Chapter One - Human Movement

Physiotherapists study the science of movement. They learn how to pinpoint an injury’s root causes.

Physiotherapy is treatment to restore, maintain, and make the most of a patient’s mobility, function, and well-being.

Physiotherapy helps through physical rehabilitation, injury prevention, and health and fitness.

Physiotherapists focus on both prevention and rehabilitation. Treatment can be for problems caused by injury, disease or disability. Here are some examples:

  • Musculoskeletal Rehabilitation: Neck and back pain caused by problems in the muscles and skeleton.
  • Sports Rehabilitation: Sports Injuries Problems in the bones, joints, muscles and ligaments, such as arthritis and the after-effects of amputation.
  • Cardiopulmonary Rehabilitation: Lung problems such as asthma.
  • Disability as a result of heart problems.
  • Women's Health: Pelvic issues, such as bladder and bowel problems related to childbirth.
  • Neurological Rehabilitation: Loss of mobility because of trauma to the brain or spine, or due to diseases such as Parkinson’s disease and multiple sclerosis.
  • Fatigue, pain, swelling, stiffness and loss of muscle strength, for example during cancer treatment, or palliative care.
  • Paediatric Rehabilitation: Treat children with Cerebral Palsy, with growth deficiencies.
  • The International Classification of Functioning, Disability and Health, known more commonly as ICF, is a classification of health and health-related domains. As the functioning and disability of an individual occurs in a context, ICF also includes a list of environmental factors.

    ICF is the WHO framework for measuring health and disability at both individual and population levels.

    The ICF provides a common language for disability.

  • Functioning is an umbrella term for body functions, body structures, activities and participation.
  • It denotes the positive aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors).
  • Disability is an umbrella term for impairments, activity limitations and participation restrictions.
  • It denotes the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors).
  • Body functions - The physiological functions of body systems (including psychological functions).
  • Body structures - Anatomical parts of the body such as organs, limbs and their components.
  • Impairments - Problems in body function and structure such as significant deviation or loss.
  • Activity - The execution of a task or action by an individual. E.g., walking, completing an assignment, running, swimming
  • Activity level - is the starting position/s in which the activity is performed
  • Participation - Involvement in a life situation.
  • Activity limitations - Difficulties an individual may have in executing activities.
  • Participation restrictions - Problems an individual may experience in involvement in life situations.
  • Environmental factors - The physical, social and attitudinal environment in which people live and conduct their lives. These are either barriers to or facilitators of the person’s functioning.
  • Contextual factors:
  • A range of factors that can influence health, safety, wellbeing and participation in physical activity. These factors include personal, social, cultural, economic and political factors that exist in differing ways and have varying impacts across population groups.
  • Personal and environmental factors.
  • Missing components:
  • If a part of something is missing, it has been removed or has come off, and has not been replaced.
  • It is the deviation from the typical/normal way the activity would be performed as result of disease or pain.
  • Problem List

    Once the analysis has been done, the most important FUNCTIONAL problems should be identified and documented.

    Prioritise the most important problems and analyse completely, using the following table.

    The Canadian Medical Education Directions (CanMEDS) Physician Competency framework (Frank, Snell & Sherbino, 2015). Competency is defined in CanMEDS as “an observable ability of a health professional that develops through stages of expertise from novice to master clinician” (Frank, Snell & Sherbino, 2014, p.7). The Competence Framework structure is:
  • Role
  • Definition of role
  • Key competencies
  • Enabling competencies
  • The Competence Framework principally reflects the roles undertaken by physiotherapists interacting with clients. Physiotherapists may also work entirely in non-client contact roles, such as management/ administration, policy and planning, teaching and research.

    The CanMEDS seven roles are Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional. The Medical Expert role has been changed to Physiotherapy Practitioner in the Physiotherapy Competence Framework.

    Morbidity: Refers to having a disease or a symptom of disease, or to the amount of disease within a population. Morbidity also refers to medical problems caused by a treatment.

    Mortality: Mortality rate, or death rate, is a measure of the number of deaths in a particular population, scaled to the size of that population, per unit of time.

    Musculoskeletal: Musculoskeletal Medicine (MSK medicine) is the diagnosis and treatment of problems arising from the musculoskeletal system. This includes injuries and diseases affecting the muscles, bones and joints of the limbs and spine.

    Therapy: Defined as the prescription of and assistance with specific physical, cognitive, social, and spiritual activities to increase the range, frequency, or duration of an individual's (or group's) activity.

  • A measure taken in advance to prevent something dangerous, unpleasant, or inconvenient from happening.
  • A precaution is a measure taken in advance to prevent something dangerous or unpleasant from happening when a drug is administered, or a warning about something dangerous or unpleasant that could happen.
  • Contra-indications:
  • A contraindication is a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person. There are two types of contraindications:
  • Relative contraindication means that caution should be used when two drugs or procedures are used together.
  • Body Structures

    Defined as a position used as a reference when describing parts of the body in relation to each other.

    Position with the body erect with the arms at the sides and the palms and feet forward.

    Anatomical terms such as anterior and posterior, medial and lateral, abduction and adduction, and so on apply to the body when it is in the anatomical position

    Anterior: the front surface/direction of the body

    Posterior: the back surface/direction of the body

    Superior: meaning 'above' is used to refer to what is above something

    Inferior: (from Latin, meaning 'below') to what is below it.

    For example, in the anatomical position the most superior part of the human body is the head, and the most inferior is the feet.

    Lateral is the side of the body or part of the body that is away/furthest from the middle.

    Medial side of a part of the body is the inside part or side nearest to the centre of the body.

    Proximal: Closer to the trunk or closer to the point of origin. The shoulder is proximal to the elbow.

    Distal: Farther from the trunk or from the point of origin. The elbow is distal to the shoulder.

    Superficial: Closer to the surface. For instance, the skin is superficial to the muscles.

    Intermediate: In between. The abdominal muscles are intermediate between the skin and the small intestines.

    Deep: Farther from the surface. The abdominal muscles are deep to the skin.

    Unilateral: On only one side of the body, like the stomach and liver.

    Bilateral: On both the left and right sides of the body, such as the eyes, the kidneys, and the arms and legs

    Ipsilateral: On the same side of the body. For example, the right ear and the right eye are ipsilateral.

    Contralateral: On opposite sides of the body. The right ear is contralateral to the left ear.

    Ipsilateral and contralateral always must be relative to something

    It's an imaginary line that divides the body into two equal halves.

    The spine is in the body's midline. It runs from the base of the skull through all 24 vertebrae to the sacrum, ending at the coccyx. It connects the top, middle, and bottom of the body and is the body's structural and functional center.

    Axial(central) Region makes up the main axis of the human body and includes the head, neck, chest, and trunk.

    Appendicular(attachments) Region makes up the parts of the human body that connect to the axial region. This includes the limbs and appendages.

    Skull – (cranium)including the jawbone.

    Spine – Divides into four parts
  • Cervical(neck),
  • Thoracic (chest),
  • Lumbar vertebrae (waist),
  • Cacrum and tailbone (coccyx)
  • Chest – ribs and breastbone (sternum)

    Pelvis – hip bones, femur

    Arms – shoulder blade (scapula), collar bone (clavicle), humerus, radius and ulna.

    Hands – wrist bones (carpals), metacarpals and phalanges.

    Legs: femur, Patella, Tibia, Radius

    Feet- ankle bones(talus), metatarsals

    Condyle: A rounded protuberance at the end of some bones, forming an articulation with another bone.

    Epicondyle: An epicondyle is a rounded eminence on a bone that lies upon a condyle.

    Head: The head of a bone usually refers to the proximal end of the bone. The shaft refers to the elongated sections of long bone, and the neck the segment between the head and shaft (or body). The end of the long bone opposite to the head is known as the base.

    Malleolus: Is the bony prominence on each side of the human ankle. Each leg is supported by two bones, the tibia on the inner side (medial) of the leg and the fibula on the outer side (lateral) of the leg. The medial malleolus is the prominence on the inner side of the ankle, formed by the lower end of the tibia.

    Process: Derived from Latin is a projection or outgrowth of tissue from a larger body.

    Tubercle: A tubercle is a small, rounded point of a bone. It also refers to a nodule attached to bone, mucous membrane (moist layer lining parts of the body), or skin.

    Tuberosity: A moderate prominence where muscles and connective tissues attach. Its function is similar to that of a trochanter. Examples include the tibial tuberosity, deltoid tuberosity, and ischial tuberosity.

    Trochanter: A trochanter is a tubercle of the femur near its joint with the hip bone. In humans and most mammals, the trochanters Serve as important muscle attachment sites.

    Notch: A depression in a bone which often, but not always, provides stabilization to an adjacent articulating bone. The articulating bone will slide into and out of the notch, guiding the range of motion of the joint.

    Major Anterior Landmarks:
  • Sternal notch,
  • Xiphoid process,
  • Lateral Epicondyle,
  • Anterior Superior iliac crest,
  • Pubic Symphysis,
  • Patella,
  • Medial Malleolus
  • Major Posterior landmarks:
  • C7 spinous process,
  • Lateral Epicondyle of Humerus,
  • Olecranon Process of ulna,
  • Styloid Process of Radius,
  • Iliac crest,
  • Posterior Superior Iliac Spine,
  • Ischial Tuberosity,
  • Medial Epicondyle,
  • Calcaneus
  • Coracoid process of the scapula
  • Lateral Epicondyle
  • Head of Radius
  • Greater trochanter
  • Head of Fibula
  • Lateral Malleolus
  • Synovial Joints (consists of a capsule, cavity, synovial fluid)

    Types of Synovial Joints:
  • Ball and socket joint: Permitting movement in all directions, the ball and socket joint features the rounded head of one bone sitting in the cup of another bone. Examples include your shoulder joint and your hip joint.
  • Pivot joint: The pivot joint, also called the rotary joint or trochoid joint, is characterized by one bone that can swivel in a ring formed from a second bone. Examples are the joints between your ulna and radius bones that rotate your forearm, and the joint between the first and second vertebrae in your neck.
  • Hinge joint: The hinge joint is like a door, opening and closing in one direction, along one plane. Examples include your elbow joint and your knee joint.
  • Condyloid joint: The condyloid joint allows movement, but no rotation. Examples include your finger joints and your jaw.
  • Gliding joint: The gliding joint is also called the plane join. Although it only permits limited movement, it is characterized by smooth surfaces that can slip over one another. An example is the joint in your wrist.
  • Saddle joint: Although the saddle joint does not allow rotation, it does enable movement back and forth and side to side. An example is the joint at the base of your thumb.
  • Uniaxial joints (one degree of motion): flexion and extension.

    Biaxial joints (two degree of motion) radiocarpal joint: wrist flexion and extension as well as ulnar and radial deviation.

    Multiaxial joints: three degrees of motion: shoulder joint: flexion/extension, abduction/adduction, internal rotation/external rotation

    Major Joints:
  • Acromio clavicular joint
  • Shoulder (glenohumeral joint)
  • Elbow
  • Lumbosacral joint
  • Sacro-iliac joint
  • Hip
  • Knee
  • Ankle joint
  • Major Muscle groups:
  • Trapezius
  • Deltoids
  • Erector spinae
  • Pectoralis muscle
  • Rectus Abdominus, latissmus dorsi
  • Obliques, Triceps, Bicep's muscle
  • Gluteas muscles
  • Gastrocnemius
  • Quadriceps
  • Atrophy decrease in size of a body part, cell, organ, or other tissue. The term implies that the atrophied part was of a size normal for the individual, considering age and circumstance, prior to the diminution.

    Hypertrophy is an increase and growth of muscle cells. Hypertrophy refers to an increase in muscular size achieved through exercise. When you work out, if you want to tone or improve muscle definition, lifting weights is the most common way to increase hypertrophy.

    Edema is swelling caused by excess fluid trapped in your body's tissues. Although edema can affect any part of your body, you may notice it more in your hands, arms, feet, ankles and legs.

    Activity is a series of movements to accomplish a task/function

    Normal Tone: Defined as slight constant tension of healthy muscles (Kandel, Schwartz& Jessel 1991).

    Range of motion: is the measurement of movement around a joint.

    Passive range: of motion requires full assistance for an individual to move their joint.

    Active-assistive requires partial assistance, and active range of motion is when the client is able to move their joint independently.

    Hypertonia: Muscle overactivity that occurs when communication between the brain and nerves is affected by injury or illness. The neural component is called spasticity and is the inability to turn off the electromyographic at rest (no inhibitory stimuli)Which results in hyper-reflexia, cant modulate force. Results in altered muscle length(shortening) due non-neural components and joint alignment.

    plane is an imaginary flat surface running through the body. An axis is an imaginary line at right angles to the plane, about which the body rotates or spins.

    An axis is a straight line around which an object rotates. Movement at a joint takes place in a plane about an axis. There are three axes of rotation. ... The frontal axis passes horizontally from left to right and is formed by the intersection of the frontal and transverse planes.

    Sagittal plane - a vertical plane that divides the body into left and right sides. Flexion and extension types of movement occur in this plane, eg kicking a football, chest pass in netball, walking, jumping, squatting. Frontal plane - passes from side to side and divides the body into the front and back.

    Transverse(horizontal) plane: divides into body into top&bottom half, superior and inferior halves, movement in this plane are rotations, dissociations.

    Frontal plane: divides body into anterior and posterior halves, movements in this plane are abduction/adduction.

    Sagittal plane: divides human body into left and right halves, movements in this plane are flexion/extension.

  • Flexion is the medical term for bending an arm or leg. Technically speaking, it's a physical position that decreases the angle between the bones of the limb at a joint. It occurs when muscles contract and move your bones and joints into a bent position. Sagittal plane.
  • Extension Extension refers to a movement that increases the angle between two body parts. Extension at the elbow is increasing the angle between the ulna and the humerus. Extension of the knee straightens the lower limb. Sagittal plane.
  • Movement of a body part to the side is called lateral flexion. For example, when you move your head toward one of your shoulders or bend your body sideways, you're performing a lateral flexion. Frontal plane.
  • Abduction and adduction are two terms that are used to describe movements towards or away from the midline of the body. Abduction is a movement away from the midline – just as abducting someone is to take them away. For example, abduction of the shoulder raises the arms out to the sides of the body. Frontal plane.
  • Body structures - Anatomical parts of the body such as organs, limbs and their components.
  • Rotation is movement in which something, e.g. a bone or a whole limb, pivots or revolves around a single long axis. Horizontal/transverse plane.
  • Medial and lateral rotation describe movement of the limbs around their long axis: Medial rotation is a rotational movement towards the midline. ... This is internal rotation of the shoulder. Lateral rotation is a rotating movement away from the midline. Horizontal/transverse plane.
  • Supination and pronation are used to describe action at the feet or forearm. In the feet, supination refers to excessive outward action; pronation refers to the ankle turning in. With the forearm, supination refers to turning the palm up; pronation refers to turning the palm down Horizontal/transverse plane.
  • Elevation is movement in a superior direction. For example, shrugging is an example of elevation of the scapula. Depression is movement in an inferior direction, the opposite of elevation. Frontal Plane.
  • Inversion and eversion refer to movements that tilt the sole of the foot away from (eversion) or towards (inversion) the midline of the body. Eversion is the movement of the sole of the foot away from the median plane. Inversion is the movement of the sole towards the median plane. Frontal Plane.
  • Scapular retraction refers to moving the shoulder blades (scapula) towards the spine. The opposite is protraction – moving the shoulder blades away from the spine. For the mandible, protraction occurs when the lower jaw is pushed forward, to stick out the chin, while retraction pulls the lower jaw backward. Sagittal Plane.
  • Thumb Opposition refers to the ability to turn and. rotate the thumb so that it can touch each fingertip. of the same hand. This allows us to grasp objects.
  • Circumduction is the movement of a body region in a circular manner, in which one end of the body region being moved stays relatively stationary while the other end describes a circle. It involves the sequential combination of flexion, adduction, extension, and abduction at a joint. This type of motion is found at biaxial condyloid and saddle joints, and at multiaxial ball-and-sockets joint.
  • Sagittal Plane:
  • Flexion: Decreasing the angle between two bones.
  • Extension: Increasing the angle between two bones.
  • Dorsiflexion: Moving the top of the foot toward the shin (only at the ankle).
  • Plantarflexion: Moving the sole of the foot downward (pointing the toes).
  • Frontal Plane:
  • Adduction: Motion toward the midline.
  • Abduction: Motion away from the midline of the body.
  • Elevation: Moving to a superior position (only at the scapula).
  • Depression: Moving to an inferior position (only at the scapula).
  • Inversion: Lifting the medial border of the foot.
  • Eversion: Lifting the lateral border of the foot.
  • Transverse/horizontal Plane:
  • Rotation: Internal (inward) or external (outward) turning about the vertical axis of the bone.
  • Pronation: Rotating the hand and wrist medially from the bone.
  • Supination: Supination-Rotating the hand and wrist laterally from the bone.
  • Horizontal Flexion (adduction): From the 90-degree abducted arm position, the humerus is flexed (adducted) in toward the midline of the body in the transverse plane.
  • Horizontal Extension (abduction): Return of the humerus from horizontal flexion.
  • Protective reactions are required to prevent injury if the equilibrium reactions are unable to restore balance. Protective reactions emerge first to the front, then the side and then backwards.

    Equilibrium reactions are patterns which maintain balance of the whole body in the dynamic relationship between the shifting of one's centre of gravity through space and one's base of support.

    Balance: an even distribution of weight enabling someone or something to remain upright and steady, In biomechanics, balance is an ability to maintain the line of gravity of a body within the base of support with minimal postural sway. Sway is the horizontal movement of the centre of gravity even when a person is standing still.

    Static balance is the ability to maintain postural stability and orientation with centre of mass over the base of support and body at rest... Dynamic balance is the ability to maintain postural stability and orientation with centre of mass over the base of support while the body parts are in motion.

    Embryology: The branch of biology and medicine concerned with the study of embryos and their development.

    The lateral wall of each somite in a vertebrate embryo, giving rise to the connective tissue of the skin.

    Dermatome: An area of the skin supplied by nerves from a single spinal root.

    Mytome: Muscles that originate from single spinal root.

    Myotome is the group of muscles that a single spinal nerve innervates. Similarly...

    Dermatome is an area of skin that a single nerve innervates. In vertebrate embryonic development, a myotome is the part of a somite that develops into the muscles.

    “Physiotherapists (PT) assess, plan and implement. rehabilitative programs that improve or restore human motor functions, maximize movement ability, relieve pain syndromes, and treat or prevent physical challenges associated with injuries, diseases and other impairments” - WHO