Learn: anatomy and clinical foundations

Human anatomy fundamentals

Anatomy describes the body in the anatomical position: standing upright, facing forwards, arms by the sides with the palms facing forwards.

• Planes: sagittal (divides left and right), frontal or coronal (front and back), transverse (upper and lower)
• Directional terms: anterior/posterior (front/back), superior/inferior (above/below), medial/lateral (towards/away from the midline), proximal/distal (nearer to/further from the trunk), superficial/deep
• Body systems relevant to physiotherapy: musculoskeletal, nervous, cardiovascular and respiratory

Musculoskeletal anatomy

The musculoskeletal system is made of bones, joints, muscles, tendons, ligaments, cartilage and fascia, working together to support and move the body.

• Bones provide structure, leverage, protection and blood-cell production; they adapt to load
• Joints: fibrous (no movement), cartilaginous (slight movement, e.g. discs) and synovial (free movement, e.g. hinge, ball-and-socket, pivot, saddle, condyloid and plane joints)
• Tendons connect muscle to bone; ligaments connect bone to bone
• Cartilage: hyaline cartilage covers joint surfaces; fibrocartilage forms the menisci and discs
• All these tissues adapt to the loads placed on them, which is the basis of exercise-based rehabilitation

Biomechanics

Biomechanics applies the principles of mechanics (forces, levers, motion) to the human body.

• Force, torque and moment arm: the turning effect of a force increases with its distance from the joint
• Most muscles work as third-class levers, trading force for speed and range
• Ground reaction force: the force the ground exerts on the body during standing, walking and landing
• Load and capacity: injury risk rises when load exceeds a tissue’s current capacity; rehabilitation builds capacity gradually
• Stress–strain: tissues deform under load and return to shape within their elastic limit

Kinesiology

Kinesiology is the study of human movement: how muscles, joints and the nervous system produce and control motion.

• Muscle roles: agonist (prime mover), antagonist (opposes), synergist (assists), stabiliser (holds a segment steady)
• Types of contraction: concentric (shortening), eccentric (lengthening under load), isometric (no change in length)
• Open-chain (the end segment moves freely, e.g. leg extension) and closed-chain movements (the end segment is fixed, e.g. squat)
• Motor control and motor learning: practice, feedback and variation improve movement skills

Joint movements

Movements are named from the anatomical position, in a plane and around an axis.

Muscle actions

A muscle’s action depends on where it attaches and which joints it crosses. Muscles crossing two joints (e.g. hamstrings, rectus femoris, gastrocnemius) act on both.

Posture and ergonomics

Posture is the position of the body at rest or during activity. There is no single correct posture; comfort and regular change of position matter most.

• A plumb line in side view passes roughly through the ear, shoulder and hip, and slightly in front of the knee and ankle
• Desk set-up: screen at eye level and an arm’s length away, feet supported, elbows near 90°, frequent movement breaks
• Lifting: keep the load close, plan the lift, and build up the weights you handle gradually
• Sustained postures, not any single posture, are most often associated with discomfort

Gait analysis

Gait analysis is the systematic study of walking, observed clinically or measured with technology such as motion capture and force plates.

• The gait cycle has a stance phase and a swing phase, each with sub-phases
• Spatiotemporal measures: walking speed, step and stride length, cadence
• Common deviations: antalgic (painful) gait, Trendelenburg gait (weak hip abductors), foot drop (weak dorsiflexors), circumduction after stroke
• Walking speed is a simple, useful measure of overall function

Range of motion

Range of motion (ROM) is the amount of movement at a joint, measured with a goniometer or inclinometer. Active ROM is produced by the person; passive ROM is produced by the examiner.

Typical adult reference values (American Academy of Orthopaedic Surgeons). Normal ranges vary with age, sex and the individual, and side-to-side comparison is often more useful.

Manual muscle testing

Manual muscle testing grades muscle strength against gravity and the examiner’s resistance, commonly with the Medical Research Council (Oxford) scale.

Grades 4 and 5 are less sensitive to change; hand-held dynamometers give more precise measurements.

Neurological examination

Physiotherapists screen nerve function when symptoms spread into a limb or when nerve or spinal cord involvement is possible.

Functional assessment

Functional assessment measures what a person can do in daily life, using performance tests and questionnaires.

Rehabilitation principles

Rehabilitation helps people return to the activities that matter to them, using goals agreed with the person.

• Person-centred, SMART goals (specific, measurable, achievable, relevant, time-bound)
• Progressive overload: gradually increase load, volume or difficulty
• Specificity: train the movements and tasks the person needs
• Load management and pain monitoring: some discomfort during exercise can be acceptable if it settles within 24 hours
• Phases: protect and calm, restore movement and strength, return to full function, prevent recurrence
• Education and self-management throughout
• Use outcome measures to track progress