Detailed Knowledge of Anatomy, Physiology, and Kinesiology

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Detailed Knowledge chapterchapter 2 of Anatomy, Physiology, and Kinesiology

CHAPTER OUTLINE • Muscle fiber direction • Tendons Areas of Competence • Fascia Anatomical Position • Joint structure Planes of Motion • Ligaments Cavities of the Body • Bursae • Dermatomes Body Movements Types of Contractions B. Physiology Muscle Movers • Response of the body to stress Biomechanics and Kinesiology • Basic nutrition principles Muscles Joints C. Kinesiology Dermatomes • Actions of individual muscles/muscle groups Nutrition • Types of muscle contractions (e.g., concentric, The Six Basic Nutrients eccentric, isometric) Questions • Joint movements • Movement patterns Answers and Explanations • Proprioception

AREAS OF COMPETENCE NCETMB (26%) This chapter includes sections that correspond to Same as above with the following additions: the organization of the NCBTMB exam as follows: A. Anatomy NCETM (26%); MBLEx (11%) • Primary and extraordinary meridians • Chakras A. Anatomy • Anatomical position and terminology (e.g., B. Physiology planes, directions) • Meridians/channels (e.g., bladder, liver, spleen) • Individual muscles/muscle groups • Muscle attachments (See Chapter 7 for Traditional Chinese Medicine modalities.)

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Strategies to Success Study Skills Find a good place to study! Think about the atmosphere where you study best. Are you distracted by the slightest noise? Do you like a certain level of noise to keep you Coronal (frontal) going and focused? Do you like studying alone plane or in groups? Also consider your comfort level. Do you find yourself drifting off when you study in bed or in a comfortable chair? Is studying at a desk too uncomfortable? There is no right place Transverse plane or way to study. Some people pace the halls while others find a secluded place where they will not be bothered. We do suggest finding a place that is well lighted. Eye strain can make you tired. Sagittal W hatever place you pick, make sure it is right for plane you and study there regularly.

Anatomical Position When learning and reviewing anatomical terms, remember to view the body from the anatomical position (Figure 2-1 and Table 2-1). Figure 2-1 Anatomical position and planes of motion. Source: ©The McGraw-Hill Companies, Inc./Photo by Planes of Motion JW Ramsey. Imaginary sections or planes are made in the body in order to examine the internal anatomy and describe body position of one body part to another. These sections are called planes of motion. There are three planes of motion (see Figure 2-1).

Sagittal plane: This plane separates the body into left and right. Motions that occur in the sagittal plane run parallel to the plane (or an imaginary line splitting the body into left and right). Those motions would be flexion, extension, dorsiflexion, and plantar flexion.

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TABLE 2-1 At a Glance: Anatomical Terms

Anatomical Position Location Superior (cephalad) Higher than or above. Example: the heart is superior to the pelvis. Inferior (caudal) Lower than or below. Example: the patella is inferior to the pelvis. Medial Closest to the midline from anatomical position. Example: the adductor magnus is medial to the iliotibial band. Lateral Farther from the midline from anatomical position. Example: the axillary border of the scapula is lateral to the vertebral border of the scapula. Proximal Proximal and distal are dealing with the arms, hands, fingers, and feet. This is because when standing in the anatomical position, the arms are out at an angle. Therefore, they cannot be “superior” or “inferior.” Proximal means closest to the midline or closer to the root of a limb. Example: the carpals are more proximal than the metacarpals. Distal Farther away from the midline in the arms, hands, fingers, feet or farther from the root of a limb. Example: the phalanges of the foot are more distal than the metatarsals. Anterior (ventral) Closer to the front side of the body. Example: the pectoralis major is anterior to the trapezius. Posterior (dorsal) Closer to the back side of the body. Example: the erector spinae is posterior to the rectus abdominus. Superficial Closer to the skin surface. Also, if you think about a superficial cut, that is one that can be taken care of with a band-aid. Example: the trapezius is superficial to the rhomboids. Deep Closer to the core of the body. Again, think about a cut. If it is deep, it might require stitches. Example: the vastus intermedius is deep to the rectus femoris.

Transverse plane: This is the plane that separates the Coronal (frontal) plane: The coronal (frontal) plane body into top and bottom. The motion that occurs in separates the body into front and back. Motions that the transverse plane runs parallel to the plane (or an occur in the coronal (frontal) plane run parallel to the imaginary line splitting the body into top and bottom). plane (or an imaginary line splitting the body into front This motion is rotation (medial, lateral, trunk). and back). These motions are abduction, adduction, shoulder elevation, and shoulder depression.

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Cavities of the Body • The abdominopelvic cavity (organs and structures below the diaphragm) The body has two main cavities: the ventral and dorsal cavities (Figure 2-2). Dorsal cavity: Ventral cavity: This cavity is more posterior on the body and contains This cavity is more anteriorly located on the body and the following: contains the following: • The cranial cavity (contains the brain) • The thoracic cavity (heart/lungs and area above the • The spinal cavity (contains the spinal cord and diaphragm) v ertebrae), also known as the vertebral canal.

Cranial cavity

Dorsal cavity

Vertebral canal

Mediastinum Thoracic cavity

Thoracic cavity Diaphragm Pleural cavity Pericardial cavity

Ventral Diaphragm cavity Abdominal cavity Abdominal Abdominopelvic cavity cavity Abdominopelvic Pelvic cavity cavity Pelvic cavity

(a) Midsagittal view (b) Coronal (frontal) view

Figure 2-2 The cavities of the body.

Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying cavities of the body.

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Body Movements (Table 2-2 and Figure 2-3). It is important as health There are a variety of body movements. Remember, care professionals that we understand each movement all body movements are from the anatomical position in order to be consistent with our clients.

TABLE 2-2 At a Glance: Body Movements and Their Descriptions

Movement Description Flexion a decrease in the angle of a joint Extension an increase in the angle of a joint Abduction movement away from the midline Adduction movement toward the midline Supination turning the palms of the hands upward, or walking on the outer edge of the foot Pronation turning the palms of the hands downward, or walking on the inside edge of the foot Medial rotation rotating toward the midline (internal rotation) Lateral rotation rotating away from the midline (external rotation) Elevation raising the shoulders upward Depression lowering the shoulders Dorsiflexion pulling the toes upward toward the lower leg (flatten the feet) Plantar flexion pointing the toes (remember the “P” in point and the “P” in plantar flexion) Eversion soles of the feet away from the midline Inversion soles of the feet in toward the midline Protraction moving the scapula away from the spine, also called scapular abduction or jutting the mandible forward Retraction moving the scapula toward the spine, also called scapular adduction or pulling the mandible backward Circumduction moving a body part in a circular motion combining flexion, abduction, extension, and adduction

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Figure 2-3 Body movements.

Elbow flexion

Shoulder extension

Shoulder flexion

Elbow extension

Finger extension

Wrist extension

Finger flexion

Wrist flexion

Hip flexion

Hip extension Ankle Toe extension dorsiflexion

Ankle plantar flexion

Toe flexion

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Figure 2-3 (continued) Knee flexion Neck Neck flexion extension

Spine Spine flexion extension

Knee extension

Shoulder abduction

Shoulder Neck horizontal Shoulder abduction lateral adduction flexion Shoulder horizontal adduction

Spine lateral flexion Thumb adduction Wrist Wrist abduction adduction

Thumb abduction

Finger Finger adduction abduction

Toe Toe adduction abduction

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Figure 2-3 (continued)

Shoulder circumduction

Forearm supination

Forearm pronation

Hip circumduction

Hip abduction

Hip adduction

Foot Foot inversion eversion

Scapular Scapular retraction protraction

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Figure 2-3 (continued) Head/neck rotation

Spine rotation

Finger circumduction

Shoulder lateral rotation

Shoulder medial rotation Scapular upward rotation Scapular downward rotation

Knee Hip Hip Knee medial medial lateral lateral Scapular rotation rotation rotation rotation elevation Scapular depression

Mandibular elevation

Mandibular Mandibular protraction retraction Mandibular depression

Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying body movements.

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Types of Contractions (the dumbbell “tension” will stay the same) or internal force (such as using weightlifting machines where A contraction is a shortening or lengthening, as in a the cam makes some movements easier than others). muscle (Table 2-3). The following list includes com- With internal force, the muscle tension stays the same mon contractions. throughout the range of motion. Internal force is generally seen in a gym setting. However, in our normal Isometric: (iso = same; metric = length) This is when movements, we generally deal with external force, so the muscle is contracting, but the joint/s is/are not that will be our focus. There are two types of isotonic moving. For example, push your hands together palm- contractions: to-palm. You feel the muscles contracting in your arms, 1. Concentric—the lifting phase of movement. The but the shoulder, elbow, and wrist are not moving. muscles shorten and contract. Isotonic: (iso = same; tonic = tension) Movement 2. Eccentric—the lowering phase of movement. The occurs with this type of contraction. The tension is muscles are contracting but lengthening, which either external force, such as a fifty-pound dumbbell allows us to put things down gently.

TABLE 2-3 At a Glance: Muscle Contractions Type of Contraction Description Isometric Stabilizing—both agonist and antagonist exert the same amount of force preventing movement at the joint. Isotonic Movement at the joint occurs 1. concentric 1. The agonist (primary mover) shortens while contracting, otherwise known as the “up” phase. 2. eccentric 2. The agonist (primary mover) is lengthening while still contracting, otherwise known as the “down” phase.

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Muscle Movers Tendons: Tendons attach muscle to bone (for example, the Achilles tendon attaches the gastrocnemius to the Agonists (primary movers): Agonists are the main calcaneous). muscle(s) doing the movements. These are usually the larger muscles since they have to be strong. Ligaments: Ligaments attach bone to bone (for example, the anterior cruciate ligament attaches the femur to Assisters: The assister muscles help the primary movers the tibia). in one of two ways: 1. Synergist helps the primary mover by moving the Cartilage: Cartilage provides the cushion between same way. If the primary mover is in a concen- bones. An example is the two cartilages between the tric contraction, so is the synergist. If the primary femur and the tibia of the knee. mover is in an eccentric contraction, so is the synergist. Fascia: Fascia is a web of tissue that serves to maintain 2. Antagonist helps the primary mover by moving structural integrity by providing support and protection opposite. If the primary mover is in a concentric while acting as a shock absorber. contraction, the antagonist is in an eccentric contraction. Bursa (pl. bursae): Bursa is a small fluid-filled sac that provides cushion between bones and tendons and/or Stabilizers: These muscles help prevent motion. We muscles around a joint. They are filled with synovial usually get hurt when our stabilizers become primary fluid. movers, such as in lifting something off the floor by bending at the waist instead of using our legs. See Figures 2-4 and 2-5 for diagrams of main muscles of the body. Remember, origins are the strong Connective tissue: The function of connective tissue non moveable ends of a muscle. Insertion is the move- is to support, protect, and connect other tissues. Types able end. Generally, origins are closer to the center or of connective tissue relating to the muscular system midline of the body, and insertions are farther away include tendons, ligaments, and cartilage. from the midline.

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Superficial Deep

Occipital belly of occipitofrontalis Semispinalis capitis

Sternocleidomastoid Splenius capitis

Trapezius Levator scapulae Supraspinatus Rhomboid minor Deltoid Rhomboid major Infraspinatus Teres minor Teres minor Teres major Teres major

Triceps brachii Serratus anterior

Latissimus dorsi Serratus posterior inferior

External oblique Internal oblique Extensor digitorum Erector spinae

Extensor carpi ulnaris

Gluteus medius Gluteus minimus Gluteus maximus Gluteus medius (cut) Piriformis Quadratus femoris

Adductor magnus

Biceps femoris Gracilis Semitendinosus Hamstrings Iliotibial band

Semimembranosus

Gastrocnemius

Soleus

Calcaneal tendon

Figure 2-4 The posterior muscles of the body.

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Frontal belly of occipitofrontalis Temporalis Orbicularis oculi

Zygomaticus major Masseter Orbicularis oris

Platysma Sternohyoid Trapezius Sternocleidomastoid

Deltoid Pectoralis minor

Pectoralis major Serratus anterior

Triceps brachii External intercostal Biceps brachii Internal intercostal

Brachialis External oblique Rectus abdominis Pronator teres Transversus abdominis Brachioradialis Internal oblique (cut) Flexor carpi radialis External oblique (cut) Palmaris longus

Iliopsoas Tensor fasciae latae Pectineus

Adductor longus

Sartorius

Gracilis Rectus femoris

Quadriceps femoris Vastus lateralis Vastus medialis Vastus intermedius

Fibularis longus

Tibialis anterior

Extensor digitorum longus

Extensor hallucis longus

Figure 2-5 Go to the Online Learning Center at The anterior muscles of the body. www.mhhe.com/massagereview2e to practice identifying muscles of the body.

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junction. They help keep us from over-contracting Biomechanics and by sending signals to the interneurons in the spinal cord, which in turn inhibit the actions of the motor Kinesiology neurons. This allows the muscle to relax, thus pro- Biomechanics is the analysis of biological systems tecting the muscle and tendon from excessive tension in mechanical terms, and kinesiology is the study of damage. So if we try to lift an object that is too heavy, body movement. The body has muscle spindles and our muscles will respond so that we realize it is too Golgi tendon organs to help us with body position heavy and drop it. Otherwise, we end up straining a (proprioception). The benefits of using proper body muscle. mechanics for massage include the following: Muscle spindles: A muscle spindle is a stretch recep- • Increased strength and power tor found in the muscle that detects a stretching force • Increased pressure in the muscles. When too much of a stretch occurs, the • Decreased possibility of injury muscle spindles causes a contraction of the muscle to • Enhanced quality and effectiveness of massage prevent overstretching. • Increased career and life span as a therapist/ bodyworker Muscles Proprioception: Proprioception is the ability to know Knowledge of muscle origins and insertions is a must where your body is in space. For example, if you were for any massage therapist or bodyworker. Remember, to close your eyes and lift your leg up to hip level, you origins are generally the stronger, nonmoveable would know it was at hip level without having to look. end of the muscle, while insertions are the weaker, See Chapter 1 for a detailed discussion. moveable end of the muscle. See Figures 2-6 and 2-7 and Table 2-4 for the main muscles of the face and Golgi tendon organs: Golgi tendon organs are nerve head. endings located within tendons near a muscle–tendon

Epicranial aponeurosis

Epicranius Frontal belly

Temporalis

Occipital belly

Orbicularis oculi

Zygomaticus minor Levator anguli oris Masseter Zygomaticus major Buccinator Orbicularis oris Sternocleidomastoid

Platysma

Figure 2-6 Side view of the muscles of the face.

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Epicranial aponeurosis

Epicranius

Frontal belly of occipitofrontalis

Orbicularis oculi

Zygomaticus minor Zygomaticus major Masseter Buccinator

Orbicularis oris

Platysma

Sternocleidomastoid

Figure 2-7 Muscles of facial expression and mastication.

Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying muscles of the face.

TABLE 2-4 At a Glance: Muscles of the Face and Head Muscle Origin Insertion Action Epicranius Occipital bone Skin and muscles around eye Raises eyebrow Orbicularis oculi Maxillary and frontal bones Skin around the eye Closes eye Orbicularis oris Muscles near the mouth Skin of lips Closes and protrudes lips Buccinator Outer surface of maxilla Orbicularis oris Compresses cheeks inward and mandible Zygomaticus Zygomatic bone Orbicularis oris Raises corner of mouth Masseter Zygomatic arch Angle and ramus of the Elevates the mandible mandible Temporalis Temporal bone and lateral Coronoid process of Closes jaw surface mandible Platysma Subcutaneous tissue of Base of mandible, skin of Depresses mandible infraclavicular and cheek and lower lip, angle (against resistance), supraclavicular regions of mouth, orbicularis oris tenses skin of inferior face and neck

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Now, we will take a look at muscles that actu- of the muscle oftentimes tells you the location. For ally move the head (Figures 2-8 and 2-9). Notice example, splenius cervicus tells you there is an attach- that some of these muscles attach onto the spine, ment on the cervical vertebrae (cervicus); splenius clavicle, and ribs to provide stabilization as well capitus tells you there is an attachment on the skull as movement at the neck and/or head. The name (capitus = head). See Table 2-5.

Deep Deeper

Sternocleidomastoid

Splenius capitis

Splenius capitis (cut)

Splenius cervicis Scalenus posterior

Figure 2-8 Posterior view of muscles that move the head.

Scalene muscles

Figure 2-9 View of the scalenes: posterior, anterior, and medius.

Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying muscles of the neck.

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TABLE 2-5 At a Glance: Muscles That Move the Head Muscle Origin Insertion Action Sternocleidomastoid Manubrium of sternum, Mastoid process of Unilaterally: laterally flexes neck medial one-third of temporal bone and rotates head to one side clavicle Bilaterally: flexes neck and assists in forced inspiration Splenius capitis Nuchal ligament, spinous Mastoid process, Unilaterally: rotates the head process of C7–T3 inferior nuchal line- and laterally flexes the neck lateral region Bilaterally: extends the head Splenius cervicus Spinous processes of T3–T6 Transverse processes of Unilaterally: rotates the head C1–C3 and laterally flexes the neck Bilaterally: extends the head Scalenes posterior Tranverse processes of Rib 2 (superior Unilaterally: laterally flexes the C5–C6 surface) neck, rotates the head Bilaterally: elevates the second rib during inhalation Scalenes anterior Transverse process of Rib 1 (superior Unilaterally: laterally flexes the C3–C6 surface) neck and rotates the head Bilaterally: elevates the first rib during inhalation Scalenes medius Transverse process of Rib 1 (superior Unilaterally: laterally flexes the C2–C7 surface) neck and rotates the head Bilaterally: elevates the first rib during inhalation

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Remember, the shoulder girdle muscles either attach and have no action or attachment to the scapula or the to or move the scapula, or they attach to the clavicle. clavicle (Table 2-6). See Figures 2-10 through 2-12 for Shoulder joint muscles only move the shoulder joint muscles that move the pectoral girdle and the trunk.

TABLE 2-6 At a Glance: Muscles That Move the Pectoral Girdle and Trunk Muscle Origin Insertion Action Trapezius External occipital pro- Lateral one-third of Upper fibers: extends the neck and head, elevates tuberance, superior clavicle, acromion scapula, and upwardly rotates the scapula nuchal lines, nuchal process, scapular Bilaterally: extends the head and neck ligament, spinous spine Middle fibers: retracts the scapula processes of C7–T12 Lower fibers: depresses the scapula Rhomboid major Spinous processes of Vertebral border of Retracts the scapula and downwardly rotates T2–T5 scapula the scapula Rhomboid minor Spinous processes of Vertebral border of Retracts the scapula and downwardly rotates C7–T1 the scapula the scapula Levator scapulae Transverse processes of Superior angle of Unilaterally: elevates the scapula, downwardly C1–C4 the spine of scap- rotates the scapula, laterally flexes the neck ula at the root Bilaterally: extends head and neck Serratus anterior Ribs 1–8 Anterior medial bor- Protracts the scapula and upwardly rotates the der of the scapula scapula Pectoralis minor Ribs 3–5 Coracoid process Depresses the scapula, protracts the scapula, of scapula downwardly rotates the scapula, and assists in forced inspiration Internal oblique Iliac crest, thoracolum- Ribs 7–12, linea Unilaterally: laterally flexes and rotates the bar fascia, inguinal alba vertebral column ligament Bilaterally: flexes the vertebral column External oblique Ribs 5–12 Iliac crest, abdomi- Unilaterally: laterally flexes and rotates nal fascia, linea the vertebral column alba Bilaterally: flexes the vertebral column Rectus Pubic symphysis and Ribs 5–7 and Flexes the vertebal column, compresses the abdominus pubic tubercle xiphoid process abdominal contents Transverse Ribs 7–12, iliac crest, Abdominal Compresses the abdominal contents abdominus thoracolumnar aponeurosis, aponeurosis, inguinal linea alba ligament Erector spinae Spinous processes of Mastoid process, Unilaterally: laterally flexes the vertebral C1–L5, nuchal liga- ribs 1–12, trans- column ment, posterior iliac verse processes of Bilaterally: extends the vertebral column and crest, ribs 1–12, pos- C2–T8, occipital head terior sacrum bone Quadratus Posterior iliac crest Ribs 12 (inferior Unilaterally: laterally flexes the vertebral column lumborum surface), trans- and elevates the hip verse process of Bilaterally: extends the lumbar spine and anteri- L1–L4 orly tilts the pelvis

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Superficial Deep

Levator scapulae

Trapezius

Rhomboid minor Supraspinatus

Rhomboid major Infraspinatus

Deltoid Teres minor

Teres major

Latissimus dorsi

Figure 2-10 Muscles of the posterior shoulder. The right trapezius is removed to show underlying muscles.

Superficial Deep

Pectoralis minor Pectoralis major

Serratus anterior

Rectus abdominis Transversus abdominis Internal oblique (cut) External oblique (cut)

Figure 2-11 Muscles of the anterior chest and abdominal wall. The right pectoralis is removed to show the pectoralis minor.

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Deep Deeper

Iliocostalis group Erector spinae Longissimus group Spinalis group

Internal oblique (cut)

Quadratus lumborum External oblique (cut)

Figure 2-12 Muscles of the erector spinae and quadratus lumborum.

Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying muscles of the shoulder, chest, and abdominal wall.

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Figures 2-13 and 2-14 show muscles that move shoulder. The origin is the name of the fossa from which the arm; however, notice that some of the muscles also they originate. The insertion can be remembered by the affect the shoulder which would make them shoulder subscapularis—it is “sub” standard and is the only rotator girdle muscles. Note that the rotator muscles are the SITS cuff muscle to attach to the lesser tubercle. The others are muscles and are listed in the order that they “sit” on the so great, they attach to the greater tubercle. See Table 2-7.

Superficial Deep

Sternocleidomastoid

Subscapularis Deltoid Coracobrachialis

Pectoralis major

Biceps brachii

Figure 2-13 Muscles of the anterior shoulder and arm.

Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying muscles of the shoulder and arms.

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Deltoid

Pectoralis major

Coracobrachialis

Biceps brachii, long head Biceps brachii, short head Triceps brachii

Brachialis

Brachioradialis

Anterior view

Figure 2-14 Muscles of the arm.

Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying muscles of the arms.

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TABLE 2-7 At a Glance: Muscles That Move the Arm Muscle Origin Insertion Action Coracobrachialis Coracoid process of the Medial humeral shaft Flexes and adducts the shoulder scapula Pectoralis major Medial half of clavicle Intertubercular groove of Adducts the shoulder, medially edge of sternal body, ribs the humerus rotates the shoulder, flexes 1–8 the shoulder (clavicular fibers only), and extends the shoulder (sternal and costal fibers) Teres major Inferior half of the lateral Intertubercular groove of Teres major extends the border of the scapula the humerus shoulder, medially rotates the shoulder, adducts the shoulder Latissimus dorsi Spinous process of T6–L5, Intertubercular groove of Extends the shoulder, medially ribs 9–12, posterior the humerus rotates the shoulder, adducts iliac crest, and posterior the shoulder sacrum Deltoid Lateral third of clavicle, Deltoid tuberosity of Anterior fibers: flex and acromion process, scap- humerus medially rotate the shoulder ular spine Medial fibers: abduct the shoulder Posterior fibers: extend and laterally rotate the shoulder Rotator Cuff Muscles Supraspinatus Supraspinous fossa of the Greater tubercle of the Abducts the shoulder scapula humerus Stabilizes head of humerus in glenoid cavity Infraspinatus Infraspinous fossa of the Greater tubercle of the Laterally rotates the shoulder scapula humerus Adducts the shoulder, extends the shoulder, horizontally abducts the shoulder Teres minor Superior half of the lateral Greater tubercle of the Adducts the shoulder and border of the scapula humerus laterally rotates the shoulder Extends the shoulder; horizontally abducts the shoulder; stabilizes head of humerus in glenoid cavity

Subscapularis Subscapular fossa of the Lesser tubercle of the Medially rotates the shoulder scapula humerus Stabilizes head of humerus in glenoid cavity

Memory Helper Memory Helper Memory Helper Internal shoulder Rotator cuff External rotator cuff rotators muscles muscles L – Latissimus dorsi S – Supraspinatus E – both E and X stand for I – Internal rotation I – Infraspinatus External Rotation (the action) T – Teres minor X P – Pectoralis major S – Subscapularis I – Infraspinatus S – Subscapularis T – Teres minor

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Remember, many muscles’ names tell you either Figure 2-15b for muscles that move the posterior the location (brachio = arm and radialis = radius bone), forearm (Table 2-8). Place your hand on the medial or how many origins they might have (bi = 2, so bicep epicondyle, and you will feel muscles flexing when has two origins), or the action (supinator supinates the your flex your wrist. The medial epicondyle is the com- forearm). See Figure 2-15a for muscles that move the mon origin for most wrist flexors. Now place your anterior forearm (Table 2-8). hand on the lateral epicondyle, and extend your wrist. Generally speaking, the wrist/finger flexors are The lateral epicondyle is the common origin for most on the anterior side of the forearm, and the wrist/ wrist extensors. See Table 2-9 for muscles that move the finger extensors are on the posterior forearm. See wrist, hand, and fingers. See Figures 2-16 and 2-17.

Brachioradialis

Extensor carpi radialis longus

Pronator teres Extensor carpi radialis brevis Brachioradialis Flexor carpi ulnaris Flexor carpi ulnaris Palmaris longus Extensor digitorum Extensor carpi ulnaris Flexor carpi radialis

Extensor pollicis brevis

(a) (b)

Figure 2-15 Muscles of the forearm.

Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying muscles of the forearm.

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TABLE 2-8 At a Glance: Muscles That Move the Forearm Muscle Origin Insertion Action Biceps brachii Long head: supraglenoid Radial tuberosity Flexes the elbow, supinates tubercle of scapula the forearm, and flexes the shoulder Short head: coracoid process of scapula Brachialis Distal anterior humeral shaft Ulnar tuberosity Flexes the elbow Brachioradialis Lateral supracondylar ridge Styloid process of radius Flexes the elbow when of the humerus the hand is in the neutral position Triceps brachii Long head: infraglenoid Olecranon process Extends the elbow and tubercle of the scapula extends the shoulder Lateral head: posterior proximal humeral shaft Medial head: posterior distal humeral shaft Supinator Lateral epicondyle of the Proximal lateral radial Supinates the forearm humerus, proximal one- shaft eighth of ulnar shaft, radial collateral ligament, and annular ligament Pronator teres Medial epicondyle of the Lateral proximal radial Pronates the forearm and humerus and the coronoid shaft flexes the elbow process of the ulna Pronator quadratus Anterior distal one-eighth of Anterior distal one- Pronates the forearm the ulnar shaft eighth of the radial shaft

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TABLE 2-9 At a Glance: Muscles That Move the Wrist, Hand, and Fingers Muscle Origin Insertion Action Flexor carpi radialis Lateral supracondylar Bases of meta- Flexes and abducts the wrist ridge of the humerus carpals 2–3

Flexor carpi ulnaris Medial epicondyle of the Base of metacarpal Flexes and adducts the wrist humerus 5, pisaform, and hamate Palmaris longus Medial epicondyle of Tranverse carpal lig- Flexes the wrist and cups the palm humerus ament and palmar aponeurosis

Flexor digitorum Anterior proximal three- Distal phalanges of Flexes the fingers and the distal inter- profundus fourths of the ulnar shaft fingers 2–5 phalangeal joint (DIP), the proximal interphalangeal joint (PIP), and the middle phalanx (MP) joints

Extensor carpi Longus: supracondylar Longus: base of Extends and abducts the wrist radialis longus ridge of the humerus metacarpal 2 and brevis Brevis: lateral epicondyle Brevis: base of Extends the distal interphalangeal joint of the humerus metacarpal 3 (DIP), the proximal interphalangal joint (PIP), and the middle phalanx (MP) joints

Extensor carpi Lateral epicondyle of the Base of Extends and adducts the wrist ulnaris humerus metacarpal 5 Extensor digitorum Lateral epicondyle of the Middle phalanges Extends the wrist and extends the fin- humerus of the four fingers gers at the DIP, PIP, and MP joints

Extensor pollicis Longus: posterior ulnar Longus: distal Extends the thumb longus and brevis shaft middle region, phalanx of posterior radial shaft thumb middle region, and interosseous membrane Brevis: posterior radial Brevis: proximal shaft distal region and phalanx of interosseous membrane thumb Flexor pollicis Longus: anterior radial Longus: distal Flexes the thumb longus and brevis shaft middle region, phalanx of interosseous membrane, thumb and anterior ulnar shaft middle region Brevis: trapezium and Brevis: proximal transverse carpal phalanx of ligament thumb Oppenens pollicis Trapezium and transverse Proximal phalanx Flexes and adducts the thumb carpal ligament of thumb

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Look for similarities among muscle groups. For example, the quadriceps group (rectus femoris, vastus medialis, vastus lateralis, and vastus intermedialis) all have a common insertion—the tibial tuberosity. See Supinator Table 2-10 for muscles that move the hip, thigh, and knee (Figures 2-18 through 2-22). Think about the action of the muscle to help you figure out its location. For example, for the toes to flex, it makes sense that the flexors be on the plantar aspect of the foot, whereas the extensors would be on the dor- Flexor digitorum profundus sal. Remember, muscles only pull; they never push. Flexor pollicis See Table 2-11 for muscles that move the ankle, foot, longus and toes (Figures 2-23 through 2-26).

Pronator quadratus

Psoas major

Iliacus

Figure 2-16 Muscles of the wrist and forearm.

Adductor longus Adductor brevis

Gracilis

Adductor magnus

Opponens pollicis

Figure 2-17 Oppenens pollicis muscle.

Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying muscles of the wrist and forearm. Figure 2-18 Deeper muscles of the right anterior thigh.

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Gluteus medius Tensor fasciae latae Sartorius Gluteus maximus Iliacus Iliopsoas Rectus femoris Psoas major

Vastus lateralis Tensor fasciae latae

Biceps femoris, long head Adductor longus

Semimembranosus Gracilis

Biceps femoris, Sartorius short head Rectus femoris

Vastus lateralis

Vastus medialis

Figure 2-19 Muscles of the right lateral thigh.

Figure 2-20 Muscles of the right anterior thigh.

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Gluteus medius

Gluteus maximus

Adductor magnus Gracilis

Hamstrings: Semimembranosus Semitendinosus Biceps femoris, long head Biceps femoris, short head

Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying muscles of the Figure 2-21 Muscles of the right posterior thigh. thigh and hip.

Gluteus medius (cut)

Gluteus maximus (cut) Gluteus minimus

Gluteus medius (cut) Piriformis

Gluteus maximus (cut)

Obturator internus

Quadratus femoris

Gracilis

Adductor magnus

Semitendinosus

Figure 2-22 Muscles of the thigh and hip.

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TABLE 2-10 At a Glance: Muscles That Move the Thigh and Leg

Muscle Origin Insertion Action Psoas major Transverse processes Lesser trochanter Unilaterally: laterally rotates the hip and vertebral bodies of Bilaterally: flexes the hip and the verte- T12–L5 bral column Iliacus Iliac fossa and anterior Lesser trochanter Flexes and laterally roates the hip inferior iliac spine Flexes hip; extends hip

Gluteus maximus Posterior sacum, poste- Glutal tuberosity Extends, laterally rotates, and abducts rior coccyx, and poste- (25%) and iliotibial the hip rior iliac crest band (75%) Gluteus medius Superior gluteal line Greater trochanter Abducts and medially rotates the hip Flexes hip; extends hip Gluteus minimus Inferior gluteal line Greater trochanter Abducts and medially rotates the hip, and flexes hip Tensor fasciae latae Anterior iliac crest and Iliotibial band Abducts, flexes, and medially rotates anterior superior iliac the hip spine Adductor longus Pubic tubercle Linea aspera Adducts and flexes the hip, medially rotates hip Adductor magnus Ischial tuberosity, infe- Linea aspera and Adducts, flexes, and extends the hip, rior pubic ramus, and adductor tubercle of and medially rotates hip ischial ramus the femur Adductor brevis Inferior pubic ramus Linea aspera Adducts the hip and medially rotates the hip Gracilis Inferior pubic ramus Medial proximal tibial Adducts and flexes the hip; flexes and shaft (pes anerine) medially rotates the knee

Sartorius Anterior superior iliac Medial proximal Flexes, laterally rotates, and abducts spine tibial shaft (pes the hip; medial and laterally rotates anserine) the knee when the knee is flexed. Pectineus Pectineal line of pubis Pectineal line of Adducts and flexes thigh femur Hamstrings Group Biceps femoris Ischial tuberosity Fibular head Flexes the knee, laterally rotates the knee (when knee is flexed), extends the hip, medially rotates hip, posteriorly tilts the pelvis

Semitendonosis Ischial tuberosity Medial proximal Flexes the knee, medially rotates the tibial shaft (pes knee (when knee is flexed), extends anserine) the hip, medially rotates hip, posteriorly tilts the pelvis Semimembranosis Ischial tuberosity Medial condyle of the Flexes the knee, medially rotates the tibia knee (when knee is flexed), extends the hip, medially rotates hip, posteriorly tilts the pelvis

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TABLE 2-10 (continued) Deep Six Hip Rotators Piriformis Anterior surface of Greater trochanter Laterally rotates hip, abducts the hip sacrum when the hip is flexed Quadratus femoris Lateral border of ischial Intertrochanteric Laterally rotates the hip tuberosity crest, between the greater and lesser trochanters Obturator internus Obturator membrane Medial surface of the Laterally rotates the hip and inferior surface of greater trochanter the obturator foramen Obturator externus Superior and inferior Trochanteric fossa of Laterally rotates the hip rami of pubis femur Gemellus superior Ischial spine Upper border of Laterally rotates the hip greater trochanter Gemellus inferior Ischial tuberosity Upper border of Laterally rotates the hip greater trochanter Quadriceps Group Rectus femoris Anterior inferior iliac Tibial tuberosity Flexes the hip and extends the knee spine Vastus lateralis Linea aspera and Tibial tuberosity Extends the knee gluteal tuberosity Vastus Anterior lateral Tibial tuberosity Extends the knee intermedialis femoral shaft Vastus medialis Linea aspera Tibial tuberosity Extends the knee

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TABLE 2-11 At a Glance: Muscles That Move the Ankle, Foot, and Toes Muscle Origin Insertion Action Tibialis anterior Lateral tibial shaft and Base of the first metatarsal Dorsiflexes the ankle and interosseous membrane and cuneiform 1 inverts the foot Peroneus brevis Lateral distal two-thirds of Base of fifth metatarsal Everts the foot and plantar (fibularis brevis) the fibular shaft flexes the ankle Peroneus longus Fibular head and lateral Base of first metatarsal and Everts the foot and plantar (fibularis longus) proximal two-thirds of the cuneiform 1 flexes the ankle fibular shaft Extensor Longus: fibular head, proxi- Longus: middle halanges Extends digits 2–5 and dor- digitorum mal two-thirds of fibular 2–5 and distal phalanges siflexes the ankle (longus longus and shaft, and lateral condyle of 2–5. only) brevis the tibia. Brevis: calcaneus Brevis: tendons of extensor digitorum longus Gastrocnemius Medial and lateral epicon- Calcaneus via the Achilles Plantar flexes the ankle and dyles of the femur tendon (aka: calcaneal flexes the knee tendon) Soleus Superior posterior one-third Calcaneus via the Achilles Plantar flexes the ankle of the fibular shaft and soleal tendon line of the tibia Flexor digitorum Posterior tibial shaft-middle Distal phalanges 2–5 Flexes digits 2–5 at the DIP, PIP, longus region MP joints, and plantar flexes the ankle Tibialis posterior Posterior tibial shaft, pos- Navicular bone, third cunei- Inverts the foot and plantar terior fibular shaft, and form, cuboid, and bases of flexes the ankle interosseous membrane metatarsals 2–4 Flexor hallucis Posterior fibular shaft Distal phalanx of big toe Flexes big toe, plantar flexes the longus ankle, inverts the foot, and supports the longitudinal arch Extensor hallucis Anterior fibular shaft, Distal phalanx of big toe Extends the big toe and dorsi- longus interosseous membrane flexes the ankle

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Joints classified as synarthrosis. However, the articulation between the radius and ulna and between the tibia In order for muscles to move, we must have joints or and fibula, while fibrous, are functionally classified as articulations. The main types of joints in our bodies, amphiarthrosis or slightly moveable. as well as their description, movements, and examples, are listed below. Cartilaginous: In cartilaginous joints, articulating bones are connected by hyaline cartilage or fibrocar- Fibrous: With this type of joint, articulating bones are tilage. They provide for limited movement, as when fastened together by a thin layer of dense connective the back is bent or twisted. An example is the joints tissue. An example is the sutures between bones of the between the bodies of vertebrae and the symphysis skull. These joints generally do not move, making them pubis (amphiarthrosis or slightly movable). Another

Gastrocnemius (cut)

Fibularis longus Gastrocnemius Tibialis posterior

Tibialis anterior

Fibularis brevis

Flexor digitorum Extensor digitorum longus longus

Flexor hallucis longus

Extensor digitorum brevis

Figure 2-24 Muscles of the right anterior leg.

Figure 2-23 Deep posterior, leg muscles.

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Gastrocnemius

Gastrocnemius Tibialis anterior Lateral head Medial head Soleus

Fibularis longus Extensor digitorum longus

Fibularis Extensor hallucis longus brevis

Flexor hallucis longus tendon Extensor digitorum brevis

Figure 2-25 Muscles of the right lateral leg.

Figure 2-26 Muscles of the right posterior leg. example is the hyaline cartilage plate between bones, which is functionally classified as synarthrosis. Go to the Online Learning Center at Synovial: With these joints, articulating bones are sur- www.mhhe.com/massagereview2e to rounded by a joint capsule of ligaments and synovial practice identifying muscles of the leg. membranes; the ends of articulating bones are covered by hyaline cartilage and separated by synovial fluid. Several types are listed here. See Figure 2-27. Synovial 3. Gliding: Articulating surfaces are nearly flat or joints are functionally classified as diarthrosis or freely slightly curved, which provides sliding or twisting movable joints. movements. Gliding joints occur between various 1. Ball-and-Socket: The ball-shaped head of one bone bones of the wrist and ankle, sacroiliac joint, joints articulates with the cup-shaped cavity of another between ribs two and the sternum and rib 7 and bone. This movement occurs in all planes and the sternum. rotations. Examples include the shoulder and hip. 4. Hinge: The convex surface of one bone articulates 2. Condyloid: The oval-shaped condyle of one bone with the concave surface of another. This makes articulates with the elliptical cavity of another. A flexion and extension possible, for example, in the variety of movements occur in different planes but elbows, joints of phalanges, and knees. no rotation. An example is the joints between the 5. Pivot: The cylindrical surface of one bone articulates metacarpals and phalanges. with ring of bone and ligament, and rotates around

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Dens of axis

Atlas

Axis

Pivot joint Ball-and-socket joint

Ilium

Hinge joint

Humerus

Radius

Head of femur

Ulna

Carpal bones

Plane joint Triquetrum

Hamate bone Trapezium

First Saddle joint metacarpal bone Phalanges

Metacarpal bone Proximal phalanx

Condylar joint

Figure 2-27 Types of synovial joints. Go to the Online Learning Center at www.mhhe.com/massagereview2e to practice identifying these joints.

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a central axis. An example is the joint between the proximal ends of the radius and ulna. Nutrition 6. Saddle: Articulating surfaces have both concave and convex regions; the surface of one bone fits The Six Basic Nutrients the complementary surface of another, providing Six basic nutrients are needed in order for our bodies a variety of movements, for example, the joints to survive. between the carpal and metacarpal of the thumb. Water: Water assists in many chemical functions, Dermatomes such as the formation of ATP. That is one reason we feel fatigued when we are dehydrated. Generally it is Dermatomes: These are band-like unilateral patterns recommended to drink half your body weight in ounces of peripheral nerves or an area or section supplied by a of water daily; however, some disease situations con- single spinal nerve. This means that the skin of the body tradict that. For example, those with congestive heart may be divided into sensory segments that collectively failure should follow the recommendations of their make up a dermatome map. (See Figure 2-28.) physician as to how much water they should drink.

C2 Cranial nerve (CN V)

C2 C3 C4 C5 C3 C6 C4 C7 C8 C5 T1 T1 T2 C5 C5 T2 T3 T3 T4 T2 T4 T2 T5 T5 T1 T6 T1 T6 T7 T7 T8 T8 T9 T9 T10 C7 T11 C7 T10 C6 C8 T12 C8 C6 C5 T11 C5 L1 L2 T12 L3 L4 L1 S2 L1 S3 S4 S3 S5 C6 C6 Co L2 L2 C7 C8 C8 C7 L5 L5 L1 S1 S1 L3 L3 S2 S2

L2 L2 L4 L4

L5 L5

S1 S1

L4 S1 S1 L5 L5

Anterior view Posterior view

Figure 2-28 The dermatomes.

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Protein: Twelve to twenty percent of our diet should oils or liquid at room temperature and should make be made up of protein. Food sources include meats, up no more that twenty percent of our caloric intake. poultry, beans, and legumes. Protein helps to repair Cholesterol falls into the fat category. and rebuild muscle. It does not build muscle as some think . . . exercise does! Vitamins: Vitamins have no caloric value but play a big role in a healthy diet. We have water soluble vitamins Carbohydrates: Carbohydrates should make up fifty- (B and C). If too much is ingested, our bodies expel the five to sixty percent of our total diet. Carbohydrates excess through the urine. Fat soluble vitamins (A, D, E, help us to hold onto needed water. We have simple and K) are not expelled easily. Excesses are stored in the carbohydrates (refined sugars) that should be limited body fat and can create toxicity. in our diet and complex carbohydrates (breads, pastas, cereals) that benefit our bodies and provide necessary Minerals: Minerals are generally needed only in trace energy. Carbohydrates are our primary fuel source— amounts. However, two minerals of concern to women your brain uses twenty percent of all carbohydrates are iron (important during the menstrual cycle years) just to function. Some carbohydrates are high glycemic and calcium (important during bone growing years (good to eat after a bout of exercise to replace the fuel of eleven to twenty-five and postmenopausal years). used), and others are mid/low glycemic (best to eat If supplemental iron or calcium is taken, it should be before a long bout of exercise). through a physician’s recommendation. Remember, our role in nutrition is to provide basic Fats: Fats should make up no more than thirty percent information, follow the FDA Food Guide Pyramid of our total diet. Saturated fats are the bad fats that are (Figure 2-29), and refer to a registered and licensed generally solid at room temperature and should be no dietitian or the client’s physician. more than ten percent of our diet. Unsaturated fats are

Memory Helper Cholesterol There are two main types of cholesterol: HDL (high density lipoproteins), which are the good or “happy” cholesterol, and LDL (low density lipoprotein), which are the bad or “lousy” cholesterol.

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Figure 2-29 The FDA Food Guide Pyramid. In 2005, the FDA announced a new food pyramid, seen here alongside the previous pyramid, which you will need to know for your exam.

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5. The muscle that is also known as the “six pack” Strategies to Success is the A. external oblique. Test-Taking Skills B. rectus abdominus. No tricks, just focus! C. internal oblique. D. transverse abdominus. Always read all of the responses to a question 6. The insertion for the triceps brachii is before answering. If you choose an answer too A. radial tuberosity. quickly, you might miss the best answer. Do not B. supraglenoid fossa. make assumptions about the questions and how C. coracoid process. the writer of the question might be trying to trick D. olecranon process. you. Use only the information provided in the question, and choose the best answer based on 7. External rotators of the shoulder are your knowledge of the subject. A. supraspinatus and teres minor. B. subscapularis and supraspinatus. C. teres major and infraspinatus. D. teres minor and infraspinatus. 8. A band of connective tissue that wraps around *Some questions are not directly addressed in this tendons is called chapter, but are meant to act as a general review of A. retinaculum. subjects studied in various school curriculums. B. aponeurosis. C. fascia. D. myocardium. Questions 9. If your client has an anterior pelvic tilt, this means Detailed Knowledge of Anatomy, that the Physiology, and Kinesiology A. hamstrings are tight and the rectus femoris is stretched. NCETM (26%); MBLEx (11%); and B. rectus femoris is tight and the biceps femoris NCETMB (26%) is stretched. C. biceps femoris is tight and the rectus femoris 1. The type of stretching where temporary lengthen- is stretched. ing of the muscle is the goal is called D. hamstrings are tight and the iliopsoas is A. stretch reflex. stretched. B. elastic elongation. 10. If your client has an exaggerated outward curve of C. plastic elongation. the thoracic spine, he or she is D. post-event stretch. A. kyphotic. 2. When the anterior superior iliac spine (ASIS) B. lordotic. is lower than the posterior superior iliac spine C. sway back. (PSIS) in postural analysis, this means D. scolitic. A. an anterior pelvic tilt. 11. Your client is internally rotated at the shoulders. B. a posterior pelvic tilt. This means you need to focus on what muscles in C. a high hip. his or her massage session? D. None of the above are correct. A. infraspinatus and teres minor 3. The insertion of the sternocleidomastoid is B. latissimus dorsi and teres minor A. manubrium. C. supraspinatus and latissimus dorsi B. medial clavicle. D. subscapularis and latissimus dorsi C. sternum. 12. Which of the following represents poor body D. mastoid process. mechanics or positioning? 4. Two muscles that insert on rib 1 are A. bending at the waist to increase leverage A. posterior scalenes and anterior scalenes. B. hands and arms relaxed to the side of the body B. middle scalenes and anterior scalenes. C. knees slightly bent with weight evenly dis- C. posterior scalenes and sternocleidomastoid. tributed on both feet D. posterior scalenes only. D. shoulders relaxed

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13. The anterior cruciate ligament attaches the C. vastus lateralis A. humerus to the radius. D. semimembranosus B. anterior side of each vertebrae. 22. What are the three muscles that attach to the C. femur and the tibia. coracoid process? D. fibula and the femur. A. pectoralis minor, biceps brachii, and 14. What type of muscle is NOT striated? coracobrachialis A. visceral B. pectoralis major, biceps brachii, and B. cardiac coracobrachialis C. mylineated C. pectoralis major, brachialis, and coracobrachialis D. skeletal D. pectoralis minor, brachialis, and coracobrachialis 15. The vastus lateralis muscle inserts at the A. posterior medial tibial condyle. 23. The tibialis anterior muscle attaches at the base of the B. tibial tuberosity. A. first metatarsal and dorsiflexes the foot. C. posterior lateral tibial condyle. B. first metatarsal and plantar flexes the foot. D. ischial tuberosity. C. fifth metatarsal and dorsiflexes the foot. D. fifth metatarsal and plantar flexes the foot. 16. The nerve endings located in the tendon that protect the tendon and muscle from over- 24. Another name for a hairline fracture is a contracting and are over-ridden in fight or flight A. stress fracture. are called B. comminuted fracture. A. Golgi tendon organs. C. compression fracture. B. muscle spindles. D. compound fracture. C. proprioceptors. 25. The joint type that allows for the most range of D. stretch reflex. motion is the 17. The hip joint is made up of A. diarthroses. A. the femur and infraglenoid fossa. B. synchondrosis. B. the femur and the pubic symphysis. C. sutured. C. the femur and the acetabulum. D. fibrous. D. the femur and the ischium. 26. The ligament that helps support the femur-tibia 18. The medial malleolus is the distal end of the joint is the A. radius. A. deltoid ligament. B. ulna. B. anterior cruciate ligament. C. tibia. C. glenoid labrum. D. fibula. D. femoral acetabulum ligament. 19. The muscles that perform mastication are the 27. Your client has hurt his or her ankle. It is very A. masseter, medial pterygoid, lateral pterygoid, swollen and discolored. He or she may have what and temporalis. type of injury? B. masseter, suprahyoid, platysma, and A. a third-degree sprain temporalis. B. a third-degree strain C. masseter, omohyoid, temporalis, and C. a first-degree sprain platysma. D. a first-degree strain D. masseter, medial pterygoid, lateral ptery goid, 28. A muscle that when tight can cause sciatica and and platysma. externally rotate the hip is the 20. The deep six hip rotators include all of the follow- A. gluteus maximus. ing except B. gluteus minimus. A. gemellus superior. C. iliopsoas. B. gemellus interior. D. piriformis. C. quadratus femoris. 29. A muscle that flexes the knee and extends the hip D. obturator internus. is the 21. Which of the following muscles does NOT attach A. biceps femoris. to the os coxae? B. rectus femoris. A. internal oblique C. vastus lateralis. B. sartorius D. gluteus maximus.

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30. All of the following are rotator cuff muscles C. ramus. except the D. acetabulum. A. teres minor. 39. The ligaments that help prevent rotation of the B. teres major. knee are the C. subscapularis. A. anterior cruciate and the posterior cruciate. D. supraspinatus. B. medial collateral and the lateral collateral. 31. The origin of the deltoid muscle is the C. the inferior cruciate and the superior A. lateral one-third of clavicle, acromion pro- cruciate. cess, and crest of scapular spine. D. the patellar ligament. B. medial one-third of clavicle, acromion pro- 40. Which specific joint in the body is the most mobile? cess, and crest of scapular spine. A. the shoulder C. lateral one-third of clavicle, glenoid fossa, B. the hip and crest of scapular spine. C. the metacarpal-phalange D. deltoid tuberosity. D. the wrist 32. What nerve innervates the trapezius? 41. Synovial joints functional classification is A. spinal accessory A. synarthrosis. B. long thoracic B. diarthrosis. C. pectoral nerve C. amphiarthrosis. D. trapezius nerve D. symphysis. 33. What is the insertion of the long head of the triceps? 42. The mouth opens in a hinge-like motion due to A. olecranon process which joint? B. infraglenoid fossa A. temporopteygoid joint C. supraglenoid fossa B. maxilla-mandibular joint D. coracoid process C. ethmoid-sphenoid joint 34. What muscles flex the elbow? D. temporomandibular joint A. triceps and anconeus 43. Paresthesia is a medical term for B. brachialis, biceps brachii, and supinator A. paralysis. C. brachioradialis, supinator, and coracobrachialis B. prickly, tingling feeling in a limb. D. pronator teres, brachioradialis, and brachialis C. an abnormal opening. 35. What muscles extend the elbow? D. excessive thirst. A. triceps and anconeus 44. How many types of synovial joints are there? B. brachialis, biceps, and supinator A. three C. brachioradialis, supinator, and coracobrachialis B. four D. pronator teres, brachioradialis, and brachialis C. five 36. What are the boundaries/borders of the cubital D. six fossa? 45. Which of the following is NOT one of the carpal A. semitendonosis, sartorius, and biceps femoris. bones? B. brachioradialis, pronator teres, and the line A. hamate between the humeral epicondyles. B. scaphoid C. adductor magnus, gracilis, and adductor C. lunate brevis. D. cuneiform D. None of the above are correct. 46. All of the following muscles form the tendon of 37. What two muscles are connected by the broad the ligamentum patellae except epicranial aponeurosis? A. rectus femoris. A. temporalis and occipitalis B. vastus lateralis. B. temporalis and frontalis C. biceps femoris. C. frontalis and occipitalis D. vastus intermedialis. D. frontalis and masseter 47. The weight-bearing part of the foot is 38. The meeting of the ilium, ischium, and pubis A. calcaneus. forms the B. heads of metatarsal bones one and five. A. pubis symphysis. C. heads of metatarsal bones one through five. B. ischial tuberosity. D. Both A and B are correct.

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48. The border of the posterior triangle of the neck 57. Which of the following is a rounded bony land- are all of the following except mark that is for articulation? A. middle one-third of the clavicle. A. epicondyle B. sternocleidomastoid. B. tuberosity C. latissimus dorsi. C. condyle D. trapezius. D. fossa 49. Hinge joints allow what type of movements? 58. What structure in the popliteal fossa makes this A. abduction and adduction area an endangerment site? B. medial and lateral rotation A. sciatic nerve C. flexion and extension B. tibial nerve D. circumduction C. the posterior thigh nerve 50. The cartilage that surrounds and protects the ends D. peroneal nerve of long bones is called A. fibrocartilage. 59. What anatomical structure should be avoided B. hyaline cartilage. when massaging around the sartorius and adduc- C. periosteum. tor longus muscles? D. None of the above are correct. A. sciatic nerve B. popliteal artery 51. The class of joints where bones or cartilage are C. inferior vena cava joined only by fibrous tissue are called D. femoral artery A. fibrous. B. syndesmosis. 60. All of the following are general effects of heat C. hinge. except D. condylar. A. increased blood flow. 52. The bony projection on C2 is called the B. decreased metabolic rate. A. axis. C. increased pulse rate. B. atlas. D. dialation of peripheral blood vessels. C. odontoid. 61. Which of the following is considered an ellipsoi- D. None of the above are correct. dal joint? 53. Movement between C1 and the skull is A. wrist A. flexion/extension. B. elbow B. lateral flexion. C. knee C. rotation. D. hip D. No movement occurs here. 62. Your client has had an inversion ankle sprain. The 54. Movement between C1 and C2 is muscle that should be strengthened is the A. flexion/extension. A. tibialis anterior. B. lateral flexion. B. posterior tibalis. C. rotation. C. gastrocnemius. D. No movement occurs here. D. peroneus longus. 55. What bone is on the anterior neck? A. thyroid 63. The carotid sinus is located B. cricoid A. posterior neck triangle. C. hyoid B. anterior neck triangle. D. thymus C. brachial plexus area. D. deltopectoral area. 56. All of the following muscles form the border of the popliteal fossa except 64. Ligaments are A. biceps femoris. A. slow to heal. B. gastrocnemius. B. receive poor blood supply. C. semimembranosus. C. attach bone to bone. D. gracilis. D. All of the above are correct.

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65. The lubricating fluid that is found in moveable C. production of heat joints is called D. exchange of gases A. serous fluid. B. synovial fluid. 74. The ischial tuberosity is located on the C. arthropometric fluid. A. ischium. D. diarthrotic fluid. B. ilium. C. sacrum. 66. The anterior superior iliac spine is located on D. pubic bone. which bone? A. vertebrae 75. The largest joint in the body B. hyoid A. shoulder. C. ischium B. knee. D. ilium C. hip. 67. This joint allows pronation and supination of the D. elbow. hand 76. The sensory receptors stimulated by both tension A. radioulnar. and excessive stretch and activated an inhibitory B. intercarpal. response in the motor neuron are called C. radiocarpal. D. ulnarcarpal. A. muscle spindles. B. Golgi tendon organs. 68. The abdominal muscle group includes all of the C. baroreceptors. following except D. proprioceptors. A. rectus femoris. B. rectus abdominus. 77. Which muscle crosses two joints? C. internal oblique. A. anconeus D. external oblique. B. brachialis C. gastrocnemius 69. The coranoid process is located on the A. radius. D. soleus B. ulna. 78. The function of ligaments is C. scapula. A. to provide mobility. D. clavicle. B. to stabilize the joint. 70. The most abundant and widely distributed tissue C. to cushion. of the body is D. None of the above are correct. A. connective tissue. B. epithelial tissue. 79. The sciatic nerve can be compressed and irritated C. serous tissue. when which muscle is tight? D. tendons. A. biceps femoris B. rectus abdominus 71. Which muscle is the only muscle that moves the C. adductor magnus head but does not attach to any vertebrae? D. piriformis A. scalenes B. trapezius 80. The type of movement that occurs at the distal C. splenius capitus radioulnar joint is D. sternocleidomastoid A. gliding. 72. The muscle that can entrap the brachial nerve, B. abduction. artery, and vein is pectoralis minor and C. circumduction. A. SCM. D. rotation. B. scalenes. 81. Your client’s lower back hurts when he or she C. spenius capitus. lies flat. The muscles that might be tight would D. None of the above are correct. be 73. Which of the following is not a function of the A. iliopsoas and rectus femoris. muscular system? B. iliopsoas and biceps femoris. A. creating external and internal movement C. quadratus femoris and rectus femoris. B. maintaining posture D. quadratus lumborum and biceps femoris.

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82. Winged scapula is weakness in which muscle? 91. The bones of the vertebral column, skull, hyoid, A. supraspinatus and pelvis make up the B. infraspinatus A. appendicular skeleton. C. serratus anterior B. diarthrotic skeleton. D. subscaularis C. axial skeleton. 83. From the anatomical position, the semitendonosis D. axis skeleton. is immediately superficial to the 92. The pes anserine is made up of all of the following A. biceps femoris. muscles except B. semimembranosus. A. sartorius. C. rectus femoris. B. semimembranosus. D. plantaris. C. gracilis. 84. Fats are classified as D. semitendonosis. A. solid or liquid. B. saturated or unsaturated. 93. Golfer’s elbow is irritation on the C. water soluble or fat soluble. A. lateral epicondyle. D. Both A and B are correct. B. medial epicondyle. C. olecranon process. 85. The largest sesamoid bone in the body is the D. radial tuberosity. A. ischial tuberosity. B. xiphoid process. 94. This bone is also known as the atlas C. patella. A. C2. D. malleolus. B. C1. 86. The muscles used in forced expiration are C. L2. A. diaphragm and abdominals. D. S1. B. abdominals. 95. Slow, light, and rhythmic movements are sooth- C. internal and external intercostals. ing to the nerves because they produce a low level D. external intercostals and levator scapula. of excitement to the nervous system, whereas 87. The joint that is generally involved in a shoulder vigorous movements separation is the A. stimulate the parasympathetic nervous A. glenohumeral. system. B. acromioclavicular. B. decrease synaptic transmission. C. coracoid-humeral. C. excite nociceptors. D. humeral-scapular. D. stimulate the sympathetic nervous system. 88. Migraine headaches are generally 96. The receptors for vibration and touch are called the A. tension headaches. A. proproceptors. B. vascular headaches. B. nociceptors. C. phantom headaches. C. mechanoreceptors. D. All of the above are correct. D. noreceptors. 89. A tough, dense material that has the greatest 97. First stages of healing result in tensile strength and is found in the intervertebral A. increased fibrin production. discs is B. histamine release. A. elastic cartilage. C. redness of skin. B. fibrocartilage. C. hyaline cartilage. D. collagen remodeling. D. osseous cartilage. 98. Functions of the connective tissue include all of 90. This is referred to as the yes-yes joint the following except A. atlanto-occipital joint. A. nutrient transportation. B. atlantoaxial joint. B. defense against disease. C. acromioclavicular joint. C. clotting mechanisms. D. the occipital-temporal joint. D. neural transport.

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99. Fluid found in all diarthrotic joints is 108. The ability of a muscle to return to its original A. synovial. shape after being stretched is known as B. serous. A. irritability. C. tissue. B. contractibility. D. visceral. C. plastic elongation. D. PNF. 100. Nerve endings that are pressure sensitive and respond to skin displacement are 109. The three main types of connective tissue of the A. free nerve endings. skeletal or muscular system are all of the following B. Meissner’s corpuscles. except C. Pacinian’s corpuscles. A. ligaments. D. Krause’s end bulbs. B. joint capsule. 101. What layer of connective tissue wraps around the C. cartilage. entire muscle? D. tendons. A. endomysium 110. The common origin of the hamstrings is the B. ectomysium A. medial tibal condyle. C. perimysium B. lateral tibal condyle. D. epimysium C. PSIS. 102. Which bones are not one of the five classifications? D. ischial tuberosity. A. long 111. Which area of the spine has the most vertebrae? B. short A. cervical C. regular B. thoracic D. sesmoid C. lumbar 103. Certain massage strokes create minute muscle D. sacral contractions by 112. The name of the upper jaw bone is the A. increasing Golgi tendon organs response. A. zygomatic. B. increasing muscle spindle activity. B. masseter. C. increasing lymph flow. C. mandible. D. stimulation of the myosin. D. maxilla. 104. Cartilage that is found on the tip of the nose and the lobes of the ears is called 113. Receptors responding to air vibrations or sound A. fibrocartilage. waves are the B. hyaline cartilage. A. mechanoreceptors. C. meniscus. B. chemoreceptors. D. elastic cartilage. C. photoreceptors. D. nociceptors. 105. Carbohydrates are classified as A. solid or liquid. 114. Lumbricles are located in the B. mono-, di-, tri-, and polysaccharides. A. hands. C. water soluble or fat soluble. B. feet. D. saturated or unsaturated. C. lumbar vertebrae. D. Both A and B are correct. 106. All of the following are types of connective tissue except 115. Small canals found in the bone that help to A. blood. nourish it are called B. cartilage. A. Pacinian canals. C. ligaments. B. Haversian canals. D. organs. C. Meissner canals. D. marrow. 107. All of the following are functions of adipose tissue except 116. The capitulum of the humerus articulates with A. protection. A. lateral condyles of the humerus. B. thermal heat. B. olecranon. C. movement. C. ulnar head. D. insulation. D. radial head.

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117. The sternum articulates with how many ribs? C. heat stroke. A. twelve pairs D. heat exhaustion. B. six pairs C. seven pairs 126. If your client has an exaggerated outward curve of D. five pairs the thoracic spine, he or she is A. kyphotic. 118. The greater amount of rotation in the spine occurs B. lordotic. in the C. sway back. A. thoracic region. D. scoliotic. B. cervical region. C. lumbar region. 127. Another term for pes planus is D. sacral region. A. flat feet. B. high arches. 119. Which bone is not in the distal row of the carpals? C. lost transverse arch. A. capitate D. None of the above are correct. B. hamate C. lunate 128. The pear-shaped sac located on the right side of D. trapezoid the body that stores bile is called the 120. What are the major actions of the peroneus longus A. liver. and brevis? B. pancreas. A. Inversion and dorsiflexion of the foot C. gallbladder. B. Inversion and plantar flexion of the foot D. stomach. C. Eversion and plantar flexion of the foot 129. A client with lordosis may experience a reduction in D. Eversion and dorsiflexion of the foot low back discomfort if a pillow is placed under the 121. Your client has an anterior pelvic tilt. In addition A. abdomen in the prone position. to the quads and iliopsoas, what other muscle B. chest in the prone position. would tilt the pelvis anteriorly if tight? C. pelvis in the prone position. A. gluteus maximus D. None of the above are correct. B. piriformis C. biceps femoris 130. Stretching can be done by the therapist D. Tensor fascia latae/ITB with no assistance from the client or by the client with no assistance from the therapist. 122. The quadriceps muscles are all of the following A. passively; actively except B. actively; passively A. vastus lateralis. C. PNF; MET B. rectus femoris. D. ballistically; statically C. biceps femoris. D. vastus intermedialis. 131. A muscle synergistic to the biceps brachii is the A. brachialis. 123. What is the largest muscle in the body? B. coracobrachialis. A. sartorius C. brachioradialis. B. gluteus maximus D. triceps. C. quadriceps D. abdominas 132. Repetitive motion injuries are caused by 124. When the quads receive information to contract A. repeated flexing and extending of a joint and the hamstrings receive information to relax, against resistance. this is known as B. normal daily activities. A. muscle tone. C. manual manipulation of tools. B. atrophy. D. Both A and C are correct. C. reciprocal inhibition. 133. When the hamstrings are acting as an antagonist, D. sliding filament theory. the movement is 125. The type of heat illness that is a medical emer- A. hip extension. gency is B. knee extension. A. heat cramps. C. knee flexion. B. hypothermia. D. Both A and C are correct.

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134. Which muscle is not a part of the shoulder girdle C. orbicularis oris group? D. temporalis A. pectoralis minor 144. When the serratus anterior contracts, what move- B. trapezius ment takes place? C. deltoid A. scapular retraction D. bicep brachii B. scapular protraction 135. Where is the least amount of movement in the C. scapular elevation spine? D. scapular depression A. C3–C6 145. Which muscle depresses the ribs? B. T4–T6 A. scalenes C. T1–T3 B. pectoralis minor D. L4–L5 C. internal intercostals 136. The muscle that initiates shoulder abduction is D. external intercostals A. the medial deltoid. 146. Which muscle is also known as the “hip hiker”? B. supraspinatus. A. quadratus femoris C. subscapularis. B. quadratus lumborum D. latissimus dorsi. C. quadratus teres 137. Plantar fasciitis can be caused by all of the follow- D. latissimus dorsi ing except 147. The trapezius is to the rhomboids. A. old shoes. A. superficial B. high arches. B. deep C. low arches. C. medial D. tight peroneals. D. superior 138. When slowly sitting down in a chair, how are 148. In placing the bolster under the ankle when the muscles being worked? client is prone, you are preventing excessive A. hamstrings concentrically A. dorsiflexion of the ankle. B. quadriceps eccentrically B. flexion of the knee. C. gluteals concentrically C. plantar flexion. D. all of the above D. None of the above are correct. 139. Which muscle abducts the hip? 149. The metacarpals are to the carpals. A. gluteus maximus A. proximal B. gluteus medius B. distal C. hamstrings C. medial D. gracilis D. lateral 140. Another name for the cheek bone is the 150. Muscles that adduct the femur include all of the A. temporalis bone. following except B. ethmoid bone. A. adductor magnus. C. zygomatic bone. B. gracilis. D. pterygoid. C. sartorius. D. pectineus. 141. The ITB is to the gracilis. A. medial 151. In lordosis, which muscles would be weakened? B. lateral A. quadriceps C. superior B. hamstrings D. proximal C. iliopsoas D. quadratus lumborum 142. The function of the masseter muscle is to A. extend the jaw. 152. When the body is standing with the hands supi- B. retract the jaw. nated, arms slightly abducted, and feet facing C. open the jaw. forward, this is known as the D. close the jaw. A. Traditional Chinese Medicine anatomical position. 143. Which muscle helps us to smile? B. Northern anatomical position. A. zygomaticus C. Western anatomical position. B. masseter D. essential medical position.

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153. With your client’s elbow bent to ninety degrees, 160. Which of the following is not part of the iliopsoas you apply resistance as he pulls his hand toward muscle? the navel. Pain is felt. This would be inflamma- A. iliacus tion of B. psoas major A. latissimus dorsi. C. psoas minor B. pectoralis major. D. iliacus major C. subscapularis. 161. If the erector spinae is contracted bilaterally, this D. All of the above are correct. would result in 154. The most common ankle sprain is the inversion A. scoliosis. sprain because B. kyphosis. A. the medial malleolus is lower on the medial C. rotation. side. D. lordosis. B. because the stronger ligaments are on the 162. If a client has torn his or her supraspinatus mus- lateral side of the ankle. cle, he or she will not be able to C. because the lateral malleolus is lower on the A. open a door. lateral side. B. hold his or her arm out to the side. D. because talo fibular ligament is not in a C. push a grocery cart. mechanically strong place. D. None of the above are correct. 155. You are performing a push-up. You get about 163. If a client has drop foot, the muscle affected is halfway off the floor and cannot push the rest of A. gastrocnemius. the way up. You struggle to go up, but you will B. soleus. not move. What type of muscle contraction is C. anterior tibialis. occurring on the biceps brachii? D. peroneals. A. isometric B. isotonic 164. A concentric contraction of the biceps femoris C. eccentric results in D. concentric A. hip extension. B. hip flexion. 156. Your client states he or she was running outdoors, C. knee extension. planted his or her foot and twisted the knee, D. internal hip rotatation. which is now painful and swollen. What structure may be damaged? 165. A concentric contraction of the biceps brachii results in A. the ACL A. elbow extension. B. the PCL B. shoulder extension. C. the MCL C. shoulder adduction. D. the patellar tendon D. elbow flexion. 157. Which rotator cuff muscle does not rotate the 166. When standing and performing trunk flexion, the humerus? primary muscle mover is A. supraspinatus A. rectus abdominus. B. infraspinatus B. internal/external oblique. C. teres minor C. erector spinae eccentrically. D. subscapularis D. None of the above are correct. 158. Which end of the muscle has the most 167. In order to strengthen anterior tibialis, your client movement? can A. the ligament A. walk on his or her heels only. B. the insertion B. walk on his or her toes. C. the origin C. perform heel raises. D. none of the above D. All of the above are correct. 159. The “kissing” muscle is the 168. Thrusting the lower jaw forward is called A. buccinator. A. protraction. B. masseter. B. retraction. C. orbicularis oris. C. elevation. D. platysma. D. depression.

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169. The three muscles that cause internal shoulder 178. Another term for scapular adduction is rotation include all of the following except A. horizontal shoulder flexion. A. infraspinatus. B. protraction. B. latissimus dorsi. C. retraction. C. pectoralis major. D. extension. D. subscapularis. 179. In performing a squat, the stabilizer would be 170. Starches belong to which basic nutrient group? A. gastrocnemius/soleus. A. proteins B. rectus abdominus. B. fats C. iliopsoas. C. meats D. hamstrings. D. carbohydrates 180. The fat-soluble vitamins include all of the follow- 171. When the sole of the foot is turned outward, this ing except is called A. A. A. inversion. B. E. B. eversion. C. B. C. pronatiaon. D. K. D. supination. 181. The basic nutrients include the following except 172. Which muscle flexes the knee and attaches to the A. carbohydrates. fibula? B. cholesterol. A. biceps femoris C. fats. B. rectus femoris D. protein. C. semitendonosis 182. Guidelines to consider when using herbs or sup- D. semimembranosis plements include 173. What muscle initiates walking? A. more is not necessarily better. A. iliopsoas B. ask friends their dosage since one dosage is B. vastus lateralis suitable for all. C. vastus medialis C. if the dosage does not work quickly, change D. hamstrings your dosage. D. All of the above are correct. 174. Your client is having trouble laterally flexing his or her head. Which muscle is not involved? 183. An excellent natural antibiotic is A. sternocleidomastoid A. basil. B. splenius capitus B. jojoba. C. cervical lamina C. licorice. D. splenius cervicus D. garlic. 175. When stepping down off a curb, what kind of 184. The appropriate amount of carbohydrates in the contraction is occuring? diet according to the American Dietetic Associa- A. concentric on the quads tion (ADA) is B. eccentric on the quads A. twelve to twenty percent. C. concentric on the hamstrings B. forty-five to sixty-five percent. D. eccentric on the hamstrings C. ten to twenty percent. D. more than thirty percent. 176. The three muscles of the erector spinae in order from most lateral to most medial are 185. The most unhealthy fats are called A. longissimus, spinalis, and iliocostalis. A. unsaturated. B. spinalis, iliocostalis, and longissimus. B. HDL. C. iliocostalis, spinalis, and longissimus. C. saturated. D. iliocostalis, longissimus, and spinalis. D. LDL. 177. The most distal bones of the foot are called 186. High glycemic foods are A. tarsals. A. foods that are low in sugar. B. phalanges. B. foods that are high in sugar. C. carpals. C. foods best eaten before a long bout of exercise. D. metatarsals. D. Both A and C are correct.

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187. are one of the six basic nutrients with no caloric value that are needed in the body in small Answers and Explanations (trace) amounts. A. Vitamins Detailed Knowledge of Anatomy, B. Proteins Physiology, and Kinesiology C. Minerals NCETM (26%); MBLEx (11%); D. Fats and NCETMB (26%) 188. Vitamins that can be harmful to the body if taken 1. B Remember, rubber bands are elastic and in huge amounts are called temporarily lengthen before going back to A. fat soluble. their original length. Plastic elongation is more B. water soluble. permanent, like the plastic bottle that will C. vitamin C. maintain its shape. Therefore, elastic elonga- D. vitamin B. tion is temporary and more for pre-event or pre- 189. One gram of fat equals calories. exercise with the goal of preparing you for A. four exertional movement. Plastic elongation B. seven stretch is for post-exercise to help improve, in a C. nine more permanent way, flexibility. D. twelve 2. A Think of your pelvis as a basin of water. Tilt 190. The glucose amount that is ideal in sports drinks is the basin downward in the front, and the water A. more than ten percent. spills out in front. If the pelvis does the same B. ten to twelve percent. movement, this is an anterior pelvic tilt. In this C. less than five percent. case, the anterior superior iliac spine is tilted D. six to eight percent. down or lower in front than the posterior iliac spine in back. This is commonly seen in peo- 191. Which vitamin best helps the body to absorb ple whose pants are higher in the back on the calcium? waist and low in front on the waist. A. vitamin A B. vitamin B 3. D The origin is the medial clavicle and the manu- C. vitamin C brium of the sternum. The insertion, which is D. vitamin D the question, is the mastoid process. 4. B The posterior scalenes attaches to rib 2; the 192. Which mineral is a concern for those taking sternocleidomastoid attaches to the clavicle diuretics because it tends to be flushed out of the and the sternum, not to the ribs. body easier? A. zinc 5. B When someone is very toned with low body B. potassium fat, the rectus abdominus gives the appearance C. calcium of separate little muscle bulges, thus the name D. chromium “six pack.” 193. Organic acid(s) that assist in the production of 6. D The other three answer choices listed are ori- ATP are gins and insertions for the biceps brachii. A. chromium. 7. D Remember the EX in EXternal, the I in Infraspina- B. creatine. tus, and the T in Teres minor, and you have EXIT. C. potassium. D. Both A and B are correct. 8. A Aponeurosis is a flat, broad tendon that attaches skeletal muscle to bone, to another 194. A plant that is excellent to use on minor burns is muscle, or to skin; myocardium is the muscle A. aloe vera. of the heart; fascia is the lining around muscles, B. licorice. blood vessels, and nerves that connects them to C. ivy. surrounding tissue to hold them in place. D. wild cherry bark. 9. B An anterior pelvic tilt means muscles attaching 195. The following are true concerning sugar except to the anterior side of the pelvis are pulling it A. can improve the immune system. downward in the front (the ASIS is lower than B. contributes to obesity. the PSIS). Therefore muscles attaching to the C. can increase the risk of osteoporosis. ASIS and the AIIS are tight; muscles attaching to D. can produce an acidic stomach. the PSIS, ischial tuberosity will be stretched.

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10. A By definition, kyphosis is an exaggerated 24. A Comminuted is shattered; compression is frac- outward curve of the spine; lordosis is an tured by a compressive force; and compound exaggerated inward curve of the spine (more is a fracture that breaks through the skin. commonly seen in the cervical and lumbar 25. A These joints are also the synovial joints (the sections of the spine). moveable ones). D L 11. Remember LIPS— atissimus dorsi, the action 26. B The deltoid ligament is in the ankle, the I P of nternal rotation, ectoralis major, and glenoid labrum is in the shoulder, and the S ubscapularis. These muscles are the internal femoral-acetabulum is in the hip joint. rotators of the shoulder. 27. A Third degree means tearing has occurred—a A 12. Bending at the waist not only puts pressure on complete tear. This would also possibly tear the the back, but it also probably means too much joint capsule causing synovial fluid to spread pressure is being exerted on an extended wrist, throughout the joint. Blood vessels would which can lead to wrist/hand problems. also possibly be torn, which would cause the 13. C The anterior cruciate ligament is one of two bleeding and bruising. ligaments situated behind the patella that 28. D The sciatic nerve runs through or under the connects the femur to the tibia. piriformis, so tightness of this muscle can cause 14. A Visceral muscle needs to be smooth in order for pressure on the nerve and mimic sciatica. organ functions to occur such as digestion. 29. A Rectus femoris and vastus lateralis are a 15. B The vastus lateralis is one of the four quad- part of the quadriceps group that extends, riceps muscles. All four muscles insert at the or straightens, the knee. Gluteus maximus tibial tuberosity. extends the hip. = 16. A Golgi tendon organs protect the muscle from 30. B SITS Supraspinatus, Infraspinatus, Teres over-contracting; muscles spindles protect the minor, Subscapularis. muscle from overstretching; the stretch reflex 31. A The deltoid tuberosity is the insertion of the is the combined action of the two that occurs deltoid muscle. when stretching properly. Proprioceptors assist us with balance and movement in rela- 32. A The pectoral nerve innervates the pectoral tion to space. muscles; the long thoracic muscles innervate the thoracic region. There is no trapezius nerve. 17. C The infraglenoid fossa is in the shoulder 33. A The infraglenoid tubercle is the origin of the (scapula); the pubis symphysis is in the ante- long head of the triceps, the question asked rior middle of the pelvis. The ischium is the for the insertion. The other two choices are bottom portion of the pelvis (ischial tuberosity, attachments for biceps brachii. that on which we sit). 34. D One muscle not included is biceps brachii. 18. C The lateral malleolus is the distal end of the fibula. Distal means farthest away; proximal 35. A Brachialis, biceps, and brachioradialis flex means closest to. the elbow, supinator supinates the forearm, prontator teres pronates the forearm, and 19. A Mastication is chewing. oracobrachialis flexes the shoulder. 20. B The six hip rotators are gemellus superior, gemel- 36. B This is the elbow area (anterior side). lus inferior, obturator internus, obturator externus, piriformis, and the quadratus femoris. 37. C This refers to the top of the head (scalp). 21. C The vastus lateralis does not cross the pelvis; it 38. D The acetabulum is also referred to as the hip joint. only crosses the knee joint, and the os coxae is 39. B Movement of the tibia anteriorly or posteriorly on the pelvis. are handled by the ACL and the PCL. There is no 22. A The pectoralis major originates on the clavicle such ligament in the knee as the inferior or supe- and ribs 1 through 6; the brachialis originates rior cruciate. The patellar ligament attaches the on the shaft of the humerus. patella to the tibial tuberosity and is commonly lumped in with the patellar tendon. 23. A While the tibialis anterior inserts on the base of the first metatarsal, it dorsiflexes the foot. 40. A The shoulder is the most mobile as a ball and Remember muscles pull; they do not push. socket joint but also the most injured.

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41. B Synovial joints are diarthrosis (freely movable). areas, thus causing us to sweat. This requires an Most fibrous joints are synarthrosis (immov- increase in pulse and an increase in metabolism. able). Cartilaginous joints are amphiarthrosis 61. A Ellipsoidal joints allow for flexion, extension, (slightly movable). abduction, and adduction. Rotation is not 42. D The temporomandibular joint is a hinge joint. permitted. 43. B This is the basic definition of paresthesia—the 62. D An inversion ankle sprain means the sole of prickly, burning, tingling feeling you get in a the foot has turned inward. That means the limb when a nerve is damaged or compressed; muscles on the lateral side have been stretched also, it is the same feeling you get when your and need to be strengthened. arm falls asleep. 63. B This is also an endangerment site where the 44. D Hinge, ball and socket, condylar, saddle, pivot, carotid artery is located (also where we often gliding are all synovial joints. take a pulse). 45. D Cuneiform is one of the tarsals. The other 64. D Ligaments are slow to heal because they receive carpal bones are the pisiform, triquetrum, little or no blood supply. capitate, trapezoid, and trapezium. 65. B Both C and D are made-up terms. 46. C Biceps femoris is one of the hamstring muscles; the others are part of the quad group. 66. D The word “iliac” helps with this one. 47. D The medial and longitudinal arches place the 67. A It is both the radius and the ulna that allow for pressure points on heads of metatarsals one pronation and supination movements at the and five and the heel (calcaneus). wrist/hand. 48. C Latissimus dorsi does not border the neck. 68. A The rectus femoris is a part of the quadriceps group. 49. C The other choices could be ball and socket joints or condyloid (abduction/adduction or 69. B Review bony landmarks; coracoid process is medial/lateral rotation). Hinge joints move on the scapula. like a door on a hinge. 70. A Connective tissue includes fascia, tendons, 50. B Periosteum is the fascia around bones. Fibro- ligaments, skin, and other material. cartilage cushions between bones. 71. D Scalenes attach to the transverse process of 51. A Syndemosis is a type of fibrous joint but not a C2–C7, trapezius attaches to C1–T12, and class. the splenius capitus attaches to C7–T3. SCM 52. C This is also known as the dens. attaches to the medial clavicle and sternum and inserts on the mastoid process. 53. A This is the movement as if you are nodding “yes.” 72. B Because of the attachments of the three scalenes on ribs one and two, and along 54. C This is the movement as if you are nodding “no.” with the pec minor attachments on ribs 55. C The others are cartilage; thymus is a gland. three through five, tightness in this area can compress these blood vessels. 56. D Gracilis is located on the medial thigh and does not border the popliteal fossa (which is 73. D Exchange of gases is the respiratory system. the area behind the knee joint). 74. A Just like it sounds, the word itself reveals the 57. C Epicondyle and tuberosity are more for muscle location. attachments, not articulation. A fossa is not a 75. B Although the shoulder can be pretty complicated, rounded bump but a rounded groove such as it is not the largest. While the hip is large, the knee the olecranon fossa of the humerus. is the largest of the synovial joints. 58. B The nerve located at this point of the leg is the 76. B Muscle spindles are stretch sensitive only, tibial nerve. baroreceptors are pressure sensitive, and pro- 59. D The femoral triangle is in this area, which prioceptors are balance sensitive. includes the femoral artery and nerve. 77. C Review muscle anatomy: gastrocnemius crosses 60. B When internal heat goes up, blood vessels dilate the knee joint (originates on the femoral condyles) in order for blood flow to reach the superficial and the ankle joint (attaches to the calcaneus).

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78. B Ligaments attach bone to bone and therefore 94. B Atlas holds up the world (Greek mythology), work to create a stabilized joint. so the atlas holds up the head. 79. D The sciatic nerve runs either through or just 95. D Remember that parasympathetic has the “para- under the piriformis (it can be either). There- chute” (the “para”) that slows us down; therefore, if it is tight, the nerve will be compressed fore, the vigorous massage will stimulate the and will create sciatica symptoms. sympathetic system. 80. D Circumduction is flexion, abduction, extension, 96. C Proprioceptors are more for balance; nocicep- and adduction, and the abduction/adduction tors are for detecting pain. does not occur at this joint. Gliding occurs at 97. A This allows clotting to occur. the carpal joints. 98. D That would be nerve tissue. 81. A The problem here is when he or she lies down his or her back arches and is unsupported. 99. A These are your moving joints, and synovial That would mean an anterior pelvic tilt and fluid helps to lubricate them. tightness in the quadratus lumborum, rectus 100. C Meissner’s corpusles detect light pressure; femoris (quad), and iliopsoas. The best answer Pacinian’s detects pressure and respond to skin choice, then, is “A.” Quadratus femoris is a hip displacement and high frequency vibration; rotator, and biceps femoris is a hamstring that, Krause’s end bulbs are believed to respond to if tight, would posteriorly tilt the pelvis. cold. Free nerve endings are the pain receptors. 82. C The serratus anterior helps keep the scapula 101. D The endomysium encloses each muscle fiber. flat along the rib cage when they are retracted. The perimysium is a fascial layer within the If the muscle is weak, the scapula stick out or muscle that binds the fasciculi together. The look like wings ectomysium does not exist. 83. B In other words, the semitendonosis sits on top of the semimembranosis. 102. C The five categories are long, short, flat, irregular, and sesmoid. 84. D Water soluble and fat soluble are vitamin classifications. 103. B Strokes such as petrissage with the pulling and tugging can activate the muscle spindles for 85. C The other bones are not sesamoid bones. protection of overstretching. 86. B Answer “A” is wrong because the diaphragm is 104. D Fibrocartilage and meniscus are the same and not used in forced expiration. are found between bones; hyaline cartilage is 87. B Review bony landmarks: shoulder separation is a around the ends of bones. third degree sprain of the AC ligament (or the ster- 105. B Saturated and unsaturated pertain to fats; water noclavicular ligament, which is not listed here). or fat soluble to vitamins. 88. B Because of the effect on the blood vessels (vascu- 106. D Blood, cartilage, tendons, ligaments are all lar), it can affect vision, balance, and other senses, connective tissues. which is why migraines can be so terrible. 107. C Another name for adipose tissue is fat tissue. 89. B It is also found in between the tibia and femur Fat does not move. (also called meniscus) and between the pubic bones. Hyaline cartilage is on the ends of 108. B This is what allows us to move. moveable bones. 109. B The joint capsule holds the connective tissue 90. A Skull and C1 moves flexion/extension. and synovial fluid together to nourish the joints but is not considered a main type of C 91. The appendicular skeleton includes the connective tissue in the skeletal system. appendages (arms, legs, hands, feet); as far as axis goes, there is an axis vertebrae and atlas 110. D The medial and lateral condyles of the tiba are but not an axis skeleton system. Diarthrotic insertions. skeleton is a made-up term. 111. B Cervical (7), thoracic (12), lumbar (5), sacrum 92. B Say Grace before Tea—Sartorius, Gracilis, (5 fused). Remember, breakfast at 7, lunch at semi-Tendonosis. 12, dinner at 5. 93. B Remember General Manager: Golfer’s elbow is 112. D Zygomatic is the cheekbone; masseter is the Medial epicondyle. jaw muscle; mandible is the lower jaw bone.

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113. A The nociceptors detect pain, photoreceptors 127. A Think of the Great Plains of the Midwest: they are related to vision, and chemoreceptors are flat, as are feet that have pes “planus.” detect taste and smell. 128. C The pancreas and stomach are on the left side. 114. D These are the muscles in between the metacarpals and the metatarsals. 129. A This will help to lengthen the low back and put the client in a more neutral pelvic position, 115. B Marrow is the soft material in the bone con- which would be more comfortable. Remem- taining blood cells and other material. The ber, lordosis is sway back. other terms are made up. 130. A Passive stretching means the therapist does the 116. D The capitulum is on the lateral side of the work, and/or both antagonistic and agonistic humerus near the lateral epicondyle. The muscles are relaxed. Active means the client troch lea is closest to the medial epicondyle. does the work and/or the antagonistic muscle 117. C The true ribs that articulate with the sternum is contracting to stretch the agonist. (hence their name) are ribs one through seven. 131. A The “S” in synergist and the “S” in same: the The false ribs are eight through twelve, and the synergist performs the same movement as the floating ribs are eleven and twelve. primary mover (agonist). 118. B We have more rotation in the neck than anywhere 132. D Normal daily activities should not create else in the spine (ninety degrees each direction). repetitive stress injuries. 119. C Remember, the mnemonic device Sally Left 133. B If the hamstrings are the antagonist, the quad- The Party . . . (Scaphoid, Lunate, Triquetrum, riceps are the agonist. The quads perform knee Pisaform) is the proximal row. . . . To Take Cathy extension and hip flexion (rectus femoris). Home (Trapezium, Trapezoid, Capitte, Hamate) is the distal row. 134. D The bicep only acts on the shoulder joint, not 120. C Tibialis anterior performs inversion and the girdle (meaning the scapula and clavicle). dorsiflexion. The other muscles either act on the scapula or attach to the clavicle and therefore are girdle 121. D Because of the TFL/ITB attachment on the muscles. anterior crest of the ilium, it can tilt the pelvis anteriorly if tight. 135. B This is mainly due to the true rib attachments. 122. C Biceps femoris is the hamstring group. If you 136. B The supraspinatus initiates abduction, then, remember that the rectus abdominus is on the at about seventy to eighty degrees, the medial anterior side of the body, it might help you deltoid takes over. Latissiumus dorsi performs to remember that the rectus femoris is on the adduction, and the subscapularis performs anterior side—quads! external shoulder rotation. 123. B Quads and abs are muscle groups not indi- 137. D The peroneals attach to the base of metatarsals vidual muscles. The gluteus maximus is the and therefore do not affect the development of strongest; the sartorius is the longest. plantar fasciitis directly. Old shoes will lower shock absorption, high arches will tighten the 124. C Muscle tone is a state of continuous, partial fascia, and low arches will stretch it. contraction, so the muscles stay systemically stimulated. It allows us to stay upright. Atro- 138. B Because of gravity, the quadriceps are doing phy is the decrease in size of a muscle. The the work to make sure the body does not slam sliding filament theory explains how a muscle down into the chair. Even though the knees are contracts via the myosin and actin. flexing and hamstrings do that, gravity must be taken into account. 125. C Heat stroke occurs when the thermoregulatory system has shut down. Body temperature can 139. B The gluteus medius and minimus abduct the hip. rise to very dangerous levels and cause perma- Gluteus max extends the hip, gracilis adducts the nent brain damage and even death. hip, and hamstrings extend the hip. 126. A By definition, kyphosis is an exaggerated 140. C The temporalis is on the skull by the ears; outward curve of the spine, and lordosis is an the ethmoid bone is part of the nasal/sinus exaggerated inward curve of the spine (more cavity and forms part of the orbital wall. The commonly seen in the cervical and lumbar pterygoid provide attachments of muscles for sections of the spine). the lower jaw and soft palate.

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141. B The gracilis is on the medial thigh, and the 156. C The medial collateral and lateral collateral iliotibial band is on the lateral thigh. ligaments prevent rotation of the knee. The anterior and posterior cruciate ligaments pre- D 142. The masseter originates on the lower border vent forward or backward motion of the femur of the zygomatic arch and inserts on the man- on the tibia. dible. Remember, muscles pull, they do not push, it makes sense that it closes the jaw. 157. A The supraspinatus initiates shoulder abduction. 143. A The masseter closes the jaw, the orbicularis 158. B The origin is the immoveable end, and the oris is the “kissing” muscle (helps us pucker!), insertion is the moveable end. Ligaments attach and the temporalis muscle elevates and retracts bone to bone and have no direct involvement the mandible. with muscle movement. 144. B Another term for scapular protraction is scapu- 159. C The buccinator compresses the cheeks, the lar abduction. masseter is a chewing muscle, and the platysma is the sheath on the anterior neck. 145. C Scalenes elevate the first and second rib; the 160. D There is no iliacus major. pectoralis minor elevate the ribs. The external intercostals also elevate the ribs. 161. D This would affect the lumbar spine the most and cause an exaggerated inward curve of the spine. 146. B The quadratus lumborum originates on the inferior surface of rib twelve and the transverse 162. B Supraspinatus initiates humeral abduction. processes of the lumbar vertebrae. It inserts 163. C Drop foot means the client is unable to on the iliac crest. When the muscle pulls or dorsiflex the foot. The muscle that dorsiflexes tightens, it lifts the hip upward. is anterior tibialis. 147. A The trapezius sits on top of the rhomboids; 164. A Biceps femoris is a part of the hamstrings therefore, the correct term is superficial. group. Concentrically, it extends the hip and 148. C When lying prone, our feet tend to be extremely flexes the knee. plantar flexed, or pointed. 165. D The biceps brachii performs shoulder flexion 149. B The metacarpals are further away from the mid- and elbow flexion. line than the carpals, and the terms distal and 166. C Because of gravity, the erector spinae controls proximal are used for the upper extremities. trunk flexion in an eccentric way when standing or sitting, which is why we do not work 150. C Sartorius performs hip flexion, external rota- our abs from this position. tion, and knee flexion. 167. A Anterior tibialis performs dorsiflexion; there- 151. B This would be an anterior pelvic tilt which fore, walking only on the heels will strength it. would mean the hip flexor muscles would be tight (quads, iliopsoas), and the hip extensors 168. A Retraction is pulling the mandible backward. would be stretched and weakened. Closing the jaw is elevation; opening the jaw is depression. 152. C Traditional Chinese Medicine anatomical position is with the arms overhead, palms facing 169. A Remember LIPS—Latissimus dorsi, Internal forward. The other terms do not exist. rotation, Pectoralis major, and Subscapularis. 153. D The movement described is internal rotation. 170. D Amino acids are proteins; lipids and triglyc- Remember LIPS for Latissimus dorsi, the erides are fats. Meats generally fall into the action of Internal rotation, Pectoralis major, protein category. and Subscapularis. 171. B Pronation is a combination of dorsiflexion 154. C Not only is it due to the lateral malleolus and eversion, and supination is a combination being lower than the medial, but the deltoid of plantar flexion and inversion. ligament on the medial side of the ankle is also 172. A The semitendonosis and semimembranosis very strong. Both of these help prevent more attach medial tibia. The rectus femoris, being eversion ankle sprains. a part of the quadriceps group, inserts on the tibia, but extends the knee. 155. A Because the muscles are contracting, but there is no joint movement (you are stuck halfway 173. A Hip flexion is what needs to occur, so it would up), everything is in an isometric contraction. not be the hamstrings since they are involved

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in hip extension. The vastus lateralis and medi- 184. B Protein recommendations are twelve to twenty alis do not cross the hip joint and therefore do percent, fats less than thirty percent, and not perform hip flexion. unsaturated fats ten to twenty percent. 174. C Cervical lamina is an area of the neck, not a 185. C HDL and LDL are types of cholesterol. The “S” muscle. in Saturated, and the “S” in Sorry: saturated fats are the sorry fats. 175. B Because gravity is acting downward on the body, the quads are lengthening and contracting in 186. B High glycemic foods have to do with the order to prevent you from falling. glucose, which is a simple sugar. Since carbs are the primary fuel source, after exercise it is 176. D Remember I Like Spaghetti: ILS are the first better to eat the high glycemic foods to replace letters of each muscle. the energy burned for fuel. Mid-to-low glyce- 177. B Distal means farthest away, which would be mic is better before exercise, so a rush of sugar the phalanges. The tarsals are more proximal, does not enter the bloodstream and cause a and the carpals are in the hands. spike in energy. 178. C Remember adduction means you are “adding” 187. C Vitamins and minerals both are a basic nutrient everything toward the midline (or spine), so with no calories, but minerals are the ones when you retract something, you take it back; needed in small, trace amounts. therefore, the scapula are pulling back toward 188. A A, D, E, and K are fat-soluble vitamins. Water- the spine. soluble vitamins (B and C) will be excreted in 179. B Stabilizers prevent motion; therefore, the rec- the urine if taken in large amounts, but the tus abdominus (along with the erector spinae) fat-soluble will not. would be a stabilizer in order to prevent 189. C One gram of protein or carbohydrates equals trunk flexion. The gastroc/soleus is an assister four calories; one gram of fat equals nine because the foot goes from dorsiflexion into calories. slight plantar flexion, movement is taking place there. Hamstrings are antagonist; quads and 190. D The purpose of the glucose is for energy. Too gluteus max are the primary movers. Iliopsoas little or too much produces an undesirable at the hip is an antagonist because the hip is effect. While five to ten percent is acceptable, extending (but not hamstrings because the six to eight percent is ideal. knee is extending, and that is quads!). 191. D Fortified milk has vitamin D. 180. C Vitamin A is a fat-soluble vitamin, meaning 192. B Potassium can be easily flushed out of the the body cannot expel overdoses easily; it gets body with diuretics, and thus causes cramp- stored in the fat. B and C overdoses are excreted ing. Some doctors will advise or prescribe through the urine because these vitamins are a potassium supplement in severe cases or water soluble. recommend eating bananas or potato skins 181. B There are six basic nutrients: water, fat, protein, (plain!). carbohydrates, vitamins, and minerals. 193. D Creatine and chromium are both involved in 182. A Herbs should be treated as medicine; many the Krebs cycle, which produces ATP (chemi- of them are used as such. You would not ask cal energy). Although potassium is a mineral, friends about dosages for prescription medicine it is a component in muscle contractions but or increase your prescription dosages if they do does not assist in the production of ATP. not work immediately, so you do not want to 194. A Aloe vera has an antiseptic cooling effect, do that with herbs. which is wonderful for minor burns. 183. D While many herbs are wonderful for many A situations, garlic has been shown to be an 195. Too much sugar can actually suppress the excellent antibiotic. immune system.

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