BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK Musculoskeletal Anatomy & Kinesiology ROM & GONIOMETRY

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1 BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK Musculoskeletal Anatomy & Kinesiology & GONIOMETRY MSAK201-II Session 2 LEARNING OBJECTIVES: By the end of this session, the student will be expected to: 1. Apply all review material. a. Identify the four types of joints. b. Identify classifications of joints in terms of degree of movement. c. Cite examples of the different classifications of joints. d. Name each joint of the body and cite its classification based on movement. 2. Identify the correct by degree for each joint/region listed. 3. Utilize a goniometer to measure for each joint/region listed. 1) JOINT REVIEW from MSAK I a) Types: i) Fibrous Bones are held together by fibrous connective tissue. ii) Ligamentous Bones are held together by strong ligaments. iii) Cartilaginous Bones are held together by cartilage. iv) Synovial Bones are held together with a joint capsule. b) Classification: Joints are also classified in terms of the degree of movement permitted. i) Synarthroses Immovable, Fibrous joints (i) Suture (suture = seam) (ii) Gomphosis (gompho = nail) ii) Amphiarthroses Slight movement, Ligamentous OR Cartilaginous joints (i) Syndesmosis (syndesmo = ligament) (ii) Synchondrosis (syn = together, chondrosis = cartilage) 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 1

iii) Diarthroses Freely movable, Synovial joints 1. Gliding (arthrosis or arthrodial ) 2. Hinge (ginglymus) 3. Pivot (trochoid) 4. Ellipsoid (condyloid) 5. Ball and Socket (enarthrodial) 6.

2 iii) Diarthroses Freely movable, Synovial joints 1. Gliding (arthrosis or arthrodial ) 2. Hinge (ginglymus) 3. Pivot (trochoid) 4. Ellipsoid (condyloid) 5. Ball and Socket (enarthrodial) 6. Saddle (sellar) 2) USING A GONIOMETER a) A goniometer is a device used to measure joint angles or. b) Massage Therapists use a goniometer to quantify pretreatment status and measure progress and return of after treatment. c) A traditional goniometer is a protractor with extending arms. d) To use a goniometer: i) Align the fulcrum of the device with the fulcrum or the joint to be measured ii) Align the stationary arm of the device with the limb being measured iii) Hold the arms of the goniometer in place while the joint is moved through its iv) The degree between the endpoints represents the entire range-ofmotion. e) Disadvantages: It is sometimes difficult to position and maintain the arms of the goniometer along the bones of the segments throughout the measurement, and the axis of rotation is not always clear, especially for complex joints. 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 2

3) AXIAL SKELETAL JOINTS a) CLASSIFICATION - Review i) Atlantooccipital joint arthrodial or gliding joint ii) Atlantoaxial joint trochoid or pivot joint iii) Vertebral articulations arthrodial or

Two-finger widths distance between the chin and the chest can be considered normal. (b) Extension (i) Seated assessment Therapist instructs the client to look towards ceiling or bend head backwards.

3 3) AXIAL SKELETAL JOINTS a) CLASSIFICATION - Review i) Atlantooccipital joint arthrodial or gliding joint ii) Atlantoaxial joint trochoid or pivot joint iii) Vertebral articulations arthrodial or gliding joints b) & GONIOMETRY i) CERVICAL (1) (a) Flexion (i) Seated assessment Therapist instructs the client to tuck the chin toward the chest. Two-finger widths distance between the chin and the chest can be considered normal. (b) Extension (i) Seated assessment Therapist instructs the client to look towards ceiling or bend head backwards. The plane of nose and forehead should be nearly horizontal. (c) Lateral Flexion (i) Seated assessment Therapist instructs client to drop one ear toward their shoulder. Compare to opposite side. (d) Rotation (i) Seated assessment Therapist instructs the client to look over their shoulder. Often, the client s chin does not reach the same plane as shoulder. Compare to opposite side. (2) GONIOMETRY (Rotation can be difficult to assess with a goniometry in the C/S) Flexion Extension Lateral Flexion Rotation degrees 55 degrees 45 degrees degrees http%3a//academic.uofs.edu/faculty/kosmahle1/courses/pt350/goniomet/cervrot.htm 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 3

ii) THORACIC (1) True thoracic is difficult to assess because of concurrent movement of the lumbopelvic spine. Recognize that practitioners often eyeball this.

4 ii) THORACIC (1) True thoracic is difficult to assess because of concurrent movement of the lumbopelvic spine. Recognize that practitioners often eyeball this. There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). (2) GONIOMETRY It is difficult to utilize a goniometer for the T/S. Flexion degrees (Limited) Extension degrees (Limited) Lateral Flexion Rotation iii) LUMBAR (1) (a) Flexion (i) Standing assessment The client bends forward in an attempt to touch the toes. The client tries to keep the knees straight. The distance from the client s fingertips to the floor is assessed. (b) Extension (i) Standing assessment The client bends backward. The distance from the client s sternum to the wall is assessed. (c) Lateral Flexion (i) Client runs hand down side of leg with out bending forward or backward. Distance from fingertips to floor is measured and compared bilaterally. (d) Rotation Client rotates to the right or left and amount of rotation is assessed. 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 4

(2) GONIOMETRY Flexion Extension Lateral Flexion Rotation 90 degrees 30 degrees 20 degrees Limited 4) UPPER EXTREMITY JOINTS a) CLASSIFICATION Review i) Shoulder Girdle (1) Sternoclavicular (SC)

5 (2) GONIOMETRY Flexion Extension Lateral Flexion Rotation 90 degrees 30 degrees 20 degrees Limited 4) UPPER EXTREMITY JOINTS a) CLASSIFICATION Review i) Shoulder Girdle (1) Sternoclavicular (SC) joint multi-axial arthrodial or gliding joint (a) Protraction and retraction (b) Elevation and depression (2) Acromioclavicular (AC) joint gliding or arthrodial joint (a) Glides and rotates to accompany other shoulder girdle and shoulder joint motions. (3) Coracoclavicular joint - syndesmosis (4) Scapulothoracic Not a true synovial joint ii) Shoulder Joint (1) Glenohumeral joint multi-axial ball and socket or enarthrodial joint (a) Abduction and Adduction (b) Flexion and Extension (c) Internal and External rotation (d) Horizontal abduction and Horizontal adduction iii) Elbow and Radioulnar joints (1) Elbow ginglymus or hinge joint (a) Composed of two joints (i) Humeroulnar (ii) Radiohumeral joints (b) Movement limited to flexion and extension (2) Proximal Radioulnar joint trochoid or pivot joint (a) Supination and Pronation (3) Distal Radioulnar joint syndesmotic joint (a) Supination and Pronation 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 5

6 iv) Wrist and Hand joints (1) Wrist joint condyloid joint (a) Motion occurs primarily between the distal radius and proximal carpal row consisting of the scaphoid, lunate, and triquetrum (i) Flexion and Extension (ii) Abduction (Radial Deviation) (iii)adduction (Ulnar Deviation) (2) Intercarpal joints gliding or arthrodial joints (3) Finger joints (a) Carpometacarpal (CMC) joint of Thumb saddle joint (i) Extension and Flexion (ii) Abduction (b) Carpometacarpal (CMC) joint of #2-5 condyloid joint (i) Extension and Flexion (c) Metacarpophalangeal (MCP) joint condyloid joint (i) Extension and Flexion (d) Proximal interphalangeal (PIP) joint ginglymus joint (i) Extension and Flexion (e) Distal interphalangeal (DIP) joint ginglymus joint (i) Extension and Flexion (f) Thumb (i) Interphalangeal (IP) joint 1. Extension and Flexion b) UPPER EXTREMITY GONIOMETRY i) Shoulder Flexion 180 degrees (Hyper) Extension 45 degrees External Rotation 90 degrees Internal Rotation 70 degrees Abduction 180 degrees Adduction 50 degrees 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 6

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8 ii) Elbow Flexion 145 degrees Extension 0 degrees (Up to 10 degrees of hyperextension is still within normal limits.) Carrying angle Valgus angle from 0-15 degrees Supination 90 degrees Pronation 90 degrees 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 8

9 iii) Wrist and Hand Flexion Extension Radial deviation Ulnar deviation 80 degrees 70 degrees 20 degrees 35 degrees 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 9

10 5) LOWER EXTREMITY JOINTS a) CLASSIFICATION Review i) Pelvic Girdle (1) Symphysis pubis Synchondrosis, amphiarthrodial joint (2) Sacroiliac joints amphiarthrodial joint ii) Hip joint (1) Acetabulofemoral joint multi-axial ball and socket or enarthrodial joint (a) Abduction and Adduction (b) Flexion and Extension (c) Internal and External rotation (d) Horizontal abduction and Horizontal adduction iii) Knee joint (1) Tibiofemoral joint ginglymus or hinge joint (a) Flexion and extension (2) Patellofemoral joint arthrodial or gliding joint iv) Ankle and Foot joints (1) Distal tibiofibular joint syndesmotic amphiarthrodial joint (2) Talocrural (ankle) joint hinge or ginglymus joint (a) Plantarflexion and Dorsiflexion (3) Subtalar joint - gliding or arthrodial joints (a) Inversion and Eversion (4) Intertarsal joints gliding or arthrodial joints (5) Toe joints (a) Tarsometatarsal (TMT) joint - condyloid joint (b) Metatarsophalangeal (MTP) joint condyloid joint (c) Proximal interphalangeal (PIP) joint ginglymus joint (i) Extension and Flexion (6) Distal interphalangeal (DIP) joint ginglymus joint (a) Extension and Flexion 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 10

11 b) LOWER EXTREMITY i) Hip (1) Flexion Supine assessment Therapist raises the client s leg above the body with the knee extended to maximum. Then the therapist flexes the knee and continues to assess the degree of hip flexion by bending the leg into the abdomen. (2) Extension Prone assessment Therapist applies downward pressure to the sacrum with a flattened hand. Examiner s other hand, which is placed midway against the anterior aspect of the client s thigh, is used to lift the thigh on the side that is being examined. Draw the leg backward until the point at which the pelvis starts to rotate. (3) Abduction Supine assessment Therapist stands at the side of the table and places one hand on the client s ASIS and the other on the medial aspect of the thigh just distal to their knee. The examiner swings the client s leg laterally (toward the therapist) while keeping the knee straight. (4) Adduction Supine assessment Therapist stands at the side of the table and places one hand on the client s ASIS and the other on the lateral aspect of the thigh just distal to their knee. Therapist swings client s leg medially while keeping knee straight. (5) External rotation Supine assessment Therapist stands at the side of the table, places client s lateral side of foot on the opposite knee and moves the flexed knee down toward the table. (6) Internal rotation Supine assessment Therapist stands at the side of the table, flexes client s knee and rotates leg so that flexed knee moves in toward opposite leg. 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 11

12 ii) Knee (1) Flexion Prone - The normal knee can flex from 130 to 150 degrees. A simple, useful but less precise method of comparing flexion of both knees involves comparing the distance between the heel and buttock when both knees are maximally flexed. (2) Extension Prone - The knee should normally extend to a straight line (0 degrees) and occasionally can be hyperextended up to 15 degrees. iii) Ankle (1) Dorsiflexion Supine - Neutral position for the ankle is when the lateral border of the foot is at 90 degrees in relation to the leg and the knee is in full extension. Client points foot up toward the ceiling. (2) Plantarflexion Prone - The client points the foot down toward the floor. (3) Inversion Client bends foot at ankle; points medial side of foot toward midline. (4) Eversion Client bends foot at ankle; points medial side of foot away from midline. c) LOWER EXTREMITY GONIOMETRY i) Hip Flexion with knee extended Flexion with knee flexed Extension Abduction Adduction External rotation Internal rotation 80 degrees 125 degrees 10 degrees 45 degrees 10 degrees 45 degrees 45 degrees 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 12

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ii) Knee Flexion Extension 140 degrees 0 degrees iii) Ankle

ankle joint dorsiflexion range of motion.

sub-talar pronation), the subtalar joint must be stabilized in

To assess the range of JOINT motion, flex the knee (second

To assess tightness of the gastrocnemius muscle, extend the

14 ii) Knee Flexion Extension 140 degrees 0 degrees iii) Ankle Pronation of the sub-talar joint can compensate for a loss of ankle joint dorsiflexion range of motion. To avoid measurement error (by accidentally including sub-talar pronation), the subtalar joint must be stabilized in its neutral position. To assess the range of JOINT motion, flex the knee (second illustration). To assess tightness of the gastrocnemius muscle, extend the knee (first illustration) Dorsiflexion Plantarflexion Inversion Eversion 20 degrees 45 degrees 35 degrees 20 degrees 11/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 14

Muscle Tissue. Isometric Contraction. Isotonic Contractions 11/22/2016. Muscles. Anatomy Two Joints And Movements

Muscle Tissue. Isometric Contraction. Isotonic Contractions 11/22/2016. Muscles. Anatomy Two Joints And Movements Muscles Anatomy Two Joints And Movements Structure of a Muscle Organ Copyright 2008 by Saunders Muscle Tissue Highly elastic and vascularized, produces movement through elongation and contraction Types