Chapter 2

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

Figure 1

Fundamental (Physiological) Position

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.

Figure 2

Reference Positions – Starting Points

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

CAPTION

CAPTION

Reference Curve: The convex side of the curve or rotation of the vertebral body, as compared to the concave side

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)

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

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.

Planes of Motion

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.

Figure 11

Plqnes of Motion

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.

Axes of Rotation

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.

Figure 12

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.

Fill in the following table:

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)

Figure 13

Syndesmosis

Held together bystrong ligaments

Figure 14

Symphysis

Separated by a fibrocartilage pad

Figure 15

Synchondrosis

Separated by hyaline cartilage

Diarthrodial (freely moveable)

Figure 16

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

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.

ClassificationName General Name	Planes of MotionAxes of RotationDegrees 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	HumeroulnarTibiotarsalTibiofemoral (dual) InterphalangealMetacarpophalangeal of the thumb
Condyloid	Two Planes of Motion (Biaxial) Two degrees of freedom	MetacarpophalangealRadiocarpal Atlantooccipital Metatarsophalangeal
Trochoidal(Pivot)	One Plane of Motion (Uniaxial) One degree of freedom	Radioulnar (proximal & distal) AtlantoaxialTibiofemoral (dual)
Enarthrodial (Ball & Socket)	Three Planes of Motion (Triaxial) Three degrees of freedom	AcetabulofemoralGlenohumeralHumeroradial (Atypical Ball & Socket - biaxial)
Sellar (Saddle)	Three Planes of Motion (Triaxial) Three degrees of freedom	Carpometacarpal of thumb Sternoclavicular (Complex Saddle)
Arthrodial (Gliding)	Three Planes of Motion (Triaxial) Three degrees of freedom	Upper BodyVertebral FacetsCostovertebral CostotransverseSternocostalAcromioclavicular IntercarpalIntermetacarpalCaropmetacarpal	Lower BodySacroiliacPatellofemoralIntertarsalSubtalarTarsometatarsalIntermetatarsal

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”)

Figure 22

Example #1

Figure 23

Exampe #2

Fill in the following table for practice:

Anatomical (Osteokinematic) Movement Terms Specific to the Shoulder Girdle

Figure 24

Plane of Motion:Axis if Rotation

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).

Anatomical (Osteokinematic) Movement Terms Specific to the Shoulder Joint

Figure 25

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: ___________________________

Figure 26

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: ___________________________

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: ___________________________

Figure 27

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: ___________________________

Figure 28

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)

Figure 29

Anatomical (Osteokinematic) Movement Terms Specific to the Hip

Figure 30

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: ___________________________

Figure 31

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: ___________________________

Figure 32

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

Figure 33

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.

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:

Figure 34

Arthrokinematic Motion

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.

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 35

Figure 36

Arthrokinematic Rules:

1. There is usually some glide/slide that accompanies roll

2. 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.

3. Roll will always occur in the same direction as the moving bone/segment

4. 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

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?

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.

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.