Dennis-upper Extremity Kinesiology

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Structural Kinesiology

Prepared by DENNIS N. MUÑOZ, RN, RM, PTRP,MANDENNIS N. MUÑOZ, RN, RM, PTRP,MAN

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Anatomical Review

• Skeletal System

• Muscular System

• Nervous System

• Human Movement

• Basic Biomechanics

• Application of Kinesiology to Physical Activity

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CHAPTER 1

FOUNDATIONS OF STRUCTURAL KINESIOLOGY

• Understand the skeletal system

• Understand directional terminology

• Understand planes of motion

• Understand joint movements

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Skeletal Systems

• 206 bones make up the skeletal system• Functions of the skeletal system

– Provides support– Provides protection– Provides a structure for muscles to attach– Provides levers (joints) for human movement– Provides a place for mineral storage– Provides a place for blood cell formation

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Skeletal Systems

• Appendicular skeleton– Upper extremity & shoulder girdle– Lower extremity & pelvic girdle

• Axial skeleton– Skull– Vertebral column– Ribs– Sternum

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Bones

• Skull

• Frontal bone

• Zygomatic bone

• Parietal bone

• Temporal bone

• Occipital bone

• Maxilla

• Mandible

scapula

• Axillary border

• Vertebral border

• Spine of the scapula

• Acromion process

• Coracoid process

• Inferior angle

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Bones

• Pelvic girdle

• Iliac crest

• Ilium

• Ischium

• Ischial tuberosity

• pubis

• Sacrum

• coccyx

• Femur

• Greater trochanter

• Lesser trochanter

• Medial femoral condyle

• Lateral femoral condyle

• Patella

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Bones

• Thoracic cage• Manubrium• Sternum• Xiphoid process• Ribs• Thoracic Vertebrae

• Arm• Humerus• Greater tubercle• Lesser tubercle• Radius• Ulna• Carpal bones• Metatarsals• phalanges

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Bones

• Lower leg

• Tibia

• Tibial tuberosity

• Medial malleolus

• Fibula

• Fibular head

• Lateral malleolus

• Ankle and foot

• Calcaneus

• Talus

• Tarsal bones

• Metatarsal

• phalanges

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Anatomical Directional Terminology

• Anterior: in front of

• Anteroinferior: in front and below

• Anterolateral: in front and to the side

• Anteromedial: in front and toward the midline

• Anteroposterior: relating to both front and rear

• Anterosuperior: in front and above

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• Contralateral: opposite side

• Ipsilateral: same side

• Deep: below the surface

• Distal: away from the midline

• Dorsal: relating to the backside

• Inferior: below another structure

• Lateral: away from the median

• Medial: nearer to the median

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• Posterior: in the rear

• Posteroinferior: behind and below

• Posterolateral: behind and to one side

• Posteromedial: behind and to the inner side

• Posterosuperior: behind at the upper part

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• Prone: the body facing downward

• Supine: the body facing upward

• Proximal: nearest the trunk or point of origin

• Superficial: near the surface

• Superior: above in relation to another structure

• Volar: relating to the palm of the hand or the sole of the foot

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Planes of Motion

• Sagittal Plane: divides the body into right and left halves.

• Frontal Plane: divides the body into front and back halves.

• Horizontal Plane: divides the body into superior and inferior halves.

• Diagonal Plane: is a combination of more than one plane.

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Types of Bones

• Long Bones

• Short Bones

• Flat Bones

• Irregular Bones

• Sesamoid Bones

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Bony Features• Bone growth

– Epiphyseal plates– Osteoblasts, Osteoclasts– Osteocytes

• Bone properties– Made of calcium, collagen, and water– Size and shape are influenced by outside forces

• Bone markings– Processes– Cavities

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Types of Joints

• Synarthrodial: immovable

• Ampiarthrodial: slightly movable

• Diarthrodial: freely movable

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Diarthrodial Joints

• Arthrodial (gliding) joint: usually two flat bones make up this joint and they permit limited gliding movement:

– intercarpal joint – scapular-thoracic joint

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Diarthrodial Joints

• Condyloidal (biaxial ball-and-socket) joint: bones with a concave and convex surface which allow movement in two planes without rotation.

– Radial-carpal joint– Metacarpophalangeal joints

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Diarthrodial Joints

• Enarthrodial (multiaxial ball-and-socket) joint: concave and convex bones which allow movements in all planes

– Glenohumeral joint– Illiofemoral joint

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Diarthrodial Joints

• Ginglimus (hinge) joint: usually concave and convex surfaces which allow movement in only one plane

– Radioulnar joint (elbow)– Tibiotalar joint (ankle)– Tibiofemoral joint (knee)

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Diarthrodial Joints

• Sellar (saddle) joint: two concave surfaces which permit ball-and-socket movement without rotation.

– Carpometacarpal joint (thumb)

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Diarthrodial Joints

• Trochoidal (pivot) joint: a concave and convex joint which allows for rotation around a long axis.

– Radioulnar joint

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Movements in Joints

• Measured by a goniometer

• Limited by:– Skeletal structue– Muscular structure– Ligamentous structure– Fat– Cartilage

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Movements in Joints

• General– Abduction: away from the midline– Adduction: toward the midline– Flexion: decreased angle of a joint– Extension: increased angle of a joint– Circumduction: circular movement

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Movements in Joints

• General– Diagonal abduction: away from the

midline in a diagonal plane.

– Diagonal adduction: toward the midline in a diagonal plane.

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Movement in Joints

• General– External Rotation: rotary movement around a

longitudinal axis of a bone away from the midline.

– Internal Rotation: rotary movement around the longitudinal axis of a bone toward the midline.

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Movement in Joints

• Ankle– Eversion– Inversion– Dorsiflexion– Plantarflexion

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Movement in Joints

• Radioulnar– Pronation– Supination

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Movement in Joints• Shoulder Girdle and Joint

– Depression– Elevation– Horizontal abduction– Horizontal adduction– Protraction (abduction)– Retraction (adduction)– Downward rotation– Upward rotation

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Movement in Joints

• Spine– Lateral flexion (side bending)– Reduction (return to anatomical position)– Slight flexion & Extension

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Movement in Joints• Wrist and Hand

– Palmar flexion– Radial deviation– Ulnar deviation– Opposition of the thumb

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CHAPTER 2NEUROMUSCULAR

FUNDAMENTALS• Review basic anatomy• To learn and understand terminology• To learn and understand muscle contraction• To learn and understand basic

neuromuscular concepts• To understand neural mechanisms for

movement

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INTRODUCTION

• Over 600 muscles

• Muscle contraction causes joint (body) movement

• Muscle provide protection for bones and organs of the body

• Muscles contribute to posture and support

• Muscles create body heat

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MUSCLE NOMENCLATURE

• Muscles are usually named and grouped for their characteristics.• Visual appearance• Anatomical location• Function • (see pages 22 & 23)

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MUSCLES

• Sternocleidomastoid

• Trapezius

• Deltoid

• Pectoralis Major

• Supraspinatus

• Infraspinatus

• Teres minor / major

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MUSCLES

• Triceps brachi• Biceps brachi• Brachioradialis• Extensor carpi radialis longus• Extensor carpi radialis brevis• Extensor carpi ulnaris• Flexor carpi ulnaris• Anconeus

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MUSCLES• Extensor digitorum communis

• Abductor pollicis longus

• Extensor pollicus brevis

• Pronator teres

• Brachialis

• Coracobrachialis

• Brachioradialis

• Flexor carpi radialis

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MUSCLES• Extensor carpis radialis longus

• Extensor digitorum communus

• Palmaris longus

• Abductor pollicus longus

• Extensor pollicus brevis

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MUSCLES

• Latissimus dorsi

• Serratus anterior

• Recuts sheath

• External oblique

• Interanl oblique

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MUSCLES• Tensor fasciae latae• Sartorius• Iliopsoas• Pectineus• Gluteus maximus• Iliotibial band• Adductor longus• Adductor Magnus• Gracilis

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MUSCLES

• Biceps femoris

• Semitendinosus

• Semimembranosus

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MUSCLES

• Rectus femoris

• Vastus lateralis

• Vastus medialis

• Vastus intermedius

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MUSCLES

• Tibialis anterior

• Tibialis posterior

• Peroneus longus

• Peroneus brevis

• Extensor digitorum longus

• Extensor hallucis longus

• Gastrocnemius

• Soleus

• Plantaris

• Achilles tendon

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MUSCLES SHAPE AND ARRANGEMENT

• Force Generating Capacity is Effected By:– Cross sectional diameter– Pennation of muscles

• Range of Motion is Effected By:– Ability of a muscle to shorten and lengthen– Parallel muscles

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• Flat: thin and broad (external oblique)

• Fusiform: spindle-shaped (brachialis)

• Strap Muscles: long parallel manner (sartorius)

• Radiate: fan shaped (pectoralis major)

• Sphincter: circular muscles which close openings upon contraction (anal sphincter)

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• Pennate muscles have shorter fibers that are arranged obliquely to their tendons.– Unipennate: muscle fibers run obliquely from

one side of the tendon (biceps femoris).– Bipennate: muscle fibers run obliquely from

both sides of the tendon (rectus femoris).– Multipennate: muscles have several tendons

with fibers running obliquely between them (deltoid).

– (see page 26)

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MUSCLE TISSUE PROPERTIES

• Irritability: sensitive to chemical, electrical, and mechanical stimuli.

• Contractility: ability to contact and develop force against resistance.

• Extensibility: ability of a muscle to return to its original length after contraction.

• Elasticity: ability of a muscle to return to its orginal length following stretching.

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Muscle Terminology• Intrinsic: internal

• Extrinsic: external

• Action: the joint movement that occurs from a muscle contraction

• Innervation: a segment of the nervous system that causes a muscle to contract

• Amplitude: the range of muscle fiber length between maximal and minimal lengthening.

• Origin: proximal attachment

• Insertion: distal attachment

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Types of Muscle Contractions

• Isometric Contraction: a maximum static contraction that is equal to the resistance and therefore no joint movement occurs.

• Isotonic Contraction: a shortening or lengthening of the muscle to develop tension.– Concentric Contraction: muscle shortening under

tension to create joint movement.

– Eccentric Contraction: muscle lengthening under tension to allow joint movement.

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The Role of Muscles

• Agonist: the prime mover of a joint.

• Antagonist: the opposing muscle of a joint

• Stabilizers: contract to stabilize a joint.

• Synergist: muscles that assist in the action of the agonist.

• Neutralizers: contract to resist specific actions of other muscles.

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The Role of Muscles

• Several factors decide the action of a muscle:– Motor units activated– Joint position– Muscle length– Contraction vs Relaxation– The action of all muscles involved.

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The Role of Muscles

• Determination of Muscle Action– Lines of pull

• Palpation: feeling a muscle contract

• Use of a rubber band: simulation of a muscle contraction using origin and insertion.

• Electromyography: detects neural impulses when a muscle contracts.

• Electrical muscle stimulation: causes muscle contraction which can then determine the action of the muscle.

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The Role of Muscles

• Determination of Muscle Action– Line of Pull

• Rotary component: when the line of muscular force is at 90 degrees to the bone of which it attaches, all of the force is rotary in nature

• Stabilizing component: if the angle of pull is less than 90 degrees it has a % of stabilizing force.

• Dislocating component: if the angle of pull is greater than 90 degrees it has a % of dislocating force.

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Neural Control of Voluntary Movement

• All voluntary movement is a result of both the muscular and nervous systems working together.– Every muscle fiber is innervated by a somatic

(efferent) motor neuron.– Senses create communication to the CNS

through (afferent) neurons

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• Levels of the Central Nervous System– 1: Cerebral cortex:

creates voluntary gross motor movements and interprets senses.

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– 2: Basal Ganglia: white matter below the cerebral cortex that controls the maintenance of posture and equilibrium, and learned motor movements.

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– 3: Cerebellum: located behind the brain stem and is the major integrator of sensory information and provides feedback relative to motion. It also controls the timing and intensity of muscle activity to assist in the refinement of motor movements

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• Levels of the Central Nervous System– 4: Brain Stem: integrates all CNS

activity through excitation and inhibition of desired muscle activity

– 5: Spinal Cord: the common pathway between the CNS and the peripheral nervous system. Specific control and integrates spinal reflexes.

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– 6: Peripheral Nervous System: sends the impulse to the specific muscle for contraction or relaxation. (afferent vs efferent, see pg. 34)• Nerve roots: 12 cranial,

8cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

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• The Cell Body (nucleus)• The Dendrites

– the receivers• The Axon

– the transmitter– contains the axon

terminals– contains the synaptic knobs that

release chemicals known as neurotransmitters.

– The axon hillock decides if the impulse is a graded potential or an action potential.

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• Dermatomes

• Myotomes

• Proprioception: internal receptors located in the skin, joints, muscles and tendons which provide feedback to muscle length, tension, and contraction state of muscle.– Muscle spindles are sensitive to stretch (contract)

– Golgi tendon organs are sensitive to tension (relax)

• Kinesthesis: awareness of the position and movement of the body in space.– Kinesthetic receptors provide joint feedback

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Neuromuscular Concepts

• All or None Principle: muscle fibers within a given motor unit will either fire and contract maximally or not at all.

• Muscle Length-Tension Relationship: the greatest amount of tension can be developed when a muscle is stretched between 100% and 130% (stretch reflex) of its resting length

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• Biarticular and Multiarticular Muscles– Cross over two joints– Can move two joints– Can control length tension relationship– Examples

• Biceps• Rectus femorus• Gastrocnemius• Hamstrings

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• Autogenic Inhibition: relaxation of the agonist muscle after contraction

• Reciprocal Inhibition: relaxation of the antagonist muscles when the agonist muscles contract.– Example: PNF stretching

• Contract – relax

• Contract – hold - relax

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• Active Insufficiency: when the muscle becomes shortened to the point that it can not generate or maintain active tension.– Rectus femorus: in hip flexion can not extend the knee with

as much force.

• Passive Insufficiency: when an opposing muscle becomes stretched to the point where it can no longer lengthen and allow movement.– Rectus femorus: hamstrings won’t allow hip flexion

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Types of Training

• Isometric

• Isotonic

• Isokinetic

• Plyometrics

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Modes of Training• Free weights• Nautilus• Hydraulics• Friction• Rubber tubing• Cybex• Bow-flex• Box-jumps• Hydrotherapy• Etc.

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Web Sites

• MUSCLES www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/dissector/mml/

• PROPRIOCEPTION

http://sportsmedicine.about.com/library/weekly/aa062200.htm

• MUSCLES CONTRACTINGhttp://users.rcn.com/jkimball.ma.ultranet/BiologyPages/M/Muscles.html

• MUSCLES CONTRACTINGwww.ebsa.org/npbsn41/intro_muscle.html

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Chapter 3Basic Biomechanical Factors and Concepts

• Biomechanics: the study of the mechanics as it relates to the functional and anatomical analysis of the human body.– Statics: involves all forces acting on the body being

in balance, resulting in the body being in equilibrium.

– Dynamics: involves the study of systems in motion while unbalanced due to unequal forces acting on the body.

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Chapter 12Basic Biomechanical Factors and Concepts

– Kinematics: the description of motion.• Time

• Displacement

• Velocity etc.

– Kinetics: is the study of forces associated with the motion of a body.• Force

• Resistance

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Levers

• Lever: a rigid bar that turns about an axis.– Force– Axis – Resistance

• The “Dog Principle”– “A” in the middle– “R” in the middle– “F” in the middle

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First Class Levers• Axis is in the middle• Produces balanced movements

when the axis is centered in the middle.

• When the axis is close to the force it provides speed and range of motion.

• When the axis is close to the resistance it provides greater force.

• Examples: elbow, ankle

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Second Class Levers

• Resistance is in the middle• Designed to produce forceful

movements.• There are relatively few

occurrences of second class levers in the body.

• Examples: – Plantar flexion– Scapular rotation

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Third Class Levers

• Force is in the middle

• Designed to produce speed and range of motion movements.

• Most of the levers in the human body are third class.

• Examples:– Elbow (bicep)

– Elbow (brachialis)

– Knee (hamstrings)

– Many others…

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Factors In Use of Anatomical Levers• Torque: force which causes a turning effect.

– Force X Force Arm = Torque

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Factors In Use of Anatomical Levers

• Eccentric Force: force that is applied in a direction not in line with the center of rotation.

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• Force Arm: the distance between the axis and the point of force.

• Resistance Arm: The distance between the axis and the point of resistance.

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• The longer the force arm, the less force required to move the lever.

• A greater resistance may be moved by shortening the resistance arm.

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F X FA = R X RALbs. inches lbs. inches

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Factors in Use of Anatomical Levers

Force =

Force Arm = 3 inches

Resistance Arm = 5 inches

Resistance = 20 lbs

What is the force required?

How much force is required if the

FA equals 2 inches?

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• The system of leverage in the human body is built for speed and range of motion at the expense of force.– Short force arms– Long resistance arms

• The human body is a system of levers that have to work together to create athletic movement.

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• Sports also use the advantage of longer levers– Longer golf clubs– Longer tennis racquets– Long arms for pitching

• What limitations are there with longer levers?

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• Angle of Pull: the angle between the line of pull of the muscles and the bone on which it inserts.– With every degree of joint motion, the angle of pull

changes.– The angle of pull decreases as the bone moves away

from its anatomical position.– The range of motion depends on the type of joint,

the bony structure, and other considerations.

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• 3 Components of Muscular Force– Rotary component: muscular force that acts

perpendicular to the long axis of the bone.– Stabilizing component: the muscular force pulls the

bone toward the joint at less than 90 degrees.– Dislocating component: the muscular force pulls the

bone away from the joint at greater than 90 degrees.

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Laws Of Motion and Physical Activities

• Two Types of Motion– Linear motion: motion along a line

• Rectilinear: motion along a straight line

• Curvilinear: motion along a curved line

– Angular (rotary) motion: motion around an axis• Example: motion around a joint axis

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• Displacement: refers to a change in location of an object from its original position.– Angular displacement: change in location of a

rotating body.– Linear displacement: change in location of a body

moving in a straight line.• Distance: length of measurement the body travels.• Speed: how fast a body is moving per distance.• Velocity: the rate of displacement.

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• Law of Inertia: A body in motion tends to remain in motion at the same speed in a straight line unless acted on by a force; a body at rest tends to remain at rest unless acted on by a force.

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• Law of Acceleration: A change in the acceleration of a body occurs in the same direction as the force that caused it. The change in acceleration is directly proportional to the force causing it and inversely proportional to the mass of the body (A = F / M)– Mass: the amount of matter in a body which affects the

speed and acceleration in physical movements.– baseball vs shot put

– Lineman vs runningback

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• Law of Reaction: for every action there is an opposite and equal reaction.

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• Centripetal Force: a force which pulls an object toward the center of motion in a circular path (axis).

• Centrifugal Force: the equal and opposite reaction to centripetal force, causing the object to pull away from the center of motion (eccentric force).

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Balance, Equilibrium, and Stability

• Balance: is the ability to control equilibrium.– Equilibrium: the state of zero acceleration or change

in direction.• Static equilibrium: a state of complete motionlessness

• Dynamic equilibrium: when forces of motion are acting on a moving body to keep it balanced

• Center of Gravity: the point at which the body’s mass and weight is equally balanced.

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• Balance is Enhanced by:– Wide base of support

– Low center of gravity

– Increased weight

– Relationship of center of gravity to base of support

– Increased friction of supporting structures

– Rotation about an axis aids balance

– Kinesthetics sense• Inner ear, touch, vision, practice etc.

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• Force: a strength or energy exerted to cause motion or change.– Force = Mass X Acceleration– Baseball vs shot put

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• Momentum: the quantity of motion– Momentum = Mass X Velocity– Running back vs Lineman– The greater the momentum the

greater the resistance to change in inertia.

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• Summation of Forces: the forces accumulated from each muscle to a joint and each joint to an activity.– Throwing a baseball– Swinging a golf club

• Skillful performance requires– The regulation (speed) of force – The control (direction) of force

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A Kinesiological Analysis is a Summary of all Components of A

Movement• Anatomy used for the activity• Directional terminology• Planes of motion• Types of bones and joints

– Types of levers– Mechanical advantages

• Types of muscle contractions• Laws of motion• Balance, Equilibrium, and Stability

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Chapter 2The Shoulder Girdle

• Objectives– Identify bones and landmarks– Identify shoulder girdle muscles– Identify shoulder girdle movements

• Planes

• Axis of rotation

– Palpate the muscles of the shoulder girdle– Palpate the joints of the shoulder girdle

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Bones• Scapula

• Acromion process• Glenoid cavity• Infraspinatus fossa• Lateral border• Posterior surface• Inferior angle• Medial border• Spine of the scapula• Supraspinatus fossa• Superior angle• Coracoid process• Subscapular fossa

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Bones• Clavicle

• Manubrium

• Sternum

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Movements

• Abduction (protraction)

• Adduction (retraction)

• Elevation

• Depression

• Upward Rotation

• Downward Rotation

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Muscles

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LEVATOR SCAPULAE MUSCLE

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• Innervation:

– Dorsal scapula nerve C5 and branches of C3 and C4.

• First Class Lever

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• Origin:

– Transverse processes of the upper four cervical vertebrae.

• Insertion:

– Medial border of the scapula above the base of the scapular spine.

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• Action:– Elevates the medial margin of the scapula, as

seen in shoulder elevation.

• Synergist:– Trapezius, Rhomboid Muscles

• Antagonist:– Part 3 of the Trapezius, Pectoralis Minor

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• Strengthening Exercises:– Shoulder shrugs are the major strengthening exercise for

the Levator Scapulae Muscle.

– Four-way neck machine can also be used to do neck extensions and lateral flexion to strengthen the Levator Scapulae Muscle.

• Stretching:– Best stretched by rotating the head approximately 45

degrees to the opposite side and flexing the cervical spine actively while maintaining the scapula in a relaxed, depressed position.

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NECK EXTENSION

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CERVICAL LATERAL FLEXION

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SHOULDER SHRUGS

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STRETCHING

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• Sporting Activities Where Muscle is Used:– When in stance waiting to hit a baseball, you

must elevate your shoulders using this muscle along with the Trapezius , and the Rhomboid Major and Minor.

– During Football, whenever you brace your neck to initiate or withstand impact, you are using your Levator Scapulae Muscle.

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SPORTING ACTIVITIES

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RHOMBOIDSRHOMBOIDSMajor and

Minor

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Physiological Information

• Innervation- Dorsal scapula nerve (C5)• Lever- 3rd Class• Origin: Spinous process of the last cervical

and the first five thorasic vertebrae.• Insertion: Medial border of the scapula,

below the spine.• Relation to other muscles: Deep to the

trapezius muscle

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Actions

• Both major and minor work together.• Adduction: draw the scapula toward the

spinal column.• Rotation downward: from the upward

rotated position; they draw the scapula into downward rotation.

• Elevation: slight upward movement, accompanying adduction.

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Actions, cont.

• Elevation, cont.: elevates the medial border of the scapula.

• Stabilizes the scapula.

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Other Helpful Muscles

• SYNERGISTS

• Trapezius

• Posterior Deltoid

• Levator scapulae

• ANTAGONISTS

• Pectoralis major

• Latissimus dorsi

• Anterior Deltoid

• SITS

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WORKOUTS

• Chin ups

• Dips

• Seated rows

• Low rows

• Push-ups

• Theraband activity

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Chin ups

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Dips

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Seated Rows

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Incline Rows

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Push-ups

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Theraband

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SPORTS

• Rowing

• Hockey (slap shot wind up)

• Pitching (wind-up)

• Javelin (preparatory)

• Pretty much any sport where the scapula adduct!

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Rowing

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Hockey

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Pitching

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Quarterback

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Javelin

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STRETCHES

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STRETCHES cont.

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STRETCHES cont.

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Muscle Analysisof the

Serratus Anterior

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Overviewof the

Serratus Anterior• Anterior shoulder girdle muscles are the serratus

anterior, pectoralis minor, and subclavius and function primarily in abduction and depression.

• Provides dynamic stability of the scapula so that it can serve as a relative base of support for the shoulder joint while holding the scapula against the thoracic wall.

• An example of a 1st class lever

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Nerve Innervation

• Innervated by the long thoracic nerves C5 – C7

C5 slips from ribs 1 & 2C6 slips from ribs 3 & 4

C7 slips from ribs 5 – 8

A winged scapula condition indicates a weakness of the muscle resulting from injury to the long thoracic nerves.

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Origin & Insertion

• Origin is located on the surface of the upper nine ribs at the side of the chest and intercostal membranes from the midclavicular line.

• Insertion is near the anterior aspect of the whole length of the medial border of the scapula.

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Actions

• Primarily abduction and depression

• Abduction (protraction) draws the medial border of the scapula away from vertebrae.

• Rotation upwards is present with the longer, lower fibers drawing the inferior angle of the scapula farther away from the vertebrae,

thus rotating the scapula slightly upward.

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Role of Other Muscles

• Synergists include the other anterior shoulder girdle muscles of the subclavius and pectoralis minor and major.

• Antagonists primarily include the trapezius, rhomboid, and often the levator scapula.

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Strengthening Exercises

Bench Press Overhead Press

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Seated Upright Rows Dumbbell Rows

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Push-ups

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Stretching Exercises

Wall Push Sit and Reach (Scapular Adduction)

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Applications

• The serratus anterior is used commonly in movements drawing the scapula forward with slight upward rotation.

• It works with the pectoralis major (synergist) in typical action such as throwing a baseball.

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Relevant Athletic Activities

Swinging a Bat Throwing a Baseball

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Relevant Athletic Activities

Tackling in Football Shooting a Basketball

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Pectoralis MinorPectoralis Minor

Innervated by the Medial Pectoral Nerve (C8-T1)

1st Class Lever (force- ribs, axis- shoulder joint,

resistance- weight on scapula)

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Pectoralis MinorPectoralis Minor

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OriginsOrigins InsertionsInsertions

• Anterior surfaces of the 3rd, 4th, & 5th ribs (outer surface & upper margin)

• Medial & upper surface of coracoid process of scapula

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Actions of the MuscleActions of the Muscle

•Abduction (protraction): draws the scapula forward and tends to tilt the lower border away from the ribs

•Downward rotation: as it abducts, it draws the scapula downward

•Depression: when the scapula is rotated upward, it assists in depression

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SynergistSynergist AntagonistAntagonist

• Serratus anterior (abduction)

• Rhomboid muscles (downward rotation)

• Rhomboid muscles (depression and abduction)

• Levator scapulae muscle (depression)

• Serratus anterior (downward rotation)

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Strengthening ExercisesStrengthening Exercises

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Bench Press

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Chin-Ups

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Dips

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Push-Ups

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Standing Fly

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StretchesStretches

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Wall Pectoralis Minor Stretch

• Keep back against the wall with a step away

• Arms at 90º against the wall

• Push arms and shoulders into the wall while raising and lowering as far as possible

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Doorway Modified Chest Stretch

• Arm at 90º against wall

• Stand a step away

• Lean into the wall while turning your body away from the wall

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Wall Push-Up Stretch

• Push your shoulders toward the corner

• Hold for 15 seconds

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Sporting Activities that use Sporting Activities that use the Pectoralis Minorthe Pectoralis Minor

• Gymnastics• Softball • Bowling• Tennis• Golf

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KINESIOLOGY

TRAPEZIUS Muscle

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CHARACTERISTICS

* INNERVATION*– Dorsal scapula nerve C5 – Branches of C3 and C4

* CLASS LEVER*– THIRD

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ORIGIN

• Upper fibers: base of skull, occipital protuberance, and posterior ligaments of neck

• Middle fibers: spinous processes of seventh cervical and upper three thoracic vertebrae

• Lower fibers: spinous processes of fourth through twelfth thoracic vertebrae

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INSERTION

• Upper fibers: posterior aspect of the lateral third of the clavicle

• Middle fibers: medial border of the acromion process and upper border of the scapular spine

• Lower fibers: triangular space at the base of the scapular spine

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ACTIONS

• Upper fibers: elevation of the scapula, extension of the head at the neck

• Middle fibers: elevation, upward rotation, and adduction of the scapula

• Lower fibers: depression, adduction, and upward rotation of the scapula

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SHOULDER GIRDLE MUSCLE

* SYNERGIST· Primarily adduction

and elevation

· Rhomboid

· Levator Scapula

* ANTAGONIST

· Primarily abduction and depression

· Pectoralis Minor

· Serratus Anterior

· Subclavius

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STRENGTHENING EXERCISES

• Shoulder-shrugging exercises

• Bent rowing from a prone position

• Side arm shoulder joint abduction

• Lawn mowers

• Upright row

• Sitting row

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•

Seated Row

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Lawn Mowers (Low Row)

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Lateral Flys

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Upright Row

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STRETCHES

• Use one hand to pull the head and neck forward into flexion or slight ipsilateral flexion to the opposite side while the ipsilateral hand is hooked under a table edge to maintain the scapula in depression

• Use a partner to pull the scapula into protraction

• Move the scapula into max elevation and protraction

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SPORTING ACTIVITIES

• THROWING

• ROWING

• X-C SKIING

• REBOUNDING

• TACKLING

• BATTING

• BLOCKING

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Subclavius Muscle

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Origin

• Superior aspect of first rib at its junction with its costal cartilage

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Insertion

• Inferior groove in the mid-portion of the of the clavicle

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Action

• Stabilizes and protects the sternoclavicular joint during upper extremity movements

• Assists the depression of the clavicle

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Lever• Third-class lever system

-force(subclavius) is being applied between the axis (origin) and the resistance (insertion)

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Role of Subclavius

• SynergistAssists in the depression of the

clavicle

• Stabilizer

Protects and stabilizes the sternoclavicle joint

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List of Sporting Activities

• Baseball

- the motion of throwing a ball

• Shot Put

- tossing a shot

• Basketball

-the motion of shooting

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Exercises

Dips, Lat Pulldowns

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Dips

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Lat Pulldown

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Stretches

• Extreme elevation of the shoulder girdle

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Sporting Activities

• THROWING

• ROWING

• X-C SKIING

• REBOUNDING

• TACKLING

• BATTING

• BLOCKING

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The Deltoid Muscle• The deltoid muscle overlies most of the

anterior shoulder to the middle of the lateral humorous.– The Deltoid is used in virtually any lifting

movement– Innervated by the Axillary nerve (C5, C6)

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Origin/Insertion

• There are three points of origin for the deltoid muscle.– Anterior Fibers:

• Anterior lateral third of the clavical

– Middle Fibers:• Lateral aspect of the acromion

– Posterior Fibers:• Inferior edge of the spine of the scapula

• The insertion of the deltoid is the deltoid tuberosity on the lateral humerus.

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Actions of the Deltoid

• Actions of the deltoid are separated into actions produced by three categorized fibers of the muscle.– Anterior fibers– Middle fibers– Posterior fibers

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Anterior Fibers

• Abduction, flexion, horizontal adduction, and internal rotation of the glenohumeral joint

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Middle Fibers

• Abduction of the glenohumeral joint

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Posterior Fibers

• Abduction, extension, horizontal abduction, and external rotation of the glenohumeral joint

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Levers

• Because the insertion of the deltoid muscle lies at the deltoid tuberosity of the lateral humerus, this is a 3rd class lever.– In all cases, the force (muscle insertion) is in

the middle, between the axis (shoulder joint) and the resistance (anything being lifted).

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Synergists/Antagonists

• Depending on the task being performed by the deltoid muscle, various other muscles play a role in the action.

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• Anterior Deltoid • Dumbbell front raise

– Grasp the dumbbells in both hands– Raise one dumbbell with elbows fixed in a 10°

to 30° angle throughout until upper arm is parallel to the floor.

– Continue with alternate arm.

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Dumbbell Front Raise

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Dumbbell Front Raise

• Synergists– Pectoralis major, middle and lower trapezius,

serratus anterior

• Antagonist– Latissimus dorsi

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• Lever Shoulder Press– Sit at machine, and grasp the bar with an

overhand grip.

– Press lever until arms are extended overhead. – Lower and repeat.

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Lever Shoulder Press

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Lever Shoulder Press

• Synergists– Pectoralis major, triceps brachii, middle and

lower trapezius, serratus anterior

• Antogonist– Latissimus dorsi, biceps brachii

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• Lateral Deltiod• Barbell upright row

– Grasp bar with shoulder width or slightly narrower overhand grip.

– Pull bar to neck with elbows leading. Allow wrists to flex as bar rises.

– Lower and repeat.

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Barbell Upright Row

• Synergists– Anterior deltoid, supraspinatus, brachialis,

briachioradialis, biceps brachii, middle and lower trapezius, serratus anterior, infraspinatus, teres minor

• Antagonists– Lattisimus dorsi

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• Posterior Deltoid• Row

– Sit on platform with knees slightly bent. – Grasp cable attachment. – Pull cable attachment with upper arm

perpendicular to trunk until upper arms is just beyond parallel to one another.

– Return and repeat.

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Seated Row

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Row

• Synergists– Infraspinatis, teres minor, lateral deltoid,

middle and lower trapezius, rhomboids, brachialis, brachioradialis

• Antagonists– Triceps brachii, latissimus dorsi

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Anterior Deltoid Stretch

• Doorway front deltoid stretch– Stand at end of wall or in doorway facing

perpendicular to wall.

– Position palm on surface of wall slightly lower than shoulder.

– Bend elbow slightly.

– Turn body away from positioned arm. Hold stretch for 20 seconds.

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Doorway Front Deltoid Stretch

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Lateral Deltoid Stretch

• Position arm across chest. Place opposite hand on elbow.

• Push elbow toward chest. Hold stretch for 20 seconds.

• Repeat with opposite arm.

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Lateral Deltoid Stretch

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Posterior Deltoid Stretch

• Position arm across neck. Place opposite hand on elbow.

• Push elbow toward neck. Hold stretch for 20 seconds.

• Repeat with opposite arm.

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Posterior Deltoid Stretch

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Sports Using Deltoids

• Baseball

• Football

• Track and Field

• Gymnastics

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Structural Kinesiology:

Supraspinatus Muscle

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Supraspinatus Muscle

• (sú pra-spi-ná tus)

• Origin: Medial two thirds of the Supraspinatus fossa

• Insertion: Superiorly on the greater tubercle of the humerus

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Palpation

• The Supraspinatus cannot be palpated

• This muscle lies:

• under the deltoid muscle distally– Distal: situated away from the center or midline of the

body, or away from the point of origin

• under the trapezius proximally– Proximal: nearest the trunk or the point of origin

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Innervation

• Suprascapular nerve (C5)

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3rd Class Lever

• Axis - shoulder joint

• Force - the muscle inserts at the greater tubercle of the humerus

• Resistance - is the weight held in the hand

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• “empty can exercise”

• shoulder abduction with the use of Theraband

• lateral dumbbell raises

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“Empty can exercise”

Finish Start

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Shoulder Abduction with Theraband

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Lateral dumbbell raise

Start Finish

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Stretches

• Adducting the arm behind the back with the shoulder internally rotated and extended stretches the supraspinatus

• Lying supine with elbow at ninety degree angle with hand pronated (partner applies pressure to the dorsal side of hand)

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Athletics Utilizing Supraspinatus

• Baseball - throwing, batting

• Basketball - shooting, passing

• Football - throwing, blocking

• Golf - full motion of swing

• Softball - throwing, batting

• Volleyball - hitting, digging

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Synergists

• Deltoid

• Infraspinatus

• Teres minor

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Antagonists

• Coracobrachialis

• Subscapularis

• Teres major

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Infraspinatus

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Nerve InnervationSuprascapular Nerve

(C5,6)

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Actions*External rotation of the glenohumeral joint

*Horizontal abduction of the glenohumeral joint

*Extension of the glenohumeral joint

*Stabilization of the humeral head in the glenoid fossa

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Origin/Insertion*Origin: Medial aspect of the infraspinatus fossa just below the spine of the scapula

*Insertion: Posteriorly on the greater tubercle of the humerus

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SynergistsTeres Minor, Subscapularis, Deltoid

AntagonistsDeltoid, Pectoralis Major

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Palpation*Immediately below the spine of the scapula and the posterior fibers of the deltoid muscle

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3rd Class LeverAxis- glenohumeral joint

Force-is at the insertion: posteriorly on the greater tubercle of the humerus

Resistance-in the hand

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Stretching

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Exercises

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Sports

Baseball

Tennis

Rowing

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Teres Minor Muscle

By Chris Laz

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Innervation

• The axillary nerve innervates the teres minor as well as the deltoid and the skin over the deltoid tuberosity of the humerous.

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Lever Class

• If the scapula is stabilized this muscle becomes a first class lever with the axis being the insertion point, the force being applied to contract the muscle and the resistance being applied on the humerous.

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Origin/Insertion

• Origin: Posteriorly on the upper and middle aspect of the lateral border of the scapula.

• Insertion: Posteriorly on the greater tubercle of the humerous.

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Actions of the teres minor

• External rotation of the glenohumeral joint: Rotary movement around the longitudinal axis of the bone away from the center of the body; turning the upper arm outward.

• Horizontal abduction of the glenohumeral joint: moving the upper arm away from the chest with the elbows facing down.

• Extension of the glenohumeral joint

• Stabilization of the humeral head in the glenoid fossa

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Synergist Muscles

• The infraspinatus helps the teres minor in stabilizing the glenohumeral joint posteriorly.

• The supraspinatus and the subscapularis muscles also are involved in the rotator cuff in order to make sure the humeral head stays in its proper location within the glenoid cavity.

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Antagonist Muscles

• Anterior Deltoid

• Latissimus Dorsi

• Subscapularis

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• Chin-Ups

• Rope Climbing

• Dips on a parallel bar

• Rotating the arm against resistance in the 0-degree and the 90-degree abducted

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Chin-Ups

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Climbing Rope

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Dips

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Stretches

• Internally rotating the shoulder while moving into extreme horizontal adduction.

• Externally rotating the shoulder in a 90-degree abducted position.

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Broomstick

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Bent-Over Stretch

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Seated Bent-Over

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Sporting Activities

• Several sporting exercises use the rotator cuff. The teres minor is involved in swimming, tennis, volleyball, golf, and throwing any object.

-Kick serve to the backhand

-Hitting a hook

-Throwing a slider

-Swimming butterfly

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Subscapularis

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Origin• Entire anterior surface of the subscapular

fossa

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Insertion• Lesser tubercle of the humerus

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Innervation

• Upper and lower supscapular nerve (C5-C6)

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Action

• Glenohumeral head depressor

• (Medial) Internal rotation of glenohumeral joint

• Adduction of the glenohumeral joint

• Extension of the glenohumeral joint

• Stabilization of the humeral head in the glenoid fossa

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Third Class Lever

• During stabilization of the scapula

• Force – insertion at humeral head

• Axis – glenohumeral joint

• Resistance – weight of arm or dumbell

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First Class Lever

• Stabilization of the glenohumeral joint

• Force – supscapularis

• Axis – scapular rotation

• Resistance – weight of scapula

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Supscapular Exercises

• Synergists – Pectoralis Major, Latissimus Dorsi, Teres Major, Deltoid – anterior

• Stabilizers – Pectoralis minor, Rhomboids, Levator scapulae, Wrist Flexors

• Antagonists – Teres minor, Infraspinatus, Deltoid - posterior

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Cable Internal Rotation

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Dumbbell Internal Rotation

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Broom Stick Subscapularis Stretch

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Doorway Subscapularis Stretch

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Sporting Activities

• Baseball – throwing a pitch

• Swimming – freestyle, butterfly

• Tennis – forehand swing

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Tennis

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Swimming

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Baseball

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TERES MAJOR

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Teres Major

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Origin• Posteriorly on the inferior third of the lateral

border of the scapula and just superior to the inferior angle

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Insertion

• Medial lip of the intertubercular groove of the humerus

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Actions

• Extension of the glenohumeral joint, particularly from the flexed position to the posteriorly extended position

• Internal rotation of the glenohumeral joint• Adduction of the glenohumeral joint,

particularly from the abducted position down to the side and toward the midline of the body

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Palpation Innervation

• Posterior scapular surface, moving diagonally upward from the inferior angle of the scapula

• Lower subscapular nerve, C5,6

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Synergists Antagonists

• Latissimus dorsi, Pectoralis major, and the Subscapularis in all three major actions of Teres Major

• Teres minor and Infraspinatus in extension of glenohumeral joint

• Coracobrachialis in adduction of glenohumeral joint

• Deltoid, Teres Minor, Supraspinatus and Infraspinatus in adduction

• Coracobrachialis in extension

• Teres Minor and Infraspinatus in internal rotation

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Third Class Lever

A: The glenohumeral joint of the shoulder

F: Muscle attaches at medial lip of intertubercular groove of the humerus

R: Resistance in your hand

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How to stretch theTeres Major

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How to strengthen theTeres Major

Lat Pulldowns

Rope Climbing

Internal Rotation using Theraband

Adduction using Theraband

Extension using Theraband

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Lat Pull-Down

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Rope Climbing

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Internal Rotation

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Adduction with Theraband

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Extension using Theraband

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Sports that use theTeres Major

Internal rotation in the follow through of the swing

Extension while pulling yourself upwards

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Sports that use the Teres Major

Left: Extension following serve

Below: Extension in the free style

Extension in the row

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Sports that use the Teres Major

From abduction (left) to adduction (right) in the rings

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Latissimus Dorsi

Posterior shoulder

joint muscle

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Origin

• Posterior crest of the ilium

• Back of sacrum

• Spinous processes of the lumbar vertebrae (L1-5) and lower 6 thoracic vertebrae (T7-12)

• Slips from the lower 3 ribs

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Insertion

• Medial side of the intertubercular groove of the humerus

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Palpation

Posterolateral aspect of the trunk below the armpit

(Don’t tickle your partner)

Innervation

Thoracodorsal nerve (C6-8) from brachial plexus

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Synergists

• Rhomboids

• Pectoralis major

• Teres major

Stabilizers• Triceps

• Biceps

Antagonists

• Pectorals

• Deltoids

• Rotator cuff muscles Supraspinatus

Infraspinatus

Subscapularus

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Lever Type

• Third class leverforce- insertion on humerus

axis- shoulder joint

resistance- varies depending on movement

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Actions

• Adduction of the glenohumeral joint• Extension of the glenohumeral joint• Internal rotation of the glenohumeral joint• Horizontal abduction of the glenohumeral

joint

(Accompanied by depression, downward rotation, and adduction of the scapula)

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• Chin-ups (assisted or weighted)

• Pull-ups (over or underhand)

• Dips

• Lat pull downs (front and rear)

• Lat pullovers (Lat pulls)

• Seated rows (keep elbows close to body)

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Pull-up

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Dips

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Pulldowns(can be done in front or back)

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Pullovers (Lat Pulls)

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Seated Rows(should be done with elbows kept close to body)

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Stretches

• Bent-over lat stretch

• Overhead lat stretch

• Wall lat stretch

• Side-to-side bends

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Bent-over Lat Stretch

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Overhead Lat Stretch

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Wall Lat Stretch

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Side-to-side Bends

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Sports

• Baseball

*throwing, hitting

• Running

• Soccer throw-ins

• Rope/rock climbing

• Gymnastics

• Volleyball

*serve, block

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Biceps Brachii Muscle

• The bicep is known as a two-joint muscle. Although it should be a three joint muscle—the shoulder, elbow, and radioulnar.

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Origin

• Two Heads– Long Head: supraglenoid tubercle above the

superior lip of the glenoid fossa– Short head: coracoid process of the scapula

and upper lip of the glenoid fossa

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Insertion

• Tuberosity of the radius and bicipital aponeurosis

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Innervation

• Musculocutaneous nerve (C5, C6)

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• SynergistsElbow Flexion:

Brachialis BrachioradialisPronator teres

Supination of the forearm:brachioradialisSupinator muscle

Flexion of the Shoulder joint:Coracobrachialis

• AntagonistsElbow Fexion:

Triceps BrachiiAconeus

Supination of the forearm:Pronator quadratusPronator teres muscle

Flexion of the Shoulder joint:Triceps brachii

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Action

• Flexion of the elbow

• Supination of the forearm

• Weak flexion of the shoulder

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Palpation Type of Lever

• The bicep brachii is easy to be palpated on the aterior aspect of the humerous and the elbow

• Third class leverAxis = the elbow jointForce = the bicep

insertion at the radial tuberosity

Resistance = center of gravity, or weight in the hand

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Bicep Brachii Exercises

• Bicep Curls Normal– Hold the weights with your

palms facing away from you, in the downward position.

– Aim to keep the elbows tucked into the side and avoid swinging the weights up, or arching your back.

– Move the weights in a smooth motion from your middle up towards your chin, then lower under control, and repeat.

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Biceps Brachii Exercises

• Hammer CurlsStand with soft knees, keeping

your back straight and your shoulder width apart.

Hold the weights with your palms facing towards your sides.

Aim to keep the elbows tucked into the side and avoid swinging the weights up.

Move the weights in a smooth motion from your middle up towards your chin, in a hammer like motion.

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Biceps Brachii Exercises

• Incline Bench Bicep CurlStand behind an incline bench, resting one arm

along the bench.

Hold a dumbbell in that arm, with your palm facing upwards.

Smoothly curl the weight up towards your shoulder, then lower and repeat.

This method helps isolate the biceps, and is good for beginners, as it helps you develop correct technique.

Change arms then repeat on the other side.

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Stretches for the Biceps Brachii

• Place your arm straight against a wall, with your palm facing the wall.

• With your body close to the wall, slowly turn your body away from it, keeping the arm in contact with the wall.

• This is an excellent stretch for the biceps and chest muscles.

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Additional Stretches

• The elbow must be extended maximally with the shoulder in full extension. The biceps must be stretched by beginning with full elbow extension and progressing into full horizontal abduction.

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Sporting Activities

• Rowing

• Bowling

• Tackling in Football

• Softball Pitching

• Throwing a curve ball in baseball

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Brachialis Muscle

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Brachialis Muscle

• Origin– Distal half of the anterior portion of the humerous.

• Insertion– Coronoid process of the Ulna.

• Palpation– Lateral side of the upper arm under the biceps brachii

muscle.• Innervation

– Muscolocutaneous nerve and sometimes branches from the radial and median nerves (C5,C6)

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Brachialis Muscle

• Action– The brachialis muscle is used whenever the

elbow flexes.– It pulls on the ulna and is the only pure flexor

of the elbow joint.

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Brachialis Muscle

• Third Class Lever– The axle is the elbow.– The force is the insertion point on the ulna– The resistance is the object that is being lifted.

04/08/23 340

Brachialis Muscle

• Synergist Muscles– Biceps Brachii

– Brachioradialis

• Antagonist Muscles– Triceps Brachii

04/08/23 341


• Preacher Curl (Barbell or Dumbbell)

04/08/23 342


• Isolation Curls

04/08/23 343


• Any other elbow curling exercises

04/08/23 344

Stretching

• Brachialis can only be stretched by extending the elbow with the shoulder relaxed and flexed.

04/08/23 345

Activities

• Any activity where the elbow is flexed, such as…

– Bowling

– Softball

04/08/23 346

Brachioradialis

04/08/23 347

Origin: Distal two-thirds of the lateral condyloid ridge of the humerus

Insertion:Lateral surface of the distal end of the radius at the styloid process

origin

insertion

04/08/23 348

Innervation: Radial nerve (C5,6)

Palpation: On the lateral anterior side of the forearm

Third Class Lever

04/08/23 349

Actions: - Elbow flexion

- Pronation (from supinated position to neutral)

- Supination (from pronated position to neutral)

Sports examples:- Golf swing, baseball swing, throwing, catching, rock climbing, running, shooting

04/08/23 350

Synergists: Biceps brachii, brachialis, pronator teres, pronator quadratus, supinator

Antagonists: Triceps brachii, anconeus

Brachioradialis

04/08/23 351

Lifting & Stretching Lifts:

- dumbbell hammer curl

- barbell reverse curl

- reverse preacher curl

- cable reverse curl

- overhead tricep extension

- wrist curls

Stretches: - extend elbow with shoulder in flexion, then

maximally pronate or supinate the forearm

04/08/23 352

Dumbbell Hammer Curl

04/08/23 353

Barbell Reverse Curl

04/08/23 354

Reverse Preacher Curl

04/08/23 355

Cable Reverse Curl

04/08/23 356

Overhead Tricep Extension

04/08/23 357

Wrist Curls

04/08/23 358

TRICEPS BRACHII

04/08/23 359

TRICEPS BRACHII

Triceps Brachii has three parts, the long head (1), the lateral head (2), and the medial head (3).

04/08/23 360

TRICEPS BRACHII

• Innervation:– Radial Nerve C7 and C8

• Lever Class:– In elbow extension, is First Class Lever

– F: Olecranon A: Elbow R: Nonsupported forearm

– In pushups, is Second Class Lever

– F: Olecranon A: Hand R: Body weight at elbow joint

04/08/23 361

TRICEPS BRACHII

• Origin:– Long Head: infraglenoid tubercle below

inferior lip of glenoid fossa of the scapula.– Lateral Head: upper half of the posterior

surface of the humerus.– Medial Head: distal two-thirds of the posterior

surface of the humerus.

04/08/23 362

TRICEPS BRACHII

• Insertion:– Olecranon process of the ulna.

• Actions:– All Heads: Extension of the elbow– Long Head: Extension of the shoulder joint &

Adduction of the shoulder joint.

04/08/23 363

TRICEPS BRACHII

• Synergist:– Anconeus muscle. Few synergists because the

three heads of the muscle do all the work.

• Antagonist:– Biceps brachii, brachialis muscle,

brachioradialis muscle.

04/08/23 364

STRENGTHENING EXCERCISES

• Typical action of the triceps brachii is shown in push-ups when there is powerful extension of the elbow.

04/08/23 365


• Bench pressing a barbell or a dumbbell is an excellent exercise to perform elbow extension.

04/08/23 366


• The overhead press is also a very good way to emphasize the triceps brachii.

04/08/23 367


Dips are also a good way to achieve elbow extension and extensively work the triceps brachii.

04/08/23 368


• Standing elbow extensions work the triceps brachii very well.

04/08/23 369


• Bent over elbow extensions are another form of elbow extensions that work the triceps brachii primarily.

04/08/23 370

STRETCHING EXCERCISE

• Can be flexed with both the shoulder and the elbow in maximal flexion, as seen in those overhead elbow flexion stretch.

04/08/23 371

SPORTING ACTIVITIES

When shooting a basketball, you use your triceps to extend your elbow on your follow through.

04/08/23 372

SPORTING ACTIVITIES

• In golf, when you are swinging your club and pulling the club back, you are doing shoulder adduction and using your triceps.

04/08/23 373

SPORTING ACTIVITIES

• In hockey, when pulling your stick back to hit the puck, you are doing shoulder extension and using your triceps.

04/08/23 374

Anconeus

• Triangular muscle overlying the back of the head of the radius

04/08/23 375

Anconeus

• Origin is posterior surface of the lateral condyle of the humerus

• Insertion is the posterior surface of the olecranon process of the ulna

04/08/23 376

Anconeus

• Chief function – pull the synovial membrane of the elbow joint out of the way of the olecranon process

• 3rd class lever

• Actions – Weak extension of the elbow

– Abducts ulna in pronation

– Stabilizes the elbow joint

04/08/23 377

Anconeus

• Contracts along with the triceps brachii during extension of the elbow

• ‘4th head of the triceps’

• Weakness of the anconeus results in the inability to extend the forearm against gravity

04/08/23 378

Anconeus

• Antagonists – Biceps brachii– Brachialis– Brachioradialis

• Synergists – all three heads of the triceps– Long head– Lateral head– Medial head

04/08/23 379

Anconeus

• Palpation can occur on the posterior lateral aspect of the olecranon process

04/08/23 380

Anconeus

• Innervated by the radial nerve (C7 & C8)

04/08/23 381

Anconeus - Stretch

• Maximal elbow flexion stretches the anconeus

– First reach towards the middle of the back where the scapulae meet during retraction

– Then with the opposite hand slightly push the elbow posteriorly

04/08/23 382

Anconeus - Exercise

• Cable pull-downs

– Extend the cable to a 180 degree angle between the upper and lower arm

– Decrease the angle to no less than 90 degrees and return to the original position

04/08/23 383

Anconeus - Exercise

• Dumbbell extension

– Begin with a 90 degree angle and contract the tricep in an attempt to raise the lower arm

– Return the weight slowly to the original position

04/08/23 384

Anconeus - Exercise

• Overhead Barbell Extension

– Begin with maximal elbow flexion and contract the triceps to extend the lower arm

– Then return slowly from the overhead straightened-arm position

04/08/23 385

Anconeus - Exercise

• Bench Dips

– Begin with the elbow flexed and contract the triceps to extend the lower arm and raise the body

– Return slowly

Beginning position

04/08/23 386

Anconeus - Activities

• Extending the elbow during follow through of a basketball shot

04/08/23 387

Anconeus - Activities

• Blocking in football maximizes usage of the anconeus as a great deal of resistance is obtained

04/08/23 388

Pronator Teres

04/08/23 389

Biomechanical Information

• Origin– Distal part of the medial condyloid ridge of the humerus and medial side of the ulna.

• Insertion—Middle third of the lateral surface of the radius

• Innervation— Median nerve (C6, 7)

• Palpation– Anteromedial surface of the proximal forearm [up near the elbow joint]

04/08/23 390

Action of Pronator Teres

• Pronation of the forearm.

• Weak flexion of the elbow.

• Lever—3rd classAxis- radio-ulnar joint

Force- near origin

Resistance- radius

04/08/23 391

Synergists and Antagonist

• Synergists– Pronator quadratus

– Flexor carpi radialis

– Anconeus

• Antagonists– Supinator

– Biceps Brachii

04/08/23 392


• The best exercise to hit the pronator teres is any exercise that would add resistance to the action of forearm pronation and supination (eccentric and concentric contraction). A small dumbbell or large hammer can be held while you twist the forearm from the palm down position to the palm up position and back.

04/08/23 393

Beginning Phase of exercise

04/08/23 394

Mid-phase of exercise

04/08/23 395

Stretches

• The elbow must be fully extended while taking the forearm into full supination to stretch the pronator teres.

04/08/23 396

Sports

• Baseball swing (right handed batter)

• Tennis (forehand return)

• Golf (swing)

• Hockey (slap-shot)

• Racquetball

• Pinick-pinuck (table tennis)

04/08/23 397

Baseball swing

Tennis

04/08/23 398

Golf Hockey

04/08/23 399

Racquetball Table tennis

04/08/23 400

Pronator Quadratus Muscle

04/08/23 401

Origin

• Distal fourth of the anterior side of the ulna

04/08/23 402

Insertion

• Distal fourth of the anterior side of the radius

04/08/23 403

Action

• Pronation of the forearm– the ulna is fixed, so the

pronator quadratus moves the radius over the ulna

04/08/23 404

Innervation

• Median nerve, (palmar interosseous branch) (C6,7)

04/08/23 405

Lever

• 3rd class

• Axis- radioulnar joint

• Force(insertion)- distal fourth of the anterior side of the radius

• Resistance- whatever you are holding

04/08/23 406

Synergist Antagonist

• Pronation– pronator teres

– flexor carpi radialis

– anconeus

– triceps (when also extending the elbow)

• Supination– supinator

– biceps brachii

– brachioradialis

04/08/23 407

Stretches

• Have a partner take your wrist and passively place your forearm in extreme supination (or you can do this yourself)

04/08/23 408


• Pronation with a dumbell or hammer

• wringing out a towel

04/08/23 409

Sporting Activities

• Swimming- pulling back during a stroke

• Baseball- pitching in release of a screwball

• Tennis- to put spin on a ball

• Volleyball- when hitting to put spin on the ball

• also used when turning a screwdriver to unscrew

04/08/23 410

SUPINATOR MUSCLE

KINESIOLOGY

10/09/01

04/08/23 411

ORIGIN

• Lateral epicondyle of the humerus

• Neighboring posterior part of the ulna

04/08/23 412

INSERTION

• Lateral surface of the proximal radius just below the head

04/08/23 413

CLASS LEVER• THIRD class lever

• Axis = Elbow Joint

• Force = insertion on the lateral surface of proximal radius just below the head

• Resistance = weight of hand or resistance against the supination of the hand

04/08/23 414

ELBOW AND RADIOULNAR JOINT MUSCLES

• ANTAGONISTS• Primarilu flexion and

pronation

– Biceps brachii– Brachialis– Brachioradialis– Pronator teres– Pronator quadratus

• SYNERGISTS• Primarily extension

and supination

– Triceps brachii

– Aconeus

– Supinator

04/08/23 415

CHARACTERISTICS

• ACTIONS• Supinates the forearm

• Extension movements

• Rotates radius to turn palm anteriorly

• INNERVATION• Deep branch of radial

nerve

• C5 and C6

• PALPATION• Cannot be palpated

04/08/23 416

EXERCISES• Supination of forearm with dumbbells

• Holding a hammer with the head suspended from the ulnar side while the forearm is supported on a desk or table…the hammer should be hanging toward the floor with the forearm supinated to the palm-up position

• Hands grasped and forearms extended in an attempt to supinate forearm against grip of the hands

04/08/23 417

SUPINATION WITH DUMBBELLS

04/08/23 418

GRASPING OF HANDS

04/08/23 419

HAMMER (with dumbbells)

This is like wrist curls; full extension for supinator.

04/08/23 420

STRETCHING

• Supinator is stretched when the forearm us maximally pronated

04/08/23 421

SPORTING ACTIVITIES• Baseball (throwing a curve)

• Volleyball (snapping in hitting and serving)

• Tennis (cross court swing - snap)

• Also…the motion of turning a screwdriver

04/08/23 422

CURVE BALL PITCH

04/08/23 423

VOLLEYBALLDIGGING

SERVING

HITTING

04/08/23 424

TENNIS

04/08/23 425

Flexor Carpi Radialis

04/08/23 426


OriginMedial Epicondyle of the

Humerus

InsertionAnterior base of the second and

third metacarpals (palmar surface)

04/08/23 427


• Palpation

-Anterior surface of the wrist, slightly lateral, in line with the second and third metacarpals

04/08/23 428


• Innervation

-Median Nerve (C6, C7)

04/08/23 429


• Action

-Flexion of the wrist

-Abduction of the wrist

-Weak flexion of the elbow

04/08/23 430


Synergists

-Flexor carpi ulnaris

-Palmaris longus

-Flexor digitorum profundus

-Flexor pollicis longus

04/08/23 431


• Antagonist

-Extensor carpi radialis longus

-Extensor carpi radialis brevis

-Extensor carpi ulnaris

04/08/23 432


• Third Class Lever-Resistance at the fingers, force at

the insertion point, and the axis at the wrist

04/08/23 433


Stretches-the elbow must be fully extended

with the forearm supinated while the wrist is extended and adducted.

04/08/23 434

Praying wrist stretch

04/08/23 435

Seated Wrist Stretch

04/08/23 436

Single Arm Wrist Stretch

04/08/23 437


• Exercises

-Cable wrist curl

-Barbell wrist curl

-Rope curl

04/08/23 438

Barbell Wrist Curl

04/08/23 439

Cable Wrist Curl

04/08/23 440

Rope Curl

04/08/23 441


• Sports

(Baseball)-movement of wrist at the end of a throw

(Baseball)-movement of wrist when

hitting a ball

44204/08/23

Palmaris Longus

04/08/23 443

• Originates at the medial epicondyle of the humerus

04/08/23 444

• Inserts at the palmar aponeurosis of the second, third, forth, and fifth metacarpals

04/08/23 445

• Palpation– Anterior medial aspect of the forearm and the

central aspect of the anterior forearm just proximal to the wrist

• Innervation– Median nerve (C6, C7)

04/08/23 446

• Actions– Flexion of the wrist– Weak flexion of the elbow

• Lever– 3rd class lever

04/08/23 447

• Synergists– Flexor Digitorum Superficialis– Flexor Digitorum Profundus – Flexor Carpi Radialis – Flexor Carpi Ulnaris – Flexor Pollicis Longus

04/08/23 448

• Antagonists– Extensor Digitorum

– Extensor Carpi Radialis Longus

– Extensor Carpi Radialis Brevis

– Extensor Carpi Ulnaris

– Extensor Indicis

– Extensor Digiti Minimi

– Entensor Pollicis Longus

– Extensor Pollicis Brevis

04/08/23 449

• Wrist Curl– Barbell– Cable– Dumbbell

04/08/23 450

04/08/23 451

• Praying Wrist Flexor Stretch

04/08/23 452

• Seated wrist flexor stretch

• Kneeling wrist flexor stretch

04/08/23 453

• Activites– Bowling– Softball– Baseball– Tennis– Gymnastics

04/08/23 454

The Flexor Carpi Ulnaris

04/08/23 455

Flexor Carpi Ulnaris

• Origin– Medial epicondyle of the humerus– Posterior aspect of the proximal ulna

04/08/23 456


• Insertion– Pisiform

– Hamate

– Base of the fifth metacarpals

Pisiform Hamate Base of 5th metacarpal

04/08/23 457


• Innervation– Ulnar nerve (C8, T1)

04/08/23 458


• Lever type– 3rd Class Lever

04/08/23 459


• Actions– Flexion of the wrist– Adduction of the wrist– Weak flexion of the elbow

04/08/23 460


• Palpation– Anterior medial aspect of forearm and central

aspect of the anterior forearm just proximal to the wrist

04/08/23 461

Flexor Carpi UlnarisSynergists

• Wrist Flexion– Flexor carpi radialis– Palmaris longus– Extensor carpi ulnaris– Flexor digitorum superficialis– Flexor digitorum profundus– Flexor pollici longus muscle

04/08/23 462

Flexor Carpi UlnarisSynergists

• Wrist adduction– Extensor carpi ulnaris

04/08/23 463


• Antagonists– Flexor carpi radialis (wrist abduction)– Extensor carpi ulnaris (wrist & elbow

extension)– Extensor carpi radialis longus & brevis (in all

actions)– Flexor digitorum superficialis (wrist and elbow

extension)

04/08/23 464


• Strengthening exercises

04/08/23 465


04/08/23 466


• Stretches

04/08/23 467


04/08/23 468


• Sporting Activities– Basketball jump shot– The javelin throw – Baseball swing

04/08/23 469


04/08/23 470


04/08/23 471


04/08/23 472

Extensor Carpi Ulnaris

04/08/23 473


• Origin– Lateral epicondyle of the humerus– Middle two fourths of the posterior

border of the ulna

• Insertion– Base of the dorsal surface of the fifth

metacarpal

04/08/23 474


• Nerve Innervation– Radial Nerve

• Palpation– Near the base of the 5th metacarpal

04/08/23 475


• Actions– Extension of the wrist

– Adduction (ulnar deviation) of the wrist

– Weak extension of the elbow

04/08/23 476


• Synergists– Wrist exntensors

• Ext. Carpi Rad. Brev.

• Ext. Carpi. Rad. Long.

– Elbow extensors• Triceps

• Anconeus

– Wrist Adductors• Flexor Carpi Ulnaris

• Antagonists– Wrist flexors

• Fl. Carpi. Rad.

• Palmaris Longus

– Elbow Flexors • Biceps Brachi

• Brachioradialis

– Wrist Abductors• Flexor Carpi Radialis

04/08/23 477

Wrist Extension Exercises

DUMBELL

EXTENSIONS:

• Support the forearm on a bench or table

• Hold the elbow down with the opposite hand

• Hold the dumbell and extend the wrist

04/08/23 478


BARBELL

EXTENSIONS:

• Support the forearm on a bench or table

• Hold the elbow down with the opposite hand

• Hold the barbell and extend the wrist

04/08/23 479


THE WRIST ROLLER:

• Grab the bar

• Extend the wrists with an alternating action

• Slowly lower the bar with an eccentric motion

04/08/23 480


UNAR DEVIATION:

• Hold a dumbell over your head

• Adduct the wrist

04/08/23 481

Wrist Extensor Stretches

• The elbow should be straight

• Grab the involved hand and pull it toward you

04/08/23 482

Sports and Activities

04/08/23 483

Extensor Carpi Radialis Brevis

04/08/23 484

ORIGIN

*Lateral epicondyle of the humerus

INSERTION*Base of the third metacarpal (dorsal surface)

04/08/23 485

ACTIONS~Extension of the wrist

~Abduction of the wrist

~Weak extension of the elbow

04/08/23 486

NERVE INNERVATION*Deep branch of the radial

nerve

(C6, 7)

PALPATION*Dorsal side of the forearm,

which is difficult to palpate

04/08/23 487

LEVER

*Third class

A-Elbow joint

F-Insertion=base of third metacarpal

R-Resistance in hand

04/08/23 488

SYNERGISTS

Extensor Carpi Radialis Longus


ANTAGONIST

Palmaris Longus

Flexor carpi ulnaris

04/08/23 489

*With palm facing downward, pull wrist and fingers downward toward forearm.

*Extend or straighten elbow. Hold stretch for 20 seconds. Repeat with opposite arm.

04/08/23 490

*Sit and grasp bar with narrow to shoulder width overhand grip. Rest forearms on thighs with wrists just beyond knees.

*Hyperextend wrist and return until wrist are fully flexed. Repeat.

04/08/23 491

*Sit and grip dumbbell with overhand grip. Rest forearm on thigh with wrists just beyond knees.

*Hyperextend wrist and return until wrist is fully flexed. Repeat. Continue with opposite arm.

04/08/23 492

Sit and grasp cable bar with narrow to shoulder width overhand grip. Rest forearms on thighs with wrists just beyond knees.

Hyperextend wrist and return until wrists are fully flexed. Repeat.

04/08/23 493

SPORTS

04/08/23 494

04/08/23 495

Extensor carpi radialis longus

04/08/23 496

Origin + Insertion

• O, Lower third of the lateral supracondylar ridge of the humerus and lateral epicondyle of the humerus

• I, Base of the second metacarpal(dorsal surface).

04/08/23 497

Actions

• Extension of the wrist

• Abduction of the wrist

04/08/23 498

Innervation

• The extensor carpi radialis longus is innervated by the Radial nerve(C6,7).

04/08/23 499

Lever Class

• This is an example of a first-class lever.– Axis- wrist

– Resistance- weight in hand

– Force- muscle

04/08/23 500

Synergist muscles

• Extensor Carpi radialis brevis

• Extensor Carpi Ulnaris

04/08/23 501

Antagonist muscles

• Primary wrist flexors– Flexor carpi radialis

– Flexor carpi ulnaris

– Palmaris longus

– Other muscles involved in flexion of the wrist

04/08/23 502

Strengthening exercises

• Dumbell Reverse Wrist Curl

• Barbell Reverse Wrist Curl

• Rope Wrist Curl

04/08/23 503

Exercises

04/08/23 504

04/08/23 505

04/08/23 506

Stretches

• With the palm facing downward, pull wrist and fingers downward toward forearm.

04/08/23 507

Sports

• Racquetball

• Tennis

• Golf

• Baseball

04/08/23 508

04/08/23 509

Flexor Digitorum Superficialis

04/08/23 510

Origin

• Medial epicondyle of the humerus

• Ulnar head – medial coronoid process

• Radial head – upper two-thirds of the anterior border of the radius

04/08/23 511

Insertion

• Palmar surface of the middle phalanx of the four fingers

04/08/23 512

Actions

• Flexion of the fingers at the proximal interphalangeal joints and at the metacarpophalangeal joints

• Flexion of the wrist

• Weak flexion of the elbow

04/08/23 513

Levers

• Third Class - occurs when resistance is at the fingertips

• Second Class – occurs when resistance is in the palm

04/08/23 514

Palpation

• Anterior wrist surface on the ulnar side

• Next to the flexor carpi ulnaris

04/08/23 515

Innervation

• Median nerve (C7, C8, T1)

04/08/23 516

Synergists

• Flexor Digitorum Profundus

• Flexor Carpi Radialis

• Flexor Carpi Ulnaris

• Palmaris Longus

• Flexor Pollicis Longus

04/08/23 517

Antagonists

• Extensor Digitorum

• Extensor Carpi Radialis Longus

• Extensor Carpi Radialis Brevis

• Extensor Pollicis Longus

• Extensor Pollicis Brevis

• Extensor indicis

• Extensor digiti minimi

04/08/23 518

Wrist Barbell Curl

04/08/23 519

Wrist Dumbbell Curl

04/08/23 520

Hand Gripper

04/08/23 521

Praying Posture Stretch

04/08/23 522

Seated Forearm Stretch

04/08/23 523

One Arm Forearm Stretch

04/08/23 524

Sporting Activities

• Rock Climbing – gripping the rock

• Baseball – gripping the bat

• Baseball – gripping the ball and flexing the wrist on a pitch

04/08/23 525

04/08/23 526

04/08/23 527

04/08/23 528


Flexor Digitorum Profundus

04/08/23 529

Origin

• Proximal 3/4 of the anterior and medial ulna Insertion

Base of the distal phalanxes of the four fingers

04/08/23 530

Palpation

Anterior surfaces of the middle phalanges of the four fingers

04/08/23 531

Innervation

Median nerve (C8,T1) to the second and third fingers

Ulnar nerve C8,T1) to the fourth and fifth fingers

04/08/23 532

Actions

• Flexion of the four fingers at the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints


04/08/23 533

Agonists

• In wrist flexion: Flexor carpi radialis, Palmaris longus, Flexor carpi ulnaris, Flexor digitorum superficialis, Flexor pollicis longus

• In flexion of the 4 fingers: Flexor digitorum superficialis

04/08/23 534

Antagonists• In wrist flexion: Extensor

carpi ulnaris, Extensor carpi radialis brevis, Extensor carpi radialis longus, Extensor digitorum, Extensor indicis, Extensor digiti minimi, Extensor pollicis longus, Extensor pollicis brevis

• In flexion of 4 fingers: Extensor digitorum, Extensor indicis (2), Extensor digiti minimi(5)

04/08/23 535

What Lever is It?

2nd in wrist flexion at the radioulnar joint:

A: radioulnar joint

R: weight in hand

F: base of distal phalanxes

1st in fist clenching, distal interphalangeal joint:

R: At fingertips

A: distal interphalangeal joint


04/08/23 536

What Lever is it?3rd in fist clenching, proximal interphalangeal joint:

R: At fingertips


A: proximal interphalangeal joint2nd in fist clenching, metacarpophalangeal joint:

F: base of the distal phalanxes

R: right above the joint, between the metacarpalphalangeal joint and the proximal interphalangeal joint

A: metacarpophalangeal joint

It is important to note that the resistance is dependant on the size of the ball

04/08/23 537

Stretching the Flexor Digitorum Profundus

• Wrist/Finger extension

• Palm press

04/08/23 538

Wrist/Finger Extension

04/08/23 539

Palm Press

04/08/23 540

Strengthening theFlexor Digitorum Profundus

√ Wrist Curls using a bar

* alternative: dumbbells

√ Wrist flexion with twisting bar

√ Fist clenching using a ball

04/08/23 541

Wrist Curls using a bar

Forearms are placed on bench to isolate the wrist movement

04/08/23 542

Wrist Flexion with twisting bar

04/08/23 543

Fist Clenching with a ball

04/08/23 544

Sporting Events that use theFlexor Digitorum Profundus

• Softball: holding the bat,throwing and catching the ball

• Baseball: holding the bat,throwing and catching the ball

• Tennis: holding the raquet

• Hockey:holding the hockey stick, punching the opponent

• Bowling: holding and releasing the ball

• Volleyball: passing, slight flexion setting and blocking

• All sports involving clenching of the fist and wrist flexion….

04/08/23 545

That’s my roommate!

04/08/23 546

Flexor Pollicis Longus

04/08/23 547

Origin

• Middle anterior surface of the radius

• Anterior medial border of the ulna just distal to the coronoid process

04/08/23 548

Insertion

• Base of the distal phalanx of the thumb (palmar surface)

04/08/23 549

Action• Flexion of the thumb carpometacarpal,

metacarpophalangeal, and interphalangeal joints


04/08/23 550

Synergists and Antagonists

• Wrist Flexors– Flexor carpi radialis– Flexor carpi ulnaris– Palmaris longus– Flexor digitorum profundus– Flexor digitorum

superficialis– Flexor pollicis brevis

• Wrist and thumb extensors– Extensor pollicis brevis– Extensor pollicis longus

• Wrist extensors– Extensor carpi ulnaris– Extensor carpi radialis

brevis/longus– Extensor digitorum– Extensor indicis (weak)– Extensor digiti minimi

(weak)

04/08/23 551

Palpation

• Anterior surface of the thumb

• How to:

-Flex the interphalangeal joint

-Feel muscle along proximal phalanx of thumb

04/08/23 552

Nerve Innervation

• Median nerve, palmar interosseous branch (C8, T1)– From the 8th cervical

and 1st thoracic vertebrae

04/08/23 553

Lever

• Second Class Lever– When the carpometacarpal and metacarpophalangeal

joints are being used in gripping, the resistance is proximal to the force and distal to the axis.

• Axis- carpometacarpal/metacarpophalangeal joints of thumb

• Resistance- barbell, bat, ball, etc. on proximal phalanx

• Force- muscle insertion on the distal phalanx of thumb

04/08/23 554

Lever

• Third Class Lever– At the interphalangeal joint,

• Axis- interphalangeal joint

• Force- muscle insertion at base of distal phalanx of thumb

• Resistance- middle of distal phalanx (holding a football)

– During wrist flexion:• Axis- wrist joint

• Force- muscle insertion on distal phalanx of thumb

• Resistance- barbell, bat, ball, etc. on other 4 fingers (distal to force)

04/08/23 555

Exercises

• Gripping and grasping exercises that flex the wrist and thumb– Dumbell curls– Barbell curls– Cable curls– Stress ball squeezes

04/08/23 556

Dumbbell Curls Barbell Curls

04/08/23 557

Cable Curls and Stress Ball

04/08/23 558

•Extension of thumbPassively extend the entire thumb while simultaneously maintaining maximal wrist extension

•Extension of wrist•Praying •Seated•Single arm•Kneeling

04/08/23 559

Praying flexor stretch

Seated flexor stretch

04/08/23 560

Single arm stretch

Kneeling stretch

04/08/23 561

Sports

• Bowling

• Gymnastics

• Catching

• Throwing– Baseball/softball– Football– Javelin

04/08/23 562

04/08/23 563

04/08/23 564

Extensor Digitorum

04/08/23 565

Nerve Innervation

• The Radial Nerve (C6-8)

04/08/23 566

Origin Insertion

• Lateral epicondyle of the humerus

• Four tendons to bases of middle and distal phalanges of four fingers(dorsal)

04/08/23 567

2nd Class Lever

• Force: Insertion on the dorsal side of 2-5 phalanges.

• Resistance: Weight in the palm.

• Axis: Wrist joint.

04/08/23 568

Palpation

• Middorsal surface of the forearm

04/08/23 569

Actions

• Extension of the second, third, fourth, and fifth phalanges at the metacarpophalageal joints.

• Extension of the wrist

• Weak extension of the elbow.(biarticular)

04/08/23 570

Antagonist Synergist

• Extensor carpi radialis longus & brevis

• Extensor carpi ulnaris

• Palmaris longus

• Flexor digitorum superficialis & profundus

• Flexor pollicis longus

• Extensor carpi radialis longus & brevis

• Extensor carpi ulnaris

• Extensor indicis

• Extensor pollicis brevis & longus

04/08/23 571

Exercises

• Rope curls

• Forearm curls

• Backward curls

04/08/23 572

Stretch

• With fingers maximally flexed at all joints and the maximally flex the wrist joint.

04/08/23 573

Sports movements

• Tennis bringing racket back and back hand.

• Baseball throwing

• Discus throwing.

• Shooting a basketball.

04/08/23 574

Extensor Indicis Muscle

04/08/23 575

Extensor Inicis Muscle

• Origin– Posterior surface of ulna (distal to extensor

pollicis longus)– Middle to distal one-third

04/08/23 576

Extensor Indicis muscle

• Insertion– Base of the middle and distal phanlanxes of

second phalange (dorsal surface)

04/08/23 577

Extensor Indicis muscle

• Action– Extension of the index finger at the

metacarpophalangeal joint– Weak wrist extension

04/08/23 578

Extensor indicis

• Palpation– Posterior aspect of the distal forearm and dorsal

surface of the hand just medial to the extensor digitorum tendon of the index finger

04/08/23 579

Extensor indicis

• Innervation: Radial nerve (C6-8)

• Synergist– Extensor Digitorum

• Antagonist– Flexor digitorum superficialis muscle– Flexor digitorum profundus muscle

04/08/23 580

Extensor indicis

• Third class lever– The axis is the metacarpophanlangeal joint– The Resistance is the Insersertion at the base of

middle and distal phalanxes of second phalange.

– The force falls in the middle!

04/08/23 581

Extensor indicis

• Exercises– Rubber band extension

04/08/23 582

Extensor indicis

• How to stretch?– Passively taking the index finger into miaximal

flexion at its metacarpophanlangeal, proximal interphalangeal, and distal interphalangeal joints while fully flexing the wrist.

04/08/23 583

Extensor Indicis

• This is not a particularly main muscle in any movement. It is the muscle used in pointing with the index finger, particularly when the other fingers are flexed

• This muscle would be used “flicking” objects.

04/08/23 584

Extensor Digiti Minimi

04/08/23 585


• Origin– Lateral Epicondyle of the Humerous

• Insertion– Base of the middle and distal phalanxes of the

fifth phalange.• Palpation

– Cannot be palpated.

• Innervation– Radial nerve (C6-8)

04/08/23 586


• Action– Extension of the little finger at the metacarpophalangeal joint.

– Weak wrist extension

04/08/23 587


• Third Class Lever– Axis is the Metacarpophalangeal joint– Force is the insertion point– Resistance is the tip of the finger

04/08/23 588


• Synergist Muscles– Extensor Carpi Ulnaris

– Extensor Carpi Radialis Brevis

– Extensor Carpi Radialis Longus

– Extensor Digitorum

– Extensor Indicis

– Extensor pollicis longus

– Extensor pollicis brevis

• Antagonist Muscles– Flexor Carpi Radialis

– Flexor Carpi Ulnaris

– Flexor Digitorum Superficialis

– Flexor Digitorum Profundus

– Flexor Pollicis Longus

04/08/23 589


• Same exercises used for Extensor Digitorum– Reverse Curls

04/08/23 590


• Can also be strengthened by applying manual resistance to the dorsal aspect of fifth phalange, while flexed, and then extending it fully.

04/08/23 591

Stretching

• Same stretches used for the rest of the wrist extensors.

04/08/23 592

Activities

• Any sport that involves wrist extension– Basketball

– Baseball

04/08/23 593

Abductor Pollicis Longus

• Tendons of this muscle and those of the abductor pollicis brevis form the “anatomical snuffbox”

04/08/23 594


• Origin is posterior aspect of the radius and midshaft of ulna

• Insertion is the base of the first metacarpal on the dorsal surface

04/08/23 595


• Primary function – abduction of thumb

• Assists to extend and rotate 1st metacarpal

• Radially deviates wrist

• Flexes hand at wrist

04/08/23 596


• Innervated by the posterior interosseus nerve (C7,8) and the deep branch of the radial nerve (C6,7)

• Palpated on the lateral aspect of the wrist joint just proximal to the thumb

• 3rd Class Lever

04/08/23 597


• Antagonists– Flexor Carpi Radialis/Ulnaris

– Palmaris Longus

– Flexor Digitorum Superficialis/Profundus

– Flexor Pollicis Longus

• Syngergists– Abductor Pollicis Brevis

– Extensor Pollicis Longus

04/08/23 598


• Stretching– Fully flexing and adducting

the entire thumb across the palm with the wrist fully adducted

• Strengthening– Abducting the thumb from

the adducted position against a manual resistance

04/08/23 599


Volleyball

04/08/23 600

Abductor Pollicis LongusBasketball

04/08/23 601

Abductor Pollicis LongusCatching a Football

04/08/23 602

EXTENSOR POLLICIS BREVIS

04/08/23 603


• Origin: Posterior surface of the lower middle radius.

• Insertion: Base of the proximal phalanx of the thumb (dorsal surface).

• Palpation: Just lateral to the extensor pollicis longus tendon most prominent on lower dorsal side of the hand.

04/08/23 604


• Innervation: Radial nerve C6,7.

• Action; – Extension of the thumb at the

metacarpophalangeal joint.– Weak wrist extension.

04/08/23 605


• Lever Class:3rd Class Lever:– Axis: Metacarpophalangeal joint– Force: Insertion– Resistance: Weight at end of thumb

04/08/23 606


• Synergists:– Extensor pollicis

longus

– Abductor pollicis longus

• Antagonists:– Flexor pollicis longus

04/08/23 607

Strengthening Exercise

• The only real way of strengthening is by extending the flexed thumb against manual resistance, as seen in the picture.

04/08/23 608

Stretching Exercise

• It is stretched by passively taking the first carpometacarpal joint and the metacarpophalangeal joint of thumb into maximal flexion while fully flexing the wrist.

04/08/23 609

Sporting Activities

• In football, when you extend your hands to catch a ball, you are extending your thumb and using this muscle.

• Also in football, when lineman are in their stance they are extending their thumb for balance and using this muscle.

04/08/23 610

Sporting Activities

• In baseball, when you are wearing a baseball glove to catch the baseball, you are extending your thumb and using this muscle.

• When gripping a bowling ball, football, or basketball, you are extending your thumb and using this muscle.

04/08/23 611

Extensor Pollicis Longus

04/08/23 612

Actions

• Weak extension of the wrist

• Extension of the thumb

04/08/23 613

Origin & Insertion

• Origin: Posterior lateral surface of the lower middle ulna

• Insertion: Base of the distal phalanx of the thumb (dorsal surface)origin

insertion

04/08/23 614


• 3rd class leveraxis: wrist- force: insertion of muscle- resistance: weight in hand

• Innervation: Radial nerve (C6-8)

• Palpation: Most prominent on dorsal side of thumb

04/08/23 615


• Synergists: extensors - extensor pollicis brevis* - abductor pollicis longus* - extensor carpi ulnaris - extensor carpi radialis - extensor carpi radialis

longus - extensor digitorum - extensor indicis (weak) - extensor digiti minimi

(weak)

• Antagonists: flexors - flexor pollicis longus* - flexor carpi radialis - palmaris longus - flexor carpi ulnaris - flexor digitorum

superficialis - flexor digitorum profundus

04/08/23 616

• Stretches - kneeling

- single arm

Strengthening & Stretching

• Lifts - barbell reverse wrist curl

- cable reverse wrist curl

- dumbbell reverse wrist curl

- weighted rope twist

04/08/23 617

Barbell Reverse Wrist Curl

04/08/23 618

Cable Reverse Wrist Curl

04/08/23 619

Dumbbell Reverse Wrist Curl

04/08/23 620

More strengthening…

• This muscle can also be strengthened by extending the flexed thumb against manual resistance.

04/08/23 621

Kneeling Wrist Stretch

04/08/23 622

Single Arm Stretch

04/08/23 623

More stretching…

• This muscle can also be stretched by passively taking the entire thumb into maximal flexion while fully flexing the wrist.

04/08/23 624

Sports Applications

• Extension of wrist before shooting, throwing

• Gripping a racquet, golf club, bat

• Catching

• Other uses: hammering, shaking hands, thumb wars, knocking on a door

04/08/23 625

CHAPTER 6

Muscular Analysis of the Upper Extremity

04/08/23 626

Objectives

• Analyze movements of simple exercises

• Learn the concept of open / closed chain exercises

• Group muscles by their actions

• Learn the names of different exercises used to strengthen muscles and increase performance

04/08/23 627

Exercises

• Pull-up

• Pull-Down

• Shoulder Press

• Low/High Rows

• Upright Rows

• Supine Flys

• Lateral Flys

• Bench Press

• Millitary Press

• Arm Curl

• Tricep Extensions

• Push-Ups

• Wrist Curls

• Wrist Extensions

• Dips

04/08/23 628

CHAPTER 7

The Hip Joint and Pelvic Girdle

04/08/23 629

Bones

• Bones of the Illium

• Bones of the Ischium

• Bones of the Pubis

• Bones of the Sacrum

• Bones of the Coccyx

• Bones of the Femur

04/08/23 630

Lumbar Spine Movements

• Flexion

• Extension

• Lateral Flexion

• Lateral Rotation

04/08/23 631

Pelvic Movements

• Anterior Rotation (sagital plane)

• Posterior Rotation (sagital plane

• Lateral Rotation (frontal plane)

• Transverse Rotation (horizontal plane)

04/08/23 632

Hip Movements

• Flexion

• Extension

• Abduction

• Adduction

• Internal Rotation

• External Rotation

• Circumduction

04/08/23 633

Iliopsoas Muscle(composed of)

Iliacus and Psoas major and minor

04/08/23 634

Information

• ORIGIN—iliacus inner surface of ilium.

• ORIGIN—psoas major and minor lower borders of the transverse processes (L1-5), sides of the bodies of T12, the lumbar vertebrae (L1-5), intervertebral fibrocartilages, and base of sacrum.

• INSERTION—Iliacus and psoas major lesser trochanter of the femur and shaft just below.

04/08/23 635

Information, cont.

• INSERTION– psoas minor pectineal line and iliopectineal eminence.

• 3rd Class Lever– Axis (Hip joint)– Force (the muscle)– Resistance (the leg, in both movements)

04/08/23 636

Actions

• Flexion of the Hip

• External Rotation of the Hip

• #2 is the Psoas

• #1 is the Iliacus

04/08/23 637

Palpation

• Impossible to palpate except with almost complete relaxation of the rectus abdominis muscle.

04/08/23 638

Innervation

• Lumbar nerve and femoral nerve (L2-4) from the Lumbar Plexus

• This diagram shows the femoral nerve (in yellow with a red arrow) in relation to other muscles and veins.

04/08/23 639

Synergists

• Synergists:– Flexion: Sartorius, Rectus femoris, Tensor

fasciae latae, Pectineus– External rotation: Sartorius, six deep lateral

rotator muscles, Gluteus medius, Gluteus maximus, Biceps femoris, Adductor magnus

04/08/23 640

Antagonists

• Antagonists– Flexion (extension of the hip): Gluteus

maximus, Semitendinosus, Semimembranosus, Biceps femoris

– Ext. rotation (internal rotation of hip): Gluteus minimus, Gluteus medius, Semitendinosus, Semimembranosus, Pectineus

04/08/23 641

Strengthening Exercise and Stretches

• The iliopsoas muscle is powerful in actions such as raising the legs from the floor while in the supine position.

• The muscle may be strengthened by supporting the arms on a dip bar and then flexing the hips to lift the legs. To decrease resistance, flex the knees into a tucked position.

04/08/23 642

Stretching the Iliopsoas

• The hip must be extended so that the femur is behind the plane of the body. Full knee flexion must be avoided. Slight additional stretch may be applied by internally rotating the hip while it is extended.

04/08/23 643

Exercises

Weighted Leg RaiseVertical Leg Raise

04/08/23 644

Hanging Leg Raise

Lever Hip Flexion

04/08/23 645

StretchesPNF

Self-stretch

04/08/23 646

Sports

• Running

• Baseball (stealing a base, pitching from the “stretch”)

• Gymnastics

• Bicycling

04/08/23 647

Gymnastics

Cycling

04/08/23 648

Baseball pitcher

Running

04/08/23 649

SartoriusSartorius

Origin- anterior

superior iliac spine and

notch just below the spine

Insertion- anterior medial condyle of the tibia

04/08/23 650

• Palpation- easiest to palpate at the anterior superior spine of the ilium

• Innervation- Femoral Nerve

04/08/23 651

Synergists Antagonists• Hip flexion

– iliopsoas– pectineus– rectus femoris

• Knee flexion– semitendinosus– semimembranosus– biceps femoris– gracilis– popliteus– gastrocnemius

• External rotation of hip joint– iliopsoas– six deep lateral rotator muscles– gluteus medius & maximus– biceps femoris– adductor brevis & magnus

• Hip flexion– gluteus maximus

– biceps femoris

– semitendinosus

– semimembranosus

– six deep external rotators

• Knee flexion– rectus femoris

– vastus medialis, intermedius, & lateralis

• External rotation of hip joint– gluteus minimus

– semitendinosus

– semimembranosus

– pectineus

– gracilis

04/08/23 652

Levers• when resistance is on posterior side of ankle with

knee flexion– axis: knee joint

– force: anterior medial condyle of tibia

• 3rd Class Lever

• when resistance is at the knee or thigh with hip flexion or external rotation– axis: hip joint

– force: anterior medial condyle of tibia

• 2nd Class Lever

04/08/23 653

Actions

• Flexion of the hip

• Flexion of the knee

• External rotation of the thigh as it flexes the hip and the knee

04/08/23 654


• Leg lifts (either tucked or straight legs)

– support arms on parallel or dip bars and flex hips to lift the legs

• Leg Curls

– in a supine position, flex knees to lift ankles

• Knee Raises

– lift resistance placed on anterior of the knee

• Sitting Exercise

– put ankle weight on externally rotate hip while flexing knee and hip to raise ankle superior to opposite knee

04/08/23 655

Leg Lifts Leg Curls

•

04/08/23 656

Knee Raises Sitting Exercise

04/08/23 657

Stretches

04/08/23 658

Hip Extension, Adduction, and Internal Rotation

• Have a partner passively take your hip into – extreme extension

– extreme adduction

– extreme internal rotation

04/08/23 659

Sporting Activities

• Ballet- plies

• Baseball & Softball - steping of the plate to catch a ball

• Swimming- breast stroke

04/08/23 660

RECTUS FEMORIS

04/08/23 661

QUADRICEPS

1) RECTUS FEMORIS

2) VASTUS LATERALIS

3) VASTUS INTERMEDIUS

4) VASTUS MEDIALIS

04/08/23 662

ORIGINAnterior inferior iliac spine of the ilium and

groove (posterior) above the acetabulum

04/08/23 663

INSERTIONSuperior aspect of the patella and patellar

tendon to the tibial tuberosity

04/08/23 664

CLASS LEVERThird Class LeverAxis = hip joint/knee joint Force = insertion (patella)Resistance = weight at

feet (squat, leg press, etc.) or mid-shin (knee extension

Second Class Lever

Axis = hip jointForce = insertion

(patella)Resistance = mid-

thigh/quad (hip flexion)

04/08/23 665

DOES WHAT?ACTION

Flexion of the hipExtension of the knee

04/08/23 666

APPLICATIONSYNERGISTS

SartoriusTensor Fascia LataeVastus LateralisVastus MediusVastus Intermedius

ANTAGONISTSHamstringsGluteus

Maximus

04/08/23 667

PALPATIONINNERVATION

Femoral nerveL2L3L4

PALPATIONAny place on the

anterior surface of the femur

04/08/23 668

EXERCISESLeg pressLungeLeg ExtensionStep-upSquat

Front Squat Full Squat Hack Squat Safety Squat

04/08/23 669

LEG PRESS

04/08/23 670

SQUATS

04/08/23 671

LUNGE

04/08/23 672

STEP-UP

04/08/23 673

HIP FLEXION

04/08/23 674

PLYOMETRICSBOX JUMPS

04/08/23 675

STRETCHESLying quad stretchStanding quad stretchSquat quad stretchLunge stretch

04/08/23 676

KNEE BACK

04/08/23 677

04/08/23 678

SITTING SQUAT

04/08/23 679

LUNGE STRETCH

04/08/23 680

SPORTING ACTIVITIES

Volleyball (jumping and digging)Baseball/Softball Catchers (positional

stance)Basketball (jumping)Track (Running, Long and High Jump)Soccer (kicking the ball)

04/08/23 681

04/08/23 682

04/08/23 683

TensorFasciaeLatae

04/08/23 684

Tensor fasciae lataeOrigin

-Anterior iliac crest and surface

of the ilium just below the crest

04/08/23 685

Tensor fasciae lataeInsertion

-1/4th of the way down the thigh into the illotibal tract, which in turn inserts onto Gerdy’s tubercle of the anterolateral tibal condyle

04/08/23 686

Tensor fasciae lataeAction

-Abduction of the hip

-Flexion of the hip

-Tendency to rotate the hip internally as it flexes

04/08/23 687

Tensor fasciae lataeSynergists (Flexion of the Hip)

-Rectus femoris-Sartorious-Ilipsoas

Synergist (Abduction of the Hip)-Gluteus Minimus-Gluteus Medius

04/08/23 688

Tensor fasciae lataeAntagonist (Extension of the Hip)

-Gluteus Maximus

-Semitendinosus

-Semimembranosus

-Biceps Femoris

04/08/23 689

Tensor fasciae lataeAntagonist (Adduction of the hip)

-Adductor brevis

-Adductor longus

-Adductor magnus

-Pectineus

04/08/23 690

Levers (Second class lever)Axis is at the origin on the ilium

Resistance is on the thigh

Force is at the insertion point

(Third class lever)Axis is at the origin on the ilium

Force is at the insertion point

Resistance is at the feet

Tensor fasciae latae

04/08/23 691

Tensor fasciae lataePalpation

-Slightly in front of the greater trochanter

Innervation

-Superior gluteal nerve (L4-5, S1)

04/08/23 692

Tensor fasciae lataeExercises

-Abduction of the hip-Cable hip abduction-Lever standing hip abduction

-Flexion of the hip-Lever hip flexion-Cable lying leg raise

-Cable leg raise

04/08/23 693

Cable Hip Abduction

04/08/23 694

Standing Lever Hip Abduction

04/08/23 695

Lever Hip Flexion

04/08/23 696

Cable Lying Leg Raise

04/08/23 697

Cable Leg Raise

04/08/23 698

StretchesStanding Ibiotibal Stretch

04/08/23 699

StretchesWall Ibiotibal Stretch

04/08/23 700

Sports

Basketball-Defensive slide (Abduction of hip)-lay-up (Flexion of hip)

Soccer-Juggling a ball (Flexion of the hip)

Baseball-windup of a pitcher (Flexion and Abduction)

04/08/23 701

The Six Deep Lateral Rotator Muscles

• Piriformis

• Gemellus superior

• Gemellus inferior

• Obturator externus

• Obturator internus

• Quadratus femoris

04/08/23 702

Origin

• Anterior sacrum

• Posterior portions of the ischium

• Obturator foramen

04/08/23 703

Insertion

• Superior and posterior aspect of the greater trochanter

04/08/23 704

Nerve Innervation

• Piriformis– 1st or 2nd sacral nerve

• Gemellus superior– sacral nerve (L5-S2)

• Gemellus inferior– branches from sacral

plexus (L4-S2)

• Obturator exernus– obturator nerve (L3-4)

• Obturator internus– branches from sacral

plexus (L4-S2)

• Quadratus femoris– branches from sacral

plexus (L4-S1)

04/08/23 705

Palpation

04/08/23 706

Action/Lever

• External rotation of the hip

• 3rd class Lever– Axis = hip– Force = insertion– Resistance = leg

04/08/23 707

Synergists

• Iliopsoas

• Sartorius

• Gluteus medius – posterior fibers

• Gluteus maximus

• Biceps femoris

• Adductor brevis

• Adductor mangus

04/08/23 708

Antagonists

• Tensor fasciae latae

• Gluteus minimus

• Gluteus medius– anterior fibers

• Semitendinosus

• Semimembranosus

• Pectineus

• Gracilis

04/08/23 709

Exercises

• Using a theraband– keep one foot planted on the ground while

forcefully turning the body and the opposite leg away from the planted foot.

04/08/23 710

Exercises

04/08/23 711

Exercises

• Using a theraband– Attach one end of the theraband to a foot– Use theraband as resistance as you externally

rotate the hip

04/08/23 712

Exercises

04/08/23 713

Stretches

• While standing, maximally internally rotate the hip while rotating the torso in an opposite direction

• While lying on your back, bend at the knee and adduct one leg while a partner slightly raises your foot (to internally rotate the hip)

04/08/23 714

Stretches

04/08/23 715

Applications

• Baseball– batting

– pitching

• Basketball– pivoting

• Dance

• Track & Field– discus

– shotput

04/08/23 716

Applications

04/08/23 717

Applications

04/08/23 718

GLUTEUS MEDIUS

04/08/23 719

GLUTEUS MEDIUS

• ORIGIN– Lateral surface of the ilium just

below the crest.

• INSERTION– Posterior and middle surfaces of the

greater trochanter of the femur

04/08/23 720

GLUTEUS MEDIUS

• Actions– Abduction of the hip

– External Rotation of the hip as it abducts (posterior fibers)

– Internal rotation of the hip

04/08/23 721

GLUTEUS MEDIUS

• Palpation– above the greater trochanter

• Innervation– superior gluteal nerve (L4-S1)

• Lever– third class lever

04/08/23 722

GLUTEUS MEDIUS

• Synergists– Gluteus minimus (hip abduction)

– Tensor fascia latae (hip abduction)

– Gluteus maximus (hip external rotation)

– 6 deep lateral rotators (hip external rotation)

– Biceps

– Gluteus minimus (hip internal rotation)

– Semitendonosis (hip internal rotation)

– Semimembranosus (hip internal rotation)

04/08/23 723

GLUTEUS MEDIUS

• Antagonists– Adductors (adduction)– Biceps femoris (external rotation)– Gluteus Maximus (external rotation)– 6 deep lateral rotators (external rotation)– Semitendonosis (internal rotation)– Semimembranosus (internal rotation)

04/08/23 724

GLUTEUS MEDIUS

• Exercises– Hip Abduction machine– Lateral lunges– Lateral step ups– Squats etc.

04/08/23 725

External Rotation Exercise

• Externally rotate the leg against resistance.

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Hip Abduction Machine

• Abduction of the hip against resistance

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GLUTEUS MEDIUS

• Stretches– The hip should be placed in extreme adduction

in front of the opposite leg with the foot internally rotated (posterior fibers).

– The hip should be placed in extreme adduction behind the opposite leg with the foot

externally rotated (anterior fibers).

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Gluteus Medius Stretch

• With the involved leg adducted in front or behind the opposite leg, lean the opposite direction

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Application

• Trendelenburgs Test

• Push Off from a base or pitching rubber

• Gluteus medius is also a great stabilizer of the hip for proprioception (balance) of the leg during any exercise

• Slide step in baskeball

• Push off in the shot put

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Application

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Application

Date post:	14-Nov-2014
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Dennis-upper Extremity Kinesiology

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