K Class 1 TG Intro & Assessment

8/10/2019 K Class 1 TG Intro & Assessment

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CLASS 1:

INTRODUCTION &ASSESSMENT – TG

Kinesiology



AristotleArchimedes

Galen

Sir Isaac NewtonGuillaume Duchenne

Eadweard Muybridge

History of Kinesiology



Aristotle

Greek philosopher – Father of Kinesiology(384-322 B.C)

His treatises on muscles of animalsdescribed actions of muscles PARTS OF ANIMALS

MOVEMENT OF ANIMALS

PROGRESSION OF ANIMALS

He was first to analyze & describe walking

He discussed of the problems of pushing aboat under various conditions which was aprecursor of Newton's 3 laws of motion.



Aristotle



Archimedes

Greek philosopher(287-212 BC)

His principles ofbuoyancy still used

today. Determined

hydrostatic principlesgoverning floatingbodies that are stillaccepted inswimming.

His work may haveincluded the laws of

leverage &determining the



Archimedes



Galen

Roman physician & citizen (129-217 AD)

Because of his work with gladiators, he is

considered to have been the first team physician

in history. His essay DE MOTU MUSCULORUM distinguished

between:

Motor & sensory nerves

Agonist & antagonist muscles

Described tonus

introduced terms such as diarthrosis &

synarthrosis.



Galen

He taught that muscular contraction

resulted from the passage of "animal

spirits" from the brain through the nerves

to the muscles.

Some writers consider his treatise the first

textbook on kinesiology & he has been

termed "the Father of Sports Medicine."



Sir Isaac Newton

English

philosopher (1642-

1727)Developed

Newton’s 3 Laws

of MotionFTM p. 141 Box 4-

3

FES p. 261 Box 9-



Sir Isaac Newton



Guillaume Duchenne (1806-

1875)

French neurologist

Developed

electromyography

(EMG)



Electromyography (EMG)

An electrical

recording of muscle

activity that aids inthe diagnosis of

neuromuscular

disease



Eadweard Muybridge (1830-1904)

English photographer who

lived in the US

Developed motion

photography or

cinematography

Famous for his movie of a

galloping English race

horse in 1887

http://en.wikipedia.org/wiki/

File:Muybridge_race_horse

_animated.gif



Eadweard Muybridge (1830-1904)



KinesiologyApplied Kinesiology

Kinesthesia

Biomechanics

Terminology



Terminology

Study or science of

movement, which includes

anatomical (structural) &

biomechanical

(mechanical) aspects of

movement.

Study of movement thatcombines the fields of

anatomy, physiology,

physics, & geometry &

relates them to human

FTM p. 34 Box 2-3

A muscle testingprocedure used bychiropractors toevaluate muscles

Developed in 1960sby Americanchiropractor Dr.George Goodheart

Kinesiology FES p. 468 Applied kinesiology



Terminology

Sensory

perception of bodymovement

Study of

mechanicalprinciples & action

applied to living

bodies

Mechanicalanalysis of

movement

KinesthesiaBiomechanics FES p.

468



Who needs Kinesiology?

Anatomists, coaches, strength and

conditioning specialists, personal trainers,

nurses, physical educators, physical

therapists, physicians, athletic trainers,massage therapists & others in health-

related fields

Should have an adequate knowledge &

understanding of all large muscle groups to

teach others how to strengthen, improve, &

maintain these parts of human body



Importance to Massage TherapistsFES p. 469

Understanding principles of biomechanics &

kinesiology helps to assess & observe the body

& in developing treatment plans

Important on 2 levels:Many clients may have pain from poor

posture, restricted movement, or repetitive

motion injuries

If the therapist does not move in a safe &

efficient manner, the therapist risks career-

shortening injuries



SOAP Notes

FTM pp. 138

FTM p. 141 Figure 4-19SOAP Charting Form

S=Subjective:

Frequently contains theclient’s informationregarding the pain theyare feeling

O=Objective: You

record information herethat you have observed& obtained throughdifferent assessmentmethods

PQRST: used for

recording

information about a

client‟s pain whichis subjective

information.

HOST & HOPST:

used for recordingobjective

information



PQRST

P = Provocation and Palliation

Q = Quality and Quantity

R = Region and RadiationS = Severity and Scale

T = Timing and Type of Onset

P P ti d



P = Provocation and

Palliation

What causes o r tr iggers i t?

Examples: stress, position, certain activities,arguments

What makes it better?Examples: changing diet, changing position,taking medication, being active, resting

What makes i t wo rse?

Does i t seem to be gett ing bet ter or worse

or does i t remain the same?



Q = Quality and Quantity

Try to let the client describe the pain in their

own words since sometimes they will say what

they think you would like to hear.

How does i t feel , look or sound?

Is i t sharp, du l l , stabb ing , bu rning,

crush ing?

How much of i t is there?



R = Region and Radiation

Where is i t?

Is i t in one place?

Does it go anywhere else?

Examples: down the back, down your arm, up

your neck, down your legs

Did i t s tar t somewhere & is now local ized

to one spot?



S = Severity and Scale

Does i t inter fere with your act iv i t ies?

How does i t rate in sever i ty?

How bad is i t at i ts worst?

Does i t force you to s i t dow n, l ie down, s lowdown?

How long does an episode last?

Pain Scales:

Visual Analog Pain Scales – Black & White &

Color

Wong-Baker FACES Pain Rating Scale FTM p.

391 Figure 11-3



Visual Analog Pain Scales

C l Vi l A l P i



Color Visual Analog Pain

Scale

W B k F P i



Wong-Baker Faces Pain

Scale




When did i t begin?

How long does i t last?

How o f ten does i t occu r?

Examples: hourly, daily, weekly, monthly

Is i t sudden o r gradual?

What t ime did i t begin?

When was the f i rst date i t happened?

What were you doing when you not iced i t?




When do you usual ly exper ience i t?

Examples: daytime, night, in the early morning

Are you ever awakened by i t?

Does it lead to anyth ing else?

Is i t accompanied by other s igns &

symptoms?

Does it ever occu r before, du ring or after

meals?

Does i t occu r seasonally?



Other possible questions

Any medicat ions o r al lerg ies?

Does i t hu rt on breath ing or deep

inspirat ion?

Any history of pain?

Any fam i ly h is tory of s imi lar pain?



HOST & HOPST

H = History (medical)

O = Observation

P = PalpationST = Specialized Testing



H=History

Can include:

Health history

Reason for massage

History of current problemHistory of past illness & health

History of family illness

Current health practicesClient‟s goals for therapy

Medical clearance recommendations



C f f



Is the Client in „fight or flight‟ or

Sympathetic Dominance?

Restless

Anxious Fearful

Angry

Agitated Elated

Initially your

approach andstrokes used need

to match the client

Then you can work

to slow or calmclient down during

massage

Signs can include: Solution

I th li t l th i i



Is the client lethargic or in

Parasympathetic Dominance?

Generally relaxed

appearance Slowness

Depression

Your initial approach

needs to matchclient

Then your actions

can increase as the

client’s energylevels increase

Signs can include: Solution



How clients indicate problems on their bodies

Body language & non-verbal communication

FTM p.387 Gesturing

Example: If a client grabs at his shoulder

while he talks about it, he could beindicating a shortened muscle or fascia



P=Palpation

Definition: use of touch to examine tissues

FTM p. 404 - Assessment by Palpation

Main considerations:

Differentiate between different types of tissue

Detect differences in texture in same tissue types

Ability to palpate through tissue layers fromsuperficial to deep

Hot and cold areas

Skin color

General skin condition

Body rhythms including breathing



Mechanism of Palpation FTM p. 405

Proprioceptors & mechanoreceptors in our

hands, arms & shoulders send information

to the brain where the sensations are

interpreted.

The somatosensory region of the brain

devoted to the hand is very large

Ability is mainly sense of comparison –this tissue feels softer than that tissue



During visual assessment of a new client, younotice an area of skin that appears noticeablypaler than others. You believe that this mightbe a localized area of reduced blood supply or

ischemia. On your soap notes, the mostappropriate description for this conditionwould be:

A. “Localized area of pale skin”

B. “Possible localized ischemia” C. “Abnormal looking patch of skin”

D. Nothing; you would not include theinformation



During visual assessment of a new client,

you notice an area of skin that appears

noticeably paler than others. You believe

that this might be a localized area ofreduced blood supply or ischemia. On

your soap notes, the most appropriate

description for this condition would be:

B. “Possible localized ischemia”



Activity: Palpating on YourselfBones

Ligaments

Muscle

Tendon

FasciaSkin

Blood vessels



Palpating on Yourself - Bone

Hold arm in front of you with elbow bent. With pads of fingers, find pointy end of elbow (olecranon

process)

Still palpating, bend & straighten arm. The bone shouldretain its shape as you move.

Keep your arm bent & move fingers toward sides of elbow tofeel 2 hard bumps, one on each side (epicondyles ofhumerus)

Bend & straighten elbow while holding these bumps. Theywill retain their shape as you move.

Explore these structures. Follow the epicondyles proximallytoward shoulder & the olecranon process distally towardwrist.

Other areas: clavicle, patella, & malleolus



Palpating on Yourself - Ligaments

Ligaments are static stabilizers so do notmove.

Ligaments are present at the ends of bones wherethey help form joints. Sometimes a network of

ligaments will wrap around a joint, creating a jointcapsule.

Interosseous membranes are related to ligamentsbut are thinner & connect bones along the length

of their shafts. They are in the forearm & lowerleg but are too deep to palpate.

Tendons & ligaments often appear in the samelocations. Tendons will move & change shape as

the joint moves. Ligaments remain relatively



Palpating on Yourself - Ligaments

Remove your shoes & socks & cross your legs with one footresting on the opposite knee.

Find the inside ankle bone (medial malleolus) with pad ofyour thumb.

Move your thumb to the bottom edge of the malleolus &

slightly anteriorly. Actively move your foot around in circles as you press with

your thumb, locating the space between the ankle & footbones.

You should notice the gap between the bones opening &

allowing the deltoid ligament to come closer to the surface &be more easily palpated.

There are several ligaments in the ankle. You can practice tofeel the difference between bone, tendons & ligaments.



Deltoid Ligament

Deltoid Ligament Ankle Tendons



Ankle Ligaments

Palpating on Yourself -




Muscle Skeletal muscle made up of distinct bundles of

parallel fibers giving them a corrugated feel.(Tendons feel „smoother‟.)

The parallel fibers have distinct direction of alignment.If you know the direction of the fibers of a muscle, itcan help you distinguish it from surrounding muscles.

Muscles change shape as the body moves. When itis stretched, it becomes longer & the fibers feel taut,like a tightened rope.

When a muscle contracts, it becomes thicker in thecenter & firmer throughout.

You can see this by viewing your own arm whenrelaxed & then with your fist clenched.





Muscles Wrap your hand around your opposite forearm, just

distal to the elbow. With your forearm relaxed, theflesh should feel soft & pliable.

Slowly bend your wrist back & forth. Notice how the

flesh under your palm changes as you move yourother wrist.

Notice the movements that make the muscles feelstretched & taut & which makes the muscles feelcontracted & thick.

Wrap your hand around different places on yourforearm & move your wrist. Are there locations thatmove more than others?

Other places to practice are around shoulder & knee




Tendons

Tendons come in a variety of shapes & sizes.

They can be broad & flat like those in the smallof the back or long & cable-like such as thosein arm & wrist.

Tendons, like muscle, change shape asthey stretch & contract.

They tend to be denser & smoother than

muscles. When palpating tendons, it helps to find a

muscle & follow the fibers until they becomesmoother prior to attaching to a bone.





Tendons

Lay the pad of your thumb across the inside of

your opposite wrist.

Gently strum your thumb back & forth, feeling

the tendons just under the skin. Hold your thumb still as you open & close your

hand. Do the tendons move & change?

Continue to hold your thumb still as you wiggle

your fingers. Do the tendons move & change?




Palpating on Yourself

Tendons

Follow the tendons with the pad of your

thumb proximally toward the elbow. Can

you feel when the tendon changes to

muscle? Follow the tendons distally to the hand.

Can you feel where they insert on the

bone? This is more easily felt on the backof the hand.

Good places to practice are around

kneecap (patella) & dorsal surface of the



Palpating on Yourself - Fascia

Fascia comes in many different forms & is

separated into layers. Multiple layers with

individual collagen fiber directions give it its

unique feel & appearance.

It can feel wavy, dense or smooth depending

on location & health of the tissue.

It also has the ability to be solid & firm as well as

liquid or fluid in nature. Which form it takesdepends on temperature, pressure & tension

applied to the tissue.

Fascia is more challenging to palpate than other

tissues.



Fascia

f



Palpating on Yourself - Fascia

Slightly flex one arm & grasp the loose skin at the point ofyour elbow with the thumb & finger of your opposite hand.

Grasp firmly & see if you can roll the flesh between yourfingers. This is superficial fascia.

Bend & straighten your elbow as you keep hold of the fleshbetween your fingers. Feel the alternating tension &slack?

Grasp in the same way other areas of your forearm. Finda mark on your skin (freckle, scar) or mark your skin with apen. Keeping your eyes on the mark, see if you can causeit to move by pulling on flesh on different parts of your arm.

Practice at your patella & abdomen. Compare themovement of the flesh at different locations. Does the

amount of movement change the more you palpate an

P l i Y lf Ski



Palpating on Yourself - Skin

Pay attention to temperature, pliability & texture of skin as youpalpate.

Place pad of your fingers on the palm of your opposite hand.

Brush your fingertips lightly across the skin without moving it. Is

the skin rough or smooth? Any ridges, bumps or calluses? Is itoil, sweaty, or dry? What color is the skin? Repeat on the back

of the hand.

Move back to the palm. Keep both hands relaxed & make

small, deep circles with your fingertips on your palm. Try to

move the skin.

Open your hand wider & observe if the skin changes.

Return to back of the hand & repeat exercise. How do they

differ? How are they the same? Does anything change with your

touch?

Palpating on Yourself – Blood



Palpating on Yourself Blood

Vessels

The blood vessels are in a network which is

woven throughout the body, existing side by side

with lymphatic structures, nerves & structures of

movement.

Use caution when palpating near these structures

to avoid damaging the blood vessels.

When you palpate a pulse under your

fingertips, you have compressed an artery. Place your fingers on the inside of your opposite &

feel for the radial pulse. Gently roll your fingers

over the artery to feel the tube-like structure.

R di l P l P i t



Radial Pulse Point



Letting your fingers do the exploring!

Hidden Palpation Activity

Hidd P l ti A ti it



Hidden Palpation Activity

You will palpatethrough the fabric ofa pillowcase to try toidentify the hidden

items. 9 Stations

Take a sheet of

paper & numberfrom 1-9.

At each station, notea description of whatyou feel, how manyitems, & your guess

to what it is. (Ignoreany staples youfeel.)

After everyone has‘felt’ each station,we’ll reveal thehidden items.

Hidd It



Hidden Items

Straws (bloodvessels)

Coins

Glass circleshapes

Pipe cleaners

Yarn

Plastic wrap (deepfascia)

Pill capsules

Plastic tape Ribbed fabric

(skeletal muscle)

Pompoms (lymphnodes)

Cotton balls

Twine

Duct tape (deepfascia)

A t P l t FTM 405



Areas to Palpate – FTM p. 405

Skin

Superficial fascia

Fascial sheaths

Tendons

Ligaments

Blood vessels

Muscle layers

Bone

H t P l t FTM 405



How to Palpate FTM p. 405

Use back of hand to detecthot (inflammation,spasm, or increased

circulation) or cold(reduced circulation) areas

Areas that seem thick,dense or bumpy & pushyou away – hyperactive

Areas that seem thin orthat have ‘holes’ -hypoactive

Dry or damp (feels sticky &can mean activatednervous system)

Color: blue (lack ofoxygen) or yellow (liverproblems)

Moles & growths

Condition of hair & nails

Do gentle, small stretchingin all directions & noteareas that are stuck,restricted or too loose

In times of stress, epithelial

tissues affected first

Near touch (no contact)

p. 405Skin p. 406

H t P l t



How to Palpate

Area can feel spongy,resilient & springy like

gelatin Since it holds fluids, can

feel like water balloon

Kneading & skin rolling

can help find areas ofbinding

Look for areas thatbecome redder thansurrounding tissue or thatstay red longer

Superficial vesselsfeel like soft tubes

Should feel firm butpliable & supported

Feeling for pulses canhelp find this area

Watch for vessels that

bulge, are mushy or areconstricted & refer to aphysician

Superficial Connective Tissue

p. 407Blood Vessels p. 408

H t P l t



How to Palpate

Lymph nodes feel likesoft gel caps in joint

area If enlarged, refer to a

physician

Tissue should not bebogy & taut from water

retention If person has

unexplained &consistent edema, referto a physician

Since they have morecollagen, feel morepliable & less ribbed

than muscle Should feel pliable &

mobile

Under tendons can findbursa which feel like

small water balloon orbubbles

Tendons move withisometric contractions,ligaments don’t

Lymphatic Structures

p. 408Tendons p. 410

How to Palpate - Skeletal Muscles



p

p. 408

Feel like corded fabric or fine rope

Should feel firm & pliable but can also feel

tense & ropy

Palpate through layers till reach bone with aeven, broad based & slow pressure

Can slide layers to find adhesions

Having client move joint can help identifymuscles

H t P l t Sk l t l M l



How to Palpate - Skeletal Muscles

Tension in concentrically contracted musclesshows as tissue that is hard & bunched (caves)

Tension in eccentrically contracted muscles shows

as long, taut bundles with some shortenedgroups (hills)

Flexors, adductors, & internal rotators usually

shorten

Extensors, abductors & external rotators palpatetense & taut but are long with eccentric

dysfunctions

Musculotendinous junction & belly can contain

tri er oints & h ersensitive s ots

How to Palpate



How to Palpate

Thin & fibrous layerthat feels like sheets

of plastic wrap orduct tape

Location affects feel

Can feel fascialseparations withfingers

Larger nerves &vessels lie in fascialgrooves

Found around

joints & generally

feel like bungee

cords

Some feel flat

Deep Fascia p. 410 Ligaments p. 412

How to Palpate



How to Palpate

Careful palpation canreveal space between

bone ends Can feel like hinges

Most assessmentsdone with passive &active JMs

End-feels provideinformation

Smaller bones can

feel like young tree

saplings &

branches

Important to palpate

bony landmarks thatare attachment sites

Joints p. 412 Bones p. 413



How to Palpate



How to Palpate

Liver on right, stomach& spleen on left

Liver & LI feel firm Light to moderate

stroking good for largeintestine

Refer to physician if

any hard, rigid, stiff ortense areas

Skin often tighter inareas of visceralreferred pain

Hands on lateral lower ribswhile person does 3 ormore complete breaths

Upper abdomen slightlyrounds in relaxedbreathing

Watch for movement inshoulders & upper chest

Tight leg & foot musclescan interfere withbreathing. Test for yourselfby tensing those muscles& taking a deep breath.

Abdominal Viscera (Organs)p. 413 Breathing p. 414

How to Palpate



How to Palpate

Pulse should bebilaterally even – feel

pulse on both sides Vascular refill – press

nail beds till pale &count 3-5 seconds forcolor to return

Lymph have type ofundulating rhythm ofperistalsis

Subtle widening &narrowing of cranial

bones Place hands on both

sides of head & feel forcranial ‘pulse’

Also a subtle back &forth movement ofsacrum

Rate 10-14 times/min

Circulation p. 414Craniosacral Rhythm p.

414

ST=Specialized Testing



ST=Specialized Testing

Muscle strength testing FTM p. 417

ROM testing FTM p. 398

Specific dysfunction tests such as:

Adson Maneuver for Thoracic OutletSyndrome

Tinel‟s sign for Carpal Tunnel Syndrome.

Muscle Guarding



Muscle Guarding

Definition: a protective reflexive responsein muscle that results from pain or fear ofmovement

The spasm will deter the muscle againstmovement, reducing the likelihood of re-injury.

Muscle guarding is not always localized. Theguarding may come from a distant source as a

referred pain. In most cases muscle guarding will cease

when the painful stimulus is removed.

Intrinsic Muscle Spasm



Intrinsic Muscle Spasm

This type of spasm is caused from circulatorychanges or nutritional deficiency.

Alterations in calcium blood levels can also

lead to muscle spasms. When severe enough, a muscle spasm can

lead into a cramp.

A cramp is a sustained or prolonged spasm.

Character armor



Character armor

Concept proposed by Wilhelm Reich that thesuppression of emotions causes muscular

tension

Armoring is the sum total of the muscularattitudes which a person develops as a

defense against the breakthrough of emotions,

especially anxiety, rage, & sexual excitation.

Character armor is the sum total of all the

years of the muscular attitudes that have also

been incorporated in the person's character

Reich‟s 7 Body Regions



Reich s 7 Body Regions

Ocular

Oral

Neck

Chest

Diaphragm

Abdomen

Pelvis

K Class 1 TG Intro & Assessment

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