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Chapter 2: Musculoskeletal Physical Therapy

Mark Dutton; Chris Ivey; Kayla Smith

FOUNDATIONAL SCIENCES

Overview

The musculoskeletal system includes bones, muscles with their related tendons and synovial sheaths, bursa, and joint structures such as cartilage, menisci, capsules, and ligaments. These body tissues are designed to accommodate the stresses of everyday life. An understanding of how these structures are designed and respond to stress is essential for the evidence-based practitioner. Also, it is important to understand the mechanisms behind how energy is provided to the musculoskeletal structures for them to perform optimally. This knowledge helps the clinician perform a thorough examination and establish an accurate diagnosis.

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High-Yield Terms to Learn
Collagen The main structural protein found throughout the various connective tissues.
Elastin A component of connective tissue that is very good at resisting tensile loads and determines the patterns of distension and recoil in most organs.
Stress-strain curve A graphical representation of the relationship between the stress and strain that a specific material displays.
Crimp The first line of response to stress by collagen tissue; occurs in the toe phase of the stress-strain curve. When a load is applied, the fibers line up in the direction of the applied force.
Creep The gradual rearrangement of collagen fibers, proteoglycans, and water that occurs because of a continuously applied force after the initial lengthening caused by crimp has ceased.
Stress relaxation A phenomenon in which a stress or force within a deformed structure decreases with time while the deformation is held constant.
Stiffness The inelasticity of an object and the degree to which the object resists deformation in response to an applied force.
Plastic deformation Occurs when a tissue remains deformed and does not recover its pre-stress length.
Stress response The method by which a tissue responds to an applied stress. Exercises may be used to change the physical properties of muscles/tendons and ligaments, as both have demonstrated adaptability to external loads with an increase in strength:weight ratios. The improved strength results from an increase in proteoglycan content and collagen cross-links.
Viscoelasticity The time-dependent mechanical property of a material to stretch or compress over time and to return to its original shape when the force is removed.
Open (loose)-packed position The joint position that results in a slackening of the major ligaments of the joint, minimal surface congruity, minimal joint surface contact, maximum joint volume, and minimal stability of the joint.
Close-packed position The joint position that results in the maximal tautness of the major ligaments, maximal surface congruity, minimal joint volume, and maximum stability of the joint.
Capsular pattern A capsular pattern of restriction is a limitation of pain and movement in a joint-specific ratio, which is usually present with osteoarthritis or following prolonged immobilization.
Neutral zone The zone within a joint’s motion in which there is little or no internal resistance offered by the tissues to movement, and the range in which the crimp of the tissue is ...

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