Objective

Athletes move; therefore, the massage therapist who works with athletes needs to understand kinesiology. Kinesiology for the purposes of this text is the study of body movement and the factors that limit or enhance the capacity to move, which affects performance. Kinesiology is a multidisciplinary science encompassing anatomy, biomechanics, and physiology. An understanding of kinesiology will become an integral part of the assessment process for athletes, beginning with identifying fitness-based normal function as a foundation. This knowledge supports massage application during sport-specific training programs to develop optimal performance function. Finally, an understanding of kinesiology is necessary to identify pathologic movement, compensation caused by injury, and the effects that injury has on movement. This chapter targets functional relationships among bones, connective tissues, joints, fasciae, and muscles.

As mentioned in Chapter 1, it is expected that the fundamental elements of anatomy and physiology are in place, and that you, the reader, will take the next step toward understanding the real element of kinesiology, which is movement. Movement is a process for athletes. Athletic movement begins with a stable, strong, yet dynamic and flexible posture. Athletes are constantly balancing necessary stability and strength with flexibility and agility.

Kinesiology is the science of the study of movement and of active and passive structures involved, including bones, joints, muscle tissues, and all associated connective tissues. Elements of kinesiology include the following:

An important development in biomechanics research is the concept of the kinetic chain (also known as the kinetic link). This concept came out of mechanical engineering in the 1970s and was applied to biomechanics. The kinetic chain describes the body as a linked system of interdependent segments. By understanding their relationships to each other, we can maximize the effectiveness of massage application with an understanding of the importance of whole-body massage rather than isolated spot work. The diagram in Figure 4-1 illustrates the common areas of interrelated kinetic chain function. Follow the colored line to locate the interconnections.

Beginning from the understanding that the body moves in an integrated fashion, let’s consider some of the individual elements, beginning with the integrative tissue—connective tissue.

Objectives

Chapter 3 presented the research on fascia. Now we will review and explore the relevance of the connective tissue anatomy and physiology to massage therapy application.

Connective tissue is made up of ground substance and fibers. Connective tissue consists of hard and soft tissues. It forms the structure of the organs and blood vessels and binds joints together through ligaments and joint capsules. It transmits the pull of muscles through connective tissue surrounding the muscles and the tendons. It forms tensegretic tension lines that transverse the body in many directions.

Collagen

Collagen forms approximately 80% of tendons, ligaments, and joint capsules, and a large percentage of cartilage and bone, giving shape to the soft tissue. It forms the structural support of the skin, muscles, blood vessels, and nerve fibers. Normal stresses, in the form of exercise and activities of daily living, increase collagen synthesis and strengthen connective tissue. This is an important aspect of fitness, especially for the elderly.

Collagen stabilizes the joints through the ligaments, joint capsules, and periosteum by resisting the tension or pulling force transmitted through the joints by movement or gravity. Collagen transmits the pulling force of muscle contraction through the fascia within the muscle and the tendon attachment. The collagen fibers tend to orient to parallel and longitudinal alignment along the lines of mechanical stress imposed through loading of the tissue during activity. Normal gliding of collagen fibers is maintained by movement and lubrication from connective tissue ground substance.

Immobilization or lack of use decreases collagen production, leading to atrophy in the connective tissue and to osteoporosis in the bone. Without movement, collagen is laid down in a random orientation, with fibers packed close together and forming microadhesions. Adhesions are abnormal deposits of connective tissue between gliding surfaces (Figure 4-2). This atrophy with random orientation of fibers creates weakness in the tissue and instability of the associated joint. This condition is more common in those who are just beginning a fitness and performance regimen and increases injury potential. The aging process decreases the amount and quality of the collagen structure; therefore, exercise helps prevent age-related soft tissue dysfunction.

Excessive mechanical and repetitive stress results in excessive deposits of collagen, causing abnormal cross-fiber links and adhesions. The fibers pack closer together, lubrication is decreased, and the water content of ground substance is reduced. This in turn decreases the ability of fibers and fascicles to slide relative to each other. This condition is often called fibrosis. Adhesions and fibrosis create a resistance to normal electrical flow. This decrease in electrical currents conducted in the connective tissues interferes with the normal repair and rejuvenation process.

Athletes are prone to excessive mechanical stress during practices and performance activity and to repetitive strain from the athlete’s specific activities, such as throwing, hitting, jumping, and running. Massage mechanically deforms the collagen fibers by introducing bind, shear, torsion, compression, and tension forces. Piezoelectricity is the ability of a tissue to generate electrical potentials in response to pressure of mechanical deformation. It is a property of most, if not all, living tissues. Piezoelectric potentials direct collagen fiber formation. Also, the negative charge in the soft tissue is increased, and this has a strong proliferative effect, stimulating the creation of new cells to repair an injured site.

Injury results in an acute inflammatory response. During the acute and subacute repair phases of the healing process, connective tissue fibers are laid down in a random orientation, instead of along normal lines of force. In essentially the same process of fibrotic change discussed earlier, the fibers pack closer together, forming abnormal cross-fiber links and adhesions. These adhesions can occur at every level of the soft tissue, including in the ligament or tendon adhering to the bone or between the fascicles, the fibers themselves, or individual muscle layers. In athletes, it is common to find first- and second-layer muscle adhesions, such as gastrocnemius/soleus and pectoralis major/pectoralis minor.

Because adhesions decrease tissue extensibility, the tissue becomes less elastic, thicker, and shorter. Clients often feel stiff in the area of adhered and fibrotic tissue.

Tendons

Tendons represent a continuation of connective tissue within the muscle. Tendons consist of long, spiraling bundles of parallel collagen fibers, oriented in a longitudinal pattern along the line of force stress; they are embedded in ground substance with a small number of fibroblasts. Tendons have a microscopic “crimp” or wave-like structure that acts like a spring, enabling them to withstand large internal forces. The junction where the muscle fibers end and the connective tissue that forms the tendon begins is called the musculotendinous junction. This area is vulnerable to injury.

Tendons may be cord-like, as in the Achilles tendon; may be seen as a flattened band of tissue, as in the rotator cuff; or may appear as a broad sheet of tissue called an aponeurosis, as in the attachment of the latissimus dorsi. They are surrounded by a loose connective tissue sheath. In areas of high pressure or friction, such as where tendons rub over the bones of the wrist and ankle, the tendon sheath is lined with a synovial layer to facilitate gliding. Tendon attaches to bone by weaving into the connective tissue covering of the bone called the periosteum. Tendons attach muscle to bone and transmit the force of muscle contraction to the bone, thereby producing motion of the joint. They also help to stabilize the joint and act as a sensory receptor through the Golgi tendon organs.

A strain is an injury to the tendon. It is a tearing of the collagen fibers at the musculotendinous junction, at the tenoperiosteal junction, or within the body of the tendon. Loss of normal motion in a tendon through injury or immobilization creates loss of collagen fibers and formation of adhesions between the tendon and surrounding structures, including the tendon sheath.

Ligaments

Ligaments attach bones at joints, help to stabilize joints, help to guide joint motion, prevent excessive motion, and act as sensory receptors. Ligaments are composed of dense, white, short bands of nearly parallel bundles of collagen fibers embedded in a matrix of ground substance and a small number of fibroblasts. They contain some elastic fibers and a “crimp” structure, giving them greater elasticity, and are pliable and flexible. All ligaments surrounding the joints contain proprioceptors, mechanoreceptors, and pain receptors that provide information about posture and movement, which plays an important role in joint function by directing joint movement.

Under normal conditions, when the joint moves, the ligament is stretched and the crimp in the tissue straightens out. The ligament returns to its normal length when the joint returns to a neutral position. If tension or force is slowly applied to a ligament consistently and is sustained, the tissue will assume the new length because of its viscous nature. This condition can lead to overstretched, or lax, ligaments and compromises stability of the joint. Because ligaments stabilize joints and act as neurosensory structures, injuries to ligaments can create dysfunction of the joint and surrounding soft tissue. A reflex connection exists between the ligaments of a joint and surrounding muscles; this connection affects the motor tone of muscles. In the case of lax ligaments, tone in muscles reflexively increases to provide joint stability. Ligaments function to transmit mechanical forces created by muscle contraction; they cross the joint, supporting integrated function.

The joint capsule and ligaments typically respond to an injury by becoming stretched, with resulting joint instability. These structures can also shorten, creating loss of a joint’s normal range of motion and joint stiffness. Immobilization causes ligaments to atrophy and weaken, changing the normal gliding motion of the joint. Ligaments can twist into abnormal positions. Irritation or injury of the ligaments usually causes a reflexive contraction or inhibition in the surrounding muscles. Muscle energy methods that address gait and firing pattern sequences can help restore normal function temporarily because the muscle is connected to the ligaments through a neurologic reflex. The condition will continue to occur because the instability of the joint is the underlying causal factor.

Injured ligaments can become thick and fibrous from increased collagen, abnormal cross-fiber links, and adhesions. This is especially common if inflammatory responses are slow to resolve or have remained chronic.

Massage applied to ligaments that have developed adhesions is performed across the direction of fibers to increase pliability and realign fiber structure. If ligaments are too lax, exercise rehabilitation can stimulate the production of new collagen and help restore normal integrity. Friction massage can be used to create small, controlled inflammation in the ligament structure to stimulate collagen production as well.

Periosteum

Periosteum is a dense, fibrous connective tissue sheath covering the bones. The outer layer consists of collagen fibers parallel to the bone and contains arteries, veins, lymphatics, and sensory nerves. The inner layer contains osteoblasts (cells that generate new bone formation). Repetitive stress can stimulate the inner layer of the periosteum to create bone outgrowths called spurs. This often occurs at the heel when the plantar fascia is short.

The periosteum weaves into ligaments and the joint capsule. Stretching of the periosteum provides mechanoreceptor information regarding joint function.

The periosteum also blends with the tendons, forming the tenoperiosteal junction, where the muscle pulls on the bone during joint movement. The sensory nerves in the periosteum are sensitive to tension forces. The periosteum also functions to transmit mechanical forces created by muscle contraction, supporting integrated function.

A common site of soft tissue injury is the tenoperiosteal junction. An acute tear or cumulative microtearing of the periosteum can cause the orientation of the collagen in the area to become random, leading to the development of abnormal cross-fiber links and adhesions. Massage can address this abnormal fibrotic developed at the tenoperiosteal junction. Friction is used to introduce small amounts of controlled inflammation. This results in an active acute healing process. When coupled with appropriate rehabilitation, more functional healing is the outcome.

Fascia

Fascia is a fibrous connective tissue arranged as sheets or tubes. Fascia can be thick and dense, or it can consist of thin, filmy membranes. Fascia is connected throughout the body, creating a unified form. You can conceptualize fascia as duct tape or plastic wrap (Figure 4-3). However, we must remember that we now know that fascia is not a passive tissue. Research shows that fascia responds to and sends nerve signals. Recent research (see Chapter 3) indicates that there may be a proprioceptive component, as well as an active contractile component, to fascia based on myofibroblast cells and sensory receptors embedded in the fascia. We now know that fascia tone is more than thickness or thinness of the tissue and is controlled through neuroendocrine mechanisms. The implications for massage therapists, particularly sports practitioners, are significant because our approach to connective tissue function and dysfunction would be expanded. Along with methods used to produce increased pliability, length and slide application of massage would include nervous system functions as well. It is important to understand that at the same time that massage application is introducing mechanical forces such as tension and torsion forces into the tissues to change the more passive elements of fascia (i.e., ground substance, fiber alignment), the nervous system is also being stimulated.

Fascia functions by connecting, unifying, and separating structure while acting as a communication network based on the interconnect tensegric structure. Muscle fibers are embedded in fascia, not just wrapped in it, and a single muscle structure becomes a unified functional unit consisting of multiple muscles in an intertwined chain of a variety of fascia wrappings, tendons, ligaments, joint capsule structures, and periosteum, which are located up and down, spiral around, and flow through the body. Through these interconnected structures, the forehead is connected to the bottoms of the feet, the left wrist connects to the right ankle (and vice versa), and the left shoulder is connected to the right hip and down through the knee. Tom Myers calls these chains myofascial meridians (Myers, 2008).

Information from the Stecco group describes the chains as myofascial units that function as uniting elements between unidirectional myofascial units (myofascial sequences), and as connecting elements between body joints through myofascial expansions and retinacula (myofascial spirals; Stecco at http://www.fascialmanipulation.com/englishhome32.html).

Functionally, muscle cells bundled together rarely transmit full contraction force directly via tendons into the skeleton. Instead, contractile or tensional forces caused by muscle action are distributed onto fascia sheets. These sheets transmit forces to synergistic and antagonistic muscles, affecting not only the target joint, but also distant sites within the myofascial unit.

For example, the muscles gluteus maximus and tensor fascia lata both insert into the dense fascia sheet along the lateral thigh, called the iliotibial tract, which is part of the fascial sleeve of the thigh, called the fascia lata. The latissimus dorsi on the opposite side weaves into the lumbar dorsal fascia, creating the connection to the opposite shoulder. This interconnected myofascial unit influences low back stability, shoulder motion, and stiffness of the lateral hamstrings and quadriceps, while stabilizing and guiding knee motion and finally stabilizing the foot though the plantar fascia and other connective tissue structures that support the arches of the foot and the elastic spring action of the foot during walking, running, and jumping. How then can we say that the quadriceps primarily extends the knee when the entire unit works together? An expanded understanding of fascia/muscle units challenges the typical study of muscles based on origin, insertion, and function. This being said, we can still benefit from studying the forms and function of the myofascial component of the body.

Superficial fascia lies under the dermis of the skin and is composed of loose, fatty connective tissues. Deep fascia is dense connective tissue that surrounds muscles and forms fascial compartments called septa, which contain muscles with similar functions. These compartments are well lubricated in the healthy state, allowing the muscles inside to move freely. At the same time, each layer is connected to the layer above and below by microscopic filaments with a wavy configuration that allow the sliding yet maintain connection and integrity between layers.

Fascia can tear, adhere, torque, shorten, or become lax, just as other connective tissue structures can, and it responds well to connective tissue massage methods, as described in Unit Two of this book.

Common sources of musculoskeletal pain are the deep somatic tissues, including periosteum, joint capsule, ligaments, tendons, muscles, and fascia. The most pain-sensitive tissues are the periosteum and the joint capsule. Tendons and ligaments are moderately sensitive, and muscle is less sensitive. This is an important awareness for massage therapists, who often are overly focused on muscle function as opposed to the total soft tissue system.

In general, mechanical forces applied during massage create heat within the tissues. This heat stimulates cellular activity and improves the lubrication of fibers by making the ground substance more fluid. Specific application of a massage approach to generate heat in the tissue can be used as a part of a warm-up activity. Strains and sprains of muscles, tendons, and ligaments are common in athletic activity and damage connective tissue. Fascial tone increases as part of protective guarding. With disuse and immobilization, the tissues become cool and the ground substance becomes thicker and more gel-like. Stiffness and aching, decreased circulation and nutrition, and decreased lubrication may result. Massage therapy can change the viscosity of ground substance from a gel to a more fluid state through the introduction of mechanical forces—that is, bend, shear, tension, compression, and torsion.

The active and passive tissue movement of massage stimulates the synthesis of ground substance and glycosaminoglycans (GAGs), promotes the circulation of blood and lymph, and supports ground substance pliability, creating greater lubrication to the tissue. Tissue movement also facilitates transport of nutrients and promotes the exchange of waste products.

Massage changes the shape of the fascia, which triggers response from the myofibroblasts; they contract similarly to smooth muscle cells and draw together, pulling the fascia taut and increasing stiffness.

Effectively focused massage can do the following:

Objectives

A joint, or articulation, is the junction between two or more bones of the skeleton that allows movement. Depending on joint type, the movement can be very small, as in cranial sutures and most evident in infants, or large, as in the ball and socket joint of the shoulder. The focus of this text will be on the synovial or freely movable joints of the body. Joint movement depends on the shape of the bones and articular surfaces where the bones meet, how ligaments cross the joint, and what type of movement is produced by muscles crossing the joint.

Simply, contraction of muscles crossing the joint causes the joint to move throughout its range of motion. Each specific joint has a normal range of motion that is expressed in degrees (Box 4-1). However, we now know that it is not that simple. The pulling forces created by contracting muscle cells are embedded in connected functional units unified by spans of connective tissue structures that are individually called fascia, aponeuroses, tendons, ligaments, and so forth. More than individual muscles, joint movements are caused by the distribution of force throughout these tissues.

Box 4-1

Normal Range of Motion for Each Joint

Remember that each person is unique, and that many factors influence available range of motion. Just because a joint does not have the textbook range of motion does not mean that what is displayed is abnormal. Abnormality is indicated by nonoptimal function. This can be a limit or an exaggeration in the “textbook normal” range of motion.

Available range of motion is measured from the neutral anatomic position (0). If 0 is listed first, this means that movement is away from neutral. If 0 is listed second, it means that the joint is moving toward neutral.

Normal Values (in Degrees)

Hip flexion 0-125

Hip extension 115-0

Hip hyperextension 0-15

Hip abduction 0-45

Hip adduction 45-0

Hip lateral (external) rotation 0-45

Hip medial (internal) rotation 0-45

Knee flexion 0-130

Knee extension 120-0

Ankle plantar flexion (movement downward) 0-50

Ankle dorsiflexion (movement upward) 0-20

Foot inversion (turned inward) 0-35

Foot eversion (turned outward) 0-25

Shoulder flexion 0-90

Shoulder extension 0-50

Shoulder abduction 0-90

Shoulder adduction 90-0

Shoulder lateral (external) rotation 0-90

Shoulder medial (internal) rotation 0-90

Elbow flexion 0-160

Elbow extension 145-0

Elbow pronation 0-90

Elbow supination 0-90

Wrist flexion 0-90

Wrist extension 0-70

Wrist abduction 0-25

Wrist adduction 0-65

< div class='tao-gold-member'>

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

What Is Sports Massage? Nutritional Support and Banned Substances Sport-Specific Movement Indications and Cautions Injury by Area Common Categories of Injury

Stay updated, free articles. Join our Telegram channel

Join