Exam 1

Terminology/Conventions Planes and Axes of Motion Sagittal (zy) Plane • ____/____Axis Frontal Plane •_____/______Axis Transverse •_____/______ Axis Sagittal (yz) Plane _______________ Axis Frontal (xy) Plane •____________Axis Transverse (xz) Plane ________________Axis

Medial/ Lateral Anterior/ Posterior Superior and inferior • Medial-lateral or mediolateral (x) Anterior-posterior (z) • Superior-inferior (y)

Muscle actions during squat • What are the roles of Rectus Femoris, Sartorius, Biceps Femoris when doing a squat? o _____ -_____Prime Mover; eccentric contraction by knee; controls lowering o ___________: Synergist o _____ ______ Antagonist

Rectus Femoris: Sartorius Biceps Femoris:

Muscle Plasticity: Muscle Response to Exercise Increased Muscle Strength o ________ training and recruitment of additional ____ ____ • A permanent increase in muscle size is due to an increase in either the ______of the existing ___ _____or the __________of muscle fibers (_________- arguable as to whether this occurs in humans) • However, early gains in strength are generally due to _______ adaptations o _____ _______ has been enhanced o Neural recruitment

Resistance motor units size muscle fibers number hyperplasia neural Recruitment pattern

Pathological changes • Scoliosis? o ______changes - lung capacities and volumes reduced o Can't get air in • Chronic obstructive pulmonary disease = COPD? - Obstructive o Damage to airways, destruction of ___ ___ o Inefficient exhalation, "air trapped", ________ o Decreased ______of rib cage, decreased _____of lung tissue - Increased ___diameter at rest Residual volume ______, inspiratory capacity ________, vital capacity ______ Key point: Overall reduction in volumes and capacities • Hyperinflation of the thorax • COPD—increase ___ and decrease ____ Key point: Huge increase in ___, reduction particularly in ______

Restrictive alveolar walls hyperinflation compliance recoil AP increased decreased decreased RC IRC RV IRV

____ _____ is the primary location of pain due to high level of vascularization and innervation.

Retrodiscal lamina

Voluntary (1) Involuntary (2) Striated (2) non-striated Multicucleated (1) Single (2) Non-branched -- Branched-- Tapered--

Skeletal Cardiac Smooth Skeletal and Cardiac smooth skeletal Cardiac and smooth skeletal Cardiac Smooth

PAGE 36 and 37 CHARTS!! Voluntary Contraction • ___ -____ will start first • Fast twitch later Electrical stimulation; _____ to _____! • Which one activated first? o ____ ______fiber activated first o _______easier Want to recruit all at the same time • ESTIM and Voluntary Contraction ESTIM- usually for pain not contraction

Slow twitch FAST to SLOW Fast twitch Fatigue

Hyaline or Articular Cartilage • _____ cellular component o _____ and _____ • ECM with large volume of ________material o Major PG is _______ which binds to HA ▫ o Aggrecan contains chondroitin sulfate and keratan sulfate -ratio of the two is important __________sulfate increases with age, immobilization, and arthritis • Less maintain and harder to do job Higher ___________sulfate concentrations help withstand compressive forces better load-________ • Help modulate ____ _____

Small Chondrocytes and chondroblasts interfibrillar aggrecan Keratan chondroitin bearing shock absorption

Muscle Structure and Function Types of muscle • ________: involuntary - not under conscious control. Walls of blood vessels causing vasoconstriction or vasodilation. In organs also. • _________muscle is found only in the heart. Mostly like skeletal muscle although it controls itself and is not under conscious control. • ____________muscle-voluntary-conscious control. o Chemical makeup: 75% _______, 20% _______, ____% is phosphate, lactic acid, calcium, magnesium, phosphorous, enzymes, sodium, amino acids, fats, and CHO

Smooth Cardiac Skeletal water protein 5

Actin and Myosin _______- thin o Each end is inserted in the Z disk with the other end extending toward the sarcomere in the space between myosin filaments. Each has an ____ ______ which a myosin head can bind. o Composed of 3 protein molecules- (3) Myosin-thick o 2/3 of skeletal muscle protein is ______. o Has _____ protein strands forming globular head- myosin head. o These____ _____form cross bridges that interact with active sites on the actin filaments. Cross bridge formed in top half AN ACTIN FILAMENT PAGE 5 ARRANGMENT OF FILAMENT PAGE 5

Actin active site actin, tropomyosin, and troponin myosin two myosin heads

Muscle Plasticity: Muscle Response to Immobilization • ______- reduction in size of muscle mass o decrease in cell _______- cross-sectional size of the muscle o decrease in cell _______ - the # of myofibrils o protein __________- decay in contractile protein o greatest muscle mass loss occurs in the first _____ weeks o occurs in _____-twitch and _____-twitch fibers

Atrophy size number degradation 3 slow fast

Bone Structure Layers: o ______ or ________: bone-inner spongy layer Founds in the _______ _____ —changes where deposits are responding to load o Cortical bone -outer compact layer ________- fibrous layer which covers bone • Microscopic structure o _________bone- irregular arrangement of alternating course and fine fibers -Young. o __________bone-requires a framework to form into organized parallel layers -Adult.

Cancellous or trabecular epiphysis Dynamic Periosteum Woven Lamellar

Fibrillar Components • ______ -main substance of connective tissue o Greek word meaning "glue producer" o Tensile strength close to steel o ____ ______ (tropocollagen) Hair vs. braided hair o Arranges in fibers and fascicles o Cross-linking o ____ _______ collagen provides tensile strength to tissue Subject to a lot of pull We will see a lot o Strong

Collagen Triple helix Type I

Combined Loading=

Compression and Torsion

Heel Raise ;; BOTH WAYS UP AND DOWN Heel to butt • Hamstring- agonist • Quad- antagonist *** Gravity component More EMG activity—Muscle Activity--- __________ • Force output is smaller for eccentric • From AP • No weight... gravity ? ____ _______ and _______ increase with hard muscle contraction

Concentric Firing rate and amplitude

Gait • Hamstring—early o _________contraction o Or isometric • Pass mid-line o ___________contraction Lower extremity—two movements Length doesn't change - 2 joint muscle

Concentric Eccentric

Typical Thoracic Vertebrae (T2-T9) • _______on body for rib articulation (superior, inferior) • ________ processes additional articular surfaces for costal tubercles • _____--- small and round • Spinous processes point ______backward and _____(roof shingles) Thoracic Spine • ____ _____ process • Why long spinous process? o _________ATTACHMENT o A lot of muscle in thoracic area • Shingles on a roof • Facets for the ______-—demi or half facets o Interacts with ___ vertebra o Inferior and superior facets • Costal factet • ____ and ____ ___ of vertebra - where ribs articulate

Demifacets Transverse Foramen obliquely downward Steep spinous MUSCLE ribs 2 Body and transverse process

Anterior Displaced with Reduction •__________in mandibular pathway • ______click with reduction o Meniscus is able to _____back to normal position o Audible opening and closing click o Clicking—most likely have this condition o Opening—where it should be at normal position o Closing—where is • Closing click with loss of _______ • Gross ROM WNL's o Max opening o A lot of flexibility • History of ___________ o But then all of a sudden, they get within normal limits when disk moves in and out o Can have deviation Deviation vs. deflection __________: the jaw (open) and it moves to one side and stays to one side; never returns to midline when fully open __________: moves to the side, but fully open you will be at the midline Deflection—WITH reduction o Deviation with reduction Can have a C-Curve Little lag which makes you deviate to ___ ___ Makes condyle glide to same side o Have normal ROM o High tone of ____ ____—makes it come forward Muscle guarding—overuse Bruiseism—clenching and grinding • Why people lose their teeth -______ Shorten it—pull anteriorly Parafunctional activity

Deviation Opening return reduction hypermobility Deflection Deviation affected side lateral pterygoid Hypertonicity

Overview of Muscle Tissue Characteristics that produce movement • ________- receive & respond to stimuli o eg. Stimulus is chemical ___________- response is generation of action potential __________- respond to stimuli by shortening, generating force (unique to muscle) o *** unique o Tendons are passive Can not contract ________- stretched or lengthened _______- return to resting length after stretch

Excitability neurotransmitter (Ach), Contractility Extensibility Elasticity

GAGs - examples • Chondroitin 4 • Chondroitin 6 sulfate • Keratansulfate • Heparansulfate • Dermatansulfate • ____________-not sulfated and not attached to protein core-can be a free chain or anchor point for other PGs (aggrecan, which is the major PG in cartilage)

Hyaluronan

Kinetics Newton's Laws • Law of ________ o Moving or stop unless a force • Law of __________ o F = M*A • Law of Reaction o Action and reaction Translation—Force • No _____, just moves in space Rotation—Torque = Force * Moment arm • Moment arm—distance they have • Pivots Primary Rules of Forces • Push or a pull • Your book: "All forces on an object must come from something touching the object" (what about Gravity?) • Anything that contacts an object must create a force on that object o ___________ • All forces are vectors and can be drawn or visualized Free Body Diagram SLIDE 66 Sum of forces is equivalent to weight of cup Torque- how far from axis

Inertia Acceleration rotation TRUE

Physical Stress theory PAGE 21 • Death - Loss of adaptation • Thresholds for adaptations o (4) Injury or don't use it—______ of tissue

Injury o Increased tolerance (hypertrophy) o Maintenance o Decreased tolerance (atropy) ? DEATH

_____ ____: wiggle it around, asses how much motion, moving joint in open packed position _______ movement o Beyond active ROM o Necessary for full pain free normal ROM _____ movement o Requires external force for testing o Not under _______control Joint ______ can be related to a loss or excess of joint play o Lack of sufficient joint play if joint structures are too tight will not allow full joint ____ o Excess joint play if structures are lax, which may cause an _____joint

Joint play Accessory Passive voluntary dysfunction ROM unstable

How can we explain clinical observations in scoliosis? • ____ _____ to concave side (decreased height - shoulder drop) • Vertebral bodies rotate towards the ________side (name of the curve) • Spinous processes deviate more and more to the _______side • Ribs follow vertebrae. o Convex side ribs pushed ________-hump ◦ o Concave side ribs pushed _______ Normal Curve vs. Scoliosis • In scoliosis the thoracic vertebrae not only laterally deviate but also ________, altering the alignment of the costovertebral and costotransverse articulating surfaces. o ________- rib deviated • "Rib hump" • Asymmetrical distribution of rib cage _____ o Important for ______ Kinematics of the ribs - Axes of motion Axis closer to M-L: ______Ribs - Medial Lateral • So plane of motion is most closely _______ o ________plane Axis closer to AP: ______Ribs • So plane of motion is most closely __________ o ______Plane

Lateral flexion convex concave posteriorly anteriorly ROTATE volume organs Upper Saggital Lower Frontal

Mechanical Behavior • __________= external force(s) applied to a structure • Force produces _____ o Tensile load produces ________• o ________produces shortening • Result is a _____-____ curve o Depends on _____ (area, length) o Accounting for the effect of dimensions: ___ and ____

Load deformation elongation Compression load-deformation dimensions stress and strain

Functions of Skeletal Muscle • __________(primary function) • ____ _____ o ______ are actually working o Even working when sleeping Ex. Upper Trap • _____ _____ • _______ • Primary store of body ______

Locomotion Body posture Muscles Venous return Thermogenesis protein

Phases of Excitation-Contraction Coupling Part 1 1. Resting 2. AP carried down___ _____ 3. AP triggers______+ release from SR 4. Ca2+ binds ______, exposing actin active site 5. Activated _________head binds to actin, ________sarcomere 6. Ca2+ removed by _________in to SR; contraction ends; ____ AP carried down T tubule __________in blocking position

T tubule Ca2 TnC myosin contracting reuptake 2 tropomyosin

Bone ECM (2) Load Cartiage ECM (2) Load Ligament ECM (2) Load Tendon ECM (2) Load

Type I Collagen Inorganic Hydrooxypalitie Compressive Type 2 Collagen (a lot of PG) Compressive Type I: Collagen GAG: Dermatan Sulfate Tensile Type 1: Collagen GAG: Dermatan Sulfate Tensile

Types of Connective Tissue • Ligaments • Tendons • Bursae • Cartilage • Bone Ligaments • Connect ____ _to ___ (attachment: enthesis, pl. entheses) • _____ number of cells (mostly ______) and large amount of ____ (10-20:90-80% ratio) • Mainly type-____ collagen (lesser amounts of type III, IV and V) and varying amounts of _____ • Ratio collagen/elastin : stability vs. mobility • Type I collagen fibrils run in many directions -_________resistance o Resistance to many directions because of how the collagen fibers are laid out o Gives them strength o Can get pulled in many different directons • Most -have more collage than elastin • _____________ ("roots") attach ligament to periosteum to bone • Named by location, shape, bony attachments and relationships to each other • _________common site for degenerative changes

bone to bone Small fibroblasts ECM I elastin multidirectional Sharpeyfibers Enthesisis

Synovial joints: many different components • Joint ____ • Joint _____ • Synovial ______ lining inner surface of capsule • Synovial _____ • _________cartilage on bone surfaces o ____ and _____ on each other • May have discs, plates, menisci, labra, fat pads, ligaments, and tendons o ______—shock absorption o Function dictates what is has o ______—restrict the movement of the joint

capsule cavity tissue fluid Hyaline Glide and roll Menisci Ligaments

Fatigue and Surface EMG Signal Characteristics • During a fatiguing contraction the frequency content of the surface EMG signal shows a progressive compression toward the lower frequencies. • This compression may be measured using the ____ ____ ____ Firing Rate Estimation PAGE 24 Each color is a different NM • When muscle makes contraction o Red is recruited o Incremental recruitment o The ______ is shut down first when lower the force exerted! o Slow to fast twitch fibers are recruited

median frequency parameter. last

Bursae • Flat sacs of synovial membranes separated by fluid film • Reduce ______and position to make it advantageous • Located where moving structures are _____approximated o ______ bursae-between skin and bone o ________bursae-between tendon and bone o _______- between muscle and bone

friction tightly Subcutaneous Subtendinous Submuscularbursae

** Different muscle shape provides different ____ and _____ Which one makes more sense if you want to pull something? Most efficient • ________ • But big force output need big muscle and big tendon attachment o Not how our muscle is designed

function and output Longitudinal

Costovertebral Joints • Connection between the ____of the rib and___ adjacent ___ ___+ disc Ligaments include: o superior costotransverse ligament • anterior costocentral ligament (radiate) • intra-articular ligament • anterior longitudinal ligament **You don't need to memorize all ligaments listed here. Do make sure you understand that the main support of these costo-vertebral joints are from the ________ • All _______joint and affect ________and stability • Relevant functionally Costotransverse Joint • Connection between the ______of a rib and ____ ____of corresponding vertebra Absent at ____ and _____ ribs - no costal transverse joint Ligaments: o costotransverse ligament o superior transverse ligament o lateral costotransverse ligament

head 2 vertebral bodies ligaments stabilize ROM tubercle transverse process 11th and 12th

Biomechanics : Study of mechanics applied to biological systems Kinesiology Kinesis + ology (To move + study) • --- Study of ___ ____ What comes to your mind when you hear the word "movement"? • Human movement is much more complex than you think it is. • One location to another Domains that Affect Movement • (3) o Interacton = ______

human movement Organism • Task • Environment Biomechanics

Summary of Muscle Contraction • Motor nerve ______action • _________released • Impulse travels____ _____ and SR • ______ions released • • Ca+ binds with _________ • Lifting of __________, makes AS available for myosin. • Myosin combines with ______. • With ATP present, ______splits ATP to ADP + P + energy • Sliding action of ______over ______ • Impulse stops, _____ ions return to SR • ____________returns over active sites on actin for inhibition

impulse Acetylcholine t-tubules Ca+ troponin Tropomyosin actin ATPase actin myosin Ca+ Tropomyosin

Larger Cross-Sectional Area: _____ force production

increased

Temporomandibular Joint SLIDE 5 • Condyle comes off and moves anterior to tubercle - have dislocation - stays open • Normal position: Condyle has direct contact with _____with the ____ o Meniscus is in between ____ and ____ • ____ _____ have attachment to the meniscus • Joint: 2 convex surfaces o Temporal bone and condyle

meniscus eminence condyle and eminence Lateral pterygoid

TMJ Function • The disc creates two independent ___ _____ • ________occurs in the inferior joint space • _______occurs in the superior joint space • ____________portion get affected when you have TMD of dearragement (something is blocking the joint) • When you open jaw—meniscus stays with condyle it wants the cushion • Sometimes displaces anterior and that's when we get blocking the joint • The disc stays on the condyle TMJ Function •Mandibular depression (maximal interincisal opening)—opening jaw: ____-____ mm opening NORMAL, specifically - 2 knuckles o The first 11-25 mm ______at the __________portion of joint _______rotation of the condyle o The condyle moves with movement Head rolls _______and slides _______ what ligament helps slide anterior is the ___________ligament • Helps the condyle SLIDE anterior AFTER 25 mm of opening • We call this ____________(after 25 mm of opening) then translation occurs for the remaining of the opening Laterotrusion (Lateral Deviation): o Right laterotrusion would involve ______on the left condyle and _______on the right condyle o Usually the ipsilateral sides rotates/spins o Contralateral side—translation only o Left—left TMJ is ______and right TMJ ____ _____ Superior portion on right slide is blocked—_______laterotrusion is affected o No translation --- 25 mm

joint spaces Rotation Translation Superior 40-55 inferior rotation Posterior POSTERIOR ANTERIOR temporalmandicular TRANSLATION translation rotation rotates translates anterior left

Stress Relaxation • Tissue stretched to a fixed _______, and force required to maintain this length is measured • Force required over time will ______ • Length constant, force changes • Clinical application? o Hold stretch for 45 secs o Force _________ o To keep a specific length—less force needed ________forces for both ^ Stress relaxation vs. creep QUESTION: What if we are dealing with compression forces (for example on bone)?? • Compressive (pushing) - it will keep compressing

length decrease decreases Tensile

Ligaments • More variable orientation of collagen fibers causes ____resistance to tensile forces than tendons o More multidirectional o Not as good as dealing with them as opposes to one direction o Not as strong as tendons but can function in many directions • More able to function in _______of load ______ • _______tension increases thickness and strength • Immobilized ligaments become weaker more quickly than tendons and take longer to heal • Able to withstand ( 3) forces o SOME shear stress - only tissue

less range directions Intermittent compressive, shear, and tensile

Tensile Loads • Equal applied forces acting along the same ____in _____directions • Create Tensile Stress and Tensile strain Compressive and Shear Loading • External applied forces equal and acting in a line towards each other on opposite sides of each other are _______ • External applied forces that are equal, parallel, and opposite direction but not in line create _____ Torsional Loading • Equal, parallel, and opposite forces acting __________to the long axis of a structure

line opposite compressive shear perpendicular

Connective Tissue Changes • Connective tissue structure can be modified by changes in ______ conditions o ________of the mechanical environment can cause connective tissues to change • Wolves Law—if you don't use it, you lose it

loading Manipulation

Muscles of Mastication SLIDE 16 Elevation (closing)—(3) and superior fibers of ___ ___ Depression (opening): Inferior fibers of _____ ____, (2) Protrusion: Superficial (3) Retrusion: Deep fibers of ______, _______, __________ (_____) Lateral excursion (deviation): Ipsilateral (2), contralateral (2) Blood Supply • Loss of blood supply leads to avascular necrosis • ____ _____ _______ coming from the ____ ____ ____ • TMD of the condyle o Need a replacement • Trauma or occlusion of artery

masseter, temporalis, medial pterygoid, lateral pterygoid (stabilize disk) lateral ptyergoid, suprahyoids, infrahyoids masseter, medial pterygoid, lateral pterygoid masseter temporalis suprahyoids (digastrics) temporalis and masseter medial and lateral pterygoids Superficial temporal artery external carotid artery

perpendicular distance to axis

moment arm

Fiber Length and shorten Capability • The relationship between fiber length and shortening capacity of the whole muscle o A muscle with _____sarcomeres in ______ o Can shorten more than a with few sarcomeres in series • More sarcomeres—more shortening Force and Cross-Sectional Area • Bigger = stronger • Because there are more _____ ____ • ______ —small cross-sectional area • Rectus femoris—bigger cross sectional • POWER - not longitudinal • Cross sectional--- perpendicular

more series muscle fibers Sartorius

•Sphenomandibular o Helps to ______mandible in space as well • Stylomandibular o Helps suspend mandible and limits _____of the mandible ** Collateral o Ligaments that attach from lateral and medial pole of condyle onto _______itself o Prevent ____ _and ______movement of the meniscus o Meniscus usually goes with condyle Posterior o PAD o _______ and ______ _______ _______ Prevents disks from excessively moving __________ Difference • ________—made function is to bring it back to condyle ; back to resting position, bring meniscus back to normal position (at rest) o ______properties Capsule TMJ Ligaments Collateral Ligament Posterior Ligaments

suspend protrusion meniscus medial and lateral Superior and inferior retrodiscal lamina (SRL) anteriorly Superior Elastic

Skeletal Muscle • Human body contains more than _____(______pairs) skeletal muscles • Adult men: _____-_____% of body weight • Adult women: ____-_____% body weight o Difference _____ • Various architectures for different _______

430 215 40-45 23-25 fat function

Degrees of Freedom (DOF) • More generally, an unconstrained solid object in 3-dimensional space has ____ DOF: • There are _____ translational dof and ____ rotational DOF • Exercise: Describe what happens if an ice cube is constrained to slide on a tabletop surface? • By constraining, only has ___ degrees of freedom o Our joint has a focal joint o Has to stay together o Not free in space MAX of ____ possible degrees of freedom

6 3 3 3 3

Range of Motion • Normal ROM -amount of motion available within the anatomic limits of the joint structure o _______ ROM--- how far you can get yourself physiological o _______ROM—how far you can with joint ? Anatomical __________-exceeds the normal anatomical limits of motion o Does it interfere, bothers them, issues with functional tasks o Sometimes so extreme that it puts joint in danger o Does it impact the function of the patient • ___________-less than the normal amount of motion that should be available in the joint structure o Interferes more with daily activities • __________- shortening of the soft tissues around a joint which causes hypomobility

Active Passive Hypermobility Hypomobility Contracture

Active vs. Passive Insufficiency • _______ _____: Decrease in active tension with muscle shortening o When muscle is too short, can't generate enough force for motion o Muscle too short to continue with motion o Ex. Flex hand and try to grip _____ ______: Increase in passive tension that limits full range of motion o Muscle length of opposite side; antagonist side o Not long enough for action to occur o Too tight; too stretched—limit motion o Ex. Hamstring limits hip flexion o Ex. Hamstring stretch

Active Insufficiency: Passive Insufficiency

Range of Motion • ______of motion available at a joint • Defined by the ____/_____ where the motion occurs (in the anatomical position) Sagittal plane : ______/______ (Exception: thumb carpometacarpal joint) o Frontal plane: ______/_______ (exception: thumb CMC again) o Transverse/horizontal plane: ___________ Arthrokinematics 3 Motions •__________________ o Only translational • (2) Joints • Mostly is ____ and _____ Spinning—shaped in a specific way; circular or spherical • Head of _____ • __________

Amount plane/axis Flexion/extension adduction / abduction internal/external rotation Slide (Glide) Spin • Roll slide and roll femur Radius

Vectors •_____ and ____ • Direction and magnitude Units: International System/ Système Internationale (SI) • Mass kg • Displacement m • Velocity ms-1 m/sec • Acceleration ms-2 m/sec2 • Force (m*a) kgms-2 N • Torque = F* dist kgms-2m Nm • Pressure = F/A Kinematics • _____ itself • Point A to B • Object changing position in space • Where, reference point, 3 Planes • Sagittal • Frontal • Transverse

Amount and direction Motion

________change during motion, and so do _______forces Why are deep knee bends painful for Jack? • The deeper you get, the two forces add up to a larger resultant • More force you feel presses _____into femur! o ________forces get bigger and bigger Painful - more stress • Squat—what muscle is acting at the knee? o _______—not the hamstring o Eccentric contraction Lengthening and deaccelerating o Gravity—weight of our body Takes us into flexion o ________ is the main force going down

Angles resultant patella Resultant Quads Gravity

1st Class Lever System: Axis in between • EF: Effort Force = muscle force • EA: effort arm • RF: resistance force (example: gravity, or the PT's resistance) • RA: resistance arm AXIS IS IN _______- 1st class level • You don't know who is likely to win without details Head—heavy • First class lever • Extensors - constantly are opposing head • Head—Occipital joint—extensors 2nd Class Lever System: • Axis on one ______, and RA ______ EA • __________is always smaller than effort • Effort (muscle) always has a ________moment arm o Will win

BETWEEN end < RESISTANCE larger

Diarthroses (synovial Joints) Triaxial - sagittal, frontal and transverse • (2) Biaxial • (2) Uniaxial • (2) SLIDE 11

Ball and socket • Plane -glide and translate Condyloid • Saddle Hinge • Pivot

Cartilaginous Components Fibrocartilaginous meniscus o - ____-concave o - Attachments o - Provides _____ o - Separates into 2 separate joint spaces Joint: Aligns Fibrocartilaginous Joint Surfaces • Lines ____ ___ • Thickest over the _____ _____ • Covers the _____ _____ • Fibrcatialgge aligns •Actual surface of temporal bone (eminence) and condyle is aligned with _______ o Resilient to stress • TMJ is most used joint in the body and pound for pound strongest and joint • Innervated _____ and ______ - nerve endings • Not innervated in the _____—no nerve endings

Bi congruency temporal fossa articular eminence condylar head fibrocartilage anterior and posterior middle

Force Generation of the Contractile Elements: Concentric Contraction The Cross-Bridging Cycle 1. ________: Activated myosin binds to actin a. ADP + P remain bound to myosin 2. ____ _____ Myosin head swivels causing displacement of actin filament a. ADP + P are released from myosin 3. _________ : ATP binds to myosin a. Actin and myosin dissociate (cross-bridges detach) 4. _______: Energy from the hydrolysis of ATP used to activate the myosin head a. ADP + P remain bound to myosin

Binding Power Stroke: Dissociation Activation

Ligamentous Support 1. Anterior Longitudinal Ligament (ALL) lies anterior to the vertebral body • ____ to ___ • Strong, thick and very wide • L4-L5 - very strong 2. Posterior Longitudinal Ligament lies posterior to the vertebral body • More ________ • 1/6 the tolerance for stress compared to Anterior ligament • Damage to disk happens in extreme _______- • Not as strong as anterior and room on side to be damaged • Dislocations happen in flex 3. Ligamentum flavum • C2-sacrom and have extension to occitput • A lot of __________ • Very flexible • Very close to spinal cord • During motion we don't have it to buckle • It will hurt the ____ ____ • Special because it always has some degree _______- o More in some areas • Has ________function o Make sure everything stays • Very difference purposes 4. Interspinous ligament • 5. Supraspinous ligament • Connects the tips 6,7. Annulus fibrosus 8. Nucleus Pulposus 9. Capsular Ligament • Joints between the _____ 10. Intertransverse ligament • Connects ____ ____

C2- to sacrum narrow flexion ELASTIN spinal cord tension compression facets spinous process

Synovial joints -biaxial Saddle (e.g. _____thumb) o Biplanarmotion o Flex/ext and abd/add ____ and ______planes, respectively o Both are concave and convex at the same time o Depends on direction o Rider-saddle fit Condyloid (e.g. _________) o Biplanarmotion o Flex-extand IR/ER or abd/add o "____ on _____" o One is concave and the other is convex

CMC Frontal and sagittal tibiofemoral Knuckle on cup

Strategies to reduce effects of immobilization • ______machines after joint surgeries. Evidence? http://www.youtube.com/watch?v=UST32Ff9A_E • Reduced casting periods after fractures and sprains • Dynamic __________devices to allow safe motion but protect against unwanted motion • Use of ____ ____ after immobilization • Extension of recovery period including PT and work or sports restrictions o Pre-rehabilitation - before surgery or chemotherapy Higher level of function before treatment

CPM splinting graded loading

Effects of immobilization and exercise on tissues Immobilization • _____structures will become weaker o Junctions, attaches to bone, joint capsule - first • Results of casting, bed rest, non-weight bearing, denervation, or self -imposed reaction to pain and inflammation • Swollen or inflamed joint will assume a _______packed position to accommodate _____fluid volume • Position of minimum pressure for comfort • Joint capsule may _____and _________-may occur o Hard to get to full ROM after • After immobilization may lack full ______at the joint

CT loose increase shorten contractures ROM

Motor Units (MU) Motor Units: contain (4) • Axon—from the _____nerve root • 1 motor unit—1 -____and the muscle fibers it ______ • ____________principle—all the way, fired up to max or not at all o All fibers in one motor unit will work together o Doesn't mean the other motors units will o It's not ALL the muscle fibers in the muscle just the muscle fibers of the specific motor units

Cell body, axon, neuromuscular junction and muscle fiber ventral nerve innervates All-or none

Temporomandibular Joint • 2 Convex surfaces o - _______- o - ________- part of temporal bone • Between two convex area have a____ ______ o Type I and Type II collagen o Lies between o Cushing, proprioception and stability o Moves with the condyle and gives cushing Separates joints into two spaces _______- Meniscus and temporal bone _______- Mencius and the condyle

Condyle Eminence fibrcartalous meniscus Superior Inferior

Force Systems •(3) Types of Forces • (4) o Parallel in opposite directions •__________ • Combined _____ • __________ • __________ o Pulling apart o Can use therapeutically Patient care—____ and __________ ______—two parallel forces in opposite directions

Coplanar • Colinear • Concurrent Tension • Compression • Bending • Shear Torsion loading Unloaded Distraction compresson and distraction Shear

Properties of specific connective tissue types Mechanical Properties of Bone • ________-bone withstands greater stress and deforms less than cancellous bone • Bone can withstand greater _______and tensile ________stress than _______stress o More ________stress than tensile stress o __________stress is more resistant than transverse • Bone can withstand greater ________stress and strain than tensile stress and strain Accident vs. overuse o High loads over a short time produce high stresses - ___ o Lower loads held for a long time produce high strain - ________ No time to recover o Both are bad—no time to recover • Increased loading of _________ bone causes hypertrophy • Trabecular bone becomes smaller and weaker if loading is decreased or absent

Cortical compressive longitudinal transverse compressive Longitudinal compressive accident overuse trabecular

Tendon Injury • _________ • _______deficiencies • ________-imbalance • __________ • Chronic __________in high linear region of stress-strain curve • Inadequate ___ ___ • Sudden _____loads • Continual ________forces decrease ______strength and alter composition to be more like _____

Corticosteroids Nutritional Hormonal Dialysis loading recovery time large compressive tensile cartilage

Fatigue o Causes of fatigue ____ _________depletion, for short bursts of ______exercise (<10 sec) ____ ______ buildup, for exercise lasting 2-15 min ________ depletion ("hitting the wall") for exercise lasting 20 min to several hours ________dysfunction (for very long term exercise over many hours or days)

Creatine phosphate intense Lactic acid Glycogen Neuromuscular

Anterior Displaced without Reduction • _________ in mandibular pathway : disk is blocking it • Leads to ____ and ____ ____to one side • ____ROM • Disk is a doorwedge • Condyle is not go anterior ____ ____ is affected that means translation is affected - TRANSLATION is affected o Jaw opening is limited 25 mm of opening then a deflection _______to the side effect because it can not translate ______ lateral trusion limited Right side the disk is anteriorly displace— When open—the disk blocks the translation of condyle • Deflect to _____ side and open to 25mm Lateral trustion— go to ______ —unable to translate—meniscus is acting • _____ lateral trusion is limited • Left side is translating right side is rotating Protrusion • Deflect to ____side • But limited • Cannot get into 3 mm • Protrusion is deflected because ______ is affected • No _____, possibly crepitus • _________stage • MIO limited to_____-____mm • _____decreased • There is a history of clicking o When there is blockage there is NO ______ Tenderness of lateral pole— _______ Behind the TMJ , inside ear and push forward; tender What are you palpating? • ___________ is inflamed Block of joint—all are inflamed

Deflection deflection and lateral deviation Limited Superior portion IPISLATERAL Contranlateral right left Left right translation clickHypomobile 25-35 Laterotrusion clicking capsulitis Retro discal pad

Ductility and toughness • ________= extent to which solid materials can be plastically deformed without fracture. The opposite of ductile is _______ o I.e. how far can we go into the plastic region before failure? • _________= resistance to fracture of a material when stressed. o Resistance to ____ o Defined as amount of _____ per -______that a material can ______before rupturing. o Area under the stress-strain curve SLIDE 66 SLIDE 67 High Strength, Low Ductility = Low toughness High strength, HI ductility = high toughness Low strength, low ductility = low toughness

Ductility brittle Toughness breakage energy volume absorb

Mechanical Advantage • Mechanical advantage = ___/_____ (internal moment arm/external moment arm) o Think: ◦ 3rd class lever - EA/RA less than 1 or more than 1? _____1 o 2nd class lever - EA/RA less than 1 or more than 1? _____1 o So which of the two is more efficient? •_________ Class Lever System is more efficient o 2nd class • But what about our anatomical structures? o Most is _______class • And how efficient is 1st class? o It depends o Depends on distance Have to know where everything is

EA / RA less greater 2nd 3rd

Stress-strain curves ▫ • Toe -tissues un-crimp • _____ region-deformation that is not permanent • ____ ____ transition between elastic and plastic • _____region-permanent deformation once load is removed Ultimate failure point o Ultimate stress is _____ at the point of failure o Ultimate strain is ____ at the point of failure Slope of graph- - o Highest slope—more stiff • Plastic - some materials can be in the plastic region longer o ________- cannot withstand plastic region o _________- can withstand region • __________- how much energy to break it o Bigger area under the curve—the more toughness

Elastic Yield point: Plastic stress strain stiffness Brittle Ductile Toughness

_________- o Single strands cross linked to form rubber-like fibers o Cross-link with each other o Rubber band o A lot of give, flexible o A lot of ___________ • Ear vs Femur o ______ —ear > femur • Structure and function! More elastin, or more collagen? • Aorta- _______ > ______ o Why? Has to let go and come back o Need collagen for the structure • Achilles tendon—_______- a lot of pulling and some elastin o Collagen > elastin

Elastin compliance Elastin elastin collagen collagen

Bone • ____ and _____ produce collagen and ECM components • ________—fixed in place • _________-—make bone • __________-—break bone o Follow wolves law • ECM contains inorganic ____________ • ______produce bone, then become osteocytes • _________ : resorb bone • Bone is a living, dynamic tissue • What happens in osteoporosis? o ____________are more active o More than osteoblasts o Ex. From being in bed rest, immbolization Don't have loads bone is not deposited as much SLIDE 56

Fibroblasts and fibrocytes Osteocytes Osteoblast Osteoclasts hydroxyapatite Osteoblasts Osteoclasts Osteoclasts

Viscoelastic material properties • Creep • Stress relaxation • Strain rate sensitivity • Hysteresis Creep • Force is applied and the amount of deformation increases over time • ______is constant, _______changes • Force constant and the tendon keeps deforming for a little bit o Doesn't stop • Clinical Application? o ________, hold stretch and not increasing force o It gives a little o Force is the same but the length keeps changing o More to give o Tissue is still moving Get more of stretch without increasing force Graph—AS the load remains constant SLIDE 78 • Muscle keeps stretching slowing to a certain point

Force length Stretching

Stress and Strain • Stress= ____ ___ /___ _________is deformation that results from stress • Strain= (Final-Original Length)/Original Length = Change in Length/Original Length • How much it deforms compared to how big it was to start with • Strain = _____ _____ / ____ ____ Stress Strain Curve 1. Nonlinear (toe region) 2. Stretches out a little 3. Once straight, responds linearly a. Called the linear region b. Linear relationship i. In the ____ region- predictable and come back to original form when done ii. Normal exercise c. Too much stress—not predictable d. The collagen fibers get injured—micro damage = ___ ___ i. Material behaves unpredictable ii. Plastic—no long returns to original form e. Then ____ -___ ____ —collage fibers breaks

Force Applied/Area Strain Changing length / original length elastic YEILD POINT Ultimate failure point

SLIDE 37 Structure Collagen and Hammock • ______ to hold everything together • Tightly and strong ____________Components—glue that holds everything together • ___________ • ___________-carbohydrate covalently linked to a protein - most o __________-subclass of glycoproteins formerly called mucopolysaccharides, found in connective tissue Regulates how much _______to absorb _____ What tissue? ____________ • Shock absorption • Compressed—lets a lot of water out

Framework Interfibrillar Water Glycoproteins Proteoglycans flexibility water Cartilage

_____ Classification: Based on relative Joint Mobility • _________: Freely moveable synovial joint, most complicated o ________________ joint o ________ - primary purpose __________: slightly movable joints o _____ or _____ o Intervertebral disks ______: Joints with little or no movement o ____ or ____ o Skull o ________- primary purpose

Functional Diarthroses Synovial Mobility Amphiarthroses Synovial or cartilaginous Synarthrose Cartilaginous or fibrous Stability

PGs attract water through their _______portion, creating ______stress on collagen network _______fibers contain the swelling modulates ________ When water comes out—it can relaxe That's how we modulate how rigid the tissue is *

GAG tensile Collagen rigidity

• ______________________ o reduced contractile activity - deterioration of motor unit recruitment • ______________ o Reduced bone mass o Reduced mechanical loading Decreased: muscle mass; fiber CSA; strength or force production; protein content; fiber number o Decrease in numbers of sarcomeres from____ _____ (Shortened position) Muscle can be shortened • ________muscle o Decrease in ____ ______relationship affects production of tension o ________ of ______ fibers - adhesions Adhesive capsulitis • Affects the entire muscle

Hypokinesia Hypodynamia sarcomere absorption Contractured length-tension Adherence collagen

___________: Quick cyclic loading and unloading of tissue does not allow recovery. Viscoelastic materials exhibit a time delay in recovering their shape. • Load CT and take load away = energy lost as ______- • Path to come back is not the same path to get to load state • Loading and unloading are different pathway • Some energy is also lost as heat • If you load a tissue and don't give it time to rest—you will go into plastic range almost right away • Unloading takes longer and loses energy • Need to rest to do something else • Still creeping and add more load—_____more easily

Hysteresis heat injured

Cartilage • Mainly type _____ collagen and large amounts of aggregating _____ • For compressive forces • Sugars and CHOs -needs ability to ______ and let go out ____ o Gives the properties for _____ _____ • Types: o ____________-forms bonding cement in joints with very little motion o __________cartilage-higher ratio of elastin to collagen (ears and epiglottis) o _______cartilage -thin covering of the ends of bones in most joints

II PG's absorb water shock absorption Fibrocartilage Elastic Hyaline

Myotendinous junction (MTJ) • Tendon-muscle union • ___________of collagen fibers, muscle cells o Merge fibers o Braided o Stronger connection o But still first place that will get weaker Muscle rupture is in the ____ ____ _____or insertion of tendon on _____ • Direct connections between muscle cell membrane and fibroblasts, PGs, and collagen • ______blends into _____ • • Decreased loading = ________at the MTJ

Interdigitation muscle tendon junction bone Endotenon endomysiu weakening

Electrical Properties And Activities of Muscle • Electrical properties of muscle Electromyography (EMG) • ______________EMG : detect motor unit firing; diagnostic and research purpose • __________ EMG : general muscle activity; clinical and research Needle Electrode Electrode and Buffer Needle and Fine-wire Electrodes PAGE 23

Intramuscular Surface

_____ —what causes the motion • (2) Describe forces and torques that ______ motion Measurement If it moves, give it a number! Why? • Measure ___ • Establish a ____ o Able to see ____ • Show___ and _____that the patient is getting better Measurements _________: ◦ • Direct measures (Cadavers) Calculated/derived from anthropometry... • ___________ ____ _____ • _____ of segments • Moment of _____

KINETICS Force • Torque PRODUCE differences baseline progress patient and insurance Anthropometry Center of mass Weight

So what's "better", a long moment arm or a short moment arm? • It depends on whether you are looking at effort or resistance, and which of the two is the one you want to be the winner!! Gravity • Too easy—want to give him a hard exercise—_____MOMENT ARM • Old lady struggle—______MOMENT ARM Muscle • Long—_______ • Short- ______ Gravity • Long- _____ • Short- ______

LARGE SMALL easier harder harder easier

For an object to be stable, the ______must fall within the _____ • Mastoid process, shoulder, COG (S2), posterior to hip, knee, ankle joint • When LOG is outside BOS—you fall A larger base of support provides enhanced _________ The greater the _______between the surface and the body, the more stable the body will be. Example: walking on ice vs. walking on a carpeted surface But is more friction always desirable? • No. Patients who are weak, rolling walker o Carpets will be harder The _______the COG, the more stable the object

LOG BOS stability friction lower

Synovial Fluid • ____ joint surfaces • Reduces _____ between bony components • Provides _______for hyaline cartilage o Provides nutrients • Similar to_____ _____ plus: _______-_______ acid -controls viscosity ________: glycoprotein for cartilage-on-cartilage lubrication _______-viscosity decreases with increased speed of motion and provides less resistance to motion -opposite is also true • _______ temperature decreases viscosity and _____temperature increases viscosity • Fast motion—viscosity goes ____as opposed to slow movement

Lubricates friction nourishment blood plasma Hyaluronate-hyaluronic Lubricin- Thixotropic High low down

Length Tension Relationship • Isometric contractions at increasing sarcomere lengths • Shorten—not a lot of force • Too much—not a lot of force o Cross bridge can't full • Someone in resting position o Can pull most force when contraction Where does muscle produce the most force? o ____ ______ o Because of the ____ _____relationship ** o Test muscle—mid range • _____ force increase o Needs to be added in

Mid-range length tension Passive

Muscle Plasticity: Muscle Response to Exercise • Increased ____ ______ - A muscles ability to maintain action for an extended period of time o Muscular endurance is increased through gains in ______and changes in local _____ and _______function. o Enhances exercise ________and _______power when load is _____ and ________are high - 20 RM o Muscles become more _________ o _______ _______ increases o Increases in blood volume help to dissipate ____ ______during exercise o Well-trained endurance athletes have low ____ ____ -___ and ____ _____

Muscle Endurance strength metabolic and circulatory performance aerobic low repetitions oxidative Blood volume heat loads resting heart rates blood pressure

CONTRACTING MUSCLE FIBER SLIDE 8 • Muscle Shortens • How do we do an isometric contraction? Is actin and myosin actually moving? o __________- Sliding mechanism is only for concentric contraction

NOO

Does a Pennate Muscle Really have Biomechanical Advantage? • __________ o Waste of forces o But gives up more fibers _____- larger summative force Which one has a larger summative force? • _______

NOO Straight Straight

Why do PTs need to know about biomechanics and Kinesiology? • If a patient has a problem. You need to know what is _____first • Compares to normal movement • And how you are going to help the patient • What direction to do manipulation - ____ How will you know how to help a patient with movement problems if you don't understand normal movement? How do you know what is "normal" and what is not?

NORMAL biomechanics

• _____ __________ increased CNS activation; improved motor unit synchronization; and lowered neural inhibitory reflexes Normal muscle mass - balance between ____ _____ and _____ ______. Greater protein synthesis leads to muscle ________. Greater protein degradation leads to ___________-. o _____ weeks—atrophy Increased Muscle Strength: Strength training is enhanced when load is ______and repetitions are _____- _____-____% of 1 RM • Endurance opposite _______- Gains in muscle size. Generally paralleled with gains in ____ _______ Anabolism: Muscle ________→ microscopic tearing of the muscle fiber ____ __________ → _______ is released → _________cells are activated → the cells _______, increase and add _______to the proteins that is in the existing cell

Neural Adaptation: protein synthesis protein degradation HYPERTROPHY ATROPHY 2 high low 85-90 Hypertrophy muscle strength contraction cell wall (sarcolemma FGF satellite divide protein

____ ______: The synapse between the a motor nerve and a muscle fiber. o Neural impulse travels down ____ _____ nerve endings o ____ _____-chemical conduction has to take place o________________is released to bind to the receptor sites. If enough, electrical charge will be generated to bring muscle to threshold to produce action potential.

Neuromuscular junction axon terminals Synaptic cleft Neurotransmitter-acetylcholine (ACH)

"shock Absorption"-- 70-90% water ** GAGS type 2 collage Annulus Fibrosis --

Nucleus Polpsus Force Distributer -- zig zag orientation to support nucleus polposus

What if we had a closed kinetic chain? Concave/convex rule still ok? • Now the distal segment is fixed and the proximal segment moves. Concave/convex still applies • Examples: o Knee flexion in standing (squatting) -roll and glide are in ______ direction _____________ o Elbow extension in closed chain (push ups) -roll and glide are in _____ direction ____________- Ex. Open chain • Ulna on humerus o Roll—posterior o Glide- posterior Closed- humerus on ulna o Roll- posterior o Glide—anterior Hip flex Pelvis on Femur • Roll- anterior • Slide—anterior

Opposite Opposite

Supplements for patients with connective tissue injury? • _________- • We don't have proper evidence that it works right now • But no proof that they hurt anything • But would make sense—it will help CT • What would be the problem? o How much will actually reach the knee// not targeted o Not a lot • Injections—maybe more effective

Osteoarthritis

Joint Motion • Range of Motion (physiological motion - Determined by the joint and surrounding structures • _________ - movement of the bones in the cardinal planes during physiological joint motion o Just movement of bones • ____________- Movement of joint surfaces on one another. Occurs during physiological motion, but cannot be independently produced voluntarily o Two bones together, how they are moving in respect to each other o At surface of the bones, in respect to each other

Osteokinematics Arthrokinematics

Bone—Trabecular • _______can occur because of the large amount of trabecular • Spongy • Spongy bone is where ______ ______ part of ____ _____ attaches to the meniscus Retro Diskal Pad • ____ and _______lamina ______—attaches to the meniscus Muscles of Mastication - _______Nerve except dual innervation ______(tri and facial nerve) Masseter—____________the mandible (closes), (2) ______lateral trusion (aka lateral deviation) (same side) right using right master, o Strongest muscle o Clench was writing o Most trigger point - overwork o Brusism

Osteoporosis osteoporosis Superior lateral pterygoid Superior and inferior Masseter Trigeminal Digastric elevates retruson and protrusion, isplateral

Tissues subjected to high compressive forces have more _____ and different _______ than those that sustain tensile forces Tension—tendon Compressive forces—cartilage • Type of GAG depends on tensile or compressive forces o Compression: (2) o Tension: ____ _____ Actual changes in composition based on function of the tissue o Structure < -- > Function o Keep pulling on it--- the structure will eventually change o Ex. Gynaastics—tissues start changes Constantly being pulled on - bone has a lot more _____sulfate

PGs GAGs chondroitin sulfate, keratin sulfate dermatan sulfate dermatan

Kinematics : Coupling - lateral flex and rotate Flexion limited by : anything that is posterior will limit motion o Facet orientation o Tension of the (4) (both)—surround joints between top and bottom vertebra, don't want to lose contact Extension limited by o Facet orientation o Contact of the ____ ____ and ______ o Tension of the , (3) • Both motions restrained by the ____ _____ *** Lateral bending limited by o Facet contact on the ____ side Everything on concave side gets close o The rib cage What else limits it? _____ ____ _______ligaments • Flex to the left o Right intertransverse ligament is being stretch Limitation • Rotation limited by o The ____ ___- the amount of distortion the ribs can undergo, as well as the motion available at the __________ and __________ joints o MAIN LIMITATION IS THE ____ ___

PLL, ligamentum flavum, interspinous ligament, and facet joint capsules spinous processes and laminae ALL facet joint capsules and abdominals ' rib cage concave Ligatmetum flavum Intertransverse rib cage costovertebral and costotransverse RIB CAGE

Factors of Muscle Tension (4)

Passive Tension Active Tension Isometric Length-Tension Relationship Dynamic Contractions (concentric vs. Eccentric)

Ultrasound • Feedback to patients When doing a straight leg raise you found your knee starts to bend. It is because • Active insufficiency • Passive insufficiency Force Velocity Relationship PAGE 17 • The fast you move, the _____force to generate—Concentric • At 100% of isometric - _______> force • Eccentric > Isometric > Concentric • Isometric can create over _____% of the isometric Lab Setting • How do we measure strength? o _______Testing—not true Max Quads • Knee flexed at 45 degrees • Why?

Passive insufficiency ***** OF HAMSTRINGS less Eccentric 100 Isometric

Anatomical Pulley System • _______ • Transfer tension • So it isn't pulling on tibia Clinical applications of vectors • Knee _________ • ____,_____, deviation from normal alignments • Predict __________later in life

Patella misalignments Varum, Valgum degeneration

Changes may affected how you move • Environments • Tasks - fine motor tasks o Precision o Vs. simple tasks All 3 interact on how well someone moves Biomechanics KINEMATICS •(4) Describe ______ • Where, how fast • The motion itself _______ —muscle function •(3) Describe ____ _____

Position (x) • Displacement (dx) • Velocity (dx/dt) • Acceleration (dv/dt) MOTION Electromyography Amplitude (mV) • Energy (RMS) • Co-activation (%) MUSCLE activity

Role of Muscles • __________________ o - Produce the motion • Antagonist o Oppose the motion __________________ o - aid the prime mover. Stabilize the joint or modify the direction o Close to prime mover o Usually the same joint _______________ o prevents proximal movement o Different joint o Shoulder

Primer Mover (agonist) Synergist Fixator

__________IS IN BETWEEN. • Therefore, the moment arm of the resistance is always _________than the moment arm of the effort (muscle) • ADVANTAGE FOR ______—larger moment arm • Ex. _______- strongest motion 3rd Class Lever System: Axis on one end, and RA____EA • Moment arm is always shorter for _____ • ________will win • You need to put a lot of effort • EFFORT IS IN BETWEEN. o Therefore, the moment arm of the effort (muscle) is always ________than the moment arm of the resistance • Ex. Biceps—lifting Remembering all that? • "The levers are what they ARE" • In first class, Axis is in between • In second class, Resistance (for example gravity) is in between (RA smaller than EA) • In third class, Effort (i.e. muscle) is in between (EA smaller than RA)

RESISTANCE smaller EFFORT Plantarflexion > effort Resistance smaller

Smaller Cross-Sectional Area: greater ____, less ____

ROM force

Strain-rate sensitivity • ________loading will allow greater peak force to be applied (tissue will be stiffer) o Load quickly responds quickly o And vice versa o Blasick vs static o Blasick - goes into plastic region quicker • Subsequent ____ ____will be larger after rapid loading • __________takes longer under rapid loading (more energy required to deform the tissue) • Application: Plyometrics

Rapid stress relaxation Creep

Tissue response to tensile loads • Toe phase- slack is taken up. Response can be non-linear. • Elastic region-collagen fibers elongate and resist force o Linear relationship between stress and strain o When load is removed structure returns to pre-stressed state o Return • Plastic Region-progressive micro-failure of collagen fibers o No longer capable of returning to original length Permanent deformation • End of plastic phase- macro-failure or o ______-mid-substance tearing of connective tissue o ________-tearing off the bony attachment of a tendon or ligament o _____-failure of bone tissue

Rupture Avulsion Fracture

Review of Kinetics • Types of forces • Lever systems • Mechanical advantage • Forces, moment arms and torques o Resultant forces and torques o Effect of motion on moment arms and angles o Clinical applications Another basic concept: Stability • Center of gravity = COG o _____in anatomical position •_____________ : Area within an outline of all ground contact points o Ground that is supporting you Feet and area in between feet Bigger- more stable • __________________________ o Imaginary line passing through center of gravity toward the center of the Earth

S-2 Base of support = BOS Line of gravity = LOG

Ultra-structure of muscle fiber • ______ ______: passage of nerve messages from the sarcolemma to the myofibrils. Also provides the inner pathway of the fiber for carrying ______ -______ and _____from outside of the fiber. • ______ ______ parallel and surround myofibrils. Storage site for calcium which is important for contraction.

SR Transverse tubules (T-tubules): glucose, O2, and ions Sarcoplasmic reticulum (SR):

Kinematics of the Ribs • Upper Ribs—______—Pump Handle motion Movements in the costovertebral and costotransverse joint are functionally coupled • Movement in the sagittal plane (primarily in _____ribs, axis is closer to ___-___): a ___ ____motion • Movement in the frontal plane (primarily in _____ribs, axis is closer to___-____: a ____ ____ motion Thoracic Spine / Rib cage Bucket Handle : lower ribs Pump Handle : A-P - Rib cage mobility affects ____ _____ and _____ ____ Increase in A-P Dimension Pump- Handle Motion- ______plane Increase in Mediolateral Dimension-- Bucket-handle motion—________plane All ribs that are not floating (i.e. all ribs fromT1-T10) have ____pump & bucket-handle motions, but: • __________ ribs have more pump-handle motion ; A-P • _________ ribs have more bucket-handle motion: M-L o Always a combination of both

Sagittal upper M-L pump handle lower A-P) bucket handle pulmonary function shoulder mobility sagittal frontal BOTH Cephalic (upper) Caudal (lower)

Classification: Longitudinal (STRAP) Example: ________ Classification: Fusiform Example: _____ -_____ Classification: Radiate Example: _____________ Classification: Unipennate Example: (2) Classification: Bipennate Example (2) Classification: Circular Example: (2) Classification: Multipennate Example: ________

Sartorius : Biceps Brachii Gluteus Medius/Max tibialis Posterior, flexor pollicis longus : Gastrocuenius , Rectus Femoris Orbicular Oculi and Spinacters Subscapularis

So what? • What is the clinical relevance? o ________ • In abnormal, sustained vertebral position changes, what will be affected besides posture and alignment? o Structures: _______-_____ relationship is messed up,shortened and other side lengthened—no optimal power o Lungs—___________ One lung will get less space That is why people who have scoliosis will consider surgery age >40-45 o ____ and ___ Scoliosis • Typical—____ ____- most common • Left thoracic scoliosis—spinal ____or other type of tumor—red flag • Lateral flexion to ___________side *** o Shoulder _____ on concave • Vertebral body rotates to ________side • Rotation to _______side, rib ___ _____convex side • Hump on ______side • Shoulder drop- ____ • Hump—_____side o _____is used to name scoliosis

Scoliosis Length-Tension Ventilation Posture and Alignment right thoracic tumor concave lower convex convex hump on opposite concave convex conve

Are synovial joints also "stable"? • Of course! They have to be. • Factors that contribute to stability: _____ of opposing bone surfaces Degree of match between bones Passive _________structures (ligaments, capsule) Passive ________surrounding the joint Actively stabilize the joint

Shape Reinforcing Muscles

what is the most damaging for the tissues

Shear

Pain • ____ache kind of pain • ______ears • TMJ will give you ear ache and pain around jaw • _____pain and _______pain The thorax Straight when looking from the front or back Lateral view: • Cervical and lumbar : _____curve • Thoracic and sacral : ______curve Posterior View—straight line Nucleus Propulois and Annular fibrous—in disk • ____ ______ but have a movement part • Provides ______ Vertebral Body—Anterior Spinous Process--- Posterior

Tooth Clogged Temporal neck lordotic kyphotic Shock absorption mobility

strength of rotation produced by a force couple?

Torque (force * Moment Arm)

Structure of Connective Tissue Cellular Component o Fixed vs. transient Native— fixed ______- -cells of immune system, blood cells o ________-basic cell _______ , _____ - Cartilage _____ ______ - bone Extracellular Matrix o _____ or _______components- o _________or _____ ______ —holds everything together

Transient Fibroblast Chondroblasts, chondrocytes Osteoblasts, osteocytes Fibrillar or fibrous Interfibrillar ground substance

•Protrusion: ________in both condyles o Both translate anterior o Right side blocked--- the jaw will take path of least resistance Whole mandible will go to _____side Will deflect of pain and blockage Because it can't translate Superior and inferior lax—too much anterior Main conditions of Jaw—anterior disk displacement Examination AROM AROM: • Maximal interincisal opening (MIO) • Laterotrusion • Protrusion MIO (Maximum Interincisal Opening) • Gross ROM • Normal AROM: ____ to ____mm Laterotrusion • ___:___ ratio to MIO • Normal AROM ____ to ____mm Right - left is translaterion and right Left is block—____lateral trusion is affected Protrusion • Normal AROM ___ to ___ mm

Translation affected 40 to 50 4:1 10 to 15 right 3 to 6

Calculate the leg-foot angle Hint: Sin θ= side opposite/hypotenuse Cosθ = side adjacent/hypotenuse ________: Displacement per unit time (miles/hour; m/sec; ft/sec; deg/sec) • Difference between velocity and speed? o Velocity has ______ o Speed is just how much o Velocity—how much and direction Derivative of the displacement is ______ __________ Rate of velocity change (change in velocity per unit time; m/sec2; miles/hour2; degree/sec2) • Derivative of _____ Degrees of Freedom (DOF) Concepts • The least number of ____ _____ required to specify the positions of the system elements without _____any geometric constraints. • WHAT?? • Let's go simple.

Velocity (V) direction velocity Acceleration (a): velocity independent coordinates violating

__________- a property of biological tissue (elastc) • _________-ability to return to original state after deformation after removal of the load o Work= ____ * ____ o Work is done and energy ______and is stored o Stored energy released as ______and material returns to original dimensions _______---material's resistance to flow o High viscosity -_____resistance to deformation o Low viscosity -____resistance to deformation Time and rate dependent o Viscosity decreases as temp. ______and pressure _______- think of applications -warming up before exercising; warming tissue before stretching

Viscoelasticity Elasticity force x distance increases recoil Viscosity high low rises increases

Measurement Other Measurements: • ___/___ o How to move effectively • Conservation • Efficiency • Power • Coordination • Stability • Shock • Stiffness

Work/Energy

____ _____- slope of linear portion • Elasticity of a material under compressive or tensile loading • Measure of a material's ____ or _____(compliance is the reciprocal of stiffness) • Slope of the ______ portion of the stress-strain curve o If slope is steep, the material is -___with low _____ o If slope is gradual, the material has greater -_____and less -__

Young's modulus stiffness or compliance linear stiff compliance compliance stiffness

Mechanical Behavior of Connective Tissues • Stress • Strain • Stiffness • Reminds me of students (and professors) during finals week. Ligament—multi-directional Tendon—not Connective Tissue Properties • Homogeneous materials have the same mechanical behavior no matter what direction forces are____ _____ materials • Heterogeneous materials behave differently depending on the nature and direction of applied forces ___________materials o Chart SLIDE 59 o Response different o Biological tissue Connective tissues are _____, composed of solids and semisolids, and are ________materials

applied isotropic anisotropic heterogeneous anisotropic

Innervation Trigeminal Nerve (V) • Primarily _________ o Just innervates the ____ • Used for differential diagnosis o Surgeon go in and block it, ________, to see if the pain goes away o You can say the origin of the pain was from the joint o What if the pain does not go away—joint is not from the TMJ o Also could use ___ and _____ for longer duration of pain relief EPI - keep medication in joint longer Ligaments • ________ - attached to temporal bone and attach medial and laterally to medial and lateral poles on the _____ o If you touch lateral pole—you are touching the capsule o Tenderness = capsulities o Has synovial membrane and fluid o Joint is converged by a _________tissue o DOES NOT HAVE ______ CARTILAGE for this joint Temporomandibular Ligament o It _______the mandible in space Hangs o Limits ________of the mandible * o Translation of the joint function When opening your jaw

auriculotemporal TMJ lidocaine corticosteroid and (EPI) Capsule fibrocartilage HAYLINE suspends retrusion

Osteokinematics • Bones moving in the 3 main planes • Movements of the _______-in space during physiologic joint motion • Movements in sagittal, frontal, and transverse planes • Movements described in the ____ , around an _____, and in a specific _______ SLIDE 19 Arthrokinematics • Can't see, how joints move on each other • Movements of ______ surfaces on each other • _____ -progression of points of contact o Example is femoral condyles on tibial plateau ______ -translator motion of gliding one surface over another without change in contact points o Example -proximal ______ slides over fixed end of _____ ______ -rotary motion where the same points remain in contact on both surfaces o Example head of _____spins on the _______of the humerus in supination and pronation Remember: Axis can change during motion (Instantaneous axis of rotation) SLIDE 21 Knee Joint

bones plane axis direction joint Slide phalanx metacarpal Spin radius capitulum

Synovial joints - triaxial Plane (e.g. _____ joints) o Triaxial-allows _____ and _____ o Between carpal bones o ____ DOF Ball and socket o _________surface paired with _____socket o Distal bone can theoretically move around a center in an infinite number of axes. o In reality, ___________(flexion-extension, adductionabduction, external-internal rotation). o Degrees of freedom? ______DOF—capsule, ligaments, and tendons Technically, it could have many more but the structures restrict it

carpal gliding and rotation. 3 Sphericconvex concave triplanarmotion 3

Motor Units • A motor unit consists of(4) • Each motor unit controls multiple ____ _____ the number is depending on the _________of the muscle (for _____—less fibers ; for ______---more fibers). o Back—more fibers o Finger—less fibers • # of fibers in the MU depends on the _____of the muscle • When a motor unit is activated, all the muscle fibers that particular _____ ______controls will contract (all-or-none).

cell body, axon, neuromuscular junction and muscle fibers muscle fibers; function precision endurance precision motor unit

Effort or resistance arms can ________during motion • Notice how the moment arm of gravity changes. So torque changes... • For any force, as you move they moment arm can change • Changes in ______—much larger than changes in muscle o But both of them change • Gravity—different degrees of elbow flexion o Moment arm changes o Feels heavier because torque is greater Holding a weight at different degrees of elbow flexion. Where will it be easier for the muscle? • At _____degrees o Muscle moment arm is _____(same with gravity) Gravity moment arm and center of mass • May change as position of body segment changes • Which of these is easier? Why? _________________/FORWARD o C o B is easier than A ____ ____ -___gets closer to rest of body Moment arm of ______gets smaller Closer to center of mass - S2 o A >B >C - hardest

change gravity 90 biggest o Hands at the side Center of gravity gravity

Effects on ligaments and tendons • Decreased loading decreases ______content and cross-linking • Tissue _______as a result of decreased loading • ______looses interdigitating structure, making it weaker • Loss of up to _____% of tensile strength and stiffness after _____ weeks of immobilization • _________reloading restores strength to tendons and ligaments, but may take longer than 12-18 months • Avoid immobilization

collagen weakens MTJ 50 8 Graded

Joints • Minimal motion vs. motion in multiple planes o Skull vs. shoulder or hip o degree of ______ Joint Types SLIDE 4 ________ Classification: Based on the way bones are held together: what does it look like anatomically Synovial Joints: bones are separated by a ____ ____ lubricated by synovial fluid and enclosed in fibrous ____ ____ o (2) Fibrous Joints: bone held together by ________ fibers extending from the ______of one bone into the _____of the next: NO -______ ____ o (2) Cartilaginous Joints: bones held together by ____; NO ____ ___ (2)

complexity Structural joint cavity, joint capsule Diarthroses o Amphiarthroses collagenous matrix matrix JOINT CAVITIY Amphiarthroses synarthroses o Cartilaginous cartilage JOINT CAVITY Amphiarthroses synarthroses

Changes with Aging • Decreased _____of rib cage • Decreased _____of lung tissue o Retain more air at end of exhalation (increased ____ ____ ____), so decrease in ___ _____ • Decreased effectiveness of _____muscles • _____energy expenditure of breathing Pathological changes in volumes and capacities Restrictive Versus Obstructive Pulmonary Disease Obstructive Diseases: o Difficulty getting air ___of the lungs o Reduction in the ___ ____(bronchoconstriction, mucus, inflammation or mucosal thickening) increases _____to airflow, traps air within the lungs Restrictive Diseases o Abnormal reduction in the ability to ____(difficulty getting air ___-) o Impaired pulmonary or chest wall _____ o Asthma Scoliosis— • Get air in, there is no room • ____

compliance recoil functional residual capacity inspiratory capacity ventilatory Increased out lumen size resistance ventilate in compliance Restrictive

Cartilage • Main function is _________- shock absorption and water ? Three forces interact in cartilage o __________developed in fibrillar portion of ECM o _________pressures developed in fluid phase (PGs, water) o _____ ______ from fluid flow through ECM -causes toe region of stress-strain curve Compression ________volume of cartilage, increases ________, causes outward flow of ___ ____ • Fluid flow through ECM creates ____ ____ • Exudation of fluid causes ________--shock absorber, force dissipation • Cartilage resistance to shear depends on the amount of _________present -PGs little resistance to shear o Not very good with shear o Ligaments are probably the only ones

compressive Stress Swelling Frictional drag reduces pressure interstitial fluid frictional resistance deformation collagen

Orthopnea • Difficulty breathing when lying down • Better in sitting or standing. • Related to (2) • But also, biomechanically, can you think of why position would matter based on what we just discussed o ______helps diaphragm o And gravity compresses lung o Lying—biomechanical disadvantage o Sitting up—gravity does not affect it as much Review! Respiratory Volumes and Capacities Mnemonic: http://www.youtube.com/watch?v=wD6-B1jQGCQ

congestive heart failure and blood volume redistribution Gravity

As muscle contracts, it pulls on the ____ ______ in which it is wrapped, causing the -_______to move the ________to which it is attached • connective tissue that surrounds ____muscle o 3 layers of connective tissue (epi-, peri- and endomysium) provide _________that _____muscle together

connective tissue (fascia) tendon bone entire framework holds

What about ribs 11 and 12? • No ________joint • Motion is "____ ____" along a horizontal plane. o Windshield wiper • This motion produces slight changes in both diameters ___ and ____) • _____PLANE Rib cage motions during ventilation Inspiration: Flattening of _____-and rib ______increases ______of thoracic cavity and air moves into lungs • Expansion of thoracic cavity • Ribs are coming out and increase diameter • Vertical increase in volume • Negative pressure—flow of air into thoracic cavity • Pressure _________-—air in Expiration: Diaphragm and ribs return to ____positions decreasing ______of thoracic cavity; air moves out of the lungs • Decrease volume • Pressure ______—air out Ventilation Inspiration: active process o Caused by muscular contraction o Mainly _____ and _____muscles o May have accessory muscles Expiration: typically passive process o _____ ____ of the diaphragm o Muscle relaxation—passive o People who have trouble use _____muscles

costotransverse caliper-like TRANSVERSE AP and transverse diaphragm elevation volume decrease normal volume increase diaphragm and intercostal Elastic recoil accessory

Each thoracic vertebra has three additional articulating surfaces on each side to form the ________ and ________ joints with the rib Which vertebrae does each rib articulate with? • Rings articulates with the verbrea with the same number and the vertebra _____it • Rib 6—interacts with ___ and ____ Some interact with sternum Rib—cartilage -- sternum • Ribs 1-7 Merge Cartilage - not has direct 8-10- -false ribs 11-12 floating • No true attachment • No articulation Joints • Intervertebral discs • Facet joints o Between vertebra • Costovertebral joints (AKA costocorporeal) • Costotransverse joints • Sternocostal (Chondrosternal + Costochondral) joints • Interchondral joints/ligaments

costotransverse and costovertebral T5 and T6 above

Ventilatory Muscles • Primary: (3) • Secondary: (3).... etc. ** Primary muscles listed here are the ones that help to increase the volume of the thoracic cavity Ventilatory Muscles Inspiration • ____ ___Contract • Expansion of the ribs moves sternum upward and outward Expiration • ___ ____relax • ____ and ____ ___contracts for active expiration • Ribs and sternum depress Mechanics of ventilation SLIDE 40 Inspiraton • Abdominal viscera - ____room • Thoracic _____ • ___ _____ expansion Pressure and volume—____relationship Increase volume—decrease pressure

diaphragm, intercostal muscles and scalene muscles SCM, trapezius, pectoralis External Intercostals External intercostals Internal intercostals and abdominals less expansion Anterolateral abdominal inverse

Joint DOF • The number of independent _______ of movements allowed at a joint • In a nutshell: number of ____ in which the joint can move. ** _____ possible DOF, one per cardinal plane • THE NUMBER OF PLANES THE JOINT CAN MOVE ** o Highest is 3 o If higher, using two directions Hinge— ___ degree • Elbow • Sagittal o Med-lateral axis

directions planes • 3 1

Extra Capsular Ligaments Sphenomandibular ligament-- limits _____ movement Stylomandibular ligament-- prevents excessive movement ____

downward anteriorly

Intracapsular Ligaments Tempormandibular Ligament -- blends with capsule,prevents ___ and excessive _____ movement of the mandible Collateral ligament-- holds meniscus and prevents excessive movements on the ____

downward posterior condyle

SLIDE 25 • Arthrokinetmatics at the GH joints during ABD o The glenoid fossa is concave and the humeral head is convex. o Roll and slide arthrokinematics typical of convex articular surface moving on a relative stationary concave surface o Consequences of a roll occurring without a sufficient offsetting slide Train _______ contraction at the knee - to improve squat Clinically, if you improve concentric it will not help to improve squat Primary muscle at joint—concentric and eccentric Squat at knee • ______ contraction at quad • Patient will be able to do that better Hip • Concentric contraction of quads are knee • Eccentric contraction of the ???

eccentric Eccentric

Synovial joints - uniaxial Hinge (e.g. ____) o Uniaxial o Flex-ext o Mechanical analog: _____ ___ Pivot (e.g.: ________joint) o Spinning around one axis of rotation o Radial head and the ulna Ex. _____-____joint ___ and ____ joint - only rotation o Mechanical analog: doorknob

elbow door hinge atlantoaxial Radio-ulna Atlas and axis

Temporalis-- ______the mandible, ______-, ______lateral trusion or lateral deviation o Move jaw to left—use left ____ and _____ Lateral and medial pterygoid o Medial Pterygoid - _____the jaw (_____the mandible), ______, _______lateral trusion Jaw to right—_____medial pterygoid Lateral Ptyergoid—assist with mandibular ____ or____, ______, ________lateral trusion _________contracts when you close your jaw during mandible elevation _______--when you open your jaw Both - contralateral lateral protrusion but some might say lateral pterygoid is ipsilateral Digastric—innervated by ____ and _______ o ______the mandible and _____ o Need _______ muscle to contract To keep hyoid bone nice and stable Used _____bone for leverage Stable surface for the digastric can depress mandible down

elevate retrusion ipsilateral masseter and temporalis closes elevates protrusion contralateral left opening or depression, protrusion contralateral Eccentrically Concentrically trigeminal and facial nerve (which heads) (posterior belly- facial nerve, anterior belly trigeminal) Depress retrusion Infrayoid hyoid

Structure of skeletal muscle • Don't think of each muscle as a single unit for it consists of: o The __________or outer connective tissue, surrounds the entire muscle holding it together. o __________- surrounds small bundle of fibers. o _________-surrounds bundles, up to 150 fibers in each bundle. (surrounds fasciculus). o Each fiber is surrounded by the _________

epimysium Fasciculus Perimysium endomysium

Cartilaginous joints (4)

epiphyseal plates of long bones costosternal joints pubic sympthsis intervertrbal disks

Internal and external torques • External torque—gravity—Into ________ • Internal torque—biceps—into ________ o Equibliubrum = Torque * distance Torque = force * moment arm Moment arm is perpendicular distance to axis Movement—_________torque has to become greater • Or change distance or positions Internal torque = External torque • IF * D = EF * D - equilibrium

extension flexion internal

Types of Tendon-Bone Attachments (Entheses) • Fibrocartilaginous - most o 4 zones changing from tendon to ______ , to _________ fibrocartilage to _____ o ______appears between calcified and uncalcified zones o Sharp difference between tendon to bone Changes Morph into fibrocartilage Then mineeralzied Then its bone • Morphs into bone • Otherwise very weak • Makes junction strong Less subject to injury= that's why there is this transition • Fibrous ___________-indirect attachment of tendons to bone via periosteum _______-tendon attaches directly to bone

fibrocartilage mineralized bone Tidemark Periosteal Bony

Effects on bone, articular surfaces • Proliferation of ________connective tissue in the joint • _________between folds of the synovium • Atrophy of _________ • Regional _________ • ________--of bone and _______fibers at ligament insertion sites • Decrease in PG content • _____in water content of articular cartilage • Atrophy of menisci • Deformation under compressive test loads increased by 42% o Much worse absorption of shock

fibrofatty Adhesions cartilage osteoporosis Resorption Sharpey's Increase

Synarthroses Characteristics: reinforced by a combination of_____ and ______ connective tissues; permit slight to no movement Fibrous Joints o Sutures of the ____ o ____ ____joint o ___________-membrane reinforcing radio-ulnar joints Cartilaginous Joints o _____ ____ o ______ joint of the spine __________joints ___________joint - young

fibrous and cartilaginous skull Distal tibiofibular Interossesous Symphysis pubis Interbody Intervertebral Manubriosternal

Kinetic Chain - Open vs. closed Open kinetic chain : free to move in space o Joint ______of each other o End of the chain is free -1 joint can move independently of the others in the chain ▫ _____ moves o Limbs move Closed kinetic chain o Distal segment is ______ but the other joint follow up o __________ o Surface does not move o ____ _____movement o End of the chain is fixed movement at 1 joint causes movement in _____ joints of the chain (interdependence) o Ex. Squat, push up, pull up o _____ moves Doing a squat is a(n) ___ kinetic chain exercise for the LE • _________

independent Limb fixed Interdependence Whole body all Body Closed

Amphyiarthroses

intervertrbral disks joints between articular process of cervical to lumbar vertbra costosternal joints pubic symphysis distal radioulnar joints tibiofibular joints

Rotate Right RR—posterior SP—posterior RL—anterior Rib on that side—goes posterior—HUMP Rib on other side goes anterior- • Rotates clockwise SP to the left • Vertebra is rotating right Kinematics • During rotation of the thoracic vertebrae, the rib pair distorts • Given rotation of the vertebral body to one side, there will be o Posterior displacement of rib _______to rotation o __________-displacement of rib on the opposite side • NOTE that the above is worded with respect to rotation of the vertebral body - the ____ _______ goes in the opposite direction

ipsilateral Anterior spinous process g

Skeletal Muscle Structure PAGE 3 Muscle fiber • A single muscle cell is known as a _____ _____ • It is encased by a plasma membrane called a ________. • The sarcolemma fuses with the ______which is connected to _________ to ultimately create ______. o Most common o Some attach to muscle and bone Range in diameter from ___ to_____ micrometers • Muscle fibers have smaller subunits- ________- • Most myofibrils extend the entire _____of the muscle. • _________ is jello-like substance that surrounds the spaces between the myofibrils. It is the fluid part of the muscle fiber-its ______. • It contains _______ and _______ (oxygen carrying compound) A Muscle Fiber PAGE 3 ____- stores calcium

muscle fiber. sarcolemma tendon bone motion 10 to 80 myofibrils length Sarcoplasm cytoplasm glycogen and myoglobin

Tendons • Connect ____ to ____ • Transmit forces to ____ or _____ joints • Collagen fibers lined in direction of _______forces; ____ ___ • Similar composition to ligaments, with >Type____ and < type III collagen (handle >tensile forces) o Even more type____than ligaments • One direction o Most fibers are in one direction _______encloses groups of fiber bundles • _________covers entire tendon • __________= double layer sheath attached to outer surface of epitenon • _________= Epitenon and paratenon together • __________=synovium filled sheath surrounding a tendon subjected to high levels of friction

muscle to bone move or stabilize tensile dermatan sulfate I I Endotenon Epitenon Paratenon Peritenon Tenosynovium

Myofibrils • Each fiber breaks down into several hundred to thousand ______. • These are the ______ elements of skeletal muscle. • Has striped appearance, thus _____- muscle. • These break down to yet even smaller subunits: _______or the ______ • _________is the smallest functional unit of a muscle. o ____-____- end to end- dark stripe o ____ _____- light zone o ____ _____- dark zone o____ _____ in middle of A band.

myofibrils contractile striated myofilament sarcomere Sarcomere Z disk I band- A band H zone-

Muscle contraction requires a lot of energy • Process and reuptake Organization of a Muscle Fiber • Muscle fibers: ________ cylindrical cells, 10-100m diameter; 1-400 mm (or more) in length (400 mm = almost 16 in.) • Composed mostly of smaller units called _______that are made of ___________(actin and myosin)

myofibrils myofilaments

Roles of ATP in Muscle Contraction • ATP breakdown: provides energy to activate and reactivate _____ ______prior to binding actin (myosin ATPase) • ATP binding to myosin head: needed to ______ actin from myosin so cross-bridge cycle can repeat • ATP breakdown: provides energy for______ reuptake into ____ ____ • ATP breakdown: provides energy for ______of ____ ____ _______lafter contraction (Na+-K+ ATPase)

myosin head dissociate Ca2+ sarcoplasmic reticulum (SR Ca2+ ATPase) restoration resting membrane potential

More about sliding filament theory • After breaking, the myosin goes back to _____position and attaches to a new ____ _____further along the actin filament. o Z bands are pulled ______to center o I band ______ o No change in the ____ ____ o H zone can _____ • ___________contraction: spacing between I band is constant • During eccentric contractions: ____ and ____band become wider.

normal active site together decreases A band disappear Isometric H and I

Epidemiology • 50-75% of population suffers at least ____symptom of TMD o - Anastassaki et al, 2000 o - Ho S, 2006 o - Gremillion, HA, 2000 o - Armijo Olivo et al, 2006 • ____-____ years old—reproductive ages of females o Females 9:1 o More prevalent to _____ o Has a lot to do with estrogen o - Helkimo, 1979 • Prevalence women greater than men - Helkimo,1979 • Annual cost of approximately 4 billion dollars o - National Institiude of Dental and Craniofacial Research (NIDCR)

one 13-35 women

SLIDE 31 Which one is fixed • So we have the ______ glide direction compared to open chain, BUT the overall motion is still the same, we are just looking from a different perspective because the fixed segment changed. You are simply looking at the glide of the other bone now Open and close-packed positions • _____ _____ position-joint surfaces are most congruent (i.e. fit tightly together like the pieces of a puzzle) and the ligaments and capsule are maximally taut. Example: ___ ___ and ____ -___ o Joint is _____ o Very close, tight, and cannot get a lot of motion _____ _packed position -articular surfaces are relatively free to move, joint structures are lax and joint cavity has greater volume o Technically, any position other than close packed how is that confusing o In practice, commonly used to refer to the position where structures are most lax and there is maximum joint play o Position in which an _____ force may produce motion of one articular surface on another for assessment of joint play o The most open packed—the position when you have the most motion Ligaments laxed A lot of motion Used for _____- glide the joint Inflammation and swelling—your body will go into _____ o A lot of fluid o Place themselves in open packed position

opposite Close-packed ankle dorsiflexion, wrist extension locked Loose (open)- external treatment OPEN

Shorter muscle with sarcomeres in ____: able to produce more ____

parallel force

Summation of Action Potentials on Surface EMG Unique Patterns for Different Activities PAGE 26 • Muscle needs a _______ for contraction • When a muscle kicks in—important What Can we Use This Information For? • Compliance • Testing • Assessing coordination of firing • Timing of muscle activation • Kinesotape

pattern

Repeated Bone Loading • High repetition and low load or low repetition and high load may cause _________strain and lead to failure • ______- where it takes load - orient o In epiphysis o Accommodates to resistances and strains • Bone loses ___ and ____ with repetitive loading • "___ _____" occurs with repetitive loading while material is undergoing creep o Additional _________and cost for injury o Can't recover property = less strong o Appropriate rest periods

permanent Trabecula stiffness and strength Creep strain deformation

Coordinate Systems • Give the ______ of a body in space • 2D or 3D (how far are point A and B from the respective origins? Coordinate Systems • In human studies the origin of the local coordinate system is usually set at the ____________ • In a research setting, researchers will define a global coordinate system in order to reference all points in space. All points in a local coordinate system can be converted to a global system for comparison purposes. • Center of Mass is _____ __________: Change of position of a body in space • 2D or 3D SLIDE 37

position center of mass (S-2) S2 Displacement

4 Key Features of TMD

pre-auricular pain in and around the ear tenderness of muscles of masticiation limitations of joint motion Audible sounds

Exercise after immobilization • Moderate, ________-loads are best Overuse • Sudden application of large loads may be detrimental o Microscopic rupture o Macroscopic rupture Application of repeated or sustained ____loads may also be detrimental o Physiologic loads while ______occurs can damage tissue!! (no time for recovery) Structures subjected to repeated loads before time to recover -may enter ______range AKA Repetitive strain injury, overuse syndrome or repetitive motion disorder Also systemic influences (hormones, nutrition, etc) Questions?? • • Next week we start discussing biomechanics/kines by body segments • I will post "thought questions" for the first three class sessions -please review those. Answers will be provided before exam 1. • Also review "clinical case" for each lecture

progressive low creep plastic

Cartilage has a lot of ________- a lot of water goes in and out for shock absorption Majority is a ________and _____stuck onto it • Carbohydrate portion = ______________ o Sugar portion • Most GAGs attach to ______to form PGs Exception: __________acid—supplements for osteoarthritis o All regulate water ?

proteoglycans CHO proteins glycosaminoglycans (GAGs) proteins hyaluronic -- controls viscosity

Arrangement of Fasciculi • Architectural Organization - via different arrangements of fasciculi • Shape of muscle determines ____ _____ _____& affects ____ ____ • ______ muscle, _______fibers, greater shortening • Shorten little, but are more ______

range of motion power production Longer parallel powerful

Mean Firing Rate Before and After Muscle Fatigue • In normal condition, in order to exert more force the motor unit ________ and _____ ______ both need to increase. o _____ and _________ increase • When muscles are fatigued, motor unit recruitment and firing rate both need to _________ in order to maintain the same force output. • Once muscle fatigues—more NM recruited • Fatigue—we need a sub to help out Staircase Contractions PAGE 25

recruitment firing rate Number and rate increase

SLIDE46-48 Scoliosis- Restrictive • Everything is -_____ • CODP—increase ____ • NM weakness—look like a restrictive disease o Can't take air in properly o Restrictive pattern o Overall, reduced

reduced RV

At Axis—toque is 0! • Has to be at a distance from axis (F4) - we don't care Clinical applications • Longer moment arm—less _______needed • When providing resistance—the longer moment arm will be ______for you - less force needed o Not always good Focus activation • Longer moment arm—less _____for same torque with manual resistance How can you make it easier for Patient? • ______ moment arm • And/or ______force Make it harder • ______moment arm • Or force How you position hand matters • Place hand in plane of motion—all force is going where you want it • Saggital plane--- sagiital placement • Full use of force More clinical applications • Orthotics/ protesthics • Specific points of contacts • Stabilizes—length and force are calibrated

resistance easier force Shorten decrease Increase

During human joint motion, a combination of____ and _______arthrokinematic movements usually occurs in order to maintain joint integrity • Slide and Roll o Prevents ____ and _____ o Flex hip Head rolls backward Femur moves forward—osteokinetmatic o ADB Shoulder Head of humorous rolls up Humerus slides—_________ Osteokinetic—moves up • Rolls • And it slides down o To keep head of humorous in place

rolling and sliding damage and dislocation Osteokinetic

Convex Concave Rule • When a concave joint surface is moving on a stable convex surface, the glide and roll are in the ________direction. o Where you see it in space o Tibial plateau o CONCAVE IS MOVING o Acetabulum moving on femur When a convex articulating surface is moving on a stable concave, sliding occurs in the _________direction as motion of the bony lever. o Femur and shoulder o CONVEX IS MOVING Cut outs So for example, the head of the femur glides _____ on the acetabulum during hip flexion • Posterior • Roll—anterior • Glide—Posterior NOTE: Here we assume distal segment is moving on proximal segment - AKA "open chain". More about this in the joint function lecture! BONE MOTION ANIMATIONS - blackboard

same opposite

1. Resting 2. Action Potential in the _______carried to the interior of the cell through the ___ _____ 3. AP triggers release of Ca from the ____ _____ 4. Calcium binds to TnC subunit of ______, causing exposure of the actin active site a. ___________removed from blocking position on actin 5. Activated ______ head binds to active site pulling the actin over the myosin and contracting the _______ 6. Ca2+ removed by reuptake into the SR; Contraction ends; Tropomyosin restored to blocking positon

sarcolemma T -Tubules sarcoplasmic reticulum (SR) troponin Tropomyosin myosin sarcomere

Joint Structure and Function Joints or articulations • Connect ______ together and allow _____ between segments • ______ dictates the design of the joint o Mobility versus Stability • The way the joint is designed is how it _____ • The way you uses the joints can change o Adapt to what you demand from it Structure is determined by _____ . Changes in function can cause structural changes in the joint o -Feet pianist _____ and _____ determine function o Cartilage, muscle, ligaments o What's in it Give tissues the properties • Example: prosthetic design

segments movement Function functions function Materials and composition

Surface Electromyography • Summation of the motor unit action potentials can be detected on the skin under the ____ • Max signal can be obtained on ____ _____ • No or minimal signal at tendon or motor point • ____ _____ where the motor nerve going into muscle o Where AP goes into T-tubule • Best place-higher signal is in the muscle belly

sensor muscle belly Motor Point:

Longer muscle with sarcomeres in ____: able to shorten more, greater ____

series ROM

Diarthroses (6)

shoulder, elbow, carpal joints, hip knee, tarsal joint, interphalangeal joint

synarthroses (5)

skull teeth epihyseal plates of long bones first costosternal joint mental symphysis

Fibrous (4)

skull teeth in sockets distal radioulnar joint tibiofibular joints

Factors of Muscle Function? (5)

slow twitch/ fast twitch arrangement of fibers (pennation) Muscle fiber length *** Muscle Mass Physiological Cross-Sectional Area ***

End feel • Sensation felt on passive physiologic movement of the joint • Ex. Elbow flexion o You are feeling ___ ___ o Soft end feel • Elbow EXT o Hard end feel o Bone on bone Normal end feels: o ____-bone o _____-soft tissue approximation • ____-capsule and ligament stretching o 80% joints Lying on back—lift leg Hamstrings - feel pull Muscles and tendons being lengthened Abnormal: o ________-end of motion cannot be reached due to pain Pain and patient is contracting Go too far and didn't feel what you thought o __________-edema Feel fluid stopping you o ____________ Excess ROM

soft tissue Hard Soft Firm Empty Boggy Hypermobile

Stress Strain Curve • Muscle becomes increasingly ______as it lengthens. • Curve is ____ ____ • Both _____ and ______increases stiffness Force-Length Relationship SLIDE 16 • ________—most force • Isometric > Concentric

stiffer Non-linear strain and stress Eccentric

ESTIM—helps with muscle ______ • 80% or higher Muscle Plasticity: Muscle Response to Exercise • Increased Muscle Power - _____ * ______ o Power is the product of____ _and _______ o Muscles become more ________ o Increase in ____ ______(but not number) and ______ o __________ ______ _______ the main contributor Strength gain

strength Force X Velocity (D/T) speed and strength. glycolytic fiber size speed Fast motor units

Terminology and Definitions • Temporomandibular joint (TMJ): TMJ is a _____, ______, modified ovoid and hinge-type joint with _________-surfaces and an ____ ___ - Magee, 2014 • Temporomandibular disorders (TMD): TMD are disorders that affect the TMJ o Pair in and around the _____ o Pain in muscle of ______/ muscular _____ o Lack of ______ o _____/______ sounds

synovial condylar fibrocartilaginous articular disc ear chewing tenderness ROM Clicking/ clunking

Diarthroses Characteristics: possess a ____ _____-filled cavity; permit moderate to extensive movement Examples:______ joint, ___________ joint of the spine, Knee or _____joint, ankle (______joint) Types of Joints Diarthroses -____joints o Complex joints o Primarily for _____ Synarthroses-non-synovial joints o Simple joints o Primarily for _____ In between: ___________ o "Slightly movable" o Eg: ________-discs

synovial fluid GH Apophyseal (facet) tibiofemoral talocrural synovial mobility stability Amphiarthroses Intervertebral

The Capsule Attaches: Superiorly Inferiorly Anteriorly posteriorly

temporal bone neck of the mandibular condyle lateral pterygoid muscle retrodiscal pad

Ways of Muscle Attachments 1. To bone indirectly— a. epimysium continues as ______that merges into ________ b. Ex.- many, including ____ ____ to _____ c. Most commonly 2. To bone directly— a. epimysium is continuous with ______of a bone b. Ex.- ____ _____ c. No tendons there 3. To a broad sheetlike tendon, ___________— a. Ex.--certain _________muscles 4. To _______fibers (dermis)— a. Ex.--muscles for _____ _____ b. Innervates to dermis c. Forms skin

tendon periosteum biceps brachii to scapula periosteum intercostal muscles aponeurosis abdominal collagen facial expression

Tendons • Creep in tendons occurs with _______loading • Loading on _____linear region creates damage o Enough rest = stronger • Intermittent tension increases the thickness and strength of tendons • Tendons are generally weaker at the _____, esp. MTJ o _________from one area to another = weaker • Immobilized tendons show _______, esp. at the MTJ o Immobilization • Tendons adapt to changes in ___ and ______of loading • _______changes direction and structure - injuries and embolization • ____ ______programs are successful in treating tendon dysfunction o Little by little and give tendon respond to adapt and remodel

tensile high ends Transition atrophy magnitude and direction Force Progressive loading

Exercise • Bone deposition increases with ___ ____and increased muscle _____--Wolff's law • Application and removal of loads leads to healthy ________ • Increased tensile loading increases _______concentration and cross linking, tensile strength, and ____in tendons • Exercise counteracts negative effects of ________and appears to help ligament ________ • Connective tissue adapts to increased loading o Compression for _______and _____ o Tension for ___ and ___

weight bearing force cartilage collagen stiffness immobilization healing cartilage bone ligament and tendon

Types of Displacement (2) • ____ ___ (combination of both) Displacement • In real life, almost all human movements are a _______of both translation and rotatory motion. • We often oversimplify joint motions as rotations only Knee Flexion Model Example of combined motion : knee

• Translation (linear) • Rotation (angular) General Motion combination