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Chapter 2: Musculoskeletal Physical Therapy

Mark Dutton

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. The evidence-based practitioner must understand how these structures are designed and respond to stress. Also, it is important to understand how energy is provided to the musculoskeletal structures 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
Capsular pattern A capsular restriction pattern is a limitation of pain and movement in a joint-specific ratio, usually present with osteoarthritis or after prolonged immobilization.
Close-packed position The joint position with the maximal tautness of the major ligaments, maximal surface congruity, minimal joint volume, and maximum stability of the joint.
Collagen The main structural protein found throughout the various connective tissues.
Concave-convex rule A concept used with joint mobilizations. If the joint surface is convex relative to the other surface, the slide (arthrokinematic motion) takes place opposite the osteokinematic motion. If, on the other hand, the joint surface is concave, the slide takes place in the same direction as the osteokinematic motion.
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.
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.
Elastic zone The zone where the first barrier or movement restriction occurs at the neutral zone’s end. The elastic zone extends from the crimp area through the physiological barrier (end of the active movement) and toward the anatomic barrier (end of the passive movement).
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.
Neutral zone The zone within a joint’s motion in which the tissues offer little or no internal resistance to movement and the range in which the crimp of the tissue is being taken up.
Open (loose)-packed position The joint position with 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.
Plastic deformation Occurs when a tissue remains deformed and does not recover its prestress length.
Plastic zone The zone in which deformation of the tissue is extended beyond the tissue’s elastic recoil and the tissue begins to deform; injury can occur if the deformation is sufficient in time or load.
Stiffness The inelasticity of an object and the degree to which the object resists deformation in response to an applied force.
Stress relaxation A phenomenon ...

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