Massage Therapist: The Basics of Kinesiology

Key Topics:
- Characteristics of muscles
- Planes of motion
- Range of motion
- Postural alignment
- Tips for answering questions on kinesiology
 

Kinesiology is the study of body movement and the body parts involved in movement. This topic is a key area for massage therapists from two perspectives. First, you will find that many of your clients’ physical problems originate with or are exacerbated by kinesiological issues like restricted movement, poor postural alignment, and repetitive motion injury. Second, massage therapy is a physical profession. In order for you to maintain the ability to pursue this career for the long term, you need to be aware of the positions and movements of your own body, particularly when you are working on clients.

For examination study, at a minimum, you should be able to do the following five things:

(1) identify major muscle groups; (2) explain the primary characteristics and actions of different muscle groups; (3) describe general movement patterns, movement of the joints, and the body’s range of motion; (4) recognize and describe appropriate postural alignment; and (5) define proprioception and explain what it means.

This guide highlights important information and gives you some practice questions in these areas. If you are having trouble understanding the information or answering the practice questions, take some time to review your textbooks and notes.

The number of questions you will need to answer on kinesiology varies by exam. If you are taking the MBLEx, you will be required to answer a total of 125 questions; of these, about 11 percent, or 14 questions, are on this topic. If you are taking the NCETMB, you will be required to answer a total of 160 questions; of these, between 5 and 10 percent, or 8 to 16 questions, touch on this topic.

Characteristics of Muscles
In this guide you reviewed the muscular system in depth. From that study, you will recall that muscle is composed of fibers interwoven with a complex system of connective tissue. Muscle powers all major body functions and movement. It also works with other components in the body to stabilize the body and allow us to stand erect. In short, the role of the muscular system is to produce and control the force that powers movement.

Muscles have unique characteristics, including irritability, contractility, and elasticity.
- Irritability (also called excitability) is the ability to react to stimuli, such as electrical currents, thermal heat, or nervous impulses.
- Contractility is the process of generating tension within the muscle to power movement; for example, when cardiac muscles contract, the heart pumps; when skeletal muscles contract, attached bones are drawn closer together, allowing movement.
- Elasticity is muscle’s ability to return to its original shape after being stretched.

Muscular Contractions
Muscle contractions are described as voluntary and involuntary. They originate with the central nervous system in response to conscious thought from the brain (voluntary) or reflexes (involuntary).

Muscle contractions can be described as concentric, eccentric, isometric, and isotonic.
- During concentric contraction, the tension generated is enough to overcome the resistance being applied, and the muscle shortens as it contracts. For example, if you perform a bicep curl with a relatively heavy barbell, your bicep muscle will shorten and contract as it responds to the weight load. This is the type of contraction most people think of when they consider muscular contractions.
- During eccentric contraction, the tension generated is insufficient to overcome the resistance and the muscle lengthens as it contracts. For example, if you place a heavy box gently on the floor rather than allowing it to drop, your bicep muscles will lengthen as they contract in response to the force and movement.
- During isometric contraction, the muscle remains the same length. Isometric contraction occurs when the tension matches the load applied to it. For example, if you stood still and held an object such as a box in front of you, the tension and the load would match exactly, and no movement would result.
- During isotonic contraction, the tension in the muscle remains constant even though the muscle’s length changes. This occurs, for example, when a joint is moved through a range of motion against a fixed resistance. The muscles will shorten or lengthen with the movement but the tension will remain the same.

Muscular contractions allow for the movement of body structures. Muscular contraction may move parts of the skeleton relative to each other (or may move parts of internal organs relative to each other). All movement is classified by the direction in which the affected structures are moved. In human anatomy, movement is described in planes of motion, or the direction in which the body part is moved.

Exercises: Characteristics of Muscles
Choose the option that best answers the question.
1. One characteristic that all three types of muscle tissue have in common is they all (A) are under voluntary control. (B) are capable of contracting. (C) allow an individual to move. (D) perform functions automatically.
Skeletal, cardiac, and smooth muscle tissues can all contract. Skeletal muscles can be controlled voluntarily for the most part and allow an individual to move, while cardiac and smooth muscle tissues are controlled unconsciously (involuntary). The correct answer is (B).
2. In which of the following would you find fibrous connective tissue? (A) Adipose (B) Bone (C) Tendons (D) Blood
Fibrous connective tissue is made up of tightly packed collagen fibers. It is found in tendons, cartilage, and ligaments. Adipose, bone, and blood are all special types of connective tissue. The correct answer is (C).

Planes of Motion
You will recall from your study of anatomy that for purposes of discussion, we use imaginary lines to divide the body into different planes: the lateral or sagittal plane, the frontal or coronal plane, and the transverse plane. These planes correspond to the planes of motions.

Humans move in three planes of motion: sagittal plane, coronal plane, and transverse plane.
- The sagittal plane divides the body into left and right sections. Movements in this plane are up-and-down motions called flexion and extension. Flexion is movement that decreases the angle of a joint (for example, if you straighten your arm and raise it over your head, shoulder flexion occurs). Extension, on the other hand, is movement that increases the angle of a joint (for example, lowering your arm back down is shoulder extension). Many synovial joints are capable of flexion and extension, such as the knee, hip, shoulder, elbow, and wrist.
- The coronal plane divides the body into front and back halves. Movement in this plane is sideways and involves moving the body part toward and away from an imaginary center line. This movement is referred to as abduction and adduction. Abduction moves the body part away from the central line (for example, if you swing your knee outward) while adduction moves the body part toward the central line (for example, if you swing your knee inward). Many joints are capable of abduction and adduction, including the shoulder, hip, and knee.
- The transverse plane divides the body into upper and lower halves. Movements in this plane are rotational or twisting in nature, and include internal and external rotation, pronation, and supination. Internal and external rotation involves twisting toward and away from the body. Ball-and-socket joints like the hip, shoulder, and wrist as well as pivot joints such as the neck allow for rotational movement. Pronation is rotational movement in which the palm is turned downward or the sole of the foot is turned outward. Supination is the opposite movement; the palm is turned upward or the foot is turned inward.
- The prefix hyper- is sometimes added to indicate movement beyond the normal position, such as hyperflexion (flexion beyond the natural range of the joint) and hyperextension (extension beyond the natural range of the joint). Hyper-movements can put significant stress on the joints involved.

Ergonomics
Ergonomics is the study of work. More specifically, it is the study of the design and arrangement of the workplace to ensure that work is performed at maximal safety and efficiency. Ergonomics seeks to make work as safe as possible by identifying potential sources of injury and proactively removing or replacing them.
Massage therapy is a physical profession. It involves a near-constant use of the hands and fingers as well as the need to bend and twist over the client. The former may result in repetitive motion disorders, such as carpal tunnel syndrome; the latter might result in a lower back injury.
Understanding ergonomics means being aware of appropriate body mechanics and positioning and being proactive about reducing the physical demands of your job. You might opt to use a hand-held massager for certain therapeutic applications, for example, or replace your massage table with one that is the right height and width for your body.

Exercises: Planes of Motion
Choose the option that best answers the question.
1. Raising your arm in a forward motion is considered what kind of movement? (A) Adduction (B) Abduction (C) Hyperextension (D) Hyperflexion
Abduction involves moving the body part away from the body. Adduction involves moving the body part back toward the body. Hypermovements involve overextending the joints. The correct answer is (B).
2. What plane divides the body into upper and lower sections? (A) Transvere (B) Coronal (C) Sagittal (D) Frontal
The transverse plane divides the body into upper and lower halves. The sagittal plane divides the body into left and right sections. The coronal, or frontal, plane divides the body into front and back halves. The correct answer is (A).
 
Note:
Conditions such as rheumatoid arthritis impair range of motion by causing pain, swelling, and stiffness in the joint.

Range of Motion
Joint flexibility is described as a joint’s range of motion (ROM), or the distance and direction that a particular joint can travel. ROM is a measure of flexibility and it is stated in degrees. Normal ROM means the joint can travel its full distance and direction. Joints with limited ROM have an impaired ability to travel, which may be caused by a mechanical problem or by a condition such as rheumatoid arthritis.
Range-of-motion exercises can preserve or improve the flexibility and mobility of the joints. They can also reduce stiffness, prevent deformities, and keep the joints supple and flexible.
- Active range of motion (AROM) indicates the distance (or number of degrees) the client can move his or her joints without assistance. AROM exercises can be done without assistance.
- Passive range of motion (PROM) indicates the distance (or number of degrees) joints can be moved with assistance from equipment or another person. (In other words, how far can you move the client’s joints when the client is completely relaxed?) PROM exercises are done with the assistance of a therapist or other health-care provider.
 
Tips:
One effective way to study for examinations such as the MBLEx and the NCBTMB is to learn how to study actively. Active study means being actively involved with the material in order to maximize your ability to later recall it. The brain retains more information if it is processed in an active manner.

Some ideas for active study include:
- Rewriting and reworking your notes several times. This activity requires you to read and regurgitate the information in a repetitive way. You can also use this opportunity to reorganize material and “fill in the blanks” with any information you missed the first time around.
- Reading the material out loud. For example, you might recite your notes or read essential parts of your textbook into a tape recorder to play back later.
- Creating diagrams that illustrate relationships among the concepts being studied. Association is one of the keys to information retention. In addition, you may recognize previously overlooked relationships in the material you are studying.

Range of motion can be improved in a variety of ways. Of special interest to massage therapists are stretching and reciprocal inhibition.

Stretching
Regular stretching can improve the body’s flexibility and range of motion. When a muscle is stretched, tension is placed on it, which causes the muscle to lengthen. Once the muscle reaches its maximum length, the fibers in the surrounding connective tissue and tendons pick up the tension and begin to align themselves along the same line of force as the tension being applied. In this way, disorganized fibers are realigned and scarred tissue can be rehabilitated.
Assisted stretching is a standard part of sports and rehabilitative massage work as these therapies focus on the prevention and rehabilitation of injuries. Therapeutic stretching is classified as active, active-assisted, active-resisted, passive, and passive-assisted. As part of your studies, you should be able to define each of these terms as well as discuss the care that must be taken to prevent injury to the client during the course of this treatment. You should know when it is appropriate to execute stretching activities and when stretching is contraindicated.

Reciprocal Inhibition
Another way to improve flexibility is the use of reciprocal inhibition. In this technique, tension is applied to a particular muscle group (the antagonist group) with the intention of forcing the opposing muscle group (the agonist group) to release tension and relax. For example, if a client tends to get muscle cramps in the calves (the agonist), the calf muscles are probably over-contracting. The problem can be resolved by helping the client to contract the muscles of the shin (the antagonist).
Reciprocal inhibition is commonly used to relieve muscle cramps and is a standard part of sports massage. By repeatedly undergoing this process, the body eventually unlearns the undesirable response (in our example, over-contracting the calves) in favor of the desired one.

Exercises: Range of Motion
Choose the option that best answers the question.
1. Which of the following is the BEST definition of flexibility? (A) The level of elasticity of the muscles (B) The distance the tendons can stretch (C) The amount of pliability in the bones (D) The range of motion in one or a series of joints
Flexibility is mainly determined by the level of movement that is possible within the joints. Tendons are relatively inflexible, bones are not flexible, and muscles do not play so important a role in overall flexibility as joints. The correct answer is (D).
2. One of the primary purposes of the stretch reflex is to (A) limit muscle lengthening. (B) stimulate a dynamic muscle response. (C) maximize muscle lengthening. (D) stimulate a static muscle response.
The stretch reflex helps prevent muscle injury by limiting (not maximizing) the amount of muscle lengthening. The static reflex and the dynamic reflex are two stages of the stretch reflex. The correct answer is (A).
 
Note:
Other postural terms you should be able to define and apply include:
- Balance
- Biomechanics
- Center of gravity
- Equilibrium
- Gait/gait analysis

Postural Alignment
Posture is the position in which the body is held upright against gravity while standing, sitting, or lying down.

Good posture means sitting, standing, walking, and lying in the positions that place the least amount of strain on supporting muscles and ligaments. Good posture is the body’s ability to maintain the structural integrity of the joints no matter the position the body is in.
Among other benefits, good postural alignment facilitates efficient movement, improved circulation, and favorable organ and muscle functioning. It prevents pain and fatigue associated with imbalances between the left and right sides of the body or between the front and back sides of the body. Imbalances and lack of symmetry occur for different reasons, such as disease, physical injury, or lifestyle. Imbalances often lead to compensatory patterns of muscular contraction, which can worsen problems by further damaging the muscles and tissues involved.
You can help your clients to resolve damaging patterns by engaging in assisted stretching during your massage sessions. The goal of assisted stretching is not only to resolve the current issue but also to prevent further problems down the road by making clients aware of their patterns of movement and helping them to become part of the solution. One of the keys to this heightened awareness is proprioception.

Proprioception
Proprioceptors are specialized nerve endings in your joints, muscles, and tendons. Proprioceptors provide a continuous, unconscious stream of sensory input to the central nervous system. This stream of input includes information about the body’s spatial positioning, the movement of body parts, and any changes to tension or force on or in the body. The brain uses this information to create an image of where you are and what you are doing; thus, proprioception is your sense of how you are oriented in space.
Massage techniques can enhance your clients’ proprioception and create better mind-body connections by heightening awareness of movement patterns. Heightened perception can help clients to consciously recognize, for example, common movement patterns, where they hold tension in the body, and so on.

Exercises: Postural Alignment
Choose the option that best answers the question.
1. A client assumes a slouched posture. The best description for the line of gravity associated with this condition is that it (A) passes in front of the cervical spine. (B) passes behind the lumbar spine. (C) passes in front of the knee joint. (D) passes behind the hip joint.
When you slouch, the line of gravity passes through the cervical spine and lumbar spine, behind the hip joint and knee joint, and in front of the ankle joint. The correct answer is (D).
2. Reciprocal inhibition is a common occurrence between muscles in agonist/antagonist relationships. It refers to the fact that when one muscle in the pair contracts, the other will (A) not be affected. (B) increase in size. (C) relax. (D) contract.
Reciprocal inhibition refers to the fact that when the muscle on one side of a joint contracts, the muscle on the other side of the joint relaxes. This is commonly seen in agonist/antagonist muscle pairs. The correct answer is (C).

Tips for Answering Questions on Kinesiology
- Muscles equal force. While studying the muscular system, remember that muscles produce and control the force that powers the movement of the body. Muscles have unique characteristics and they function in particular ways.
- Remember how to divide the body. The imaginary anatomical lines we use to divide the body into different planes also correlate to planes of motion in which we move: the sagittal plane, the coronal plane, and the transverse plane. When reviewing this material, go back to your notes about anatomical structure and positioning. You may find it easier to study that material together.
- How can you move your own joints? Range of motion is the distance and direction that a joint can travel. Make a practical study of your own body as you review this material. In what ways can you move different joints on your body, such as your elbow or shoulders? How about your ankles and knees? Can you identify each type of joint? What does your self-study reveal about the motion of each type of joint?
- Keep your back straight! Postural analysis will most likely be a common activity once you begin practicing as a massage therapist. You will learn to watch the way clients move and hold their bodies from the moment you meet them. Poor posture can cause a host of problems for a person, including a restricted range of motion, chronic pain, and undue stress on the muscles, joints, and tendons. These problems may be the very reasons the client is seeking help from you. Meanwhile, apply your studies to your own posture. Can it be improved? Why might you be holding your body in particular ways?