Learning Outcomes: Students will be able to: - Effectively communicate, using proper terminology, anatomical positions, joint movements, and anatomical deviations from the norm.
- Describe the various movements that take place at joints and the planes of motion and axes of rotation in which these movements occur.
- Properly classify and describe the characteristics of the diarthrodial joints of the body.
- Describe the osteokinematic movements that take place at each of the various diarthrodial joints of the body, and be able to apply them in the analysis of various movements.
- Understand the fundamental rules governing arthrokinematic motions that can take place between the joint surfaces of the diarthrodial joints of the body, and be able to apply them in the analysis of various movements.
- Describe the characteristics of open-pack and closed-packed joint positions and the general application of this knowledge as it pertains to joint injury evaluation and joint mobilization interventions.
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Reference Positions – Starting Points |
Anatomical position  Figure 1
The human body is constantly moving and capable of numerous movements wherein the relationship between various body segments change. To accurately describe these movements a specific body position was selected to serve as a starting point from which all movement could be referenced. This is known as anatomical position. | Fundamental (Physiological) Position  Figure 2
The fundamental position is similar to the anatomical position except that the palms face the body. This is how the body naturally positions itself and is often used in discussing rotation of the upper extremity. |
Reference Segment and Reference Curve for Identification of Anatomical Deviations |
Reference Segment: The Distal Segment, in relation to the joint where the “problem” is occurring   Figure 6 Figure 7 |
Reference Curve: The convex side of the curve or rotation of the vertebral body, as compared to the concave side  Figure 8 |
Anatomical Directional Terminology Specific terms are used to describe the location of a structure and its position relative to other structures. |
Anterior - In front. Toward the front (Anteroinferior, Anterosuperior, Anterolateral, Anteromedial) Posterior - In back. Toward the back (Posteroinferior, Posterosuperior, Posterolateral, Posteromedial) Superior - Above in relation to another structure (Superolateral, Superomedial) Inferior Below in relation to another structure (Inferolateral, Inferomedial) Medial - Nearer to the midline. Toward the middle Lateral – Farther from the midline. Toward the outside Dorsal – Relating to the back. Upper surface (prone position) Ventral – Relating to the abdomen. Lower surface (prone position) Proximal – Nearest the point of origin (extremity) Distal – Farther from point of origin (extremity) Palmar – Relating to the palm or volar aspect of the hand Plantar – Relating to the sole or volar aspect of the foot Ulnar – closer to or toward the ulna Radial – closer to or toward the radius Tibial – closer to or toward the tibia Fibular – closer to or toward the fibula Cephalic – Above in relation to another structure. Toward the head Caudal – Below in relation to another structure. Toward the tail Volar – Relating to palm of hand or sole of foot Dorsum – Superior surface of an anterior projecting structure Prone – Face down position Supine – Face up position Ipsilateral – Pertaining to the same side Contralateral – Pertaining to the opposite side Unilateral – Pertaining to one side Bilateral – Pertaining to both sides Superficial – Near the surface (describes depth) Deep – Below the surface (describes depth)
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Figure 9
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General Anatomical/Medical Terms |
Cubitus – elbow Coxa – hip Genu – knee Pes – foot Pollux – thumb Hallux – big toe
Talipes – congenital club foot problem Equino/Equinus – extreme plantarflexion Calcaneo/Calcaneus – extreme dorsiflexion Recurvatum – backward or reverse curve Varum/Varus/Vara – distal segment nearer midline Valgum/Valgus/Valga – distal segment farther from midline
Plana – flat Cavus – cave like (high arch) Acquired – not present at birth Congenital – present at birth Etiology – the cause of Idiopathic – the cause is unknown
Contracture – the abnormal and relatively permanent shortening of a tissue/muscle Elongation – the relatively permanent lengthening of a tissue/muscle Hypertrophy – increased growth Atrophy – diminished growth
|      Figure 10 |
Types of Motion – Displacement of the body or one of its segments from one point to another |
As stated, kinesiology is the analysis of motion. Motion is fundamental to physical activities, rehabilitation, etc. Specific to the body, motion is generally produced, or at least started, by muscular action. Basically there are two types of motion: linear motion and angular motion.
Linear Motion (also known as translatory motion) is motion that takes place along a line from one location to another. All parts of the object move the same distance, in the same direction, and at the same time.
- Rectilinear motion: when the motion is along a straight line. (e.g., sledding down a hill, running from home plate to first base, jumping up to get a rebound)
- Curvilinear: when the motion is along a curved line. (e.g., skiing down a mountain, running from first base to third base)
Angular Motion (also known as rotary motion) is motion that takes place around a fixed point or axis. All parts of the object move through the same angle, in the same direction, and at the same time – but they do not move the same distance.
- Movement of joints through a range of motion.
When you consider physical activities in which a person might engage, both types of motion are involved. The angular motion of joints working together produces the linear motion of walking, running or jumping, or the linear motion of a thrown or struck object.
To describe motion of the human body, we need to describe or map the space through which motion occurs. Because space is three-dimensional we need to describe the three dimensions of space. We describe them with a plane.
A plane, or plane of motion, is an imaginary flat surface that cuts through space. The human body, or a part of the body, may move in each of these three dimensions. The three types of planes are sagittal, frontal, and transverse.
A. Sagittal Plane: divides the body into left and right portions, running in an anteroposterior (or posterior to anterior) direction. B. Frontal Plane (also called coronal): divides the body into anterior and posterior portions, running in a left to right (or right to left) direction. It can also be described as running in a medial to lateral (or lateral to medial) direction. C. Transverse Plane (also called horizontal): divides the body into superior and inferior portions, where the body part stays in place and spins. Oblique Plane: is a combination of the sagittal and frontal planes.
Note: these three cardinal planes are defined relative to anatomical position. Whenever a plane passes through the midline of a body, whether it is the sagittal, frontal, or transverse plane, it is referred to as a cardinal plane, because it divides the body into equal parts. The point where the three cardinal planes intersect is the center of gravity. |
 Figure 11 |
As a body segment moves through a plane of motion it rotates around an axis. An axis is an imaginary line around which motion occurs. This is often referred to as axial movement, or rotary movement. Therefore, for each one of the planes of the body, a corresponding axis exists. This axis is always perpendicular to the plane of motion or has a 90º relationship with the plane.
Cardinal Axes A. Frontal Axis (mediolateral axis): a line that runs from medial to lateral. Movements that occur in the sagittal plane move around a frontal or mediolateral axis. B. Sagittal Axis (anteroposterior axis): a line that runs from anterior to posterior. Movements that occur in the frontal plane move around a sagittal or anteroposterior axis. C. Vertical or Longitudinal Axis (superoinferior axis): a line that runs superior to inferior. Movements that occur in a transverse plane moves around a vertical/longitudinal or superoinferior axis. |
Figure 12 |
Fill in the following table:
Plane of Motion | Description of Plane | Axis of Rotation | Description of Axis | Common Movements |
Sagittal
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| Runs medial - lateral |
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| Divides body into anterior and posterior |
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| Abduction Adduction |
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| Longitudinal/Vertical |
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Diagonal/oblique
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Joints – the union/articulation of two or more bones |
Simply defined a joint is the union between two or more bones. The primary function of a joint is to allow movement. The movement at a joint is created by muscle contraction acting on the bone or bones forming the joint. Ligaments and joint capsules function to limit excessive or undesired movement at a joint. Therefore, joints allow movement; muscles create movement, and ligaments and joint capsules limit movement at the joint. In addition to allowing movement, joints have three other functions:
- Weight bearing: joints of the lower extremity and the spine (very stable)
- Shock absorption: cushioning effect of the fluid within the joint cavity or separating discs
- Stability: sufficiently stable to prevent injury and yet allow motion. Mobility and stability are antagonistic characteristics, therefore, the more mobile a joint is the less stable it is, the more stable a joint is the less mobile it is.
Joints are classified according to structure or function.
- Structural Classification: Fibrous, Cartilaginous, Synovial
- Functional (Kinesiological) Classification: Synarthrodial, Amphiarthrodial, and Diarthrodial
Synarthrodial (immoveable) |
- Suture: union of skull bones
- Gomphosis: teeth in socket
Amphiarthrodial (slightly moveable) |
Syndesmosis: Held together by strong ligaments  Figure 13 | Symphysis: Separated by a fibrocartilage pad 
Figure 14 | Synchondrosis: Separated by hyaline cartilage 
Figure 15 |
Diarthrodial (freely moveable) |
Components of a Diarthrodial (Synovial) Joint - Articular surfaces and articular joint capsule
- Synovial membrane layer of the joint capsule
- Synovial fluid
- Articular hyaline cartilage lining the articulating surfaces of the bones
- Synovial cavity
- Accessory Structures: Ligaments, Muscles, Bursae
Note: The joint surface shape affects the type of motion that can occur at the joint. All joint surfaces are either: 1. Ovoid – convex-concave relationship 2. Seller – convex in one direction and concave in the other direction |
 Figure 16 |
Classification of Diarthrodial (Synovial) Joints |
There are six classifications of diarthrodial joints, each having motion in one or more planes. If a joint has motion in only one plane it is often referred to as having one degree of freedom, whereas joints having motion in two or three planes are described as having two or three degrees of freedom, respectively.
Classification Name General Name | Planes of Motion Axes of Rotation Degrees of Freedom | Joints (anatomical name) | Joints Images
Figures 17, 18, 19, 20, 21 below |
Ginglymus (Hinge) | One Plane of Motion
(Uniaxial)
One degree of freedom | Humeroulnar Tibiotarsal Tibiofemoral (dual) Interphalangeal Metacarpophalangeal of the thumb |    
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Condyloid (Concave-Convex) | Two Planes of Motion
(Biaxial)
Two degrees of freedom | Metacarpophalangeal Radiocarpal Atlantooccipital Metatarsophalangeal |    
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Trochoidal (Pivot)
| One Plane of Motion
(Uniaxial)
One degree of freedom | Radioulnar (proximal & distal) Atlantoaxial Tibiofemoral (dual) |  
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Enarthrodial (Ball & Socket) | Three Planes of Motion
(Triaxial)
Three degrees of freedom
| Acetabulofemoral Glenohumeral Humeroradial (Atypical Ball & Socket - biaxial) |   
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Sellar (Saddle) | Three Planes of Motion
(Triaxial)
Three degrees of freedom
| Carpometacarpal of thumb Sternoclavicular (Complex Saddle) |  
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Arthrodial (Gliding) | Three Planes of Motion
(Triaxial)
Three degrees of freedom | Upper Body Vertebral Facets Costovertebral Costotransverse Sternocostal Acromioclavicular Intercarpal Intermetacarpal Caropmetacarpal | Lower Body Sacroiliac Patellofemoral Intertarsal Subtalar Tarsometatarsal Intermetatarsal |
Joint Movements – Types and Terminology |
Osteokinematic Motion - motion that takes place by the bones moving through a plane of motion about an axis. Said another way, movement is the change in relationship between segments. Movement Terminology are the terms used to describe the actual change in position of the bones relative to each other. The specific amount of movement in a joint can be measured using an instrument called a goniometer.
Differentiate between movement (dynamic – “ion”) and position (static – “ed”)
Example #1:
Figure 22 | Example #2:
 Figure 23 |
Fill in the following table for practice:
General Anatomical (Osteokinematic) Movement Terms – common among a number of joints |
Abduction – lateral movement away from body midline. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
| Adduction – medial movement toward body Midline. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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Flexion – movement resulting in a decrease of the joint angle. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
| Extension – movement resulting in an increase of the joint angle. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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Circumduction – circular movement. Combination of Flexion/extension and abduction/adduction Plane of Motion: ___________________________ Axis of Rotation: ___________________________
| Diagonal Abduction – movement of limb through a diagonal plane away from body midline. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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Diagonal Adduction – movement of a limb through a diagonal plane toward or across body midline. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
| Internal Rotation – rotary movement around the longitudinal axis of bone toward body midline. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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External Rotation – rotary movement around longitudinal axis of bone away from midline. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
| Hyperextension – extension movement beyond anatomical position. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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Anatomical (Osteokinematic) Movement Terms Specific to the Shoulder Girdle |
a. Elevation – superior movement of shoulder girdle (scapula).
b. Protraction (Scapular Abduction) – lateral movement of shoulder girdle away from spine.
c. Depression – inferior movement of shoulder girdle (scapula).
d. Retraction (Scapular Adduction) – medial movement of shoulder girdle toward spine.
e. Upward Rotation – upward rotary movement of Scapula (acromion process = superomedial).
f. Downward Rotation – downward rotary movement of Scapula (acromion process = inferolateral).
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Figure 24
Plane of Motion: _______________________ Axis of Rotation: _______________________ |
Anatomical (Osteokinematic) Movement Terms Specific to the Shoulder Joint |
a. Flexion – movement resulting in a decrease of the joint angle. Humerus moves anterior.
b. Extension – movement resulting in an increase of the joint angle. Humerus moves posterior. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
c. Abduction – lateral movement away from body midline. Humerus moves lateral.
d. Adduction – medial movement toward body Midline. Humerus moves medial. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
e. Horizontal Abduction – shoulder movement of humerus (90° abd.) away from body midline.
f. Horizontal Adduction - shoulder movement of humerus (90° abd.) toward body midline. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
g. External Rotation – shoulder rotary movement around longitudinal axis of bone away from midline.
h. Internal Rotation – shoulder rotary movement around the longitudinal axis of bone toward body midline. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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Figure 25
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Anatomical (Osteokinematic) Movement Terms Specific to the Elbow Joint & Radiounlar Joint |
a. Extension – elbow movement resulting in an increase of the joint angle, forearm moves back to anatomical position.
b. Flexion – elbow movement resulting in a decrease of the joint angle, forearm moves away from anatomical position. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
c. Supination – external rotation of radius/forearm. Palm turns up.
d. Pronation – internal rotation of radius/forearm. Palm turns down. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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Figure 26 |
Anatomical (Osteokinematic) Movement Terms Specific to the Wrist |
Ulnar Deviation – wrist movement with little finger side of hand moving toward medial forearm.
Radial Deviation – wrist movement with thumb side of hand moving toward lateral forearm. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
Flexion – wrist movement with palmer aspect of hand moving toward anterior forearm.
Extension – wrist movement with dorsal aspect of hand moving toward posterior forearm. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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Figure 27 |
Anatomical (Osteokinematic) Movement Terms Specific to the Pelvis |
a. Anterior Pelvic Tilt/Rotation – anterior part of pelvis tilts downward.
b. Posterior Pelvic Tilt/Rotation – posterior part of pelvis tilts downward.
c. Lateral Pelvic Tilt/Rotation (right or left) – indicated side tilts downward, opposite side elevates.
d. Transverse Pelvic Tilt/Rotation (right or left) – trunk turns toward indicated direction, with movement taking place primarily at the hip joints (internal and external respectively)
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Figure 28 |
Anatomical (Osteokinematic) Movement Terms Specific to the Hip |
a. Flexion – hip movement resulting in a decrease of the joint angle. Femur move anterior.
b. Extension – hip movement resulting in an increase of the joint angle. Femur moves posterior. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
c. Internal Rotation – hip rotary movement around the longitudinal axis of bone toward body midline.
d. External Rotation – hip rotary movement around longitudinal axis of bone away from midline. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
e. Abduction – hip lateral movement away from body midline. Femur moves lateral.
f. Adduction – hip medial movement toward body Midline. Femur moves medial. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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 Figure 29 |
Anatomical (Osteokinematic) Movement Terms Specific to the Knee |
a. Flexion – knee movement resulting in a decrease of the joint angle. Tibia move posterior.
b. Extension – knee movement resulting in an increase of the joint angle. Tibia moves anterior. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
c. Internal Rotation – knee rotary movement around the longitudinal axis of bone toward body midline.
d. External Rotation – knee rotary movement around longitudinal axis of bone away from midline. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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Figure 30 |
Anatomical (Osteokinematic) Movement Terms Specific to the Ankle and Foot |
a. Plantarflexion – extension movement of ankle. Toes move away from body. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
b. Dorsiflexion – flexion movement of ankle. Top of foot moves toward anterior tibia. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
c. Inversion – foot movement turning sole of foot inward. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
d. Eversion – foot movement turning sole of foot outward. Plane of Motion: ___________________________ Axis of Rotation: ___________________________
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Figure 31 |
Anatomical (Osteokinematic) Movement Terms Specific to the Spine |
a. Flexion – forward movement of neck or trunk.
b. Extension – backward movement of the neck or trunk. Plane of Motion: _________________ Axis of Rotation: _________________
c. Lateral Flexion – movement of neck and/or trunk to side away from midline (side bending). Plane of Motion: _________________ Axis of Rotation: _________________
Reduction - return of the spinal column to the anatomical Position.
d. Rotation – right or left spinal rotation.
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Figure 32 |
Anatomical (Osteokinematic) Movement Terms Specific to the Caropmetacarpal Joint of the Thumb |
a. Adduction: CMC movement from abducted position back to anatomical position in the sagittal plane.
b. Abduction (Short Abduction) – CMC movement with thumb moving away from palm in the sagittal plane.
c. Extension (Long Abduction) – CMC movement of thumb moving away from hand in frontal plane.
d. Flexion: CMC movement across the palm in the frontal plane.
e. Thumb Opposition – CMC movement of the thumb across the palm to make contact with fingers. This movement is the combination of CMC abduction, flexion, and internal rotation.
f. Thumb Reposition – CMC movement of the thumb back to the anatomical position from opposition. This movement is the combination of CMC adduction, extension, and external rotation.
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Figure 33 |
Anatomical (Osteokinematic) Movement Terms Specific to the Mandible |
Protrusion – forward thrusting of jaw. Plane: | Retrusion – movement of jaw back to anatomical position from protrusion. Plane: |
In order for osteokinematic movements to occur there must be movement at the actual articular surfaces of the joint. This is known as arthrokinematic motion. The three types of arthrokinematic motion are:
Spin – A single point on one articular surface rotates about a single point on another articular surface. Example: A top spinning on a surface. | Roll – a series of points on one articular surface contacts with a series of points on another articular surface. Example: A tire rolling across a surface. | Glide/Slide– a specific point on one articulating surface comes in contact with a series of points on another surface. Example: A block sliding across a surface. |
Figure 34 |
Figure 35 |
Figure 36 |
Arthrokinematic Rules:
- There is usually some glide/slide that accompanies roll
- The shape of joint surfaces and the congruency (maximal contact of joint surfaces) of the joint determine the movements. The greater the congruency of a joint the more glide/slide motion that occurs.
- Roll will always occur in the same direction as the moving bone/segment
- Glide/slide movement depends on which surface is moving in a particular movement:
- Convex surface will always move (glide/slide) in the opposite direction as the roll
- Concave surface will always move (glide/slide) in the same direction as the roll
 Figure 37
Is this a concave on convex, or a convex on concave movement? Is the roll anterior, posterior, medial, or lateral? How would you describe the glide/slide?
|  Figure 38
At the knee joint is this a concave-convex or a convex-concave movement? How would you describe the roll? How would you describe the glide/slide? |
 Figure 39 Is this a concave-convex or a convex-concave movement? Is the roll medial, lateral, anterior, or inferior? How would you describe the glide/slide? |  Figure 40 Is this a concave-convex or a convex-concave movement? How would you describe the roll? How would you describe the glide/slide? |
 Figure 41 Is this a concave on convex, or a convex on concave movement? Is the roll anterior, posterior, medial, or lateral? How would you describe the glide/slide? |  Figure 42 Is this a concave on convex, or a convex on concave movement? Is the roll anterior, posterior, medial, or lateral? How would you describe the glide/slide?
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Knowing what you do about arthrokinematics, what movement would you want to limit or avoid if you had a total shoulder replacement with an anterior entry?
| Knowing what you do about arthrokinematics, what movement would you want to limit or avoid if you had a total hip replacement with a posterior entry?
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Joint Open-Pack and Closed-Pack Positions |
How well a joint’s surfaces fit together, match or lineup is referred to as joint congruency. As a joint moves through a plane of motion, the degree of alignment or matching can change.
Characteristics of Close-Packed Position of a Joint: 1. The joint surfaces that make up the joint are in maximum contact with each other (well matched or lined up). This is referred to as congruency. 2. The joint is compressed together tightly via tension, allowing very little joint play or movement. 3. The joint capsule and ligaments that stabilize the joint are taut. - Example of a closed-pack position: Shoulder abducted 90° and fully externally rotated.
Note: It is in the closed-pack position that a joint is usually tested for its stability and integrity. It is also in this position that a joint is vulnerable to injury.
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Characteristics of Open/Loose-Packed Position of a Joint: 1. The joint surfaces are in minimal contact with each other. This is referred to as incongruence. 2. The joint is loose as parts of the joint capsule and associated ligaments are lax. 3. Arthrokinematic motions of roll, glide, and spin can best occur. - Example of an open-pack position: Shoulder abducted 55º, horizontally adducted 30º
Note: It is in the open pack position that joint mobilization techniques are best applied.
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