Sports Massage Manual

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Section One: Introduction to Sports Massage

Sports Massage is fast becoming one of the most popular areas of study within the health, fitness, sport and exercise sector. This manual is designed to provide a comprehensive, theoretical and practical guide to support the learner through the Level 3 Diploma in Sports Massage.

While no formal pre-requisites are required for entry onto this course, it is recommended that learners have prior knowledge of anatomy and physiology at level 2 before embarking upon this course of study.

Sports Massage Scope

A Level 3 Sports Massage Therapist’s role includes planning, providing and evaluating sports massage treatments. Treatments can be carried out for pre-event, inter-event, post-event, maintenance and restorative purposes, using a range of basic massage techniques. Scope of practice is restricted to working on dysfunctional tissue and excludes working on recent acute injuries or preexisting conditions

Professional Conduct and Dress

The design of this programme includes an extensive range of practical techniques. These will be demonstrated by the tutors and then practiced by the group. You should therefore attend the course in loose fitting sports type clothing. You will be required to partially disrobe during practice sessions with appropriate covering. The groups are invariably mixed, therefore you should expect both to be massaged by and to massage members of both sexes. A high standard of personal hygiene is essential; make-up should be kept to a minimum and finger nails kept short to avoid scratching. Due to the states of undress required and physical contact included within this course you are expected to display a professional approach to your work at all times.

Please make the course tutor aware of any known allergies at the start of the programme so that suitable massage mediums can be used at all times.

Section Two: Organisational Structure of Human Body

The six levels of an organism

Chemical level

This is the simplest level within the structural hierarchy. The chemical level includes the smallest building blocks of matter and atoms which combine to form molecules like water. In turn, molecules combine to form organelles, the internal organs of a cell

Cellular level

The cellular level is made up of the smallest unit of living matter; the cell. Individual cells may have some common functions but vary widely in size and shape. Each type of cell carries out a unique set of tasks within the human body.

Tissue level

Tissues are groups of similar cells that have a common function. A tissue must contain two different types of cells. The four basic tissue types in humans include epithelium, connective, muscle and nervous tissue. Each tissue has a characteristic role within the human body which we will discuss later.

Organ level

An organ is a structure composed of at least two different tissue types that performs a specific function within the body. Examples include the brain, stomach and the liver. Complex functions begin to emerge at this level.

System level

At this level two or more organs work in unison to accomplish a common purpose. For instance, the heart and blood vessels work together to circulate blood throughout the body to provide oxygen and nutrients to cells. Besides the cardiovascular system the other organ systems of the body are the integumentary, skeletal, nervous, muscular, endocrine, respiratory, lymphatic, digestive, urinary, and reproductive systems.

Organismal level

The organismal level is the highest level of organisation. It is the sum total of all structural levels working together. In short, it is the human being (or organism) as a whole.

Structure and function of the human cell

Cell membrane

The cell membrane is the outer coating of the cell and contains the cytoplasm and substances within it and the organelle. It is a double-layered membrane composed of proteins and lipids. The lipid molecules on the outer and inner part (lipid bilayer) allow it to selectively transport substances in and out of the cell.

Endoplasmic reticulum

The endoplasmic reticulum (ER) is a membranous structure that contains a network of tubules and vesicles. Its structure is such that substances can move through it and be kept in isolation from the rest of the cell until the manufacturing processes conducted within are completed.

There are two types of ER – rough and smooth.

The rough ER contains a combination of proteins and enzymes. These parts of the ER contain a number of ribosomes giving it a

rough appearance. Its function is to synthesize new proteins.

The smooth ER does not have any attached ribosomes. Its function is to synthesize different types of lipids (fats). The smooth ER also plays a role in carbohydrate and drug metabolism.

Golgi apparatus

The Golgi apparatus is a stacked collection of flat vesicles. It’s closely associated with the endoplasmic reticulum in that substances produced in the ER are transported as vesicles and fuse with the Golgi apparatus. In this way, the products from the ER are stored in the Golgi apparatus and converted into different substances that are necessary for the cell’s various functions.

Lysosomes

Lysosomes are vesicles that break off from the Golgi apparatus and vary in size and function depending on the type of cell. Lysosomes contain enzymes that help with the digestion

Figure 1 – Anatomy of the human cell

of nutrients in the cell and break down any cellular debris or invading microorganisms like bacteria.

A structure that is similar to a lysosome is the secretory vesicle. It contains enzymes that are not used within the cell but emptied outside of the cell, for example the secretory vesicles of the pancreatic acinar cell release digestive enzymes which help with the digestion of nutrients in the gut.

Mitochondria

These are the powerhouses of the cell and break down nutrients to yield energy. Apart from producing its own energy, it also produces a high-energy compound called ATP (adenosine triphosphate) which can be used as a simple energy source elsewhere. Mitochondria are composed of two membranous layers – an outer membrane that surrounds the structure and an inner membrane that provides the physical sites of energy production.

Nucleus

The nucleus is the master control of the cell. It contains genes, collections of DNA which determine every aspect of human anatomy and physiology. The DNA which is arranged into chromosomes also contains the blueprint specific for each type of cell which allows for replication of the cells. Within the nucleus is an area known as the nucleolus. The nucleolus is not enclosed by a membrane but is just an accumulation of RNA (a nucleic acid that is essential component of all cells) and proteins within the nucleus and is the site where the ribosomal RNA is transcribed from DNA and assembled.

Structure and function of different types of human tissue

Epithelial tissues

Epithelial tissue lines the cavities and surfaces of blood vessels and organs in the body.

There are three basic forms of epithelial cell; squamous, columnar and cuboidal. Each form can be arranged in a single layer of cells as simple epithelium, or in layers of two or more cells deep as stratified (layered). All glands in the body are made up of epithelial cells. Functions of epithelial cells include secretion, selective absorption, protection, transcellular transport and sensing.

Glandular tissue

Glandular tissue produces substances such as enzymes, secretes bodily products such as sebum and releases hormones such as insulin required for normal function of the body and its tissues.

Membranes

The body contains many different forms of membrane, which includes the mucous, serous, synovial and meninges

Each provides a lining for the interior wall of the structures which they cover

Mucous Membrane – Consists of a thin lining of epithelial tissue that lines body cavity and canals that lead externally and secretes mucus.

Common areas where mucous membranes are present include the respiratory (mouth, nose, trachea and lungs), digestive (stomach and intestines) and urogenital (the ureters, urethra, and urinary bladder) tracts.

Serous Membrane – Consists of a single layer of squamous cells that surrounds a thin layer of connective tissue and secretes fluid that closely resembles blood serum.

Serous membrane encapsulate a fine layer of serous fluid that is responsible for protecting and lining.

Specific serous membrane can be distinguished by their location. They consist of:

 Pleura membrane of the lungs

 Pericardium of the heart

 Peritoneum of the digestive system

Figure 2 –

Examples of different types of tissues

The following section briefly describe the different tissues within the body. These involve a simple definition as they will be addressed in more detail later in this module.

Lymphoid tissue

Lymphoid tissue cells and organs that make up the lymphatic system include white blood cells (leukocytes), bone marrow and the thymus, spleen and lymph nodes. Lymphoid tissue has several different structural organisations related to its particular function in the immune response. The most highly organised lymphoid tissues are in the thymus and lymph nodes.

Several types of cells are found within the lymphoid system including two types of white blood cells called macrophages and lymphocytes. Macrophages help the immune system by engulfing foreign materials and initiating the immune response. These cells may be fixed in one place such as lymph nodes or they may wander in the loose connective tissue spaces. The most common cell type in the lymphoid tissue is the lymphocyte. Like macrophages, lymphocytes are formed from stem cells in the bone marrow and then circulate in the blood to the lymphoid tissue.

Connective tissue

Connective tissues are the group of tissues in the body that maintain the form of the body and its organs and provides cohesion and internal support. Bone, ligaments, tendons, cartilage and adipose (fat) tissue are all examples of connective tissue. The entire body is supported from within by a skeleton composed of bone, a type of connective tissue endowed with great resistance to stress. The individual bones of the skeleton are held firmly together by ligaments and muscles are attached to bone by tendons, both of which are examples of dense connective tissue to

provide great tensile strength. Within joints the articular surfaces of the bones are covered with cartilage, a connective tissue with an abundant intercellular substance that gives it a firm consistency as well as enabling smooth gliding movements between the joint surfaces.

Nervous tissue

Nervous tissue forms the key components of the two main divisions of the nervous system; the brain and spinal cord of the central nervous system (CNS) and the branches of our peripheral nerves of the peripheral nervous system (PNS). These monitor, adjust and control bodily functions and activity. Nervous tissue includes neurons or nerve cells which receive and transmit impulses and neuroglia which assist the transmission of the nerve impulse as well as providing nutrients to the neuron.

Muscle tissue Skeletal

Skeletal muscle is voluntary and looks striped or ‘striated’ – the fibres contain alternating light and dark bands (striations) packed into regular parallel bundles. Skeletal muscle can be found all over the body, examples include the quadriceps, triceps and deltoids.

Smooth

Smooth muscle is involuntary and contains cells that are smaller than those of skeletal muscle and have no striations, instead they have bundles of thin and thick filaments. Smooth muscle can be found in the walls of the bronchi and blood vessels and in the urinary and digestive systems. In the digestive system smooth muscle allows for peristalsis to occur; a series of wave like contractions which helps move food down the digestive tract.

Cardiac

Cardiac muscle tissue, like skeletal muscle tissue is striated in appearance. The bundles are branched like a tree but connected at both ends. Unlike skeletal muscle tissue the contraction of cardiac muscle tissue is usually not under conscious control so it is referred to as involuntary. Cardiac muscle is located in the heart.

Figure 3 – Different muscle tissues in the body

The Skin

Functions of skin

Beneath the surface of the skin are nerves, nerve endings, glands, hair follicles and blood vessels.

The key functions of the skin can be described using the PRESSD acronym:

P Protection from infection and injury.

Epidermis

R

Regulation of temperature due to sweat gland activity and/or vasodilation of superficial vessels.

E

S

Excretion of sweat, which is 99% water and 1% salts.

Sensation by detecting temperature, pressure, touch and pain.

S

Secretion of sebum to lubricate and protect the skin by making it acidic.

D

Formation of chemicals, including vitamin D (for calcium utilisation) and melanin (to protect underlying structures from UV radiation i.e. sun tan.

The different layers of the skin

The skin has 2 main layers; the Epidermis, and the Dermis, however, in cases the Subcutaneous layer is considered a third layer.

The epidermis is the thin (0.1mm thick), tough, outer layer of the skin and has five layers, however it contains no blood vessels. The body reproduces new epidermis every 30 days. This regenerative characteristic means that when damaged, the epidermis is capable of healing itself, usually without scarring.

The 5 layers of the Epidermis are the Horny layer, Clear layer, Granular layer, Prickle Cell layer and the Basal layer.

Horny layer (Stratum corneum)

The constant exposure of skin to friction stimulates the formation of Callus (an abnormal thickening of the corneum). The epidermis layer also provides a water repellent barrier.

Clear layer (Stratum lucidum)

Present in only the thick skin of the fingertips, palms and soles. Large amounts of the protein Keratin are found here.

Granular layer (Stratum granulosum)

This is the middle of the epidermis and contains Lamellar granules which release a lipid rich secretion. This secretion fills the spaces between cells of the Horny and Clear layers. The lipid rich secretion acts as a water

Figure 4 – Layers of skin

repellent sealant, reducing the loss of body fluids and entry of foreign materials.

Prickle cell layer (Stratum spinosum)

This layer helps provide the skin with strength and flexibility.

Basal layer (Statum basale)

This layer is responsible for the production of melanin which absorbs dangerous ultraviolet light and creates pigments which give skin its tanned appearance after exposure to sunlight

Dermis

The dermis is a thick layer of fibrous and elastic tissue (made mostly of collagen, elastin and fibrillin) that gives the skin its flexibility and strength. The dermis contains nerve endings, sweat glands, oil (sebaceous) glands and hair.

The nerve endings sense pain, touch, pressure and temperature. Some areas of the skin contain more nerve endings than others. For example, the fingertips and toes contain many nerves and are extremely sensitive to touch.

The sweat glands produce sweat in response to heat and stress. Sweat is composed of water, salt and other chemicals. As sweat evaporates off the skin, it helps cool the body. Specialised sweat glands in the armpits and the genital region secrete a thick, oily sweat that produces a characteristic body odour when the sweat is digested by the skins bacteria in those areas. The sebaceous glands secrete sebum into hair follicles. Sebum is an oily substance which lubricates the skin and helps protect it from foreign substances by making its surface slightly acidic.

The hair follicles produce the various types of hair found throughout the body. Hair not only contributes to a person's appearance but has a number of important physical roles,

including regulating body temperature, providing protection from injury and enhancing sensation. A portion of the follicle also contains stem cells capable of re-growing damaged epidermis.

The blood vessels of the dermis provide nutrients to the skin and help regulate body temperature. Heat makes the blood vessels enlarge (vasodilate) allowing large amounts of blood to circulate near the skin surface where the heat can be released. Cold makes the blood vessels narrow (vasoconstrict) retaining the body's heat.

Subcutaneous

Subcutaneous tissue, also known as the hypodermis is the innermost layer of skin. It comprises of fat and connective tissues that house larger blood vessels and nerves. Subcutaneous tissue helps to insulate and regulate body temperature. The thickness of this layer varies throughout the body.

The structures and cells found within the subcutaneous tissue include; collagen and elastin fibres, fat cells, blood vessels, sebaceous glands, nerve endings and hair follicle roots.

Section Three: Skeletal System

Structure and function of the skeletal system

The human skeleton consists of 206 bones. We are actually born with more bones (about 300), but many fuse together as our skeletons develop throughout childhood. These bones support our bodies and allow us to move. Bones contain a lot of calcium, manufacture

blood cells and store other important minerals such as phosphorus. The skeleton is classified into 2 sections: Appendicular and Axial skeletons.

Figure 5 – Bone locations within the skeletal system

The bones of the Axial skeleton include:

o Cranium

o Vertebrae

 Cervical (7)

 Thoracic (12)

 Lumbar (5)

 Sacral (5)

 Coccyx (4)

o Sternum

o Ribs (12)

The bones of the Appendicular skeleton include:

o Scapula

o Clavicle

o Humerus

o Ulna

o Radius

o Carpals

o Metacarpals

o Phalanges

o Ilium

o Ischium

o Pubis

o Femur

o Patella

o Tibia

o Fibula

o Tarsals

o Metatarsals

Axial Skeleton

Figure 6 – Axial skeletal system Appendicular skeleton

Figure 7 – Appendicular skeletal system

The five main functions of the skeleton are:

Shape/structure

The skeletal system forms a rigid structure onto which all of our tissues attach. The shape and structure of our skeleton has developed over millions of years of evolution to become optimally adapted to how we live our lives. Without a skeletal system underneath our tissues we would be a big heap of skin, organs and muscle on the floor

Movement

As the skeletal system forms a rigid structure onto which all of our tissues attach, it forms a solid anchor point and also allows the tissues to interact to form controlled movements. As our skeleton has evolved, the shape of the bones and the tissues that attach onto them have developed to best produce every day movements such as walking upright on two legs. Our long bones provide the leverage required for propulsion needed for movement.

Protection

The rigid skeletal system forms a hard protective shell over the body’s vital organs e.g. the ribs protect the lungs, the vertebrae column protects the spinal cord and the cranium protects the brain. These protective shells prevent these organs from becoming damaged during our everyday lives.

Mineral Reserve

The skeletal system forms a holding area for the body to store minerals such as calcium required for later use within the body by our physiological systems.

Production of blood cells

The production of blood cells, or sometime referred to as Haemopoiesis, occurs in the

bone marrow located within the centre of the bones. Bone marrow most commonly produces new red blood cells.

Bone Tissue

The bones within the skeleton are made up of two types of bone tissue:

Cancellous Bone

Cancellous bone, sometimes referred to as spongy bone due to its resemblance to a sponge or a honeycomb is low in density and strength but has a very high surface area. It represents the inner component of our bones and is where the production of blood cells occurs.

Compact Bone

This bony material has a smooth solid appearance and has a high density and strength providing the hard outer layer of our bones. This is what gives bones their strength to withstand load.

Figure 8 – Compact (outer layer) and cancellous (inner layers) of bone

Classifications of Bones

The individual bones of the body can be classified according to their shape. There are 5 classifications:

Long Bones

Characterised by being longer than they are wide e.g. Femur and Humerus.

Features of long bones include the periosteum (membrane covering the outer surface), diaphysis (shaft of the bone), epiphysis (end of long bones where joints form), epiphyseal growth plates, medullary cavity (location of bone marrow) and articular cartilage (connective tissue lining the ends of the bones).

Short Bones

Characterised by appearing as long as they are wide e.g. Tarsal and Carpal bones.

Figure 9 – Structure of a long bone

Flat Bones

Consist of bones that are flat and they mostly function to either protect other structures e.g. the sternum (protects the heart and lungs) or provide large surface areas for muscle attachments e.g. Scapula (Rotator cuff muscles).

Occasionally short or irregular bones can be embedded with a tendon. Where these occur the bone is classed as a sesamoid bone e.g. the Patella.

Stages of bone growth

Irregular Bones

Bones that do not fit the qualities of those previously described are classified as irregular Bones. These display a nonuniform shape and can often provide attachment points for soft tissues e.g. the Vertebrae.

There are several cells that play key roles in the development of our bones or where injury has occurred and the healing takes place, these include osteoblasts, osteoclasts and osteocytes. The processes that account for the growth of bone within the body is referred to as ossification.

Ossification is the formation of bone by the activity of osteoblasts and osteoclasts and the addition of minerals and salts. Calcium compounds must be present for ossification to take place. Osteoblasts do not make these minerals, but take them from the blood and deposit them in the bone. By the time we are born, many of our bones have been at least partly ossified.

In long bones, the growth and elongation (lengthening) continue from birth through adolescence. Elongation is achieved by the activity of two cartilage plates called epiphyseal plates, located between the shaft (the diaphysis) and the heads (epiphysis) of

Sesamoid Bone

the bones (see figure 10). These plates expand forming new cells and increase the length of the shaft. In this manner, the length of the

also are needed for normal bone growth and development.

shaft increases at both ends with each head of the bone moving progressively apart. As growth proceeds the thickness of the epiphyseal plates gradually decreases and this bone lengthening process ends. In humans different bones stop lengthening at different ages but ossification is fully complete by about age 25. During this lengthening period, the stresses of physical activity result in the strengthening of bone tissue.

Bone development is influenced by a number of factors including nutrition, exposure to sunlight, hormonal secretions and physical exercise. For example, exposure of skin to the ultraviolet portion of sunlight is favourable to bone development because the skin can produce vitamin D when it is exposed to such radiation. Vitamin D is necessary for the proper absorption of calcium in the small intestine. In the absence of this vitamin calcium is poorly absorbed, the bone matrix is deficient in calcium and the bones are likely to be deformed or very weak. Vitamins A and C

Bone repair process

Following injury or damage to a bone the body activates a healing process similar to that which takes places during bone development. The trigger for this however is stimulated by trauma to the periosteum. In these events osteoblasts migrate to the area of damage and develop a clot around the damaged site. This clot acts to minimise further damage and bleeding that allows for the body to begin cleaning the damaged or dead cells from the injury site.

Through ossification this clot becomes calcified to form a weak callus connecting the two ends of the broken bone. This callus creates a thickened appearance to the bone. Osteoclasts then act to remove unwanted bone and help to remodel the structure back to its original form. As time progresses, as long as no further trauma occurs, osteocytes enable the tissue to fully mature and return to its normal characteristics.

Figure 10 – Location of bone tissue and growth plate

Joint classifications

In simple terms a joint is a point in the body where two or more bones meet. In the body there are three classifications of joints:

Fibrous Joints

These are joints where the bones are joined together by a strong, flexible, fibrous tissue allowing for only very minimal movement. Examples of this include the suture joints of the bones in the skull.

Fibrous

Example

Plates of the skull

Cartilaginous Joints

Movements Permitted

None

These are joints where the bones are joined together by a strong, flexible cushion of fibrocartilage tissue. These joints often display a limited range of motion, examples include our intervertebral joints in the spine

Cartilaginous Example

Spine (Vertebrae)

Synovial Joints

Movements Permitted

Flexion; Extension; Lateral flexion; Rotation

These are joints where the bones are held together by a strong, flexible ligamentous structure called a capsule. They are known as freely moveable and allow large ranges of movements to occur in the body. There are six different types in the body.

Synovial Example

Movements Permitted

Shoulder joint

Flexion; Extension; Lateral flexion; Lateral extension; Abduction; Adduction; Circumduction

Figure 11 – Phases of bone repair

Structure of synovial joints

The structure of a synovial joint enables it to perform its functions effectively. The ends of bones forming synovial joints are covered in a hyaline cartilage which provides a fibrous covering containing synovial fluid. This lining provides protection to the surfaces of the bones and allows for freedom of movement to occur by reducing friction between the articulating bones. During movement and compression of the joint surfaces, synovial fluid is emitted in to the joint. This allows for the joint to remain lubricated, but also contains many nutrients for joint health which become reabsorbed into the joint and bones to maintain nutrition and health.

Surrounding the outsides of synovial joints are strong fibrous ligaments. These give strength and stability to a joint and help absorb the forces placed on joints and reduce unwanted movements, reducing the risk of injuries such as dislocations.

To further reduce friction between the bones and surrounding soft tissues e.g. muscles and tendons, are Bursae. These fluid filled sacks lie between the rough bony surfaces and the smoother soft tissues and permit the shortening and lengthening of tissues to occur at joints.

Types of Synovial Joints

Hinge

Hinge joints are very simple in structure, they occur when the convex part of one bone fits into the concave part of another bone forming a hinge similar to a door. This allows for flexion and extension to take place.

Ball and Socket joint

A Ball and Socket joint consists of a ballshaped surface at the proximal end of a long bone which fits into a ‘cup-like’ depression of another bone. The distal long bone is then able to move in any direction in any axis through its centre point.

Figure 12 – Structure of a synovial joint

Figure 13 - the different synovial joints within the body

Gliding Joint

Gliding joints occur between flat or nearly flat articular surfaces of bones. This allows the bones to glide past one another in any direction along the plane of the joint.

Pivot

Pivot joints are formed when the round part of a bone fits into a ring formed by a tendon at the other bone. This allows the bone to rotate around a fixed axis.

Synovial joint movement and actions

Condyloid

A condyloid joint is formed when the oval portion of one bone fits into the oval part of another bone. This allows angular movement without rotation.

Saddle joint

Saddle joints are referred to as bi-axial as they allow movement in the sagittal and frontal planes. The two bone sin a saddle joint resemble a saddle, one with a convex aspect, the other with a concave aspect which fit together.

Specific Joint Movement Permitted

Elbow (Humerus and Ulna)

Flexion, Extension

Knee (Tibia, and femur)

Flexion, Extension, Rotation (when flexed)

Ankle (Talus, Calcaneus)

Dorsiflexion, Plantarflexion

Hinge joint Elbow joint

Ball and Socket Joint

Specific Joints Movement Permitted

Shoulder (Humerus and Scapula)

Flexion, Extension, Horizontal Flexion and Extension, Medial and Lateral Rotation, Adduction, Abduction

Hip (Femur and Pelvis)

Flexion, Extension, Horizontal Flexion and Extension, Medial and Lateral Rotation, Adduction, Abduction

Shoulder joint

Gliding joint

Specific Joints Movement Permitted

Wrist (between the carpals and metacarpals)

Gliding movement

Shoulder (Sternum, Scapula)

Elevation, Depression, Protraction, Retraction

Carpals

Specific Joints Movements Permitted

Elbow

(Between the Ulna and Radius)

Pronation, Supination

Neck – first and second vertebrae

(Between the atlas and axis)

Rotation

Condyloid joint

Specific Joints Movements Permitted

Wrist (Radius and ulna with the Carpals)

Flexion, Extension, Abduction and Adduction

Ankle (Talus and Calcaneus)

Inversion, Eversion

Pivot Joint

Elbow joint

Wrist

Specific Joint Movement Permitted

Thumb joint Flexion, extension, adduction, abduction, and circumduction

Characteristics of connective tissue

Ligaments

Ligaments are made of a tough fibrous material and connect bone to bone across joints. Their lack of ability to stretch allows them to stabilise the joints by limiting how far a joint moves, this helps protect against injury and allows for smooth movements.

The properties of this tissue consist of:

o Avascular (poor blood supply)

o Non-elastic (but may lengthen under stress)

o Non-contractile (but may shorten through disuse)

o Lengthened ligaments will result in less stable joints

Tendons

Tendons are made of dense, fibrous tissue and firmly connect to the muscle fibres at one end and to the bone at the other. Their role is

to transmit the mechanical force of a muscle contraction to the bones. They are able to withstand the stresses generated by muscle contractions and are one of the strongest soft tissues found in the body.

The properties of this structure are:

o Avascular (poor blood supply)

o Primarily non-elastic, however the Achilles tendon may act as a ‘spring’ by storing energy (tension) during gait

o Non-contractile (but may shorten through disuse)

Saddle Joint

Thumb joint

Section Four: Skeletal Muscular System

Major muscles of the body

Muscles of the back

Erector spinae

Origin Insertion Action

Along the length of the vertebral column, ribs and pelvis.

Vertebral column and ribs. Extension of the spine.

Multifidus

Origin Insertion Action

Sacrum, transverse processes of C3-L5

Spinous processes 24 vertebral levels superior to their origin

Extension and laterally flexion of the trunk and neck, rotates to opposite side.

Infraspinatus (Part of the rotator cuff)

Origin Insertion Action

Posterior surface of the scapula (Infraspinatous fossa).

Superior posterior humerus. Adduction and lateral rotation of the shoulder join.

Latissimus dorsi

Origin Insertion Action

Vertebral spines of T6 – T12 and L1 –L5 and lower 3 ribs

Anterior surface of humerus.

Extension, adduction and medial rotation of shoulder.

Pectoralis major

Origin Insertion Action

Clavicle, sternum and 1st to 6th ribs.

Top of the humerus Adduction, horizontal flexion and medial rotation of shoulder joint.

Pectoralis minor

Origin Insertion Action

3rd, 4th and 5th ribs. Carocoid process (anterior scapula).

Rhomboids (minor and major)

Origin Insertion Action

Spines of vertebrae C7 – T5.

Medial border of the scapula inferior to the spine of the scapula.

Retraction and elevation the shoulder girdle.

Depression and protraction of shoulder girdle.

Subscapularis (Part of rotator cuff)

Origin Insertion Action

Anterior surface of scapula (subscapular fossa).

Superior posterior humerus.

Medial rotation of shoulder joint.

(photo shows Rhomboid major)

Supraspinatus

Origin Insertion Action

Superior surface of scapula (Supraspinatous fossa).

Superior humerus. Initiates abduction of shoulder joint.

Teres major

Origin Insertion Action

Inferior angle of scapula.

Superior anterior humerus.

Extension, adduction and medial roation of shoulder joint.

Teres minor (Part of the rotator cuff)

Origin Insertion Action

Lateral border of scapula. .

Superior posterior humerus. Adduction and lateral rotation of shoulder joint.

Trapezius

Origin Insertion Action

Base of cranium and cervical and thoracic vertebrae.

Clavicle and scapula. Elevation, depression and retraction of shoulder girdle.

Serratus Anterior

Upper 8 or 9 ribs. Medial border of scapula. Protraction of shoulder girdle.

Quadratus Lumborum

Arms

Biceps brachii

Origin Insertion Action

Long head: superior scapula.

Short head: anterior scapula.

Radius. Flexion of the shoulder joint and elbow.

Supination of forearm.

Brachialis

Origin Insertion Action

Mid humerus. Superior ulna. Flexion of forearm.

Brachioradialis

Origin Insertion

Action

Distal humerus. Distal radius. Flexion and supination of forearm.

Triceps brachii

Origin Insertion Action

Long head: superior scapula.

Lateral head: lateral posterior humerus.

Medial head: posterior humerus.

Superior ulna (olecranon process).

Extension of shoulder joint and elbow.

Deltoid

Scapula and clavicle.

Lateral humerus. Anterior head: flexion, horizontal flexion and medial rotation of shoulder joint.

Lateral head: abduction of shoulder joint.

Posterior head: Extension, horizontal extension and lateral rotation of shoulder joint.

Coracobrachialis

Superior scapula. Medial humerus. Flexion and adduction of humerus.

Common wrist flexors

Medial humerus Palm of hand. Flexion of wrist.

Common wrist extensors

Lateral humerus. Back of hand (dorsum). Extension of wrist.

Neck

Levator scapulae

Origin Insertion Action

Transverse processes of C1-C4 vertebrae

Thoracic Region

Diaphragm

Superior angle of scapula. Elevation of shoulder girdle. Lateral flexion of neck.

Origin Insertion Action

Xiphoid process, costal margin, fascia over the quadratus lumborum and psoas major mm.(lateral & medial arcuate ligaments), vertebral bodies L1-L3

Central tendon of the diaphragm

Abdominal Region

External abdominal oblique

Pushes the abdominal viscera inferiorly, increasing the volume of the thoracic cavity (inspiration)

Origin Insertion Action

Lower 8 ribs. Iliac crest and linea alba Rotation and lateral flexion of the spine.

Intercostals

Ribs. Ribs. Inhalation (external) Expiration (internal)

Internal abdominal oblique

Iliac crest and lumbar fascia. .

8th, 9th and 10th ribs and linea alba. Rotation and lateral flexion of spine.

Quadratus lumborum

Iliac crest. 12th Rib and L1-L4. Lateral flexion of spine.

Bilaterally extends spine.

Rectus abdominis

Origin Insertion Action

Pubis and the pubic symphysis

Xiphoid process of the sternum and 5th 6th and 7th ribs (costal cartilages).

Flexion of the spine.

Transversus abdominis

Origin Insertion Action

Iliac crest, lower 6 ribs and lumbar fascia.

Linea alba and pubis. Drawing abdomen inwards.

Lower Limbs

Adductor brevis

Origin Insertion Action

Anterior pubis. Medial femur Adduction of hip, flexion and medial rotation the femur

Adductor longus

Origin Insertion Action

Anterior pubis. Medial femur Adduction of hip, flexion and medial rotation the femur

Adductor magnus

Origin Insertion Action

Anterior pubis. Medial femur Adduction of hip, flexion and medial rotation the femur

Biceps femoris (Part of the hamstrings)

Origin Insertion Action

Long head: ischial tuberosity; Short head: posterior femur.

Head of the fibula and lateral condyle of tibia.

Extension of hip and flexion of knee.

Gastrocnemius

Origin Insertion Action

Posterior medial/lateral upper femur.

Calcaneus. Flexion of knee and plantarflexion of ankle.

Gluteus maximus

Origin Insertion Action

Iliac crest, sacrum and coccyx.

Upper posterior femur and ITB. Extension and lateral rotation of the hip.

Gluteus medius

Origin Insertion Action

Lateral and posterior ilium. Anterior surface of upper femur. Abduction and medial rotation of hip.

Gluteus minimus

Origin Insertion Action

Lateral ilium. Anterior surface of upper femur. Abduction and medial rotation of hip.

Gracilis

Origin Insertion Action

Ischiopubic ramus. Medial tibia. Adduction of hip and flexion of knee.

Sartorius

Origin Insertion

Anterior superior iliac spine (ASIS) Medial condyle of tibia.

Action

Flexion, abduction and lateral rotation of hip.

Flexion and medial rotation of knee.

Iliacus

Origin Insertion Action

Iliac fossa and iliac crest; ala of sacrum.

Lesser trochanter of the femur.

Flexion of the hip; if the thigh is fixed.

Psoas major

Origin Insertion Action

Bodies and transverse processes of lumbar vertebrae

Lesser trochanter of femur (with iliacus) via iliopsoas tendon

Flexion of the hip; flexion & lateral flexion of the lumbar vertebral column.

Pectineus

Origin Insertion Action

Anterior pubis. Upper femur. Adduction and flexion of hip.

Pirifomis

Origin Insertion Action

Anterior surface of sacrum.

Upper border of greater trochanter of femur

Adduction and lateral flexion of the hip.

Rectus femoris (Part of the quadriceps)

Origin Insertion Action

Anterior inferior iliac spine (AIIS).

Tibial tuberosity via patella.

Flexion of hip and extension of knee.

Semimembranosus (Part of the hamstrings)

Origin Insertion Action

Upper, outer surface of the ischial tuberosity

Medial condyle of the tibia

Extension of the hop and flexion of the knee.

Semitendinosus (Part of the hamstrings)

Origin Insertion Action

Upper, outer surface of the ischial tuberosity

Medial condyle of the tibia.

Extension of the hop and flexion of the knee.

Soleus

Origin

Insertion Action

Upper posterior tibia and fibula. Calcaneus. Plantarflexion of ankle.

Tensor fasciae latae

Origin

Anterior part of the iliac crest, anterior superior iliac spine

Insertion Action

Iliotibial tract Flexion, abduction, and medial rotation the thigh Medial rotation as hip flexes.

Tibialis anterior

Origin

Insertion Action

Lateral tibia. . Plantar surface of foot. Dorsiflexion and inversion of ankle.

Tibialis posterior

Origin Insertion Action

Posterior surface of tibia and fibula. Plantar surface of foot. Plantarflexion and inversion of ankle.

Peroneus longus

Origin Insertion Action

Upper lateral surface of fibula. Plantar of foot. Plantarflexion and eversion of ankle.

Peroneus brevis

Origin Insertion Action

Lower lateral surface of fibula. Plantar surface of foot. Plantarflexion and eversion of ankle.

Peroneus tertius

Origin Insertion Action

Lower anterior surface of fibula. Dorsal surface of foot. Dorsiflexion and eversion of ankle.

Vastus intermedius (part of the quadriceps)

Origin Insertion Action

Anterior surface of the femur Tibial tuberosity via patella Extension of knee.

Vastus lateralis (part of the quadriceps)

Origin Insertion Action

Lateral/upper femur.

Tibial tuberosity via patella

Extension of knee.

Vastus medialis (part of the quadriceps)

Origin Insertion Action

Medial intermuscular septum, medial lip of the linea aspera

Patella and medial patellar retinaculum

Extension of the knee.

Popliteus

Origin Insertion Action

Lateral upper femur. Posterior upper tibia. Flexion and medial rotation of knee.

Plantaris

Origin Insertion Action

Lateral upper femur. Calcaneus. Plantarflexion of ankle.

Flexor hallucis longus

Origin Insertion Action

Anterior surface of fibula. Dorsal surface of 1st (big) toe. Dorsiflexion and inversion of ankle. Extension of 1st (big) toe.

Extensor digitorum longus

Origin Insertion Action

Lateral upper tibia and anterior fibula. Dorsal surface of 4 outer toes. Dorsiflexion and eversion of ankle. Extension of 4 outer toes.

Flexor digitorum longus

Origin Insertion Action

Posterior surface of tibia. Plantar surface of 4 outer toes. Plantarflexion and inversion of ankle. Flexion of 4 outer toes.

Flexor hallucis longus

Origin Insertion Action

Lower fibula. Plantar surface of 1st (big) toe. Plantarflexion and inversion of ankle. Flexion of 1st (big) toe.

Roles of skeletal muscles

Muscles function in a variety of ways to help generate movement during every day and sporting activities. There are usually several muscles involved in a movement, each performing a different role.

Agonists

The agonist in a movement is the muscle or muscles that provide the major force to complete the movement, because of this agonists are also known as the ‘prime movers’. In the bicep curl which produces flexion at the elbow, the biceps muscle is the agonist, as seen in the image below.

The agonist is not always the muscle that is shortening (contracting concentrically). In a bicep curl the biceps muscle is the agonist on the way up when it contracts concentrically and on the way down when it contracts eccentrically. This is because it is the prime mover in both cases.

not to impede the agonist, as seen in figure 14.

The antagonist doesn’t always relax though, another function of antagonist muscles can be to slow down or stop a movement. We would see this if the weight involved in the bicep curl was very heavy, when the weight was being lowered from the top position the antagonist triceps muscle would produce a sufficient amount of tension to help control the movement as the weight lowers.

This helps to ensure that gravity doesn’t accelerate the movement causing damage to the elbow joint at the bottom of the movement. The triceps becomes the agonist and the biceps the antagonist when the elbow extends against gravity such as in a push up, a bench press or a tricep pushdown.

Figure 14 - example of agonist and antagonist relationship

Antagonist

The antagonist in a movement refers to the muscles that oppose the agonist. During elbow flexion where the bicep is the agonist, the triceps muscle is the antagonist. While the agonist contracts causing the movement to occur, the antagonist typically relaxes so as

Some examples of Antagonistic pairs working together include:

Synergist

The synergists in a movement are the muscle(s) that stabilise a joint around which the movement is occurring, which in turn helps the agonist function effectively. Synergist muscles also help to create the movement. In the bicep curl the synergist muscles are the brachioradialis and brachialis which assist the biceps to create the movement and stabilise the elbow joint.

Fixators

The fixator(s) in a movement are the muscle(s) that stabilise the origin of the agonist in order to help it function effectively. In the bicep curl this would be the rotator cuff muscles; the ‘guardians of the shoulder joint’. The majority of fixator muscles are found working around the hip and shoulder joints.

Muscle contractions

During movement, the body is capable of generating different forms of muscle contractions in order to meet the challenges of the activity it is engaged in and vary the level of force generated to complete each task. The three main types of muscle contractions that occur in the body are Isotonic, Isometric and Isokinetic.

Isotonic contraction

Concentric contraction

A contraction where the muscle shortens under load or tension is known as a concentric contraction. For example, the quadriceps muscles in the thigh contract concentrically (shorten) during the upward phase of the

Biceps pairs with triceps

Tibialis anterior pairs with the gastrocnemius

Glute maximus Pairs with the Iliopsoas

squat movement, or bicep brachi during the upward phase of a bicep curl.

Eccentric contraction

Muscles can also generate force as they lengthen under load or tension. Using the same squat example as above, the quadriceps muscles will contract eccentrically (lengthen) in the downward phase of the movement.

Isometric contraction

Muscles can generate force without movement (shorten or lengthen) taking place at all. An isometric contraction refers to any contraction of muscles where little or no movement occurs. If during the bicep curl the person stopped moving the weight at a certain point and held that position for 10 seconds, the bicep muscle would be contracting isometrically, it would still be under load/tension but no movement would occur.

Isokinetic contraction

Isokinetic contractions are similar to isotonic contractions in that the muscle or muscles

involved shorten or lengthen under tension. Where they differ is that the contraction occurs at the exact same speed throughout. This is difficult to produce naturally, usually a special piece of equipment called an Isokinetic Dynamometer is used.

Structure of a skeletal muscle

Skeletal muscles come in various shapes and sizes but despite this their basic structure remains the same.

The outer layer of the skeletal muscle is called the Epimysium, a layer of connective tissue or fascia that wraps around the entire body of the muscle. Inside the Epimysium are tightly packed bundles of Fascicles which are also wrapped in their own layer of connective tissue, the Perimysium. The Perimysium contains further bundles of muscle fibres which are wrapped in their own connective tissue called the Endomysium. Inside the Endomysium are Myofilaments which consist of smaller segments called Sarcomeres which are made up of thin protein filaments called Actin and thick protein filaments called Myosin. Actin and Myosin play a key role in how a skeletal muscle contracts.

Figure 15 –

Structure of a skeletal muscle

Structure of a Sarcomere

Sarcomere are made of four distinct zones which interact during the process of a muscle contracting. These are:

1- Z line – marks boundaries between the sarcomeres

2- A band and H Zone contain only Myosin (thick filaments)

3- I band contains only Actin (thin filaments)

4- M line – centre of sarcomere

Sarcomere

Figure 16 – Structure of a skeletal muscle with sarcomere

The sliding filament theory explains the mechanisms involved in a skeletal muscle contraction. This process depends on the precise interactions between a series of key variables:

Actin a protein that allows cells to move and function

Myosin

part of a large family of Motor Proteins that help muscles contract by attaching to Actin proteins

ATP

broken down to activate the Myosin with large amounts of energy

Sarcoplasmic reticulum

a type of endoplasmic reticulum found in muscle fibres, whose function is to store and release calcium ions

There are three main phases that take place for the above to happen:

Phase 1

Tropomyosin

a thin filament that wraps around Actin to stop the binding of actin and myosin, stopping muscle contractions

Calcium ions helps the tropomyosin to bind to the actin

At rest, troponin and tropomyosin cover the actin and myosin filaments to prevent myosin from binding to actin. When the brain signals for our muscles to contract, calcium is released which binds to troponin and takes it away from the myosin binding site As it moves away it moves the tropomyosin molecule with it resulting in the myosin binding site being exposed

Figure 17 – Example of a sarcomere

Sliding filament theory

Phase 2

The myosin heads bind to the actin filament and slide it across the myosin filament resulting in the sarcomere getting shorter

Energy is then used to break the attachment of the actin and myosin filaments The myosin heads then re-attach at a site further up the actin filament, resulting in further shortening of the sarcomere

Phase 3

When the stimulus to the muscle ends Calcium ions are released from the troponin and are pumped out of the sarcoplasm allowing the troponin and tropomyosin to bind to the myosin heads once again At this point contraction can no longer occur

Figure - 18 illustration of sarcomere shortening

Section Five Nervous System

Structure of nervous system

Like other systems within the body, the nervous system contains a series of organised structures that perform specific functions within the body. The body’s nervous system in broken into two main divisions, these are the Central Nervous System and the Peripheral Nervous System.

Central nervous system (CNS)

Consisting of the brain and spinal cord the CNS contains the body’s main control center. The nervous system has three main functions:

o To gather sensory information from external stimuli

o Synthesizing (interpreting) the information it receives

o Responding accordingly to the stimuli.

The CNS is mainly devoted to the ‘information synthesizing’ function. During this step in the process, the brain and spinal cord decide on appropriate motor output, which is computed based on the type of sensory input received. The CNS regulates everything from organ function to high-level thought processes to generating body movement. Therefore it becomes easy to recognise why the CNS is

Figure 19 – Locations of the major nerves in the body

commonly thought of as the control centre of the body.

Peripheral nervous system (PNS)

In conjunction with the central nervous system (CNS), the PNS co-ordinates actions and responses by sending signals from one part of the body to another. The PNS includes all sensory neurons, clusters of neurons (known as ganglia) and connector neurons that attach to the CNS and other neurons. The PNS contains different neural pathways in which information is transmitted – afferent (sensory) and efferent (motor).

The PNS is further divided into two separate systems: the Somatic Nervous System (SNS) and the Autonomic Nervous System (ANS).

Somatic nervous System (SNS)

The somatic nervous system keeps the body co-ordinated via our reflexes and voluntary actions. The somatic nervous system controls systems in areas as diverse as the skin, bones, joints and skeletal muscles. Its afferent fibres receive information from external stimuli e.g. cold, hot, sharp or blunt and carry the sensory information through pathways that connect the skin and skeletal muscles to the CNS for processing. The information is then transmitted back via efferent nerves from the CNS, back through the somatic system. These responses transmit to neuromuscular junctions to produce motor output.

Autonomic Nervous System (ANS)

The autonomic nervous system regulates involuntary and unconscious actions such as internal organ function, breathing, digestion and heartbeat. This system consists of two complementary parts; the sympathetic and parasympathetic systems. Both divisions work without conscious effort and have similar

nerve pathways but they generally have opposite effects on target tissues.

Sympathetic nervous system

The sympathetic nervous system activates the ‘fight or flight’ response under sudden or stressful circumstances such high pressure situations or feeling under threat. It increases our physical arousal levels which raises the heart and breathing rates and dilating the pupils as it prepares the body to run from or confront danger.

Parasympathetic nervous system

The parasympathetic nervous system triggers the ‘rest or digest’ responses in the body after experiencing stressful events. This form of response conserves energy and replenishes the system. It reduces our arousal levels, slows the heart and breathing rates and collectively works with the sympathetic system to maintain homeostasis within the body.

Function of the nervous system

Nerve tissue characteristics

Each nerve cell within the body is formed by a collection of components whose combined structure and function ensure efficient and accurate sensory and motor functions to occur. These structures include:

Cell body Contains the nucleus and associated organelles (Nissl's granules involved in protein synthesis)

Dendrites Conduct impulses towards the cell body

Axon Carries electrical impulses away from cell body and is covered by Schwann cells that form a myelin sheath along the length of the axon

Synapse

Contact points between the axon of one neuron and the dendrite of another neuron

Each neuron contains a nerve cell body with a nucleus and organelles such as mitochondria, endoplasmic reticulum and Golgi apparatus. Branching off the nerve cell body are the dendrites which act like tiny antennae picking up signals from other cells and conducting the impulses towards the cell body.

At the opposite end of the nerve cell body is the axon, a long thin fibre that contains branches at the end that sends signals away from the cell body. The axon is insulated by a myelin sheath, made up of segments called Schwann cells. This membrane protects the axon and prevents the interference between neurones. Nerve impulses are received by the dendrites, travel down the branches of the dendrites to the nerve cell body and are carried along the axon. At the end of a neuron is the synapse. The nerve impulse cannot directly pass to the next neuron so this triggers the release of a neurotransmitter

Figure - 20 structure of the nervous system

called acetylcholine to bridge the gap between the two neurons. Impulses continue to be carried in this way until they reach their final destination. The final destination depends on what type of neurons they are.

Figure – 21 Structure of a nerve cell

Section Six: Endocrine System

Role of the Endocrine system

The endocrine system works in response to the nervous system. Collectively the two systems act to maintain homeostasis within the body. The collective actions of these systems can be referred to as the neuroendocrine response. The endocrine system itself is made up of all of the glands of the body and the hormones produced by those glands. The glands are controlled directly by stimulation from the nervous system as well as by chemical receptors in the blood and hormones produced by other glands. Cellular metabolism, reproduction, sexual development, sugar and mineral

homeostasis, heart rate and digestion are among the many processes regulated by the actions of hormones

Structure of the Endocrine system

The key structures of the endocrine system are:

Hypothalamus

The hypothalamus is a part of the brain located superior and anterior to the brain stem and inferior to the thalamus. This is known as the ‘master’ gland and controls

Figure 22 – Location and components of the Endocrine system

many of the actions of the glands in the endocrine system. It serves many different functions in the nervous system and is also responsible for the direct control of the endocrine system through the pituitary gland. The hypothalamus contains special cells called neurosecretory cells which are nerves that secrete hormones.

Pituitary gland

The pituitary gland, also known as the hypophysis is a small pea-sized lump of tissue connected to the inferior portion of the hypothalamus of the brain. Many blood vessels surround the pituitary gland to carry the hormones it releases throughout the body, the pituitary gland is actually made of two completely separate structures: the posterior and anterior pituitary glands.

Posterior Pituitary

The posterior pituitary gland is actually not glandular tissue at all, but nervous tissue instead. The posterior pituitary is a small extension of the hypothalamus through which the axons of some of the neurosecretory cells of the hypothalamus extend. These neurosecretory cells create two hormones in the hypothalamus that are stored and released by the posterior pituitary; Oxytocin triggers uterine contractions during childbirth and the release of milk during breastfeeding. Antidiuretic hormone (ADH) prevents water loss in the body by increasing the re-uptake of water in the kidneys and reducing blood flow to sweat glands.

Anterior Pituitary

The anterior pituitary gland is the true glandular part of the pituitary gland. The function of the anterior pituitary gland is controlled by the releasing and inhibiting hormones of the hypothalamus. The anterior pituitary produces 6 important hormones:

o Thyroid stimulating hormone (TSH) as its name suggests, is a hormone responsible for the stimulation of the thyroid gland.

o Adrenocorticotropic hormone (ACTH) stimulates the adrenal cortex, the outer part of the adrenal gland to produce its hormones.

o Follicle stimulating hormone (FSH) stimulates the follicle cells of the gonads to produce gametes, ova in females and sperm in males.

o Luteinizing hormone (LH) stimulates the gonads to produce the sex hormones. Oestrogen in females and testosterone in males.

o Human growth hormone (HGH) affects many target cells throughout the body by stimulating their growth, repair and reproduction.

o Prolactin (PRL) has many effects on the body, chief of which is that it stimulates the mammary glands of the breast to produce milk.

Pineal gland

The pineal gland is a small pinecone-shaped mass of glandular tissue found just posterior to the thalamus of the brain. The pineal gland produces the hormone melatonin that helps to regulate the human sleep-wake cycle known as the circadian rhythm. The activity of the pineal gland is inhibited by stimulation from the photoreceptors of the retina. This light sensitivity causes melatonin to be produced only in low light or darkness. Increased melatonin production causes humans to feel drowsy at night-time when the pineal gland is active.

Thyroid gland

The thyroid gland is a butterfly-shaped gland located at the base of the neck and wrapped

around the lateral sides of the trachea. The thyroid gland produces 3 major hormones:

o Calcitonin

o Triiodothyronine (T3)

o Thyroxine (T4)

Calcitonin is released when calcium ion levels in the blood rise above a certain set point. Calcitonin functions to reduce the concentration of calcium ions in the blood by aiding the absorption of calcium into the matrix of bones. The hormones T3 and T4 work together to regulate the body’s metabolic rate. Increased levels of T3 and T4 lead to increased cellular activity and energy usage in the body.

Parathyroid glands

The parathyroid glands are 4 small masses of glandular tissue found on the posterior side of the thyroid gland. The parathyroid glands produce the hormone parathyroid hormone (PTH), which is involved in calcium ion homeostasis. PTH is released from the parathyroid glands when calcium ion levels in the blood drop below a set point. PTH stimulates the osteoclasts to break down the calcium containing bone matrix to release free calcium ions into the bloodstream. PTH also triggers the kidneys to return calcium ions filtered out of the blood back to the bloodstream so that it can be conserved.

Adrenal glands

The adrenal glands are a pair of roughly triangular glands found immediately superior to the kidneys. Each gland is made of two distinct layers, each with their own unique functions: the outer adrenal cortex and inner adrenal medulla.

Adrenal cortex

The adrenal cortex produces many cortical hormones in 3 classes: glucocorticoids, ineralocorticoids and androgens.

o Glucocorticoids have many diverse functions including the breakdown of proteins and lipids to produce glucose. Glucocorticoids also function to reduce inflammation and immune response.

o Mineralocorticoids, as their name suggests are a group of hormones that help to regulate the concentration of mineral ions in the body.

o Androgens such as testosterone are produced at low levels in the adrenal cortex to regulate the growth and activity of cells that are receptive to male hormones. In adult males, the amount of androgens produced by the testes is many times greater than the amount produced by the adrenal cortex, leading to the appearance of male secondary sex characteristics.

Adrenal medulla

The adrenal medulla produces the hormones epinephrine and norepinephrine under stimulation by the sympathetic division of the autonomic nervous system. Both of these hormones help to increase the flow of blood to the brain and muscles to improve the ‘fight-or-flight’ response to stress. These hormones also work to increase heart rate, breathing rate and blood pressure while decreasing the flow of blood to and function of organs that are not involved in responding to emergencies.

Pancreas

The pancreas is a large gland located in the abdominal cavity just inferior and posterior to the stomach. The endocrine cells of the pancreas produce the hormone glucagon which is responsible for raising blood glucose

levels. Glucagon triggers muscle and liver cells to break down the glycogen to release glucose into the bloodstream. The pancreas also produces the hormone insulin which is responsible for lowering blood glucose levels after a meal. Insulin triggers the absorption of glucose from the blood into cells where it is added to glycogen molecules for storage.

Gonads

The gonads; ovaries in females and testes in males are responsible for producing the sex hormones of the body. These sex hormones determine the secondary sex characteristics of adult males and females.

The testes are a pair of organs found in the scrotum of males that produce testosterone after the start of puberty. Testosterone has effects on many parts of the body including the muscles, bones, sex organs and hair follicles. This hormone causes growth and strengthens bones and muscles, including the accelerated growth of long bones during adolescence. During puberty, testosterone controls the growth and development of the sex organs and body hair of males, including pubic, chest and facial hair. In men who have inherited genes for baldness, testosterone triggers the onset of androgenic alopecia, commonly known as male pattern baldness.

The ovaries are a pair of glands located in the pelvic body cavity, lateral and superior to the uterus in females. The ovaries produce the female sex hormones progesterone and oestrogen. Progesterone is most active in females during ovulation and pregnancy where it maintains appropriate conditions in the human body to support a developing foetus. Oestrogens are a group of related hormones that function as the primary female

sex hormones. The release of oestrogen during puberty stimulates the development of female secondary sex characteristics such as uterine, breast tissue and the growth of pubic hair. Oestrogen also triggers the increased growth of bones during adolescence that lead to adult height and proportions

Section Seven: Circulatory System

Structure and function of the circulatory system

The circulatory system is made up of the heart, blood and a complex network of blood vessels. Its job is to deliver nutrients to the

body and remove by-products from the tissues. At the centre of the circulatory system is the heart, a four chambered muscular pump that dispenses blood to the arteries. The arteries carry nutrients and oxygenated blood to the body's tissues. The veins return deoxygenated blood to the heart, where the cycle repeats itself thousands of times a day.

Figure 23 – Location and components of the Circulatory system

Blood pathway around the body

The heart is a muscle about the size of an adult fist. It is composed of two sides and four chambers; the left and right atria and the left and right ventricles. These chambers are separated from left to right by the septum and from atria to ventricle by valves (bicuspid and tricuspid). The pumping action of the heart is regulated and generated via electrical impulses from our Sinoatrial node (SA node), often referred to as our ‘pacemaker’.

The two atria, the top two chambers receive blood from various parts of the body via the Pulmonary Vein and the Superior and Inferior Vena Cava. The two ventricles are located on the bottom of the heart and pump blood

away from the heart to the body. The right ventricle is responsible for pumping deoxygenated blood to the lungs via the Pulmonary Artery. The left ventricle pumps oxygenated blood to the rest of the body via the large Aorta. Separating the atria and ventricle chambers are valves known as atrioventricular valves or AV valves. These valves control the flow of blood, ensuring it flows in one direction. The right AV valve (Tricuspid) prevents backflow from the right ventricle back into the right atria. The left AV valve (Bicuspid) prevents backflow from the left ventricle into the left atria.

Figure 24 - Structure of the circulatory system including flow of blood around the body

Structure of the heart

Blood Vessels

Blood Vessels are the routes through which the blood carries and transports nutrients and gases around the circulatory system. There are 3 main types of blood vessels:

Arteries

Arteries have thick, elastic muscular walls, particularly those close to the heart enabling them to withstand high amounts of pressure. They carry blood away from the heart and to the extremities of the body and contain a smooth muscular lining that acts to pump and propel the blood around the body. As arteries move through the body they contain smaller branches known as arterioles

Veins

These vessels are two layers thick and again contain a smooth muscle lining. Veins are thinner than arteries and help return blood back to the heart. This return is aided by a valve structure within the veins which prevents the backflow of blood. The smaller branches of veins are called venules.

Capillaries

These are the smallest blood vessels at only one blood cell thick and are responsible for the delivery of nutrients and removal of waste products via the diffusion of chemicals and gases in the capillaries. This interaction acts as the link between the arterial and venous circuits.

Figure 25 – Structure of the heart

This systematic structure of the cardiovascular system enables it (and blood) to provide 3 key functions:

o To transport nutrients and waste products

o Control body temperature

o Provide protection to blood cells

Composition of blood

Blood is made up of a number of types of cells:

Plasma

Plasma is a straw coloured fluid in which blood cells are suspended. It is made up of approximately 90% water as well as proteins and electrolytes such as sodium and potassium.

Red Blood Cells (Erythrocytes)

The main function of red blood cells (RBCs) is to carry oxygen. RBCs contain a protein called Haemoglobin which binds with oxygen to form Oxyhaemoglobin. Each RBC has a

lifespan of approximately 120 days before it gets broken down by the spleen. New RBCs are manufactured in the bone marrow of most bones. There are approximately 4.5-5 million RBCs per micro-litre of blood.

White Blood Cells (Leucocytes)

There are a number of types of white blood cells, although the function of all of them is to help fight disease and infection. They typically have a lifespan of a few days and there are only 5-10 thousand white blood cells per micro-litre of blood.

Platelets (Thrombocytes)

Platelets are disc shaped cell fragments which are involved in clotting the blood to prevent the excess loss of body fluids.

Figure 26 – Difference between artery and vein

Blood pressure

Blood pressure is the pressure exerted by the blood on the walls of the arteries. It is measured in millimetres of mercury (mmHg) and is expressed in two readings. These figures refer to our:

Systolic Pressure

The pressure applied to the artery walls during the contraction phase of the myocardium

Diastolic Pressure

The pressure applied to the artery walls during the relaxation phase of the myocardium

Factors that can affect blood pressure

Blood pressure can fluctuate as a result of several factors. Changes in our blood pressure can result in Hypertension (high blood pressure) or Hypotension (low blood pressure). Both states can be an indicator of poor health and must be considered by the sports massage therapist prior to treatment.

Changes in blood pressure are heavily associated with lifestyle factors. Some of the key factors include:

Exercise

Regular exercise, along with an active lifestyle may decrease blood pressure. To significantly reduce the risk of developing high blood pressure, it is recommended that adults

participate in 150 minutes a week of cardiovascular exercise such as walking, cycling and swimming. Increasing daily activity by walking to and from class and work (rather than taking the bus) and walking up and down stairs (versus taking the elevator) will also contribute to an active, healthy lifestyle.

Obesity

Many medical studies have shown a relationship between obesity and high blood pressure. Obese people tend to have a higher blood pressure than people with healthy a weight. The cardiovascular risk is increased with obesity. This is reported to be due to obesity presenting an increase in cardiac output, blood volume and in the arterial resistance.

Nutrition

Research has shown that diet affects the development of high blood pressure (hypertension). Diets low in fat and rich in fruits and vegetables, low in cholesterol and saturated fat and high in dietary fibre, potassium, calcium and magnesium and moderately high in protein are recommended to maintain a healthy blood pressure.

Alcohol

When regularly over-consumed, alcohol can raise blood pressure dramatically as well as cause an elevation upon withdrawal. It is recommended that both men and women limit alcohol intake to 14 units per week to keep a healthy blood pressure.

Stress

The effects of stress can vary, but long-term chronic stress has been found to raise blood pressure. Various relaxation techniques such as deep breathing, progressive relaxation, massage and psychological therapy can help to manage stress and stress-induced blood pressure elevations.

Smoking

Smoking causes peripheral vascular disease (narrowing of the vessels that carry blood to the legs and arms) as well as hardening of the arteries. These conditions clearly can lead to heart disease and strokes and are contributing factors in high blood pressure.

Age

As we age blood vessels become less elastic causing ‘average’ blood pressure increases from 120/70 to 150/90 and continue to remain slightly high even if treated. The blood vessels respond more slowly to a change in body position with age too.

Family History

Research has begun to highlight the influence of our genetic make-up on related blood pressure conditions with high blood pressure tending to run through family generations.

Excessive Sweating

Initially, exercise will raise your blood pressure but if you're healthy and exercise regularly, your blood pressure will be low when you're resting. Excessive sweating as a result of activities such as strenuous exercise can result in temporary low blood pressure due to lower blood volume.

Section Eight: Respiratory System

Structure of the respiratory system

The respiratory system, like the cardiovascular system consists of a network of structures that work together, in this instance to transport gases in and out of the body. The following parts, divided into the upper and lower respiratory tracts.

Parts of the Upper Respiratory Tract

Mouth, nose and nasal cavity

The function of this part of the system is to warm, filter and moisten the incoming air

Pharynx

Here the throat divides into the trachea (wind pipe) and oesophagus (food pipe). There is also a small flap of cartilage called the

epiglottis which prevents food from entering the trachea

Larynx

This is also known as the voice box as it is where sound is generated. In addition, it helps protect the trachea by producing a strong cough reflex if any solid objects pass the epiglottis into parts of the lower respiratory tract

Parts of the Lower Respiratory Tract

Trachea

Also known as the windpipe, this is the tube which carries air from the throat into the lungs. The inner membrane of the trachea is covered in tiny hairs called cilia which catch particles of dust which can then be removed through coughing. The trachea is surrounded by 15-20 C-shaped rings of cartilage at the

Figure 27 - Location and components of the respiratory system

front and side which help protect the trachea and keep it open. They are not complete circles due to the need for the trachea to partially collapse to allow the expansion of the oesophagus when swallowing large pieces of food.

Bronchus

The trachea divides into two tubes called bronchi, one entering the left and one entering the right lung. The left bronchi is narrower, longer and more horizontal than the right. Irregular rings of cartilage surround the bronchi whose walls also consist of smooth muscle. Once inside the lung the bronchi split several ways forming tertiary bronchi.

Bronchioles

Tertiary bronchi continue to divide and become bronchioles which are very narrow tubes, less than 1 millimetre in diameter. At the ends of the bronchioles are small air sacs called alveoli.

Alveoli

Alveoli allow for the exchange of gases Oxygen and Carbon Dioxide. They are surrounded by a network of capillaries into which the inspired gases pass. There are approximately 3 million alveoli within an average adult lung.

Diaphragm

The diaphragm is a broad band of muscle which sits underneath the lungs, attaching to the lower ribs, sternum and lumbar spine and forming the base of the thoracic cavity.

Function of the respiratory system

The collective function of the human respiratory system is to transport air into the lungs, facilitate the diffusion of Oxygen into the blood stream and receive waste in the form of Carbon Dioxide from the blood to be exhaled from the body. These processes occur through a mechanism known as gaseous exchange.

Figure 28 - Gaseous exchange

Muscles involved in breathing

The mechanics of breathing

The action of breathing in and out is due to changes of pressure within the thorax, in comparison with the outside. This action is also known as external respiration. When we inhale the intercostal muscles (between the ribs) and diaphragm contract to expand the chest cavity.

The diaphragm flattens and moves downwards and the intercostal muscles move the rib cage upwards and out. This increase in size decreases the internal air pressure and so air from the outside (at a now higher pressure that inside the thorax) rushes into the lungs to equalise the pressures.

When we exhale the diaphragm and intercostal muscles relax and return to their resting positions. This reduces the size of the thoracic cavity, thereby increasing the pressure and forcing air out of the lungs.

The muscles used in breathing:

Inhalation

Diaphragm

Passage of air through the cardiorespiratory system

External Intercostal muscles

Sternocleidomastoid Scalenes

Exhalation

Internal intercostals

External/internal obliques

Rectus abdominus

Section Nine: Lymphatic System

The lymphatic system is unique in that it is a 1-way system that returns lymph fluid via vessels to the cardiovascular system for eventual elimination of toxic by-products by end organs such as the kidney, liver, colon, skin and lungs.

The major components of the lymphatic system include lymph, lymphatic vessels and lymphatic organs which contain lymphoid tissues.

Lymphatic Vessels

Lymphatic vessels are structures that absorb fluid that diffuse from capillaries into surrounding tissues. This fluid is directed toward lymph nodes to be filtered and ultimately re-enters blood circulation through veins located near the heart. The smallest lymphatic vessels are called lymph capillaries. Lymphatic capillaries come together to form larger lymphatic vessels. Lymphatic vessels from various regions of the body merge to form larger vessels called lymphatic trunks. Lymphatic trunks merge to form two larger lymphatic ducts (Thoracic Duct and the Right Lymphatic Duct). Lymphatic ducts return lymph to blood circulation by draining lymph into the subclavian veins in the neck.

Lymph Nodes

Lymphatic vessels transport lymph to lymph nodes. These oval shaped structures are located in different areas of the body. They serve to “clean” lymph as it flows through them by removing pathogens, such as

bacteria and viruses, and filtering cellular waste, dead cells and cancerous cells

Lymph nodes produce and store immune cells called lymphocytes. These cells are necessary for the development of humoral immunity (defence prior to cell infection) and cell mediated immunity (defence after cell infection). Lymph enters a node through afferent lymphatic vessels, filters as it passes through channels in the node called sinuses and leaves the node through an efferent lymphatic vessel. There are larger numbers of afferent vessels than efferent vessels, which has the effect of slowing down the flow of lymph, thereby assisting lymphocytes in their removal of pathogens

Thymus

The thymus gland is the main organ of the lymphatic system. Its primary function is to promote the development of specific cells of the immune system called T-lymphocytes. Once mature, these cells leave the thymus and are transported via blood vessels to the lymph nodes and spleen. T-lymphocytes are responsible for the immune response that involves the activation of certain immune cells to fight infection. In addition to immune function, the thymus also produces hormones that promote growth and maturation.

Spleen

The spleen is the largest organ of the lymphatic system. Located to the left of the abdomen below the rib cage, its primary function is to filter blood of old red blood

cells, cellular debris and pathogens. Like the thymus, the spleen houses and aids in the maturation of lymphocytes.

The spleen is rich in blood supplied via the splenic artery. The spleen also contains efferent lymphatic vessels, which transport lymph away from the spleen and toward lymph nodes. Rupture to this key structure can prove fatal.

Functions of the lymphatic system

The lymphatic system plays a vital role in the proper functioning of the body, and is involved in three primary functions, which includes:

Removes excess tissue fluid (oedema) and returns it to the bloodstream

One of the major roles of this organ system is to drain excess lymph fluid surrounding tissues and organs and return it to the bloodstream. Lymph is a clear-to-white fluid and consists of white blood cells (mainly lymphocytes) which attack bacteria in the blood and fluid from the intestines called chyle, which contains proteins and fats Returning lymph to the bloodstream helps to maintain normal blood volume and pressure. It also prevents oedema, the excess accumulation of fluid around tissues.

Filters fluids to help prevent infection of the blood and tissues

The lymphatic system is a major part of the body’s immune system and as such, one of its essential functions involves the development and circulation of immune cells, specifically lymphocytes. These cells destroy pathogens and protect the body from disease. In addition, the lymphatic system works in

conjunction with the cardiovascular system to filter blood of pathogens via the spleen before returning it to circulation.

Aids digestion via the absorption of lipids from the small intestine

The lymphatic system works closely with the digestive system as well to absorb and return lipid nutrients to the blood.

Location of the major lymph nodes

Figure 29 – The structure of a lymph node and the location of lymph nodes in the body

Section Ten: Digestive System

Function of the digestive system

The human digestive system consists of a large number of organs and processes with the combined functions of breaking down our food, both mechanically and through enzymes into smaller molecules which can be used to produce energy and for a range of other nutritional purposes. Any waste produced by the system is then eliminated.

Structure of the digestive system

Mouth

The mouth is the starting point of digestion. Mechanical chewing (mastication) initiates the breaking down of the food while enzymes such as salivary lipase and amylase start to chemically break down the food.

Oesophagus

Upon swallowing food moves into the oesophagus where continual waves of

Figure 30 – Components of the digestive system

involuntary contractions push the food into the stomach, this is known as peristalsis.

Stomach

The stomach provides a mechanical and chemical function in digestion. The upper part of the smooth, involuntary stomach muscle relaxes to allow a large volume of food to be stored. The lower muscle then contracts in a rhythmical manner, churning up the food inside and mixing it with gastric acid and digestive enzymes, such as pepsin a proteinemulsifying enzyme

The stomach is also the main site for the absorption of nutrients into the blood stream using enzymes produced in the liver, gall bladder and pancreas.

Any remainder content not absorbed is then passed into the small intestine.

Small Intestine

Whilst in the small intestine food is subjected to more enzymes, those from the Pancreas and glands within the intestine walls that work to break down carbohydrates and proteins. It is also mixed with bile produced

in the liver which is stored and released into the intestine by the gall bladder. This is commonly known as bile. Bile works to dissolve fat so that it can be digested by the other enzymes. Rhythmical smooth muscle contractions continue within the small intestine and pushes the digesting food through its narrow tube.

Once completely broken down into its individual components the nutrients are absorbed through the intestinal walls into the blood flow of the capillaries which surround the intestine

Large Intestine

The large intestine continues the foods journey and is the body’s last chance to absorb any water and minerals still remaining. The rest of the contents of the large intestine is waste such as indigestible pieces of food and fibre. This is passed through to the rectum where it is excreted from the body as faeces.

Section Eleven: Urinary System

Components

Structure and function of the urinary system

The urinary system consists of two kidneys, two ureters, urinary bladder and urethra. The

kidneys filter the blood to remove waste and produce urine. The ureters, urinary bladder and urethra together form the urinary tract which acts as a plumbing system to drain urine from the kidneys, store it and then release it during urination. Besides filtering and eliminating waste from the body, the

Figure 31 –

of the Urinary system.

urinary system also maintains the homeostasis of water, ions, pH, blood pressure and calcium.

The ureters are a pair of tubes that carry urine from the kidneys to the urinary bladder.

Gravity and peristalsis of smooth muscle tissue in the walls of the ureters move urine toward the urinary bladder. The ends of the ureters extend slightly into the urinary bladder and are sealed at the point of entry.

The urinary bladder is used for the storage of urine and is located along the body’s midline at the inferior end of the pelvis. Urine entering the urinary bladder from the ureters slowly fills the hollow space of the bladder and stretches its elastic walls. The walls of the bladder allow it to stretch to hold anywhere from 600 to 800 millilitres of urine. The urethra is the tube through which urine passes from the bladder to the exterior of the body

Section Twelve: Effects of Sports Massage

The reported benefits of sports massage cross physical, physiological and psychological responses to the athlete.

Physical Effects of Sports Massage

Pumping

The stroking and squeezing movements during a massage are purported to assist with the flow of both blood and lymph. The effect of this would be to both increase the flow of nutrients to tissues (required for growth/repair) and away from them, helping eliminate waste products such as lactic acid.

Increased tissue permeability

Deep massage causes the pores in tissue membranes to open enabling fluids and nutrients to pass through. This helps remove waste products such as lactic acid and encourages the muscles to take up oxygen and nutrients which help them recover quicker.

Stretching

Massage can stretch tissues that could not be stretched in the usual methods. Bundles of muscle fibres are stretched lengthwise as well as sideways. Massage can also stretch the sheath or fascia that surrounds the muscle, so releasing any tension or pressure build up.

Breaks down soft tissue adhesions

Specific techniques may assist in the removal/reduction of any soft tissue adhesions, aiding free movement

Improve tissue elasticity

Longitudinal and transverse stretching of soft tissue aids in mobility and helps to influence the formation of collagen fibres

Physiological and Neurological effects of massage

Pain reduction

Tension and waste products in muscles can often cause pain. Massage helps reduce this in many ways including releasing the body’s endorphins.

Relaxation

Muscles relax through heat generated, circulation and stretching. Mechanoreceptors which sense touch, pressure, tissue length and warmth are stimulated causing a reflex relaxation.

Psychological effects of massage

Depending on the speed and techniques used, massage can be either invigorating or relaxing.

Invigorating (sympathetic response)

The use of fast vigorous techniques can be particularly useful to help an athlete prepare for fast/explosive events, such as sprinting, by increasing mental alertness and increasing adrenaline and endorphins production

Relaxing (parasympathetic response)

However, with some athletes/events, sometimes a more calming and relaxation approach can prove more beneficial to them by helping reduce tension promoting a feeling of well-being and lowering anxiety

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