Hướng dẫn đường đi cho cơ thể

Hướng dẫn đường đi cho cơ thể Trước khi bạn có thể đánh giá hoặc điều trị một cơ, trước tiên bạn phải xác định được vị trí của nó. Cuốn sách nổi tiếng này cung cấp thông tin minh họa đẹp mắt cho việc học cách sờ nắn và hệ thống cơ xương. Nó làm cho việc nắm vững các kỹ năng trị liệu bằng tay cần thiết trở nên thú vị, dễ nhớ và dễ dàng. Với 504 trang và 1.400 hình ảnh minh họa bao gồm hơn 162 cơ, 206 xương, 33 dây chằng và 110 cột mốc xương, văn bản này cung cấp một bản đồ vô giá về cơ thể. Ấn bản mới này bao gồm một phụ lục dài 56 trang mô tả các vị trí điểm kích hoạt phổ biến và các kiểu đau của 100 cơ. Trail Guide to the Body là sách giáo khoa được khuyến khích sử dụng cho các bài kiểm tra cấp phép của tiểu bang được quản lý bởi cả Hội đồng Chứng nhận Quốc gia về Mátxa Trị liệu và Chăm sóc Cơ thể (NCBTMB) và Liên đoàn Ban Trị liệu Mátxa Tiểu bang (FSMTB) và là một trong năm cuốn sách duy nhất về danh sách tham khảo kiểm tra chính thức. Ngoài ra, chương trình chứng nhận của Hội đồng cho các huấn luyện viên thể thao ở Hoa Kỳ. sử dụng các hình minh họa về Đường mòn về Cơ thể chất lượng cao của chúng tôi trong các sản phẩm khác nhau của họ, bao gồm cả các bài kiểm tra. Cho dù bạn là một nhà trị liệu xoa bóp, nhà trị liệu vật lý, huấn luyện viên thể thao hay sinh viên theo bất kỳ hình thức tập thể dục nào, Trail Guide to the Body là dành cho bạn

Building the Body

in Motion

Andrew Biel

From the author of Trail Guide to the Body

Chapter 1 – Introduction 1

Chapter 2 – The Essentials of Movement 15

Kinesiology 16

Mobility, Stability, Balance and Coordination 18

Simultaneous and Sequential Movement 19

Movement Patterns and Kinetic Chains 20

Proportion, Symmetry and Compensation 21

The Basics of Connective Tissue 24

The Recipe for Connective Tissue 24

Cells 25

Stretch 28

Elasticity 28

Plasticity 28

Creep 28

Thixotropy 29

Colloidal 30

Considering Them Structurally 31

Considering Them Functionally 32

The Push and Pull of Your Tissues 33

Bone 36

Cartilage 40

Septum 43 Aponeurosis 43

Retinaculum 43

Bones, Fasciae and All the Rest 46 Functions of Your Connective Tissue Network 46

In the Lab—Local, Global, Internal and External 49

In the Lab—Collagen, Demand and Flushing 50

Planes 54 Axes 56

End-Feel 80

In the Lab—Rejected Bone and Joint Concepts 88 Table of Contents

v

Chapter 7 – Muscles, part 1 91

Muscle and Fascia: The True Story 93

Myofibrils and Muscle Fibers 101

Shapes and Arrangements of Muscles 106

Structure 106

Recruitment 111

Ratios? 114

Concentric 115

Eccentric 115

Isometric 116

In the Lab—Tight, Short and Long Muscles 119

Factors That Affect a Muscle’s Role 126

In the Lab—

Nerves and Muscles—The Dynamic Duo 138

Functions 141 Classifications 141

Plexi and Nerve Distribution in the Appendages 145

Proprioception and Muscle Function 152

Vulnerable 153

Pacinian Corpuscles and Ruffini’s End Organs 157

I Can’t Shorten If You Don’t Lengthen 158

Reciprocal Inhibition and Other Reflexes 158

Tonus Equilibrium Above All Else Reflexes

The Neuromuscular System in Action 160

Using Muscle Tissue’s Properties 161

Stretch Reflex versus Styles of Stretching 162

Using the Stretch Reflex to Your Advantage 163

Relax with Your Golgi Tendon Organs 163

Post-Isometric Relaxation

The Infant and Lifelong Patterns

Fun in a Doorway

Osteokinematics and Arthrokinematics 168

Torque 169

Friction 170

Gravity 171

Levers 182

In the Lab—Stability, Balance and Motion 188

Posture 192

Other Postural Points-of-View Healthy Posture

The Role of Soft Tissues in Upright Posture 197

Stability Dysfunction and Pain Patterns 201

Swayback 203 Scoliosis 203 Torticollis 203

Postural Elements in the Lower Limbs 206 Hyperpronation 206

In the Lab—Sitting, Bending Over and Lying Down 208

Gait 214

Limitation of Joint Range of Motion 228

A Day in the Life of Movement, Part 2 234

Objectives 248

Bibliography 257 Index 259

vii

Return to the Whole

As a student of the body, you will find it best to begin your

learning journey by dividing the whole into its parts Usually this

would begin with the bones, then proceed to the muscles, fascial

structures and nerves You would learn how each one is designed

and its specific role This makes sense since the body is, after all,

tremendously vast and complex

Yet, at some point, the parts need to return to the whole

Continuing the auto mechanic analogy from above, to understand

your car’s structure and function, you would want to take it apart

and examine all of its components But to truly comprehend how all

of those parts operate to get you down the road, you’d want to put

them all back together That is where we’re headed

BThen the muscles and tendons would be pulled away

How to Use This Book

To Separate or Connect?

Trail Guide to Movement is a companion book to Trail Guide to

the Body: A hands-on guide to locating muscles, bones and more

While Body covers the hands-on subject of palpatory anatomy,

this text explores how bones, fasciae, joints, muscles and other

structures come together to produce human movement Body

puts your hands on the tissues; Movement wraps your mind

around the body

The intent of this book is to serve as an introduction to

the study of human movement for students, practitioners

and instructors (FYI: Laypersons might find it interesting,

too.) For those who work with the human body, a solid

understanding of its structure, function and biomechanics is

critical (If you don’t understand how something works, how

are you going to change it?) For the same reason you would

take your car to a trained mechanic, you would want only

a knowledgeable and experienced practitioner to work on

your body

In order to examine the miraculous acts of movement, balance and stability, we need to go inside the body to explain its parts and pieces Historically, this process has begun with a knife, cutting into the tissue, layer by layer,

to the deepest recesses of bone and viscera (images A–C) Over the previous hundred years, this “autopsy approach” has proven valuable to virtually all anatomy and movement texts—including Trail Guide to the Body

For our purposes here, however, a different—polar opposite—method will be in order Instead of dissecting the body into smaller, isolated pieces, this book will attempt to

build the body into larger, interconnected segments We

won’t dig in, we’ll build up (p 3, images 1–5)

This concept isn’t just a writer’s whimsy To “start from scratch” and fabricate, assemble and organize the body will give you, the reader, an opportunity to don a construction hat

or lab coat and participate in the process You’ll have a stake in how the body functions

It won’t just be any body that we’ll be building and analyzing, but your body Your knee, your muscles, your gait (style of walking) As Trail Guide to the Body suggests, you’ll

AThe typical learning approach

would begin with the removal of the skin and supericial fascia

CAnd inally the ligaments would be stripped down

to the bones.

Introduction

1Here’s a diferent learning method: Begin with the bones of the arm

2Strap on ligaments and joint capsules

3Attach a variety of

muscles and fascial

components

4And insert several long strands of nerves and blood vessels

need to “roll up your sleeves” and take part in the process—

maybe not always with your hands, but certainly with your

mind and senses

Please note, we’re not going to be constructing all of you

For instance, your kidneys and tonsils (as vital as they are) will

not be our focus Instead, we’re going to look at the structures

and systems chiefly involved with movement

First, we’ll design four key structures essential for

move-ment: (1) connective tissue formations like bone, fascia, tendon and ligament, (2) joints, (3) muscles and (4) nerves We’ll then apply some biomechanical principles before putting your “body” to the ultimate tests of posture and gait

(standing and walking)

Foremost (as we’ll see on the following couple of pages),

we need to draw up a parts list and go on one heck of a shopping spree

5If we’ve constructed it properly, the body part should be highly functional In the case of the forearm and hand, the ultimate test would be to gently grasp an egg without cracking its shell (Oh, well—back to the lab.)

The following six pages present some common

actions you might perform over the course of a

single day Because they are rather mundane,

you might have never considered them Yet,

they are nothing short of miracles

For instance, at this very moment—

regardless of what you might be doing or not

doing—it’s guaranteed that your mind and

body are joining forces to ensure that you do

so with as much poise and grace as you can

muster Whether you are currently lying in bed,

putting food in your mouth or safely crossing a

waxed floor in slippery, woolen socks, you are

deserving of the Nobel Prize in Movement—

if they offered such an award

Catching up with a friend

as you walk to class

A big stretch to start the day

A brush of the teeth

This book is not only about you, but also for you It is about

you because you have a body capable of performing some or all of the actions seen on these pages You deserve a book of your own You—the homo sapiens who climbs hills, sips lattes, rakes leaves, suffers in pain, stares at computers and scratches his noggin wondering what this life is all about

It is for you because chances are you’re a student,

instructor or practitioner who would like to gain greater insight into human mobility and its relationship to your work with your clients

Pulling on pants

It begins with a stretch and ends with a yawn

The brushing of teeth, the chewing of toast, the guzzling of juice, the panting of the morning jog The carrying of books, the walking up stairs The collapse of the gluteals into chairs, the assuming of postures and the developing

of pain in the low back The tying of laces, the leaping of hurdles, the giving of massages The pulling of ropes, the lifting of boxes, the twisting of torsos The rubbing of eyes, the slipping on of PJs, the snuggling of pillows The snores of mouths, the twitches of legs and the dreams of minds

It is a day in the life of movement

Yes, holding a toothbrush happens at the hand, but it all starts way up in the shoulder at the scapulothoracic joint.

A Day in the Life of Movement

Have you ever wondered how you were meant to move, stand or walk? A good place to answer that question is in front

of a mirror Hopefully, you’ll observe two arms and two legs connecting to a central torso A head will be on top

You weren’t designed with three arms or one leg Nor with three legs and a head coming out from the side Your design evolved over millennia for one express purpose—to move Symmetrical, bipedal and upright Sure, digestion and the other bodily functions are critical, but a strong case could

be made that they all serve one larger purpose: to get you from here to there

Trail Guide

to Movement

18

Kinetics and Kinematics

Kinetics studies forces (such as gravity, friction and pressure) that

act on the body to generate or alter motion Kinematics involves the

analysis of movement in terms of mechanical elements (such as time

and space)

From a kinetics perspective, slipping on a banana peel (2.5) would

encompass how little friction there is between the peel and the floor

and how gravity laid you out Kinematics, on the other hand, would

be concerned with how fast you were walking when you slipped and

how far your center of gravity fell Neither would address whether or

not you’re absentminded

We’ll discuss these concepts further on page 168

2.5 Whoops!

2.6 Stability in action

kinetics ki-neh-tics

kinematics ki-neh-mat-ics

The Essentials of Movement

Mobility, Stability, Balance and Coordination

In the “dance troupe” of human movement, there are four “prima ballerinas”—mobility, stability, balance and coordination The choreographed participation of all four is required for virtually all of your daily actions

Mobility, the ability to move, is the obvious

and expressive aspect of motion, and receives much attention Often unseen and far less considered, however, is its silent partner,

stability Whether you’re jumping hurdles

or standing perfectly still, the ability to be firmly fixed or supported is always working

in the background Using an ever-changing contingent of joints and myofascial units (muscles and fascial elements), stability generates the necessary—and sometimes oppositional—support for mobility

If you’d like to give stability a moment in the spotlight, just play Twister, where it will

be front and center, holding you in place on the mat (2.6) Before you commence your next awkward move, stability is already

on the scene (“stability before mobility”), anticipating which structures will need reinforcement so you don’t crumble into a pile of arms and legs

Looking for some inexpensive kinesiological analysis of contorted postures? With ten bucks and a handful of classmates, nothing beats a game of Twister.

The previous page divided up connective tissue types based on structure Now let’s look at them in terms of

their function

First of all, each type of connective tissue performs a range of purposes Bones serve as levers and ligaments support joints, while other tissues transport nutrients, defend against disease, repair tissue, store energy, and protect and insulate internal organs But for our purposes here (the understanding of human mobility), connective tissues can be functionally divided into two

groups—compression tissues and tension tissues

Before we discuss these two groups, we need to first pose a simple, yet crucial, question If your body is to swing bones, hoist limbs, bend over and more, how shall it be supported?

An initial, wild guess might involve poles from below

or puppet strings from above (3.21, 3.22) It turns out that as crazy as these two ideas sound, they aren’t far off We’ll just need to incorporate both concepts and build them inside the body (No small order.) The reason these “stick and string” ideas aren’t

so far-fetched is that there are only two ways to hold up a structure (at least in this universe)—with

compressive or tensile forces In other words,

propped or suspended For example, skyscrapers are propped, mobiles are suspended (3.23, 3.24) Everything around you—a chair, plant, teacup, house, trampoline or your body—is based on one

of these designs, with all structures using both forces as the need arises

For instance, sit on a stool—a classic “propped”

device—and sense how it primarily uses compression

as a force to support your weight The top and bottom

of each leg squeeze together while lesser tensile forces expand each leg’s girth (3.25)

In contrast, lie in a hammock—a quintessential suspended structure—and feel how it principally uses tension as a force to support your

body Its ropes stretch apart while other compressive energy pushes together the cords’ fibers, making them thinner (3.26)

This dynamic dance between both com-pression and tension can be easily felt on a third resting option, a FitBall The top and bottom compress together, while the sides bulge apart with tension (3.27)

Now let’s look at what all of this has do with your connective tissues

with a bit of tension

3.23 Willis Tower

(a.k.a Sears

Tower), built on

compression

body from below

from above

together with tension

Types of Connective Tissue Considering Them Functionally

combination of both compression and tension

3.26 A hammock—

tension with a bit of compression

Connective Tissue—Part 2

Fascial Tissues

Now that we’ve constructed the compression structures of

bone and cartilage, let’s move to their connective tissue

comrades that generate tension

Fascial tissues are the body’s sheets, cables, conduits and

padding and are composed of loose or dense connective

tissue (page 31) They include tendons, ligaments, superficial

fasciae and the tissues that envelop muscle bellies Unlike

bones and cartilage, which will provide compressional

strength to your body, these structures will use their fastening

attributes to form a body-wide network of tension They’ll not

only bind structures together, but also allow tissues to slide

smoothly over each other

In a few chapters we’ll see how muscle fibers serve as the engines of contraction and mobility That being the case, you might wonder, “What is facial tissues’ role in movement?” An analogy might help: Just as a car will sit idle without a drive shaft, belt and motor oil, muscle tissue is crippled without the organization, transference of energy and lubrication provided

by fascial tissues (4.13) One is useless without the other

We’ll divide these structures into three groups—(1) the

sheets (proper fascia), (2) the cables (tendon and ligament) and (3) the other variations (such as superficial fascia

and periosteum).

Fascia profunda

Shaft of femur (coated in periosteum)

Quadriceps femoris group

Epimysium

Superficial fascia and adipose

Skin

One Single Mass of Tissue

Historically ignored, fascia has only recently found some well-deserved respect for its role in mobility and postural integrity There is even a semi-annual Fascia Research Congress to discuss the stuff (Yes, they have such meetings, and you can even attend.) Latin for band, bandage or strap, fascia has been defined as the “soft tissue component of the connective tissue system that permeates the human body.” Yet its very nature confounds attempts to define it As helpful as it might be to isolate and describe these tissues, the fact is that they’re separate

in name only Attend a cadaver class (highly recommended, by the way) and you’ll see and feel how they truly represent one single mass of tissue As

we build and explore further, please keep in mind that “fascial tissues” is really just “tissue”—singular

Epimysium

Fasciculi (bundles of fascicles)