Body Tissues and Basic Physiology 13

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 2NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORBody SALE OR DISTRIBUTIONTissues and NOT FOR SALE OR DISTRIBUTION

© Jones & CHAPTERBartlett Learning, OUTLINE LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION TYPES OF TISSUE Synarthrotic Motor Unit Recruitment Amphiarthrotic Muscle Tone CONNECTIVE TISSUE Diarthrotic Muscle Fatigue Bones © Jones & BartlettStructural Learning, Classification LLC Types of Skeletal© Jones Muscle & Fibers Bartlett Learning, LLC Bone Tissue NOT FOR SALEFibrous OR DISTRIBUTION Origin, Insertion,NOT Action FOR SALE OR DISTRIBUTION Shapes of Bones Cartilaginous Concentric, Eccentric, and Isometric Axial vs. Appendicular Skeleton Synovial Contractions Bone Markings Synergists and Antagonists Cartilage MUSCLES Shortened and Lengthened Muscles Dense© Jones Connective & TissueBartlett Learning,Muscle LLC Tissue © JonesPalpation & Bartlett and Massage Learning, of Muscles LLC LooseNOT Connective FOR SALETissue OR DISTRIBUTIONStructure of a Skeletal Muscle NOT FOR SALE OR DISTRIBUTION Blood Skeletal Muscle Cell Components NERVE SUPPLY TO MUSCLES Lymph Skeletal Muscle Contraction Sliding Filament Mechanism ARTERIAL SUPPLY TO MUSCLES JOINTS Motor Units Chapter Summary © Jones & BartlettFunctional ClassificationLearning, LLC All-or-Nothing Principle© Jones & Bartlett WorkbookLearning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

KEY TERMS © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Epithelial tissue: tissue that coversNOT surfaces, FOR and SALE lines cavities OR and DISTRIBUTIONAppendicular skeleton: includes all theNOT bones ofFOR the upper SALE and lower OR DISTRIBUTION hollow organs. limbs, as well as the bones that hold the limbs to the axial skeleton, Connective tissue: abundant and continuous tissue that supports, binds, including the clavicle (collar bone) scapula (shoulder blade), and hip and protects the body and structures within the body bones Compact bone tissue: the dense type of bone tissue that comprises the Bone markings: special projections, shapes, and textures on bones that entire outer© Jones surface of &bones Bartlett Learning, LLC serve varied anatomical© Jones functions & Bartlett Learning, LLC Synarthrotic: immovable SpongyNOT bone tissue: FOR the SALElighter type OR of bone DISTRIBUTION tissue, formed by thin NOT FOR SALE OR DISTRIBUTION slivers of bone arranged in an irregular pattern and located deep to Amphiarthrotic: slightly movable compact bone tissue Diarthrotic: freely movable Axial skeleton: includes the bones that generally run along the vertical Synovial joint: a freely movable, diarthrotic joint in which the ends of the axis of the body, including the bones of the skull and spine, as well as joining bones are covered with cartilage and held together by a synovial the ribs, sternum (breast bone), and hyoid bone, which is a small curved joint capsule containing synovial fluid © Jones bone& Bartlett in the anterior Learning, neck LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

12 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. CHAPTER 2 Body Tissues and Basic Physiology 13

© Jones &Endomysium: Bartlett sheet-likeLearning, connective LLC tissue structure that surrounds each© JonesMuscle & fatigue: Bartlett exhaustion Learning, of muscle cells, LLC so that they can no longer contract NOT FOR SALEmuscle OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Perimysium: sheet-like connective tissue structure that surrounds each Origin: muscles typically connect to two or more locations on at least fascicle or group of muscle cells two different bones; the stable or less movable location is called the Epimysium: sheet-like connective tissue structure that surrounds each origin individual muscle cell Insertion: muscles typically connect to two or more locations on at least Sarcolemma: cell membrane© Jonesof a skeletal & muscle Bartlett cell Learning, LLCtwo different bones; the more movable,© Jones less stable & location Bartlett is called Learning, the LLC insertion Myofibril: a basic structureNOT that forms FOR skeletal SALE muscle cellsOR and DISTRIBUTION that NOT FOR SALE OR DISTRIBUTION contains multilayered rows of alternating protein fibers called myofilaments Action: movement that occurs at a joint when a muscle’s insertion moves closer to the muscle’s origin Myosin: thicker myofilament or protein fibers that overlap with actin when a muscle shortens Concentric contraction: a muscle contraction resulting in shortening of the muscle Actin: thinner myofilament or protein fibers that overlap with myosin when© a Jonesmuscle shor &tens Bartlett Learning, LLC Eccentric contraction:© Jones a muscle & Bartlett contraction resulting Learning, in lengthening LLC of the muscle SarcoplasmicNOT FOR reticulum: SALE a network OR of sacsDISTRIBUTION and tubules that surround NOT FOR SALE OR DISTRIBUTION each myofibril Isometric contraction: a muscle contraction in which the length of the muscle does not change, yet muscle tension occurs Sliding filament mechanism: the process by which myosin and actin are pulled closer together, resulting in muscle shortening Synergists: muscles that perform one or more of the same actions Motor units: a single motor neuron (nerve cell designed to allow movement) © Jones & andBartlett the set of skLearning,eletal muscle cells LLC innervated by that single neuron © JonesAntagonists: & Bartlett muscles that Learning, perform one or LLC more opposite actions NOT FOR SALEMotor unit OR recruitment: DISTRIBUTION the use of additional motor units to accomplishNOT FORShortened SALE muscle: OR a muscle DISTRIBUTION that remains in a shortened position, with a muscle contraction or movement origin and insertion closer together than typical Muscle tone: continuous contraction of alternating motor units, which Lengthened muscle: a muscle that remains in a lengthened position, causes muscles to have tension or firmness during rest with origin and insertion farther apart than typical

his chapter provides an introduction to the physiol- for a particular purpose. There are four types of tissue in the © Jonesogy of bones, & Bartlett joints, and Learning, muscles, and LLCa brief overview body. Epithelial© Jones tissue &lines Bartlett the cavities, Learning, vessels, and LLC hollow TNOTof nerveFOR and SALE arterial OR supply DISTRIBUTION to muscles. This infor- organs of theNOT body FOR and forms SALE the outerOR DISTRIBUTIONcovering of the body. mation provides a framework for the understanding of my- It also comprises various glands. Nervous system tissue ology and kinesiology, as these studies relate to massage forms the brain, spinal cord, peripheral nervous system, and therapy. We begin this chapter by discussing the types of tis- all supporting nerve tissue. Nervous system tissue is designed sue and the particular categories and functions of connective to sense stimuli and respond to it by generating nerve im- © Jones & tissue.Bartlett Within Learning, this discussion, LLC we explore the bones and bone© Jonespulses. & MuscleBartlett tissue Learning,is designed LLCto contract, which enables NOT FOR SALEmarkings OR of the DISTRIBUTION body, many of which serve as muscle attach-NOT FORit to shorten SALE and OR lengthen DISTRIBUTION and thus allow movement. Con- ment sites. Next, we explore joints of the body, including the nective tissue includes all other tissue in the body and is the different categorizations of joints and the movement permit- most abundant type of tissue we have. Connective tissue pro- ted at each. Then, we move on to muscles, including their tects, supports, and binds together other tissue. Of these four structure and functions© andJones how they& Bartlett contract to Learning, allow us to LLCtypes, this chapter will focus© primarily Jones on & connective Bartlett tissue Learning, LLC move. We conclude thisNOT chapter FOR with SALE a look at OR shortened DISTRIBUTION and and muscle tissue. NOT FOR SALE OR DISTRIBUTION lengthened muscles, how they impact posture and function, as well as the importance of muscles’ innervation and arterial supply. Understanding these concepts prepares you for the CONNECTIVE TISSUE study of myology and assists you in designing treatment plans © Jones & Bartlett Learning, LLC It is just as© important Jones &for Bartlettmassage therapists Learning, to understand LLC for your clients. and address connective tissue as it is to address muscles. In NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION fact, it is impossible to differentiate the massage of muscle TYPES OF TISSUE from the massage of connective tissue. As we will see later in this chapter, muscles are infused with and surrounded by A brief description of tissues can help create a context for connective tissue. Restrictions in a client’s connective tissue © Jones & learningBartlett about Learning, muscles, bones, LLC and joints. Tissue is a mass© of Jonescan cause & Bartlett pain, limited Learning, range of motion, LLC and postural abnor- NOT FOR SALEthe same OR type DISTRIBUTIONof cells that form a particular kind of structure,NOT FORmalities, SALE all of which OR DISTRIBUTIONcan be addressed with massage therapy.

© Jones &Connective Bartlett tissueLearning, is made upLLC of cells and matrix. The ma-© Jonesbones have & Bartlett unusual shapes. Learning, They include LLC the vertebrae and NOT FORtrix, SALE which isOR secreted DISTRIBUTION by the cells, gives connective tissue itsNOTsome FOR facial SALE bones. OR Sesamoid DISTRIBUTION bones are shaped like sesame unique properties. The matrix is made of ground substance seeds. The patella is the most famous. Other sesamoid bones and fibers, and depending upon its composition, may be are present in varying numbers and are generally imbedded fluid, gel-like, fibrous and flexible, or solid. in tendons. Connective tissue includes bone, cartilage, fascia (dense and loose connective tissue),© Jones blood, and & Bartlettlymph. Each Learning, of these AxialLLC vs. Appendicular Skeleton© Jones & Bartlett Learning, LLC is described below. NOT FOR SALE OR DISTRIBUTIONThe human skeleton contains 206NOT bones FOR and isSALE divided OR into DISTRIBUTION the axial and appendicular skeletons (Fig. 2-2).The bones Bones of the axial skeleton form somewhat of a vertical axis through the center of the body. The axial skeleton includes the 22 It is important for you, as a massage therapist, to understand bones of the skull, six auditory ossicles, 26 bones that make bones ©and Jones bony landmarks, & Bartlett as they Learning, are attachment LLC sites for © Jones & Bartlett Learning, LLC up the vertebral column, the hyoid bone, 24 ribs, and the muscles.NOT In addition, FOR SALE an understanding OR DISTRIBUTION of the exact location NOT FOR SALE OR DISTRIBUTION sternum. The appendicular skeleton consists of the bones of of muscles and their position relative to bones and joints is the appendages or limbs and the girdles that hold the limbs needed to understand the movements muscles allow us to to the axial skeleton. perform. You will also benefit from understanding the exact The bones of the appendicular skeleton include the shoul- location of a muscle’s connection to bone, as it is often help- © Jones & Bartlett Learning, LLC © Jonesder girdle & bones: Bartlett two clavicles Learning, and two LLC scapulae. The appen- ful to massage this area to enhance muscle relaxation, or to dicular skeleton also contains the bones of the upper limb: NOT FORtreat SALE or prevent OR tendonitis.DISTRIBUTION NOT FOR SALE OR DISTRIBUTION two humerus, two ulna, and two radius bones, 16 carpal Bones are a rigid form of connective tissue that provide bones (which include two each of the following bones: the overall structure of the body. They have several impor- scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, tant functions, including protecting organs, producing blood capitate, and hamate), ten metacarpals, and 28 phalanges in cells, and storing fats and© minerals.Jones In& addition,Bartlett bones Learning, pro- LLC © Jones & Bartlett Learning, LLC the hands. The appendicular skeleton also contains the pelvic vide attachment sites forNOT muscles FOR and SALEact as levers, OR orDISTRIBUTION solid NOT FOR SALE OR DISTRIBUTION girdle, or two coxal or hip bones, and the bones of the lower structures that move when muscles contract. limb, which include two femurs, two patellae, two tibia, two Bone Tissue fibula bones, 14 tarsals (which include two each of the fol- There are two types of bone tissue: compact and spongy (Fig. lowing bones: calcaneus, talus, navicular, medial cuneiform, 2-1). Compact© Jones bone & Bartletttissue forms Learning, the outer layer LLC of bones intermediate cuneiform,© Jones lateral & Bartlett cuneiform, Learning, and cuboid), LLC ten and isNOT more solidFOR in SALEstructure. OR Spongy DISTRIBUTION bone tissue is deep metatarsals, andNOT 28 phalangesFOR SALE in the ORfeet. DISTRIBUTION to compact bone and is porous. Spongy bone tissue is com- Bone Markings posed of thin beams of bone, called , which are pat- trabeculae Bone markings are specific markings and textures on the terned in a criss-cross or latticelike structure. The space surface of bones that serve many purposes. Most relevant to between the beams of bone are filled with red bone marrow, © Jones & Bartlett Learning, LLC © Jonesmyology & is Bartlett the fact that Learning, bone makings LLC serve as muscle at- which produces blood cells. NOT FOR SALE OR DISTRIBUTION NOTtachment FOR SALEsites and OR provide DISTRIBUTION the particular shapes that allow Shapes of Bones the bones to articulate (join) with other bones, thus creating Bones are classified by shape: long, short, flat, irregular, or joints. The list below describes the common markings that sesamoid. Long bones are longer than they are wide. The are relevant to the joints and muscles covered later in this book (Fig. 2-3). bones of the arm, forearm,© fingers,Jones thigh, & Bartlett leg, and toes Learning, are all LLC © Jones & Bartlett Learning, LLC 1. The head of a bone is generally rounded and appears long bones. Typical adultNOT long FORbones SALEcontain spongyOR DISTRIBUTION bone NOT FOR SALE OR DISTRIBUTION only on the proximal and distal ends of the bone and a hol- at either the distal or the proximal end of many low space called the medullary canal in the shaft of the bone. bones. Just distal or proximal to the head is a nar- The medullary canal is filled with yellow marrow and con- row portion of bone called a neck. A head may fit tains fat cells. nicely into a socket to form a ball-and-socket joint. Short© Jonesbones are & small Bartlett and somewhat Learning, square-shaped LLC and Other heads© Jones articulate & Bartlett with curved Learning, bone markings LLC containNOT an outer FOR layer SALE of compact OR boneDISTRIBUTION and an inner layer of at jointsNOT that permitFOR lessSALE movement. OR DISTRIBUTION Note the heads spongy bones. Most of the carpal bones (most proximal bones of the humerus and radius in Figure 2-3, the ulna in in the hand) and the tarsal bones of the foot are short bones. Figure 5-2B, and the fibula in Figure 5-3A. Flat bones are as named: They are flat. Flat bones consist of 2. A condyle (which means knuckle) is also a rounded © Jones two& Bartlett outer layers Learning, of compact LLC bone with an inner layer of© Jonesbone & Bartlettmarking at Learning, the distal or proximal LLC end of a bone. NOT FORspongy SALE bone OR between DISTRIBUTION them. Examples include the ribs, ster-NOT FOR(The SALE condyles OR of theDISTRIBUTION occiput, a skull bone, are on the num, scapula, and many bones of the skull. Irregular-shaped inferior aspect of the bone.) Condyles come in pairs.

Proximal epiphysis © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Spongy bone NOT FOR SALE OR DISTRIBUTION NOT FOR(containing SALE red OR marrow) DISTRIBUTION

Compact bone © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Distal epiphysis A © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Trabeculae

Spaces for bone marrow © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONSpongy bone NOT FOR SALE OR DISTRIBUTION

Compact bone

© Jones & Bartlett Learning, LLC AXIAL© Jones SKELETON & Bartlett(80) Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Cranium (8) Skull and APPENDICULAR SKELETON (126) Auditory ossicles (6) associated Face (14) bones (29)

Clavicle© Jones (2) & Bartlett Learning,Hyoid LLC (1) © Jones & Bartlett Learning, LLC Shoulder girdle (4) ScapulaNOT (2) FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Sternum (1) Humerus (2) Thoracic cage (25) Ribs (24) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Upper limb (60) Vertebrae (24) Ulna (2)

Vertebral column (26) Radius (2) Sacrum (1) Coccyx (1) © Jones & BartlettCarpals Learning, (16) LLC © Jones & Bartlett Learning, LLC NOT FOR SALEMetacarpals OR DISTRIBUTION (10) NOT FOR SALE OR DISTRIBUTION

Phalanges (28) AXIAL SKELETON

Pelvic girdle Hip bone Skull (2) coxa (2)© Jones & Bartlett Learning,APPENDICULAR LLC SKELETON © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Femur (2) Clavicle Vertebrae Patella (2) Shoulder girdle Scapula Tibia (2) Fibula (2) Humerus Lower© limb Jones (60) & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONRibs

Tarsals (14) Upper limb Ulna Metatarsals (16) Phalanges (28) © Jones &A Bartlett Learning, LLC © JonesRadius & Bartlett Learning, LLC Sacrum NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Carpals Coccyx Metacarpals

Phalanges

Femur

Tibia © Jones & Bartlett Learning, LLC Fibula © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONLower limb NOT FOR SALE OR DISTRIBUTION

Tarsals Metatarsals © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC B Phalanges NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION FIGURE 2-2 • Axial and appendicular skeleton.

Lesser tubercle Head Greater tubercle Scapula Medial border © Jones & Bartlett Learning,Bicipital or Intertubercular LLC groove © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Deltoid tuberosity

Humerus Inferior angle

Capitulum Medial epicondyle Head of radius Trochlea © Jones & Bartlett Learning, LLC Tuberosity© of Jones radius & Bartlett Learning,Coronoid LLC process NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONTuberosity of ulna

Radius Ulna

Head of ulna © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORStyloid SALE process OR of radiusDISTRIBUTION Styloid processNOT FORof ulna SALE OR DISTRIBUTION Carpal bones Distal phalanx Metacarpal bones

Proximal phalanx Proximal © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Middle Phalanges NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Distal

Note the condyles of the femur and tibia in Figure trochanter and the lesser trochanter. See Figure 5-2B. Note also that the distal end of the humerus 5-2A. has bone markings named trochlea (which means pul- 7. Many bone markings are called processes, each with ley) and capitulum© Jones(which means & Bartlett little head), Learning, rather LLC a descriptive name, such© asJones the acromion & Bartlett process, Learning, LLC than condyles. NOT FOR SALE OR DISTRIBUTIONthe coracoid process, andNOT the FORcoronoid SALE process. OR In DISTRIBUTION 3. Epicondyles (“epi” means upon) are raised areas on or Figure 2-3, look for these three processes. near condyles. In Figure 2-3, note the medial and lat- 8. A crest is a prominent, narrow ridge of bone. An eral epicondyles of the humerus. example of a crest is the iliac crest. See iliac crest in ©4. Jones A tubercle &is Bartletta small, rounded Learning, projection. LLC Note the tu- Figure© 5-1A.Jones & Bartlett Learning, LLC NOTbercles FOR on theSALE humerus OR and DISTRIBUTION scapula in Figure 2-3. 9. A spineNOTis a FORthin, sharp SALE projection. OR DISTRIBUTION The spine of the 5. A tuberosity is a rounded, roughened area on a bone. scapula can be seen in Figure 2-3. Tuberosities tend to be larger than tubercles. Note the 10. A fossa is a shallow indentation in a bone. See Figure deltoid tuberosity on the humerus and the radial 5-1A to see the iliac fossa. © Jones & Bartletttuberosity Learning, in Figure 2-3.LLC © Jones11. & A Bartlettgroove is a narrow, Learning, linear indentation LLC in a bone. Locate NOT FOR SALE6. A trochanterOR DISTRIBUTIONis a large projection on the femur. ThereNOT FOR theSALE bicipital OR groove, DISTRIBUTION also called the intertubercular are two trochanters on each femur, the greater groove, in the proximal, anterior humerus in Figure 2-3.

© Jones &12. Bartlett A facet is Learning,a smooth, flat, LLC articular surface on a bone. © Jonesalso absorbs & Bartlett extra fluid Learning, when edema LLCis present. An example NOT FOR SALEFacets OR are locatedDISTRIBUTION on the ribs and vertebrae. NOTof areolarFOR SALEtissue is theOR tissue DISTRIBUTION surrounding organs. 13. A foramen is a rounded opening in a bone. Typically, Adipose tissue is dominated by fat cells. It functions as a nerves or vessels pass through a foramen. Examples temperature insulator and protector. Examples of adipose tis- include the foramen magnum in the occiput and the sue include the tissue that protects and holds the eyeballs in obturator foramen in the hip or coxal bones. their sockets, provides padding around the kidneys and © Jones & Bartlett Learning, heart,LLC and makes up fat deposits.© Jones & Bartlett Learning, LLC Cartilage NOT FOR SALE OR DISTRIBUTIONReticular connective tissue isNOT composed FOR of SALEa fine, fibrous OR DISTRIBUTION Cartilage is made of a dense arrangement of collagen and elas- network, providing the framework of some organs such as the tic fibers within a rubbery ground substance that contains liver and spleen. An additional function of reticular connective chondroitin sulfate. Cartilage has no blood or nerve supply. tissue is to bind smooth muscle cells together. Examples in- There ©are Jones several &types Bartlett of cartilage, Learning, distinguished LLC by the clude the framework© Jones of the & liver, Bartlett spleen, Learning,and lymph nodes. LLC arrangementNOT FORand composition SALE OR of DISTRIBUTIONfibers and ground sub- NOT FOR SALE OR DISTRIBUTION stance. Hyaline is the most common type of cartilage and cov- Blood ers the articular surfaces of most bones, providing them with Blood comprises blood cells and platelets in plasma. The smooth surfaces where they form joints. Hyaline cartilage function of blood is to transport oxygen, carbon dioxide, © Jones forms& Bartlett the nose Learning,and parts of larynx.LLC The function of hyaline© Joneswhite blood & Bartlett cells, platelets, Learning, and many LLC other substances NOT FORcartilage SALE is toOR provide DISTRIBUTION flexibility and support. NOTneeded FOR for SALE our body’s OR health DISTRIBUTION and homeostasis. Elastic cartilage has a matrix containing thin elastic fibers. The external ear is elastic cartilage. The function of elastic Lymph cartilage is to provide support and shape. Lymph is interstitial fluid that has passed into lymphatic ves- Fibrous cartilage has a matrix with abundant collagen sels. Lymph assists in our body’s immune response by trans- fibers, making it the strongest© Jones type of &cartilage. Bartlett Fibrous Learning, carti- LLC © Jones & Bartlett Learning, LLC porting lymphocytes to areas where they are needed. Lymph lage is located in the intervertebralNOT FOR discs SALE and at the OR pubic DISTRIBUTION sym- NOT FOR SALE OR DISTRIBUTION also transports lipids and vitamins from the digestive tract to physis and is the cartilage of the knee joint. The function of the blood. fibrous cartilage is to provide support and attach structures. The portion of connective tissue most relevant to massage Dense© Connective Jones & Tissue Bartlett Learning, LLC therapists is the© Jonesbody’s dense & Bartlett and loose Learning, connective tissue, LLC DenseNOT connective FOR tissue SALE contains OR numerous,DISTRIBUTION thick, densely which is collectivelyNOT FORtermed SALE fascia. Fascia OR DISTRIBUTIONcreates a continu- packed fibers. There are several types of dense connective ous three-dimensional web around and within every struc- tissue. Dense regular connective tissue contains many colla- ture of the human body, right down to the cellular level. gen fibers organized in parallel groupings. Its function is Fascia is made of collagen and elastin fibers in a gel-like attachment. Examples include tendons, which attach muscle ground substance. Again, this web surrounds and connects © Jones to& bone; Bartlett ligaments Learning,, which attach LLC bone to bone; and aponeu-© Jonesevery cell & of Bartlett the body, creatingLearning, space betweenLLC our cells while NOT FORroses, SALEwhich OR are flat,DISTRIBUTION sheet-like tendons. NOTnourishing FOR SALE and protecting OR DISTRIBUTION them. Dense irregular connective tissue also contains primarily Tears, adhesions, or other disruptions in the fascia are collagen fibers, randomly arranged. Its function is to add called restrictions, and these have a major impact on our strength. Examples include fascial membranes that cover, health. Such restrictions can be caused by trauma, infection, support, and separate muscles,© Jones deep & Bartlettlayers of dermis Learning, of or LLC posture imbalances. In turn, fascial© Jones restrictions & Bartlett cause pain Learning, LLC skin, membrane capsulesNOT around FOR organs, SALE and joint OR capsules. DISTRIBUTIONand limits in movement. CertainNOT bodywork FOR techniquesSALE OR di- DISTRIBUTION Elastic connective tissue is made of elastic fibers that con- rectly impact the fascia, thus reducing pain and improving tain the protein elastin, and have the function of allowing mobility. These techniques may lengthen the elastic compo- elasticity (stretching). Examples of elastic connective tissue nents of fascia, leading to greater mobility, and/or they may include lung tissue and the walls of arteries. change the viscosity of the ground substance, enhancing the © Jones & Bartlett Learning, LLC overall health© and Jones function & of Bartlett the fascia. Learning, LLC LooseNOT Connective FOR SALETissue OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Loose connective tissue contains fewer fibers and more cells JOINTS than dense connective tissue, thus there is more space between fibers. There are several types of loose connective tis- It is important for massage therapists to have an understand- © Jones sue.& Bartlett Areolar is Learning,soft, flexible tissueLLC made of many types of© Jonesing of joints & Bartlett and how differentLearning, joints LLC permit different move- NOT FORfibers SALE in semifluid OR DISTRIBUTION ground substance. Its function is to cush-NOTments. FOR Massage SALE therapy OR clientsDISTRIBUTION frequently have treatment goals ion, protect, and give strength and elasticity. Areolar tissue related to the functioning of their joints. For many people, their

© Jones &sense Bartlett of health Learning, is directly related LLC to their ability to move, and© JonesFibrous & Bartlett Learning, LLC NOT FOR SALEmovement OR occurs DISTRIBUTION at joints. A common reason for clientsNOT to FORFibrous SALE joints are OR connected DISTRIBUTION by fibrous tissue with plentiful seek massage therapy is to improve their range of motion or collagen fibers and can be synarthrotic or amphiarthrotic. reduce pain that occurs during movement. Many clients They do not have a synovial cavity. Sutures, the joints between present with joint injuries and joint problems they would our skull bones and gomphoses, which are joints between our like addressed. To satisfy these clients, we need to under- teeth and their sockets, are classified as fibrous joints. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC stand the structure and function of the joints we have in our Another type of fibrous joint is a syndesmosis, such as the bodies. NOT FOR SALE OR DISTRIBUTION distal tibiofibular joint of theNOT leg. ThisFOR joint SALE is classified OR DISTRIBUTION as An articulation, or a joint, is a point where bones come to- amphiarthrotic. gether. Joints are necessary to allow our bodies to move. The surfaces of bones that contact other bones are called articular Cartilaginous surfaces© Jones, and bones & Bartlett are said to Learning, articulate with LLC each other at Cartilaginous© Jonesjoints have & noBartlett synovial Learning, cavity and are LLC united joints.NOT Joints FOR are SALEclassified OR in twoDISTRIBUTION ways, functionally and either by hyalineNOT FORcartilage, SALE fibrous OR cartilage, DISTRIBUTION or both. They structurally. allow little or no movement. The two types of cartilaginous joints are synchondroses and symphyses. Synchondroses are Functional Classification synarthrotic joints that are joined by hyaline cartilage. An ex- Classifying joints functionally means placing joints into cat- ample is the joint between the rib 1 and the sternum. Sym- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC egories based on the amount of movement they allow. The physes, such as the pubic symphysis, are amphiarthrotic joints NOT FOR SALEthree functional OR DISTRIBUTION categories are listed below. NOT FORin which SALE hyaline OR cartilage DISTRIBUTION covers the surfaces of the articulating bones, and the bones are united by strong fibrous tis- Synarthrotic sue. The joints between the bodies of the vertebrae are also Synarthrotic joints are considered “immovable” joints. The symphyses, as they are united by fibrocartilaginous discs. The joints between the skull© Jones bones are & classified Bartlett as synarthroticLearning, LLCjoints between the ribs and the© sternumJones are& Bartlettalso symphyses. Learning, LLC joints. Many bodywork practitioners, however, recognize NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION that movement is possible between the skull bones, and this Synovial movement is one of the cornerstone beliefs of craniosacral Synovial joints have four basic components. Articular carti- therapy. Other examples include the joints between the lage (generally hyaline cartilage, although sometimes fibro- roots of the teeth and their sockets in the mandible and cartilage) covers the ends of both bones forming the joint. An maxillae.© Jones & Bartlett Learning, LLC articular capsule© Jones or sleeve & Bartlett encloses theLearning, joint surfaces. LLC This NOT FOR SALE OR DISTRIBUTION sleeve containsNOT an FOR outer layerSALE of fibrous OR DISTRIBUTIONconnective tissue and Amphiarthrotic an inner layer called the synovial membrane. Inside the sleeve Amphiarthrotic joints are considered “slightly movable” is a joint cavity filled with synovial fluid. In addition, most joints. The joints between the bodies of the vertebrae are synovial joints contain reinforcing ligaments (either inside or examples of amphiarthrotic joints. The bodies make up the outside of the joint capsule), which add strength to the fi- © Jones & anteriorBartlett aspects Learning, of the vertebrae LLC and are joined together ©by Jonesbrous & capsule. Bartlett Some Learning, synovial joints LLC also contain discs or NOT FOR SALE fibrocartilaginous OR DISTRIBUTION discs. Other examples include the pubicNOT FORmenisci SALE(pads of OR fibrocartilage) DISTRIBUTION to support and cushion the symphysis, which is the joint between the two pubic bones, joint. and the joint between the ribs and the sternum. There are six types of synovial joints, described below (Fig. Diarthrotic 2-4). It is important to understand the movement permitted Diarthrotic joints are© consideredJones & “freely Bartlett movable” Learning, joints. LLCat each type of synovial joint.© This Jones allows & us Bartlett to properly Learning, as- LLC Freely movable may NOTappear FORto be aSALE misnomer OR in DISTRIBUTION some in- sess range of motion. The movementNOT FOR permitted SALE at each OR joint DISTRIBUTION stances, as in the case of the intercarpal joints, which are lo- is determined by the shapes of the articulating surfaces of the cated in the very proximal aspect of the hand. The joints bones that come together to form the joint. The movement between the eight tiny carpal bones do not permit a wide permitted at each joint is also influenced by the ligaments that stabilize the joints and the soft tissue located in the area. range© Jonesof motion, & butBartlett they are Learning, classified as diarthrotic. LLC More © Jones & Bartlett Learning, LLC obvious diarthrotic joints include the elbow, the shoulder or Plane or Gliding NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION glenohumeral joint, the hip and the knee. Plane or gliding joints permit the least movement of all the types of synovial joints. Usually, they are joints between two Structural Classification flat surfaces of bone and permit only a small amount of back- The second way to categorize joints is structurally. Structural and-forth or gliding movement. Examples include the inter- © Jones & classificationBartlett Learning, is based on whether LLC joints have a synovial cav-© Jonescarpal & joints, Bartlett the joint Learning, between the LLC sternum and clavicle, and NOT FOR SALEity and theOR type DISTRIBUTION of connective tissue that holds the bones NOTto- FORthe joint SALE between OR the DISTRIBUTIONacromion of the scapula and the clavicle gether. The three structural categories are listed below. (AC joint).

Femur © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Proximal NOT FOR SALE OR DISTRIBUTION phalanx Ellipsoid/ condyloid

Ball and socket A © Jones & Bartlett Learning, LLC D © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

1st metacarpal © Jones & Bartlett Learning,Humerus LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Hinge

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Saddle Ulna NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Carpal (trapezium) B E © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Atlas Clavicle

Axis

Scapula Gliding C © Jones & Bartlett Learning, LLCF © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

FIGURE 2-4 • Types of synovial joints.

Condyloid© Jones or Ellipsoidal & Bartlett Learning, LLC Saddle © Jones & Bartlett Learning, LLC CondyloidNOT or FOR ellipsoidal SALE joints OR permit DISTRIBUTION flexion, extension, The saddle jointNOT brings FOR together SALE the OR trapezium DISTRIBUTION bone in the abduction, and adduction, or in other words, circumduction. proximal hand with the metacarpal of the thumb. Saddle Condyloid joints bring together convex and concave surfaces. joints permit a greater range of circumduction than do condy- You could perhaps picture an egg in an oval bowl. The loid joints. egg can roll in two directions but cannot turn or spin. Exam- © Jones ples& Bartlett of condyloid Learning, joints include LLC the wrist, the joint between© JonesPivot & Bartlett Learning, LLC NOT FORthe SALE occiput ORand C1DISTRIBUTION (atlanto-occipital joint), and the metacar-NOTPivot FOR joints SALE allow ORrotation DISTRIBUTION only. They are formed by the pophalangeal joints. articulation between a rounded surface on a bone and a

© Jones & concaveBartlett surface Learning, on a bone. TheyLLC may also be formed by a ring© JonesStructure & Bartlett of a Skeletal Learning, Muscle LLC NOT FOR SALEof bone articulatingOR DISTRIBUTION with an axis of bone. Examples of pivotNOT FORA typical SALE skeletal OR muscle DISTRIBUTION contains hundreds to thousands of joints include the joints between the radius and ulna within long, thin muscle cells called muscle fibers. The gastrocne- the forearm and the atlantoaxial joint between C1 and C2. mius muscle contains roughly one million muscle fibers, Hinge whereas the first dorsal interosseus muscle contains roughly Hinge joints permit flexion© Jones and extension & Bartlett only andLearning, mimic a LLC80,000. Muscle cells line up ©next Jones to each &other. Bartlett Each muscle Learning, LLC door opening and closing.NOT ExamplesFOR SALE of hinge OR joints DISTRIBUTION in the fiber is encased in a thin, areolarNOT connective FOR SALE tissue coveringOR DISTRIBUTION body include the elbow, the knee, and the ankle. called an endomysium. Within each muscle, fibers are grouped together into bundles called fascicles. Each fascicle is Ball-and-Socket wrapped in a dense regular connective sheet covering called Ball-and-socket joints permit the most movement of any syn- a perimysium. Many fascicles are bundled together to make ovial© joint.Jones There & areBartlett only two Learning, ball-and-socket LLC joints in the a muscle. The© Jones most superficial & Bartlett connective Learning, tissue wrapping LLC body,NOT the shoulderFOR SALE and the OR hip. DISTRIBUTION The articulating surfaces of around eachNOT muscle FOR is called SALE an epimysiumOR DISTRIBUTION. Epimysium is this type of joint are shaped like a ball and a socket. also made of dense regular connective tissue.

MUSCLES Skeletal Muscle Cell Components © Jones & Bartlett Learning, LLC © JonesEach &muscle Bartlett fiber or Learning, cell contains LLCmany components that are NOT FOR SALEAs massage OR therapists, DISTRIBUTION we must know and understand theNOT FORnecessary SALE for muscle OR contraction.DISTRIBUTION The sarcolemma is the cell muscles we touch so we can provide the most effective mas- membrane, surrounding the muscle cell. The sarcolemma is sage and achieve the goals our clients seek. In addition, edu- responsible for controlling what enters and exits the cell. cating our clients about their bodies and potential postural or Myofibrils are the structural components of the muscle cell, functional imbalances requires an understanding of and © Jones & Bartlett Learning, LLCwhich actually contract and shorten.© Jones Myofibrils & Bartlett are cylindrical Learning, LLC ability to communicate about our muscles. in shape and contain thousands of thread-like protein struc- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Muscles are organs, composed of fiber-like cells, which tures beautifully positioned in organized rows and segments. are specialized to contract and thus allow movement. Mus- These thread-like protein structures are called myofilaments. cles move not only our bones, but also food, fluids, and Myofilaments are classified as thick or thin. There are al- other substances through the body. In addition, muscle ternating rows of thick and thin myofilaments, lying next to contraction© Jones generates & Bartlett 85% of Learning, our body’s heatLLC and allows each other ©within Jones each myofibril.& Bartlett Thick Learning, myofilaments LLC appear us NOTto maintain FOR our SALE body’s OR internal DISTRIBUTION temperature, despite a darker on anNOT electron FOR micrograph SALE andOR are DISTRIBUTION primarily composed colder external environment. Muscles also help us to main- of the protein myosin. Thin myofilaments appear lighter on tain our posture, such as standing up or holding our head an electron micrograph and are composed primarily of the up. Finally, muscles cross our joints and thus help to protein actin. Although myofibrils run the full length of each stabilize them. Muscles make up 40% to 50% of our body’s muscle fiber, the myofilaments do not. The shorter myofila- © Jones & weight.Bartlett Learning, LLC © Jonesments & of Bartlett myosin and Learning, actin line up endLLC to end along the length NOT FOR SALE OR DISTRIBUTION NOT FORof a muscle SALE cell, OR as well DISTRIBUTION as next to each other. The lineup of Muscle Tissue myosin and actin is such that an actin myofilament extends There are three types of muscle tissue: skeletal, smooth, and beyond each end of the myosin. This lineup permits the actin cardiac. Skeletal muscle attaches to our bones and moves myofilaments to slide toward the center of each myofibril seg- them. It contracts voluntarily,© Jones meaning & Bartlett it is generally Learning, under LLCment. Each segment of a myofibril,© Jones which includes& Bartlett the myosin Learning, LLC our conscious control.NOT Skeletal FOR muscles SALE also appear OR DISTRIBUTIONstriated or and the actin myofilaments thatNOT extend FOR beyond SALE the myosin, OR DISTRIBUTION is striped when viewed under an electron microscope. The called a sarcomere. Figure 2-5 illustrates the lineup of actin stripes are caused by alternating bands of thin and thick and myosin and the length of a sarcomere. myofilaments, as will be discussed later. Myosin myofilaments have projections called crossbridges, Smooth muscle lines many of our body’s organs and which connect to the actin. During concentric contraction, vessels© Jones and contracts & Bartlett to move Learning, food, fluids, LLC and other sub- myosin’s crossbridges© Jones & swivel Bartlett and pullLearning, or slide theLLC actin stancesNOT along FOR their SALE pathways. OR DISTRIBUTION Smooth muscle is consid- myofilamentsNOT toward FOR the SALE center ofOR the DISTRIBUTION sarcomere. Bringing ered involuntary, as it is not generally under conscious the actin myofilaments toward the center of the sarcomere control. Cardiac muscle is the muscle of the heart. It con- literally shortens the muscle. Myosin uses adenosine triphos- tracts to push blood throughout our body. Cardiac muscle phate (ATP) (energy) to do the work of pulling the actin. © Jones & isBartlett also considered Learning, involuntary, LLC although we have some© JonesThe & thinBartlett actin myofilaments Learning, have LLC two regulatory proteins, NOT FOR SALE capacity OR to control DISTRIBUTION our heart rate through breathing andNOT FORtropomyosin SALE and OR troponin, DISTRIBUTION which can prevent myosin’s cross- imagery. bridges from pulling the actin myofilaments toward the center

Bone

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONSingle myofibril NOT FOR SALE OR DISTRIBUTION Bundle of muscle fibers (Fascicle) Single muscle fiber © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Mitochondrion NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Myofibrils H zone Nucleus I bandA band I band Sarcoplasmic reticulum © Jones & Bartlett Learning, LLC © Jones Sarcolemma& Bartlett Learning, LLC Sarcomere unit (plasma membrane) Z line NOTM FOR line SALE OR DISTRIBUTIONZ line NOT FOR SALE OR DISTRIBUTION Myosin (thick filament)

II bandband Myosin tail Myosin head HH zone Actin (thin filament) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,Myosin LLC binding site NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION AA band Troponin complex Tropomyosin

Cross section of filaments © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC FIGURE 2-5 • Skeletal muscle and the myofilaments within a skeletal muscle cell. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

of the sarcomere. When troponin and tropomyosin cover the Skeletal Muscle Contraction myosin binding sites on the actin, contraction is impossible. The contraction of skeletal muscle is complex and in- However,© Jones as soon &as Bartlettthe troponin Learning, and tropomyosin LLC are re- volves many ©components Jones & and Bartlett factors. TheseLearning, are discussed LLC movedNOT from FORthe actin, SALE the myosin OR DISTRIBUTION crossbridges are free to below. NOT FOR SALE OR DISTRIBUTION swivel and pull the actin toward the center of the sarcomere. The sarcoplasmic reticulum is a specialized network of Sliding Filament Mechanism smooth tubules and sacs that surround each and every my- The concept of the sliding filament mechanism was first ofibril like a loosely knit sweater. The sacs in the sarcoplas- introduced in 1954 and was called sliding filament theory. © Jones mic& Bartlett reticulum Learning,store calcium LLC ions, which are essential for© JonesSince that & time,Bartlett researchers Learning, have refined LLC their knowledge of NOT FORcontraction. SALE OR Figure DISTRIBUTION 2-5 illustrates a skeletal muscle and theNOTmuscle FOR contraction, SALE OR allowing DISTRIBUTION us to have a more detailed un- myofilaments within a skeletal muscle cell. derstanding of the process. As time passes, it is likely that our

© Jones &understanding Bartlett Learning, of how muscles LLC contract and allow us to move© Jonestropomyosin & Bartlett unit reactLearning, chemically, LLC causing the troponin– NOT FOR SALEwill be developed OR DISTRIBUTION even further. NOT FORtropomyosin SALE units OR to DISTRIBUTIONmove away from the actin, thus reveal- The sliding filament mechanism is the means by which ing the myosin binding sites. With the myosin binding site muscles contract or shorten. For a muscle to contract, a nerve exposed, the myosin crossbridges automatically attach to the impulse or electrical signal is required. As an illustration, we actin and pull the actin myofilaments from both ends of the will follow the path of a nerve impulse toward the biceps muscle toward the center of the sarcomere, thus shortening brachii muscle, located© inJones the superficial & Bartlett anterior Learning, arm. Biceps LLCthe muscle. As the muscle shortens,© Jones the muscle’s & Bartlett tendons Learning, pull LLC brachii helps us to flexNOT our elbow. FOR For SALE biceps brachii OR DISTRIBUTIONto contract the bones, causing them to moveNOT closer FOR to eachSALE other. OR In DISTRIBUTIONthe and for us to flex our elbow, a nerve impulse must be sent from case of elbow flexion, the forearm is pulled closer to the an- the brain, travel down the spinal cord, and move out a spinal terior arm. As additional action potentials are produced, and nerve heading toward the anterior arm. The nerve cell that car- enough ATP energy and calcium are available, myosin con- ries© the Jones impulse & required Bartlett for muscleLearning, contraction LLC is called a tinues to pull© Jonesthe actin &over Bartlett and over Learning,to sustain the LLCcontrac- motorNOT neuron. FOR The particularSALE OR fiber DISTRIBUTIONwithin the motor neuron that tion. This NOTtype of FOR muscle SALE contraction, OR DISTRIBUTIONin which the muscle carries the nerve impulse toward a muscle is called a motor shortens, is called a concentric contraction. axon. At the end of the motor axon, the axon branches into Relaxation of a muscle fiber happens when the nerve impulse axon terminals. At the end of each axon terminal, there are ends and ACh is no longer released. Acetylcholinesterase is synaptic end bulbs, which house acetylcholine (ACh). released to break down the acetylcholine in the synaptic cleft. © Jones & BartlettWhen a nerveLearning, impulse LLCtravels down a motor axon, then© JonesWithout & Bartlett the continuation Learning, of nerve LLCimpulses reaching the sar- NOT FOR SALEdown the OR axon DISTRIBUTION terminals, it reaches the synaptic end bulbs.NOT FORcolemma, SALE the chain OR ofDISTRIBUTION events needed for muscle contraction The synaptic end bulbs do not touch the muscle; there is a stops. Energy is used to return calcium to the sarcoplasmic retic- space between the axon terminal and the muscle cell called a ulum and remove sodium from the cell. Troponin and synaptic cleft. The nerve impulse must reach the skeletal mus- tropomyosin also return to cover the myosin binding sites on cle cell to cause contraction.© Jones If the & impulse Bartlett is strong Learning, enough, LLCthe actin. At this point, the myosin© Jones no longer & can Bartlett pull the actin.Learning, LLC it will stimulate the NOTrelease FORof ACh SALE from the OR synaptic DISTRIBUTION end Contraction stops, and the muscleNOT relaxes FOR and SALEreturns to OR its orig- DISTRIBUTION bulbs. Acetylcholine is a neurotransmitter that carries the inal length. Figures 2-6 and 2-7 illustrate the position of actin nerve impulse across the synaptic cleft and attaches to par- and myosin during muscle contraction and relaxation. ticular receptor sites on the sarcolemma. These receptor sites on the sarcolemma are called motor end plates. Motor Units ©Once Jones the ACh & has Bartlett carried the Learning, nerve impulse LLC and attached Some types© of Jones motor axons & Bartlett each carry Learning, nerve impulses LLC to just to NOTits receptor FOR sites SALE on theOR sarcolemma, DISTRIBUTION the sarcolemma a few muscleNOT cells, FOR as is the SALE case with OR motor DISTRIBUTION axons that serve becomes temporarily permeable to sodium ions. The inter- the muscles that move our eyes. Other motor axons can carry stitial fluid surrounding muscle cells contains a high con- impulses that reach roughly 750 muscle cells, as do the motor centration of positively charged sodium ions. When the axons that bring impulses to the biceps brachii muscle. Some © Jones & sarcolemmaBartlett Learning,becomes permeable LLC to sodium, sodium ions rush© Jonesmotor & axons Bartlett carry impulsesLearning, to thousands LLC of skeletal muscle NOT FOR SALEinto the cell.OR The DISTRIBUTION entry of positive sodium ions alters the elec-NOT FORcells. The SALE single OR motor DISTRIBUTION axon and all the skeletal muscle cells trical charge within the cell and causes an electrical signal it stimulates are together called a motor unit. The number of (called an action potential) to travel along the sarcoplasmic motor units that comprise and serve each muscle varies reticulum. The action potential causes the sarcoplasmic retic- greatly. Some small muscles contain just a few motor units, ulum to release calcium from its storage sacs. The calcium whereas others have hundreds. travels to the troponin© and Jones tropomyosin, & Bartlett which isLearning, resting on LLCBecause we have motor units,© Jonesour bodies & can Bartlett move in many Learning, LLC actin, the thin myofilament.NOT FOR Calcium SALE and ORthe DISTRIBUTIONtroponin– ways and in varying degrees. ForNOT instance, FOR we canSALE flex our OR elbow DISTRIBUTION

a little or a lot. We can flex our elbow when we have nothing in dria, which generate ATP slowly. They contract slowly but are our hand,© Jones or we can & flex Bartlett it while carrying Learning, a 5-pound LLC weight. A resistant to fatigue© Jones and can &maintain Bartlett sustained Learning, contraction LLC for small movementNOT FOR with SALElittle force OR applied DISTRIBUTION requires a smaller num- many hours. MusclesNOT FOR used in SALE distance OR running DISTRIBUTION and other en- ber of motor units. A larger movement with greater force applied durance activities have higher concentrations of SO fibers. requires the contraction of a greater number of motor units. A second type of skeletal muscle fiber is fast oxidative gly- Thus, the size and number of motor units contracting at any one colytic (FOG). They are intermediate in diameter, are red be- © Jones time& Bartlett determines Learning, the amount LLCof movement possible and the© Jonescause they & Bartlettcontain much Learning, myoglobin, LLC and can generate ATP NOT FORstrength SALE of theOR movement. DISTRIBUTION In addition, motor units take turnsNOTby FORaerobic SALE cellular ORrespiration DISTRIBUTION and glycolysis. Aerobic cellu- contracting; some are engaged while others rest. This enables us lar respiration involves a series of oxygen-requiring mito- to maintain contraction for a longer period of time. chondrial reactions that produce ATP. Glycolysis is a series of ten reactions that break glucose into pyruvic acid and form All-or-Nothing Principle ATP. The muscles in our lower limbs that we use for walking When a motor unit does contract,© Jones every & muscleBartlett cell within Learning, the haveLLC a high concentration of FOG© Jonesfibers. & Bartlett Learning, LLC motor unit contracts fully.NOT This means FOR that SALE the entire OR set DISTRIBUTIONof actin Fast glycolytic (FG) fibers, theNOT third type,FOR are SALE largest inOR di- DISTRIBUTION and myosin myofilaments within each cell shorten to their full ameter, and are white because they contain little myoglobin, extent. In other words, there is no partial contraction within a and generate ATP by glycolysis. Muscles we use for weight muscle cell. This concept is called the all-or-nothing principle. lifting have a high concentration of FG fibers. They fatigue quickly. Most skeletal muscles have mixtures of these three Motor© Unit Jones Recruitment & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC types of fibers. Amazingly, we seem able to change the con- WhenNOT we perform FOR repetitive SALE movementsOR DISTRIBUTION or use our muscles NOT FOR SALE OR DISTRIBUTION centrations of these three types of fibers within our individual for a long time, we require more motor units to be activated. muscles to adapt to the type and level of activity we perform. The generation of more nerve impulses to more skeletal muscle fibers to assist in muscle contraction is known as motor Origin, Insertion, and Action unit recruitment. When additional motor units are recruited, © Jones & Bartlett Learning, LLC © JonesNow that & weBartlett have discussed Learning, muscle LLC contraction in some the ones in use initially can rest and get ready to contract again. NOT FOR SALE OR DISTRIBUTION NOTdepth, FOR we SALEcan begin OR to prepare DISTRIBUTION for the study of individual mus- Muscle Tone cles. There are some terms we will need to understand to help us study the muscles. Recall that concentric skeletal muscle A small number of motor units are involuntarily activated to contraction involves a shortening of a muscle due to the slid- produce muscle tone. The motor units take turns being ac- ing of myofilaments toward the center of the muscle’s sarcom- tive to sustain these contractions, which create tone or firm- © Jones & Bartlett Learning,ere. LLC As a muscle shortens, a pull© occurs Jones on both& Bartlett ends of the Learning, LLC ness in our muscles. NOT FOR SALE OR DISTRIBUTIONmuscle, and thus a pull, via the NOTmuscle’s FOR tendons, SALE on both OR of DISTRIBUTION Muscle Fatigue the sites where the muscle connects to bones. The shortening When muscle fibers can contract for a prolonged period, they of a muscle occurs when the more movable attachment site eventually fatigue and can no longer contract. Some factors moves toward the more stable attachment site. The more sta- that contribute© Jones to muscle& Bartlett fatigue Learning, are lack of calcium, LLC insuf- ble attachment© site Jones of a muscle & Bartlett is called theLearning, origin. The LLCmore ficientNOT oxygen, FOR depletion SALE of glycogen OR DISTRIBUTION and other nutrients, and movable attachmentNOT FORsite of aSALE muscle isOR called DISTRIBUTION the insertion. possibly the buildup of lactic acid. For each muscle we will discuss in this text, we will name the origin and insertion. It is important for massage thera- Types of Skeletal Muscle Fibers pists to know and remember many origin and attachment There are three main types of skeletal muscle fibers. Slow ox- sites, as this helps us know the exact location of a muscle. It © Jones idative& Bartlett (SO) fibers Learning, are small in diameterLLC and appear red because© Jonesis also helpful & Bartlett to remember Learning, the origin LLC and insertion sites of NOT FORthey SALE have large OR amounts DISTRIBUTION of myoglobin, a red protein that bindsNOTmuscles FOR because SALE these OR sites DISTRIBUTION are useful places to provide mas- oxygen in muscle fibers. SO fibers have many large mitochon- sage, particularly friction, as we seek to help muscles relax.

© Jones & BartlettPractice will Learning, make it easier LLC to determine origin and inser-© Jonesyou. Let& Bartlettus assume thatLearning, you set the LLC books down by slowly ex- NOT FOR SALEtion sites ORof the DISTRIBUTION muscles and to remember them. If we considerNOT FORtending SALE your elbows. OR DISTRIBUTION In this instance, your elbow extensors how our bodies typically move, we can determine which body are relaxing, and your elbow flexors are working or con- parts are more movable (and thus contain insertion sites) and tracting. The elbow flexors contract to control the rate at which are more stable (and contain origin sites). For exam- which you set the books down, preventing gravity from ple, the forearm is more movable that the arm. It is certainly pulling the books down quickly. Thus, the elbow flexors con- easier to bring the forearm© Jones closer to & the Bartlett arm than Learning,it is to bring LLCtract eccentrically. Another example© Jones to describe & Bartlett the difference Learning, LLC the arm closer to the NOTforearm. FOR Consider SALE a muscle OR DISTRIBUTIONthat flexes between concentric and eccentricNOT contractions FOR SALE can ORbe illus- DISTRIBUTION the elbow and that attaches to both the arm and forearm. The trated as follows. Suppose you abduct your arm with a attachment on the humerus will be the origin and the attach- 5-pound weight in your hand. This action requires your arm ment on the forearm will be the insertion. abductors to contract concentrically. If you slowly lower the Likewise,© Jones the & hand Bartlett is more Learning, movable than LLC the forearm. It weight by ©adducting Jones your & Bartlett arm, you areLearning, using your LLCarm ab- is easierNOT to FOR bring theSALE fingers OR closer DISTRIBUTION to the forearm than it is to ductors eccentrically.NOT FOR Every SALE muscle OR can DISTRIBUTION be used concentri- bring the forearm closer to the fingers. A finger flexor’s at- cally and eccentrically, depending on the circumstances. tachment on the forearm will be the origin and the attach- In addition, one can contract a muscle with no movement at ment on the fingers will be the insertion. all. This type of muscle contraction is described as an isometric We could consider another muscle that attaches to the ribs contraction. Literally, isometric means “same length.” A muscle © Jones & andBartlett also to theLearning, humerus. TheLLC ribs are more stable than the© Jonescontracting & Bartlett isometrically Learning, does not shorten LLC or lengthen, so it re- NOT FOR SALEhumerus: OR it is DISTRIBUTION easier to move the humerus toward the ribsNOT FORmains theSALE same length.OR DISTRIBUTION An example of an isometric use of arm than it is to move the ribs toward the humerus. Therefore, the flexors is to hold your arms out in front of you in a position of origin of such a muscle would be on the ribs and the insertion flexion. If you hold your arms in a flexed position, you can no- would be on the humerus. The bone that moves when per- tice that the arm flexors are working to allow you to maintain this forming an action will© be Jones the bone & that Bartlett contains theLearning, insertion LLCposition. Gravity would pull your© Jones arms back & to Bartlett your sides ifLearning, you LLC site. Muscles that are NOTlocated FOR in the SALEextremities OR will DISTRIBUTION have ori- did not use muscles to hold yourNOT position. FOR Another SALE example OR DISTRIBUTION of gin sites more proximal than their insertion sites, as the more an isometric use of muscles is how the neck extensors contract proximal body parts in an extremity are more stable. to simply hold the head up. All muscle can be used isometri- The action that a muscle performs is simply the name of cally, when they tighten, but do not cause movement. the movement that occurs when insertion moves toward origin.© Note Jones that it& is Bartlettpossible for Learning, muscles to contract LLC and pull Synergists© and Jones Antagonists & Bartlett Learning, LLC originNOT toward FOR insertion. SALE This OR is true DISTRIBUTION if both muscle attachments SynergistsNOTare muscles FOR that SALE work ORtogether DISTRIBUTION to perform an ac- are relatively equal in their mobility or if we fix the insertion, tion at a given joint. In the following chapters of the book, making it more stable. For instance, if we are hanging onto a synergists will be listed for each muscle presented. Reviewing chin-up bar, we have fixed our forearm, and when an elbow synergists helps you to remember the actions of muscles. Antagonist or opposing muscles are ones that perform the © Jones & flexorBartlett contracts, Learning, the arm will LLC actually move toward the forearm.© Jones & Bartlett Learning, LLC opposite action from each other. Antagonist muscles must op- NOT FOR SALEIt is essential OR for DISTRIBUTION you to learn and remember the actions of mus-NOT FOR SALE OR DISTRIBUTION cles as the muscle’s actions determine postural and functional erate at the same joint. Antagonists will also be listed for each problems. When a client presents with a postural or functional muscle presented in the following chapters. To have optimal problem that he or she wishes to have addressed, you must de- health and posture, we need a balance between opposing mus- termine the action he or she is having trouble with, or the ac- cle groups. If opposing muscle groups are in balance, we can tion he or she is performing© Jones too much, & Bartlett so you can Learning, determine LLChave both strength and flexibility© Jonesin all muscles. & Bartlett However, mostLearning, LLC which muscle to addressNOT in your FOR massage SALE session. OR For DISTRIBUTION this pur- of us have some imbalance betweenNOT FOR opposing SALE muscles. OR WeDISTRIBUTION pose, the actions of each muscle covered in this book are listed tend to have certain groups of muscles that are shortened and under that muscle as a reference for you. opposing muscle groups that are lengthened. For example, it is common for medial rotators of the arm to be shortened and Concentric, Eccentric, and Isometric Contractions lateral rotators of the arm to be lengthened. Typically, a lack of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC It is important to note that the above description of muscle balance occurs because one group of muscles becomes short- contractionNOT FOR refers SALE only to ORconcentric DISTRIBUTION contractions. Concen- ened, resultingNOT in FORthe lengthening SALE ORof the DISTRIBUTION opposing muscles. tric contractions involve shortening of muscles. However, muscles may contract while lengthening or without any Shortened and Lengthened Muscles movement at all. A muscle contraction that occurs when a Muscles frequently become shortened due to overuse. If your © Jones & muscleBartlett lengthens Learning, is called LLCan eccentric contraction. Eccen-© Jonesjob requires& Bartlett continuous Learning, or frequent LLC elbow flexion, your NOT FOR SALEtric contractions OR DISTRIBUTION often occur when one moves to resist a forceNOT FORelbow flexorsSALE become OR DISTRIBUTION shortened. If you perform elbow curls, such as gravity. An example of eccentric contraction occurs flexing your elbows repetitively with weights in your hands, when you slowly set a heavy stack of books down in front of you will likely cause your elbow flexors to shorten. Muscles

© Jonesalso & Bartlettbecome shortened Learning, by being LLC held in a position in which© Jonesin the example & Bartlett above, lengtheningLearning, the LLC shortened muscles can NOT FORinsertion SALE has OR been DISTRIBUTION moved toward origin. Wearing a sling thatNOTbe FORenough SALE to restore OR the DISTRIBUTION strength of the lengthened muscles. holds your elbow in a bent or flexed position for several weeks can cause shortened elbow flexors. Palpation and Massage of Muscles When muscles shorten, there are postural as well as func- For each muscle discussed in this text, a suggestion for how tional implications. A shortened muscle causes one to hold to palpate the muscle and a list of appropriate massage the muscle in a contracted,© Jonesshortened & position. Bartlett Perhaps Learning, you strokesLLC for the muscle are provided.© Jones Although & Bartlett the list ofLearning, LLC have noticed people whoNOT have slightlyFOR SALEbent elbows, OR withoutDISTRIBUTIONstrokes is certainly not exhaustive,NOT it gives FOR you SALE a sense ofOR ap- DISTRIBUTION intention to bend them. It is likely that such people have propriate and helpful strokes to use to reduce muscle tension shortened elbow flexors. and adhesions in this muscle. Keep in mind that knowledge In addition, shortened elbow flexors limit the ability to ex- of each muscle’s action keep allows you to use reciprocal in- tend the© elbowJones fully. & In Bartlett other words, Learning, a shortened muscleLLC limits hibition to assist© in Jones muscle relaxation& Bartlett Reciprocal Learning, inhibition LLC re- the rangeNOT of motion FOR ofSALE the opposite OR DISTRIBUTIONaction. Shortened hip ad- quires that youNOT engage FOR the opposing SALE muscleOR DISTRIBUTION isometrically. By ductors result in limited hip abduction. Shortened knee exten- causing the opposing muscle to contract, you limit the nerve sors limit the ability to perform knee flexion fully. For many of impulse to contract to your target muscle and create an op- the individual muscles covered in this text, we will explore the portunity for lengthening the muscle. For example, if you wish postural and functional implications of the muscle’s shortening. to use reciprocal inhibition to relax the plantarflexors of the © Jones & MusclesBartlett can Learning,also become weak LLC and/or lengthened. When-© Jonesankle, simply & Bartlett dorsiflex Learning,the ankle isometrically. LLC Continued re- NOT FORever SALE a muscle OR shortens, DISTRIBUTION its opposing muscle lengthens. Thus,NOTsearch FOR and SALE exploration OR allows DISTRIBUTION our understanding of the nerv- muscles that remain in a shortened state cause their antago- ous system to grow and change. We now know that reciprocal nists to remain in a lengthened state. Because shortened mus- inhibition is much more complicated than the simple concept cles receive continuous impulses to contract, the impulses to that our nervous system cannot simultaneously innervate op- contract the opposing lengthened© Jones muscles & Bartlett may be inhibited,Learning, posingLLC muscles. In fact, there are© many Jones instances & Bartlett when nerve Learning, LLC causing them to seem weak.NOT These FOR lengthened SALE musclesOR DISTRIBUTIONthat impulses are sent to opposing musclesNOT simultaneously,FOR SALE partic- OR DISTRIBUTION seem weak may be overworked, as they may need to contract ularly muscles that cross more than one joint. However, it does eccentrically or isometrically to counteract the pull of a short- seem that impulses to contract sent to a muscle can, at times, ened muscle. For example, a muscle like the pectoralis minor, inhibit impulses to the antagonist. This is why reciprocal inhi- that pulls our scapulae (shoulder blades) forward and causes bition is such an effective cramp reduction technique. a posture© Jones of rounded & shoulders,Bartlett isLearning, commonly shortened LLC and For most muscles© Jones discussed, & Bartlett directions Learning, to stretch the LLCmus- feels tight.NOT Thus, FOR the SALE rhomboid OR muscles,DISTRIBUTION which pull our cle are offered.NOT To stretch FOR a muscleSALE is OR to move DISTRIBUTION the origin and scapulae back toward the spine, remain lengthened. A client insertion away from each other. This means that you can with this particular muscular imbalance may experience pain stretch muscles by performing the opposite action(s) of the in the area of the lengthened rhomboids. These rhomboids muscle you wish to stretch. Sometimes you have to experiment © Jones may& Bartlett feel tight andLearning, ropy to the LLC massage practitioner. But the© Joneswith various & Bartlett combinations Learning, of opposite LLC actions you perform NOT FORfact SALE of the matter OR DISTRIBUTION is that they are lengthened, so they will notNOTwhen FOR seeking SALE a stretch. OR Remember DISTRIBUTION that stretching should never benefit from lengthening massage strokes. The solution lies in hurt, and if you wish to stretch a client’s muscles, you must lengthening the shortened muscles to restore balance. This give him or her a clear explanation of what you are doing be- solution is likely to restore strength to the weak muscles. fore you begin a stretch. You must also tell your client to let you Muscles can also become weak when their nerve innerva- know as soon as he or she feels a good stretch and if any pain tion is interrupted or when© theyJones have &been Bartlett injured. ForLearning, many is LLC experienced. Stretching is an excellent© Jones technique & Bartlett for length- Learning, LLC of the muscles covered inNOT this text,FOR we SALE will discuss OR theDISTRIBUTION im- ening a muscle and increasing rangeNOT of motionFOR SALEat a joint. OR DISTRIBUTION plications of individual lengthened muscles. Massage therapy techniques such as deep effleurage, fric- NERVE SUPPLY TO MUSCLES tion, and range-of-motion work can literally lengthen muscles. Such© Jones massage & applied Bartlett to shortened Learning, muscles LLC can help to As described© above Jones in the & sectionBartlett on theLearning, sliding filament LLC restoreNOT the balance FOR betweenSALE opposingOR DISTRIBUTION shortened and length- mechanism, NOTnerves FORare needed SALE to carryOR DISTRIBUTIONimpulses for con- ened muscles. Circulatory massage to lengthened muscles can traction to all muscles. Any disruption in the process of bring- also assist their overall health. When approaching imbalances ing a nerve impulse to a muscle can cause mobility problems. between muscle groups, it is commonly recommended to Massage therapy clients may present with mobility problems, massage the shortened muscles first and with techniques de- and thus it is important to have as full an understanding as © Jones signed& Bartlett to break Learning, adhesions and LLC lengthen fibers. Afterward, it© Jonespossible & of Bartlettthe physiology Learning, of movement. LLC A brief overview of NOT FORmay SALE appropriate OR DISTRIBUTIONto address the weaker, lengthened musclesNOTthe FOR nervous SALE system, OR as DISTRIBUTION well as information about which with techniques that strengthen them. However, as mentioned nerves innervate which muscles, is given below.

© Jones & BartlettThe nervous Learning, system is divided LLC into the central nervous sys-© Jonesemerge & Bartlettdirectly from Learning, the spinal cord.LLC These roots join to- NOT FOR SALEtem, which OR consists DISTRIBUTION of the brain and the spinal cord, and theNOT FORgether, SALE pass through OR DISTRIBUTIONthe intervertebral foramen, and divide peripheral nervous system, which includes the nerves that ex- immediately into two branches called rami (rami is the plu- tend from the brain and spinal cord and carry impulses to all ral of ramus). The roots split into a ventral ramus, which in- parts of the body. There are two sets of nerves in the periph- nervates muscles of the extremities and the lateral and eral nervous system, the cranial nerves, which carry impulses anterior trunk, and a dorsal ramus, which innervates deep to and from the brain,© and Jones the spinal & Bartlettnerves, which Learning, carry im- LLCmuscles and the skin of the ©back. Jones Most &of theBartlett ventral Learning,rami LLC pulses to and from theNOT spinal FOR cord. ThereSALE are OR 12 pairs DISTRIBUTION of cra- form plexuses (Latin for braidNOT), or FOR networks SALE of adjacentOR DISTRIBUTION nial nerves and 31 pairs of spinal nerves. The 31 pairs of spinal nerves. The main plexuses are the cervical, brachial, spinal nerves are named according to the area of the spine lumbar, and sacral. The plexuses consist of spinal nerves that from which they emerge (cervical, thoracic, lumbar, sacral, or divide, join with other nerves, divide again, and rejoin other coccygeal)© Jones and the& levelBartlett of the spineLearning, from which LLC they emerge. nerves to create© Jones a complex & Bartlett configuration Learning, of nerve pathways. LLC TheNOT first pair FOR of spinalSALE nerves OR emerges DISTRIBUTION between the occiput The plexusesNOT eventually FOR SALEbecome ORindividual DISTRIBUTION nerves that in- and C1 (C1 is the first vertebra and is also called the atlas). nervate particular body areas and muscle groups. Each of the remaining spinal nerves emerges from a space be- The cervical plexus comprises the ventral rami of spinal tween the vertebrae that is called the intervertebral foramen. nerves C1 to C4, and a portion of C5. The cervical plexus in- The spinal nerves include eight pairs of cervical nerves, twelve nervates some muscles of the head, neck, and the diaphragm. © Jones & pairsBartlett of thoracic Learning, nerves, five LLC pairs of lumbar nerves, five pairs© JonesThe & brachialBartlett plexus Learning, primarily LLCinnervates muscles of the NOT FOR SALEof sacral ORnerves, DISTRIBUTION and one pair of coccygeal nerves. NOT FORupper extremitySALE OR (Fig. DISTRIBUTION 2-8). The brachial plexus begins as the The structure of spinal nerves is quite elaborate. Each ventral rami of spinal nerves C5 to C8 and T1. The rami of spinal nerve has an anterior and a posterior root, which spinal nerves C5 and C6 unite to form the superior (or upper)

Musculocutaneous nerve

NOT FOR SALE OR DISTRIBUTIONRadial nerve NOT FOR SALE OR DISTRIBUTION

Median nerve © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Ulnar nerve © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jonestrunk & Bartlett of the brachial Learning, plexus. LLC The ventral ramus of C7 be-© JonesThe nerves& Bartlett of the lumbar Learning, plexus, L1 LLC to L4, innervate some NOT FORcomes SALE the middle OR DISTRIBUTION trunk. The ventral rami of C8 and T1 uniteNOTabdominal FOR SALE muscles, OR some DISTRIBUTION thigh flexors, all knee extensors, to form the inferior (or lower) trunk. The three trunks divide and all hip adductors. into anterior and posterior divisions. The anterior divisions The nerves of the sacral plexus, L4, L5, and S1 to S4, serve from the superior and middle trunks unite to form the lat- the gluteal muscles, hamstrings, and many muscles of the leg eral cord. The anterior division of the inferior trunk contin- and foot. ues on its own to become© Jones the medial & Bartlettcord. The posteriorLearning, LLC © Jones & Bartlett Learning, LLC divisions from all three NOTtrunks FOR unite toSALE form theOR posterior DISTRIBUTIONARTERIAL SUPPLY TO MUSCLESNOT FOR SALE OR DISTRIBUTION cord. (The lateral cord runs more laterally, the posterior cord more posteriorly, and the medial cord more medially.) The Each muscle requires a blood supply to function. Blood is cords branch into many specifically named nerves that in- delivered to the muscles via arteries, which branch and nar- nervate© muscles Jones of &the Bartlett upper extremity. Learning, LLC row to arterioles.© Jones Massage & therapy Bartlett has Learning,long been credited LLC ThereNOT are FORfive major SALE nerves OR that DISTRIBUTION arise from the cords of with the enhancementNOT FOR of blood SALE flow. OR While DISTRIBUTION the exact effect the brachial plexus. They include the axillary nerve, which of Swedish massage on the overall circulatory system is the supplies the deltoid and teres minor muscles and thus is subject of ongoing research and debate, it is commonly be- necessary for arm abduction. The musculocutaneus nerve lieved that massage enhances local circulation, reduces supplies the coracobrachialis, biceps brachii, and brachialis edema, and alters the interstitial fluid to enhance removal © Jones and& Bartlett thus is largely Learning, responsible LLC for elbow flexion. The radial© Jonesof metabolic & Bartlett waste and Learning, delivery of nutrientsLLC to the body’s NOT FORnerve SALE supplies OR musclesDISTRIBUTION of the posterior arm and forearmNOTcells. FOR SALE OR DISTRIBUTION and is thus responsible for elbow, wrist, and finger exten- An understanding of the circulatory system enables mas- sion. The median nerve supplies most of the anterior sage therapists to better understand the effects of our work. forearm compartment and some muscles in the hand. The A basic explanation of the structure and function of the sys- median nerve passes through© Jones the carpal & Bartlett tunnel and Learning, thus is temLLC follows, including a list of the© arterial Jones supply & Bartlett to the major Learning, LLC the nerve that becomes irritatedNOT FOR when SALEone has carpalOR DISTRIBUTION tunnel muscle groups of the body. NOT FOR SALE OR DISTRIBUTION syndrome. Finally, the ulnar nerve supplies some antero- The cardiovascular system is comprised of the heart, blood medial muscles of the forearm and most muscles of the vessels, and the blood. One of the main functions of the sys- hand. tem includes delivery of nutrients to the cells of the body and Note the following regarding the source of certain nerve removal of waste products from cells. Another function is fibers:© Jones & Bartlett Learning, LLC maintenance ©of Joneshomeostasis & Bartlettin regards Learning,to temperature LLC and • AllNOT axillary FOR nerve SALE fibers ORarise DISTRIBUTIONfrom the ventral rami of pH. In addition,NOT the bloodFOR allows SALE clotting OR andDISTRIBUTION the delivery of C5 and C6. white blood cells to provide protection from pathogens. • All musculocutaneous nerve fibers arise from the ven- The heart is a muscular pump that pushes our blood tral rami of C5 to C7. through 60,000 miles of blood vessels in our bodies. The healthy adult heart generally beats about 70 times per minute © Jones & •Bartlett All radial Learning,nerve fibers arise LLC from the ventral rami of © Jones & Bartlett Learning, LLC while at rest. The heart is located in the mediastinum, which NOT FOR SALEC5 to ORC8 and DISTRIBUTION T1. NOT FOR SALE OR DISTRIBUTION is between our lungs and between the sternum and thoracic • All median nerve fibers arise from the ventral rami of vertebrae. The heart is surrounded and protected by a three- C5 to C7. layered membrane called the pericardium. Deep to the peri- • All ulnar nerve fibers arise from the ventral rami of C8 cardium is the myocardium, the striated, involuntary cardiac and T1. © Jones & Bartlett Learning,muscle. LLC The innermost layer of the© Jonesheart is the & endocardium, Bartlett Learning, LLC Other nerves that emergeNOT from FOR this SALE plexus OR include DISTRIBUTION the which provides a lining for the chambersNOT FOR of the SALE heart. OR DISTRIBUTION suprascapular nerve, which emerges from the superior trunk The heart has four chambers, a right atrium, a left atrium, and supplies the supraspinatus and infraspinatus muscles. a right ventricle, and a left ventricle. Blood flows from the The nerve to the subclavius emerges from the superior trunk right atrium through the tricuspid valve into the right ven- and supplies© Jones the &subclavius Bartlett muscle. Learning, The medial LLC pectoral tricle. From the© rightJones ventricle, & Bartlett blood is pumped Learning, into the LLC pul- nerve NOTemerges FOR from SALE the medial OR cord DISTRIBUTION and supplies the pec- monary trunk,NOT which FOR splits SALEinto the ORpulmonary DISTRIBUTION arteries that toralis major and pectoralis minor. The subscapular nerve bring blood to the lungs via the pulmonary veins. Blood is supplies the subscapularis and teres major. And the thora- oxygenated in the lungs and then flows into the left atrium. codorsal nerve supplies the latissimus dorsi. From the left atrium, blood passes through the bicuspid or The thoracic nerves T2 to T12 are simply numbered and mitral valve into the left ventricle and is pumped into the © Jones organized& Bartlett as singular Learning, nerves LLC rather than a plexus. These© Jonesaorta. & Bartlett Learning, LLC NOT FORspinal SALE nerves OR innervate DISTRIBUTION the intercostals muscles, some ab-NOT FORThe aorta SALE is the OR largest DISTRIBUTION artery of the body, with a width dominal muscles, and some deep back muscles. of close to 1 inch. The aorta contains four sections. The

© Jones & Bartlett Learning, LLCSuperficial temporal © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Superior NOT FOR SALE OR DISTRIBUTION temporal Frontal Frontal Superficial Maxillary temporal Occipital © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Occipital Vertebral NOT FOR SALE ORLabial DISTRIBUTION NOT FOR SALE OR DISTRIBUTION External External jugular Anterior carotid Facial facial Internal Lingual Internal Superior jugular © Jonescarotid & Bartlett Learning,thyroid LLC © Jones & Bartlett Learning, LLC Common NOT FOR SALEcarotid OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Vertebral Common Internal jugular carotid Subclavian External jugular Subclavian Aortic arch Brachiocephalic Intercostals Brachiocephalic © Jones & BartlettIntercostals Learning, LLC Superior © Jones & BartlettAxillary Learning, LLC Thoracic aorta NOT FOR SALE ORCeliac DISTRIBUTION vena cava NOT FOR SALECephalic OR DISTRIBUTION Axillary Renal Azygos Basilic Testicular Inferior Brachial Inferior vena cava Brachial Superior mesenteric mesenteric Median cubital Common iliac Radial Cephalic © Jones & Bartlett Learning, LLCInternal iliac © JonesHepatic & Bartlett Learning, LLC Ulnar Basilic NOT FOR SALE OR DISTRIBUTIONExternal iliac NOT FORRenal SALE OR DISTRIBUTION Volar arch Lumbar Volar Testicular metacarpals Volar digitals Internal iliac Digitals External iliac Popliteal Femoral © Jones & Bartlett Learning, LLC Geniculate © Jones & BartlettFemoral Learning, LLC NOT FOR SALEAnterior OR tibialDISTRIBUTION NOT FOR SALESaphenous OR DISTRIBUTION Posterior tibial Popliteal Peroneal Tibial

Dorsalis pedis Venous © Jones & Bartlett Learning, LLC arch © Jones & Bartlett Learning, LLC Dorsal metatarsals NOT FOR SALE OR DISTRIBUTION Dorsal NOT FOR SALE OR DISTRIBUTION digitals

FIGURE 2-9 • Arterial supply and venous return to various body areas. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ascending aorta carries blood directly from the left ventricle vian artery. The brachiocephalic trunk divides into the right of the heart. The right and left coronary arteries branch from subclavian artery and the right common carotid artery. The the ascending aorta and bring blood to nourish the heart right subclavian artery carries blood to the brain and spinal muscle. The ascending aorta becomes the arch of the aorta, cord, as well as to muscles of the neck, shoulder, and © Jones & whichBartlett is aptly Learning, named for itsLLC curved shape. Three major ©ar- Jonesscapula & Bartlettregions. The Learning, right common LLC carotid artery carries NOT FOR SALEteries branch OR offDISTRIBUTION of the arch of the aorta: the brachiocephalicNOT FORblood toSALE the right OR side DISTRIBUTION of the head and neck. The left com- trunk, the left common carotid artery, and the left subcla- mon carotid artery carries blood to the left side of the head

© Jonesand & Bartlettneck. The leftLearning, subclavian LLC artery supplies the left upper© Jonesblood and & muscleBartlett cells. Learning, Oxygen is diffused LLC through capillary NOT FORextremity. SALE OR DISTRIBUTION NOTwalls, FOR into SALE the interstitial OR DISTRIBUTION fluid, where it can be accessed by The arch of the aorta becomes the thoracic aorta. Many our cells. Carbon dioxide is diffused into the capillaries, and smaller vessels branch off from the thoracic aorta as it descends the blood carries it into venules (small veins), then veins, and and provide blood to the bronchial tubes, esophagus, and mus- then back into the right atrium. cles of the chest wall and rib cage, as well as to the diaphragm. We have two types of circulation: systemic and pul- Finally, the thoracic aorta© Jones becomes & theBartlett abdominal Learning, aorta. monary.LLC Systemic circulation refers© Jones to the delivery& Bartlett of oxy- Learning, LLC Many arteries branch offNOT from theFOR abdominal SALE aorta, OR DISTRIBUTIONinclud- genated blood from the left ventricleNOT FORto the SALEbody’s tissues OR DISTRIBUTION ing the celiac trunk, and the superior and inferior mesen- and organs. Pulmonary circulation is the delivery of de- teric branches, as well as other branches serving glands and oxygenated blood to the lungs, where it gains oxygen, and organs in the abdominal region. The celiac trunk serves some delivery of this oxygenated blood from the lungs to the digestive© Jonesorgans including & Bartlett the stomach, Learning, gall bladder, LLC liver, heart. © Jones & Bartlett Learning, LLC pancreas,NOT and FOR spleen. SALE The superior OR DISTRIBUTION mesenteric trunk sup- The bloodNOT is a liquidFOR connectiveSALE OR tissue DISTRIBUTION that contains plies the small and large intestines. The inferior mesenteric plasma (about 91% water and some dissolved substances) branch delivers blood to portions of the colon and rectum. and formed elements (red blood cells, white blood cells, and The abdominal aorta branches into the right and left com- platelets). Hematocrit is the percentage of blood volume that mon iliac arteries. These vessels divide further into the femoral is red blood cells. Average hematocrit is 38%–46% of blood © Jones arteries,& Bartlett which serveLearning, the muscles LLC of the thigh; the popliteal ar-© Jonesvolume. & Red Bartlett blood cells Learning, contain hemoglobin, LLC which carries NOT FORtery, SALE which servesOR DISTRIBUTION muscles of the posterior knee; and the ante-NOToxygen FOR and SALE carbon OR dioxide, DISTRIBUTION and helps regulate blood pres- rior and posterior tibial arteries, which serve muscles of the leg. sure. White blood cells help fight infections and inflamma- When blood is brought to a muscle, it must enter the tion. Platelets are needed for clotting. smallest vessels, called capillaries, which are structures to Figure 2-9 illustrates the arterial and venous supplies to allow the exchange of oxygen© Jones and carbon & Bartlett dioxide Learning,between theLLC various body areas. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & BartlettCHAPTER Learning, SUMMARY LLC © Jones & Bartlett Learning, LLC NOT FOR SALEChapter OR2 has DISTRIBUTION provided a basic introduction to the physiol-NOT FORto the nerveSALE and OR blood DISTRIBUTION supplies to muscles. This information ogy of connective tissue (including bones, cartilage, fascia, should equip you to begin a comprehensive study of the mus- blood, and lymph), joints, and muscles, and an introduction cles of the body.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION WORKBOOK d. ______Review Exercises e. ______Connective Tissue ______1.© What Jones are bones? & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT______FOR SALE OR DISTRIBUTION 3. Two mainNOT types FOR of bone SALE tissue are: OR DISTRIBUTION ______a. ______2. List five functions of bones: b. ______a. ______© Jones & Bartlett Learning, LLC © Jones &______Bartlett Learning, LLC NOT FOR SALE______OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION b. ______4. List the five shapes of bones: ______a. ______c. ______b. ______© Jones & Bartlett Learning, LLC c. ______© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Head (cephalic): Forehead (frontal) Skull (cranial) Eye (orbital) Face (facial) Base of skull Head (cephalic or Cheek (buccal) (occipital) © JonesChin (mental)& Bartlett Learning,Ear (otic) LLC © Jones & Bartlett Learning,cranial) LLC NOTNeck FOR (cervical) SALE OR DISTRIBUTIONNose (nasal) NecNOTk (cervical) FOR SALE OR DISTRIBUTION Chest (pectoral) Mouth (oral) Shoulder (acromial) Armpit (axillary) Breastbone Shoulder blade (sternal) (scapular) Arm (brachial) Breast Front of elbow ChestChest (mammary) Spinal column © Jones & Bartlett(antecubital Learning, LLC(thoracic)(thoracic) © Jones &(vertebral) Bartlett Learning,BackBack of of torso torso LLC Upper Naval limb NOT FOR SALEor cubital) OR DISTRIBUTIONAbdomenAbdomen (umbilical) NOT FOR SALE OR DISTRIBUTION (abdominal)(abdominal) Back of elbow Forearm Hip (coxal) (olecranal) (antebrachial) LoinLoin (lumbar) (lumbar) TrTrunk unk Trunk Groin Wrist (inguinal) (carpal) Palm PelvisPelvis (palmar)© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Hand NOT FOR SALE(manual) OR DISTRIBUTION Between NOT FOR SALE OR DISTRIBUTION Thigh hips (sacral) Fingers femoral Back of hand (digital or Pubis (pubic) Buttock (dorsal) phalangeal) (gluteal) Anterior surface of knee (patellar) Hollow behind Lower © Jones & Bartlett Learning, LLC knee© (popliteal) Jones & Bartlett Learning,limb LLC Leg (crural) NOT FOR SALE OR DISTRIBUTIONShin (tibial) NOTCalf (sural) FOR SALE OR DISTRIBUTION Ankle (tarsal)

Toes (digital Top of foot and phalangeal) (dorsal) Sole (plantar) © Jones & Bartlett Learning, LLC © Jones &Heel Bartlett (calcaneal) Learning, LLC NOT FOR SALEA OR DISTRIBUTION NOT FORB SALE OR DISTRIBUTION

© Jones & Bartlettd. ______Learning, LLC © Jones1. Plane & orBartlett gliding Learning, LLC NOT FOR SALEe. ______OR DISTRIBUTION NOT FORa. ______SALE OR DISTRIBUTION b. ______5. Skeleton is divided into axial and appendicular segments. c. ______a. The axial skeleton consists of: ______2. Condyloid or ellipsoidal © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ______a. ______NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ______b. ______c. ______b. The appendicular skeleton consists of: ______3. Saddle ©______Jones & Bartlett Learning, LLC a. ______© Jones & Bartlett Learning, LLC NOT______FOR SALE OR DISTRIBUTION b. ______NOT FOR SALE OR DISTRIBUTION c. ______6. Define fasci a, and give four examples of connective tissue structures that are called fascia: 4. Pivot ______© Jones & Bartlett Learning, LLC © Jonesa. ______& Bartlett Learning, LLC a. ______NOT FOR SALE OR DISTRIBUTION NOT FORb. ______SALE OR DISTRIBUTION b. ______c. ______c. ______5. Hinge d. ______a. ______Joints © Jones & Bartlett Learning, LLCb. ______© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1. Fill in the appropriate functional classifications of joints: c ______a. ______ϭ immovable joint 6. Ball-and-socket b. ______ϭ slightly movable joint a. ______c. ______ϭ freely movable joint © Jones & Bartlett Learning, LLC b. ______© Jones & Bartlett Learning, LLC 2. StructuralNOT FOR classifications SALE of OR joint useDISTRIBUTION the following terms: c. ______NOT FOR SALE OR DISTRIBUTION a. ______joints are held together by fiber. Muscles b. ______joints are held together 1. What are muscles? by cartilage. ______© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC c. ______joints contain all the ______NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION components of synovial joints. ______

3. List the four components of a synovial joint: 2. Three types of muscle tissue include: a. ______a. ______, which is ______, ______, and b. ______© Jones & Bartlett Learning, LLC______© Jones & Bartlett Learning, LLC c. ______NOT FOR SALE OR DISTRIBUTIONb. ______, which is ______,NOT FOR ______, SALE OR and DISTRIBUTION d. ______4. For each type of synovial joint listed below, please fill in the fol- c. ______, which is ______, ______, and lowing: a., the movement permitted at this joint; b., the shape ______of© the Jones articulating & surfaces;Bartlett and Learning, c., an example LLC of where this © Jones & Bartlett Learning, LLC jointNOT is in FORthe body. SALE OR DISTRIBUTION 3. FunctionsNOT of muscles FOR include: SALE OR DISTRIBUTION a. ______b. ______c. ______© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlettd. ______Learning, LLC © Jones______& Bartlett Learning, LLC NOT FOR SALEe. ______OR DISTRIBUTION NOT FOR______SALE OR DISTRIBUTION ______4. Structure of a skeletal muscle: ______a. Each individual muscle cell is enclosed in a connective tissue sheath called an ______© Jones & Bartlett Learning, . LLC______© Jones & Bartlett Learning, LLC b. Each fascicle, orNOT group ofFOR muscle SALE cells, is wrappedOR DISTRIBUTION in a con- ______NOT FOR SALE OR DISTRIBUTION nective tissue sheath called a 7. Define a motor unit, and explain the relationship between ______. motor units and the all-or-nothing principle. c. Many fascicles, bound together to form a muscle, are ______© Joneswrapped in& a Bartlettcovering called Learning, a LLC © Jones & Bartlett Learning, LLC ______NOT______FOR SALE OR DISTRIBUTION . NOT FOR SALE OR DISTRIBUTION ______d. The epimysium blends into a tendon or aponeurosis, attaching muscles to bone. 8. What is the difference between origin and insertion? ______5. List and define the components of a skeletal muscle cell: © Jones & Bartlett Learning, LLC © Jones ______& Bartlett Learning, LLC ______NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ______9. Give an example of a concentric contraction and an example ______of an eccentric contraction: ______6. Write out the steps involved in the sliding filament mechanism: ______© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ______NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ______