Kinesiology is the scientific study of human motion. Movement evaluation is an important component of clinical care, especially when you are looking at massage from an orthopedic perspective. Orthopedics is the branch of medicine that deals with function and problems within the locomotor (movement) systems. Consequently, kinesiology is at the root of the whole field of orthopedics, and the treatment of pain and injury conditions.

Kinesiology can be split into three distinct disciplines:

• Musculoskeletal anatomy: The study of structure and form

• Neuromuscular physiology: The coordinated activities of the neurological and muscular systems that govern movement

• Biomechanics: Principles of mechanical physics applied to the human body

 Let’s take a look at these areas and how their study relates to practical clinical applications of massage.

Musculoskeletal Anatomy

Studying anatomy is a significant component of most massage school training programs. For some, this study may have seemed like a constant process of memorization without a true understanding of real-life application. However, a thorough knowledge of the structure and function of the body is essential. This knowledge helps us recognize how specific tissues may be involved in a client’s pain complaint and what treatment strategies are likely to be most effective.

Studying kinesiology helps you appreciate the integrated function of tissues and physiological processes throughout the body. In massage school training, education is focused more on muscles than on other pain-producing locomotor tissues, such as ligaments, tendons, or nerves. It is great that we place so much attention on muscles; however, this focus comes at the cost of not paying attention to the role of other soft tissues involved in movement-system disorders. Applying the science of kinesiology helps massage therapists develop a more balanced approach.

Clinical Applications of Anatomy

There are many benefits of applying sound anatomical knowledge. If a client comes in and points to a location in which they are experiencing pain, we should recognize the structures. Likewise, if somebody reports having sustained a biomechanically involved injury, such as a high impact force on their shoulder like in a sports collision, we should understand what structures took the brunt of that force and may be involved in the injury.

Neuromuscular Physiology

While anatomy is the study of structure, physiology is the study of function. Proper movement requires a tightly integrated coordination with the neurological and muscular systems. Outgoing neurological signals are necessary to engage motor activity, while incoming neurological signals provide essential feedback to monitor movement. Interestingly, scientists were able to teach a computer how to beat a world-class chess champion before they were able to develop a mechanical robot that could consistently walk across the floor. That is how intricate neuromuscular integration is for just walking.

In kinesiology, the emphasis on neuromuscular physiology begins with a basic understanding of three types of muscular contractions in movement:

• Concentric contractions are muscle contractions in which the two ends of a muscle are brought closer together, and the overall length of the muscle shortens during the movement. Concentric contractions are generally associated with acceleration movements that are trying to overcome some existing force, such as gravity, moving a weight, or other external forces.

• Eccentric contractions are muscle contractions in which the two ends of the muscle are separated farther even though the muscle is still getting a contraction stimulus. Eccentric contractions are most commonly associated with deceleration movements or slowly resisting gravity.

• Isometric contractions are muscle contractions in which the muscle is getting a neurological stimulus, but the resistance is exactly matching the contraction stimulus, so there is no motion at the joint. Isometric contractions are most common for stabilizing a limb or resisting an ongoing opposing force. Contraction of the back-extensor muscles to maintain an upright posture against the force of gravity is a good example.

Another crucial facet of neuromuscular physiology is the complex system of proprioception. Proprioception is the sensory feedback that comes back to the brain about the body’s position in space, as well as information about the state of various tissues involved in movement. We often think of the most significant amount of sensory information coming back into the central nervous system from some of our primary sense organs, such as the eyes, nose, ears, or skin. However, our central nervous system actually receives the greatest amount of sensory nerves from the myofascial tissues.¹ Some of the most powerful effects of manual therapy are likely from neurological responses to pressure, movement, and quality of touch in our sessions. These are all factors that are monitored by various proprioceptors and give feedback to the central nervous system.

Clinical Applications of Physiology

It is unfortunate that understanding and recognizing different types of muscle contractions is often relegated to rote memorization and then forgotten. Analyzing different types of contractions used in various movements helps you determine how muscle overload may have contributed to specific injuries. Multiple treatment techniques and assessment strategies also incorporate different types of muscle contractions, so you need to be familiar with these and understand them to be most effective.

Biomechanics

Biomechanics is the study of how forces act on the body. It is an application of mechanical physics to our living organism. The term biomechanics is sometimes confused with body mechanics. The former term encompasses a broad application of mechanical physics, while the latter term defines how the body is used during massage treatments. There are components of biomechanics used to study body mechanics, but the two are not the same thing.

The realm of biomechanics is often divided into two primary categories—kinematics and kinetics. Kinematics is the study of movement in space, especially as it relates to the fundamental concepts of velocity, direction, time, and acceleration or deceleration. The focus of kinematics is on motion. In kinetics, the focus is on the force and energy required to produce or limit that motion. Kinetic analysis involves an application of these key concepts:

• Inertia indicates that an object will tend to stay in its current state, whether moving or at rest, unless acted upon by some outside force. You may remember this concept from science class as Newton’s first law.

• Mass is the amount of matter contained within an object. An object can be relatively small and still have a large mass. Consider the difference in mass between a shotput and a softball even though they are relatively the same size. The shotput has a much greater mass.

• Force is the amount of effort required to accelerate or decelerate a mass. There are five different types of force we evaluate in the body. Let’s take a look at all five, but keep in mind that the majority of soft-tissue injuries occur from one of the first two, either compression or tension.

1. Compression is a compressive force that occurs when two objects press against each other, such as two vertebrae compressing the disk between them.

2. Tension or tensile force occurs when two ends of an object are pulled away from each other. High tensile forces are responsible for muscle strains and ligament sprains.

3. Torsion occurs when an object is twisted, and is called a torsion force. Because soft tissues are attached at each end within the body and under the skin, it is hard to apply a torsion or twisting force to them. However, you could also consider a torsion force applied to a larger structure, such as an entire joint.

4. Bending force applies to rigid structures when one side of the rigid structure is exposed to compression and the other side to tension. Bending force requires a rigid structure, so it only applies to bone.

5. Shear force is when two structures slide against each other. Tendons in the distal extremities are exposed to shear force as they slide back and forth within their synovial sheaths.

Clinical Applications of Biomechanics

It may not be immediately apparent, but all of the physics involved with a kinetic analysis can play a crucial role in understanding what is involved in a particular injury. Kinetic analysis may also help us understand how forces we apply to a client’s body may affect the various tissues under our fingers. It may seem a little daunting at first, but when you begin to look at the body and how we work with it through a lens of kinetic analysis, you gain an appreciation for how this information can significantly enhance your clinical success.

Kinesiology in Action

Let’s take a look at a short case study example of how we might put some of this information into practice:

Ellen has come to our clinic complaining of sharp pains in her hand, which began shortly after an incident at her workplace where she grabbed a door handle to open the door at the same moment someone on the other side of the door rapidly pulled it open. Ellen’s hand was still firmly on the door latch when this happened, so she was quickly pulled into the other room.

Ellen immediately felt pain through her arm and into the palm of her hand, which has continued ever since that incident over a week and a half ago. Her description of the pain through her forearm and hand was that it was a sharp, shooting pain sensation. Ellen is now wondering whether massage might help address the problem.

The sharp, shooting pain sensation is a frequent description of various nerve compression pathologies. However, if we think about the injury from a biomechanical perspective, a nerve compression is not likely. The client described a situation in which she was holding onto a door handle as it was suddenly pulled away from her. That motion would have put a sudden tensile (pulling) load on her upper extremity. In this case, she likely suffered excessive neural tension, in which the nerve is exposed to excessive pulling stress. There could also have been significant tensile loads on the other soft tissues in the forearm or hand that could also be producing the symptoms.

It is valuable to consider a neural tension injury here as we construct a treatment plan for her. In neural tension injuries, it is very important to be cautious about applying pressure throughout the forearm muscles because if the nerve has been overstretched, applying any additional irritation to that nerve could aggravate the symptoms.

Neural tension injuries are best treated with very light work and treatment strategies that emphasize decreasing any additional loads on the nerve. We can focus on gentle, easy movement of the nervous system throughout the whole upper extremity and advise Ellen to avoid movements that further stretch the nerve. We would also let her know that nerves take more time to heal than muscles, and to be patient.

Had we not considered the kinesiology of Ellen’s condition, and simply treated her for generalized pain and hypertonicity, we could have easily worsened her condition. Or, had we made a quick determination based on her neurological symptoms that she had a compressive type nerve injury, we could have again not been effective at addressing the complaint. Kinesiology, in this case, makes our assessment more precise and accurate. Thus, her treatment will be more successful.

Kinesiology in Action

Not only is kinesiology a much broader science than you may have realized, it is also an integral part of becoming a highly skilled soft-tissue therapist when working with pain and injury complaints. An arsenal of techniques is essentially your bag of tools. However, even with a great bag of tools, if you don’t understand when to use a wrench and when to use a screwdriver—and how much force to use when you apply it—your work will be much less effective. 

Notes

1. Robert Schleip, “Fascial Plasticity: A New Neurobiological Explanation, Part 1,” Journal of Bodywork and Movement Therapies 7, no. 1 (January 2003): 11–19, https://doi.org/10.1016/S1360-8592(02)00067-0.