Ebook (EPUB) Clinical Kinesiology and Anatomy 7e Lynn S. Lippert

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Contents
Part I
Basic Clinical Kinesiology and Anatomy
CHAPTER 1 Basic Information

Introduction
Descriptive Terminology
Segments of the Body
Kinetic Chains
Planes and Axes of Motion
Degrees of Freedom
Osteokinematic Movements
Range of Motion and Goniometry
Review Questions
CHAPTER 2 Basic Biomechanics

Introduction
Force
Types of Forces
Effects of Force Application
Velocity and Acceleration
Torque
Newton’s Laws of Motion
Equilibrium and Stability
Types of Motion
Simple Machines
Levers
Pulleys
Inclined Planes
Review Questions
CHAPTER 3 Skeletal System

Introduction
Axial and Appendicular Skeletons
Composition of Bone
Structure of Bone
Types of Bones
Common Pathologies
Review Questions
CHAPTER 4 Articular System and Arthrokinematics

Introduction
Classification of Joints
Structures of a Joint
End Feel
Joint Surfaces
Joint Surface Shapes
Joint Surface Congruency
Types of Arthrokinematic Movement
Concave/Convex Rule
Clinical Implications
Common Pathologies
Review Questions
CHAPTER 5 Nervous System

Introduction
Nervous Tissue
The Central Nervous System
Central Nervous System Protection
Brain
Spinal Cord
The Peripheral Nervous System
Cranial Nerves
Spinal Nerves
Dermatomes and Myotomes
Plexus Formation
Stretch Reflex
The Autonomic Nervous System
Common Pathologies
Congenital Defects
Spinal Cord Injury
Degenerative Diseases
Demyelinating Diseases
Disorders of Muscle and the Neuromuscular Junction
Neuropathy
Review Questions
CHAPTER 6 Muscular System

Introduction
Characteristics of Muscle Tissue
Anatomy of Muscle
Sliding Filament Theory
Fiber Types
Muscle Attachments
Muscle Fiber Arrangement
Muscle Names

Roles of Muscles
Types of Muscle Contractions
Length–Tension Relationship in Muscle Tissue
Active Insufficiency and Passive Insufficiency
Adaptive Lengthening and Shortening of Muscle Tissue
Tenodesis
Stretching
Common Pathologies
Notes on Presentation of Content
Review Questions
CHAPTER 7 Circulatory System

Introduction
Cardiovascular System
Heart
Location
Chambers
Valves
Types of Blood Vessels
Circulatory Pathways
Circle of Willis
Anastomoses
Cardiac Cycle
Pulse and Blood Pressure
Lymphatic System
Lymph Collection
Transport Pathways
Filtration and Protection
Drainage Patterns
Common Pathologies
Review Questions
Part II
Clinical Kinesiology and Anatomy of the Trunk
CHAPTER 8 Head and Temporomandibular Joint

Introduction
Movements
Bones and Landmarks
Landmarks of the Occipital Bone
Landmarks of the Frontal Bone
Landmarks of the Parietal Bone
Landmarks of the Temporal Bone
Landmarks of the Sphenoid Bone
Landmarks of the Zygomatic Bone
Landmarks of the Maxilla
Landmarks of the Mandible
Unique Structures of the Head
Hyoid Bone
Thyroid Cartilage
Articular Disc of the Temporomandibular Joint
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Joints
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Cranial Joints
Facial Joints
Temporomandibular Joint
Ligaments
Joint Capsules
Lateral Ligament
Sphenomandibular Ligament
Stylomandibular Ligament
Stylohyoid Ligament
Superior Lamina
Inferior Lamina
Muscles
Muscles of the Temporomandibular Joint
Suprahyoid Muscles
Infrahyoid Muscles
Facial Muscles
Ocular Muscles
Muscles of the Tongue
Summary of Innervations
Common Pathologies
Review Questions
CHAPTER 9 Neck and Trunk

Introduction
Movements
Atlanto-occipital Joint
Atlantoaxial Joint
Cervical Spine
Thoracic Spine
Lumbar Spine
Lumbosacral Joint
Ribs
Sternum
Bones and Landmarks
Bony Landmarks of the Skull
Temporal Bone
Bony Landmarks of the Vertebrae
Unique Bony Landmarks of the Vertebrae
Bony Landmarks of the Ribs
Bony Landmarks of the Sternum
Bony Landmarks of the Pelvis
Lumbosacral Joint
Unique Soft Tissues of the Trunk
Joint Structures
Atlantoaxial Joint
Cervical Spine
Thoracic Spine
Lumbar Spine
Sternum
Lumbosacral Joint
Ligaments

Atlantoaxial Joint
Cervical Spine
Thoracic Spine
Costovertebral and Costotransverse Ligaments
Lumbar Spine
Sternum
Lumbosacral Joint
Muscles
Muscles of the Cervical Spine
Muscles of the Anterior and Lateral Trunk
Deep Muscles of the Posterior Trunk
Diaphragm Muscle
Summary of Muscle Action
Summary of Muscle Innervation
Common Pathologies
Review Questions
CHAPTER 10 Pelvis
Introduction
Movements
Sacroiliac Joint
Pubic Symphysis
Lumbosacral Joint
Pelvic Girdle
Bones and Landmarks
Sacrum
Innominate Bones
Ilium
Ischium
Pubis
Joints
Sacroiliac Joint
Pubic Symphysis
Lumbosacral Joint
Hip Joint
Ligaments
Sacroiliac Joint
Pubic Symphysis
Lumbosacral Joint
Unique Structures
Inguinal Ligament
Muscles
Review Questions
CHAPTER 11 Pulmonary System

Introduction
Thoracic Cage
Joints
Movements
Ventilation
Structures
Mechanics

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Levels
Muscles
Accessory Muscles of Inhalation
Accessory Muscles of Exhalation
Patterns of Breathing
Diaphragmatic Breathing
Chest Breathing
Pursed-Lip Breathing
Valsalva Maneuver
Summary of Innervation
Common Pathologies
Review Questions
Part III
Clinical Kinesiology and Anatomy of the Upper Extremities
CHAPTER 12 Shoulder Girdle

Introduction
Movements
Scapulohumeral Rhythm
Bones and Landmarks
Landmarks of the Scapula
Landmarks of the Clavicle
Landmarks of the Sternum
Joints
Sternoclavicular Joint
Acromioclavicular Joint
Scapulothoracic Joint
Ligaments
Sternoclavicular Joint
Acromioclavicular Joint
Muscles
Trapezius Muscle
Levator Scapula Muscle
Rhomboid Muscles
Serratus Anterior Muscle
Pectoralis Muscles
Force Couples
Common Pathologies
Review Questions
CHAPTER 13 Shoulder Joint

Introduction
Movements
Bones and Landmarks
Bony Landmarks of the Scapula
Bony Landmarks of the Proximal Humerus
Bony Landmarks of the Radius
Bony Landmarks of Ulna
Joints
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Ligaments
Joint Capsule
Glenohumeral Ligament
Coracohumeral Ligament
Transverse Humeral Ligament
Unique Structures
Rotator Cuff
Thoracolumbar Fascia
Muscles
Deltoid Muscle
Biceps Brachii Muscle
Coracobrachialis Muscle
Pectoralis Major Muscle
Pectoralis Minor Muscle
Latissimus Dorsi Muscle
Teres Major Muscle
Triceps Brachii Muscle
Rotator Cuff Muscles
Muscular Force Couples
Common Pathologies
Review Questions
CHAPTER 14 Elbow and Forearm

Introduction
Movements
Bones and Landmarks
Bony Landmarks of the Scapula
Bony Landmarks of the Humerus
Bony Landmarks of the Ulna
Bony Landmarks of the Radius
Joints
Ligaments
Capsule of the Elbow
Medial Collateral Ligament
Lateral Collateral Ligament
Annular Ligament
Unique Structures
Interosseus Membrane
Cubital Fossa
Muscles
Brachialis Muscle
Biceps Brachii Muscle
Brachioradialis Muscle
Triceps Brachii Muscle
Anconeus Muscle
Pronator Teres Muscle
Pronator Quadratus Muscle
Supinator Muscle
Common Pathologies
Review Questions

CHAPTER 15 Wrist Joint
Introduction
Movements
Bones and Landmarks
Carpal Bones
Bony Landmarks of the Distal Humerus
Bony Landmarks of the Distal Ulna and Radius
Bony Landmarks of the Metacarpals
Joints
Ligaments
Joint Capsule
Radial Collateral Ligament
Ulnar Collateral Ligament
Palmar Radiocarpal Ligament
Palmar Ulnocarpal Ligament
Dorsal Radiocarpal Ligament
Transverse Carpal Ligament
Unique Structures
Articular Disc
Palmar Aponeurosis
Flexor Retinaculum
Extensor Retinaculum
Muscles
Flexor Carpi Ulnaris Muscle
Flexor Carpi Radialis Muscle
Palmaris Longus Muscle
Extensor Carpi Radialis Longus Muscle
Extensor Carpi Radialis Brevis Muscle
Extensor Carpi Ulnaris Muscle
Common Pathologies
Review Questions
CHAPTER 16 Hand
Introduction
Movements
Carpometacarpal Joint of the Thumb
Carpometacarpal Joints of the Fingers
Metacarpophalangeal Joints
Interphalangeal Joints
Bones and Landmarks
Bony Landmarks of Distal Surfaces of the Carpal Bones
Bony Landmarks of the Metacarpals
Bony Landmarks of the Proximal Phalanges
Bony Landmarks of the Middle and Distal Phalanges
Joints
Carpometacarpal Joints
Metacarpophalangeal Joints
Arches
Ligaments
Wrist
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Hand
Unique Structures
Wrist
Hand
Muscles
Extrinsic Muscles
Intrinsic Muscles
Functions of the Hand
Grasp
Common Pathologies
Review Questions
Part IV
Clinical Kinesiology and Anatomy of the Lower Extremities
CHAPTER 17 Hip Joint

Introduction
Movements
Bones and Landmarks
Landmarks of the Innominate Bone
Landmarks of the Femur
Landmarks of the Tibia
Landmarks of the Fibula
Joints
Ligaments
Ligamentum Teres
Joint Capsule
Iliofemoral Ligament
Pubofemoral Ligament
Ischiofemoral Ligament
Unique Structures
Iliotibial Band
Adductor Hiatus
Pes Anserine
Muscles
Iliopsoas Muscle
Rectus Femoris Muscle
Sartorius Muscle
Pectineus Muscle
Adductor Longus Muscle
Adductor Brevis Muscle
Adductor Magnus Muscle
Gracilis Muscle
Gluteus Maximus Muscle
Gluteus Medius Muscle
Gluteus Minimus Muscle
Deep Rotator Muscles
Hamstring Muscles
Tensor Fascia Latae Muscle
Common Pathologies
Review Questions
CHAPTER 18 Knee Joint

Introduction
Movements
Bones and Landmarks
Landmarks of the Femur
Landmarks of the Tibia
Landmarks of the Fibula
Landmarks of the Patella
Landmarks of the Calcaneus
Unique Structures
Menisci
Pes Anserine
Popliteal Fossa
Joints
Ligaments
Joint Capsule
Medial Collateral Ligament
Lateral Collateral Ligament
Anterior Cruciate Ligament
Posterior Cruciate Ligament
Muscles
Hamstring Muscles
Sartorius Muscle
Gracilis Muscle
Quadriceps Muscles
Gastrocnemius Muscle
Popliteus Muscle
Plantaris Muscle
Common Pathologies
Review Questions
CHAPTER 19 Leg, Ankle, and Foot

Introduction
Movements
Bones and Landmarks
Bony Landmarks of the Tibia
Bony Landmarks of the Fibula
Bones and Landmarks of the Foot
Joints
Tibiofibular Joints
Talocrural Joint
Subtalar Joint
Transverse Tarsal Joint
Metatarsophalangeal Joints
Arches of the Foot
Ligaments

Tibiofibular Joints
Ligaments of the Foot and Ankle
Unique Structures
Plantar Fascia
Pes Anserine
Muscles
Superficial Posterior Group
Deep Posterior Group
Anterior Group
Lateral Group
Intrinsic Muscles
Common Pathologies
Review Questions
Part V
Clinical Kinesiology and Anatomy of the Body
CHAPTER 20 Posture
Introduction
Vertebral Alignment
Tools and Methods for Observation
Upright Postures
Standing
Sitting
Horizontal Postures
Supine
Side-Lying
Prone
Common Postural Deviations
Review Questions
CHAPTER 21 Gait
Introduction
Terminology
Walking/Ambulation/Gait
Ambulation
Walking
Gait
Measurements of a Gait Cycle
Phases of Gait
Sub-phases of Gait
Determinants of Gait
Lateral Pelvic Shift
Lateral Pelvic Tilt
Pelvic Rotation
Knee Flexion
Ankle Plantar Flexion
Interaction of Knee Flexion and Ankle Plantar Flexion
Observation of Gait
Pelvis and Hip

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Knee
Ankle
Head, Neck, Trunk, and Arms
Age-Related Gait Patterns
Common Gait Deviations and Compensations
Muscle Weakness or Paralysis
Range of Motion Limitations
Neurological Involvement
Pain
Limb Length Discrepancy
Review Questions
Bibliography
Answers to Review Questions
Index

PART1
Basic Clinical Kinesiology and Anatomy

CHAPTER 1
Basic Information
Introduction
Kinetic Chains
Degrees of Freedom
Review Questions
For additional practice activities and videos, please visit www.kinesiologyinaction.com
Introduction
Kinesiology is the study of movement through the application of anatomy, physiology, physics, and mechanics. The
amount of information in all these fields of study is challenging to retain and apply using only memorization for
tests. The real test, however, is application of the knowledge of these fields of study to patients and clients.
Biomechanics is the term used when applying the more general term mechanics (the study of forces exerted on
an object) to the study of human movement. The two components of biomechanics are kinematics and kinetics.
Kinematics is the branch of mechanics describing the movement of a body, without consideration of the forces or
torques producing that movement, or how two objects move relative to each other without consideration of the
forces that influence movement. Examples of kinematics include osteokinematics, the movement of bones in
space about a joint axis, examples of which include flexion and extension, and arthrokinematics, the movement
of bone surfaces during joint movement, examples of which include roll and glide. Kinetics is the branch of
mechanics describing how forces and torques affect the body. An example of kinetics is the force of a muscle acting
on a bone, creating osteokinematic and arthrokinematic movement. These concepts will be discussed throughout
the text.
While proceeding through the text, keep in mind a few simple concepts. First, the human body is arranged in a
very logical way. But like all aspects of life, there are exceptions. Sometimes the logic of these exceptions is
apparent, and sometimes not. When this occurs, note the exception and move on. Second, a good grasp of
descriptive terminology and visualization of a concept or feature decrease reliance on only strict memorization.
By keeping in mind some basic principles applied to joints and muscles, understanding kinesiology need not be
mind-boggling. For example, knowing (1) what movements a joint allows, (2) that a muscle must span a specific
side of a joint surface to cause a certain movement, and (3) what the muscle’s line of pull is, specific action(s) of a
muscle can be known. The elbow joint allows only flexion and extension. To move the elbow joint against gravity, a
muscle must span the elbow joint anteriorly to flex and posteriorly to extend the elbow. The biceps brachii muscle
spans the anterior aspect of the elbow. Therefore when in the anatomical position, the biceps brachii is an elbow
flexor, flexing the elbow against gravity. The triceps brachii muscle spans the posterior aspect of the elbow.
Therefore when in a position where elbow extension is performed against gravity, the triceps brachii is an elbow
extensor. In the anatomical position, the triceps brachii does not act as an elbow extensor because gravity causes
elbow extension from a flexed position.
Yes, kinesiology can be understood by mere mortals. The study of kinesiology can even be enjoyable. A word of
caution should be given, however. Like exercise, studying in short sessions several times a week is preferable to
studying for one long session. Kinesiology is foundational material necessary to understanding future courses and
patient care management. To promote retention of this information, practice, observation, and discussion in
laboratory exercises, study groups, and clinical internships are recommended. The initial chapters of this text provide
basic information, which is then applied to the study of human movement in the remaining chapters.
Describing the organization of the human body and the relationship of limb segments and movements to each other
requires a standardized position to serve as a reference point. The anatomical position (Fig. 1-1) is this
standardized position and is defined as the human body standing in an upright position, eyes level and facing
forward, feet parallel and close together, and arms at the sides of the body with the palms facing forward. The
anatomical position is the neutral position from which limb segment movements (osteokinematics) are defined and
limb segment movement is measured.

Figure 1-1. Anatomical position.
Specific terms are used to describe the location of a structure and its position relative to other structures (Figs. 1-
2 and 1-3). The following terms are defined in relation to the anatomical position. Medial refers to a location or
position toward the midline, and lateral refers to a location or position farther from the midline. For example, the
ulna is on the medial side of the forearm, and the radius is lateral to the ulna.

Figure 1-2. Descriptive terminology.
Figure 1-3. Descriptive terminology for a quadruped.
Anterior refers to the front of the body or to a position closer to the front. Posterior refers to the back of the
body or to a position closer to the back. For example, the sternum is located anteriorly on the chest wall, and the
scapula is located posteriorly. Ventral is a synonym (a word with the same meaning) of anterior, and dorsal is a
synonym of posterior; anterior and posterior are more commonly used in kinesiology. Front and back also refer to
the surfaces of the body, but these are considered lay terms and are not generally used in documentation by health-
care professionals.
Distal and proximal are used to describe locations on the extremities. Distal means away from the trunk, and
proximal means toward the trunk. For example, the humeral head is located on the proximal end of the humerus.
The elbow is distal to the shoulder and proximal to the wrist.
Superior is used to indicate the location of a body part that is above another, or to refer to the upper surface of
an organ or a structure. Inferior indicates that a body part is below another, or refers to the lower surface of an
organ or a structure. Superior and inferior are terms used to refer to the relative location of structures of the head,
neck, and trunk. For example, the ribs are superior to the pelvis, and thus the pelvis is inferior to the ribs.
Sometimes people use cranial or cephalad (Greek: cephal, meaning “head”) to refer to a position or structure
closer to the head. Caudal (Latin: cauda, meaning “tail”) refers to a position or structure closer to the feet. For
example, cauda equina (Latin: “horse’s tail”) is the bundle of spinal nerve roots descending from the inferior end of
the spinal cord. Cranial and caudal are terms that arise from the descriptive positions of a quadruped (a four-legged
animal). Humans are bipeds (two-legged). Were the dog in Figure 1-3 to stand on its hind legs, dorsal would
become posterior and cranial would become superior, and so on.
A structure may be described as superficial or deep, depending on its relative depth from the surface of the
body. For example, in describing the layers of the abdominal muscles, the external oblique is superficial to the

internal oblique, and the transversus abdominus is deep to the internal oblique.
Supine and prone are terms that describe the body when lying in a horizontal position. When supine, the anterior
surface of the body faces upward, and the posterior surface of the body is in contact with a supporting surface, such
as a treatment table or floor. When prone, the anterior surface of the body faces downward, in contact with a
supporting surface, and the posterior surface of the body faces upward.
Bilateral refers to two, or both, sides. For example, bilateral transfemoral (above-knee) amputations refer to both
right and left legs being amputated above the knee. Contralateral refers to the opposite side. A person who had a
stroke affecting the right side of the brain may have contralateral paralysis of the left arm and left leg. Conversely,
ipsilateral refers to the same side of the body.

The extremities are divided into segments according to the major bone(s) in the segment (Fig. 1-4). In the upper
extremity, the arm is the bone (humerus) between the shoulder and the elbow joint. The forearm (radius and
ulna) is between the elbow and the wrist. The hand is distal to the wrist. The lower extremity is made up of three
similar segments. The thigh (femur) is between the hip and knee joints. The leg (tibia and fibula) is between the
knee and ankle joints, and the foot is distal to the ankle.
Figure 1-4. Descriptive terminology for body segments.
The trunk has two segments: the thorax and the abdomen. The thorax, or chest, is made up primarily of the
ribs, sternum, and thoracic vertebrae. The abdomen, or lower trunk, is made up primarily of the pelvis, internal
organs, and lumbar vertebrae. The neck (cervical vertebrae) and head (cranium) are separate segments.
Body segments are rarely used to describe joint movement. For example, flexion of the upper extremity occurs at
the shoulder and is termed shoulder flexion. The movement occurs at the joint (shoulder), and the body segment
(upper extremity) just goes along for the ride! An exception to this concept is the forearm, where the body segment
functions as a joint as well. Joint movements termed forearm pronation and forearm supination occur at the
proximal and distal radioulnar joints.
Kinetic Chains
A kinetic chain is a series of connected rigid links, which in the human body are the segments of the extremities.
The upper and lower extremities are in fact kinetic chains. Because the links are connected, movement of one link
affects movement at the other links in a predictable way. The two types of kinetic chains are a closed kinetic chain
and an open kinetic chain. A closed kinetic chain occurs when the distal segment is fixed (closed), providing
stabilization at the distal end of the kinetic chain and the proximal segment(s) is free to move (Fig. 1-5). For
example, when arising from sitting in a chair to a standing position, the foot (distal end) is fixed on the floor, and the
hip, knee, and ankle (joints proximal to the fixed end of the limb) are free to move and do so in a predictable
manner.
Figure 1-5. Closed kinetic chain.
An open kinetic chain occurs when the distal segment is not fixed (open) and the proximal segment is fixed.
This configuration provides stabilization of the proximal end of the kinetic chain and freedom of movement (open) of
the distal segments (Fig. 1-6). For example, consider knee extension while sitting. When performing this activity, the
hip joint (proximal end) is fixed, and the knee and ankle joints (distal to the fixed end of the limb) are free to move,
creating an open kinetic chain.
For a comparison of the two types of kinetic chains in the upper extremity, consider the activities of performing a
pull-up (Fig. 1-7A) and bringing a glass to the mouth (Fig. 1-7B). When performing a pull-up, the hand (distal end)
is fixed (closed), and the shoulder, elbow, and wrist joints (joints proximal to the distal end of the kinetic chain) are
free to move. Thus this is a closed kinetic chain activity. When lifting a glass to the mouth, the shoulder joint
(proximal end) is fixed, and the elbow and wrist joints (joints distal to the proximal end of the kinetic chain) are able
to move. Thus this is an open kinetic chain activity.

Figure 1-6. Open kinetic chain.


Figure 1-7. Direction of movements of biceps brachii muscle attachments: (A) Origin moves toward
insertion during pull-up. (B) Insertion moves toward origin as glass is raised to mouth.

Joint movement is described by reference to planes and axes (Table 1-1). Movement occurs within a plane and
about an axis. There are three planes within which movement occurs, and each plane is perpendicular to the other
two planes (Fig. 1-8). There are two vertical planes and one horizontal plane. Think of the vertical planes as walls
and the horizontal plane as a floor. Axes are lines that pass through a joint, about which a limb segment moves (Fig.
1-9). Thus joint axes are always perpendicular to their joint planes of motion.
Table 1-1 Joint Motions

Plane Axis Joint Movement
Sagittal Frontal Flexion/extension
Frontal Sagittal Abduction/adduction
Radial/ulnar deviation
Eversion/inversion
Horizontal Vertical Medial-lateral rotation
Supination/pronation
Right/left rotation
Horizontal abduction/adduction


Figure 1-8. Planes of the body.
Figure 1-9. Axes of the body.
A sagittal plane passes through the body vertically from anterior to posterior (or vice versa), dividing the body
into right and left portions. The mid-sagittal plane divides the body into equal left and right parts. Movements
occurring within this plane are flexion and extension. A frontal plane, also termed a coronal plane, passes through
the body vertically from side to side, dividing the body into anterior and posterior portions. Movements occurring
within this plane are abduction and adduction. A horizontal plane, also termed a transverse plane, passes through
the body horizontally and divides the body into superior and inferior portions. Rotation occurs within this plane.
When a plane—sagittal, frontal, or horizontal—divides the body into equal halves on each side of the plane, it is
termed a cardinal plane. The three cardinal planes intersect at the mid-point of each dimension. Body mass within
each half of the body determined by cardinal plane is not always equal. The center of gravity, a two-dimensional
concept, is at the mid-sagittal plane slightly anterior to the second sacral vertebra (Fig. 1-10), and is not the same
as the center of mass.

Figure 1-10. The three cardinal planes are considered to intersect at the center of gravity.
A sagittal axis, sometimes termed an anterior-posterior axis, is a line that passes through a joint from anterior
to posterior (or vice versa). Abduction and adduction occur about a sagittal axis. A frontal axis, sometimes termed
a medial-lateral axis, is a line that passes through a joint from side to side. Flexion and extension occur about a
frontal axis. A vertical axis, sometimes termed a longitudinal axis, is a line that passes through a joint from
superior to inferior (or vice versa). Rotation occurs about a vertical axis.
Joint movement occurs within a plane and about an axis. When in the anatomical position, a given joint
movement always occurs within the same plane and about the same axis. Flexion and extension typically occur
within a sagittal plane and about a frontal axis. Abduction and adduction typically occur within a frontal plane and
about a sagittal axis. Rotation typically occurs within a horizontal plane and about a vertical axis. Movements such as
radial and ulnar deviation of the wrist also occur within a frontal plane about a sagittal axis. Thumb movements are
the exception to orientation of these planes and axes of motion. Thumb flexion and extension occur within a frontal
plane and about a sagittal axis. Thumb abduction and adduction occur within a sagittal plane and about a frontal
axis. Table 1-1 presents joint movement in relation to planes and axes.

Degrees of Freedom
Joints are also described by the degrees of freedom, the number of planes within which joints can move. For
example, a uniaxial joint has movement within one plane about one axis. Therefore a uniaxial joint moves in one
plane of motion, and thus has one degree of freedom. A biaxial joint moves in two planes of motion, and thus has
two degrees of freedom. A triaxial joint moves in three planes of motion, and thus has three degrees of freedom.
The maximum number of degrees of freedom a single joint can have is three. When examining multiple joints within
one extremity, the total number of degrees of freedom is the sum of the number of degrees of freedom at each
individual joint.
Joint movement is one bone moving on another through a range of motion (ROM). The movements are flexion,
extension, abduction, adduction, and rotation. These movements are termed osteokinematic movements, which
are performed as either active or passive movements. Active range of motion (AROM) occurs when muscles contract
to move joints through a range of motion. Passive range of motion (PROM) occurs when muscles are not
contracting, and an external force moves a joint through its ROM. Synovial joints move freely in many different
directions, depending upon their anatomical structure.
A non-moving limb segment can be described as static or stable. A moving limb segment can be described as
dynamic (Fig. 1-11). Limb segment positions are described in relation to the anatomical position. An elbow in the
anatomical position is extended and is flexed as it is bent. Dynamic (osteokinematic) movements, such as flexion
and extension and abduction and adduction, describe the direction of movement with respect to the anatomical
position. For example, when the anterior surfaces of the arm and forearm are moving closer together, the movement
is described as flexing the elbow. The terms describing joint position (static) and joint movement (dynamic) are both
nouns and verbs. When used clinically, the intent and meaning of terms such as flex/flexing/flexion/flexed or
extend/extending/extension/extended are understood by considering the context in which the term is used.

Figure 1-11. Flexion and extension of the shoulder. (From Norkin & White. Measurement of Joint Motion, 4E.
Philadelphia, PA: F. A. Davis; 2009, with permission.)
Flexion, occurring within a sagittal plane and about a frontal axis, is movement of one limb segment on another
about a joint axis, bringing two anterior limb segment surfaces toward each other. The most notable exception to
this definition is knee flexion. During knee flexion, the posterior limb segment surfaces of the thigh and leg move
toward each other. Figure 1-12B presents the anatomical position of the head and neck. In the case of the neck,
flexion is a “bowing down” movement (see Fig. 1-12A) in which the head moves toward the anterior chest. Elbow
flexion is the anterior surface of the forearm moving toward the anterior surface of the arm (see Fig. 1-12D). Wrist
flexion is the moving of the anterior surface of the hand toward the anterior surface of the forearm (see Fig. 1-12F).
Movements of the ankle are exceptions to the typical definitions of flexion and extension, and are both termed
flexion. There are, however, specific terms for the movement in each direction. The position in which the toes are
pointing downward toward the floor is termed plantar flexion (see Fig. 1-12H), and in which the toes are pointing
upward toward the chin is termed dorsiflexion (see Fig. 1-12I).
Extension, occurring within a sagittal plane and about a frontal axis, is movement of one limb segment on
another about a joint axis, moving the anterior limb segment surfaces away from each other. The most notable
exception to this definition is knee extension. During knee extension, the posterior limb segment surfaces move
away from each other. Extension of the head and neck occurs when the head tips posteriorly, tilting the face toward
the ceiling (moving beyond the anatomical position) (see Fig. 1-12C). Elbow extension occurs when the anterior
surface of the forearm moves away from the anterior surface of the arm (see Fig. 1-12E).

Figure 1-12. Joint movements of flexion and extension.
When the prefix “hyper-” is added to a movement, the term describes movement of a joint beyond its normal
ROM. Thus hyperextension is extension of a joint beyond its nonpathological (expected normal, without injury or
disease) extension ROM.
Abduction is movement away from the midline of the body (Fig. 1-13A), and adduction (see Fig. 1-13B) is
movement toward the midline. Abduction and adduction occur within a frontal plane and about a sagittal axis. The
shoulder and hip can abduct and adduct. Exceptions to this midline definition are the fingers and toes. The reference
point for the fingers is the middle finger. Movement away from the middle finger is abduction, and adduction is
movement toward the middle finger. The middle finger abducts (medially and laterally) but adducts only as a return
movement to the midline from abduction. The point of reference for the toes is the second toe. Similar to the middle
finger, the second toe abducts either medially or laterally but does not adduct, except as a return movement from
abduction. Horizontal abduction and adduction are movements that do not occur from the anatomical position of the
shoulder. The shoulder must be abducted to 90 degrees before the movements of horizontal abduction and
adduction can be performed. When the shoulder has been abducted initially, shoulder movement laterally is
horizontal abduction (see Fig. 1-13C) and movement medially is horizontal adduction (see Fig. 1-13D).
Horizontal abduction and adduction occur in a horizontal plane and about a vertical axis. There are no similar
movements at the hip.


Figure 1-13. Joint movements of abduction and adduction.
Radial deviation and ulnar deviation are terms commonly used to refer to wrist abduction and adduction. Radial
deviation occurs when the hand moves laterally, or toward the radial/thumb side of the hand (see Fig. 1-13E).
Ulnar deviation occurs when the hand moves medially, or toward the ulnar/little finger side of the hand (see Fig.
1-13F). Radial and ulnar deviation occur within a frontal plane and about a sagittal axis.
Lateral flexion is the term used when the trunk bends to the side, moving the shoulder toward the ipsilateral
hip. The trunk can laterally flex to the right or the left (see Fig. 1-13G and H). With lateral flexion of the neck, the
ear moves toward the ipsilateral shoulder. Lateral flexion occurs within a frontal plane and about a sagittal axis.
Rotation is movement of a limb segment within a horizontal plane and about a vertical axis. Medial rotation
occurs when the anterior surface of a limb segment turns toward the midline (Fig. 1-14A). Medial rotation is also
termed internal rotation. Lateral rotation occurs when the anterior surface of a limb segment turns away from the
midline (see Fig. 1-14B). Lateral rotation is also termed external rotation. Joints capable of performing medial and
lateral rotation are the shoulder and the hip. The neck and trunk also rotate to either the right or left (see Fig. 1-14C
and D). Rotation of the head, neck, and trunk are termed right or left rotation.


Figure 1-14. Joint rotation movements. In A and B, the shoulder is abducted to 90 degrees only to
demonstrate the rotation more clearly.
Rotation of the forearm is termed supination and pronation. In the anatomical position (see Fig. 1-1), the forearm
is in supination (see Fig. 1-14E). Thus the palm of the hand is oriented anteriorly. In pronation (see Fig. 1-14F),
the palm is oriented posteriorly. The plane of motion and axis of motion for supination and pronation are the same
as for rotation: within a horizontal plane and about a vertical axis. When the elbow is flexed, the “palm up” position
is a result of supination, and the “palm down” is a result of pronation.
Some limb segments have unique movements. Among these are circumduction, inversion/eversion, opposition,
and scapular protraction/retraction. The examples that follow are only a sample of unique movements. Specifics for
each joint movement are presented in later chapters.
Circumduction is a triplanar movement, producing a circular, cone-shaped pattern in which distal segments
move through larger arcs of movement than proximal segments. For example, circumduction of the shoulder
requires the sequential movements of flexion, abduction, extension, adduction, with rotation. The shoulder serves as
the point of the cone, and the elbow and hand move through arcs of movement, with the hand moving through a
larger arc of movement than the elbow and shoulder (Fig. 1-15). Circumduction may also occur at the wrist, hip,
ankle, thumb, and head/neck.
Figure 1-15. Circumduction movement.
The classical, or anatomical, definition of inversion is moving the ankle so that the sole of the foot faces medially
(Fig. 1-16A), and eversion is moving the ankle so that the sole of the foot faces laterally (see Fig. 1-16B). Clinically,
the triplanar movements that occur at the ankle are termed supination (inversion, adduction, and plantar flexion)
and pronation (eversion, abduction, and dorsiflexion).
Figure 1-16. Inversion and eversion of left foot.

Opposition is movement of the thumb such that the pad of the thumb faces the pads of the other four fingers.
Reposition is movement that returns the thumb to the anatomical position. (Fig. 1-17).
Figure 1-17. Thumb opposition.
Scapular protraction is movement of the scapula laterally along the posterior chest wall (Figs. 1-18A and 1-
19A). Scapular retraction is movement of the scapula medially along the posterior chest wall (see Figs. 1-18B and
1-19A). Scapular elevation is movement of the scapula superiorly along the posterior chest wall. Scapular
depression is movement of the scapula inferiorly along the posterior chest wall. Scapular elevation and depression
are both presented in Figure 1-19B.
Figure 1-18. Scapular protraction and scapular retraction.
Figure 1-19. Shoulder girdle movements.

Each movement at every joint or region of the body has a range of motion. Range of motion (ROM) is the
amount of movement a joint can move in any of its possible directions, and is measured using a goniometer (Fig. 1-
20). The anatomical position is the starting position for the measurement of joint ROM. Because ROM is a measure

of a “range,” the measurement has starting and ending points, measured in degrees. The results of the
measurement may also be given as the number of degrees moved. Norms for nonpathological joint ROM are
published by several organizations and presented in professional publications. In this text, the ranges of motion are
those published by the American Academy of Orthopaedic Surgeons (AAOS). The norms of each joint’s ROM are
included in this text within the chapter focusing on that joint.
Figure 1-20. Goniometry. (From Norkin & White. Measurement of Joint Motion, 4E. Philadelphia, PA: F. A. Davis; 2009, with
permission.)
For example, nonpathological elbow flexion is measured from the anatomical position of 0 degrees to 145 degrees
of flexion, and the ROM is documented as “0 – 145.” The amount of movement would be reported as 145 degrees.
To avoid confusion of the degree sign “°” with the number “0” (zero), the degree sign is not used in documentation.
In the presence of elbow pathology, when full elbow ROM is not present, the starting point of the ROM is
documented as the number of degrees of flexion closest to the anatomical position, and the ending point of the
ROM is documented as the endpoint of elbow flexion. For example, pathology where the elbow lacks 20 degrees of
full extension and the full range of flexion is present, the ROM is recorded as 20 – 145 and the amount of movement
is 125 degrees.
Measurements of movement of some regions of the body are measured using a tape measure or ruler. For
example, flexion of the trunk when performing a toe-touch is measured by the distance from the floor to the
fingertip of the third finger and recorded in inches (in) or centimeters (cm).
Review Questions
1. Using anatomical descriptive terminology, complete the following:
a. The sternum is __________ to the spine.
b. The heel is on the ________________ portion of the foot.
c. The thigh is ________________ to the pelvis and ______________ to the leg.
d. The shoulder girdle is ____________ to the pelvis and __________ to the head.
2. Using the left hand to touch the:
a. Left knee is using the ____________ extremity.
b. Right knee is using the ___________ extremity.
3. Sitting in a chair with the feet supported while playing catch:
a. The upper extremities are in a(n) ____________ kinetic chain.
b. The lower extremities are in a(n) _____________kinetic chain.
4. Osteokinematic movements occur within a plane and about an axis, and are described based on the _________ ____________.
5. With few exceptions, osteokinematic movements, such as flexion, occur within the same plane about the same axis at all joints.
_____True
_____False
6. Which osteokinematic movement(s) occur(s) within the following planes?
a. Sagittal plane: __________________________
b. Frontal plane: ___________________________
c. Horizontal plane: ________________________

7. A joint that can flex/extend, abduct/adduct, and rotate has ________ degrees of freedom.
8. When rising from a sitting position, the hip and knee are performing:
a. The osteokinematic movement of ____________.
b. Within the ___________plane.
c. About the ______________ axis.
d. A(n) _______________ kinetic chain activity.
9. Lying supine, position the arms so they form a right angle with the trunk. The osteokinematic movement performed to achieve this
position of the shoulder is _______________.
10. Often, several terms can be used to describe the same thing. Match the following terms.
_____ Posterior and anterior A. Proximal and distal
_____ Superior and inferior B. Internal rotation
_____ Medial rotation C. Head and tail
_____ Cranial and caudal D. Dorsal and ventral

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CHAPTER 1 Basic Information

CHAPTER 2 Basic Biomechanics

CHAPTER 3 Skeletal System

CHAPTER 4 Articular System and Arthrokinematics

CHAPTER 5 Nervous System

CHAPTER 6 Muscular System

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CHAPTER 7 Circulatory System

CHAPTER 8 Head and Temporomandibular Joint

CHAPTER 9 Neck and Trunk

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CHAPTER 11 Pulmonary System

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CHAPTER 12 Shoulder Girdle

CHAPTER 13 Shoulder Joint

CHAPTER 14 Elbow and Forearm

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CHAPTER 17 Hip Joint

CHAPTER 18 Knee Joint

CHAPTER 19 Leg, Ankle, and Foot

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Basic Clinical Kinesiology and Anatomy

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For additional practice activities and videos, please visit www.kinesiologyinaction.com

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Figure 1-1. Anatomical position.

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Figure 1-2. Descriptive terminology.

Figure 1-3. Descriptive terminology for a quadruped.

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Segments of the Body

Figure 1-4. Descriptive terminology for body segments.

Figure 1-5. Closed kinetic chain.

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Figure 1-6. Open kinetic chain.

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Planes and Axes of Motion

Table 1-1 Joint Motions

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Figure 1-9. Axes of the body.

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Figure 1-12. Joint movements of flexion and extension.

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Figure 1-15. Circumduction movement.

Figure 1-16. Inversion and eversion of left foot.

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