

26 Muscle Origin Insertin Actin Functinal Anatmy and Injury preventin mdule Pectralis Majr Clavicular part: medial half f the clavicle. Sterncstal part: sternum and the secnd thrugh sixth cstal cartilages Crest f the greater tubersity f the humerus Adductin and internal rtatin (entire muscle), anteversin (clavicular part and sterncstal part), assists respiratin when the shulder girdle is fixed Abdminal part: anterir layer f the rectus sheath Cracbrachialis Cracid prcess f the scapula Humerus (in line with the crest f the lesser tubersity) Anteversin, adductin, internal rtatin The image n the right indicates the twisting and untwisting (fllwing the flexin mvement f the shulder) f the muscles as it ascends and attaches t the crest f the greater tubercle f the humerus. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 26 f 216

27 Functinal Anatmy and Injury preventin mdule Pectralis Minr and Subclavius The Pectralis minr is a smaller muscle which lies at the same depth as the Cracbrachialis and deeper than the Pectralis majr. The Pectralis minr helps elevate the ribs during increased respiratin. The Subclavius is a small muscle lcated inferir (underneath) t the clavicle and lies deep t the Pectralis majr. Muscle Origin Insertin Actin Illustratin shwing the pectralis minr and subclavius (right side, anterir view) Subclavius First rib Inferir surface f the clavicle (lateral third) Steadies the clavicle in the sternclavicular jint Pectralis minr Third thrugh fifth ribs Cracid prcess f the scapula - Draws the scapula dwnward, causing its inferir angle t mve pstermedially (lwers the raised arm), rtates glenid inferirly - Assists in respiratin Latissimus Drsi and Teres Majr The latissimus drsi is the bradest muscle f the back extending frm the thraclumbar fascia acrss the trs t the prximal end f the humerus attaching t multiple bny landmarks alng the way, as shwn in the illustratin belw. The teres majr, referred t in the Trail Guide t the Bdy (Biel, 2005) as the lats little helper, is a synergist fr tr the latissimus drsi and is lcated between the lateral brder f the scapula t the prximal end f the humerus. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 27 f 216

28 Functinal Anatmy and Injury preventin mdule Illustratin shwing the psterir view f the Latissimus and Teres majr The illustratin n the right captures the insertin pints f the latissimus drsi and teres majr frm the anterir view, shwing the bny landmarks which are lcated in clse prximity t this attachment site. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 28 f 216

29 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Latissimus drsi Vertebral part: - spinus prcesses f the T7-T12 vertebrae - thraclumbar fascia f the spinus prcesses f all lumbar vertebrae and the sacrum Crest f the lesser tubersity (anterir view) f the humerus Internal rtatin, adductin, retrversin (mves the arm backward), respiratin (expiratin, cugh muscle ) Iliac part: psterir third f the iliac crest Cstal part: 9 th thrugh 12 th ribs Scapular part: inferir angle f the scapula Teres Majr Inferir angle f the scapula Crest f the lesser tubersity f the humerus Internal rtatin, adductin, retrversin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 29 f 216

30 Functinal Anatmy and Injury preventin mdule Injuries t the Shulder Shulder dislcatin Dislcatins f the shulder ccur when the head f the humerus is remved frm its scket in the glenid fssa. Subluxatins ccur when nly the head partially cmes ut and then pps back. 90% f all shulder dislcatins are anterir (humeral head mved frward). Psterir dislcatins (humeral head has mved backward) are ften assciated with sprts r falls. Subluxatins can result frm the same trauma and als ccur with much less frce in jints that are naturally lse r frm injury. What is a subluxatin? A subluxatin f the glenhumeral jint cnsists f the head f the femur partially dislcating frm the glenid fssa. Depending n the severity f the sublaxatin, this can cause stretching r tearing f the structures arund the glenhumeral jint, but is nt as severe as a full dislcatin. Risk factrs Shulder dislcatin usually ccurs fllwing a trauma f sme kind, which are indicated belw: Falling and using the arm t break the fall Impact t the shulder Falling nt yur shulder Sharp twisting f the arm High impact sprts such as ftball, sccer, and hckey Recreatinal activities such as rck climbing and skiing. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 30 f 216

31 Functinal Anatmy and Injury preventin mdule Signs and Symptms Shulder dislcatin can be evident by the intense pain lcated at the glenhumeral jint fllwing a trauma (these are indicated in risk factrs), hwever, there are ther symptms that present themselves during a dislcated shulder include: Cannt mve the arm, scapula r shulder Arm numbness and weakness A visibly ut f place shulder Swelling Diagnsis Diagnsis fr a shulder dislcatin is usually made by a dctr r allied health prfessinal. X-rays are usually recmmended t cnfirm the initial diagnsis and make sure there are n brken bnes. Treatments Dislcated shulders need t be treated right away t prevent further damage f surrunding structures. The lnger the jint is ut f the scket, the mre swllen and mre painful by the injury will becme. After the shulder bne is repsitined, treatment may be required t reduce pain and swelling. When is surgery required? Surgery fr mre severe dislcated shulder injuries surgery is smetimes needed t crrectly psitin the bnes. Individuals wh are cntinually dislcating their shulder may require surgery t tighten the tendns surrunding the jint. Types f surgery include arthrscpic and pen shulder prcedures. Read the fllwing hand ut in the additinal reading sectin: Reading Treatment f shulder dislcatin: is a sling apprpriate? DVD (2 mins) Watch the fllwing DVD segment: Relcate a Dislcated Shulder Vide 1 Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 31 f 216

32 Functinal Anatmy and Injury preventin mdule Shulder (glenhumeral) jint dislcatin preventin The glenhumeral jint within the shulder cmplex is a hugely vulnerable jint due t it wide range f mvement and shallw cavity where the head f the femur fits. Like the acetabulfemral jint f the hip, the glenhumeral jint is a ball-and-scket jint, hwever they differ slightly. The acetabulfemral jint fits int a bny scket structure, whereas the glenhumeral jint sits nt the glenid fssa and a cartilage labrum, which is a lip designed t increase the stability f the jint. The fllwing illustratins shw the tw main ball-and-scket jints, indicating the slightly different structure and risk f stability. Illustratin shwing the acetabulfemral ball-and-scket jint Illustratin shwing the glenhumeral ball-and-scket jint The ther element differentiating these tw ball-and-scket jints and limits the stability f the glenhumeral jint, is the small number f supprtive ligaments that surrund the glenhumeral jint. The acetabulfemral jint has many ligaments securing the jint (these ligaments twist frm the rigin t insertin t increase their strength), whereas the glenhumeral jint relies n the strength and activatin f the rtatr cuff muscles t secure the head f the femur t the glenid fssa. The tendns f these muscles surrund the head f the femur and activate t draw it int the jint t stabilise it during mvement. These muscles include: supraspinatus infraspinatus subscapularis teres mainr In additin t these stability issues fr the glenhumeral jint, anther imprtant factr that can be respnsible fr shulder injuries is the humerscapular rhythm. This is where the humerus and scapula must crdinate mvement simultaneusly t allw all the structures surrunding these jints are kept in the crrect psitin and are nt damaged. The scapulhumeral mvement is explained here: The initial 30 degrees f shulder elevatin invlves mainly the glenhumeral, with the scapula nt being invlved. After the initial 30 degrees f shulder elevatin, the glenhumeral and scapulthracic jints mve simultaneusly. The humerscapular rhythm is shwn in the belw image: Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 32 f 216

33 Functinal Anatmy and Injury preventin mdule Illustratin shwing the humerscapular rhythm The fllwing image indicates the muscles, which are respnsible fr ensuring the humerscapular rhythm. Image surced frm By cnsidering the structure f the jint can give a fitness prfessinal sme understanding f hw t prevent the dislcatin f the glenhumeral jint. Sme strategies include: Strengthen the rtatr cuff muscles Stretch muscles arund the shulder which can influence the shulder cmplex i.e. triceps, pectralis majr Ensure the rtatr cuff muscles are activating crrectly during shulder mvement Crrect any malignment f the shulder cmplex i.e. anterirly tilted scapula Ensure the humerscapular rhythm is functining crrectly Additinal strategies include: Take precautins t avid falls Stp if pain is experienced in the shulder during physical activity Use prtective padding t prtect frm falls and impact in sprt. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 33 f 216

34 Functinal Anatmy and Injury preventin mdule Read the fllwing hand-ut in the additinal reading ntes: Reading Rehabilitatin after shulder dislcatin SLAP Lesin & Bankart Labral tears As mentined in the previus sectin, the structure f the glenhumeral jint cnsists f a cartilage lip, called the labrum that lines the glenid fssa t deepen the scket fr the head f the femur t attach t. This labrum intends t prvide greater stability within the jint; hwever, it is vulnerable t damage during trauma t the shulder. As the glenhumeral jint is expsed t a great deal f mvement and frce, if the stability f the jint is cmprmised frm a sudden mvement, jerk r unnatural mvement it can place stress n the labrum and result in damage. The damage usually invlves a lesin r tear and is described accrding t its lcatin; the tw types include: Bankart Labral tear (lesin) is the mst cmmnly type f labral tear and cnsists f a tear at the inferir anterir prtin f the labrum (belw the middle f the labrum). It is usually a result f a shulder dislcatin where the head f the femur is frced anterirly. SLAP lesin refers t Superir Labral Anterir Psterir lesin, which is where the labrum tears in the superir (abve the middle f the labrum) prtin and can be either the anterirly r psterirly part f the tp. This type f labral tear can be caused in many different ways: Repetitive shulder mtins, which ver time can wear dwn the labrum Acute trauma t the jint, where the head f the femur mves psterirly ut f the jint and can result frm: A fall nt the ut stretched arm Shulder dislcatin Frceful mvement f the arm when it is abve the head Frceful pulling f the arm dwnwards. In sme cases, the bicep tendn, which attaches t the superir prtin f the labrum, can als cntribute t this type f labral tearing. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 34 f 216

35 Functinal Anatmy and Injury preventin mdule Crss-sectin view f the shulder scket shwing a SLAP tear - image surced frm Illustratin shwing the lcatin f a bankart lesin image surced frm Signs and Symptms The signs and symptms f the tw types f labral tears cnsist f: SLAP Lesin Sensatin f lcking, catching, ppping r grinding Pain mving arm abve the head Bankart Labral tear Sense f shulder instability Aching arund the shulder Significant decrease in shulder/arm strength Pssible repetitin r feeling f shulder dislcatin Decreased shulder range f mtin Catching sensatin in shulder Diagnsis In sme cases a physical examinatin can be perfrmed by a General Practitiner (GP) t determine the strength, range f mtin and stability f the glenhumeral jint, and frm this the GP can suspect whether and where damage t the labrum has ccurred. Hwever, t gain a cnfident diagnsis f a SLAP r Bankart lesin an X-ray r MRI (Magnetic Resnance Imaging) must be cmpleted t determine visually whether the labrum has damage t it. The belw image shws the visual sign f a SLAP lesin frm an MRI scan. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 35 f 216

36 Functinal Anatmy and Injury preventin mdule (Image surce frm American Academy f Orthpaedic Surgens - Treatment Treatment fr a labrum tear initially cnsists f cnservative methds that include anti-inflammatry medicatin and rehabilitatin exercises t strength the supprting muscles. Hwever, if these cnservative measures are insufficient then the next treatment methd cnsists f arthrscpic surgery. The prcess f the surgery will depend n the type f damage that has ccurred. If the damage is just n the labral rim, usually any trn areas are remved Whereas, if the damage has included the biceps tendn, surgery will include the repair and reattachment f the biceps tendn using tacks, wires r sutures (which are absrbable). Preventin T prevent a glenid labral tear frm ccurring, the risk factrs must be addressed and prevented. Therefre preventative methds cnsist f: Take precautin methds t prevent falls Strengthen shulder stability muscles t reduce risk f dislcatin Ensure the shulder cmplex is functin crrectly t reduce wear and tear Stretch the bicep tendn DVD (12 mins) Watch the fllwing DVD segment: Labral Tears Part 1 Labral Tears Part 2 Vide 2 & 3 Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 36 f 216

37 Functinal Anatmy and Injury preventin mdule Read the fllwing hand ut in the additinal reading sectin: Reading Labral Tear Slap & Bankart Rtatr cuff Tendnitis and Shulder impingement Rtatr cuff tendnitis is a cnditin where the ne r mre f the rtatr cuff tendns becme damaged, inflammed and begin t degenerate. The rtatr cuffs muscles cnsist f: Supraspinatus Infraspinatus Subscapularis Teres minr The rtatr cuff muscles have individual rles that include internal and external rtatin and abductin hwever, they act tgether t perfrm a stabilising rle fr the glenhumeral jint. The cntractin f these muscles individually is relatively weak but becmes strng when they cntract tgether. When these muscles are required t exert a frce greater than their capacity, r they are nt perfrming efficiently tgether, tensin and stress develps n the tendns which attach t the prximal surface f the femur. When this tensin and stress becmes t much these structure are expsed t ptential damage. When damage ccurs, it is accmpanied by inflammatin, which can then lead t degeneratin f the tendns this is knwn as rtatr cuff tendnitis and can ccur t any f the muscles individual. Cause Rtatr cuff tendnitis is generally a result f repetitive r prlnged mvement that places stress n the rtatr cuff muscles. This mst cmmnly invlves cntinus lifting r perfrming mvements with the arms abve the head, but it can als include lying n ne side cnstantly r repetitive pushing and pulling. In sme cases rtatr cuff tendnitis can be caused by an abrupt mvement that expses the rtatr cuff t a high frce that causes a tendn t sudden tear. This tear is an injury in itself which causes inflammatin, hwever, if it is nt allwed t heal crrectly it can develp int rtatr cuff tendnitis. Signs and symptms The signs and symptms f this cnditin can be dependent n the severity f the cnditin. They mainly invlve a dull aching pain, that develps gradually, where the rtatr cuff tendns are lcated, but may extend t the shulder blade, upper back r neck. Hwever, in severe cases the strength can be cmprmised and muscle wasting can ccur that is accmpanied by pain at night (regardless f psitin). The decrease in strength can be evident as individual struggle t lift bjects abve their head r are presented with pain when they d s. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 37 f 216

38 Functinal Anatmy and Injury preventin mdule Risk factrs There are certain factrs, which can predispse individual t develp rtatr cuff tendnitis, which cnsist f: Shulder instability Shulder muscle weakness (i.e. the deltids, which results in the supraspinatus being required t wrk harder) Shulder muscle tightness Restricted jint ROM Pr scapula psitining and psture Excessive training that invlves the shulder muscles Inadequate warm up Previus histry f shulder injury Develpment f bne spurs Diagnsis Diagnsis f Rtatr cuff tendnitis is usually prduced fllwing a physical examinatin f an allied health prfessinal, such as a Physitherapist. T cnfirm the diagnsis and prvide mre in depth details abut the severity and specific tendn affected ultrasund, X-ray r MRI can be perfrmed. Treatments Initial treatment usually invlves addressing the inflammatin and encuraging the healing prcess, and therefre may cnsists f: Ice r heat treatment Anti-inflammatry medicatin Sft-tissue massage Electrtherapy Jint mbilisatin (use f a sling) In additin t the abve treatment, individuals with this cnditin are ften prescribed exercises t address; muscle instability, muscle tightness, muscle weakness, pr psture and restricted shulder jint ROM. These exercises are prvided in the Shulder Cnditining Exercises fllwing an injury belw. Read the fllwing hand ut in the additinal reading sectin: Reading Shulder Rehabilitatin Stages Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 38 f 216

39 Functinal Anatmy and Injury preventin mdule Shulder Bursitis Shulder bursitis is an injury r inflammatin f the bursa arund the shulder jint. Impingement caused by bursitis makes the space becme t narrw t accmmdate the tendns and the bursa and a pinching ccurs. Cause Shulder bursitis is caused by repetitive lifting r verhead activities. Anther cmmn cause f bursitis is pst shulder injuries. The prcess f inflammatin during an injury causes tendns and bursa t becme inflamed. This inflammatin causes a thickening f these structures which then takes up mre space which causes the tendns and bursa t be pinched upn even mre. Signs and Symptms Pain radiating frm the frnt f the shulder t the side f the arm Pain with lifting and reaching mvements Pain when thrwing Pain when mving arm behind the back such as buttning r zippering Pain at night Lss f strength and mtin Lcalised pain, swelling, r tenderness Risk factrs Risk factrs fr shulder bursitis include: Wrk envirnments where repetitive arm and shulder mvements are required Sprts where high repetitive shulder and arm mvements Pr psture Weak surrunding muscles f the shulder Arthritis Staphylcccal infectin Diagnsis Diagnsis fr shulder bursitis is thrugh a mvement and physical examinatin by a dctr r allied health prfessinal. X-rays and MRI scans can be recmmended fr lng term prblems with this cnditin. An X-rays will assess the bny anatmy f the shulder and can identify calcificatins in the bursa when bursitis has been chrnic r recurrent. MRI scans will further define bursitis pick up signs f any rtatr cuff tears. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 39 f 216

40 Functinal Anatmy and Injury preventin mdule Treatments The gal fr treatment f bursitis cnsists: 1) Reducing the symptms 2) Minimize damage 3) Maintain rtatr cuff mtin and strength T address the first tw pints mentined abve the inflammatry respnse shuld be preliminary targeted, which invlves anti-inflammatry medicine, ice, cmpressin and rest. Fllwing this initial treatment, the functin f the muscles surrunding the bursa shuld be addressed. This encmpasses the range f mtin and strength f muscles arund the shulder, such as deltids, rtatr cuffs, pectrals, biceps and triceps. DVD (4 mins) Watch the fllwing DVD segment: Shulder Bursitis Vide 4 Injury Preventin Like mst cnditins, t prevent this cnditin frm ccurring, the risk factrs must be addressed. Therefre t d this, the fllwing shuld be perfrmed: Strengthen any weaknesses in the shulder muscles Stretch any muscles which are restricting shulder ROM Imprve any prblems with the shulder psture Ensure humerscapular rhythm is functining crrectly Shulder impingement Shulder impingement can be an assciated cnditin t rtatr cuff tendnitis, and invlves the rtatr cuff muscles and bursa, mst specifically the supraspinatus muscle and bursa, being squeezed r impinged alng the narrw space they pass thrugh. The tendn f the supraspinatus passes thrugh the subacrmial space, which is the space between the acrmin and the head f the humerus. When this space becme reduced, r the suprspinatus tendn and bursa becme thickened impingement can ccur as the arm becmes raised. Illustratin shwing the impingement f the supraspinatus tendn Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 40 f 216

41 Functinal Anatmy and Injury preventin mdule The space can be reduced as a result f: Scapula misalignment Pr humerscapular rhythm Tight supraspinatus which draws the head f the humerus superir in the jint Develpment f spurs at the inferir surface f the acrmin The tendn can becme thickened as a result f: Inflammatin f the tendn (rtatr cuff tendnitis) Inflammatin f the bursa DVD (9mins) Watch the fllwing DVD segment: Shulder Impingement Vide 5 Shulder cnditining exercises The fllwing exercises have been taken frm a Rtatr Cuff and Shulder Cnditining Prgram prepared by the American Academy f Orthpedic Surgens (AAOS). The AAOS state that this prgram is t be used fllwing a shulder injury r surgery t help the individual return t nrmal functin. Only a few selected exercises have been included in this mdule, hwever, t see the full prgram visit the additinal readings. Stretching exercises Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 41 f 216

42 Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 42 f 216

43 Functinal Anatmy and Injury preventin mdule Strengthening exercises Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 43 f 216

44 Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 44 f 216

45 Functinal Anatmy and Injury preventin mdule Surced frm Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 45 f 216

46 Functinal Anatmy and Injury preventin mdule The Elbw and Frearm The main jint in the elbw cnsists f the articulating surface between the distal head f the humerus and the prximal head f the ulnar and radius, which are called the humerradial jint and the humerulnar jint. The majrity f the articulatin ccurs between the humerus and the radius, and therefre the humerradial jint is the main. The humerulnar and humerradial jints are bth hinge jints; the structure f the hinge jint is shwn in the image n the right. Illustratin shwing the shwing a hinge jint Illustratin shwing the lateral view f the humerradial and humerulnar jints Illustratin shwing the medial view f the humerradial jint There are anther tw jints, which exist in the frearm between the radius and ulnar called the radiulnar jints. These articulate tgether at the distal heads f the radius and ulnar and at the prximal heads f the radius and ulnar t frm: Superir radiulnar jint (r articulatin) Inferir radiulnar jint (r articulatin) Bth the inferir and superir jints are classified as pivt jints; which the structure is shwn in the image n the right. Illustratin shwing the shwing a pivt jint Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 46 f 216

47 Functinal Anatmy and Injury preventin mdule Mvement permitted at the elbw jint The mvement that is permitted at the humerradial and humerulnar jints cnsists f a single plane mvement cnsisting f: Flexin Extensin The inferir and superir radiulnar jints perfrm a different mvement that the humerradial and humerulnar jints, t give greater range f mvement t the arm. There mvements include: Prnatin Supinatin The illustratins belw demnstrate these mvements in actin and the muscles which perfrm this actin: a. Shws the mtin f the arm prnatin (when the arm is flexed). b. Shws the mtin f the arm during supinatin (when the arm is flexed). Humerradial and humerulnar Jint Mvement Muscles invlved Flexin Extensin Bicep branchii Brachialis Brachiradialis Flexr carpi radialis Flexr carpi ilnaris Palmaris lngus Prnatr teres Triceps Ancneus Superir and Inferir Radiulnar Mvement Muscles invlved Prnatin Prnatr teres Prnatr quadratus Brachiradialis Supinatin Biceps branchii Supinatr Brachiradialis Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 47 f 216

48 Muscles arund the elbw Biceps and Triceps Functinal Anatmy and Injury preventin mdule The biceps and triceps are they main muscles in the upper arm, and lcated anterirly (biceps) and psterirly (triceps) t the humerus. With the muscles being lcates either side f the elbw jint; they have an antagnistic relatinship, where ne muscle cntract and the ther relaxes. Fr example, when the biceps cntracts (and shrten) t flex the elbw the triceps relax (and length) t allw flexin t ccur. They are named fllwing the number f heads each muscle has, with the biceps having tw heads (lng and shrt) and the triceps having three heads (lng, medial and lateral). Illustratin shwing the anterir view f the right bicep branchii and brachialis Illustratin shwing the psterir view f the triceps branchii and ancneus Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 48 f 216

49 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Bicep Branchii Lng head: supraglenid tubercle f the scapula Shrt head: cracid prcess f the scapula Radial tubersity Elbw jint: - Flexin, supinatin (with the elbw flexed) Shulder jint: - Stabilizatin f humeral head during deltid cntractin - Abductin and internal (medial) rtatin f the humerus Brachialis Distal half f the anterir surface f the humerus, als the medial and lateral intermuscular septa Ulnar tubersity Flexin at the elbw jint Triceps Branchii Lng head: Infraglenid tubercle f the scapula Medial head: psterir surface f the humerus, distal t the radial grve Olecrann f the ulna Elbw jint: extensin Shulder jint: lng head: backward mvement and adductin f the arm Lateral head: psterir surface f the humerus prximal t the radial grve Functinal Anatmy f the Wrist The wrist is made up f the radicarpal jint cnsisting f the head f the distal end f the radius and the prximal carpals, and the articulating surfaces between the carpals. The radicarpal jint is an ellipsid jint, shwn belw. This ellipsid jint appears relatively similar t a ball-and-scket jint, hwever is mre restricted with the mvements permitted. Illustratin shwing theradicarpal jints Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 49 f 216

50 Functinal Anatmy and Injury preventin mdule Mvement permitted at the wrist The fllwing illustratins shw the mvement that is permitted at the radicarpal jint. a. (Drsal) extensin and (palmar) flexin b. Abductin (Radial deviatin) and Adductin (ulnar deviatin) Radicarpal Jint Mvement Muscles invlved Drsal Extensin Extensr carpi radialis lngus Extensr carpi radialis brevis Extensr carpi ulnaris Extensr digitrum (assists) Palmar Flexin Flexr carpi radialis Flexr carpi ulnaris Palmaris lngus Flexr digitrum superficialis Flexr digitrum prfundus (assists) Radicarpal Jint Mvement Muscles invlved Abductin (Radial deviatin) Extensr carpi radialis lngus Extensr carpi radialis brevis Flexr carpi radialis Adductin (Ulnar deviatin) Extensr carpi ulnaris Flexr carpi ulnaris Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 50 f 216

51 Functinal Anatmy and Injury preventin mdule Frearm muscles The frearm cnsists f many different small muscles which are respnsible fr the fine mtr cntrl required in the hands and fingers. Hwever, there are muscles which can be clustered tgether int tw grups f muscles, and these cnsist f the wrist flexrs and the wrist extensrs. The individual muscles which are part f each grup cnsist f: Flexrs f the wrist and hand are made up f: Flexr carpi radialis Flexr carpi ulnaris Flexr digitrum superficialis Flexr pllicis lngus Extensrs f the wrist and hand are made up f: Extensr carpi radialis lngus Extensr carpi radialis brevis Extensr digitrum Extensr digiti minimi Extensr carpi ulnaris Illustratin shwing the anterir view f the flexr muscles f the right frearm Illustratin shwing the psterir view f the extensr muscles f the right frearm Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 51 f 216

52 Muscle Origin Insertin Actin Functinal Anatmy and Injury preventin mdule Brachiradialis Lateral surface f the distal humerus, lateral intermuscular septum Stylid prcess f the radius Elbw jint: flexin Frearm jints: semi-prnatin Extensr carpi radialis lngus Lateral surface f the distal humerus, lateral intermuscular septum Drsal base f the secnd metacarpal Elbw jint: weak flexr Wrist jint: drsal extensin (assists in fist clsure), abductin (radial deviatin) f the hand Extensr carpi radialis brevis Lateral epicndyle f the humerus Drsal base f the third metacarpal Elbw jint: weak flexr Wrist jint: drsal extensin (assists in fist clsure), abductin (radial deviatin) f the hand Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 52 f 216

53 Functinal Anatmy and Injury preventin mdule Injuries assciated with the elbw and wrist jint and its accmpanying muscles Lateral epicndylitis r Tennis elbw Lateral epicndylitis, als knwn as Tennis elbw due t it being cmmn amngst tennis players, is a cmmn injury causing inflammatin and pain at the attachment pint f the tendns f the extensrs. This is lcated n the lateral epicndyle f the humerus r n the utside f the elbw. It can affect any f the wrist extensrs, which include: Extensr carpi radialis lngus Extensr carpi radialis brevis Extensr carpi ulnaris Extensr digitrum Extensr digiti minimi Hwever, f these extensr muscles the dysfunctin and pain is frequently caused by the extensr carpi radialis brevis, due t its functin in stabilising the wrist when the elbw is extended, and its lcatin. The extensr carpi radialis brevis rubs against bny prtrusins, which can eventually lead t the muscle wearing and tear ver time. The mst cmmn cause f tennis elbw is repeated veruse f yur arm, where a specific mvement causes the extensrs t be the dminant muscles being used. A range f different activities that invlve repeated hand, wrist and frearm mvements are mst likely t cause this cnditin as a result f the extensrs being cntinuusly stressed. Examples f these include: using a screwdriver sewing r knitting using a keybard and muse painting gardening (Image surced frm Signs and Symptms Signs and symptms f this cnditin may include any f the fllwing: Pain n the utside f the elbw when the hand is extended at the wrist against resistance. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 53 f 216

54 Functinal Anatmy and Injury preventin mdule Pain n the utside f the elbw when trying t straighten the fingers against resistance. Pain when pressing just belw the lateral epicndyle n the utside f the elbw. Pain when making a fist r shaking hands Weakness in the wrist r gripping strength Difficulty with everyday tasks (pening a tight dr handle) Neck stiffness be assciated with the cnditin Risk factrs The risk factrs fr this cnditin can invlve ccupatins r individuals wh are cntinually perfrming repetitive hand, wrist and frearm mvements that invlve the frearm extensrs. These can invlve: Office wrkers using a muse Manual Laburers wh are gripping and perfrming fine mtr mvements f the wrist e.g. painters, plumbers and carpenters Sprtspeple such as tennis players Anther risk factrs is assciated t age, with the majrity f individuals wh suffer frm this cnditin are between the age f 30 and 50 years ld. Diagnsis Lateral epicndylitis diagnsis can be frm a dctr r a allied health prfessinal such as a physitherapist. Initial cnsultatins are abut identifying signs and symptms and making a activity mdificatin t reduce inflammatin. An X-ray r ultra sund can als be recmmended t rule ut ther cnditins such as arthritis which may have similar signs and symptms t tennis elbw. Treatments Treatment fr this cnditin can be classified int nn-surgical and surgical treatment, with nn-surgical methds being the initial steps taken. Nn-surgical treatment cnsists f: Rest give the muscles and tendns the pprtunity t recver and heal Anti-inflammatry medicines (nn-steridal) helps reduce the inflammatin f the structures encuraging the healing Stretch extensr muscles by increasing the length f the extensr muscles can reduce the stress that is placed n the tendns. Brace a brace can help relieve the symptms f tennis elbw Check equipment ensure that the equipment fits prperly Strength prgram wrk n strengthening the muscles f the frearm t cpe with added stress. Sterid injectins Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 54 f 216

55 Functinal Anatmy and Injury preventin mdule If the abve nn-surgical treatment is nn-effective surgical treatment can be perfrmed, and cnsists f tw different methds: Open surgery Arthrscpic surgery Althugh surgery is usually successful, there are additinal risks t undertaking surgery t cmbat this cnditin. These risks cnsist f: Infectin t the surgical area Nerve and bld vessel damage in the surrunding area Pssible prlnged rehabilitatin Additinal lss f strength Additinal lss f flexibility Pssible need fr further surgery DVD (6 mins) Watch the fllwing DVD segment: Tennis Elbw Pain Relief Vide 6 Tennis Elbw Injury Preventin Belw is a list f injury preventin recmmendatins fr Tennis Elbw: Ensure a gradual warm up fr all activities and sprts f 5-10minutes. Avid ding the same activity fr lng perids f time take regular breaks Seek advice early frm yur dctr r physitherapist a prblem arises Stp any activity that causes pain t the area Rest between sessins D nt play sprt if the arm is painful Get prfessinal advice n technique crrectin fr the sprt r activity Perfrm strength training exercises t strengthen muscles and surrunding structures. Pst Rehabilitatin See frearm rehabilitatin exercises at the end f this sectin n page Read the fllwing hand ut in the additinal reading sectin: Tennis elbw exercises Reading Rehab fr tennis elbw: The super 7 Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 55 f 216

56 Functinal Anatmy and Injury preventin mdule Triceps Strain A triceps strain is damage t the triceps brachii. This type f strain can ccur anywhere in the triceps brachii, but usually ccurs where the muscle and tendn meet, as this is the weakest pint f the triceps muscle. As discussed with previus muscle strains, there are 3 grades: Grade 1 triceps muscle strain is essentially a muscle pull. It is mild and there is little r n lss f strength. Grade 2 triceps muscle strain invlves sme tearing f muscle fiber. Usually abut 10% f muscle fiber damaged. Grade 3 triceps muscle strain invlves a rupture f the muscle and varius amunts f damage t fibers, tendns and pssibly bne. Signs and Symptms The symptms which accmpany a triceps strain include: Pain in the muscle f the triceps r the attachment pints at the elbw r shulder. Pain is usually sudden in nset and a small ppping r ripping sensatin may be felt. Pain when extending the elbw against resistance. Pain with tensin n stretching the triceps muscles (bending the elbw, especially with the arm verhead). Tenderness Mild swelling r bruising Nticeable weakness r lack f strength in the upper arm. Read the fllwing hand ut in the additinal reading sectin: Reading Acute and Chrnic Stage Symptms Risk factrs Studies have shwn that mst triceps strains ccur in men between the ages f 30 and 50 years ld wh engage in ftball and cmpetitive weightlifting. Other sprts that invlve veruse f the elbw, such as bxing and gymnastics, may cause very minr tears in the triceps tendn. Diagnsis Diagnsis f a triceps strain is thrugh a subjective and bjective examinatin frm a physitherapist. Occasinally, further investigatins such as an ultrasund, X-ray, CT scan r MRI scan may be required t assist with diagnsis and assess the severity f the cnditin. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 56 f 216

57 Functinal Anatmy and Injury preventin mdule Treatments A grade 1 strain will be treated with rest, ice and pssible taping. The anticipated recvery time is anywhere frm, as ur reference material tells us, 2-10 days. A grade 2 strain will als be treated with ice, rest and taping but in additin will smetimes require an immbilizatin splint and even cast. Further strengthening therapy will have t take place. Anticipated recvery time is "10 days t six weeks." A grade 3 strain will ften times require surgery and take anywhere frm six t 10 weeks t heal prperly. The mst cmmn residual prblems fr a triceps muscle strain are re-ccurrence and trying t use the muscle t quickly. Injury Preventin The best way t prevent triceps tendnitis is t avid veruse and frceful mvements f the upper arm and elbw. It is imprtant t recgnise early symptms and nt t make the injury wrse by ver activity. Pst Rehabilitatin See frearm rehabilitatin exercises at the end f this sectin n page 58. Read the fllwing hand ut in the additinal reading sectin: Reading Triceps Strengthen Exercises Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 57 f 216

58 Functinal Anatmy and Injury preventin mdule Elbw Bursitis Activity Research and find infrmatin abut a Pelvic Stress Fracture and cmplete the table belw: Overview Cause Risk Factrs Signs and symptms Diagnsis Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 58 f 216

59 Functinal Anatmy and Injury preventin mdule Treatment Injury preventin methds Carpal Tunnel Syndrme The carpal tunnel is a narrw passageway in the wrist frmed by the carpal bnes at the bttm and the transverse carpal ligament at the tp. The tunnel is designed fr a number f flexr tendns and the medial nerve t travel frm the frearm int the hand. The carpal tunnel has enugh space fr the flexr tendns, which are surrunded by synvium t help lubricate each tendn, and the median nerve t pass thugh int the hand. Carpal tunnel syndrme is a cnditin where the median nerve travelling thrugh the carpal tunnel frm the frearm int the hand becmes cmpressed r squeezed at the wrist. The cmpressed nerve causes muscle weakness, numbness, pain and a tingling sensatin within the hand and ther parts f the arm. Illustratin shwing the anterir view f the carpal tunnel n the right hand Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 59 f 216

60 Functinal Anatmy and Injury preventin mdule Cause Carpal tunnel syndrme ccurs as a result f a reductin in the already narrw carpal tunnel causing pressure t be placed nt the median nerve. The reductin f space fr tendns and the median nerve t travel thrugh can be cntributed t the thickening f irritated tendns r swelling f ther structures. One structure assciated as having a significant rle in this cnditin is the synvium f the tendns, which can easily becme inflamed fllwing veruse. Signs and symptms The mst evident and cmmn symptm accmpanying carpal tunnel cnsists f numbness, tingling and pain in the hand as a result f cmpressin t the nerve. Additinal symptms may include: Shting r electric-shck type pain in the thumb r index finger Hard t describe pain r sensatin travelling up the arm twards the shulder Thrbbing sensatin r pain in the wrist and hand Weakness in grip strength r hand mvements Symptms can present themselves at any time; hwever, many peple experience sme intense symptm during the night, which may be due t the psitin f the wrist as the sleep. Risk factrs The risk factrs fr develping carpal tunnel cnsist f: Heredity this is the mst imprtant factr, if carpal tunnel runs in the family it can give individuals an increased risk f develping this cnditin. Hand use the vlume f wrk that requires hand use can cntribute t the develpment. Pregnancy related hrmnal change Age carpal tunnel usually affect individuals in later life Medical cnditin diabetes, rheumatid arthritis, thyrid prblem can all cntribute t the develpment f carpal tunnel. Diagnsis An allied health prfessinal, such as a GP, can gather infrmatin abut the individual s symptms and medical histry as well as perfrm physical tests, which include: Identifying muscular weakness arund the base f the thumb Bending and hld the wrist in psitins which are prne t cause numbness r tingling Place pressure n the median nerve in the wrist t see if it creates numbness r tingling Tapping alng the median nerve t see if any symptms present themselves Test the sensitivity f the fingers. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 60 f 216

61 Functinal Anatmy and Injury preventin mdule Treatments Carpal tunnel syndrme can be treated in many different ways, which can be categrised int Nnsurgical and surgical treatment methds. The initial treatment adpts the nn-surgical treatment methds which include: Splinting r bracing the wrist can be kept in a neutral psitin with a splint r brace, this can help prevent the wrist frm mving int a psitin which culd aggravate the median nerve. Medicatin anti-inflammatry medicatin are cmmnly used fr this cnditin t help reduce the inflammatry and cntrl the pain. Activity changes this treatment methd addresses the activities which may have caused r cntributed t the develpment f carpal tunnel syndrme, and may be wrsening the cnditin. This invlves identifying and eliminating mvements which are aggravating the median nerve r ther structures which pass thrugh the narrw carpal tunnel. Exercise by stretching any tight muscles r surrunding tissue and strengthening any weak muscles can help imprve the functin and reduce the stress place n the tendn which pass thrugh the carpal tunnel. Sterid injectins a crticsterid injectin can be used t treat the symptms, hwever, withut addressing the cause, it is likely the symptms will return. If these nn-surgical treatment methds are unsuccessful, then surgery can be perfrmed t address the cnditins. Surgery invlves cutting away at the transverse carpal ligament, which when it heals will allw mre rm in the carpel tunnel, s structures d n cmpress the median nerve. Pst Rehabilitatin See the Wrist cnditin exercises sectin fr pst rehabilitatin exercises t help fllwing this cnditin. Wrist cnditining exercises The fllwing cnditining exercises are specific wrist flexr and extensin exercises, aimed at returning the muscles back t nrmal functin after an injury in the assciated area. The exercises aim t initially increase the flexibility f the grup f flexrs and grup f extensrs, befre specific resistance exercises are used t strengthen each grup. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 61 f 216

62 Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 62 f 216

63 Functinal Anatmy and Injury preventin mdule Images taken frm Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 63 f 216

64 Functinal Anatmy and Injury preventin mdule Functinal anatmy f the Spine and Thrax Cervical spine The cervical spine is the mst superir aspect f the vertebral clumn and cnsists f seven vertebrae lcated in the neck regin. These vertebrae play a vital rle in prtecting the brain stem and superir versin f the spinal crd, supprt the weight f the skull and allw a wide range f head mvement. The first cervical vertebra is ften referred t as the atlas r C1, and it shaped specifically t supprt the skull. The secnd cervical vertebra is ften called the axis r C2, and wrks tgether with the atlas t enable the head t rtate and turn. The cervical vertebrae is the sectin f the spine which pssess the mst ptential mvement. Illustratin shwing the Cervical spine The structure f the ve Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 64 f 216

65 Functinal Anatmy and Injury preventin mdule Cervical Spine Mvement Muscles invlved Lateral flexin Flexin Sterncleidmastid Scalene muscles Spenius Lngissimus capitis & cervicis Ilicstalis Multifidus Levatr scapulae Sterncleidmastid Lngus cli Lngus capitis Extensin Rtatin Splenius Semispinalis capitis & cervicis Ilicstalis cervicis Lngissimus capitis and cervicis Trapezius (upper fibres) Sterncleidmastid Scalene muscles Spenius Lngissimus capitis & cervicis Ilicstalis Multifidus Levatr scapulae Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 65 f 216

66 Functinal Anatmy and Injury preventin mdule Thracic spine The thracic spine fllws n frm the 7 th cervical spine and is made up f a further 12 vertebrae, name T1 t T12. The thracic vertebrae gradually increase in size as they descend (shwn in the illustratins belw). The Thracic vertebrae is the mst restricted in terms f mvement, and des nt permit as much as the cervical and lumbar vertebrae. Ilustratin shwing the Thracic spine Illustratin shwing the secnd thracic vertebrae Illustratin shwing the twelfth thracic vertebrae Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 66 f 216

67 Functinal Anatmy and Injury preventin mdule Lumbar spine The lumbar spine cnsists f 5 vertebrae which are designed t supprt the weight f the bdy. This is achieved by the increased size f vertebral bdy f the vertebrae (indicated in illustratin belw). The lumbar vertebrae sectin pssesses mre mvement ptential then the thracic, hwever less than the cervical. Illustratin shwing the Lumber vertebrae Illustratin shwing the furth lumbar vertebrae Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 67 f 216

68 Functinal Anatmy and Injury preventin mdule Thracic Spine Mvement Muscles invlved Flexin Rectus abdminis Obliques Extensin Erectr Spinae Quadratus Lumbrum Trapezuis (lwer) Lateral Flexin Obliques Psas majr Quadratus Lumbrum Multifidus Ilicastalis lumbrum Ilicastalis thracis Rtatres Rtatin Obliques Psas majr Quadratus Lumbrum Multifidus Ilicastalis lumbrum Ilicastalis thracis Rtatres Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 68 f 216

69 Functinal Anatmy and Injury preventin mdule Overview f muscles arund the Spine and Thrax Erectr Spinae The erectr spinae are a large grup f muscles that run alng each side f the lumbar, thracic and cervical sectins f the spine. There are small grups within the erectr spinae which cntain individual muscles. These cnsist f the spinalis, illicstalis and lngissimus grups. Spinalis the mst medial muscles f the erectr spinae grup. The spinalis splits int three different muscles, which cnsists f: Spinalis cervicis Spinalis capatis Spinalis drsi Lngissimus the lngest ut f the three erectr spinae grup, it is lcated lateral t the spinalis. The three muscles part f the lngissimus cnsist f: Lngissimus cervicis Lngissimus capatis Lngissimus thracis. Illicstalis lying the mst lateral, the illicstalis is the biggest f the erectr spinae grup. It can be separated int three individual muscles called: Illustratin shwing the psterir view f the deep back muscles Ilicstalis cervicis Ilicstalis drsi Ilicstalis lumbrum Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 69 f 216

70 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Spinalis Spinalis thracis: Lateral surface f the spinus prcesses f the T10-T12 and L1-L3 vertebrae Spinalis cervicis: spinus prcess f the T1-T2 and C5-C7 vertebrae Spinalis thracis: lateral surface f the spinus prcesses f the T2 T8 vertebrae Spinalis cervicis: spinus prcesses f the C2 C5 vertebrae Bilaterally: extensin f the cervical and thracic spine Unilaterally: lateral flexin f the cervical and thracic spine t the same side. Ilicstalis Ilicstalis lumbrum: sacrum, iliac crest, thraclumbar fascia Ilicstalis thracis: 7 th 12 th ribs Ilicstalis cervicis: 3 rd 7 th ribs Ilicstalis lumbrum: 6 th - 12 th ribs, deep layer f the thraclumbar fascia, transverse prcesses f upper lumber vertebrae Ilicstalis thracis: 1 st 6 th ribs Ilicstalis cervicis: transverse prcesses f C4-C6 vertebrae Bilaterally: extensin the spine Unilaterally: lateral flexin f the spine t the same side Lngissimus Lngissimus thracis: sacrum, iliac crest, spinus prcesses f lumbar vertebrae, transverse prcesses f lwer thracic vertebrae Lngissimus cervicis: transverse prcesses f T1 T6 Lngissimus capitis: transverse prcesses f T1 T3 vertebrae and transverse and articular prcesses f C4-C7 vertebrae Lngissimus thracis: 2 nd 12 th ribs, cstal prcesses f lumbar vertebrae, transverse prcesses f thracic vertebrae Lngissimus cervicis: transverse prcesses f C2 C5 vertebrae Lngissimus capitis: mastid prcess f ccipital bne Bilaterally: extends spine Unilaterally: lateral flexin and rtatin f the spine Lngissimus capitis: bilaterally extensin f the head, unilaterally flexin and rtatin f the head t the same side. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 70 f 216

71 Functinal Anatmy and Injury preventin mdule Multifidus The multifidus are a series f muscles running each side f the spine that are attach t the prcesses f each vertebra within the spine. Mre specifically they expand frm attach between the spinus prcesses f each vertebrae t the transverse prcess f the inferir vertebrae directly belw. Althugh they are a small muscle, their lcatin and attachment sites enable them prduce enugh frce t efficiently perfrm their rle in stabilising the spine during mvement. They perfrm this by engaging and cntracting slightly befre ther muscles, enabling them t pull each vertebra inferirly n tp f the vertebrae t create a stable spine. Illustratin shwing the anterir view f the multifidus muscles Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 71 f 216

72 Functinal Anatmy and Injury preventin mdule Abdminal regin Illustratin shwing the anterir view f the right abdminal muscles (internal blique has been remved) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 72 f 216

73 Functinal Anatmy and Injury preventin mdule External blique The external blique s are a thin, brad superficial muscle, which lies n the lateral sides f the abdminal regin. It runs frm the 5 th 12 th rib, medially and inferirly t the linae alba where it attaches. The image belw indicates the directin f the muscle fibres as they travel inferir and medially t attach at the linea alba. Illustratin shwing the external Obliques (Anterir view f the left side) Muscle Origin Insertin Actin External Oblique Outer surface f the 5 th 12 th ribs - Outer lips f the iliac crest - Anterir layer f the rectus sheath, linea alba Unilateral: bends the trunk t the same side, rtates the trunk t the ppsite side Bilateral: flexes the trunk, straightens the pelvis, active in expiratin, maintenance f abdminal pressure. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 73 f 216

74 Functinal Anatmy and Injury preventin mdule Internal blique The internal blique s are deeper t the external blique s and run in the ppsite directin. They run frm the anterir superir iliac spine and the inguinal ligament and travel superir and medially t the linae albe. The illustratin belw and t the right indicates the attachment pints and the directin f the muscle fibres. Illustratin shwing the anterir left Internal blique Muscle Origin Insertin Actin Internal Oblique Deep later f the thraclumbar fascia, intermediate line f the iliac crest, anterir superir iliac spine, lateral half f the linguinal ligament - Lwer brders f the 10 th 12 th ribs - Anterir and psterir layers f the rectus sheath linea alba Unilateral: bends the trunk t the same side, rtates the trunk t the same side Bilateral: flexes the trunk, straightens the pelvis, active in expiratin, maintenance f abdminal pressure. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 74 f 216

75 Functinal Anatmy and Injury preventin mdule Transverse abdminis The transverse abdminis (TA) is the deepest f the abdminal muscles, sitting psterirly t the external and internal bliques. The TA s main rle cnsists f trunk stability and maintaining internal abdminal pressure. Illustratin shwing the transverse abdminis (anterir view f the left side) Muscle Origin Insertin Actin Transversus Abdminis - Inner surfaces f the 7 th 12 th cstal cartilages - Deep layer f the iliac crest, anterir superir iliac spine Psterir layer f the rectus sheath, linea alba Unilateral: rtates the trunk t the same side Bilateral: active in expiratin and maintenance f abdminal tne - Lateral part f the inguinal ligament Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 75 f 216

76 Mvement perfrmed by the abdminal muscles Functinal Anatmy and Injury preventin mdule Trunk mvements Mvement Muscles invlved Flexin Rectus abdminis External bliques (bilaterally) Internal bliques (bilaterally) Extensin Lateral flexin Spinalis (bilaterally) Lngissimus (bilaterally) Ilicstalis (bilaterally) Multifidis (bilaterally) Rtatres (bilaterally)* Semispinalis capitis Quadratus lumbrum (assists) Latissimus drsi (when arm is flexed) (All unilaterally t same side) Spinalis Lngissimus Illicstalis Quadtratus lumbrum External bliques Internal bliques Latissimus drsi Rtatin Interal bliques (t same side unilaterally) (All unilaterally t ppsite side) Multifidus Rtatres External bliques Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 76 f 216

77 Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 77 f 216

78 Functinal Anatmy and Injury preventin mdule The Quadratus Lumbrum Althugh it appears t be the deepest muscle f the lwer back, the quadratus lumbrum is actually the deepest muscle f the abdmen. It stretches frm the psterir side f the iliac crest and travels superirly attaching nt the last (twelfth) rib and the transverse prcesses f the first fur lumbar vertebrae. Illustratin shwing the Quadratus and its psitin within the trunk Muscle Origin Insertin Actin Quadratus Lumbrum Iliac crest Twelfth rib, cstal prcesses f the l1 l4 vertebrae Unilateral: bends the trunk t the same side Bilateral: bearing dwn and expiratin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 78 f 216

79 Functinal Anatmy and Injury preventin mdule The Scalenes and Intercstal muscles The scalene muscles cnsist f a grup f three muscles that lie n each side f the cervical spine r neck and invlved in perfrming mvement t the cervical spine. Mvement can be perfrmed where each muscle grup cntracts individually (unilaterally) r bth muscle grups cntract simultaneusly (bilaterally). The scalene grup cnsist f: Anterir scalenes relatively small muscle that lies psterir t the sterncleidmastid Middle scalenes slightly larger than the anterir scalenes, and lies further lateral t its anterir cunterpart Psterir scalenes the smallest and deepest muscle f the scalenes grup. The mvements perfrmed by these muscles usually invlve all three muscles within the grup; hwever, the anterir scalenes perfrms an additinal rle n its wn, assisting in flexin f the head and neck. The intercstal muscles are tw grups f muscles lcated between the ribs. They are made up f the: Internal intercstal muscles External intercstal muscles Illustratin shwing the anterir view f the anterir middle and psterir scalene and internal and external intercstsal muscles Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 79 f 216

80 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Anterir Scalenes Middle Scalenes Anterir tubercle f the transverse prcesses f the C3 C6 vertebrae Psterir tubercle f the transverse prcesses f the C3 C7 vertebrae Scalene tubercle f the first rib First rib With the ribs mbile: Raises the upper ribs With the ribs flexed: bends the cervical spine tward the same side Psterir Scalenes Psterir tubercle f the transverse prcesses f the C5 C7 vertebrae Outer surface f the secnd ribs Flexes the neck. Muscle Origin Insertin Actin External intercstal muscles Internal intercstal muscles Inferir brder f the rib abve Superir brder f the rib belw Raises the ribs (during inspiratin) and stabilise the chest wall Lwers the ribs (during expiratin) and stabilise the chest wall Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 80 f 216

81 Functinal Anatmy and Injury preventin mdule Sterncleidmastid The sterncleidmastid r cmmnly named the SCM is lcated n the anterir and lateral aspects f the neck. It has a large belly with tw heads at the distal end f the muscle. The tw heads are named after their attachment lcatins and cnsist f: Clavicular head attached t the tp f the manubrium, the prximal prtin f the sternum. Sternal head attached t the medial prtin f the clavicle. The SCM, is an interesting muscles which has multiple functins depending n the bilateral r unilateral cntractin f the muscles. These actins are indicated in the table belw. Illustratin shwing the sterncleidmastid and its attachment pints Muscle Origin Insertin Actin Sterncleidmastid Sternal head: tp f manubrium Clavicular head: medial third f the clavicle Mastid prcess and superir nuchal line Unilateral: Tilts the head t the same side and rtates the head t the ppsite side Bilateral: Extends the head and assists in respiratin when the head is fixed Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 81 f 216

82 Functinal Anatmy and Injury preventin mdule Cervical spine Mvement Muscles invlved Flexin Sterncliedmastid (bilaterally) Anterir scalene (bilaterally) Lngus capitis (bilaterally) Lngus cli (bilaterally) Extensin Trapezius (upper fibres bilaterally) Levatr scapula (bilaterally) Splenius capitis (bilaterally) Splenius cervicis (bilaterally) Rectus capitis psterir majr* Rectus capitis psterir minr* Lateral flexin Rtatin Unilaterally t the same side Rtatin Unilaterally t the ppsite side Trapezius (upper fibres) Levatr scapula Splenius capitius Splenius cervicis Sterncleidmastid Lngus capitis Lngus cli Anterir, middle and psterir scalenes Levatr scapula Splenius capitis Splenius cervicis Rectus capitis psterir majr* Oblique capitis inferir* Lngus cli* Lngus capitis* Trapezius (upper fibres) Sterncleidmastid Anterir, middle and psterir scalenes Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 82 f 216

83 Functinal Anatmy and Injury preventin mdule Injuries t the Spine and Thrax regins Facet Jint Pain (Zygapphyseal jint pain) A facet jint, als knwn as a Zygapphyseal jint, is the synvial jint between tw vertebrae. Each jining vertebrae has 2 facet jints, ne each side f the spinus prcess. The rle f the facet jint is t prvide supprt, stability and mbility t the vertebrae, giving the spine a wide range f mvement. Each facet jint is like any ther synvial jint in the bdy, cmprising f smth cartilage lining the articulating surfaces within a jint capsule that cntains synvial fluid. These structures act t cushin the impact f ne bne n anther. Als strng cnnective tissue wraps arund the bny ends prviding additinal supprt t the jint. During certain mvements f the spine, stretching r cmpressive frces are placed n the facet jint. If these frces are excessive and beynd what the facet jint can withstand, injury t the facet jint may ccur. This may invlve damage t the cartilage r tearing t the cnnective tissue surrunding the jint. This cnditin is knwn as a facet jint sprain. Causes Facet jint sprains typically ccur during excessive bending, lifting r twisting mvements. They may ccur traumatically r due t repetitive r prlnged frces. Aging can als play a rle in the cause f this cnditin. As a disc thins with aging and frm daily wear and tear, the space between tw spinal vertebrae shrinks, erding the cartilage and causing painful frictin. Fractures, trn ligaments and disc prblems can all cause abnrmal mvement and alignment, putting extra stress n the facet jints. Signs and Symptms The nset f this cnditin is usually assciated t a sudden develpment f back pain during r immediately fllwing an activity that invlves multi-plane mvements, such as twisting whilst flexing r extending at the spine. In sme cases, the pain may nt ccur immediately, with pain and sreness being present the mrning after prvcative mvements. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 83 f 216

84 Additinal symptms that can present themselves cnsist f: pain felt n ne side f the spine muscle spasm may be experienced arund the affected jint referred int the buttcks r lwer limb n the affected side Functinal Anatmy and Injury preventin mdule Signs and Symptms are generally increased with activities that invlve twisting, lifting, arching backwards, bending frwards r sideways r sitting fr prlnged perids f time. Risk factrs Factrs that may cntribute t the develpment f a facet jint sprain may include: Pr psture Lumbar spine stiffness Sedentary lifestyle Weak cre stability Muscle weakness r tightness Incrrect lifting technique Overweight Lifestyles that invlve large amunts f sitting, bending r lifting. DVD (6 mins) Treatments Watch the fllwing DVD segments: Facet Jint Injuries Vide 7 Treatments fr facet jint pain are general under supervisin r guidance frm a physitherapist and can include: Sft tissue massage Activity mdificatin advice Mbilisatin Bimechanical crrectin Dry needling Ergnmic advice Pstural taping Clinical Pilates Lumbar rll fr sitting Hydrtherapy Exercises t imprve flexibility, strength and cre stability Back brace Imprve psture Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 84 f 216

85 Functinal Anatmy and Injury preventin mdule Pst Rehabilitatin Pst rehabilitatin aims at imprving the flexibility and strength f muscles arund the spine, especially fcusing n the strength and functin f the spinal stabilisers, such as the transverse abdminals and multifidus. These muscles have shwn t be dysfunctinal with injuries and pain assciated t the spine, which is thught t be a result f the instability f the spine during mvements. Read the fllwing hand ut in the additinal reading sectin: Reading Training Lumbsacral Multifidus by Diane Lee Training Transversus Abdminis by Diane Lee In additin pst rehabilitatin addresses any pstural issues, which invlves exercise rutines t stretch muscles causing tightness and strengthen weak muscles nt prviding the required supprt t maintain an efficient psture. Read the fllwing hand ut in the additinal reading sectin: Reading Back Strain (Lumbar Facet Jint Strain) Recmmended Exercises. Spndyllisthesis Spndyllisthesis is a cnditin f the spine whereby ne f the vertebra slips frward r backward cmpared t the next vertebra. Medical terms fr this mvement are: Frward slippage: anterlisthesis Backward slippage: retrlisthesis. Image surced frm Causes The mst cmmn cause f spndyllisthesis ccurs frm extensive cartilage (vertebral disc) wear r degeneratin resulting frm anther specific cnditin such as arthritis. The degenerated cartilage Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 85 f 216

86 Functinal Anatmy and Injury preventin mdule allws the frnt prtin f the vertebrae t slip frward ut f the natural alignment. This is knwn as degenerative spndyllisthesis and mainly affects the lder ppulatin. There are fur ther types f lumbar spndyllisthesis, which cnsist f: 1. Dysplastic spndyllisthesis cnsists f a structural defect, where the frmatin f the facet, the part f the vertebrae that frms the facet jint, des nt develp crrectly. 2. Isthmic spndyllisthesis caused by a defect in the pars interacrticularis, a prtin f the vertebrae invlved in the facet jint. This type f spndylllisthesis can develp as a result f repetitive trauma r expsure t cntinual hyperextensin f the vertebrae. 3. Traumatic spndyllisthesis as the name suggests, this type f the cnditin ccurs fllwing a direct trauma r injury t the vertebrae. The trauma r injury can cause a fracture within the vertebrae that can lead t the slipping frward f the frnt prtin f the vertebrae and lead t spndyllisthesis. 4. Pathlgic spndyllisthesis abnrmal bne structure is frmed as a result f ther pathlgies such as a tumur. The abnrmal bnes structure affects the vertebrae t maintain the facet jint, which allws sme slippage and therefre the develpment f spndyllisthesis. Signs and Symptms The signs and symptms f spndyllisthesis cnsist f: Lw back pain, ften described as a deep ache in the lwer back Pain that radiates int the buttcks and back f the thighs Pain that is wrse when standing, walking, r any type f activities that invlves bending backwards Pain that feels better with sitting, especially sitting in a reclining psitin A tired feeling in the legs, and pssibly leg numbness r tingling Pain that radiates belw the knee and pssibly int the ft Risk factrs Risk factrs fr spndyllisthesis are: Family histry f back prblems Histry f repetitive trauma Hyperextensin f the lwer back r lumbar spine Gymnasts Weight lifters Ftball players Diagnsis In mst cases it is nt pssible t see visible signs f spndyllisthesis upn examinatin. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 86 f 216

87 Functinal Anatmy and Injury preventin mdule Spndyllisthesis is identified using a lateral X-ray that will shw if ne f the vertebrae has slipped frward cmpared t the adjacent vertebrae. Spndyllisthesis is graded accrding the percentage f slip: Grade I slip f up t 25% Grade II between 26%-50% Grade III between 51%-75% Grade IV between 76% and 100% Grade V fallen ff the next vertebra. Treatments Althugh nn-surgical treatments d nt specifically address the slippage f the vertebrae, it can significantly help with symptms assciated t the cnditin; therefre are usually the initial treatment given t individuals with spndyllisthesis. The mst cmmnly use nn-surgical treatment cnsists f: Exercise specific exercises that aims t target the flexibility and strength f the lw back muscles and the abdminal muscles. Medicatin anti-inflammatry medicines t address the inflammatin and relieve pain. Sterid injectins a sterid injectin cnsists f a pwerful anti-inflammatry injectin cntaining crtisne. Other suggested nn-surgical treatment methds cnsist f: Rest frm aggravating activities TENS Machine Anti-inflammatry medicatins Electrtherapy Analgesic drugs t cntrl the pain Jint Pain Relief Techniques Back bracing fr stabilizatin Kinesilgy Taping Physitherapy Sft Tissue Massage Educatin in perfrming daily activities Supprt Brace Bed Rest Acupuncture and Dry Needling Bimechanical Analysis and crrectin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 87 f 216

88 Functinal Anatmy and Injury preventin mdule Surgical treatment can be given t individuals wh d nt respnd well t nn-surgical treatment, usually ver a 6-12 mnth perid. Surgery attempts t imprve the cnditin in tw different ways, these include: Laminectmy this invlves pening the spinal canal t prvide mre rm fr the spinal crd t travel thrugh. Spinal fusin this is where the slipped vertebrae are welded tgether s they eventually fuse as ne vertebrae and d nt individually slip further. X-ray shwing screws used in spinal fusin Injury Preventin The gal is a return t activities as quickly and safely as pssible. If yu return t activities t sn with pain, the injury may wrsen. This culd lead t chrnic pain and difficulty with daily activities. Return t activities is determined by hw sn the injured area heals and hw well a persn is prgressing thrugh the rehabilitatin prcess, nt by hw many days r weeks it has been since the injury ccurred. A general return t nrmal activity fr thse with spndyllisthesis is within 2 t 4 mnths. Injury Preventin tips fr Spndyllisthesis: 1. Maintain strength in the abdminal, back and hip muscles which will assist with stabilising the spine and maintaining a healthy back. 2. Maintain hamstring flexibility - Tight hamstrings put tensin n the lw back and increase the risk fr back pain. 3. Maintain a healthy weight 4. D nt play sprts r cntinue activities with pain Pst Rehabilitatin As indicated in the treatment sectin, ne f the mst cmmn nn-surgical treatments invlves exercises; therefre exercise is perfrmed nt nly during the pst rehabilitatin stage. The exercise that is usually perfrmed within the treatment and rehabilitatin phases is usually the same, cnsisting f exercises t develp and maintain spinal stability. This invlves flexibility and strength training which fcuses n the functin and perfrmance f the multifidus, transverse abdminis and psas majr, and the flexibility f the bigger muscles arund the lwer back and hip. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 88 f 216

89 Functinal Anatmy and Injury preventin mdule Exercise shuld nt be perfrmed if the individual is symptmatic, and exercises that cause pain shuld nt be cntinued. Read the fllwing hand ut in the additinal reading sectin: Reading Spndyllysis and Spndyllisthesis Rehabilitatin Exercises Cccyx Injury The cccyx is an unimprtant, triangular bny structure lcated at the bttm f the vertebral clumn, made up f several segments called cccygeal vertebrae. It is cmmnly referred t as the tail bne, and is cmpsed f three t five bny segments held in place by jints and ligaments. Cccyx injuries usually results in pain and discmfrt in the tailbne area. A medical term fr this cnditin is called cccydynia. These types f injuries may result in a bruise, dislcatin, r fracture f the cccyx. Wmen are mre susceptible t these types f injuries because the female pelvis is brader and the cccyx is mre expsed. Cause Mst cccyx injuries are caused by trauma t the cccyx area. A fall nt the tailbne in the seated psitin, usually against a hard surface A direct blw t the tailbne, such as thse that ccur during cntact sprts. The cccyx can be injured r fractured during childbirth. Repetitive straining r frictin against the cccyx can injure the cccyx. Bne spurs, cmpressin f nerve rts, injuries t ther parts f the spine, lcal infectins, and tumurs. Signs and Symptms Severe pain and tenderness may be felt in the tailbne area. Bruise may be visible in this area if it a traumatic injury. The increased when sitting fr prlnged perids f time, r with direct pressure t the tailbne area. Bwel mvements and straining are ften painful. Risk factrs Risk factrs fr cccyx related injuries include: Deficiencies f vitamin D r calcium Lw muscle mass (Increase the risk f a fall) Cngenital bne disrders, Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 89 f 216

90 Functinal Anatmy and Injury preventin mdule Aging Osteprsis Sprts (Rwing, skating) Females are mre likely than males t break their tailbnes Diagnsis The cause f a cccyx injury is based n a medical histry and a physical exam by a GP r allied health prfessinal. The entire vertebral clumn is examined. A neurlgic exam may be perfrmed. A rectal exam may als be perfrmed. X-rays may be taken t determine whether there is a fracture r dislcatin. X-rays may nt reveal these injuries. Sme dctrs recmmend X-rays in bth the standing and seated psitins t better determine the presence f a fracture r dislcatin. Treatments Tailbne injuries can be extremely painful. Treatments are usually aimed at cntrlling pain and aviding further aggravatin t the area. Recmmendatins include: Avid sitting dwn fr lng perids f time. When seated, sit n hard surfaces and alternate sitting n each side f the buttcks. Als, lean frward and direct yur weight away frm the tailbne. Apply ice t the tailbne area fr minutes, fur times a day fr my traumatic injuries. Anti-inflammatry drugs can assist with reducing pain and imprving mbility. Use a "dughnut" cushin r pillw t sit n. This cushin has a hle in the middle t prevent the tailbne frm cntacting the flat surface. Eat fds high in fiber t sften stls and avid cnstipatin. Injectins f lcal anesthetics int the tailbne are smetimes required fr cntinuing pain. Rarely, the cccyx may be surgically remved. DVD ( 3 mins) Watch the fllwing DVD segments: Tailbne Pain Vide 8 Definitin: Prltherapy - Invlves injecting nn-pharmaclgical and nn-active irritant slutin int the bdy, generally in the regin f tendns r ligaments fr the purpse f strengthening weakened cnnective tissue and alleviating musculskeletal pain Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 90 f 216

91 Functinal Anatmy and Injury preventin mdule Read the fllwing hand ut in the additinal reading sectin: Reading A Pinch f Sugar fr Pain Pst Rehabilitatin As the cccyx is largely unimprtant cmpnent f the bdy and des nt play any part in mvement r influenced by any muscles, therefre there is little rehabilitatin exercises that can be perfrmed t help this return this t pre-injury cnditin. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 91 f 216

92 Functinal Anatmy and Injury preventin mdule Sclisis Activity Research and find infrmatin abut a Pelvic Stress Fracture and cmplete the table belw: Overview Cause Risk Factrs Signs and symptms Diagnsis Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 92 f 216

93 Functinal Anatmy and Injury preventin mdule Treatment Injury preventin methds Rib Fracture Anatmy review: The ribs are an imprtant structure within the human bdy as a result f their prtectin functin. They are made up f: 12 pairs f ribs, which all articulate psterirly with the thracic vertebrae. The true ribs (1-7) attach t the sternum by the cstal cartilages. False ribs (8-10) which attach t the cstal cartilage f rib 7, nt directly t the sternum. Flating ribs (11-12) that have n anterir attachment with the sternum. Rib fractures are like mst ther bne fractures, where a break in the bne ccurs. In the majrity f causes it is cause by a direct blw r crushing f the ribs, but can als ccur as a result frm severe cughing. Cause The incidence f rib fractures, as explained previusly is usually a result f a direct blw r crushing f the ribs, which can ccur in cntact sprt, car accidents r assault. In the cases where rib fractures are due t severe cughing r straining, it is ften fund that there is weakness f the ribs such frm a bne disease, which makes the bnes mre susceptible t injury. Children and babies are less likely t fracture ribs because their bnes are mre elastic. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 93 f 216

94 Functinal Anatmy and Injury preventin mdule Signs and Symptms The sign and symptms assciated t rib fractures include: Mild t severe pain in the injured area Pain when yu breathe Pain arund the fracture when smene pushes n yur breastbne. Shrtness f breath Risk factrs Factrs that can increase the risk f breaking r fracturing a rib cnsist f: Osteprsis - Having steprsis increase the risk f a fracture. Sprts participatin - Participating in cntact sprts, increases the risk f trauma t the chest and trauma increases the risk f rib fractures. Cancerus lesin in a rib - A cancerus lesin can weaken the bne, making it mre susceptible t breaks. Having a chrnic cugh Histry f rib/chest fractures Diagnsis Diagnsis fr this type f injury is cmpleted thrugh a physical exam frm an allied health prfessina and an X-ray. A dctr will: 1. Push n yur chest t find ut where yu are hurt. 2. Watch yu breathe and listen t yur lungs t make sure air is mving in and ut nrmally. 3. Listen t yur heart. 4. Check yur head, neck, spine, and belly t make sure there are n ther injuries. 5. Send yu fr an X-ray if required. Rib fractures dn't always shw up n an X-ray. A dctr may treat a patient fr a fractured rib, even if it is nt cnclusively diagnsed. Treatments Unlike ther bnes in the bdy, fractured ribs can t be set in a cast. Mst treatment aims t relieve pain while the injury heals, which can take up t 6-12 weeks depending n the type f injury. This rehabilitatin time can be increased if the rib has been trn frm the cartilage. Treatment ptins include: Rest Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 94 f 216

95 Functinal Anatmy and Injury preventin mdule Prescriptin strength pain-killing drugs Nn-steridal anti-inflammatry drugs Aviding activities that aggravate the injury, such as sprt Icepacks may help t reduce inflammatin in the early stages Mechanical ventilatin may be needed in cases f severe flail chest. Injury Preventin The fllwing measures may assist in preventing this cnditin: Wear prtective equipment when playing cntact sprts. Take steps t decrease yur risk f husehld falls. Decrease yur chance f getting steprsis. Getting enugh calcium in yur diet is imprtant fr maintaining strng bnes. Read the fllwing hand ut in the additinal reading sectin: Reading Rib Stress Injury Preventin Prgram Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 95 f 216

96 Functinal Anatmy and Injury preventin mdule Thracic Outlet Syndrme Thracic utlet syndrme is a cnditin where the cmpressin f nerves and bld vessels in the thracic regin causes numbness in the fingers and pain in the chest and neck. The mst cmmnly affected nerves in thracic utlet syndrme invlve part f the brachial plexus. This is a grup f nerve fibres exiting the spinal clumn thrugh the last fur cervical (C5, C6, C7, C8) and the first thracic vertebrae (T1) and descends inferirly t the hands and fingers. In the neck the brachial plexus lies between the anterir and middle scalenes and the first rib, and as it travels laterally twards the arm, it passes underneath the pectralis minr. If these muscles (the anterir scalenes, middle scalenes and pectralis minr) becme tight and shrt they can place pressure and cmpress the brachial plexus and cause thracic utlet syndrme. Image indicating the brachial pleux rute as it leaves the last fur cervical and first lumbar vertebrae In additin, the brachial plexus travels deep t the clavicle which can play a part in this cnditin. Signs and Symptms Symptms assciated t thracic utlet syndrme are mst as a result f cmpressin t the brachial plexus and bld vessels which travel alng a similar pathway acrss the chest and dwn the arm t the hand. In additin, irritatin t the muscles f the neck and shulder regin may present sme symptms, hwever these are evident in less cases. Therefre the accmpanying cnditins include: Numbness, pain r tingling sensatin in the fingers r inner frearm Pain r tingling in the neck and shulder Signs f pr circulatin in the hand and frearm pallr Muscular atrphy and weakness in the hand r frearm muscles. These symptms can range frm severe and frequent r cnstant t mild and spradic, and usually depend n the level f cmpressin f the brachial plexus. In sme cases, the symptms f this cnditin are brught n by a specific mvement. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 96 f 216

97 Functinal Anatmy and Injury preventin mdule Risk factrs The risk factr fr develping this cnditin invlves the cntinual usage f the upper extremities t perfrm activities against a heavy resistance, especially activities r mvements that cause the shulders t prtract (rund). Diagnsis Thracic utlet syndrme can be diagnsed by an allied health prfessinal, such as a GP, fllwing the analysis f symptms and physical examinatin r tests. Fllwing the explanatin f symptms, the GP can perfrm specific maneuvres with the arm and neck, which can trigger the pinching and cmpressin f bld vessels leading t the lss f a pulse and a pallr appearance will present itself. In sme circumstances additinal diagnsis can be perfrmed using: Electrmygrpahy (EMG) CT angigram MRI (Magnetic Resnance Imaging) X-ray Treatments The initial treatment fr this cnditin cnsists f exercise therapy that aims t address the cause f the shrt and tight muscles cmpressing n the brachial plexus. This specifically invlves: Imprve shulder muscle strength (strengthening exercises) Increase the shulder range f mtin (stretches exercise) Address pstural issues, especially prtracted shulders (pstural crrectin) In additin, medicatin t target any pain assciated with this cnditin may be prescribed by the allied health prfessinal. Treatment may prgress t surgery if the symptms d nt imprve. In this scenari, surgery aims t increase the space fr the brachial plexus t pass alng and prevent cmpressin. This is dne by: Remving the extra rib (if present) and cut specific muscles Remval f a sectin f the first rib Rerute the cmpressed bld vessel arund the cmpressed area. Pst Rehabilitatin The pst rehabilitatin f thracic utlet syndrme cnsists f the cntinuatin f exercise therapy perfrmed within the treatment phase. This cnsists f imprving the shulder strength and range f mvement, and crrecting any pstural issues which may be cntributing t tensin in the anterir shulder and neck regin. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 97 f 216

98 Functinal Anatmy and Injury preventin mdule The use f exercise fr treatment can imprve and eliminate the cnditin, hwever, t ensure it is prevented the cntinuatin f prgressing these exercise is imprtant. The specific muscles which can be addressed include: Pectralis minr (stretching) Scalenes (anterir and middle) Lwer traps (strengthening t help crrect prtracted shulder) Lumbag (Lw Back Pain) Lumbag is the term given t lw back pain and is generally an umbrella term given t any pain presenting itself in the lwer back regin. There are many structures arund the lwer back regin as well as assciated structures, s pinpint diagnsis f the cnditin is ften extremely hard. Structure which can be assciated t this cnditin include: Sft tissue muscles, tendns, ligaments and fascia Facet jints specialised jints between vertebrae Vertebral discs a spngy cartilage present between the vertebrae t absrb shck and prevent frictin. Nerves The cnditin can be present in tw frms: Cause Acute lw back pain has ccurred as a result f a direct injury. This usually lasts less than 6 weeks. Chrnic the cnditin has develped ver a lng perid f time and usually lasts lnger than 3 mnths As a result f the wide range f pssible structures that may be affect and present this cnditin, the majrity f causes are unknwn. Hwever, sme cmmn causes can include: General wear and tear t the vertebrae and vertebral discs Pr muscles in the lw back regin Pr psture High impact activity which places stress n the lwer back structures Underlying health cnditins, such as steprsis, stearthritis, slipped discs Signs and Symptms Symptms fr lumbag are mst cmmnly assciated with pain felt in the lwer back regin, but may be accmpanied with: Limited lumbar vertebral mvement especially flexin and extensin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 98 f 216

99 Functinal Anatmy and Injury preventin mdule Muscular spasms in r arund the lwer back Mdified psture t cmpensate r alleviate the pain Assciated numbness r tingling sensatin in the back, gluteal regin r leg Risk factrs The risk factrs fr lumbag can be classified int tw different categries physical and inherent factrs, and lifestyle factrs. Physical and inherent may factrs cnsist f: Male Middle aged r lder Family histry f back pain Previus back injury Pregnancy Spinal defects frm birth Lifestyle factrs may cnsist f: Physical inactivity weakens the back muscles, which can mean they cannt supprt r stabilise the back efficiently. Overweight/besity Increases the strain placed n the back. Als being verweight r bese ften means the individual is in pr physical cnditin, meaning their muscles are weaker and less flexible. Pr psture places stress n muscles within the bdy, which can decrease their ability t perfrm a stabilising rle leading t weakens arund the spine. Extended sitting being in a sitting psitin fr lng perids can weaken back muscles. Repetitive heavy lifting r bending this can stress the back muscles creating Smking Stress this can cause individuals t subcnsciusly tighten their back muscles Diagnsis The majrity f lumbag cnditins can be quickly diagnsed by an allied health prfessinal fllwing explanatin f the client s symptms. Specialised allied health prfessinals such as a physitherapist and chirpractr can perfrm physical examinatin identifying restrictins in mvement arund the lwer back regin. These can als be perfrmed t determine whether any nerves are being cmpressed. In sme severe and debilitating lumbag cnditins, and X-Ray r MRI can be perfrmed t assess the health f the spine and its intervertebral discs. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 99 f 216

100 Functinal Anatmy and Injury preventin mdule Treatments The treatment fr lumbag can be dependent n whether the cnditin is acute r chrnic. Acute lumbag treatment usually address the recent injury that has ccurred and invlves: Administering anti-inflammatry medicines Receiving gentle spinal manipulatin frm an allied health prfessinal Address any muscle tightness and spasms with muscle relaxants. Chrnic lumbag treatment targets muscular weakness and pr range f mtin arund the lumbar vertebrae. This invlves strengthening spinal stabilisers and increasing the flexibility f restricted muscles, which are cmmnly shrt and tight in this regin. In additin, pain reducing medicine may be prescribed. Pst Rehabilitatin The transverse abdminis and the lumbar multifidus have been identified as substantial muscles invlved in the preventin f lwer back pain. It was reprted that the functin f the transverse abdminis and the lumbar multifidus grup were significantly impaired during back pain. These tw muscles are respnsible fr stabilising the trunk and the lumbar vertebrae; hwever they are required t c-cntract t perfrm the rle efficiently. This prvides sme stance n the specific muscles t initially target t help imprve this cnditin. Read the fllwing hand ut in the additinal reading sectin: Reading Training Lumbsacral Multifidus by Diane Lee Training Transversus Abdminis by Diane Lee Back cnditining exercises The fllwing cnditining exercises have been taken frm a Spine Cnditining Prgram develped by the American Academy f Orthpaedic Surgens (AAOS) t help individuals return t nrmal functinal capacity fllwing an injury r surgery. The prgram cntains a range f stretching and strengthening exercises t develp stable and supprtive muscles whilst maintaining full range f mtin. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 100 f 216

101 Functinal Anatmy and Injury preventin mdule Stretching exercises Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 101 f 216

102 Functinal Anatmy and Injury preventin mdule Strengthening exercises Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 102 f 216

103 Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 103 f 216

104 Acetabulfemral jint (Hip jint) The Acetabulfemral jint r cmmnly knwn as the hip jint is a ball-and-scket jint cnsisting f the head f the femur (making the ball f the jint) and the acetabulum f the pelvis (making the scket f the jint). This type f jint permits a great deal f mvement, which gives the leg the ptential t perfrm diverse mvements. The acetabulfemral jint is similar t the glenhumeral jint; hwever, the structure f the acetabulum is slightly different than the glenid and prvides a deeper scket fr the head f the femur t fit int. This means the legs is slightly mre stable than the glenhumeral jint, hwever is still subject t stability issues. Functinal Anatmy and Injury preventin mdule Illustratin shwing the acetabulfemral jint Illustratin shwing the ptential mvement allwed at the acetabulfemral jint Illustratin shwing a ball and scket jint Mvement permitted at the Acetabulfemral jint The fllwing table and illustratins indicate the types f mvement that are permitted at the acetabulfemral jint: Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 104 f 216

105 Functinal Anatmy and Injury preventin mdule Acetabulfemral Jint Mvement Muscles invlved Flexin Extensin Illipsas (Psas majr and Iliacus) Rectus femris Gluteus medius (anterir fibres) Gluteus minimus Tensr Fasciae Latae Sartrius Adductr Magnus (assists) Adductr lngus (assists) Aductr brevis (assists) Pectineus (assists) Biceps femris Semitendinsus Semimembransus Gluteus maximus (all fibres) Gluteus medius (psterir fibres) Adductr Magnus (psterir fibres) Acetabulfemral Jint Mvement Muscles invlved Abductin Gluteus maximus (all fibres) Gluteus medius (all fibres) Gluteus minimus Tensr fasciae latae Sartrius Pirifrmis (when hip is flexed) Adductin Adductr magnus Adductr lngus Adductr brevis Pectineus Psas majr Iliacus Gluteus maximus (lwer fibres) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 105 f 216

106 Functinal Anatmy and Injury preventin mdule Acetabulfemral Jint Mvement Muscles invlved Internal (medial) Rtatin External (lateral) Rtatin Semitendinsus Semimembransus Gluteus medius (anterir fibres) Gluteus minimus Adductr magnus Adductr lngus Adductr brevis Gracilis Pectineus Tensr fasciae latae Biceps femris Gluteus maximus (all fibres) Gluteus medius (psterir fibres) Sartrius Pirifrmis Quadratus femris Obturatr internus Obturatr externus* Gemellus superir Gemellus inferir Psas majr Iliacus Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 106 f 216

107 Overview f Muscles arund the Hip Functinal Anatmy and Injury preventin mdule Illustratin shwing the anterir view f muscles with the ptential t perfrm actins n the hip Illustratin shwing the psterir view f muscles with the ptential t perfrm actins n the hip Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 107 f 216

108 Functinal Anatmy and Injury preventin mdule Illustratin shwing the lateral view f muscles with ptential t perfrm mvement t the hip Illustratin shwing the medial view f muscles with ptential t perfrm mvement t the hip Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 108 f 216

109 Functinal Anatmy and Injury preventin mdule Ilipsas The illipsas is the majr hip flexr in the bdy (and als perfrms external rtatin), and expands frm the anterir surface f the lumbar vertebrae t the lesser trchanter f the femur lcated n the medial surface f the prximal femur. The illipsas is cmpsed f three different muscles, these include: Psas majr Psas minr Illiacus The fllwing illustratin visually indicates the individual muscles that make up the illipsas: Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 109 f 216

110 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Psas Majr Psas Minr Psas majr (superficial layer): lateral surfaces f the T12 vertebral bdy, the L1-L4 vertebral bdies, and the assciated intervertebral disks Psas minr (deep layer): cstal prcesses f the L1- L5 vertebrae Cmmn insertin n the lesser trchanter f the femur as the ilipsas (psas minr) inserts int the ilipectineal arch Hip jint: flexin and external rtatin Lumbar spine: unilateral cntractin (with the femur fixed) bends the trunk laterally t the same side, bilateral cntractin raises the trunk frm the supine psitin Illiacus The iliac fssa The Gluteus muscles The Gluteus muscles are made up f three different muscles lcated in the buttck regin. They cnsists f: Gluteus maximus Gluteus medius Gluteus minimus The gluteus maximus is the largest and mst pwerful muscles in the bdy. It runs frm the distal prtin f the thraclumbar fascia (attached t the drsal sacrum) inferir and medially t the ilitibial tract and a tubersity lcated n the prximal psterir surface f the femur. The gluteus medius lies superirly t the gluteus maximus and runs frm the ilium (just inferir t the iliac crest) inferirly t the utside f the femur n the greater trchanter. The gluteus minimus, nt shwn in the illustratin n the right due t its psitin underneath the gluteus maximus and medius, runs a similar path t ne f its cunterparts the gluteus medius. Illustratin shwing the psterir superfiscial hip muscles f the right side. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 110 f 216

111 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Gluteus maximus Lateral part f the drsal surface f the sacrum, psterir part f the gluteal surface f the ilium (behind the psterir gluteal line), als frm the thraclumbar fascia Upper fibres: ilitibial tract Lwer fibres: gluteal tubersity Entire muscle: extends and externally rtates the hip, stabilises the hip in bth the sagittal and crnal planes Upper fibres: abductin Lwer fibres: adductin Gluteus medius Gluteal surface f the ilium (belw the iliac crest between the anterir and psterir gluteal line) Lateral surface f the greater trchanter f the femur Entire muscle: abducts the hip, stabilizes the pelvis in the crnal plane Anterir part: flexin and internal rtatin Psterir part: extensin and external rtatin Gluteus minimus Gluteal surface f the ilium (belw the rigin f gluteus medius) Anterlateral surface f the greater trchanter f the femur Entire muscle: abducts the hip, stabilizes the pelvis in the crnal plane Anterir part: flexin and internal rtatin Psterir part: extensin and external rtatin Tensr Fasciae Latae Anterir superir iliac spine Ilitibial tract Tenses the fascia latae Hip jint: abductin, flexin, and internal rtatin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 111 f 216

112 Functinal Anatmy and Injury preventin mdule The Rectus femris and Sartrius The Rectus femris is the main muscle f the quadriceps crssing bth the acetabulfemral and tibifemral jints t perfrm an actin at each. At the acetabulfemral jint the rectus femris aids the psas majr in hip flexin and at the tibifemral jint its aids the three ther quadricep muscles in knee extensin. The Sartrius is similar t the rectus femris and extends acrss tw jints, hwever, due t the directin f its fibres and psitining, it perfrms additinal rles at the hip jint. In additin t hip flexin, the sartrius muscles als perfrms hip abductin and hip external rtatin. Illustratin shwing the rectus femris and Sartrius n the anterir side f the femur Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 112 f 216

113 Muscle Origin Insertin Actin Functinal Anatmy and Injury preventin mdule Sartrius Anterir superir iliac spine Medial t the tibial tubersity (tgether with gracilis and semitendinsus) Hip jint: flexin, abductin, and external rtatin Rectus femris Anterir inferir iliac spine, acetabular rf f the hip jint On the tibial tubersity via the patellar ligament Hip jint: flexin (rectus femris) The Hamstrings The hamstrings are n the ppsite side t the rectus femris and therefre lcated psterirly t the femur. They are the main muscles in this regin, hwever sme f the muscle bulk is made up frm the adductr and quadriceps muscles (as shwn in the Overview f muscles arund the Hip Sectin. The hamstrings are a grup f muscles cnsisting f three individual muscles, which are: Biceps femris Semitendinsus Semimembransus All three muscles attach at the ischial tubersity, where they diverge inferirly with the semimembransus and semitendinsus attaching nt the head f the tibia (medial prtin) and the biceps femris (lng head) attaching t the head f the fibula. The biceps femris als has a shrt head which attaches t the lateral surface f the femur n the linea aspera. Illustratin shwing the Hamstrings n the psterir side f the femur Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 113 f 216

114 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Bicep Femris Lng heads: ischial tubersity, sacrtuberus ligament (cmmn head with semitendinsus) Head f fibula Hip jint: (lng head) extends the hip, stabilizes the pelvis in the sagittal plane Shrt head: lateral lip f the linea aspera in the middle third f the femur Semimembransus Ischial tubersity Medial tibial cndyle, blique ppliteal ligament, ppliteus fascia Hip jint: extends the hip, stabilizes the pelvis in the sagittal plane Semitendnsus Ischial tubersity and sacrtuberus ligament (cmmn head with lng head f biceps femris) Medial t the tibial tubersity in the pes anserinus (alng with the tendns f gracilis and Sartrius) Hip jint: extends the hip, stabilizes the pelvis in the sagittal plane The Hip Adductrs (including Gracilis and Pectineus) The hip adductrs are a grup f muscles lcated n the medial aspect f the femur bne and mve the leg twards the midline. The hip adductrs cnsist f a grup f adductr muscles, the gracilis and pectienus muscles, the grup f adductrs cnsist f: Adductr brevis the smallest, shrtest and mst superir muscle f the adductr grup Adductr lngus situated in the middle between the adductr brevis and adductr magnus Adductr magnus the largest f the three adductr muscles, the adductr magnus expands frm the ischium t the femur. Illustratin shwing hip adductrs n the Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 114 f 216

115 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Obturatr externus Outer surface f the bturatr membrane and its bny bundaries Trchanteric fssa f the femur - Adductin and external rtatin f the hip jint - Stabilizes the pelvis in the sagittal plane Pectineus Pecten pubis Pectineal line and the prximal linea aspera f the femur - Adductin, external rtatin, and slight flexin f the hip jint - Stabilizes the pelvis in the crnal and sagittal planes Adductr lngus Superir pubic ramus and anterir side f the symphysis Linea aspera: medial lip in the middle third f the femur - Adductin and flexin (up t 70 degrees) f the hip jint (extends the hip past 80 degrees f flexin) - Stabilizes the pelvis in the crnal and sagittal planes Adductr brevis Inferir pubic ramus Linea aspera: medial lip in the upper third f the femur - Adductin and flexin (up t 70 degrees) f the hip jint (extends the hip past 80 degrees f flexin) - Stabilizes the pelvis in the crnal and sagittal planes Adductr Magnus Inferir pubic ramus, ischial ramus, and ischial tubersity Deep part: medial lip f linea aspera Superficial part: medial epicndyle f the femur - Adductin, external rtatin, and extensin f the hip jint (the tendinus insertin is als active in internal rtatin) - Stabilizes the pelvis in the crnal and sagittal planes Adductr minimus Inferir pubic ramus Medial lip f the linea aspera - Adductin, external rtatin and slight flexin f the hip jint Gracillis Inferir pubic ramus belw the symphysis Medial brder f the tubersity f the tibia (alng with the tendns f Sartrius and semitendinsus) - Hip jint: adductin and flexin - Knee jint: flextin and internal rtatin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 115 f 216

116 Functinal Anatmy and Injury preventin mdule The Deep Lateral Rtatr muscles Underneath the gluteus muscles are the deep lateral rtatr muscles, which are a grup f muscles which perfrm femral lateral rtatin. They cnsist f the fllwing: Pirifrmis Obtruratr internus Gemelli superir and inferir Quadratus femris The Deep Lateral Rtatrs f the right side (deep t the gluteus maximus) Muscle Origin Insertin Actin Pirifrmis Pelvic surface f the sacrum Apex f the greater trchanter f the femur - External rtatin, abductin, and extensin f the hip jint - Stabilises the hip jint Gemelli Gemellus superir: ischial spine Gemellus inferir: ischial tubersity Jintly with bturatr internus tendn (medial surface, greater trchanter) External rtatin, adductin, and extensin f the hip jint (als active in abductin, depending n the psitin f the jint) Quadratus femris Lateral brder f the ischial tubersity Intertrchanteric crest f the femur External rtatin and adductin f the hip jint Obtruratr Internus Inner surface f the bturatr membrane and its bny bundaries Medial surface f the greater trchanter External rtatin, adductin, and extensin f the hip jint (als active in abductin, depending n the psitin f the jint) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 116 f 216

117 Functinal Anatmy and Injury preventin mdule Injuries t the structure assciated t the Hip Hamstring (Bicep femris) Strain Hamstring strains are cmmn amng thse wh play sprt and runners with pwerful acceleratins, deceleratins. An injury t any f the three muscles in the hamstring grup can range frm minr strains, a pulled muscle r even a ttal rupture f the muscle. Other cmmn causes f hamstring strains may include: Pushing beynd limits f the bdy Tight hip flexrs Weak gluteus muscles Pr flexibility Pr muscle strength Muscle imbalance between the quadriceps and hamstring muscle grups Muscle fatigue that leads t ver-exertin Leg Length Differences. Imprper r n warm-up Histry f hamstring injury Signs and Symptms The symptms f a pulled hamstring depend n the severity f the injury. The hamstring injury is usually sudden and painful. Other cmmn symptms include: Bruising: Small tears within the muscle cause bleeding and subsequent bruising. The bruise begins in the back f the thigh, and as time passes the bruise will pass dwn belw the knee and ften int the ft. Swelling: The accumulatin f bld frm the hamstring injury causes swelling f the thigh. This can make further muscle cntractin difficult and painful. Wearing a cmpressive bandage can help cntrl the swelling. Spasm: Muscle spasm is a cmmn and painful symptm f a hamstring injury. Because f the trauma t the muscle, signals f cntractin are cnfused, and the muscle may be stimulated. If severe, muscle relaxants can help with spasms. Difficulty Cntracting: Flexing the knee is ften painful after a pulled hamstring, and can even prevent the patient frm walking nrmally. If yu are unable t cntract the hamstring, the muscle may be cmpletely ruptured. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 117 f 216

118 Functinal Anatmy and Injury preventin mdule Risk Factrs Sprts Medicine Australia (SMA, 2014) suggests the main cntributing factrs t hamstring injuries cnsist f imbalance between the quadriceps and hamstring muscles, and the sudden change f directin which causes acceleratin r deceleratin. In additin, SMA have indicated further risk factrs which they split int tw categries, prven risk factrs and suspected risk factrs. Prven risk factrs include factrs which have been researched and cncluded t increase the risk f suffering a hamstring strain. Increasing age f player Previus hamstring injury Suspected risk factrs are elements which are believe t cntribute t the develpment f a hamstring strain, but have nt been fully researched, these include: Pr flexibility Pr strength Hamstring muscle fatigue Inapprpriate, inadequate r n warm up Diagnsis The diagnsis f a hamstring strain is dne thrugh imaging s that the cmplete view f the muscle, tendn, r bne invlvement with the injury can be seen. Hamstrings strains are graded much like ther muscle strains n a scale f 1-3. Grade 1 May have tightness in back f the thigh but will be able t walk nrmally Sme discmfrt and unable t perate at full speed Grade 2 Gait will be affected with limping Twinges f pain during activity Little swelling and pain when pressed Bending the knee against resistance will reprduce much pain Grade 3 Severe injury invlving a tear t half r all f the muscle May need crutches t walk and will Severe pain and weakness in the muscle Swelling will be nticeable immediately Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 118 f 216

119 Functinal Anatmy and Injury preventin mdule Bruising will usually appear within 24 hurs Treatments The immediate management f a hamstring strain is t deal with the inflammatry respnse which accmpanies the cnditin. Therefre t target this rest, ice, cmpressin and elevatin shuld be perfrmed. This aims t reduce the bleeding f the area and prevent further damage. Fllwing the immediate management a rehabilitatin prgram shuld be perfrmed t return the muscles and surrund muscles t nrmal functin. DVD (3.5mins) Watch the fllwing DVD segment: Hamstring Strain Initial Treatment Hw Lng fr a Hamstring Strain t Heal? Vide 11 & 12 Injury Preventin Elements that have been identified by Sprt Medicine Australia (2014) t assist in prevent the nset f this cnditin cnsist f: Perfrm a thrugh warm up, that targets muscles being used in the activity Develp acceleratin and deceleratin capacity f the hamstring Maintain a high level f cardivascular fitness t prevent fatigue Gradually increase the intensity and duratin f exercise Allwing adequate recver between wrk uts r training Pst rehabilitatin Fllwing the initial treatment f this cnditin, the injured muscle and surrunding structure must be returned t nrmal functinal capacity, which is achieved with rehabilitatin exercises. Specific exercises have been specified in the Cnditin exercises fr the knee later in this mdule. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 119 f 216

120 Functinal Anatmy and Injury preventin mdule Read the fllwing hand ut in the additinal reading sectin: Reading Hamstring Training Fr Injury Preventin and Rehabilitatin Online Vide (3.5mins) Hamstring Tendinitis Hamstring tendnitis is a cnditin characterised by inflammatin f the hamstring tendns at the attachment t the pelvis, which causes pain in the buttck. During nrmal cntractin f the hamstrings, tensin is placed thrugh the hamstring tendn. When this tensin is excessive due t t much repetitin r high frce, damage t the hamstring tendn can ccur. Hamstring tendnitis causes damage, degeneratin and inflammatin t the hamstring tendn Cmmn activities that may cause hamstring tendinitis are repetitive running, jumping r kicking activities. Other causes can be: Overuse injury cmmn in running and jumping activities Excessive speed changing whilst running Insufficient warm up exercise Pr cre strength Signs and Symptms In less severe cases f hamstring tendnitis, an ache r stiffness in the buttck maybe felt. This pain may increase with rest fllwing activities requiring strng r repetitive cntractin f the hamstring muscle. The pain assciated with hamstring rigin tendnitis may als warm up with activity in the initial stages f hamstring rigin tendnitis. Diagnsis A sprts physilgist r physitherapist will be able t diagnse hamstring rigin tendnitis. Further investigatins frm a GP maybe required which may lead t an Ultrasund; X-ray r MRI scan may t assess the severity f the hamstring rigin tendnitis. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 120 f 216

121 Functinal Anatmy and Injury preventin mdule Treatments In rder t treat hamstring tendnitis, rest is crucial in rder t allw the injury time t heal and t prevent any further activity which culd cause damage r discmfrt t the injury. Initial treatment f this injury will require the R.I.C.E methd. Anti-inflammatry drugs and crticsterid injectin may assist with inflammatin and pain. Additinal treatments may include taping and strapping techniques and physitherapy. DVD (4.5mins) Watch the fllwing DVD segment: High Hamstring Tendinpathy Vide 13 Femur Stress Fracture A femral stress fracture is a cnditin characterised by an incmplete crack in the femur. A stress fracture can ccur in a shrt space f time fllwing a trauma r ver time frm repetitive mvement r actins. When a stress fracture ccurs fllwing a trauma, is it a result f a frce greater than the femur can withstand, which is either due t an excessive frce r a weakened femur. Hwever, in mst cases this causes a cmplete fracture. In cmparisn, a femur stress fracture that develps ver a lng perid f time ccurs as a result f repetitive stress being placed n the femur. Over time the repetitive stress becmes t excessive fr the femur and it eventually weakens and a crack frms. Risk factrs A stress fracture f the femur typically ccurs ver time with excessive weight bearing activity such as running, sprinting, jumping r dancing. Pr ft psture Inadequate diet Muscle weakness Pr balance Inapprpriate r excessive training Pr flexibility Pr running technique Jint stiffness Menstrual disturbance in females Inapprpriate ftwear Signs and Symptms The symptms f a femur stress fracture include: A dull ache deep in the general area f the thigh. Pain when a bending frce is applied t the femur. Pain may be referred int the knee. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 121 f 216

122 Functinal Anatmy and Injury preventin mdule Pain may becme wrse when the thigh t hangs ver the edge f a bench r chair (Hang Test), particularly if weight is then applied dwnwards nt the thigh. Diagnsis Diagnsis f a stress femral stress fracture is frm an X-ray r MRI scan. An X-ray may nt shw up the stress fracture but a MRI will give a mre accurate diagnsis A thrugh subjective and bjective examinatin frm a physitherapist may als be sufficient t diagnse a femral stress fracture. Treatments Typical treatment fr a stress fracture cnsists f rest (r reducing the activity t a level f pain-free functining) and avidance f weight bearing activities n the affected area (therefre crutches are required t take weight f the femur). As the fracture recvers fllwing a few weeks r rest and decrease f symptms, weight bearing activities can be gradually incrprated ver a matter f weeks t mnths. This can include a rehabilitatin prgram that stretches and strengthens supprting structures. Injury Preventin Research frm the American Academy f Family Physicians reprted the fllwing methds t help prevent stress factrs: Addressing mdifiable risk factrs Ensuring adequate rest and mdifying activity level r training patterns Cnsider cnsumptin f daily supplementatin f calcium and vitamin D Addressing abnrmal bimechanics Include shck absrbing she inserts Pst rehabilitatin A pst rehabilitatin prgram fr stress fractures shuld invlve strengthening muscles in the lcal area as well as generalised cnditining. This creates a grup f strng, well-cnditined muscles which help t disperse and absrb the grund reactin frces which wuld therwise be transmitted thrugh bnes and jints and may eventually lead t stress fractures. T achieve this, the best way t avid wrsening the cnditin if it has nt fully recvered is t perfrm crss training (a different activity t nrmal). This changes the stress n the bdy, which riginally cntributed t the stress fracture by either remving the impact r by wrking different muscles. Running is a cmmn activity which can develp a femur stress fracture as a result f the frce transferred thrugh the bdy during impact f each step. In this case, a cmmn crss training activity cnsists f cycling which wrks the similar muscles withut the impact. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 122 f 216

123 Quadriceps (Rectus femris) Strain Functinal Anatmy and Injury preventin mdule Quadriceps strain is caused when the muscle r tendn is verstretched and becmes strained. A quadriceps strain can als be referred t as a pulled muscle, and can be a tear r a cmplete rupture. Injury ften ccurs as a result f an impact r an extrinsic injury when the muscle is cntracted. Risk factrs Sprts that invlve sprinting, jumping r kicking r interval increase the risk factr f develping this type f injury. Cmmn sprts include: Running Rugby Hurdles Tennis Lng jump Tight quadriceps Basketball Overexertin Sccer Cld weather Ftball Previus quadriceps injury DVD (3mins) Watch the fllwing DVD segment: Quadriceps Cmmn Sprts Injuries Vide 14 Signs and Symptms The signs and symptms f a rectus femris strain cnsist f: Sudden, sharp pain lcalised t the frnt f the upper leg, during exercise Pain n knee extensin and/r hip flexin against a resistance Pain n stretching the muscle grup thrugh knee flexin and/r hip extensin Lcalised swelling and bruising within the muscle grup If the muscle is cmpletely ruptured, a bulge may be felt. Diagnsis As previusly discussed with ther strain injuries, all strains are graded frm 1-3. Grade 1 Pain is mderate, and tightness can be felt in the quadriceps During exercise pain can disappear and might nt resume until after exercise The area arund the muscle tear might be tender t tuch, warm and red. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 123 f 216

124 Functinal Anatmy and Injury preventin mdule Grade 2 Pain is immediate and can be sudden and sharp Slight swelling and the area will be tender t tuch It may be difficult t bend the affected leg Pain can be felt when the leg is straightened against resistance. The hamstring muscles might be tight, and tightness tends t ccur the day after exercise Grade 3 (Cmplete rupture) Pain is severe, and walking is difficult Pain is wrse when the knee is flexed Inflammatin and bruising is mre severe Lump can be felt where thickening has ccurred. Gap might be felt where the muscle has ruptured. Treatments Mild quad strains usually heal within 10 days. Mderate strains take 10 days t 6 weeks, and severe strains require 3 mnths r lnger fr recvery. Return t sprt r activity shuld be based n the absence f symptms and the presence f nrmal leg strength and range f mtin, nt a certain number f days, weeks, r mnths. Treatments fr quad strains include: Sprts massage t speed up recvery Ultrasund and electrical stimulatin. Quad strain rehabilitatin prgram with a physitherapist r sprts physilgist. Injury Preventin Listed belw are sme injury preventin recmmendatins fr quadriceps strain: Keep yur quadriceps muscles strng t allw fr sudden physical stress and impact Regularly stretch the quadriceps. Learn the prper technique fr exercise and sprting activities. Allw fr mre warm-up time when exercising in cld weather. D nt increase the intensity, frequency, r duratin f exercise mre than 10% per week. Stp exercising if yu feel tightness in the quadriceps. Pst rehabilitatin Similar t the Hamstring The rle f the pst rehabilitatin phase cnsists f returning the individual t nrmal functin r previus sprting level. T d this it has been reprted that several factrs must be addressed: Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 124 f 216

125 Functinal Anatmy and Injury preventin mdule Muscle weakness in the injured muscle Reduced extensibility f the muscultendn unit as a result f scar tissue Adaptive changes in bimechanics and mtr patterns f mvement The ability f surrunding muscles t perfrm a supprtive rle i.e. lumbpelvic stabilising muscles Flexibility, tightness and strength f antagnistic muscle the hamstrings It is believed that eccentric strength training is the mst beneficial type f strength training t perfrm fllwing a muscle strain and shuld be implemented n the injured and assciated muscle; therefre the quadriceps and hamstrings. This is thught t restre ptimum muscultendn length and help align the fibres during the remdelling phase f healing. Excessive flexibility training f the injured muscle shuld be avided, if perfrmed this can restrict muscle regeneratin by encuraging the develpment f dense scar tissue. DVD (1.5mins) Watch the fllwing DVD segment: Strengthening Exercises fr Rehabilitatin f Quad Strains Vide 15 Additin rehabilitatin techniques G thrugh each mvement required in the sprt r activity withut pain. Use heat n the area befre an training sessin Limit running at full speed Avid sudden stps until there are n symptms and full strength and range f mtin have been regained. Crss-train in sprts that dn t place a heavy demand n the quadriceps Apply ice packs fr minutes after wrking ut Fam Rll the quadriceps, hip flexr and hamstrings. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 125 f 216

126 Acetabulfemral (Hip) Dislcatin Functinal Anatmy and Injury preventin mdule Acetabulfemral r cmmnly knwn as Hip dislcatins ccur when the ball f the femur mves ut f place within the scket f the acetabulum. Mst ften ccur frm rad traffic accidents r falls. Hip dislcatins ccur mre easily in children than in adults. Dislcatins can ccur anterirly, psterirly r centrally. Psterir dislcatins are mre cmmn and ccur in 90% f all cases. These ccur usually frm a backward frce n a flexed knee, when the hip is als flexed. Other injuries such as fractures t the Femur r the pelvis are als ften assciated. There is always sme extent f sft tissue damage fllwing a dislcated hip. This may include tears f the labrum r ligaments f the hip jint. Hip dislcatins are classified in t 5 categries: Type I with r withut a minr fracture Type II with a large single fracture f the psterir acetabular rim Type III with cmminatin f the acetabular rim, with r withut a majr fragment Type IV with fracture f the acetabular flr Type V with fracture f the femral head Risk Factrs The fllwing factrs increase the chance f develping this cnditin: Prir hip replacement surgery Abnrmal hip jint Pr muscle cntrl Weakness leading t falls Signs and Symptms The symptms f an acetabulfemral dislcatin cnsist f: Instant pain in the hip n impact Inability t mve the hip jint The leg may appear t be at an awkward angle The greater trchanter f the Femur can be felt easily. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 126 f 216

127 Functinal Anatmy and Injury preventin mdule Diagnsis Examinatin will be f the hip and leg fr diagnsis f this cnditin. This is cmpleted thrugh an X-ray r CT scan. Image shwing the psitin f the femral head in varius types f hip dislcatins. Treatments During the acute phase resting and icing the hip and taking anti-inflammatry and/r medicatins t reduce pain are helpful. Thse wh have a grade 1 psterir dislcatin may return t weight bearing as pain allws. Grade 3-5 psterir dislcatins and anterir dislcatins may require lnger times t achieve weight bearing. Hip jints with assciated fractures and/r instability are placed in a hip abductin brace pstperatively, which keeps the hip in abductin and slight external rtatin fr ptimal healing, while allwing cntrlled flexin and extensin. Passive range-f-mtin exercises withut assistance are usually reached within 5-7days f the injury. Pst rehabilitatin Fllwing a hip dislcatin, the pst rehabilitatin prgram shuld revlve arund strengthening the muscles arund yur hip jint, which help prevent it frm ccurring again. This invlves strengthening the fllwing muscles: Adductrs (adductr brevis, magnus and lngus) Hip flexrs (psas and rectus femris) Hip extensrs (hamstrings) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 127 f 216

128 Functinal Anatmy and Injury preventin mdule Read the fllwing hand ut in the additinal reading sectin: Reading Hip Cnditin Prgram Read the fllwing hand ut in the additinal reading sectin: Reading Pelvic Stress Fracture Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 128 f 216

129 Functinal Anatmy and Injury preventin mdule Pelvic Stress Fracture Activity Research and find infrmatin abut a Pelvic Stress Fracture and cmplete the table belw: Overview Cause Risk Factrs Signs and symptms Diagnsis Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 129 f 216

130 Functinal Anatmy and Injury preventin mdule Treatment Injury preventin methds Pirifrmis Syndrme The pirifrmis is a lateral rtatr f the leg and hip stabilising muscle which lies deep within the gluteal regin. It riginates frm the sacrum and attaches t the femur with the sciatic nerve being assciated t the muscles by travelling either thrugh the muscles r in clse prximity. The exact rute f the nerve thrugh this area f the bdy can vary in individuals. Pirifrmis syndrme is a cnditin where the symptms f lw back and buttck pain, which can be referred dwn the leg, is prduced as a result f the pirifrmis cmpressing r squeezing the sciatica nerve. Due t this cnditins assciatin with the sciatic nerve, this cnditin can als be referred t as sciatica. Cause The cause f pirifrmis syndrme is nt specifically understd, hwever, it is believed t be related t the tightening r spasming f the pirifrmis muscles causing it t cmpress the nerve. This may be related t a fall nt the area where the pirifrmis is lcated r in mst cases frm an veruse injury which stresses the muscle enugh t cause inflammatin. Risk factrs Risk factrs fr cntributing t this cnditin may include: Muscle tightness Pr bimechanics Jint stiffness Inadequate warm up Muscle weakness Pr pelvic r cre stability Lwer back injury Muscle imbalances Pr psture Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 130 f 216

131 Functinal Anatmy and Injury preventin mdule Excessive r inapprpriate training Signs and Symptms Signs and symptms f pirifrmis syndrme experience a pain r ache that is felt deep within the buttck. Pain may als radiate int the back f the thigh, calf, ankle r ft. Thse with this cnditin will have an increase in pain when this muscle is placed in a pirifrmis stretch r during a pirifrmis cntractin. Other activities that may aggravate symptms include: Sitting Squatting Climbing stairs Lunging Treatments Treatment f pirifrmis syndrme is very general as this severity and symptms f this cnditin can vary frm persn t persn. Treatments ptins fr this cnditin can include: Sft tissue massage t the gluteal regin Electrtherapy Stretches Dry needling Muscle energy techniques Jint mbilizatin Heat treatment Bimechanical crrectin Anti-Inflammatry Medicatin Prgressive exercises t imprve strength, flexibility and cre stability Activity mdificatin advice Technique crrectin Devising and mnitring a return t sprt r activity plan Rest - Avid the activities that cause symptms fr at least a few weeks In rare cases surgery is used t release, r lsen, the pirifrmis muscle tendn. This surgery is nt a small prcedure, and generally cnsidered the last resrt if a lengthy perid f cnservative treatment des nt slve the prblem. Injury Preventin Pirifrmis syndrme is mst cmmnly a result frm an verused pirifrmis muscle; therefre t help prevent the nset f this cnditin the functin, flexibility and strength f muscles arund the hip shuld be maintained. This includes ensuring the pirifrmis muscle itself is regularly stretched as well as ensure supprting muscles arund the hip, which assist in perfrming the same actin as the pirifrmis, are functining crrectly. These supprtive muscles cnsist f the deep lateral rtatrs and the gluteal muscles. DVD (4mins) Watch the fllwing DVD segment: Tp 3 Exercises fr Pirifrmis Syndrme Fam Rller Exercise fr yur Pirifrmis Vide 16 & 17 Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 131 f 216

132 Functinal Anatmy and Injury preventin mdule Read the fllwing hand ut in the additinal reading sectin: Reading Warning Signs and Symptms f Serius Sprts Injuries Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 132 f 216

133 Functinal Anatmy and Injury preventin mdule Functinal anatmy f the Tibifemral jint The Knee jint cnsists f articulatin between the distal head f the femur and the prximal head f the tibia, and is als knwn as the tibifemral jint because f the bnes invlved. Anterir t the tibifemral jint is a small bne called the patella (cmmnly referred t as the kneecap). The patella sits in a grve n the distal head f the femur and acts t prtect the jint (and the expsed articulating surface f the head f the femur) when it is flexed. The tibifemral jint is classified as a hinge jint, hwever it is specialised as it allwed additinal mvement that a cnventinal hinge jint. The additinal mvement ccur when the jint is flexin, where internal and external mvement is permitted. The abve image shws a typical hinge jint. Illustratin shwing the tibifemral jint Mvement permitted at the knee Tibifemral jint Mvement Muscles invlved Flexin Extensin Medial (internal) rtatin Lateral (external) rtatin Biceps femris Semitendninsis Semimembransus Gracilis Sartrius Gastrcnemius Ppliteus Rectus femris Vastus lateralis Vastus medialis Vastus intermedius Semitendinsus Semimembransus Gracilis Sartrius Ppliteus Bicep femris Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 133 f 216

134 Functinal Anatmy and Injury preventin mdule Overview f muscles arund the knee jint Illustratin shwing the anterir view f the right leg Illustratin shwing the psterir view f the right leg Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 134 f 216

135 Functinal Anatmy and Injury preventin mdule The Quadriceps and Sartrius The Quadriceps and Sartrius make up the majrity f the muscle bulk n the anterir side f the femur. The Quadriceps femris cnsists f: Rectus Femris Vastus Lateralis Vastus Medialis Vastus Intermedius The Rectus femris is the main muscle within the Quadriceps, and pssesses multiple functins due t its expansin acrss tw jints (the acetabulfemral and tibifemral jints). Its rle in regards t the acetabulfemral jint has been explained in the previus sectin, s its rle at the tibifemral will be addressed here. When cntracting, the Rectus femris perfrms knee extensin t increase the angle at this jint. The ther three Quadriceps femris muscles are attached at the prximal surface f the femur and therefre nly perfrm mvement at the tibifemral jint. They perfrm knee extensin alng with Rectus femris. Hwever, they are the vastus lateralis and vastus medialis are predminantly active at different stages thrughut knee extensin (althugh they will all be engaged thrughut the whle mvement but at different intensities). Vastus lateralis is predminantly active thrugh the majrity f extensin except the latter stage; this is generally frm full flexin t 30 degrees f flexin. At this pint, the vastus medialis becme the predminant muscle t perfrm the last 30 degrees f flexin. The Sartrius is like the Rectus femris and extends ver tw jints, the acetabulfemral (hip) and the tibifemral jint (knee). Illustratin shwing the extensrs (quadriceps femris and sartrius) n the anterir side f the right leg As a result it has different actins at each jint, the acetabulfemral has been explained earlier, and s the tibifemral is the jint that will be addressed in this sectin. The Sartrius cnnects frm the anterir superir iliac spine (ASIS) t the tibial tubersity via the pes anserinus. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 135 f 216

136 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Quadriceps Rectus femris: anterir inferir iliac spine, acetabular rf f the hip jint Vastus medialis: Lateral lip f the linea aspera, lateral surface f the greater trchanter. Vastus intermedius: anterir side f the femral shaft Tibial tubersity via the patellar ligament (entire muscle) Bth sides f the tubersity n the medial and lateral cndyles via the medial and lngitudinal patellar retinacula (vastus medialis and lateralis) The suprapatellar recess f the knee jint capsule (articularis genus) Knee jint: extensin (all parts), prevents entrapment f the capsule (articularis genus) Sartrius Anterir superir iliac spine Medial t the tibial tubersity (tgether with gracilis and semitendinsus) Knee jint: flexin and internal rtatin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 136 f 216

137 Functinal Anatmy and Injury preventin mdule The Hamstrings and the Ppliteus The Hamstrings are a grup f three muscles lcated n the psterir surface f the femur. They are cmpsed f: Bicep femris (Lng and shrt heads) Semitendinsus Semimembransus As all three muscles range frm the ischial tubersity n the pelvis t the heads f the tibia and fibula, they pssess rles at the acetabulfemral and tibifemral jints. Fcusing n the tibifemral jint, the Hamstrings cntract t perfrm flexin t reduce the angle at this jint. The hamstrings als have a rle in perfrming internal rtatin and external rtatin fr the shin bnes (tibia and fibula) when the knee is flexed. The ppliteus muscle is a small muscle psterir t the tibifemral jint. In additin t the ppliteus rle f flexin and internal rtatin, it acts t stabilise the knee jint during mvement. Illustratin shwing the flexrs (the hamstrings and ppliteus) n the psterir side f the right leg. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 137 f 216

138 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Bicep Femris Lng heads: ischial tubersity, sacrtuberus ligament (cmmn head with semitendinsus) Head f fibula Knee jint: (entire muscle) flexin and external rtatin (when the knee is flexed) Shrt head: lateral lip f the linea aspera in the middle third f the femur Semimembransus Ischial tubersity Medial tibial cndyle, blique ppliteal ligament, ppliteus fascia Knee jint: flexin and internal rtatin (when the knee is flexed) Semitendnsus Ischial tubersity and sacrtuberus ligament (cmmn head with lng head f biceps femris) Medial t the tibial tubersity in the pes anserinus (alng with the tendns f gracilis and Sartrius) Knee jint: flexin and internal rtatin (when the knee is flexed) Ppliteus Lateral femral cndyle, psterir hrn f the lateral meniscus Psterir tibial surface (abve the rigin f sleus) Flexin and internal rtatin f the knee jint (stabilizes the knee) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 138 f 216

139 Functinal Anatmy and Injury preventin mdule The Gracilis The gracilis is a lng thin muscle lcated n the medial aspect f the leg, and lies medially t the adductr muscles. It extends frm the inferir pubic ramus f the ischial tubersity t the medial head f the tibia, and is invlved in hip adductin and assists in knee flexin. An additin actin the gracilis can perfrm medial rtatin f the knee, and knee jint stability. Illustratin shwing the gracilis frm the anterir view f the right leg. Muscle Origin Insertin Actin Gracillis Inferir pubic ramus belw the symphysis Medial brder f the tubersity f the tibia (alng with the tendns f Sartrius and semitendinsus) - Hip jint: adductin and flexin - Knee jint: flexin and internal rtatin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 139 f 216

140 Functinal Anatmy and Injury preventin mdule Injuries t the structure assciated t the tibifemral jint Anterir cruciate ligament injuries The anterir cruciate ligament is a thick cnnective tissue fund within the tibifemral jint. It attaches t the anterir superir surface f the tibia and runs diagnally and attaches n the psterir distal surface f the femur head. Its rle is t prevent the tibia frm mving t far anterirly. It is crss by the psterir cruciate ligament acts in the ppsing directin and prevents unwanted psterir tibial mvement. Like with all ligaments, any frce abve the physical capacity f the anterir cruciate ligament can cause tearing f fibres r cmplete rupture, and is generally termed a sprain. The severity f the damage t the ligament can be graded as fllws: Grade 1 sprain mild damage t the ligament, the fibres have slightly stretched but still able t perfrm the majrity f its rle. Illustratin shwing the rupture f the anterir crucite ligament Grade 2 sprain the ligament has becme stretch t the pint where there fibres are stretched and damaged. This is ften referred t partial rupture and cnsists f the knee being slightly instable. Grade 3 Sprain the mst severe grade f anterir cruciate ligament damage and usually describes the cmplete tear r the ligament where it cannt perfrm any knee stabilising rle. Cause The cause f an anterir cruciate ligament injury usually invlves a large frce being place thrugh the tibifemral jint, causing an unnatural, twisting and verextensin f the structure. This can be a result f: A rapid change in directin Suddenly stpping Rapid deceleratin when running Landing incrrectly frm a jump Direct cntact r a cllisin which causes the tibia t mve anterirly rapidly Risk factrs The American Academy f Family Physicians (AAFP) have determined the fllwing elements as cntributing mechanism t an ACL injury: Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 140 f 216

141 Functinal Anatmy and Injury preventin mdule Extrinsic factrs: Playing field surface uneven, wet r muddy cnditins She surface i.e. lng cleats may prvide t much tractin Weather, which changes the playing surface Intrinsic factrs: Bdy size and limb girth Flexibility, strength and reactin time Hamstring strength Increase Q angle Ligamentus laxity Pelvic width ACL size Quadriceps dminance Gender prvides anther risk factr, with female athletes having a higher incidence f anterir cruciate ligament injuries. The reasning behind this is thught t be due t the slightly different structure f the pelvis and alignment f the legs, increase ligament laxity (related t hrmnes, especially estrgen) as well as differences in muscular strength and neurmuscular cntrl. Signs and Symptms The develpment f a cruciate ligament tear nearly always invlves a specific awkward mvement r impact t the knee jint causing the tw heads f the tibifemral jint t mve in ppsing directins. This is ften accmpanied by a ppping sund and immediate intense pain, fllwed by swelling within a few hurs which limits the range f mtin f the jint. As a result f the anterir cruciate ligament nt being able t perfrm its stabilising rle, the jint being unstable and may give way if the muscles arund the jint is nt strng enugh t stabilise the jint. The injury is accmpanied with additinal symptms that include: Tenderness alng the jint line (may be symptm f meniscus tear, which can als ccur during this injury explained in next sectin) Discmfrt during walking r weight bearing Diagnsis Like many f these cnditins, the initial phase f diagnsis cnsists f physical examinatin and discussin f symptms and histry by an allied health prfessinal, such as a GP. The physical examinatin invlves the GP assessing the injured structure (cmpared t the nn-injured side), and perfrming tests t evaluate the stability and Further diagnstic cnfirmatin can be made thrugh imaging tests such as: X-ray Magnetic resnance Imaging (MRI) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 141 f 216

142 Functinal Anatmy and Injury preventin mdule Treatment There are a range f treatment methds fr an anterir cruciate ligament injury; which can include nn-surgical and surgical treatment methds. The selectin f a treatment methd will cnsider the individual s needs, which usually invlve their level and vlume f sprting participatin. Althugh the anterir cruciate ligament is an imprtant structure within the knee (especially with sprt participatin) it can cntinue t functin withut this structure. Withut the anterir cruciate ligament, the knee jint relies n the surrund muscles t prvide supprt and help prevent unwanted mvement; therefre these muscles are required t be relatively strng and active. As a result, when an individual is nt invlved in sprt r physical activity treatment revlves arund nn-surgical methds that include: Bracing this is a structure which is Image shwing a pst-perative X-ray after an ACL patella tendn recnstructin. Image surced frm placed ver the knee t help supprt it and give it mechanical stability. Althugh this may be a gd methd shrt term, by using a brace ver a lng perid f time can weaken the muscles arund the knee. Physical therapy the surrund muscles f the knee can perfrm a stabilising rle fr the jint. Therefre exercise can be used t develp these muscles t becme increasingly efficient at perfrming a stabilising and prpriceptive rle. Fr individual s that participates in physical activity and especially elite athletes, surgery is usually the initial treatment adpted t allw them t return t nrmal activity and cmpetitin. Surgery cnsists f rebuilding and recnstructing the ligament rather than stitching the tw pieces tgether with sutures. This recnstructin cnsists f grafting tissue frm anther part f the bdy, usually the hamstrings tendn r patella tendn, and rebuilding the ligament with this grafted tendn. This prcedure invlves perfrming tw incisins in the knee where a miniature camera and a miniature surgical instrument are inserted t perfrm the peratin, this is knwn as arthrscpe. Injury Preventin The stability f the knee is largely dependent n the ligaments within and arund the knee as well as the surrunding muscles. Therefre t help prevent damaging r rupturing the ACL, the main stabilising ligament within the knee alng with the psterir cruciate ligament PCL, the stability functin f Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 142 f 216

143 Functinal Anatmy and Injury preventin mdule muscles arund the knee shuld be develped. The specific muscles invlved in knee stability cnsist f the vastus muscles f the quadriceps, especially the vastus medius bliqus. Pst rehabilitatin Sprts Medicine Australia (SMA, 2014) suggest there are many different rehabilitatin prgrams develped t utilise fllwing ACL recnstructive surgery, hwever, sme f these may nt be relevant t recent research. The current belief sees an ACL rehabilitatin prgram initiate with prtective mbilisatin exercises befre prgressing int specific knee strengthen exercises. Fllwing the initial stages and nce mbility and strength has been develped; exercise can advance t functinal exercises. A sample f exercises which can be adpted are shw in the Knee cnditin exercises, althugh it des nt specifically shw prtective mbilisatin exercises. Meniscal tear Anatmy recap: The meniscus cnsists f tw C shaped discs f tugh cartilage (fibrcartilage) lcated n the prximal surface f the head f the tibia and distal surface f the head f the femur. They are part f the synvial jint f the tibifemral jint t help absrbs shcking and distribute lad being placed n this structure. Each jint cnsists f the medial meniscus and the lateral meniscus. Damage t the meniscus usually ccurs in the frm f a tear, and can ccur in several different areas f the cartilaginus structure, these can include: a. Peripheral tear b. Bucket-handle tear c. Lngitudinal r flap tear f the anterir hrn d. Radial tear f the psterir hrn Illustratin shwing the effect n the meniscus during knee flexin Illustratin indicating the different areas f the meniscus can be injuried. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 143 f 216

144 Functinal Anatmy and Injury preventin mdule Cause The meniscus is a tugh structure due t its requirement t absrb great frces; hwever, the meniscus is vulnerable when the knee is mved in certain directins and lateral r twisting pressure is placed n the structure. The mst cmmn manner in which the meniscus is damaged cnsists f the knee being twisted whilst slightly flexed. This invlves the femur twisting at the same time as the ft and lwer leg remaining in a neutral r planted psitin. Risk factrs The mst cmmn ccurrence fr a sudden meniscus tears is during sprt, and can happen as a result f direct cntact t the knee, r an awkward mvement at the knee jint. This suggests a high risk factr fr this cnditin cnsists f playing a cntact sprt r a sprt which requires a quick change f directin and speed. Anther risk invlves age, with the meniscus structure degenerating as we age, causing it t weaken and becme increasingly prne t damage. As a result, even mderated twisting t the knee can be enugh t damage and tear the cartilage. Therefre, meniscus tearing is frequently experience in the elderly. Signs and Symptms A meniscus tear, in mst cases, is caused by a specific awkward mvement; and therefre pain is ften felt directly after this mvement. This can be accmpanied with a ppping sensatin in the knee jint. Subsequent t the injury, the knee can swell and becme stiff, restricting its full range f mvement (prevent it frm fully extending). In additin mvement f the knee can cause a catching r lcking sensatin. Sme f these symptms are similar t thse experienced during an anterir cruciate ligament tear, s diagnsis must be accurate t differentiate the tw; hwever, these tw cnditins are usually assciated tgether. Diagnsis Initial diagnsis fr a meniscus tear cnsists f a physical examinatin and histry frm an allied health prfessinal, such as a GP. This physical examinatin invlves checking fr tenderness arund the jint line as well as perfrming the McMurray test. Tenderness is ften a signal f meniscus tearing. The McMurray test invlves the allied health prfessinal slightly rtating the knee whilst extending it frm a flexed psitin. This mvement puts pressure n the meniscus and therefre pain will be felt, a clicking sund and lcking sensatin will be experienced. If further diagnstics is required, this can be perfrmed using imaging tests which include: X-rays Magnetic resnance imaging (MRI) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 144 f 216

145 Functinal Anatmy and Injury preventin mdule Treatments & Injury Preventin Treatment fr meniscus tears will depend n the severity, size and lcatin f the tear, as well as the individual s age, activity level and related injuries. Different parts f the meniscus have cntrasting bld supplies, and therefre can affect whether healing ccurs r nt and the rate it ccurs. The utside third f the meniscus cntains a rich bld supply whereas the inner tw-thirds have a very pr bld supply. This suggests small tears t the uter third may heal themselves due t the cntinuus delivery f bld cntain nutritin, hwever the inner tw-thirds is unlike t heal with its deprived bld supply. As a result f the ptential t heal itself any tear in the uter third will invlve a nnsurgical treatment, and in cntrast a tear in the inner tw-thirds will require surgical treatment t trim the tear as it is will nt heal itself. Nnsurgical treatment cnsists f: RICE treatment helps cmbat the swelling and inflammatin. Rest Ice Cmpressin Elevatin Nn-steridal anti-inflammatry medicines these can target the pain and swelling. Surgical treatment is perfrmed when nn-surgical treatment is unsuccessful, r damage t the meniscus is large and unlikely t heal itself. Surgical treatment usually invlves trimming r repairing the tear t the meniscus in a prcedure knwn as knee arthrscpy (similar t the prcess in anterir cruciate ligament repair). A meniscetmy is the name given t the prcedure when part f the meniscus is trimmed away. Image shwing an arthrscpy f the knee t repair the trn meniscus. Surced frm Injury Preventin Sprt Medicine Australia (2014) suggests the fllwing elements t help prevent a meniscus injury: Undertaking training prir t cmpetitin t ensure readiness t play Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 145 f 216

146 Functinal Anatmy and Injury preventin mdule Warming up, stretching and cling dwn Undertaking fitness prgrams t develp strength, balance, crdinatin and flexibility Gradually increasing the intensity and duratin f training Allwing adequate recvery time between wrkuts r training sessins Wearing the right prtective equipment including ftwear. A gd pair f shes will help t keep knees stable, prviding adequate cushining, and supprting knees and the lwer leg during the running r walking mtin Checking the sprting envirnment fr hazards Drinking water befre, during and after play Aviding activities that cause pain. (Infrmatin surce directly frm Pst rehabilitatin The primary gal f a rehabilitatin prgram is t return the knee jint t nrmal functin, prevent muscle wastage and eliminate any pain that accmpanies knee mvement. Sprts Medicine Australia (2014) suggests the rehabilitatin initiates with knee jint mbilisatin alng with hamstring and quadriceps strength training, especially the muscles which supprt the knee. Weight bearing exercises can be intrduced as the individual prgresses. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 146 f 216

147 Functinal Anatmy and Injury preventin mdule Ilitibial band syndrme Activity Research and find infrmatin abut Ilitibial band syndrme cmplete each sectin within the table belw: Overview Explain the cause f this cnditin. What are the risk factrs fr this cnditin? Describe the signs and symptms f this cnditin. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 147 f 216

148 Functinal Anatmy and Injury preventin mdule Hw is this cnditin diagnsis? What treatment is used fr this cnditin? Injury preventin methds Patellfemral Pain syndrme Patellfemral pain syndrme is a general term used t describe pain experienced where the patella slides ver the tibifemral jint. It is als knwn as anterir knee pain syndrme and patellfemral malalignment. As it is cnsidered a general term, there are a number f elements that may cntribute t this cnditin, which will be explained in this sectin. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 148 f 216

149 Functinal Anatmy and Injury preventin mdule Cause This cnditin describes pain felt behind the patella and arund the tibifemral jint, and therefre is nt a specific cnditin. As a result, there are a number f factrs which culd cause this cnditin r cntribute t the develpment, these include: Malalignment f the patella Muscular imbalance arund the knee Jint restrictin, resulting frm tight structures Prnated feet creating pr lwer limb bimechanics Injury t substructures arund the jint Degeneratin r wear and tear f structures within the jints i.e. meniscus degeneratin Risk factrs Factrs which increase the likelihd f develping this cnditin cnsist f: Malalignment f the knee jint, which can be a result f: Excessive prnatin r supinatin f the ankle during walking r running The patella being shifted superir r inferir Lse ligaments Bwed legs Knck knees External rtatin f the leg Weak r tight muscles arund the knee Pr bimechanics placing pressure n structures within the tibifemral jint The rubbing f the patella n the femur during mvement Overuse and repetitive verlading f the knee jint Participatin in high impact activities In additin t the abve cnditins, the deteriratin f structures within the knee which accmpanies aging can be a risk factr in develping patellfemral pain syndrme Signs and Symptms The majr symptm assciate with this cnditin, as suggested by its name is the presence f pain arund where the patella meets the femur. This symptm may present itself n its wn r can be accmpanied by: Ppping r grinding sund during tibifemral mvement Swelling arund the patella Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 149 f 216

150 Functinal Anatmy and Injury preventin mdule Snapping r crunching sensatin in the jint. Diagnsis The diagnsis f this cnditin usually invlves an allied health prfessinal btaining infrmatin abut the symptms as well as medical histry. They will then perfrm a physical examinatin t determine mre specifics abut where the pain is lcated and whether it can be recreated with any specific mvements. This will help determine a mre precise evaluatin n the cause f the cnditin. If further diagnstics is required, imaging culd be perfrmed in the means f: X-ray Magnetic resnance imaging (MRI) Cmputed tmgraphy (CT) scan. This will help determine any structural prblems within the jint that culd ptentially cause this cnditin. Treatments Treatment fr patellfemral jint pain usually invlves nnsurgical methds that include: Nn-steridal anti-inflammatry medicatins t cmbat the pain RICE Rest, Ice, Cmpressin and Elevatin t help reduce inflammatin Reduce activity invlving the knee and identify the cntributing r causing activity, t wrk addressing these issues In sme cases where patellfemral pain syndrme is a result f structural prblems within the jint, such as lse fragments f a damaged kneecap cartilage r pr patella alignment then surgery can be perfrmed. T remve fragments within the tibifemral jint, a prcedure called an Arthrscpy is perfrmed, which invlves a small instrument t access the inside f the knee structure and keep all the ther structure intact. Fr realignment, surgery is perfrmed slightly different. A surgen will pen the knee structure; realign the patella by releasing structures that are causing the malignment. Injury Preventin T help prevent the develpment f patellfemral pain, the fllwing actins can be perfrmed: Keep active Stretch muscles arund the knee Gradually prgress training Use crrect and functinal equipment Use crrect technique Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 150 f 216

151 Knee cnditining exercises Functinal Anatmy and Injury preventin mdule The American Academy f Orthpaedic Surgens (AAOS, 2014) prduced a Knee Cnditin Prgram which addressed the exercises t be perfrmed fllwing an injury r surgery t the knee. The prgram incrprates a cmbinatin f flexibility and strengthening exercises t help the individual return t nrmal functin and help prevent the injury fr ccurring again. The whle cnditin prgram can be fund in the additinal reading sectin. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 151 f 216

152 Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 152 f 216

153 Functinal Anatmy and Injury preventin mdule Rehabilitatin exercises fr the knee surced frm: Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 153 f 216

154 Functinal Anatmy and Injury preventin mdule Functinal anatmy f the Talcrural and Subtalar jint The ankle is a cmplex structure, which is made up f 2 different jints that perfrm different rles. These include: Talcrural jint made up f the distal end f the tibia and fibula and the prximal end f the talus (indicated in diagram a n the right). Illustratin shwing the talcrural jint Subtalar jint, smetimes knwn as Talcalcaneal jint cnsists f the articulating surfaces between the talus and the calcaneus (indicated in diagram b n the right) Bth the Talcrural jint and the Subtalar jint are hinge jints, which can be seen n the illustratin n the left. Illustratin shwing the subtalar jint Mvements permitted at the ankle The fllwing tables and illustratins indicate the types f mvement permitted at the Talcrural jint and the Subtalar jint within the ankle: Talcrural Jint Mvement Muscles invlved Plantar Flexin Gastrcnemius Sleus Tibialis psterir Perneus lngus (assists) Perneus brevis (assists) Flexr digitrum lngus (weak) Flexr halluces lngus (weak) Plantaris (weak) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 154 f 216

155 Functinal Anatmy and Injury preventin mdule Drsiflexin Tibialis anterir Extensr digitrum lngus Extensr halluces lngus Subtalar Jint Mvement Muscles invlved Eversin (prnatin) Perneus lngus Perneus brevis Extensr digitrum lngus Inversin (supinatin) Tibialis Anterir Tibialis psterir Flexr digitrum lngus Flexr hallucis lngus Extnesr Hallucis lngus The Gastrcnemius, Sleus and Plantaris The Gastrcnemius and Sleus are the tw majr muscles and make up the majrity f the muscle bulk in the psterir area f the lwer leg. They are ccasinally gruped tgether and referred t as the triceps surae. The Gastrcnemius is the largest muscle in the lwer leg spanning acrss tw (three if yu cunt bth ankle jints) jints the tibifemral f the knee and the subtalar and talcrural jints f the ankle. It cnsists f tw prtins, the medial head and the lateral head which attach the medial and lateral head f the femur and run inferir int the Achilles tendn. The sleus muscle lies deep t the gastrncenmius and arises frm the psterir surface f the upper tibia fllwing the same path as its cunterpart calf muscle and similarly inserts int the Achilles tendn. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 155 f 216

156 Functinal Anatmy and Injury preventin mdule Illustratin shwing the gastrcnemius and its attachment pints Muscle Origin Insertin Actin Illustratin shws the muscles deep t the gastrcnemius Gastrcnemius Medial head: medial epicndyle f the femur Slues Lateral head: later epicndyle f the femur Psterir surface f the head and neck f the fibula The calcaneal tubersity via the Achilles tendn Tulcrural jint: plantar flexin Subtalar jint: inversin (supinatin) Knee jint: Flexin (nly the gastrcnemius) Plantaris Prximal t the lateral head f gastrcnemius Negligible due t its small crss sectin Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 156 f 216

157 Functinal Anatmy and Injury preventin mdule The Tibialis anterir and Ankle Extensrs (Anterir Cmpartment) The Tibialis anterir, als called the shin muscle is lcated, as the name suggests, anterirly t the tibial bne. The muscle attaches t the prximal anterir surface f the tibia, and runs inferirly and medially passing the medial mallelus anterirly befre attaching t the distal surface f the first metatarsal. The ankle extensrs cnsist f the extensr digitrum lngus and the extensr hallucis lngus. They are lcated slightly deeper and distally t the tibialis anterir and run alng the drsal surface f the ankle and ft attaching t the distal psitin f the phlanages (digitrum being secnd t fifth tes, and hallucis being the big te). Their main rles invlve extending the tes, with hallucis lngus extending the big te and digitrum lngus extending the secnd t fifth tes. In additin, they assist in drsiflexin f the talcrural jint and inversin and eversin f the subtalar jint (extensr digitrum lngus perfrming eversin and extensr hallucis lngus assisting in bth inversin and eversin). Tgether the tibialis anterir, extensr digitrum lngus and extensr hallucis lngus make up the anterir cmpartment f the lwer limb. Illustratin shwing the anterir cmpartment f the right leg shwing the tibialis anterir, extensr digitrum lngus and extensr hallucis lngus Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 157 f 216

158 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Tibialis Anterir Upper tw thirds f the lateral anterir surface f the tibia Medial and plantar surface f the medial cuneifrm, medial base f the first metatarsal Talcrural jint: Drsiflexin Subtalar jint: inversin (supinatin) Extensr digitrum lngus Lateral tibial cndyle, head f the fibula, anterir brder f the fibula Middle and distal phalanges f secnd thrugh fifth tes Talcrural jint: Drsiflexin Subtalar jint: eversin (prnatin) Extends the secnd thrugh t fifth te Extensr hallucis lngus Middle third f the medial surface f the fibula Drsal apneursis f the big te and the base f its distal phalanx Talcrural jint: Drsiflexin Subtalar jint: active in bth inversin (supinatin) and eversin (prnatin) Extends the big te Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 158 f 216

159 Functinal Anatmy and Injury preventin mdule The Tibialis psterir and Ankle Flexrs (Deep Psterir cmpartment) The Tibialis psterir is the ppsing muscle t the tibialis anterir and is lcated n the psterir surface f the tibia. It runs in a similar directin and passes the medial mallelus psterirly befre als attaching nt the distal surface f the first metatarsal. The ankle flexrs cnsist f the flexr digitrum lngus and flexr hallucis lngus and are lcated each side f the tibialis psterir. These muscles are invlved in ankle plantar flexin, hwever, their main rle is t flex the tes. The hallucis lngus flexes the big te, and the digitrum lngus flexes the ther fur tes. The flexr digitrum lngus is als invlved in inversin and the flexr hallucis lngus is invlved in eversin. Tgether the tibialis psterir, flexr digitrum lngus and flexr hallucis lngus make up the deep psterir cmpartment f the lwer leg. They are lcated directly psterir t the tibia and fibula and sit deep t the gastrcenmius and sleus. Illustratin shwing the anterir cmpartment f the right leg shwing the tibialis psterir, flexr digitrum lngus and flexr hallucis lngus Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 159 f 216

160 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Tibialis Psterir Crural intersseus membrane and the adjacent brders f the tibia and fibula Tubersity f the navicular: medial, intermediate, and lateral cuneifrms; bases f the secnd thrugh t furth metatarsals. Talcrural jint: plantar flexin Subtalar jint: inversin (supinatin) Supprts the lngitudinal and transverse arches f the ft Flexr digitrum lngus Middle third f the psterir surface f the tibia Bases f the secnd thrugh t fifth distal phalanges Talcrural jint: plantar flexin Subtalar jint: inversin (supinatin) Flexes the secnd thrugh t fifth te Flexr hallucis lngus Distal tw-thirds f the psterir surface f the fibula, adjacent crural intersseus membrane Base f the distal phalanx f the big te Talcrural jint: plantar flexin Subtalar jint: inversin (supinatin) Flexes the big te Supprts the medial lngitudinal arch f the ft Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 160 f 216

161 Functinal Anatmy and Injury preventin mdule The Fibularis muscles The Fibularis muscles are lcated n the lateral aspect f the lwer leg, running parallel with the fibula. They are cmprised f tw muscles: Fibularis lngus Fibularis brevis The fibularis lngus expands the entire length f the fibula where it is attached t the prximal head and runs dwn t the cubid and fifth metatarsal. Illustratin shwing the lateral cmpartment indicating the fibularis muscles (lateral view f the right leg) Illustratin shwing the attachment lcatin f the fibularis lngus n the right ft Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 161 f 216

162 Functinal Anatmy and Injury preventin mdule Muscle Origin Insertin Actin Fibularis Lngus Head f the fibula, prximal tw-thirds f the lateral surface f the fibula Plantar side f the medial cuneifrm, base f the first metatarsal Talcrural jint: plantar flexin Subtalar jint: eversin (prnatin) Supprts the transverse arches f the ft Fibularis brevis Distal half f the lateral side surface f the fibula Tubersity at the base f the fifth metatarsal Talcrural jint: plantar flexin Subtalar jint: eversin (prnatin) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 162 f 216

163 Functinal Anatmy and Injury preventin mdule Injuries t the structure assciated t the Talcrural and Subtalar jints Achilles Tendnitis and Achilles Tendinpathy Achilles tendnitis and achilles tendinpathy are ften assciated as the same cnditin; hwever, they are in fact tw different cnditins assciate t the same structure. Achilles tendinitis simply refers t the inflammatin f the achilles tendn, whereas achilles tendinpathy is a mre cmplex cnditin invlving the degeneratin r disrganised healing respnse f the achilles tendn. Achilles tendinpathy is a chrnic cnditin, which evlves ver lng perid f repetitive lading f the achilles tendn, eventually leading t deteriratin and changes in the structural makeup. Illustratin shwing the lcatin and attachment site f the Achilles tendn Cause Achilles Tendnitis The mst cmmn cause f achilles tendnitis invlves the verstretching f the achilles tendn, which may invlve damage t fibres within the tendn. Achilles Tendinpathy (Tendnsis) The excessive lading f tendns during physical activity is cnsidered the main cntributing factr in the develpment f tendinpathies, and Achilles tendinpathy is n different. When a tendn is expsed t repetitive lad beynd its physilgical capacity it begins t degenerate ver time. Therefre if excessive lads are directed thrugh the Achilles tendn frm the gastrcnemius and sleus during running r activities, which invlve plantar flexin r require eccentric drsiflexin, the achilles tendn structure begins t break dwn. Risk factrs The risk factr fr bth achilles tendnitis and achilles tendinpathy are very similar. Achilles Tendnitis Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 163 f 216

164 Functinal Anatmy and Injury preventin mdule The ver stretching and acute damage t the achilles tendn is likely t ccur during an activity which requires high-lad plantar flexin r eccentric drsal flexin, that require the cntractin f the calf muscles. Achilles Tendinpathy (Tendnsis) Similarly t achilles tendnitis, a risk factr fr develping achilles Tendinpathy als invlves activities that expse the calf muscles t f repetitive high lad plantar flexin r eccentric drsal flexin. Hwever, fr Achilles tendinpathy the perfrmance f this activity is required ver a lng perid f time creating cntinual stress t the tendn and therefre can be classified as a chrnic repetitive stress and strain injury. Activities that are repetitive in nature fr the muscles surrund the ankle are a great risk factr, these include: Running (especially sand running and distance running) Basketball Skipping In additin, ther factrs which place an individual at greater risk f develping this cnditin are: Weak plantar flexrs (gastrcnemius and sleus) Pr/ld ft wear Exercising t much t sn (nt allwing gradual prgressin) Signs and Symptms Achilles tendinitis symptms cnsist f: Pain and stiffness in the achilles tendn in the mrning Pain the day fllwing exercise Thickening f the tendn Evidence f swelling Achilles tendinpathy is characterised by an absence f inflammatry respnse and pr healing respnse with cllagen degeneratin, fibre disrientatin and thinning, scattered vascular ingrwth. As a result these cannt be seen withut imaging tests. Hwever, ne symptm that can be identified in achilles tendinpathy cnsists f pain in the Achilles tendn regin. Diagnsis The diagnsis f Achilles tendnitis is usually perfrmed by an allied health prfessinal, where symptms and client histry is gained and a physical examinatin is cnducted, which aims t identify: Whether there is swelling present alng the Achilles tendn Whether the Achilles tendn is thickened r enlarged (cmpared t nn-affect side) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 164 f 216

165 Whether there is any lss f range f mvement r strength Functinal Anatmy and Injury preventin mdule Achilles tendinpathy is a harder cnditin t diagnse, where degeneratin r changes in tendn structure must be identified. This is usually dne using imaging testing, which include: X-rays this can identify and calcificatin r hardening f the tendn. Magnetic Resnance Imaging (MRI) this can determine whether the tendn has degenerated r under gne structural changes. Treatments Due t the different pathlgy f these tendn cnditins, the treatment fr each is slightly different and is explained here. Achilles Tendnitis This is an acute cnditin invlving inflammatin, and therefre the initial treatment cnsists f cntrlling this inflammatin. This wuld cnsist f: Rest Ice Cmpressin Elevatin Once the acute inflammatin has been cntrlled, elements that may cntribute t the develpment must be addressed, this includes: Crrectin f malalignment Stretching and strengthening f related structures Achilles Tendinpathy (Tendnsis) Being a mre cmplex cnditin, Achilles tendinpathy requires different treatment than tendnitis and can invlve bth nn-surgical and surgical methds. Nn-Surgical treatment The initial nn-surgical treatment addresses the factrs that caused the cnditin, which in mst cases invlves a repetitive physical activity. Therefre the vlume and intensity f repetitive activities shuld be reduced decreasing the stress being placed n the tendn. Imprtantly, activity shuld nt be cmpletely stpped as this can be detrimental t tendn repair. The healing and remdelling prcess is stimulated and encuraged frm tendn lading, especially eccentric tendn lading. Eccentric muscle training cnsists f perfrming strength training t the gastrcnemius and sleus whilst these muscles are extending at the same time as cntracting. This helps decrease pain assciated with chrnic achilles tendinpathies and mre imprtantly prmte the remdelling prcess and stimulate a repair t the tendn. The American Academy f Orthpaedic Surgens (AAOS, 2014) has prduced the fllwing descriptin f hw t perfrm eccentric muscle strengthening fr the Achilles, sleus and gastrcnemius: Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 165 f 216

166 Functinal Anatmy and Injury preventin mdule Guidance n hw t perfrm an eccentric strengthening exercise, surced frm In additin the abve exercise prescriptin, deep frictin massage and stretching can be perfrmed t the tendn and assciated muscles. This can release tensin frm repetitive activities, increase bld flw and als prmte healing. If the initially used eccentric strength training, flexibility and massage techniques d nt imprve the cnditin, an autlgus bld injectin can be used. This is anther nn-surgical treatment methd which invlves remving bld frm the individual and then injecting it back int and arund the Achilles tendn. This prvides the direct area with bld cells t prmte healing f the damaged tendn. Surgical Treatment Surgery is perfrmed n individuals whse symptms d nt imprve fllwing nn-surgical treatment. There are tw methds surgery can be perfrmed which invlves: Remval f ndules and adhesins that may be cntributing t the cnditin Cut a lngitudinal cut alng the tendn t stimulate healing and allw access t bld. Injury Preventin Sme suggested injury preventin methds fr achilles tendnitis and tendinpathy cnsists f: Avid repetitive stressing f the Achilles tendn withut adequate rest Increase activity level gradually Stretch the calf muscles Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 166 f 216

167 Functinal Anatmy and Injury preventin mdule Strengthen calf muscles Wear adequate ftwear Pst Rehabilitatin The specific exercise recmmendatins fr achilles tendinpathy has been included in the nn-surgical treatment sectin, hwever; rehabilitatin exercises which can be perfrmed fllwing surgical treatment can be fund n page 164. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 167 f 216

168 Functinal Anatmy and Injury preventin mdule Achilles tendn rupture Activity Research and find infrmatin abut Achilles tendn rupture cmplete each sectin within the table belw: Overview Explain the cause f this cnditin. What are the risk factrs fr this cnditin? Describe the signs and symptms f this cnditin. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 168 f 216

169 Functinal Anatmy and Injury preventin mdule Hw is this cnditin diagnsis? What treatment is used fr this cnditin? Injury preventin methds Medial Tibial stress syndrme (Shin splints) Medial tibial stress syndrme, als knwn as shin splints, is ne f the mst cmmn cnditins affecting runners. It is thught t be an veruse r repetitive stress injury alng the medial brder f the tibia that causes pain alng that regin. Cause The specific cause f this cnditin is nt specifically knwn, hwever there is belief that the muscles (the tibialis psterir, sleus and flexr digitrum lngus) and tendns that run alng the medial brder f the tibia bne becme verwrked and tight eventually pulling n the bne r its superficial layer causing inflammatin. This cntinual r repetitive perfrmance can ccur ver a lng perid f time and shin splints can gradually develp r ver a shrt perid. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 169 f 216

170 Functinal Anatmy and Injury preventin mdule When develped ver a shrt perid f time, training errrs can be identified as the cause f medial tibial stress syndrme. This invlves individuals perfrming an excessive vlume f training (in mst cases invlves running) in a shrt space f time, and nt allwing a gradual build up. As a result this cntinually stresses the area, preventing healing and eventually leads the t prgressive inflammatin f surrunding tissues and muscles. Other mre recent research suggests that medial tibial stress syndrme is a result f a stress respnse frm the bne and its surrunding layer the peristeum. It is suggested that this structure becmes inflamed and the repetitiveness f an activity causes the inability fr the bne remdelling prcess t functin efficiently. Risk factrs The risk factrs fr shin splints can cnsist f: Perfrmance f activities that require cntractin f lwer leg muscles i.e. running, basketball (jumping) Weak lwer leg muscles Pr running technique excessive prnatin r flat feet Pr understanding f training principles prgress training t quickly Previus leg injury Lack f calcium Signs and Symptms The mst cmmn signs and symptms f medial tibial stress syndrme cnsists f: Pain felt alng the medial aspect f the tibia bne Tenderness and sreness t tuch the area Inflammatin f the area Pain felt during and fllwing activity Diagnsis Shin splints can ften be diagnsed fllwing a physical examinatin and explanatin f the symptms t an allied health prfessinal. In sme cases shin splints can be accmpanied with ther cnditins, s if a physical examinatin was perfrmed initially, and the cnditin is nt imprving, additinal imaging tests can be perfrmed. Other cnditins that can present themselves alngside shin splints cnsist f a stress fracture f the tibia, tendnitis and chrnic cmpartment syndrme. Treatments Treatment fr this cnditin is usually based arund nn-surgical treatment, which initially addresses the inflammatry respnse befre targeting any imbalance f muscle flexibility and strength arund the ankle and bimechanical r technique issues. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 170 f 216

171 Functinal Anatmy and Injury preventin mdule T reduce the inflammatin nn-steridal anti-inflammatry medicines can be administered alng with rest, ice and cmpressin applied t the area f pain. Once the initial inflammatry respnse has been treated, treatment can prgress t imprving flexibility and strength f the muscles assciated with this cnditin, which cnsist f sleus, tibialis psterir and flexr digitrum lngus. Further treatment cnsists f addressing the ftwear and bimechanics f the ft with rthtics as individuals with this cnditin quite ften have flat feet r excessive prnatin. In sme severe cases, where chrnic shin splints shw n imprvement fllwing extensive treatment surgery can be perfrmed, hwever, there is n cnclusin as t hw affective this treatment is. Injury Preventin T help prevent the develpment f this cnditin, the fllwing techniques can be used t help: Build fitness level prgressively Wear crrect fitting ftwear with supprt if required Crss train Develp bareft running gradually Plantar Fasciitis The plantar fascia is a flat band f tissue that cnnects the calcaneal bne t the metatarsals and plays a vital part in absrbing shck and supprting the arch f the ft. When an excessive frce is repetitively placed n the plantar fascia, it cntinually causes it t stretch and stress the structure eventually leading t small tears and degeneratin. As a result it becmes inefficient at perfrming its shck absrbing and supprting rle limiting its rle in supprting lads applied t the arch f the ft. Plantar fasciitis is the mst cmmn injury in the ft, and is characterised as the degeneratin f the plantar fascia n the drsal surface f the ft, which can prevent it frm supprting the lads applied t the ft. Cause Plantar fasciitis is believed t develp fllwing cntinual r repetitive stretching r stressing f the structure that leads t small tears in the plantar fascia. Therefre the cause can be any activity that invlves repetitive actins that invlve landing heavily n the feet. Risk factrs Factrs which place and individual at a greater risk f develping plantar fasciitis cnsist f: Excessive prnatin Pr ftwear (unsupprtive shes) Tight calf and Achilles Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 171 f 216

172 Functinal Anatmy and Injury preventin mdule High impact activity n hard surfaces Lng perids f standing, walking r running Signs and Symptms The symptms f plantar fasciitis cnsist f: Pain in the mrning (especially the first few steps) Increase level f pain whilst climbing stairs n standing n tes Pain fllwing lng perids f standing Pain n cmmencement f exercises, which reduces r fades as exercise prgresses Diagnsis The diagnsis f plantar fasciitis is generally cnducted by an allied health prfessinal perfrming a physical examinatin and gathering the client histry. Additinal imaging tests can be perfrmed (X-ray and MRI) t identify cmplicatins such as bne spurs. Treatments Plantar fasciitis treatment mst ften cnsists f cnservative nn-surgical methds, which aim t address the symptms and help return t plantar fasciitis back t its nrmal cnditins. This invlves: Medicatin anti-inflammatries and pain relievers Exercise stretching the calf and plantar fascia Night splints stretches the calf and plantar fascia Orthtics imprves the bimechanics f the ft and help reduce stress placed n the plantar fascia. Like mst cnditins, if plantar fasciitis des nt imprve with the initial cnservative treatment, there are ther treatments that can be perfrmed. These may invlve: Sterid injectin crtisne injectins directly t the area f pain t target the inflammatin Surgery this invlves remving the plantar fascia frm the heel bne t remve the pressure and cntinual stress n the structure. Injury Preventin Sprt Medicine Australia (2014) suggests the fllwing strategies t prevent the develpment f plantar fasciitis: Maintain healthy weight t prevent additinal stress expsed t the plantar fasciitis Wear the supprtive shes this includes renewing wrn ut shes Cnduct a thrugh warm up which prepares the muscles and cnnective tissue Prgress gradually activity/exercise nt t stress muscles r tissues t quickly. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 172 f 216

173 Allw adequate recvery time between sessins Cnsume water befre, during and after sprt Avid activities that cause pain Functinal Anatmy and Injury preventin mdule Cnditining exercises fr the ankle and ft The American Academy f Orthpaedic Surgens (AAOS, 2014) have develped a ft and ankle cnditining prgram, t help individuals return t nrmal functin fllwing an injury r surgery t the ankle r ft. A number f exercises have been taken frm this prgram develped by AAOS and included in this mdule t shw the types f exercises that can be used during the rehabilitatin stage f a ft and ankle injury. The whle cnditin prgram can be fund in the additinal reading sectin. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 173 f 216

174 Functinal Anatmy and Injury preventin mdule Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 174 f 216

175 Functinal Anatmy and Injury preventin mdule Rehabilitatin exercises fr the ft and ankle surced frm Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 175 f 216

176 General Injury Preventin Strategies Functinal Anatmy and Injury preventin mdule Injuries are generally preventable in mst situatins. When training yur clients, yu undubtedly want t reduce r eliminate the chances f injury during each training sessin. By taking a clser lk at pssible causes f injury, yu may be able t reduce the risk f injury fr a client. The type and amunt f training carried by an individual plays a key rle in determining the real injury risk. Research int injury preventin has shwn that training cmpleted the previus mnth culd be linked t the direct injury. Frequency f training The number f cnsecutive days f training carried ut each week will increase the risk f injury t any client r athlete participating in activity. By reducing the number f cnsecutive days f training clients and athletes can lwer their risk f injury. Recvery time reduces injury rates by giving muscles and cnnective tissues an pprtunity t restre and repair themselves between wrkuts. Strength training Regular strength training sessins can identify weak areas f the bdy and decrease the risk f injury t that area. Many injuries are caused by weak muscles, which simply are nt ready t handle the specific demands f the activity. Reduce vlume Fr runners there is a direct link between training quantity and injury. This means that the ttal km s run is an excellent indicatr f the injury risk. The mre km s run per week, the higher the chances f injury. This is why peple wh start a running prgram fr the first time ften d well fr a few weeks but then as they add the extra km s n, suddenly develp ft r ankle prblems, hamstring sreness r perhaps lwer back pain. Their bdies simply are nt strng enugh t cpe with the demands f the increased training lad. Take a lk belw at sme ther pssible factrs that cause injury: Age Psychlgical state Gender Extrinsic factrs Bdy size Equipment Injury histry Envirnment Fitness level Type f activity Muscle strength/flexibility Cnditining errrs Skill level Recvery strategies Fllwing intensity activity r exercise, it is imprtant t allw the bdy t fully recver, therwise if adequate recvery time is nt given the bdy will nt repair and adapt t the training and structure may begin t break dwn. Therefre it is imprtant t implement recvery strategies fr clients t help prevent and minimise the risk f injury. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 176 f 216

177 Functinal Anatmy and Injury preventin mdule Crrectin f technique Many injuries can be a direct result f incrrect technique being perfrmed fr specific exercises r activities. Pr technique can place stress n structures within the bdy, which can ver time begin t break dwn and lead t injury. Therefre by crrecting technique can nt nly imprve the efficiency f the activity but als prevent the develpment f injuries. Apprpriate management and rehabilitatin f previus injuries The reccurrence f an injury frm inadequate management and rehabilitatin prcesses is extremely cmmn, and therefre places great emphasis n these stages fllwing an injury. It is vital t ensure that an individual fcuses n managing an injury and fully recvered t nrmal (if nt better) functin befre returning t nrmal activity levels. This will ensure future re-injury will be prevented and cnsidered secndary preventin. Injury preventin primary & secndary Primary preventin is preventin f ccurrence f injury Secndary preventin is preventin f re ccurrence f injury 20 additinal tips fr injury preventin 1. Avid training when yu are tired. 2. Increase yur cnsumptin f carbhydrate during perids f heavy training. 3. Increase in training shuld be matched with increases in resting. 4. Any increase in training lad shuld be preceded by an increase in strengthening. 5. Treat minr injuries with care t prevent them becming a bigger prblem. 6. If yu experience pain when training, stp the training sessin immediately. 7. Never train hard if yu are stiff frm the previus effrt. 8. Pay attentin t hydratin and nutritin. 9. Use apprpriate training surfaces. 10. Check training and cmpetitin areas are clear f hazards. 11. Check equipment is apprpriate and safe t use. 12. Intrduce new activities very gradually. 13. Allw lts f time fr warming up and cling ff. 14. Check ver training and cmpetitin curses befrehand. 15. Train n different surfaces, using the right ftwear. 16. Shwer and change immediately after the cl dwn. 17. Aim fr maximum cmfrt when travelling. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 177 f 216

178 Functinal Anatmy and Injury preventin mdule 18. Stay away frm infectius areas when training r cmpeting very hard. 19. Mnitr daily fr signs f fatigue, if in dubt ease ff. 20. Have regular sprts massage. Read the fllwing hand ut in the additinal reading sectin: Reading Sprts Club Risk Assessment Management f Sprts Injuries A large range f treatments and therapies are used in the management f sprts injuries. Belw are sme f the mre ppular sprts injury treatment methds. Sprts Taping Sprts taping can assist with the treatment f sprts injuries by applying cmpressin t a recently injured jint t help reduce swelling. Sprts taping can als help with prtecting jints and restricting mvement later in the rehabilitatin prcess. A hands-n sprts taping lessn will be cvered later in the term. Electrtherapy Electrtherapy cvers a range f treatments including: Ultrasund Laser treatment Interferential Tens Electrtherapy benefits include pain relief, reduced swelling and inflammatin, breaking dwn scar tissue and increasing bld flw. Massage therapy Sprts massage is ppular with sprts injury prfessinals. Massage can be used in preventin f injuries and management f existing injuries. A qualified massage therapist wh is experienced in sprts massage r deep tissue massage will be able t identify muscle imbalances and manager referring pain frm current injuries. Cmplimentary Therapies Cmplimentary therapies are thse which may wrk alngside mre traditinal therapies r are cnsidered t be utside the nrmal medical thery. Cmmn cmplimentary therapies include: Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 178 f 216

179 Functinal Anatmy and Injury preventin mdule Reflexlgy Reiki Shiatsu Armatherapy Acupuncture Indian head massage Hydrtherapy Hydrtherapy is the use f water in the treatment and rehabilitatin f sprts injuries which includes hydrtherapy spa baths, ht tubs, steam rms as well as clnic hydrtherapy. Benefits include pain relief, reductin in muscle spasm, increased jint ROM, strengthening f weak muscles, increase circulatin and re-educatin f paralysed muscles. Hydrtherapy is in many ppular sprts t assist with recvery and injury preventin. Plaster Casts A plaster cast is applied t hld a fractured limb in place fllwing a severe injury while the bne heals. A cast will prevent any mvement fr a perid f time t allw the injury t heal faster. A plaster cast will usually stay n fr abut six weeks. The length f time may be greater r shrt and will depend n age, general health and type f fracture. An x-rays is needed befre a plaster cast can be remved t ensure the healing f the bne has been cmpleted. Medical Imaging Medical imaging is the use f scans and tests t lk at images f the bdy, particularly inside the bdy t help diagnse and treat an injury. These include: X rays, CT scans Bne scans Ultrasund scans MRI scans Read the fllwing hand ut in the additinal reading sectin: Reading When is Heat Used fr a Sprts Injury When is Ice Used fr a Sprts Injury Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 179 f 216

180 Functinal Anatmy and Injury preventin mdule R.I.C.E fr Acute Injuries R.I.C.E. stands fr: Rest Ice Cmpressin Elevatin What is R.I.C.E. and why d yu need it? One f the mst recmmended icing techniques fr reducing inflammatin and treating minr injuries is R.I.C.E., an acrnym fr rest, ice, cmpressin and elevatin. It is best used fr pulled muscles, sprained ligaments, sft tissue injury, and jint aches. Applying R.I.C.E. treatments will decrease pain, inflammatin, muscle spasms, swelling and tissue damage. It achieves this by reducing bld flw frm lcal vessels near the injury and decreasing fluid hemrrhaging as a result f cell damage. T administer R.I.C.E. use the fllwing guidelines suggested by the American Academy f Orthpaedic Surgens: Rest: Stp using the injured bdy part immediately. If yu feel pain when yu mve, this is yur bdy sending a signal t decrease mbility f the injured area. Ice: Apply an ice pack t the injured area, using a twel r cver t prtect yur skin frm frstbite. The mre cnfrming the ice pack the better, in rder fr the injury t receive maximum expsure t the treatment. Cmpressin: Use a pressure bandage r wrap ver the ice pack t help reduce swelling. Never tighten the bandage r wrap t the pint f cutting ff bld flw. Yu shuld nt feel pain r a tingly sensatin while using cmpressin. Elevatin: Raise r prp up the injured area s that it rests abve the level f yur heart. Hw lng shuld ice be applied while practicing R.I.C.E. fr it t be effective? There are fur levels f cld felt by the skin: cldness; a prickly r burning sensatin; a feeling f aching pain; and finally a lack f sensatin r numbness. When the area feels numb, icing shuld be discntinued. The skin shuld return t nrmal bdy temperature befre icing again. Usually numbness can be achieved in 10 t 20 minutes. Never apply ice fr mre than 30 minutes at a time r tissue damage may ccur. It is generally recmmended t practice R.I.C.E. at intervals f 4 t 6 hurs fr up t 48 hurs after an injury. Heat treatments are apprpriate fr sme injuries, but shuld nly be cnsidered after inflammatin has receded, apprximately 72 hurs after an injury. If the bdy part des nt respnd t R.I.C.E. therapy within 48 hurs, it wuld be wise t cnsult yur health care prvider in the event a serius injury has ccurred such as internal bleeding r a brken bne. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 180 f 216

181 Functinal Anatmy and Injury preventin mdule Functinal Rehabilitatin Rehabilitatin after injury can take sme time depending n the type and severity f the injury. A sprts physilgist r physitherapist will usually supervise the essential tw stages f the functinal rehabilitatin prcess. The aims f any rehabilitatin prgram are t: 1. Injury management stage Manage the injury by reducing the pain and inflammatin t encurage the healing prcess 2. Restratin stage Restre nrmal functin f the injured area 3. Return t activity stage Return t activity quickly and safely and prevent injury frm reccurring The injury management prcedures that fllw will assist the achievement f these aims. Stage 1: Injury Management Whse rle: Exercise Physilgist, Physitherapist The injury management is specific t each injury and has been explained previusly fr each injury that has been explained. Management is subject t severity, level f activity and type f injury. Stage 2: Restratin Stage Whse rle: Exercise Physilgist, Physitherapist Range f Mvement Any injury invlving the muscular r cnnective tissues surrunding a jint will restrict range f mvement f that jint. Jint mbilisatin is required t imprve range f mvement. Jint mbilisatin can be achieved thrugh flexibility exercises which can invlve active r passive stretching exercises. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 181 f 216

182 Functinal Anatmy and Injury preventin mdule Mbilisatin f the injured part is usually started sn after the injury because jint inactivity can increase the frmatin f scar tissue. The prcess is knwn as prgressive mbilisatin because the range f mvement is gradually increased ver time until the full range f mvement is restred. Precautins shuld be made fr any mbilisatin prcess: Checks are made t ensure that there are n fractures present Mbilisatin shuld nt be cmmenced during the acute inflammatry phase Circulatin t the injured area shuld be increased befre the start f mbilisatin The persn must be relaxed befre and during mbilisatin N sharp and fast mvements Mvements shuld remain within a pain-free range. Part f restratin prcess fr rehabilitatin invlves the use f stretching, cnditining and maintenance. Stretching and lss f flexibility ccurs as a result f injury t muscle and cnnective tissue, and the frmatin f scar tissue. A degree f flexibility will be returned t the site thrugh prgressive mbilisatin. Flexibility can invlve slw static stretches, prpriceptive neurmuscular facilitatin (PNF) and passive stretching early in the repair phase. PNF stretching will stimulate prpriceptrs within the muscle and cnnective tissue. The stretching is gradually made mre active during the restratin prcess f rehabilitatin. All types f stretching in the prcess shuld be pain free. Passive stretching is cmmn in sprts rehabilitatin. The purpse is t lengthen sft tissue beynd its nrmal resting length by applying an external frce. The stretch shuld be held fr apprximately 15 secnds. The patient, physitherapist r machine cntrls the directin, intensity and speed f the cntractin. Neurmuscular Cntrl Specific types f exercises are prescribed by a physitherapist r exercise physilgist t imprve neurmuscular cntrl fllwing injury. This stage f the restratin prcess f rehabilitatin will invlve changes t surface stability, visin, and speed. Cmmn equipment used fr neurmuscular cntrl includes: Mini-tramplines Balance bards Stability balls Stage 3: Return t activity Whse rle: Specialised Exercise Trainer, Physitherapist, Exercise Physilgist, Strength (Endurance t Max Strength) Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 182 f 216

183 Functinal Anatmy and Injury preventin mdule Muscular strength is an essential phase f the return t activity prcess. Muscle atrphy is cmmn after an injury due t the slw healing and rehabilitatin prcess. Initial strength wrkuts may cme with swelling and sme pain. The fcus shuld always be n pain-free mvement fr each exercise. Ismetric exercises can be used fr initial strength wrk t recruit muscles withut the mvement f a jint. As strength is slwly regained, additinal resistance can be applied. Take care with weight-bearing exercises particularly after a fracture. Fcus shuld als be n agnist and antagnist muscles thrugh each exercise t ensure that an apprpriate rati f strength is being develped. Pwer (Dynamic Lifts t Plymetrics) Pwer is the ability t perfrm an activity that requires strength as quickly as pssible, and therefre required a cmbinatin f strength and speed training r explsive strength. As this type f activity usually requires muscles t wrk t their maximal r near maximal ability the ccurrence f re-injury can be relatively high. As a result, the injured area f the client shuld be at the same level (if nt higher) than pre-injury befre they can return t nrmal activity. Aerbic Capacity The chice f aerbic exercises t will depend n the type and severity f injury. Even thugh a persn may have full active range f mvement, flexibility and strength their aerbic capacity may have been affected. Examples f activities that can be used t prmte aerbic fitness during rehabilitatin include: Treadmills Rwing Cycling Swimming Water-resistance activities Walking r light jgging. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 183 f 216

184 Functinal Anatmy and Injury preventin mdule Basics f Bimechanics Bimechanics is the study f the bdy as a machine and hw internal and external frces act n the bdy and the mvements that these frces prduce. Why study bimechanics? Understanding bimechanics can give the fitness prfessinal the knwledge t: Analyse mvement Pinpinting errrs identify areas f faulty bimechanics Crrectin crrect errrs with bimechanics Develping a new technique Adapting t new equipment Understanding cmplex mvement behavir 5 imprtant areas f bimechanics are: 1. Mtin 2. Frce 3. Mmentum 4. Levers 5. Balance DVD (4 mins) Watch the fllwing DVD segment: Basics f bimechanics Vide 18 Bimechanics - Mtin Mtin is an imprtant part f all sprts and exercise. During mvements, demands are placed n the bdy requiring it t cnstantly change psitin. The nature f these changes in psitin depends n many factrs. There are 3 basic frms f mtin: Linear Angular General Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 184 f 216

185 Functinal Anatmy and Injury preventin mdule Linear mtin ccurs when all parts f the bdy mve in exactly the same directin at the same speed, which can ccur in a straight line (rectilinear mtin) r curved line (curvilinear mtin). An example f rectilinear mtin is smene running in a straight line, an example f curvilinear is a frward jump. Angular mtin is when the bdy mves in a circular path arund an axis f rtatin s all parts f the bdy mve thrugh the same angle, in the same directin in at the same time. One example f Angular mtin is when a limb mves arund n a jint in exercise. General mtin is a cmbinatin f linear and angular mtin which is the mst cmmn type f mtin during exercise. Sprt/Activity Linear Angular General 100m Sprint Glf Teeing ff Cycling Ging dwn a slide An ice skater spinning Driving a car Tssing a underhand ball in basketball Hrse riding Javelin Frce Frce = Any push r pull which causes smething t mve r change its speed r directin. Frces can be balanced r unbalanced. Balanced frces are equal in size and ppsite in directin. Unbalance frces are nt equal in size and/r ppsite in directin. If the frces f an bject are unbalanced we say a net frce results. Frictin = A frce that ppses r slws dwn mtin. Caused by the physical cntact between mving surfaces The amunt f frictin depends upn the kinds f surfaces and the frce pressing the surfaces tgether Frictin changes mtin int heat. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 185 f 216

186 Functinal Anatmy and Injury preventin mdule Newtn s Laws f mtin There are three laws prpsed by Sir Isaac Newtn t define the cncept f a frce and describe mtin, used as the basis f classical mechanics First law f mtin The first law says that an bject at rest tends t stay at rest, and an bject in mtin tends t stay in mtin, with the same directin and speed. Mtin cannt change withut an unbalanced frce acting. If nthing is happening t yu, and nthing des happen, yu will never g anywhere. If yu're ging in a specific directin, unless smething happens t yu, yu will always g in that directin. Examples f Newtn s 1 st Law Car suddenly stps and yu strain against the seat belt When riding a hrse, the hrse suddenly stps and yu fly ver its head The magician pulls the tableclth ut frm under the table full f dishes The difficulty f pushing a dead car. Secnd law f mtin The secnd law says that the acceleratin f an bject prduced by a net (ttal) applied frce is directly related t the magnitude f the frce, the same directin as the frce, and inversely related t the mass f the bject (inverse is a value that is ne ver anther number... the inverse f 2 is 1/2). The secnd law shws that if yu exert the same frce n tw bjects f different mass, yu will get different acceleratins (changes in mtin). The effect (acceleratin) n the smaller mass will be greater (mre nticeable). The effect f a 10 newtn frce n a baseball wuld be much greater than that same frce acting n a truck. The difference in effect (acceleratin) is entirely due t the difference in their masses. Examples f Newtn s 2 nd Law When a rllercaster ges dwn a steep hill the mass makes the rllercaster speed up because it is s heavy. When we get in a car and accelerate alng the rad, the size f the engine required t achieve the acceleratin has been calculated using Newtn s secnd law f mtin. Third law f mtin The third law says that fr every actin (frce) there is an equal and ppsite reactin (frce). Frces are fund in pairs. Think abut the time yu sit in a chair. Yur bdy exerts a frce dwnward and that chair needs t exert an equal frce upward r the chair will cllapse. It's an issue f symmetry. Acting frces encunter ther frces in the ppsite directin. There's als the example f shting a cannnball. When the cannnball is fired thrugh the air (by the explsin), the cannn is pushed backward. The frce pushing the ball ut was equal t the frce Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 186 f 216

187 Functinal Anatmy and Injury preventin mdule pushing the cannn back, but the effect n the cannn is less nticeable because it has a much larger mass. That example is similar t the kick when a gun fires a bullet frward. Examples f Newtn s 3 rd Law When a bullet is fired frm a gun with a certain frce (actin), there is an equal and ppsite frce exerted n the gun in the backward directin (reactin). When a man jumps frm a bat t the shre, the bat mves away frm him. The frce he exerts n the bat (actin) is respnsible fr its mtin and his mtin t the shre is due t the frce f reactin exerted by the bat n him. The swimmer pushes the water in the backward directin with a certain frce (actin) and the water pushes the swimmer in the frward directin with an equal and ppsite frce (reactin). Measuring Mtin Distance The length f the path alng which a bdy travels (Measured in metres r kilmetres). Displacement The length between the starting and end pints (Measured in mtrs r klms). Speed The distance travelled divided by the time taken. Speed = distance time taken Velcity The displacement divided by the time taken. Velcity = displacement time taken Acceleratin The rate at which an bject s speed changes ver time (Measured in metres per sec squared). change in velcity Acceleratin = time elapsed Acceleratin = final velcity initial velcity time elapsed Mmentum The mass f the bdy multiplied by its velcity (Measured in kilgram metres per secnd). Mmentum = mass x velcity Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 187 f 216

188 Functinal Anatmy and Injury preventin mdule DVD (12mins) Watch the fllwing DVD segment: Newtn s Laws f Mtin and Frces Vide 19 Mmentum Mmentum is a vectr describing a "quantity f mtin" r in mathematical terms p (mmentum) = mass (m) times velcity (v). P = mv Cnservatin f Mmentum In a clsed system, such as when tw bjects cllide, the ttal mmentum remains the same, thugh sme may transfer frm ne bject t the ther. Mmentum is always cnserved in a clsed system, but mst sprting situatins in the real wrld are nt a clsed system. Fr example, when a baseball bat hits the ball, the ball will be squished t a certain degree. After few millisecnds, it rebunds back. This cntractin and rebund actin is causes the release f heat energy, and sme mmentum is lst, r transferred elsewhere. Maximizing Mmentum As mmentum is the prduct f mass and the velcity, yu can increase mmentum by increase either f these elements. In sprt, examples include using a heavier bat r racquet and increasing running speed r hand speed. Angular Mmentum Angular mmentum is the prduct f Mment f Inertia and Angular Velcity. Mment f Inertia is the angular cunterpart t mass - it is the measure f the resistance f an bject t changing its angular speed. A gd example f angular mmentum in actin is with figure skaters. A figure skater starts a spin by pulling in his arms t lessen his Mment f Inertia. By the Cnservatin f Mmentum Principles, the angular speed must then increase. T cme ut f the spin, a skater simply extends her arms t increase angular mmentum and decrease angular velcity. Levers During exercise the skeletn acts as a lever system. It cmprises a lever r rigid bne that revlves arund an axis (Jint), prducing trque thrugh the applicatin f bth mtive frces and resistive frces. Examples f levers used in everyday life are wheelbarrws, crwbars and can peners. A lever cmprises f three cmpnents - Fulcrum r pivt - the pint abut which the lever rtates Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 188 f 216

189 Functinal Anatmy and Injury preventin mdule Lad - the frce applied by the lever system Effrt - the frce applied by the user f the lever system The way in which a lever will perate is dependent n the type f lever and there are 3 different lever classificatins. DVD (3.5mins) Watch the fllwing DVD segment: Levers Vide 20 Lever classificatins First Class Levers The fulcrum lies between the effrt and the lad. Example: Strength training Seated dumbbell triceps extensin Secnd Class Levers The fulcrum is at ne end, the effrt at the ther end and the lad lies between the effrt and the fulcrum. Example: Strength training Standing heel lift Third Class Levers The fulcrum is at ne end, the lad at the ther end and the effrt lies between the lad and the fulcrum. Example: Strength training -Seated bicep curl Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 189 f 216

190 Functinal Anatmy and Injury preventin mdule One and tw Arm Levers Resistance Devices Different types f machines have been develped t vercme the disadvantages f the bdy s wn lever system. The main functin f variable resistance is t change the resistance thrughut the range f mtin in an attempt t match the changes in frce prductin brught abut by the changes within the muscle. The disadvantage in variable resistance machines is their inability t match the strength curves f all clients due t changes in limb size, tendn attachment differences and muscle size. Centre f gravity Centre f gravity can be defines as the single pint at which all parts f an bject are equally balanced. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 190 f 216

191 Functinal Anatmy and Injury preventin mdule Fr a nrmal human being standing upright, their centre f gravity lies arund the area f their naval. A persn s centre f gravity can change depending n their bdy psitin. The centre f gravity can als lie utside an bject, especially if the bject is bent ver r in a certain directin. Line f gravity The line f gravity is the vertical line that passes thrugh the centre f gravity t the grund. If the line f gravity falls within the bjects base f the supprt (i.e. its cntact with the grund), the bject is a relatively stable. If the line f gravity falls utside the bject s base f supprt (i.e. its cntact with the grund), the bject is relatively unstable. The line f gravity is imprtant when determining the stability f an bject. Base f supprt When standing, we typically have tw feet in cntact with the grund. If ur feet are clse tgether, we feel less stable than when the feet are spread apart. Increasing the distance between the feet increases what is termed ur base f supprt, defined as the area within an utline f all grund cntact pints. The larger the area the base f supprt cvers, the mre stable an bject will be. The line f gravity must g utside the base f supprt t initiate r cntinue mvement. The directin that the line f gravity takes relative t the base f supprt will be the directin f the resulting mvement. The further away the line f gravity is frm the base f supprt, the greater the tendency the bdy has t mve in that directin. Read the fllwing hand ut in the additinal reading sectin: Reading Stability Principles and Balance in Sprt Exercise Mvement and Muscle Analysis Mvement perfrmed during exercising r physical activity cnsists f a range f singular mvement and muscle cntractins that arte put tgether There are 8 steps t analyse muscle mvements, which include: Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 191 f 216

192 Functinal Anatmy and Injury preventin mdule Step 1 Identify the crrect technique fr the exercise. Step 2 Identify the phases fr the exercise Step 3 Identify the jints arund which the exercise is perfrmed. Step 4 Identify the actins at each jint e.g. flexin, extensin. Step 5 Identify cntractins invlved e.g. cncentric and eccentric. Step 6 Identify the muscle grups used in the exercise. Step 7 Identify the specific muscles used in the exercise. Exercise Analysis Upper Bdy Exercise: Chin up (Wide Grip) Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Shulder Jint Adductin Cncentric Shulder Girdle Adductin Dwnward rtatin Cncentric Shulder jint adductrs Shulder girdle Adductrs Shulder Girdle Upward Rtatrs Elbw Jint Flexin Cncentric Elbw Jint Flexrs Latissmus drsi Teres majr Pectralis majr Subscapularis Triceps Trapezius Rhmbids Pectralis minr Biceps Brachialis Prnatr teres Brachiradialis Exercise: Chin up (Clse Grip) Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Shulder Jint Extensin Cncentric SJ adductrs Pectralis majr Deltid Latissimus drsi Teres majr Subscapularis Infraspinatus Teres minr Triceps Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 192 f 216

193 Functinal Anatmy and Injury preventin mdule Shulder Girdle Adductin Dwnward rtatin Cncentric SG Adductrs Shulder Girdle Dwnward Rtatrs Elbw Jint Flexin Cncentric EJ Flexrs Trapezius Rhmbids Pectralis minr Biceps Brachialis Prnatr teres Brachiradialis Exercise: Bench Press (Barbell) Phase: Up phase Shulder Jint Jint Actin Cntractin Muscle Grup Specific Muscles Shulder Girdle Hrizntal Adductin Adductin Eccentric Eccentric Hrizntal adductrs Abductrs Elbw Jint Flexrs Eccentric Extensrs Pectralis majr Deltid Cracbrachialis Biceps brachii Serratus anterir Pectralis minr Triceps Ancneus Exercise: Shulder Press (Narrw Grip) Phase: Up Phase Jint Actin Cntractin Muscle Grup Specific Muscles Shulder Jint Flexin Cncentric SJ Flexrs Pectralis Majr Deltid, Biceps Cracbrachialis Shulder Girdle Abductin Upward rtatin Cncentric SG Adductrs upward rtatrs Elbw Jint Extensin Cncentric EJ Extensrs Serratus anterir Pectralis minr Triceps Ancneus Exercise: Push Up (Wide Hands) Phase: Up Phase Shulder Jint Jint Actin Cntractin Muscle Grup Specific Muscles Shulder Girdle Hrizntal Adductin Abductin Cncentric Cncentric SJ Hrizntal adductrs SG Abductrs Elbw Jint Extensin Cncentric EJ Extensrs Pectralis Majr Deltid Biceps Cracbrachialis Serratus anterir Pectralis minr Triceps Ancneus Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 193 f 216

194 Functinal Anatmy and Injury preventin mdule Exercise: Push Up (Clse Hands) Phase: Up Phase Jint Actin Cntractin Muscle Grup Specific Muscles Shulder Jint Flexin Cncentric SJ Flexrs Pectralis Majr Deltid Biceps Cracbrachialis Shulder Girdle Abductin Upward rtatin Cncentric SG Abductin SG Upward rtatrs Elbw Jint Extensin Cncentric EJ Extensrs Serratus anterir Pectralis minr Trapezius Triceps Ancneus Exercise: Seated Rw (Prnated grip) Phase: Cncentric Shulder Jint Jint Actin Cntractin Muscle Grup Specific Muscles Shulder Girdle Hrizntal Adductin Adductin Cncentric Cncentric SJ Hrizntal adductrs SG Abductrs Elbw Jint Flexin Cncentric EJ Extensrs Deltid Infraspinatus Teres minr Teres majr Latissimus drsi Trapezius Rhmbids Biceps Brachialis Brachiradialis Prnatr teres Exercise: Lat Pull Dwn (Wide Grip) Phase: Dwn Phase Jint Actin Cntractin Muscle Grup Specific Muscles Shulder Jint Adductin Cncentric SJ adductrs Latissimus drsi Teres majr Pectralis majr Subscapularis Triceps Shulder Girdle Adductin Dwnward rtatin Cncentric SG Abductrs SG Dwnward rtatrs Elbw Jint Flexrs Cncentric EJ Flexrs Trapezius Rhmbids Pectralis minr Biceps Brachialis Prnatr teres Brachiradialis Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 194 f 216

195 Functinal Anatmy and Injury preventin mdule Exercise: Lat Pull Dwn (Clse Grip) Phase: Dwn Phase Jint Actin Cntractin Muscle Grup Specific Muscles Shulder Jint Extensin Cncentric SJ Extensrs Pectralis majr Deltid Teres majr Latissimus drsi Triceps Teres minr Subscapularis Infraspinatus Shulder Girdle Adductin Dwnward rtatrs Cncentric SG Adductrs Elbw Jint Flexin Cncentric EJ Flexrs Trapezius Rhmbids Pectralis minr Biceps Brachialis Brachiradialis Prnatr teres Activity Cmplete the specific muscles and ther cmpnents during the fllwing exercise Exercise Analysis Lwer Bdy Exercise: Squat (Barbell) Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Hip Jint Extensin Cncentric HJ Extensrs Knee Jint Cncentric KJ extensrs Ankle Jint Plantar Flexin Cncentric AJ Plantar Flexrs Exercise: Leg Press (Hrizntal) Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Hip Jint Extensin Cncentric HJ Extensrs Knee Jint Extensin KJ Extensrs Ankle Jint Cncentric AJ Plantar Flexrs Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 195 f 216

196 Functinal Anatmy and Injury preventin mdule Nte: When the feet are put higher n the platfrm, the vastus medialis, vastis lateralis, vastis intermedius have cntact with greater frce. Exercise: Lunge (Barbell) Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Hip Jint Extensin Cncentric HJ Extensrs Knee Jint Extensin Cncentric KJ Extensrs Ankle Jint Plantar Flexin Cncentric AJ Plantar Flexrs Exercise: Deadlift (Bent leg) Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Hip Jint Cncentric Knee Jint Extensin KJ Extensrs Ankle Jint Plantar Flexin Cncentric AJ Plantar Flexrs Exercise: Hamstring Curl Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Knee Jint Flexin Cncentric KJ Flexrs Exercise: Leg Extensin Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Knee Jint Extensin Cncentric KJ Extensrs Exercise Analysis Trunk Exercises Exercise: Crunch (Feet n flr) Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Spinal Jint Flexin Cncentric SJ Flexrs Exercise: Crunch Oblique (Feet n flr) Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 196 f 216

197 Functinal Anatmy and Injury preventin mdule Spinal Jint Rtatin Cncentric SJ Rtatrs Spinal Jint Cncentric SJ Flexrs Exercise: Reverse Curl Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Spinal Jint Flexin Cncentric SJ Flexrs Exercise: Back Extensin Phase: Up phase Jint Actin Cntractin Muscle Grup Specific Muscles Spinal Jint Extensin Cncentric SJ Extensrs DVD (10 mins) Psture Watch the fllwing DVD segment: Analysis f an Exercise Squat Analysis f mvement Squats and press ups Vide 21 & 22 Psture can be defined as the crrect anatmical psitin in which the bdy is held upright against gravity within minimal muscular cntractin. Psture is an imprtant determinant fr faulty gait and deviatin t bdy psitin, which can eventually lead t injury, therefre it is imprtant t bserve psture and crrect any faulty alignments t help prevent injury. Static Psture Static psture assessment invlves the fitness prfessinal cnducting an assessment f a client s psture whilst they are nt mving. This shuld be perfrmed in three different views, which cnsist f anterir, psterir and lateral. The bservatin at each view aims t identify different areas f the bdy t establish where any deviatin is ccurring and the cause deviatin. The fllwing sectins identify the view and the specific pints that shuld be bserved: Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 197 f 216

198 Functinal Anatmy and Injury preventin mdule Lateral View In the lateral view the fllwing is the nrmal pstural psitin and pssible malalignment: Head and neck The head and neck are the mst superir structures f the bdy, and therefre their psitin can be affected by structures belw as well as affect the psitin f structures belw. The head shuld be held upright with the midline f the bdy traveling thrugh the ear and alng the cervical spine. The cervical spine shuld pssess a shallw lrdtic curve and determine that the gaze f the eyes is hrizntal and frward. Shulders The shulders psitin in relatin t the anterir and psterir side f the midline shuld be bserved. The midline shuld pass thrugh the middle f the shulder s any deviatin away frm this can be identified. Arms The arm psitin is usually determined by the shulder psitin; hwever, its crrect psitin cnsists f the arm being slightly flexed, whilst being in line with the trs. Ribs The ribs sit at the frnt f the spine in the thracic regin, and shuld be parallel with the hips and therefre any anterir r psterir tilting shuld be bserved. Spine The spine cntains a natural S shaped curve, where the thracic spine pssesses a khyptic curve and lumbar spine pssesses and lrdtic curve. These curves shuld be relatively shallw, s any excessive curvature shuld be identified. Hip The hips are ften thught t be the centre f the bdy and therefre the bdy psitin is determined by the psitin f the hips. Therefre the psitin is imprtant t ensure that it is in a neutral psitin withut deviatin. The hips are generally required t be level, hwever a 5 anterir tilt is acceptable (especially fr wmen). T measure the level f the hips, the Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 198 f 216

199 Functinal Anatmy and Injury preventin mdule ASIS and PSIS shuld be used as bny landmarks and be level. Knees The knee shuld be in line with the hips with the midline travelling thrugh the middle f the knee. The knee shuldn t be hyperextended r flexed. Ankle The midline travels just anterir t the lateral malleli. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 199 f 216

200 Functinal Anatmy and Injury preventin mdule Anterir view In the anterir view the fllwing explains nrmal pstural psitin and pssible malalignment: Head and neck The midline f the anterir view shuld g evenly thrugh the middle f the nse and head. The anterir view can see the head tilting anterirly and psterirly r t the right and left as well as rtating t the left r right. Anterir and psterir head tilt invlves the chin mving twards the neck r further away frm the neck and left and right head tilt sees the ear mve clser t the shulder. Head rtatin sees the gaze f the individual mve t the right r left and as a result ne side f the nse becmes mre visible. Shulders Frm the anterir view the level f the shulder shuld be bserved. They shuld be at the same level with the clavicle hrizntal and symmetrical. Often ne shulder can be elevated indicated that they are nt level. Arms The arms shuld hang evenly at the side f the hips, rughly an inch away frm the bdy, with the elbw crease facing anterirly. Often ne arm sits clser r further away frm the bdy and is usually assciated t shulder r ribs tilting. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 200 f 216

201 Functinal Anatmy and Injury preventin mdule Ribs The ribs can be quite difficult t bserve in the anterir psitin due t clthing; hwever the crrect anatmical psitin invlves the midline passing thrugh the centre f the sternum. In the anterir view, the mst cmmn pstural deviatin bserved with the ribs invlves tilting t the left r right. This can be identified using specific landmarks such as the axilla (armpit) crease and clavicle psitin. Spine The spine cannt be viewed frm the anterir view. Hips Frm the anterir view, the level f the hips shuld be bserved. In crrect anatmical psitin, the hips shuld be level, hwever, it is quite cmmn t view ne hip elevated abve the ther. Anther bservatin shuld invlve the midline where it shuld travel evenly thrugh the hips; ccasinally the hips can be shifted mre t ne side. The last bservatin f the hips invlves identifying whether any rtatin exists. The hip can be rtated s that ne ASIS sits further frward than the ther. Legs and Knees The legs shuld sit evenly n each side f the midline, with the knees and ankles equidistant frm the midline. The knees, patella and tibial bne shuld face anterirly, and therefre any rtatin (medially r laterally) can be bserved. Pstural deviatin can see the knees psitined further frm the midline than the ankles, and knwn as genu varus r bwed legs. In cntrast, the knees can be psitin clser t the midline than the ankles and knwn as genu valgus r kncked knees. Ankles The anterir view is the preferred view t bserve the ankles, frm here the amunt f prnatin r supinatin can be bserved. In a nrmal anatmical psitin the ankles shuld be in a neutral psitin with the lngitudinal arch prviding supprt t the inside f the ft. In additin, internal r external rtatin can be viewed frm the anterir view. Nrmal static psture sees the feet externally rtated by arund 10. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 201 f 216

202 Functinal Anatmy and Injury preventin mdule Frm the psterir psitin, the illustratin n the left indicates the crrect anatmical psitin f the scapula in accrdance with the spine. The scapula psitin, is ften nt evaluated, hwever, it plays an imprtant rle in the psitin f the shulder. The medial brder f the scapula shuld be almst parallel with the spinus prcess f the thracic spine. The spine f the scapular shuld be in line with T3 spinus prcess. In additin, frm the psterir view, the level f the hips can als be identified. This can be view frm the tp f the iliac crest r via the PSIS. The Walking Gait Walking gait is the term used t describe human lcmtin, r the way that we walk and cnsiders hw the ft cmes in cntact and reacts with the grund during the walking mtin. A walk can be split int specific cycles and further brken dwn int phases and cnsists f a series f rhythmic alternating mvement f the legs which creates frward mvement f the bdy. One gait cycle relates t the ft perfrming a repetitive mvement which can be brken dwn int tw simple phases, these are: Stance Phase this cnsists f the ft s interactin with the grund, where it initially cmes int cntact with the grund, plants itself and then leaves the grund. Swing Phase this is the pint at which ft leaves the grund, and mves thrugh the air preparing and psitining itself t cme int cntact with the grund t begin anther cycle. The fllwing illustratin shws the prcess f ne gait cycle breaking dwn the prcess int stance and swing phases, the duratin percentage f each phase and the ft cycle within the stance phase indicating the pressure that is place dwnwards n the plantar surface f the ft. Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 202 f 216

203 Functinal Anatmy and Injury preventin mdule Image shwing mvement f the leg during ne gait cycle Australian Cllege f Sprt & Fitness 2014 Functinal Anatmy and Injury Preventin Mdule 1409C Page 203 f 216