A clinician involved in rehabilitation treats patients with various disorders, and the goals of intervention include restoring normal function of the musculo-skeletal system or improving the patient's ability to move. For treatment of movement disorders to be effective in both athletes and other patients, the practitioner must understand the functional mechanisms of the movement and how the pathomechan-ics or imbalance of musculoskeletal system should be corrected. The essential factors that govern the movement of a structure are the composition of the structure and the forces applied to it. This chapter describes the basic functional anatomy and mus-culoskeletal mechanisms that are relevant to both athletic and daily activities. The physics involved in the biomechanics of musculoskeletal systems is omitted in this chapter, but readers are encouraged to learn and apply a physics-based understanding of human movement when treating patients, especially athletes.
In view of the unique mechanisms and effectiveness of dry needling therapy for soft tissue dysfunction and musculoskeletal pathomechanics, readers should keep in mind that all the muscles described in this chapter are very important in both examination and in treatment for improving movement or restoring normal function. The acu-reflex points often appear in the muscle bellies, neuromuscu-lar attachments, and junction areas of origin and insertion. For visual convenience, the potential acu-reflex points are not labeled in the figures, but readers should know their locations.
To make the description concise, exact, and helpful for clinicians, a brief review of the musculoskeletal system (Fig. 12-1) is provided in the following section. Readers should compare the descriptions with the figures in this chapter.
FUNCTIONAL ANATOMY AND PATHOMECHANICS OF THE LOWER LIMB
The hip is a very important joint in athletics. The muscles responsible for moving the hip joint originate from the pelvis and spinal column. Some of them pass over the knee joint. The hip bone has developed from three separate centers of ossification, which give rise to three bones: the ilium, ischium, and pubis. All the cavities, outgrowths, and spines have a specific musculosk-eletal function. The most important bony marks are the iliac crest, anterior superior iliac spine, anterior inferior iliac spine, ischial tuberosity, and acetabulum.
The hip joint is a ball-and-socket joint. Certain extracapsular structures give strength to the joint and, in particular, prevent the leg from swinging outward and backward. Backward swinging is impeded by the powerful iliofemoral ligament, which is attached to the iliac part of the hip bone and passes downward to the femur. Outward swinging is restricted by the pubofemoral ligament (Fig. 12-2).
The major hip movements are abduction, adduction, flexion, extension, and medial and lateral rotation. The most important muscles that pass over the hip joint are described in the following sections. The anatomy and function of those muscles should be well understood because they are often involved in both local and systemic dysfunction of the musculoskeletal system in human movement. The muscles responsible for hip movements are listed in Table 12-1 for review and further discussion (Figs. 12-3 and 12-4).
The iliac and psoas major muscles are responsible for powerful flexion at the hip joint. They have different points of origin but a common insertion point. When the iliopsoas muscle contracts, a flexion movement between the trunk and the legs can occur: If the legs are fixed, the trunk will move towards them, as in the last phase of a sit-up; if the trunk is fixed, the legs will move towards it, as when a person is hanging from a bar and bringing the knees up toward the chest. The iliopsoas is by far the most powerful hip flexor. It is forcefully engaged in hurdling, high jump, running, javelin throwing, and sit-ups. The enormous stress on this muscle is often overlooked.
Two of the abductor muscles are attached to the greater trochanter. The gluteus medius and gluteus minimus have such a large area of origin that they can move the femur in all directions except adduction. These muscles are activated during walking and running. They serve to stabilize the hip joint when the corresponding foot alone is in contact with the ground. This stabilization is necessary in order to prevent the upper body from falling to the opposite side during walking. From the perspective of human mechanics and kinesi-ology, the hip abductor muscles together sustain about 1.5 to 2 times body weight to maintain the balance of single-limb stance. Meanwhile, the
Extensor digitorum Extensor carpi ulnaris
Extensor carpi radialis longus and brevis (long and short radiuswrist extensor)
Brachioradialis, (arm-radius muscle) Infraspinatus (below-the shoulder-blade-spine muscle) Teres minor (lesser round muscle) Teres major (greater round muscle)
Gluteus maximus (large buttock muscle) Tensor fasciae latae (tensor of the fascia of the thigh) Vastus lateralis (external vast thigh muscle) Biceps femoris (two-headed thigh muscle) Gastrocnemius (twin calf muscle) Soleus (flounder muscle) Peroneus longus (long calf muscle)
Peroneus brevis (short calf muscle)
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Looked upon as a mysterious practice, reiki originated from Japan, around 1922. Started by a Japanese Buddhist, this practice of purported healing basically uses the palm of an individual to emit positive healing energy unto the patient. Sometimes reiki is referred to as oriental style treatment by professional medical bodies.