Anatomy and Physiology for the Manual Therapies

Dr. Andrew Kuntzman, is an associate professor of anatomy at Sinclair Community College in Dayton, Ohio.  He received the Ernest Boyer Award for Innovative Excellence in Teaching, Learning,and Technology at the Ninth International Conference on College Teaching and Learning.

1 Organization of the Human Body 1

1.1 Anatomy and Physiology Defined 2

1.2 Levels of Organization and Body Systems 2

1.3 Life Processes 6

1.4 Homeostasis: Maintaining Limits 8

Control of Homeostasis: Feedback Systems 8

Homeostasis and Good Health 9

1.5 Aging and Homeostasis 12

1.6 Anatomical Terms 12

Names of Body Regions 12

Directional Terms 12

Exhibit 1.1 Directional Terms 14

Planes and Sections 16

1.7 Body Cavities 17

Abdominopelvic Regions and Quadrants 18

1.8 Medical Imaging 20

Key Medical Terms Associated with the Organization of the Human Body 24

2 Introductory Chemistry 28

2.1 Introduction to Chemistry 29

Chemical Elements and Atoms 29

Ions, Molecules, and Compounds 30

Chemical Bonds 31

Chemical Reactions 34

2.2 Chemical Compounds and Life Processes 35

Inorganic Compounds 35

Organic Compounds 36

Carbohydrates 36

Lipids 38

Proteins 41

Nucleic Acids 43

Adenosine Triphosphate 43

3 Cells 47

3.1 A Generalized View of the Cell 48

3.2 Plasma Membrane 49

3.3 Transport Across the Plasma Membrane 50

Passive Processes 51 Active Processes 54

3.4 Cytoplasm 57

Cytosol 57

Organelles 57

3.5 Nucleus 63

3.6 Gene Action: Protein Synthesis 64

Transcription 66

Translation 66

3.7 Somatic Cell Division 68

Interphase 68

Mitotic Phase 68

3.8 Cancer 70

Growth and Spread of Cancer 70

Causes of Cancer 70

Carcinogenesis: A Multistep Process 71

Treatment of Cancer 71

3.9 Aging and Cells 72

Key Medical Terms Associated with Cells 72

4 Tissues 77

4.1 Types of Tissues 78

4.2 Cell Junctions 78

4.3 Epithelial Tissue 79

General Features of Epithelial Tissue 80

Covering and Lining Epithelium 80

Glandular Epithelium 88

4.4 Connective Tissue 89

General Features of Connective Tissue 90

Connective Tissue Cells 90

Connective Tissue Extracellular Matrix 91

Classification of Connective Tissues 92

Types of Mature Connective Tissue 92

Connective Tissues: Diverse and Dynamic 100

4.5 Membranes 101

Mucous Membranes 101

Serous Membranes 101

Synovial Membranes 101

4.6 Musular Tissue 102

4.7 Nervous Tissue 104

4.8 Tissue Repair: Restoring Homeostasis 105

4.9 Aging and Tissues 106

Excess Adiposity 106

Key Medical Terms Associated with Tissues 106

5 The Integumentary System 111

5.1 Structure of the Skin 112

Epidermis 113

Keratinization and Growth of the Epidermis 116

Dermis 116

Skin Color 117

5.2 Accessory Structures of the Skin 118

Hair 118

Skin Glands 121

Nails 122

5.3 Types of Skin 123

5.4 Functions of the Skin 124

5.5 Maintaining Homeostasis: Skin Wound Healing 125

Epidermal Wound Healing 125

Dermal Wound Healing 125

5.6 Skin Conditions Important to Therapists 127

Skin Cancer 127

Burns 128

Pressure Ulcers 129

5.7 Aging and the Integumentary System 130

Key Medical Terms Associated with the Integumentary System 130

Exhibit 5.1 The Integumentary System and Homeostasis 131

6 Bone Tissue 135

6.1 Functions of Bone and the Skeletal System 136

6.2 Structure of Bone 136

6.3 Histology of Bone Tissue 138

Compact Bone Tissue 139

Spongy Bone Tissue 139

6.4 Blood and Nerve Supply of Bone 141

6.5 Bone Formation 142

Intramembranous Ossification 142

Endochondral Ossification 142

6.6 Bone Growth 145

Growth in Length 145

Growth in Thickness 146

6.7 Bones and Homeostasis 147

Bone Remodeling 147

Factors Affecting Bone Growth and Bone Remodeling 148

Fracture and Repair of Bone 148

Bone’s Role in Calcium Homeostasis 151

6.8 Aging and Bone Tissue 152

Key Medical Terms Associated with Bone Tissue 154

7 The Skeletal System: The Axial Skeleton 159

7.1 Divisions of the Skeletal System 160

7.2 Types of Bones 160

7.3 Bone Surface Markings 162

7.4 Skull 162

General Features and Functions 163

Cranial Bones 164

Facial Bones 170

Nasal Septum 173

Orbits 174

Foramina 174

Unique Features of the Skull 174

7.5 Hyoid Bone 177

7.6 Vertebral Column 177

Normal Curves of the Vertebral Column 179

Intervertebral Discs 179

Parts of a Typical Vertebra 179

Regions of the Vertebral Column 180

7.7 Thorax 186

Sternum 186

Ribs 186

7.8 Disorders of the Axial Skeleton 189

Abnormal Curves of the Vertebral Column 189

Spina Bifida 190

Key Medical Terms Associated with Axial Skeleton 191

8 The Skeletal System: The Appendicular Skeleton 195

8.1 Pectoral (Shoulder) Girdle 196

Clavicle 196

Scapula 197

8.2 Upper Limb (Extremity) 199

Humerus 199

Ulna and Radius 201

Carpals, Metacarpals, and Phalanges 202

8.3 Pelvic (Hip) Girdle 205

Ilium 206

Ischium 206

Pubis 207

False and True Pelves 207

8.4 Comparison of Female and Male Pelves 209

8.5 Comparison of Pectoral and Pelvic Girdles 210

8.6 Lower Limb (Extremity) 211

Femur 211

Patella 213

Tibia and Fibula 214

Tarsals, Metatarsals, and Phalanges 215

Arches of the Foot 217

Exhibit 8.1 The Skeletal System and Homeostasis 218

Key Medical Terms Associated with Appendicular Skeleton 219

9 Joints 221

9.1 Joint Classifications 222

9.2 Fibrous Joints 222

Sutures 222

Syndesmoses 224

Interosseous Membranes 224

9.3 Cartilaginous Joints 224

Synchondroses 224

Symphyses 224

9.4 Synovial Joints 225

Structure of Synovial Joints 225

Bursae and Tendon Sheaths 227

Types of Synovial Joints 227

9.5 Types of Movements at Synovial Joints 230

Gliding 230

Angular Movements 230

Rotation 233

Special Movements 234

9.6 Selected Joints of the Body 236

Exhibit 9.1 Temporomandibular Joint 238

Exhibit 9.2 Shoulder Joint 240

Exhibit 9.3 Elbow Joint 243

Exhibit 9.4 Hip Joint 244

Exhibit 9.5 Knee Joint 246

Exhibit 9.6 Ankle Joint 249

9.7 Factors Affecting Contact and Range of Motion at Synovial Joints 251

9.8 Arthroplasty 252

9.9 Aging and Joints 253

Key Medical Terms Associated with Joints 253

10 Muscular Tissue 257

10.1 Overview of Muscular Tissue 258

Types of Muscular Tissue 258

Functions of Muscular Tissue 258

Properties of Muscular Tissue 259

10.2 Skeletal Muscle Tissue 259

Connective Tissue Components 259

Nerve and Blood Supply 261

Histology 261

10.3 Contraction and Relaxation of Skeletal Muscle Fibers 263

Sliding Filament Mechanism 263

Neuromuscular Junction 263

Physiology of Contraction 264

Relaxation 266

Muscle Tone 268

10.4 Metabolism of Skeletal Muscle Tissue 268

Energy for Contraction 268

Muscle Fatigue 268

Oxygen Consumption after Exercise 270

10.5 Control of Muscle Tension 270

Twitch Contraction 270

Frequency of Stimulation 271

Motor Unit Recruitment 271

Types of Skeletal Muscle Fibers 271

Isometric and Isotonic Contractions 272

10.6 Muscle Spasms 273

10.7 Exercise and Skeletal Muscle Tissue 277

Effective Stretching 277

Strength Training 277

10.8 Cardiac Muscle Tissue 277

10.9 Smooth Muscle Tissue 278

10.10 Aging and Muscular Tissue 279

Key Medical Terms Associated with Muscular Tissue 280

11 The Muscular System: The Muscles of the Head and Neck 284

11.1 How Skeletal Muscles Produce Movement 285

Muscle Attachment Sites: Origin and Insertion 285

Lever Systems and Leverage 285 Effects of Fascicle

Arrangement 288 Coordination within Muscle Groups 288

11.2 How Skeletal Muscles Are Named 289

11.3 Principal Skeletal Muscles of the Head and Neck 289

Exhibit 11.1 Muscles of Facial Expression 294

Exhibit 11.2 Muscles that Move the Eyeballs and Upper Eyelids (Extrinsic Eye Muscles) 300

Exhibit 11.3 Muscles that Move the Mandible and Assist in Mastication (Chewing) and Speech 302

Exhibit 11.4 Muscles of the Anterior Neck that Assist in Deglutition (Swallowing) and Speech 304

Exhibit 11.5 Muscles of the Anterior Neck that Assist in Elevating the Ribs or Flexing the Neck and Head 307

Exhibit 11.6 Muscles of the Lateral Neck that Move the Head 310

12 The Muscular System: The Muscles of the Torso 316

Exhibit 12.1 Muscles of the Abdoman that Act on the Abdominal Wall 317

Surface Features of the Abdomen and Pelvis 320

Exhibit 12.2 Muscles of the Thorax Used in Breathing 324

Exhibit 12.3 Muscles of the Pelvic Diaphragm and Perineum that Support the Pelvic Viscera 325

Exhibit 12.4 Muscles of the Neck and Back that Act on the Posterior Head, Posterior Neck, Back, and Vertebral Column 328

Suboccipital Muscles 332

13 The Muscular System: The Muscles of the Upper Limb 336

Exhibit 13.1 Muscles of the Thorax that Move the Pectoral Girdle 337

Movements of the Scapula 340

Exhibit 13.2 Muscles of the Thorax and Shoulder that Move the Humerus 341

Surface Features of the Shoulder 341

Surface Features of the Armpit 341

Surface Features of the Back 346

Exhibit 13.3 Muscles of the Arm that Move the Radius and Ulna 347

Surface Features of the Arm and Elbow 352

Exhibit 13.4 Muscles of the Forearm that Move the Wrist, Hand, and Digits 354

Exhibit 13.5 Muscles of the Palm that Move the Digits–Intrinsic Muscles of the Hand 362

Surface Features of the Hand 366

14 The Muscular System: The Muscles of the Lower Limb 369

14.1 Introduction to the Muscles of the Lower Limb (Extremity) 370

Exhibit 14.1 Muscles of the Gluteal Region that Move the Femur 371

Surface Features of the Buttock 378

Exhibit 14.2 Muscles of the Thigh that Move on the Femur, Tibia, and Fibula 380

Surface Features of the Thigh and Knee 383

Exhibit 14.3 Muscles of the Leg that Move the Foot and Toes 386

Surface Features of the Leg, Ankle, and Foot 391

Exhibit 14.4 Intrinsic Muscles of the Foot that Move the Toes 393

14.2 Muscle Interactions 398

The Interconnectedness of the Whole Body 398

Posture and Interactions between Muscles 398

Exhibit 14.5 Contributions of the Muscular System to Homeostasis 400

15 Nervous Tissue 403

15.1 Overview of the Nervous System 404

Structures of the Nervous System 404

Functions of the Nervous System 404

Organization of the Nervous System 405

15.2 Histology of Nervous Tissue 407

Neurons 407

Myelination 409

Gray and White Matter 411

Neuroglia 411

15.3 Electrical Signals in Neurons 413

Action Potentials 413

Conduction of Nerve Impulses 417

Effect of Axon Diameter 418

15.4 Synaptic Transmission 418

Events at a Synapse 418

Neurotransmitters 420

15.5 Regeneration and Repair of Nervous Tissue 421

Neurogenesis in the CNS 421

Damage and Repair in the PNS 421

Key Medical Terms Associated with Nervous Tissue 422

16 The Spinal Cord and Spinal Nerves 426

16.1 Spinal Cord Anatomy 427

Protective Structures 427

External Anatomy of the Spinal Cord 427

Internal Anatomy of the Spinal Cord 429

16.2 Spinal Nerves 430

Connective Tissue Coverings of Spinal Nerves 432

Distribution of Spinal Nerves 433

Exhibit 16.1 Cervical Plexus 434

Exhibit 16.2 Brachial Plexus 436

Exhibit 16.3 Lumbar Plexus 440

Exhibit 16.4 Sacral and Coccygeal Plexuses 442

Dermatomes 444

16.3 Spinal Cord Physiology 444

Sensory and Motor Tracts 445 Reflexes and Reflex Arcs 449

Reflexes and Diagnosis 457

16.4 Traumatic Injuries of the Spinal Cord 458

Key Medical Terms Associated with the Spinal Cord and Spinal Nerves 458

17 The Brain and Cranial Nerves 463

17.1 The Brain 464

Major Parts and Protective Coverings 464

Brain Blood Supply and the Blood-Brain Barrier 464

Cerebrospinal Fluid 464

Brain Stem 468

Diencephalon 469

Cerebellum 471

Cerebrum 471

Hemispheric Lateralization 476

Memory 476

Electroencephalogram (EEG) 476

17.2 Cranial Nerves 477

17.3 Aging and the Nervous System 479

Key Medical Terms Associated with the Brain 479

18 The Autonomic Nervous System 483

18.1 Introduction to the Autonomic Nervous System 484

18.2 Comparison of Somatic and Autonomic Nervous Systems 484

18.3 Structure of the Autonomic Nervous System 486

Organization of the Sympathetic Division 486

Organization of the Parasympathetic Division 488

18.4 Functions of the Autonomic Nervous System 491

ANS Neurotransmitters 491

Activities of the ANS 491

18.5 Integration and Control of Autonomic Functions 492

Autonomic Reflexes 492

Autonomic Control by Higher Centers 494

Key Medical Terms Associated with the Autonomic Nervous System 494

19 Somatic and Special Senses 498

19.1 Overview of Sensations 499

Definition of Sensation 499

Characteristics of Sensations 499

Types of Sensory Receptors 499

19.2 Somatic Senses 500

Tactile Sensations 500

Thermal Sensations 501

Pain Sensations 502

Proprioceptive Sensations 503

19.3 Special Senses and Olfaction: Sense of Smell 504

Structure of the Olfactory Epithelium 504

Stimulation of Olfactory Receptors 505

The Olfactory Pathway 505

19.4 Gustation: Sense of Taste 506

Structure of Taste Buds 506

Stimulation of Gustatory Receptors 506

The Gustatory Pathway 506

19.5 Vision 507

Accessory Structures of the Eye 507

Layers of the Eyeball 509

Interior of the Eyeball 511

Image Formation and Binocular Vision 512

Stimulation of Photoreceptors 514

The Visual Pathway 514

19.6 Hearing and Equilibrium 515

Anatomy of the Ear 515

Physiology of Hearing 518

Auditory Pathway 519

Deafness 519

Physiology of Equilibrium 519

Equilibrium Pathways 519

Reflexology via the Ear 519

19.7 Aging and the Special Senses 521

Key Medical Terms Associated with Somatic and Special Senses 522

Exhibit 19.1 Contributions of the Nervous System to Homeostasis 523

20 The Endocrine System 527

20.1 Endocrine Glands 528

20.2 Hormone Action 528

Target Cells and Hormone Receptors 528

Chemistry of Hormones 528

Mechanisms of Hormone Action 528

Control of Hormone Secretions 528

20.3 Hypothalamus and Pituitary Gland 530

Anterior Pituitary Hormones 531

Posterior Pituitary Hormones 533

20.4 Thyroid Gland 535

Actions of Thyroid Hormones 535

Control of Thyroid Hormone

Secretion 536 Calcitonin 537

20.5 Parathyroid Glands 538

20.6 Pancreatic Islets 539

Actions of Glucagon and Insulin 540

20.7 Adrenal Glands 542

Adrenal Cortex Hormones 543

Adrenal Medulla Hormones 545

20.8 Ovaries and Testes 545

20.9 Pineal Gland 545

20.10 Other Hormones 546

Hormones from Other Endocrine Cells 546

Prostaglandins and Leukotrienes 546

20.11 The Stress Response 547

20.12 Aging and the Endocrine System 547

Key Medical Terms Associated with the Endocrine System 548

Exhibit 20.1 Contributions of the Endocrine System to Homeostasis 549

21 The Cardiovascular System: The Blood 553

21.1 Functions of Blood 554

21.2 Components of Whole Blood 554

Blood Plasma 554

Formed Elements 554

21.3 Hemostasis 563

Vascular Spasm 564

Platelet Plug Formation 564

Blood Clotting 564

Hemostatic Control Mechanisms 566

Clotting in Blood Vessels 566

21.4 Blood Groups and Blood Types 566

ABO Blood Group 567

Rh Blood Group 567

Transfusions 568

Key Medical Terms Associated with Blood 568

22 The Cardiovascular System: The Heart 571

22.1 Structure and Organization of the Heart 572

Location and Coverings of the Heart 572

Heart Wall 575 Chambers of the Heart 575

Great Vessels of the Heart 577

Valves of the Heart 577

22.2 Blood Flow and Blood Supply of the Heart 579

Blood Flow through the Heart 579

Blood Supply of the Heart 579

Myocardial Ischemia and Infarction 580

22.3 Conduction System of the Heart 581

22.4 Electrocardiogram 583

Arrhythmias 583

22.5 The Cardiac Cycle 584

Pressure and Volume Changes during the Cardiac Cycle 584

Heart Sounds 586

22.6 Cardiac Output 586

Regulation of Stroke Volume 586 Regulation of Heart Rate 589

22.7 Exercise and the Heart 590

Key Medical Terms Associated with the Heart 590

23 The Cardiovascular System: Blood Vessels and Circulation 594

23.1 Blood Vessel Structure and Function 595

Arteries and Arterioles 595

Capillaries 595

Venules and Veins 597

23.2 Blood Flow Through Blood Vessels 599

Blood Pressure 599

Resistance 600

Regulation of Blood Pressure and Blood Flow 600

23.3 Checking Circulation 603

Pulse 603

Measurement of Blood Pressure 603

23.4 Circulatory Routes 603

Systemic Circulation 603

Pulmonary Circulation 605

Exhibit 23.1 The Aorta and Its Branches 606

Exhibit 23.2 The Arch of the Aorta 608

Exhibit 23.3 Arteries of the Pelvis and Lower Limbs 610

Exhibit 23.4 Veins of the Systemic Circulation 612

Exhibit 23.5 Veins of the Head and Neck 614

Exhibit 23.6 Veins of the Upper Limbs 615

Exhibit 23.7 Veins of the Lower Limbs 617

Hepatic Portal Circulation 619

Fetal Circulation 620

23.5 Aging and the Cardiovascular System 620

Exhibit 23.8 Contributions of the Cardiovascular System to Homeostasis 622

Key Medical Terms Associated with Blood Vessels 623

24 The Lymphatic System and Immunity 627

24.1 Overview of Immunity 628

24.2 Lymphatic System Structure and Function 628

Lymphatic Vessels and Lymph Circulation 628

Lymphatic Organs and Tissues 631

24.3 Innate Immunity 634

First Line of Defense: Skin and Mucous Membranes 634

Second Line of Defense: Internal Defenses 634

24.4 Adaptive Immunity 636

Maturation of T cells and B cells 637

Types of Adaptive Immune Responses 637

Antigens and Antibodies 637

Processing and Presenting Antigens 638

T Cells and Cell-Mediated Immunity 639

B Cells and Antibody-Mediated Immunity 642

Immunological Memory 643

24.5 Aging and the Immune System 645

Exhibit 24.5 Contributions of the Lymphatic System and Immunity to Homeostasis 646

Key Medical Terms Associated with the Lymphatic System 647

25 The Respiratory System 651

25.1 Overview of the Respiratory System 652

25.2 Organs of the Respiratory System 653

Nose 653

Pharynx 654

Larynx 654

Trachea 656

Bronchi and Bronchioles 656

Lungs 657

25.3 Pulmonary Ventilation 660

Muscles of Inhalation and Exhalation 661

Pressure Changes During Ventilation 662

Lung Volumes and Capacities 662

Breathing Patterns and Modified Respiratory Movements 664

25.4 Exchange of Oxygen and Carbon Dioxide 664

External Respiration: Pulmonary Gas Exchange 665

Internal Respiration: Systemic Gas Exchange 665

25.5 Transport of Respiratory Gases 667

Oxygen Transport 667

Dioxide Transport 667

25.6 Control of Respiration 667

Respiratory Center 668

Regulation of the Respiratory Center 669

25.7 Exercise and the Respiratory System 671

25.8 Aging and the Respiratory System 671

Exhibit 25.1 Contributions of the Respiratory System to Homeostasis 672

Key Medical Terms Associated with the Respiratory System 673

26 The Digestive System 677

26.1 Overview of the Digestive System 678

26.2 Layers of the GI Tract and the Peritoneum 679

26.3 Mouth 681

Tongue 681

Salivary Glands 682

Teeth 682

Digestion in the Mouth 683

26.4 Pharynx and Esophagus 683

26.5 Stomach 685

Structure of the Stomach 686

Digestion and Absorption in the Stomach 687

26.6 Pancreas 688

Structure of the Pancreas 688

Pancreatic Juice 688

26.7 Liver and Gallbladder 688

Structure of the Liver and Gallbladder 688

Blood Supply of the Liver 690

Bile 690

Functions of the Liver 691

26.8 Small Intestine 692

Structure of the Small Intestine 692

Intestinal Juice 694

Mechanical Digestion in the Small Intestine 694

Chemical Digestion in the Small Intestine 694

Absorption in the Small Intestine 695

26.9 Large Intestine 697

Structure of the Large Intestine 697

Digestion and Absorption in the Large Intestine 700

The Defecation Reflex 700

26.10 Phases of Digestion 700

Cephalic Phase 700

Gastric Phase 700

Intestinal Phase 701

26.11 Aging and the Digestive System 701

Exhibit 26.1 The Digestive System and Homeostasis 702

Key Medical Terms Associated with the Digestive System 703

27 Nutrition and Metabolism 707

27.1 Nutrients 708

Guidelines for Healthy Eating 708

Minerals 709

Vitamins 710

27.2 Metabolism 711

Carbohydrate Metabolism 714

Lipid Metabolism 716

Protein Metabolism 718

27.3 Metabolism and Body Heat 719

Measuring Heat 719

Body Temperature Homeostasis 719

Regulation of Body Temperature 720

Key Medical Terms Associated with Nutrition and Metabolism 722

28 The Urinary System 726

28.1 Overview of the Urinary System 727

28.2 Structure of the Kidneys 728

External Anatomy of the Kidneys 728

Internal Anatomy of the Kidneys 728

Renal Blood Supply 728

Nephrons 729

28.3 Functions of the Nephron 732

Glomerular Filtration 732

Tubular Reabsorption and Secretion 734

Components of Urine 736

28.4 Transportation, Storage, and Elimination of Urine 737

Ureters 737

Urinary Bladder 737

Urethra 737

Micturition 738

28.5 Aging and the Urinary System 739

Key Medical Terms Associated with the Urinary System 739

Exhibit 28.1 The Urinary System and Homeostasis 740

29 The Reproductive Systems 744

29.1 Introduction to the Reproductive Systems 745

29.2 Male Reproductive System 745

Scrotum 745

Testes 745

Ducts 749

Accessory Sex Glands 750

Penis 752

29.3 Female Reproductive System 752

Ovaries 752

Uterine Tubes 755

Uterus 755

Vagina 756

Perineum and Vulva 756

Mammary Glands 758

29.4 Female Reproductive Cycle 759

Hormonal Regulation of the Female Reproductive Cycle 759

Phases of the Female Reproductive Cycle 759

29.5 Aging and the Reproductive Systems 763

Exhibit 29.1 The Reproductive Systems and Homeostasis 765

Key Medical Terms Associated with the Reproductive Systems 766

Appendix A: Measurements A1

Appendix B: Periodic Table B3

Appendix C: Answers C4

Glossary G1

Credits CR1

Index I1