Mosbys Essential Sciences for Therapeutic Massage Chapter 9: Muscles Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Mosby’s Essential Sciences for Mosby’s Essential Sciences for Therapeutic MassageTherapeutic Massage

Chapter 9:Chapter 9:

MusclesMuscles

Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 22

Lesson 9.1 ObjectivesLesson 9.1 Objectives

• Describe the functions of muscles.Describe the functions of muscles.• List the three types of muscles.List the three types of muscles.• Describe the types of skeletal muscle fiber.Describe the types of skeletal muscle fiber.

Structure and FunctionStructure and Function

• We should look at, and study the body as a We should look at, and study the body as a whole, in structure and functionwhole, in structure and function

• Physiologically, one muscle does not function Physiologically, one muscle does not function independently of others independently of others

• Three types of muscleThree types of muscle– Skeletal, smooth and cardiacSkeletal, smooth and cardiac



Muscles and ForceMuscles and Force

• Muscle can change chemical energy (from Muscle can change chemical energy (from ATP) into mechanical energyATP) into mechanical energy– Energy: the capacity to do work Energy: the capacity to do work

• When muscle contracts, muscle tissue When muscle contracts, muscle tissue transforms one form of energy into another transforms one form of energy into another and it is able to produce forceand it is able to produce force

• 2 Types of force2 Types of force– Dynamic force: creates movement and change Dynamic force: creates movement and change – Static force: expends energy, but creates no Static force: expends energy, but creates no

movement or noticeable changemovement or noticeable change• (like pushing against a wall)(like pushing against a wall)


Muscle FunctionsMuscle Functions

• 4 major muscle functions 4 major muscle functions – Movement productionMovement production– Joint stabilizationJoint stabilization– Posture maintenancePosture maintenance– Heat generationHeat generation


Functional CharacteristicsFunctional Characteristicsof Muscleof Muscle

• Excitability: the ability to receive and respond Excitability: the ability to receive and respond to a stimulus to a stimulus – Massage stimulates the muscles, which in turn Massage stimulates the muscles, which in turn

stimulates the maintenance of homeostasis stimulates the maintenance of homeostasis

• Contractility: the ability to shorten forcibly with Contractility: the ability to shorten forcibly with adequate stimulation adequate stimulation – The ability to contract allows the entire organism The ability to contract allows the entire organism

to moveto move


• Extensibility: the ability to be stretched or Extensibility: the ability to be stretched or extended extended – One group of muscles contracts, while the other One group of muscles contracts, while the other

group lengthens group lengthens

• Elasticity: the ability to recoil and resume the Elasticity: the ability to recoil and resume the original resting length after being stretched original resting length after being stretched – This also includes the ability to remember where This also includes the ability to remember where

the movement began and to return to that positionthe movement began and to return to that position


Support function of muscle tissueSupport function of muscle tissue

• The nervous system controls contraction The nervous system controls contraction – skeletal and smooth muscle skeletal and smooth muscle – influences the rate of cardiac contractioninfluences the rate of cardiac contraction

• The endocrine system The endocrine system – produces hormones promote repair of muscle produces hormones promote repair of muscle

tissuetissue

• The circulatory system The circulatory system – delivers nutrients and carries away waste delivers nutrients and carries away waste



• The digestive system The digestive system – breaks food downbreaks food down– glucose glucose ATP ATP work work

• The digestive, urinary and respiratory systems The digestive, urinary and respiratory systems – eliminate waste products from muscle metabolism eliminate waste products from muscle metabolism

• Lactic acid is the end product of muscle work Lactic acid is the end product of muscle work • Lactic Acid Lactic Acid Broken down through aerobic respiration Broken down through aerobic respiration

AKA the Kreb cycle ORAKA the Kreb cycle OR• Lactic Acid Lactic Acid or sent to the liver to be converted back to or sent to the liver to be converted back to

glucose glucose



• IsometricIsometric– Tension in the Tension in the

muscle with no muscle with no change in movement change in movement

• IsotonicIsotonic– ConcentricConcentric– EccentricEccentric

From Greenstein GM: Clinical assessment of neuromusculoskeletal disorders, St. Louis, 1997, Mosby.

Muscle ActionMuscle Action


From Thibodeau GA, Patton KT: Anatomy and physiology, ed 5, St. Louis, 2003, Mosby.

Skeletal Muscle FibersSkeletal Muscle Fibers


From Muscolino JE: Kinesiology: the skeletal system and muscle function, enhanced edition, St. Louis, 2007, Mosby.

Striated MuscleStriated Muscle


Length and TensionLength and Tension

• Direct link between Direct link between tension development tension development and length of the and length of the musclemuscle

• If shortened, or If shortened, or lengthened beyond lengthened beyond optimum, tension optimum, tension decreasesdecreases


From Muscolino JE: Kinesiology: the skeletal system and muscle function, enhanced edition, St. Louis, 2007, Mosby.

InnervationInnervation


Energy SourcesEnergy Sources

• ATPATP• Efficient contraction requiresEfficient contraction requires

– GlucoseGlucose– Oxygen: aerobic respirationOxygen: aerobic respiration

• Anaerobic respiration: no immediate oxygen Anaerobic respiration: no immediate oxygen useuse– Produces lactic acidProduces lactic acid– Leads to oxygen debtLeads to oxygen debt


Types of Muscle FiberTypes of Muscle Fiber

• Page 258/318Page 258/318• Fast-twitch (white) fiberFast-twitch (white) fiber

– Contract most rapidly, forcefullyContract most rapidly, forcefully– Fatigue quickly due to lactic acid build-up Fatigue quickly due to lactic acid build-up – Anaerobic b/c they do not need a lot of O2Anaerobic b/c they do not need a lot of O2

• Slow-twitch (red) fiberSlow-twitch (red) fiber– Contract more slowly, less intenselyContract more slowly, less intensely

• (ex. Muscles that maintain posture)(ex. Muscles that maintain posture)

• Intermediate fibersIntermediate fibers– Combine red and white qualitiesCombine red and white qualities


Muscle FatigueMuscle Fatigue

• Muscle Fatigue is the state of exhaustion Muscle Fatigue is the state of exhaustion produced by strenuous muscular activityproduced by strenuous muscular activity

• Physiologic or psychologic?Physiologic or psychologic?• Low levels of ATP cause physiologic MFLow levels of ATP cause physiologic MF• Complete physiologic MF rarely occurs b/c Complete physiologic MF rarely occurs b/c

psychological fatigue is what produces the psychological fatigue is what produces the exhausted feeling that stops us from exhausted feeling that stops us from continuing continuing


Adapted from Mathers LH, Chase RA, Dolph J et al: Clinical anatomy principles, St. Louis, 1995, Mosby.

Connective Tissue and MuscleConnective Tissue and Muscle

• FasciaFascia– Involved in nearly all Involved in nearly all

the fundamental the fundamental processes ofprocesses ofthe bodythe body

– Intimately related to Intimately related to musclemuscle


Adapted from Myers T: Anatomy trains: myofascial meridians for manual and movement therapists, London, 2002, Churchill Livingstone.

Structure of Structure of Muscle FibersMuscle Fibersand Coveringsand Coverings


Myofascial Integration: TensegrityMyofascial Integration: Tensegrity

• Sheets and lines of fascia create a whole-body Sheets and lines of fascia create a whole-body network.network.

• Tensegrity: balance of tensile forcesTensegrity: balance of tensile forces– Shows resiliency, becoming more stabile as the Shows resiliency, becoming more stabile as the

load increasesload increases

• Full-body massage addresses the tensegric Full-body massage addresses the tensegric nature of the body nature of the body

• Localized work is directed at the symptom not Localized work is directed at the symptom not the cause and is therefore less effective the cause and is therefore less effective – See Figure 9-8 on page 263 in the book.See Figure 9-8 on page 263 in the book. – Blue book 9-9 pg 325Blue book 9-9 pg 325


Pathologic ConnectivePathologic ConnectiveTissue ChangesTissue Changes

• Over time, connective tissueOver time, connective tissue– ThickensThickens– ShortensShortens– CalcifiesCalcifies– ErodesErodes

• Changes can come from sudden or sustained Changes can come from sudden or sustained forcesforces

• Ground substance and collagen combine and Ground substance and collagen combine and can cause dysfunction can cause dysfunction overworked and overworked and undernourished muscle undernourished muscle trigger point pain trigger point pain


Modified from Thibodeau GA, Patton KT: Anatomy and physiology, ed 6, St. Louis, 2007,

Mosby.

Muscle AttachmentMuscle Attachment

• Direct attachments (rare)Direct attachments (rare)– Muscles attach to bone or Muscles attach to bone or

cartilagecartilage

• Indirect attachments (more Indirect attachments (more common)common)– Muscle fascia extends Muscle fascia extends

beyond musclebeyond muscle– Attaches to other connective Attaches to other connective

tissuetissue

Muscle AttachmentMuscle Attachment

• OriginOrigin– The attachment that does not move The attachment that does not move – Usually proximal or medial Usually proximal or medial

• InsertionInsertion– The attachment that moves The attachment that moves – Usually distal or lateral Usually distal or lateral


Muscle ShapesMuscle Shapes

• ParallelParallel– Ex. Sartorius Ex. Sartorius

• Convergent Convergent – Pectoralis MajorPectoralis Major

• PennatePennate– Tendons run the length of the muscle Tendons run the length of the muscle – Unipennate, bipennate, multipennateUnipennate, bipennate, multipennate– Rectus femoris Rectus femoris

• CircularCircular– sphincterssphincters



Lesson 9.2 ObjectiveLesson 9.2 Objective

• List the components of myotatic units.List the components of myotatic units.• Page 266/328Page 266/328


Myotatic UnitsMyotatic Units

• Muscles rarely act independently Muscles rarely act independently • Muscles are part of larger movement patterns Muscles are part of larger movement patterns


Functions and NamingFunctions and Naming

• Name of muscle in specific action depends Name of muscle in specific action depends on function:on function:– Mover (agonist)Mover (agonist)– AntagonistAntagonist– Fixator (stabilizer)Fixator (stabilizer)– NeutralizerNeutralizer– Support muscleSupport muscle– SynergistSynergist


ReceptorsReceptors

• Provide information to central nervous systemProvide information to central nervous system– Muscle spindles: respond to sudden, prolonged Muscle spindles: respond to sudden, prolonged

stretchstretch– Tendon organs: respond to tension in muscle Tendon organs: respond to tension in muscle

relayed to tendonrelayed to tendon– Joint kinesthetic receptors: respond to pressure, Joint kinesthetic receptors: respond to pressure,

changes in joint movementchanges in joint movement

Reflexes are automatic responses triggered by Reflexes are automatic responses triggered by change in the environment change in the environment


From Fritz S: Mosby’s fundamentals of therapeutic massage, ed 4, St. Louis, 2009, Mosby.

Reflex ResponseReflex Response


ReflexesReflexes

• Page 268/332Page 268/332• Stretch reflexStretch reflex• Tendon reflexTendon reflex• Flexor reflex and crossed extensor reflexFlexor reflex and crossed extensor reflex• Postural reflexesPostural reflexes



Cardiac MuscleCardiac Muscle



Smooth MuscleSmooth Muscle



• Identify the attachments, function, synergist, Identify the attachments, function, synergist, antagonist, and common trigger points of antagonist, and common trigger points of individual muscles.individual muscles.

• Lesson 9.3’s muscles: face and head, neck, Lesson 9.3’s muscles: face and head, neck, deep muscles of the back and posterior neck, deep muscles of the back and posterior neck, and muscles of the torso.and muscles of the torso.


Muscle Overview IMuscle Overview I

• Arranged in layersArranged in layers• Most areas of body: three to five layersMost areas of body: three to five layers• Deep muscle: closest to boneDeep muscle: closest to bone• Superficial muscle: closest to skinSuperficial muscle: closest to skin


Muscle Overview IIMuscle Overview II

• Many muscles named using such features asMany muscles named using such features as– LocationLocation– FunctionFunction– ShapeShape– Direction of fibersDirection of fibers– Number of heads or divisionsNumber of heads or divisions– Points of attachmentPoints of attachment– Size of muscleSize of muscle


How to Palpate MusclesHow to Palpate Muscles

• When relaxedWhen relaxed– Identify bony landmarksIdentify bony landmarks– Trace muscle between attachmentsTrace muscle between attachments– Follow fiber directionFollow fiber direction– Locate belly of muscleLocate belly of muscle– Have client contract muscleHave client contract muscle

• Deep muscles are harder to feelDeep muscles are harder to feel


Muscles of the Face and HeadMuscles of the Face and Head

• Produce movement for facial expressionsProduce movement for facial expressions• Vital for nonverbal communicationVital for nonverbal communication• Vary in shape and strengthVary in shape and strength• Tend to be fused togetherTend to be fused together• Many do not attach to boneMany do not attach to bone


From Drake RL, Vogel W, Mitchell WM: Gray’s Anatomy for students, Edinburgh, 2005, Churchill Livingstone.

Lateral View of the HeadLateral View of the Head


OccipitofrontalisOccipitofrontalis

Muscles of Facial Expression IMuscles of Facial Expression I


ProcerusProcerus Corrugator superciliiCorrugator supercilii

Muscles of Facial Expression IIMuscles of Facial Expression II


NasalisNasalis

Muscles of Facial Expression IIIMuscles of Facial Expression III


AuricularisAuricularis Auricularis PosteriorAuricularis Posterior

Ear Muscles IEar Muscles I


Auricularis SuperiorAuricularis Superior

Ear Muscles IIEar Muscles II


Orbicularis OculiOrbicularis Oculi

Eye MusclesEye Muscles


Orbicularis orisOrbicularis oris

Muscles That Move the Mouth IMuscles That Move the Mouth I


Depressor anguli orisDepressor anguli oris RisoriusRisorius

Muscles That Move the Mouth IIMuscles That Move the Mouth II


Zygomaticus majorZygomaticus major Zygomaticus minorZygomaticus minor

Muscles That Move Muscles That Move the Mouth IIIthe Mouth III


Levator labii superiorusLevator labii superiorus Levator labii superioris Levator labii superioris alaeque nasialaeque nasi

Muscles That MoveMuscles That Movethe Mouth IVthe Mouth IV


Depressor labii inferiorusDepressor labii inferiorus Levator anguli orisLevator anguli oris

Muscles That Move the Mouth VMuscles That Move the Mouth V


BuccinatorBuccinator

Muscles That MoveMuscles That Movethe Mouth VIthe Mouth VI


PlatysmaPlatysma MentalisMentalis

Muscles That MoveMuscles That Movethe Mouth VIIthe Mouth VII



Lateral Pterygoid MuscleLateral Pterygoid Muscle


MasseterMasseter TemporalisTemporalis

Muscles of Mastication IMuscles of Mastication I


Lateral (external) pterygoidLateral (external) pterygoid Medial (internal) pterygoidMedial (internal) pterygoid

Muscles of Mastication IIMuscles of Mastication II


Muscles of the NeckMuscles of the Neck

• Move the neck at cervical spinal jointsMove the neck at cervical spinal joints• Assist in swallowingAssist in swallowing• Provide extension of the neckProvide extension of the neck• Tension and imbalance are major causes of Tension and imbalance are major causes of

headaches and arm and shoulder pain headaches and arm and shoulder pain



Muscles of the Muscles of the Neck INeck I


SternocleidomastoidSternocleidomastoid

Muscles of the Neck IIMuscles of the Neck II


DigastricDigastric StylohyoidStylohyoid

Suprahyoid Muscles ISuprahyoid Muscles I


MylohyoidMylohyoid GeniohyoidGeniohyoid

Suprahyoid Muscles IISuprahyoid Muscles II


SternohyoidSternohyoid SternothyroidSternothyroid

Infrahyoid Muscles IInfrahyoid Muscles I


OmohyoidOmohyoid ThyrohyoidThyrohyoid

Infrahyoid Muscles IIInfrahyoid Muscles II


Longus colliLongus colli Longus capitisLongus capitis

Posterior Triangle of the Neck Posterior Triangle of the Neck


Scalenus anteriorScalenus anterior Scalenus mediusScalenus medius

Scalene Group IScalene Group I


Scalenus posteriorScalenus posterior

Scalene Group IIScalene Group II


Deep Muscles of the Back and Deep Muscles of the Back and Posterior NeckPosterior Neck

• Responsible for neck and head extension, Responsible for neck and head extension, lateral flexion, and rotationlateral flexion, and rotation

• Affect trunk movementsAffect trunk movements• Play a role in maintaining proper spinal curvePlay a role in maintaining proper spinal curve• Complex column extending from sacrum to Complex column extending from sacrum to

skullskull


Superficial group of back musclesSuperficial group of back muscles

66




Intermediate group of back muscles – serratus Intermediate group of back muscles – serratus posterior musclesposterior muscles

67




Deep group of back muscles – erector spinae musclesDeep group of back muscles – erector spinae muscles

68




Deep group of back muscles – transversospinales and Deep group of back muscles – transversospinales and segmental musclessegmental muscles

69




Splenius capitis and splenius cervicisSplenius capitis and splenius cervicis

Deep Posterior Cervical MusclesDeep Posterior Cervical Muscles


Iliocostalis lumborum,Iliocostalis lumborum,

iliocostalis thoracis,iliocostalis thoracis,

and iliocostalis cervicisand iliocostalis cervicis

Vertical Muscles Vertical Muscles Erector Spinae Group IErector Spinae Group I


Longissimus thoracis, Longissimus thoracis, longissimus cervicis, and longissimus cervicis, and

longissimus capitislongissimus capitis

Spinalis thoracis, spinalis Spinalis thoracis, spinalis cervicis, and spinalis capitis cervicis, and spinalis capitis

Vertical Muscles Vertical Muscles Erector Spinae Group IIErector Spinae Group II


Semispinalis thoracis, Semispinalis thoracis, semispinalis cervicis, and semispinalis cervicis, and

semispinalis capitissemispinalis capitis

MultifidusMultifidus

Oblique MusclesOblique MusclesTransversospinales Group ITransversospinales Group I


RotatoresRotatoresIntertransversarii lumborum, Intertransversarii lumborum,

intertransversarii thoracis, and intertransversarii thoracis, and intertransversarii cervicisintertransversarii cervicis

Oblique MusclesOblique MusclesTransversospinales Group IITransversospinales Group II


Interspinalis lumborum, interspinalis thoracis,Interspinalis lumborum, interspinalis thoracis,and interspinalis cervicisand interspinalis cervicis

Oblique MusclesOblique MusclesTransversospinales Group IIITransversospinales Group III


Rectus capitis posterior majorRectus capitis posterior major

Suboccipital Muscles ISuboccipital Muscles I


Rectus capitis posterior minorRectus capitis posterior minor Obliquus capitis superiorObliquus capitis superior

Suboccipital Muscles IISuboccipital Muscles II


Obliquus capitis inferiorObliquus capitis inferior

Suboccipital Muscles IIISuboccipital Muscles III


Abdominal wall muscles


Muscles of the Torso, IMuscles of the Torso, I


Arrangement of structures in

vertebral column and

back


Muscles of the Torso, IIMuscles of the Torso, II


Muscles and fascia of the

pectoral region


Muscles of the Torso, IIIMuscles of the Torso, III


DiaphragmDiaphragm

Muscles of the Thorax and Posterior Muscles of the Thorax and Posterior Abdominal Wall IAbdominal Wall I


Serratus posterior superiorSerratus posterior superior Serratus posterior inferiorSerratus posterior inferior

Muscles of the Thorax and Posterior Muscles of the Thorax and Posterior Abdominal Wall IIAbdominal Wall II


External intercostalsExternal intercostals Internal intercostalsInternal intercostals

Muscles of the Thorax and Posterior Muscles of the Thorax and Posterior Abdominal Wall IIIAbdominal Wall III


Transversus thoracisTransversus thoracis

Innermost Intercostals IInnermost Intercostals I


Quadratus lumborumQuadratus lumborum

Innermost Intercostals IIInnermost Intercostals II


Psoas majorPsoas major Psoas minorPsoas minor

Innermost Intercostals IIIInnermost Intercostals III


IliacusIliacus

Innermost Intercostals IVInnermost Intercostals IV


Transversus abdominisTransversus abdominis

Muscles of the Anterior and Muscles of the Anterior and Anterolateral Abdominal Wall IAnterolateral Abdominal Wall I


Internal abdominal obliqueInternal abdominal oblique External abdominal obliqueExternal abdominal oblique

Muscles of the Anterior and Muscles of the Anterior and Anterolateral Abdominal Wall IIAnterolateral Abdominal Wall II


Rectus abdominisRectus abdominis

Muscles of the Anterior and Muscles of the Anterior and Anterolateral Abdominal Wall IIIAnterolateral Abdominal Wall III


PyramidalisPyramidalis CremasterCremaster

Muscles of the Anterior and Muscles of the Anterior and Anterolateral Abdominal Wall IVAnterolateral Abdominal Wall IV


Sacral and coccygeal plexusesSacral and coccygeal plexuses

93

From Drake RL, Vogel W, Mitchell WM: Gray’s

Anatomy for students, Edinburgh, 2005, Churchill

Livingstone.

Pelvic and Perineal MusclesPelvic and Perineal Muscles


CoccygeusCoccygeusLevator aniLevator ani

Pelvic and Perineal Muscles IPelvic and Perineal Muscles I


External sphincter aniExternal sphincter ani Deep transverse perinealsDeep transverse perineals

Pelvic and Perineal Muscles IIPelvic and Perineal Muscles II


IschiocavernosusIschiocavernosus BulbospongiosusBulbospongiosus

Pelvic and Perineal Muscles IIIPelvic and Perineal Muscles III




• Lesson 9.4’s muscles: gluteal region, anterior Lesson 9.4’s muscles: gluteal region, anterior and lateral leg, posterior leg, and intrinsic and lateral leg, posterior leg, and intrinsic muscles of the foot.muscles of the foot.


• Some of the most powerful in the bodySome of the most powerful in the body• Extend the thigh during forceful extensionExtend the thigh during forceful extension

98


Muscles of the Gluteal RegionMuscles of the Gluteal Region

• Stabilize the Stabilize the iliotibial band iliotibial band and and thoracolumbar thoracolumbar fasciafascia

• Related to Related to shoulders and shoulders and arms because arms because of walkingof walking



Nerves of the Gluteal RegionNerves of the Gluteal Region


Gluteus maximusGluteus maximus Gluteus mediusGluteus medius

Muscles of the Gluteal Region IMuscles of the Gluteal Region I


Gluteus minimusGluteus minimus Tensor fasciae lataeTensor fasciae latae

Muscles of the Gluteal Region IIMuscles of the Gluteal Region II


PiriformisPiriformis Obturator internusObturator internus

Deep Lateral Rotators of the Thigh at Deep Lateral Rotators of the Thigh at the Hip Joint Ithe Hip Joint I


Obturator externusObturator externus Quadratus femorisQuadratus femoris

Deep Lateral Rotators of the Thigh at Deep Lateral Rotators of the Thigh at the Hip Joint IIthe Hip Joint II


Gemellus superiorGemellus superior Gemellus inferiorGemellus inferior

Deep Lateral Rotators of the Thigh at Deep Lateral Rotators of the Thigh at the Hip Joint IIIthe Hip Joint III



Muscles of the Posterior ThighMuscles of the Posterior Thigh


SemimembranosusSemimembranosus SemitendinosusSemitendinosus

Muscles of the Posterior Thigh IMuscles of the Posterior Thigh I


Biceps femorisBiceps femoris

Muscles of the Posterior Thigh IIMuscles of the Posterior Thigh II


PectineusPectineus

Muscles of the Medial Thigh IMuscles of the Medial Thigh I


Adductor brevisAdductor brevis Adductor longusAdductor longus

Muscles of the Medial Thigh IIMuscles of the Medial Thigh II


Adductor magnusAdductor magnus GracilisGracilis

Muscles of the Medial Thigh IIIMuscles of the Medial Thigh III



Muscles of the Anterior ThighMuscles of the Anterior Thigh


SartoriusSartorius

Muscles of the Anterior Thigh IMuscles of the Anterior Thigh I


Rectus femorisRectus femoris Vastus lateralisVastus lateralis

Muscles of the Anterior Thigh IIMuscles of the Anterior Thigh IIQuadriceps Femoris GroupQuadriceps Femoris Group


Vastus medialisVastus medialis Vastus intermediusVastus intermedius

Muscles of the Anterior Thigh IIIMuscles of the Anterior Thigh IIIQuadriceps Femoris GroupQuadriceps Femoris Group



Muscles of the Anterior and Muscles of the Anterior and Lateral LegLateral Leg


Tibialis anteriorTibialis anterior Extensor digitorum longusExtensor digitorum longus

Anterior Muscles IAnterior Muscles I


Extensor hallucis longusExtensor hallucis longus Fibularis (peroneus) tertiusFibularis (peroneus) tertius

Anterior Muscles IIAnterior Muscles II


Fibularis (peroneus) longusFibularis (peroneus) longus Fibularis (peroneus) brevisFibularis (peroneus) brevis

Lateral MusclesLateral Muscles



Muscles of the Posterior LegMuscles of the Posterior Leg


PopliteusPopliteus Tibialis posteriorTibialis posterior

Muscles of the Posterior Leg IMuscles of the Posterior Leg I


Flexor digitorum longusFlexor digitorum longus Flexor hallucis longusFlexor hallucis longus

Muscles of the Posterior Leg IIMuscles of the Posterior Leg II


PlantarisPlantaris SoleusSoleus

Muscles of the Posterior Leg IIIMuscles of the Posterior Leg III


GastrocnemiusGastrocnemius

Muscles of the Posterior Leg IVMuscles of the Posterior Leg IV



Intrinsic Muscles of the FootIntrinsic Muscles of the Foot


Extensor digitorum brevisExtensor digitorum brevis

Dorsal AspectDorsal Aspect


Abductor hallucisAbductor hallucis Flexor digitorum brevisFlexor digitorum brevis

Plantar Aspect: Superficial Layer IPlantar Aspect: Superficial Layer I


Abductor digiti minimi pedisAbductor digiti minimi pedis

Plantar Aspect: Superficial Layer IIPlantar Aspect: Superficial Layer II


Quadratus plantaeQuadratus plantae Lumbricales pedisLumbricales pedis

Plantar Aspect: Second LayerPlantar Aspect: Second Layer


Flexor hallucis brevisFlexor hallucis brevis Adductor hallucisAdductor hallucis

Plantar Aspect: Third Layer IPlantar Aspect: Third Layer I


Flexor digiti minimi pedisFlexor digiti minimi pedis

Plantar Aspect: Third Layer IIPlantar Aspect: Third Layer II


Interossei plantaresInterossei plantares Interossei dorsales pedisInterossei dorsales pedis

Plantar Aspect: Fourth Layer Plantar Aspect: Fourth Layer




• Lesson 9.5’s muscles: scapular stabilization, Lesson 9.5’s muscles: scapular stabilization, musculotendinous (rotator) cuff, and shoulder musculotendinous (rotator) cuff, and shoulder joint.joint.


Muscles of Scapular StabilizationMuscles of Scapular Stabilization

• Isometric functionIsometric function– Hold the scapula to the ribcageHold the scapula to the ribcage

• Move the scapula during concentric and Move the scapula during concentric and eccentric functioneccentric function

• Act together to elevate or depress the Act together to elevate or depress the scapulascapula

• Clavicular movements accompany scapular Clavicular movements accompany scapular movements movements


TrapeziusTrapezius

Muscles of Scapular Stabilization IMuscles of Scapular Stabilization I


Rhomboideus majorRhomboideus major Rhomboideus minorRhomboideus minor

Muscles of Scapular Stabilization IIMuscles of Scapular Stabilization II


Levator scapulaeLevator scapulae Pectoralis minorPectoralis minor

Muscles of Scapular Stabilization IIIMuscles of Scapular Stabilization III


Serratus anteriorSerratus anterior

Muscles of ScapularMuscles of ScapularStabilization IVStabilization IV



Right Posterior Scapular RegionRight Posterior Scapular Region


Muscles of the MusculotendinousMuscles of the Musculotendinous(Rotator) Cuff(Rotator) Cuff

• Nine muscles stabilize and move the Nine muscles stabilize and move the shoulder joint shoulder joint

• SITSSITS– SupraspinatusSupraspinatus– InfraspinatusInfraspinatus– Teres minorTeres minor– SubscapularisSubscapularis

• All but subscapularis accessible during All but subscapularis accessible during massage massage


SupraspinatusSupraspinatus InfraspinatusInfraspinatus

Rotator Cuff Muscles IRotator Cuff Muscles I


Teres minorTeres minor SubscapularisSubscapularis

Rotator Cuff Muscles IIRotator Cuff Muscles II



Muscles of the Shoulder JointMuscles of the Shoulder Joint


DeltoidDeltoid Pectoralis majorPectoralis major

Muscles of the Shoulder Joint IMuscles of the Shoulder Joint I


SubclaviusSubclavius Latissimus dorsiLatissimus dorsi

Muscles of the Shoulder Joint IIMuscles of the Shoulder Joint II


Teres majorTeres major CoracobrachialisCoracobrachialis

Muscles of the Shoulder Joint IIIMuscles of the Shoulder Joint III




• Lesson 9.6’s muscles: elbow and radioulnar Lesson 9.6’s muscles: elbow and radioulnar joints, wrist and hand joints, and intrinsic joints, wrist and hand joints, and intrinsic muscles of the hand.muscles of the hand.


Muscles of the Elbow and Radioulnar Muscles of the Elbow and Radioulnar JointJoint

• Elbow: a hinge jointElbow: a hinge joint– Limited to flexion and extension of the forearmLimited to flexion and extension of the forearm– Posterior: extensionPosterior: extension– Anterior: flexionAnterior: flexion

• Strongest elbow flexor: brachialisStrongest elbow flexor: brachialis



Biceps Brachii and Brachialis Biceps Brachii and Brachialis MusclesMuscles



Deep Muscles in Posterior ForearmDeep Muscles in Posterior Forearm



Cross Section of ArmCross Section of Arm


Biceps brachiiBiceps brachii BrachialisBrachialis

Muscles of the Elbow and Radioulnar Muscles of the Elbow and Radioulnar Joint IJoint I


BrachioradialisBrachioradialis Pronator teresPronator teres

Muscles of the Elbow and Radioulnar Muscles of the Elbow and Radioulnar Joint IIJoint II


SupinatorSupinator Pronator quadratusPronator quadratus

Muscles of the Elbow and Radioulnar Muscles of the Elbow and Radioulnar Joint IIIJoint III


Triceps brachiiTriceps brachii AnconeusAnconeus

Muscles of the Elbow and Radioulnar Muscles of the Elbow and Radioulnar Joint IVJoint IV



Muscles of the WristMuscles of the Wristand Hand Jointsand Hand Joints


Flexor carpi radialisFlexor carpi radialis Palmaris longusPalmaris longus

Anterior Flexor Group: Anterior Flexor Group: Superficial Layer ISuperficial Layer I


Flexor carpi ulnarisFlexor carpi ulnaris

Anterior Flexor Group: Anterior Flexor Group: Superficial Layer IISuperficial Layer II


Flexor digitorum superficialisFlexor digitorum superficialis

Anterior Flexor Group:Anterior Flexor Group:Intermediate LayerIntermediate Layer


Flexor digitorum profundusFlexor digitorum profundus Flexor pollicis longusFlexor pollicis longus

Anterior Flexor Group:Anterior Flexor Group:Deep LayerDeep Layer


Extensor carpi radialis longusExtensor carpi radialis longus Extensor carpi radialis brevisExtensor carpi radialis brevis

Posterior Extensor Group:Posterior Extensor Group:Superficial Layer ISuperficial Layer I


Extensor digitorumExtensor digitorum Extensor digiti minimiExtensor digiti minimi

Posterior Extensor Group:Posterior Extensor Group:Superficial Layer IISuperficial Layer II


Extensor carpi ulnarisExtensor carpi ulnaris

Posterior Extensor Group:Posterior Extensor Group:Superficial Layer IIISuperficial Layer III


Extensor pollicis brevisExtensor pollicis brevis Abductor pollicis longusAbductor pollicis longus

Posterior Extensor Group:Posterior Extensor Group:Deep Layer IDeep Layer I


Extensor pollicis longusExtensor pollicis longus Extensor indicisExtensor indicis

Posterior Extensor Group:Posterior Extensor Group:Deep Layer IIDeep Layer II


Opponens pollicisOpponens pollicis

Intrinsic Muscles of the Hand:Intrinsic Muscles of the Hand:Thenar Eminence Muscles IThenar Eminence Muscles I


Abductor pollicis brevisAbductor pollicis brevis Flexor pollicis brevisFlexor pollicis brevis

Intrinsic Muscles of the Hand:Intrinsic Muscles of the Hand:Thenar Eminence Muscles IIThenar Eminence Muscles II


Opponens digiti minimiOpponens digiti minimi Abductor digitiAbductor digiti

minimi manusminimi manus

Hypothenar Muscles IHypothenar Muscles I


Flexor digiti minimi manusFlexor digiti minimi manus

Hypothenar Muscles IIHypothenar Muscles II


Adductor pollicisAdductor pollicis Interossei palmaresInterossei palmares

Central Compartment Muscles ICentral Compartment Muscles I


Interossei dorsales manusInterossei dorsales manus Lumbricales manusLumbricales manus

Central Compartment Muscles IICentral Compartment Muscles II


• Apply knowledge of the muscular system to Apply knowledge of the muscular system to therapeutic massage application.therapeutic massage application.

171

Lesson 9.7 ObjectiveLesson 9.7 Objective


Mechanisms of Disease, IMechanisms of Disease, I

• Causal factors increase muscle tension Causal factors increase muscle tension • Tension leads to localized ischemia and Tension leads to localized ischemia and

edema edema • Pain results Pain results • Pain leads to spasm; spasm increases pain Pain leads to spasm; spasm increases pain • Inflammation or chronic irritation may result Inflammation or chronic irritation may result • Stations in tense tissue report to CNS, which Stations in tense tissue report to CNS, which

leads to hyperactivity leads to hyperactivity


Mechanisms of Disease, IIMechanisms of Disease, II

• Macrophages and fibroblasts are activatedMacrophages and fibroblasts are activated• Connective tissue production increasesConnective tissue production increases• Distortions in one area could create distortions Distortions in one area could create distortions

elsewhereelsewhere• Chronic hypertension and fibrotic changes may Chronic hypertension and fibrotic changes may

occuroccur• Chain reactions occur in myotatic unitsChain reactions occur in myotatic units• Sustained tension results in ischemia in Sustained tension results in ischemia in

tendinous areastendinous areas


Mechanisms of Disease, IIIMechanisms of Disease, III

• Abnormal biomechanics and bodywide Abnormal biomechanics and bodywide compensatory patterns developcompensatory patterns develop

• Joint restriction and imbalance may occurJoint restriction and imbalance may occur

• Trigger points developTrigger points develop

• Generalized fatigue developsGeneralized fatigue develops

• Sympathetic arousal is heightenedSympathetic arousal is heightened

• Immune response is inhibitedImmune response is inhibited

• Massage intervention and medication can helpMassage intervention and medication can help

Medications Medications

• Antibiotics Antibiotics – Treat bacterial infectionsTreat bacterial infections

• Steroids and NSAID (non-steroidal anti-Steroids and NSAID (non-steroidal anti-inflammatory drugs)inflammatory drugs)– Help ease inflammationHelp ease inflammation

• Muscle RelaxantsMuscle Relaxants– Sooth spasms and hypertonic muscles Sooth spasms and hypertonic muscles

• AnalgesicsAnalgesics– Pain relieversPain relievers

• Antidepressants Antidepressants – Help restore sleep Help restore sleep


MedicationsMedications

• Any medication, prescribed, over the counter, Any medication, prescribed, over the counter, or herbal or homeopathic remedies have an or herbal or homeopathic remedies have an effect on the client and therefore must be effect on the client and therefore must be taken into consideration when developing a taken into consideration when developing a treatment plantreatment plan



Specific Disorders, ISpecific Disorders, I• Carpal tunnel syndromeCarpal tunnel syndrome

– Irritation of the median nerve as it passes through the transverse Irritation of the median nerve as it passes through the transverse carpal lig.carpal lig.

• Pain, tingling, numbness, weaknessPain, tingling, numbness, weakness

• Thoracic outlet syndromeThoracic outlet syndrome– Impingement of the brachial plexus and blood supply of the arm Impingement of the brachial plexus and blood supply of the arm

• Shooting pain, weakness, numbness, discoloration of the arm can also Shooting pain, weakness, numbness, discoloration of the arm can also occuroccur

• Stress-induced muscle tension and headacheStress-induced muscle tension and headache– Contraction of the muscles puts pressure on the nervesContraction of the muscles puts pressure on the nerves

• Dull, persistent ache, with a feeling of tightnessDull, persistent ache, with a feeling of tightness

• Muscle strainMuscle strain– Overstretching or tearing of muscle fibers Overstretching or tearing of muscle fibers

• Repair takes weeks and some muscle fibers may be replaced with fibrous Repair takes weeks and some muscle fibers may be replaced with fibrous tissue tissue

Specific Disorders, IISpecific Disorders, II• ContusionContusion

– Bruise or bleeding under the skin, inflammationBruise or bleeding under the skin, inflammation– Crush injury can result in myoglobin in the blood causing Crush injury can result in myoglobin in the blood causing

kidney failurekidney failure• Muscle infectionsMuscle infections

– Bacterial, viral, parasiticBacterial, viral, parasitic• Often produces local or widespread myositis Often produces local or widespread myositis

• PoliomyelitisPoliomyelitis– Viral infection of the nerves affecting the musculoskeletal Viral infection of the nerves affecting the musculoskeletal

sys. sys. • Myositis ossificansMyositis ossificans

– Inflammation process that produces osseous tissue in the Inflammation process that produces osseous tissue in the fascicles of muscle.fascicles of muscle.



Specific Disorders, IIISpecific Disorders, III

• Tendonitis and tenosynovitisTendonitis and tenosynovitis– Inflammation of tendon/tendon sheathInflammation of tendon/tendon sheath

• Caused by trauma or overuse, or systemic inflammatory Caused by trauma or overuse, or systemic inflammatory disease (e.g. RA) disease (e.g. RA)

• Cramps/spasmsCramps/spasms– Painful muscle spasms or involuntary twitchesPainful muscle spasms or involuntary twitches

• Flaccidity and spasticityFlaccidity and spasticity– Muscle with decreased tone vs. excessive toneMuscle with decreased tone vs. excessive tone

• ContractureContracture– Chronic shortening of a muscle Chronic shortening of a muscle

Specific Disorders, IVSpecific Disorders, IV• Muscular dystrophyMuscular dystrophy

– Atrophy of skeletal muscle with no mal-function of the nervous Atrophy of skeletal muscle with no mal-function of the nervous sys.sys.

• Amyotrophic lateral sclerosisAmyotrophic lateral sclerosis– Lou Gehrig’s Disease, characterized by tripping, stumbling, and Lou Gehrig’s Disease, characterized by tripping, stumbling, and

falling; loss of muscle control and strength in hands and arms; falling; loss of muscle control and strength in hands and arms; difficulty speaking, swallowing or breathing; chronic fatigue, difficulty speaking, swallowing or breathing; chronic fatigue, muscle twitching or crampsmuscle twitching or cramps

• Myasthenia gravisMyasthenia gravis– Autoimmune disease in which the immune sys. Attacks the Autoimmune disease in which the immune sys. Attacks the

muscle cells at neuromuscular junctions affecting ACH, therefore muscle cells at neuromuscular junctions affecting ACH, therefore nerve impulses are unable to stimulate the muscle fully nerve impulses are unable to stimulate the muscle fully

• HerniaHernia– Protrusion of an abdominal organ through the muscular wall Protrusion of an abdominal organ through the muscular wall



Specific Disorders, VSpecific Disorders, V

• Torticollis Torticollis – spasm or shortening of SCMspasm or shortening of SCM

• Whiplash Whiplash – sudden hyperextension or flexion causing damage to soft sudden hyperextension or flexion causing damage to soft

tissue of the neck tissue of the neck

• Dupuytren’s contractureDupuytren’s contracture• Rotator cuff tearRotator cuff tear

– Overuse or impingement may weaken the muscles of the Overuse or impingement may weaken the muscles of the rotator cuff can cause partial or complete tearsrotator cuff can cause partial or complete tears

– Weakness, atrophy, pain or tenderness may occurWeakness, atrophy, pain or tenderness may occur

Specific Disorders, VISpecific Disorders, VI• Shin splintsShin splints

– Inflammation or tearing of the muscle from the tibia, usually tibialis Inflammation or tearing of the muscle from the tibia, usually tibialis anterior, can also result in stress fracturesanterior, can also result in stress fractures

• Anterior compartment syndromeAnterior compartment syndrome– Any condition that increases pressure in the compartment of the leg can Any condition that increases pressure in the compartment of the leg can

cut off blood supply and nerve function cut off blood supply and nerve function – Overuse, repetitive stress and accelerated growth are common factorsOveruse, repetitive stress and accelerated growth are common factors

• Plantar fasciitisPlantar fasciitis– Inflammation and slight tearing of the plantar fasciaInflammation and slight tearing of the plantar fascia– Caused by excessive stress to the foot commonly near the attachment to Caused by excessive stress to the foot commonly near the attachment to

the clacaneus (stress causes calcium deposits, which can cause bone the clacaneus (stress causes calcium deposits, which can cause bone spurs)spurs)

• FibromyalgiaFibromyalgia– Aching, fatigue, stiffness, sleep disruption, multiple tender points, Aching, fatigue, stiffness, sleep disruption, multiple tender points,

headaches, irritable bladder, dysmenorrhea, cold sensitivity, restless leg, headaches, irritable bladder, dysmenorrhea, cold sensitivity, restless leg, Raynaud’s Phenomenon, numbness, tingling, and weakness Raynaud’s Phenomenon, numbness, tingling, and weakness

• Acquired metabolic and toxic myopathiesAcquired metabolic and toxic myopathies– Nutritional and vitamin deficiency, especially protein and vitamin C, D. E, Nutritional and vitamin deficiency, especially protein and vitamin C, D. E,

may lead to myopathy may lead to myopathy

Massage and InflammationMassage and Inflammation

• Acute phase (first 72 hours) massage is Acute phase (first 72 hours) massage is usually contraindicatedusually contraindicated

• RICE RICE • Chronic massage is usually indicated Chronic massage is usually indicated • If massage could increase the inflammatory If massage could increase the inflammatory

response it is contraindicated response it is contraindicated


Mosbys Essential Sciences for Therapeutic Massage Chapter 9: Muscles Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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