8

Level 1.

1. Study the following diagram which presents body parts.

hair

forehead
ear
cheek
jaw (mandible) nose
chin
neck
shoulder
chest
(thorax)
armpit (axilla) breast
upper arm nipple

elbow
stomach, tummy,
loin belly (abdomen)

hip
forearm
palm
buttock
groin
wrist
hand
genitals

fingers,
thumb thigh

knee
calf

shin
leg

ankle
heel
foot
toes

back

loin

buttock

2. Study the following text on the human body.

9
The human body consists of a bony skeleton and muscles. The three main parts of the body are: the
head, the trunk and the limbs (extremities).
The head is composed of the cranial and facial parts. It contains the brain, the centre of the nervous
system. The cranium is partly covered with hair. The parts of the face are the forehead, the temples,
the ears, the eyes with eyebrows, the cheeks, the nose, the jaw, the mouth and the chin. The main
parts of the mouth are the lips, the tongue, the teeth, the palate and the gums. The eyes are
protected by eyelids and eyelashes. The eyes are the organs of sight, the nose is the organ of smell,
and the ears are the organs of hearing. The nerves of the skin are organs of touch. The five senses
are: sight, hearing, smell, taste and touch.
The head is attached to the trunk by the neck. The trunk includes the chest (in front), the back, the
shoulders and the abdomen. The internal organs, which we cannot see, are the heart, the lungs, the
stomach, the liver with the gall-bladder, the pancreas, the spleen, the kidneys and the small and
large intestines (bowels).
The arms and legs are called the limbs. The upper extremity (arm) consists of the upper arm, the
elbow, the forearm, the wrist and the hand with four fingers and one thumb. The inner side of the
hand is called the palm. The finger nails protect the finger tips. The lower extremity (leg) is
attached to the pelvic girdle. It is composed of the thigh, the knee with patella, the shin, the calf, the
ankle and the foot. Each foot has a heel, a sole and five toes. The movement of the body is produced
by the expansion and contraction of the muscles. The muscles are connected with the bones by
sinews, and the bones are bound together by ligaments.
Organs of the body are positioned within spaces called cavities. There are the following cavities in
the human body: cranial, spinal, thoracic, abdominal and pelvic.

3. Exercise: Indicate if the following statements are true ( T )or false ( F ).

a) The heart and the lungs are situated within the thoracic cavity.
b) The thorax lies above the diaphragm.
c) The internal organs contained in the thorax are the heart, the lungs, the trachea and the urinary
bladder.
d) The pelvic cavity lies below the abdominal cavity.
e) The inner side of the hand is called the forearm.

4. Exercise: Complete the following sentences:

a) The face is made up of the following parts:

b) The trunk consists of two cavities, which are:
c) The main internal organs in the trunk are:
d) The upper extremity is divided into:
e) The parts of the lower extremity are:

10
 5. Study the following vocabulary related to the body

HEAD AND ARMS AND LEGS AND FEET TRUNK GENERAL

SHOULDERS HANDS WORDS

Chin Elbow Ankle Back Blood Bleed

Cheek Finger Index Point Calf Bottom Bone Break

Little Poke Support

Middle Scratch

Pinch

Ear Finger nail Clip Foot (feet) Kick Chest Cough Hair Grow

Eye Eyebrow Blink Fist Punch Heel Stomach Digest Muscle Pull

Glance Growl Sprain

Eyelash Stare Strain

Wink Relax

Blink Contract

Forehead Forearm Hip Waist Bend Skin Feel

Hair Hand Clap Knee Bend Shoulder Shrug

Grab

Shake

Slap

Smack

Head Nod Palm Pat Leg Limp

Shake Rub Paddle

Tap

Lip Kiss Thumb Stub Shin

Mouth Eat Wrist Bend Thigh

Mutter Flex

Talk

Taste

Whisper

Hum

Neck Bend Toe Big toe Stub

Little Curl
toe

Nose Breathe Toenail Clip

11
 Smell

Sniff

Nostril

Jaw

Tooth Bite

Chew

Tongue Lick

Throat Swallow

6. EXERCISE. Identify the body parts marked A, B, C...

F
A
G

H
B
I

7. Exercise: Fill in the blanks with appropriate words.

a) Teeth are used to _______________ food

b) The tongue is used to _______________ objects.
c) The throat allows you to _____________ food
d) It hurts if you ________________ your toe.
e) Lips are used for ______________ your loved ones
f) You _________________ through your nose.
g) He refused to give us any further explanations; he just __________ his shoulders.
h) As she could hardly speak, the patient simply ___________ her head to say yes.
i) The little boy couldn’t stop ______________ his arm; then, they found out he had a rash.

12
j) Everybody _____________ at him when he entered the room because he was very late.

8. Read the following text that presents clinical anatomy terms to describe the main body
regions.

In clinical anatomy the body is divided into eight regions. To understand how those anatomical
regions relate to one another requires you to learn the terminology. Imagine the body standing in
the following anatomical position:

CEPHALIC

CERVICAL

DORSAL

THORAX

UPPER
EXTREMITIES
ABDOMINAL

PELVIC

LOWER
EXTREMITIES

Here’s a look at all of the major regions (from the outside of the body) and how they relate to each
other:

The cephalic region (head) is at the top of the body and visible from the front and rear.

The cervical region (neck) starts below the head and ends at the thorax, and is visible from the
front and rear from below the head to the shoulders.

The dorsal region (back) runs from immediately below the neck down to the area below the
waist. It doesn’t include the shoulders. It’s visible from the rear.

The thorax (thoracic region) starts immediately below the neck, at the clavicles, and ends
along the bottom of the ribcage. It’s visible from the front.

The abdomen (abdominal region) starts along the bottom of the ribcage and extends to the
hips. It’s visible from the front.

The pelvis (pelvic region) starts where the abdomen ends and takes up the area between the
hip bones.

13
 The upper extremities include the shoulders, arms, forearms, elbows, wrists, and hands and
are visible from the front and the rear.

The lower extremities include the hips, buttocks, thighs, knees, legs, ankles, and feet. The
buttocks are visible only from the rear, but the rest of the lower extremities are visible from
the front and the rear.

9. Exercise: Identify the following body regions.

Pelvic Cervical Dorsal

Cephalic Abdominal Thoracic

10. Exercise: Select the correct answer from the choices provided.

a. Which of the following body cavities contains the heart?

1) spinal 2) thoracic 3) cranial 4) abdominal

b. Where can we find the wrist in the body?

1) on the arm 2) on the leg 3) on the thorax 4) on the head

c. The part of the face that is used for breathing and smelling is called the
1) mouth 2) ear 3) eye 4) nose

d. A part of the arm is called

1) the shoulder 2) the back 3) the foot 4) the calf

14
e. Some of the organs of reproduction are found in the
1) pelvis 2) thorax 3) back 4) cranium

f. Which parts of the lower limbs are visible only from the rear?
1) thighs 2) groin 3) glutei 4) kneecaps

g. The shoulders are an important part of the

1) thoracic region 2) cervical region 3) brachial region 4) dorsal region

h. The superior starting point of the thorax is located at the

1) collar bone 2) breast bone 3) shoulder blade 4) floating ribs

15
LEVEL 2

1. Study the following text on body regions.

The eight main body regions may be subdivided, in turn, into smaller areas. In this text, we will
examine the subdivisions of the body regions of the axial skeleton.
Thus, the cephalic region would include the following subdivisions:

Cranial: Frontal: The frontal region runs from the front portion of the skull above the eyes
down to the roof of the nasal cavity, and includes the forehead and the roofs of the orbits
(bony sockets) of the eyes.Temporal: The region of the temple is on the side of the head as far
forward as the eye and as low as the zygoma and infratemporal crest.

Facial: Orbital: This region is located in the upper half of the face below the anterior cranial
fossa –right below the frontal region, and anterior to the middle cranial fossa, and includes the
eyeball, the optic nerve, the extra-ocular muscles and the lacrimal apparatus.Otic: This region
is located in the posterolateral part of the cranium and structurally supports the
vestibuloauditory system. It may be considered as a sub- division of the temporal region.
Buccal: The buccal region, which has nothing to do with the mouth, is located in the space
between the mandible and the maxilla, corresponding approximately to the outlines of the
underlying buccinator muscle. Nasal: The nasal region is located over the oral region and right
below the orbital and frontal regions. It is the uppermost part of the respiratory tract and
contains the olfactory receptors in three subsections: the nasal vestibule, the respiratory
region and the olfactory region.Oral: The oral region lies below the cephalic midline, inferior
and medial to the orbital cavities, inferior to the nasal region, anterior to the pharynx and
inferior to the infratemporal fossa.Mental: This region, which has nothing to do with the mind,
is located in the median part of the mandible, right below the oral region.

The dorsal region comprises the following divisions:Scapular: The scapular region is on the
superior posterior surface of the trunk and is defined by the muscles that attach to the scapula
(shoulder blade).Thoracic: The thoracic region comprises both the anterior and posterior surfaces
of the trunk. Superiorly, its anterior boundaries are located at the jugular notch, along the
sternoclavicular joint, and the superior border of the clavicle; posteriorly, its superior limit is found
at the spinous processes of C7. Its inferior boundaries are defined –anteriorly- by the xiphoid
process, and the 12th and 11th ribs, and –posteriorly- by T12.Umbilical: This region is an
abdominal sub-division that lies inferior to the thoracic region and surrounds the navel
(umbilicus). It can only be seen anteriorly.

Lumbar: The lumbar region lies lateral to the lumbar vertebrae. It is, therefore, only visible from
the back, and comprises the five lumbar vertebrae.

Sacral: The sacral region (sacrum) is at the bottom of the spine and lies between the fifth segment
of the lumbar spine (L5) and the coccyx (tailbone).Gluteal: The gluteal region is located posteriorly
to the pelvic girdle, at the proximal end of the femur.

Perineal: This is generally defined as the region between the pubic symphysis and the coccyx. It is a
diamond-shaped area on the inferior surface of the trunk, which includes the anus and, in females,
also the vagina.

Pubic: This is the lowest part of the abdomen; it lies inferior to the umbilical region and between
the inguinal regions. It is sometimes referred to as the hypogastrium.

16
Inguinal: This region is located in the lower portion of the abdomen, with the thigh inferiorly, the
pubic tubercle medially, and the anterior superior iliac spine superolaterally.

2. Exercise. Identify the following body regions.

Inguinal Cervical Lumbar Scapular

Otic Abdominal Oral Sacral

Umbilical Thoracic Gluteal Pubic

3. Study the following text on body regions.

The upper limb, which is part of the appendicular skeleton, comprises the following
divisions:Acromial: It comprises the outward end of the spine of the scapula or shoulder blade.

Axillary: the axillary region is located in the area of the superior thorax surrounding the axilla
(armpit), lateral to the pectoral region.

Brachial: It refers to the proximal part of the arm (from the distal end of the shoulder to the
proximal side of the elbow). Since this region can be seen anteriorly and posteriorly, it is divided
into anterior and posterior brachial regions.

Antecubital: Rarely used in PT, this region comprises the area from the distal end of the humerus to
the proximal ends of the ulna and radius.

Olecranal: Not very commonly used in PT settings, this region comprises the part of the ulna
beyond the elbow joint. It can only be seen posteriorly.

17
Antebrachial: It refers to the distal part of the arm (from the lower end of the elbow to the hand);
again, since it can be seen posteriorly and anteriorly, it is divided into anterior and posterior
antebrachial regions.

Carpal: This is the region of the wrist; it comprises the part between the antebrachial region
proximally and the manus (hand) region distally.

Manus: This is the distal region of the upper limb, distal to the carpal region. It comprises several
subdivisions:

Pollex: This is the region of the hand (manus) that comprises all the
structures of the thumb. It can be seen anteriorly and posteriorly.
Digital: This region comprises the fingers (phalanges). It extends distally
from the carpal region and is posterior to the palmar (palm of the hand)
region.
Palmar: This region refers to the ventral region of the hand, anterior to
the digital region.
4. Exercise: Identify the following body regions.
Mental Gluteal Olecranal Palmar
Acromial Pelvic Scapular Pollex
Axillary Sacral Orbital Antecubital

5. Study the following text on body regions.

The lower limb comprises the following regions:

Femoral: The femoral (thigh) region runs, proximally, from the pelvic region, and distally,
to the patellar region. This is a very large area, which is why it is commonly further
subdivided according to the view from which it is observed. Thus, reference may be made
to lateral, anterior, and posterior femoral sub-regions to describe particular structures
within the femoral region.

Patellar: The region of the patella (kneecap) has its boundaries, proximally, at the distal
end of the femur, and distally at the proximal ends of the fibula and the tibia. It can only be
seen anteriorly or laterally.

Popliteal: Often referred to as the kneepit, this region can only be seen posteriorly and
comprises the back of the patellar region. Thus, it comprises the distal posterior end of the
femur and the proximal posterior end of the tibia.

18
 Crural: This region is located anteriorly, from the distal end of the patella to the proximal
end of the ankle (tarsal) region. Since it comprises a long stretch of significant skeletal and
muscular structures, it is usually subdivided into proximal, medial and distal regions. In
some taxonomies, the external medial section of the crural region may be called the
peroneal (fibular) region.

Sural: The sural (calf) region is located on the posterior part of the lower leg, and it can
only be seen posteriorly. Again, because of its size, it is subdivided into proximal, medial,
and distal regions.

Tarsal: The tarsal (ankle) region is located anteriorly at the distal end of the crural region,
at the proximal end of the digital region, and superior and anterior to the calcaneal region.
It can only be seen frontally or laterally. It comprises a significant number of bones and
joints, and it is therefore subdivided into proximal, medial and distal groups of such bones
and joints.

Calcaneal: The calcaneal (heel) region can only be seen from a posterior perspective. It lies
inferior and posterior to the tarsal region and at the distal end of the fibula.

Digital: This region comprises the toes. It extends distally from the tarsal region and it is
anterior to the plantar (sole of the foot) region and anterior and superior to the calcaneal
region.

Hallux: This is the region of the foot that comprises all the structures of the big toe. It can
be seen anteriorly and superiorly.

Plantar: This region comprises the inferior aspect of the foot.

6. Exercise. Identify the following body regions.

Sural Crural Popliteal Palmar
Tarsal Pelvic Scapular Hallux
Axillary Sacral Femoral Antecubital

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7. Exercise: Match the following Plain English nouns with the anatomical descriptive adjectives:
COLUMN A COLUMN B
(1) skull (a) axillary
(2) eye (b) inguinal
(3) cheek (c) cervical
(4) armpit (d) cranial
(5) arm (e) oral
(6) groin (f) brachial
(7) buttock (g) orbital
(8) neck (h) gluteal
(9) mouth (i) buccal
(10) hip ( j) coxal

8. Exercise. Match the terms in Column A with the terms in Column B.

COLUMN A COLUMN B
Skull Phalanges
Jaw bone Femur
Spine Scapula
Breastbone Sternum
Rib Patella
Collarbone Maxilla
Shoulder blade Vertebral column
Thigh bone Mandible
Kneecap Frontal
Shinbone Cranium
Forehead Costa
Cheek Coxis
Finger Tibia
Tailbone Clavicle

20
9. Study the following instructions to patients and the accompanying diagram
Stand upright Lie down With apart
your
feet

erect on your astride

back

up straight on your together

side

With your At your Raise Your legs

arms sides
Lower
Bend
Straighten
Tuck in

Extended Arms
over your
head

Stretched Body
sideways

Bend At your waist

down

Bob Your Head

up/down

Look right Look left Look up

Look straight ahead Look down Tilt your head to the right

21
 Tilt your head to the left Cross your arms Put your arms out at your sides

Put your arms at your sides Put your hands in your pockets Put your hands on your hips

Put your arms straight out (in Put your arms in front of you Put your hands on top of your
front of you) with your elbows bent up head

Put your hands on your Put your arms straight up over Put your hands behind your
shoulders your head head

22
 Put your hands behind your
Put your hands over your face
back

Stand with your left leg forward

Stand with your legs apart Stand with your legs together
and your right leg back

Stand on your left leg Stand with your legs crossed Sit on a chair

Sit on a chair with your right leg Sit on the floor with your legs Sit on the floor with your legs
over your left knee straight out crossed

23
Sit on the floor with your knees Sit on a chair with your right
Stoop
bent ankle over your left knee

Get down on your hands and

Kneel Bend over at your waist
knees

Lean on the table with your left

Stand on your hands Stand on your head
hand

Lean against the wall with your

Lie on your back Lie on your stomach
left shoulder

Lie on your right side Lie on your left side

24
10. Exercise. You will find below instructions for several physical exercises to be done in
pairs. While one student reads the instruction aloud, the other will carry out each of the
exercises. The first student will also be responsible for assessing whether the instructions
are being properly followed or not.
a) Stand with your back straight against the
wall. Keep your feet astride. Extend your
arms at your sides and bob your head up
and down for five repetitions.
b) Lie flat on your back with your knees
bent and your hands clasped behind your
head.
c) Bring your right arm out in front of you
and use your left arm to pull your right
elbow across your chest.
d) Lie flat on your back with your legs
straight and your arms at your side.
Raise both legs over your head and try to
touch the floor behind your head.
e) Stand at 90 degrees to a wall, with your
left side near the wall, and place your left
hand on the wall for support. Grasp your
right ankle with your right hand and pull
the foot up as high as possible towards
your body. Lean forwards from the waist
as you do this.
f) Sit on the floor with your right leg
extended straight ahead. Bend your left
knee and tuck your left foot in behind
you, close to your body. Slowly slide your
hands down to the extended leg and try
to touch your right foot.
g) Sit on the floor with your legs extended
in front of you, apart. Rest your left hand
on your left thigh and grasp the inside of
your right foot with your right hand.
Slowly lift and straighten the right leg
until it is about 45 degrees from the
floor.
h) Roll fists forward (boxers speed bag
movement), then reverse the direction.
First roll fists at face level, then slowly
raise arms (alternate levels). Roll fists
first to the left, then to the right.
i) Stand with your legs astride. Bend your
trunk forward until it is about 90 degrees
from the floor and grasp your knees.
Straighten your legs while you do this.
Tilt your head first left and then right.
Slowly lift your trunk while holding
knees with both hands.
11. Study the following text on body structures.
BODY STRUCTURES INVOLVED IN HUMAN MOVEMENT
Bone
j) Lie down on your stomach. Stretch your
arms above your head as far as you can.
Lift your right leg until it is 45 degrees
from the floor. Hold it in that position for
5 seconds and slowly bend your leg
backwards. Release the position
gradually until your knee is back on the
floor. Bring your arms down to the sides
of your trunk. Repeat the same action
with the left leg.
k) Sit on a chair. Place both hands around
your left leg and pull it up toward your
chest while keeping the sole of your right
foot on the floor. Gradually release the
position until the sole of your left leg is
back on the ground. Repeat the same
exercise with your right leg.
l) Stand with your feet together. Keep your
arms at your side, palms facing your
thighs. Stretch your right arm over your
head. Bring your left arm in front of you
and bend your left elbow to reach the
right scapula below your armpit. Turn
your head to the left. Release the position
of your head. Put your left arm back in
front of you. Lower it to touch your thigh
with the palm of your hand. Lower your
right arm into the initial position. Repeat
the same exercise with your left arm.
m) Sit on the floor with your legs crossed.
Bring your arms in front of you and bend
over at your waist until your trunk is 45
degrees from the floor. Lift your trunk
slowly and put your hands on your lap.
Sit on the floor with your legs straight and
straighten your back. Put your arms at your
side. Place the palms of your hands on the
floor, bend your arms and push up until your
buttocks are in the air. Gently release the
position until your buttocks are back on the
floor. Repeat five times.
The forces placed upon bones influence their
shape. Gravity and compression determine
the density of bones while tension from the
25
pulling of tendons shapes their bumps and
ridges. Familiarity with these topographical
features can help you to understand the
functions of bones and how they interact
with other structures in the body.
Palpating Bone
Superficial bones are relatively easy to
palpate because their firmness and constant
shape make them easy to locate. Also,
successful palpation of bone is necessary
before we can find ligaments and tendons
that hold bones together and connect
muscles to them. Below are specific steps for
palpating bone:
1. Hold your arm out in front of you with
your elbow bent.
2. With the pads of your fingers and/or the
palm of your hand, find the pointy end of
your elbow (this is the olecranon process of
the ulna).
3. Still palpating, bend and straighten your
arm. The bone that you feel should retain its
shape as you move your arm.
4. Keep the same position and move your
fingertips and thumb toward the sides of
your elbow. You should find two hard bumps,
one on each side of your elbow (these are the
epicondyles of the humerus).
5. Bend and straighten your elbow while
gently holding these bumps with your fingers
and thumb. They should also maintain their
shape as you move your arm.
6. Gently feel for the edges and features of
these structures. See how far you can follow
the olecranon process of the ulna distally
toward your hand. See how far you can
follow the epicondyles of the humerus
proximally toward your shoulder.
7. Practice this exercise on different parts of
your body.
Good places to practice are around the
clavicle (collarbone), the patella (kneecap),
and malleolus (ankle).
8. Practice this same exercise on different
people. Compare yourself and these other
people. What features and qualities are
similar? What things are different?
Ligament
Palpating Ligaments
Because ligaments and tendons often reside
in similar locations in the body, they can be
difficult to differentiate. One strategy for
finding ligaments is to palpate the ends of
two adjacent bones and then search for the
fibrous connections between them.
Movement will also help you differentiate
these two types of tissue. Tendons will
change shape and become more taut during
muscle contractions, while ligaments remain
relatively constant.
1. To palpate ligaments, let's move to our
feet. Remove your shoes and socks and cross
your legs with one foot resting on the
opposite knee.
2. Find the medial malleolus (inside ankle
bone) with the pad of your thumb.
3. Move your thumb to the bottom edge of
the anklebone and slightly anterior.
4. Actively move your foot around in circles
as you press down with your thumb, locating
the space between the ankle and foot bones.
You should notice the gap between the bones
opening and allowing the deltoid ligament to
come closer to the surface and thus be easier
to palpate.
5. Several ligaments in addition to the deltoid
ligament stabilize the ankle joint. Practice
feeling the difference between the bones, the
ligaments, and the tendons that reside
around the ankle and foot.
6. Practice this exercise with different people
and compare your results.
Muscle
Palpating Muscle
Deep muscles are difficult for beginners to
palpate. So let's begin our exploration of
muscle palpation with some superficial
muscles:
1. Wrap your hand around your opposite
forearm, just distal to the elbow. With your
forearm relaxed, the flesh should feel soft and
pliable.
2. Slowly bend your wrist back and forth.
Notice how the flesh under your palm
changes as you move your other wrist back
and forth.
3. Pay attention to which movement makes
the muscles feel stretched and taut and which
makes the muscles feel contracted and thick.
4. Wrap your hand around different locations
on the forearm and continue this exercise.
Are there locations that move more than
others? Can you visualize what the muscles
look like under your hand? How does muscle
feel compared to bone?
26
5. Try this exercise on different parts of your
body. Good places to practice are around the
shoulder and knee. Use movement to stretch
and contract muscles in order to more clearly
visualize them.
6. Try this same exercise with different
people. Compare your findings.
Tendon
Palpating Tendons
When palpating tendons, it helps to find a
muscle and then follow the fibers until they
become smoother prior to attaching to bone.
This transition to smoother tissue is that
convergence from the muscle's connective
tissue wrapping to its tendon. To explore
palpation of tendons, let's use a group whose
location and movement we can find easily.
1: Lay the pad of your thumb across the
inside of your opposite wrist.
2. Gently strum your thumb back and forth,
feeling the tendons just under the skin.
3. Hold your thumb still as you open and
close your hand. Do the tendons move and
change? How?
4. Continue to hold your thumb still as you
wiggle your fingers. Do the tendons move
and change? How?
5. Follow the tendons with the pad of your
thumb proximally toward the elbow. Can you
feel when the tendons transition to muscle?
6. Follow the tendons distally toward the
hand. Can you feel where the tendons insert
on the bone? This is more easily felt when
following tendons on the back of the hand.
7. Repeat this process at different locations
on your body. Good places to practice are
around the patella (kneecap) and the dorsal
surface of the foot.
8. Try this exercise with different people and
compare your findings.
Fascia
Palpating Fascia
Fascia is unique from other body tissues in
that it links different structures together,
binding and organizing the body.
The complexity of the fascial network is
hinted at on the surface of the body with
hanger's lines: normal, permanent skin
creases that reflect the fiber orientation of
the fascia and muscles that lie below. Fascia
can feel wavy, dense, or smooth upon
palpation, depending on location and the
health of the tissue.
Like all connective tissue, fascia has the
ability to be solid and firm or liquid and fluid
in nature. Which form it takes depends upon
temperature, pressure, and tension applied
to the tissue. This, in combination with its
presence in multiple layers and nearly
everywhere in the body, can make palpation
of fascia more challenging than palpation of
the other structures of human movement.
Let's start by trying to palpate the fascia of
your elbow and forearm:
1. Slightly flex one arm and grasp the loose
skin at the point of your elbow with the
thumb and fingers of your opposite hand.
2. Grasp firmly and see if you can roll the
flesh between your fingers. This is the
superficial fascia.
3. Bend and straighten your elbow as you
keep hold of the flesh between your fingers.
Feel the alternating tension and slack.
4. Grasp in the same way at different
locations on your forearm. Find a mark on
your skin, such as a freckle, mole, or scar, or
make a pen mark somewhere on your arm.
Keeping your eyes on the mark, see if you can
cause it to move by pulling the flesh on
different parts of your arm.
5. Practice this exercise at different locations
on your body such as your patella (kneecap)
or abdomen (belly). Compare the
"movement" of the flesh at different
locations.
See if the amount of movement changes the
more you palpate the area.
6. Practice this exercise on different people.
Compare "movement" as well as sensitivity in
different areas and different people.
Skin
Palpating Skin
Skin is the most superficial tissue and
therefore very easy to palpate. Pay attention
to the temperature, pliability, and texture of
skin as you palpate. Below are specific steps
for palpating skin:
1. Place the pads of your index finger on the
palm of your opposite hand.
2. Brush your fingertips lightly over the skin
without moving it. Is the skin smooth or
rough? Are there ridges, bumps, or calluses?
Is the skin oily, sweaty, or dry?
27
What color is the skin? Repeat on the back of
the hand.
3. Bring your fingertips again to the palm of
your hand.
4. Keep both hands relaxed and make small,
deep circles with your fingertips on your
palm. Try and make the skin move.
5. Open your hand wider and observe if the
skin changes.
12. Exercise: Fill in the blanks with appropriate words.
6. Repeat this exercise on the back of your
hand. What qualities are different about the
skin on the palm of your hand compared to
the back? What qualities are the same? Do
any of these qualities change with your
touch?
7. Try this exercise on different parts of your
body and compare your findings.
8. Try this exercise on different people and
compare your findings.

a) Fascia is unique from other body tissues in that ………

b) Several ligaments in addition to the ………. ligament stabilize the ankle joint
c) During muscle contractions,……………………… will change shape and become more taut while
…………. remain relatively constant
d) Hanger's lines are normal, permanent skin creases that reflect the fiber orientation of the fascia
and ……………………. that lie below.
e) Because of its nature and its distribution in several layers, palpation of ______________ is more
challenging than palpation of any other structure in the body.
f) Before a muscle inserts into a bone, that convergence from the muscle's connective tissue
wrapping forms the _________________.
g) Palpating bones is easy because …………………………….. make them easy to locate.

LEVEL 3

1. Study the following text dealing with anatomical positions and body planes.

Anatomical positions.

The term “anatomical position” has two
different meanings:
On the one hand, anatomical position is
understood as the reference position of the
body, i.e. with head facing forwards, neck and
trunk erect, pectoral and pelvic girdles, arms
and legs oriented primarily on the frontal
plane; arms aligned to the frontal plane with
elbow joints extended with palms facing
forwards, the legs perpendicular to
horizontal and parallel to sagittal planes,
with hip and knee joints extended, and the
feet parallel to the sagittal plane with plantar
surfaces on the horizontal plane.
On the other hand, anatomical position is not
only the aforementioned standard position of
the body used when describing body parts
and their relation to each other (standing
erect, facing forward, feet together and arms
at the side with the palms facing forward),
but also the term of comparison to situate
different parts of the body. Hence, the terms
superior, inferior, anterior, posterior, medial,
lateral, proximal and distal refer to the
“anatomical position” and not any other
anatomical reference.
superior/inferior = nearer head/feet;
anterior/posterior = nearer front/back;
medial/lateral = nearer to/further from the
midline; proximal/distal: in the limbs nearer
to/further from the trunk; in other structures
(e.g. blood vessels, digestive tract) nearer
to/further from point of origin.
Body planes.
Three basic reference planes are used in
human anatomy.
A sagittal plane, which is a plane
parallel to the sagittal suture, divides
the body into sinister and dexter
(left and right) portions.
o The midsagittal or median
plane is in the midline; i.e. it

28
 would pass through midline cranial and caudal (head and tail)
structures such as the navel portions.
or spine, and all other
When describing anatomical motion, these
sagittal planes (also referred
planes describe the axis along which an
to as parasagittal planes)
action is performed. So by moving through
are parallel to it. Median can
the transverse plane, movement travels from
also refer to the midsagittal
head to toe. For example, if a person jumped
plane of other structures,
directly up and then down, the body would
such as a digit.
be moving through the transverse plane in
A coronal or frontal plane divides the coronal and sagittal planes.
the body into dorsal and ventral
A longitudinal plane is any plane
(back and front, or posterior and
perpendicular to the transverse plane. The
anterior) portions.
coronal plane and the sagittal plane are
A transverse plane, also known as examples of longitudinal planes.
cross-section, divides the body into
2. Exercise. Identify the body planes in the pictures below.

3. Study the following text dealing with movement in relation to body parts and regions.

Imagine that a client is referred to you
because he "can't use his arm." You might
wonder what this means. Which joint is
involved? What movements are affected? Or
perhaps you've been further instructed to
"look at his golf swing."
How would you describe what you are
seeing? Fortunately, a universal system of
communication has been established to

29
precisely describe the regions of the human
body and their movements. This shared
language, called anatomical terminology,
allows for a common understanding and
point of reference for professionals, scholars,
and students. We begin by introducing you to
this specialized language.
Human movement requires the coordinated
efforts of several body structures. The bones
and muscles provide a system of levers,
which are held together by ligaments,
tendons, joint capsules, and fascia. These are
supported by special structures that provide
nutrients, stimulation, or protection.
COMMUNICATING ABOUT THE BODY
When communicating about the human body,
it is important to use the language that has
been agreed upon by scientists, scholars, and
health care providers.
Regional Terms
If a classmate were describing to you a tissue
injury in a client's leg, you might assume that
the injury was located in the thigh when your
classmate actually meant the lower leg. To
avoid such mix-ups, precise names are
assigned to different regions of the body. This
is the first point of reference and the
beginning of anatomical communication.
Anatomical Position
Even when using regional terminology,
miscommunication can occur if both parties
don't share the same point of reference.
That's where the anatomical position comes
in. In western medicine, anatomical position
is described as body erect and facing
forward, feet parallel, arms extended at the
sides, and palms facing forward. This
position of the body is used to describe the
relative location of anatomical features as
well as to describe movements of the various
parts of the body. Most anatomical textbooks
and charts utilize this position when
depicting and describing the body's
structures.
Directional Terms
Starting from anatomical position, you can
describe relative positions of different body
structures. For example:
• The chest is anterior to the spine.
• The hand is distal to the elbow; that is, the
hand is farther from the point of attachment
than the elbow, which is more proximal.
• The head is superior to the shoulders.
• The nose is medial to the ears; that is, the
nose is closer to the body midline than the
ears, which are more lateral.
Directional terms are useful for describing
the location of injuries, as in. "The client is
experiencing soreness about two inches
proximal to the left patella." They are also
useful when describing positions of the body,
such as. "The athlete should finish the
movement with the hands just lateral to the
hips."
Other relative terms describe how close to
the surface of the body a structure lies. These
include the terms superficial (closer to the
surface) and deep (farther from the surface
of the body). For example, the scalp is
superficial to the skull, whereas the brain is
deep to the skull.
Planes of Movement
Now that anatomical position and
appropriate directional terminology have
been established, we're ready to explore the
language of human movement. The human
body moves in complex ways, which can
make description difficult.
Scientists have categorized and simplified the
terminology of human movement in an effort
to heighten understanding and
communication. This strategy encourages
consistent description and analysis of
complex human movements by breaking
them down into simpler parts.
Motions occur at the joints of the body in one
of three general directions: front to back, side
to side, or rotationally.
To describe these movements precisely, it
helps to visualize the body transected by one
of three large imaginary planes.
The first plane, which divides the body
vertically into right and left halves, is called
the sagittal plane. Front-to-back movements
occur parallel to this imaginary plane.
Swinging your arms and legs back and forth
with walking are examples of sagittal
movements.
The second plane divides the body into front
and back halves. It is called the frontal
plane. Side-to-side movements occur parallel
to this imaginary plane. The arm and leg
movements that occur when you do jumping
jacks are examples of frontal movements.
The third plane divides the body into
superior and inferior regions. It is called the
transverse plane. Rotational or turning
30
movements occur parallel to this imaginary
plane. Turning your leg out or turning your
head to look over your shoulder are
examples of transverse movements. The
word transverse means "across," so a
transverse view of the body is sometimes
referred to as a cross-section.
Axes
Each of the three types of movement, sagittal
(front-to-back), frontal (side-to-side), and
transverse (rotational) must occur around an
axis (a pivot point). Visualize a wheel turning
on its axle. The axle is the axis that the wheel
turns around. Each of the three planes of
movements has a corresponding axis around
which movement occurs. This axis is always
perpendicular (at a right angle) to the
corresponding plane.
Understanding these imaginary axes, along
with their counterpart planes, helps us
communicate precisely about movement. For
example:
• The front-to-back movements that occur on
the sagittal plane pivot around the frontal
axis. This means that movements such as
swinging your arms while walking (front to
back) occur in the sagittal plane and pivot
around an imaginary line that goes through
the shoulder from right to left. This is also
true when you bend forward at the waist.
The body is moving in the sagittal plane
(front to back) around a frontal axis
(transecting at a right angle side to side) that
goes through the pelvis.
• The side-to-side movements that occur in
the frontal plane pivot around the sagittal
axis. This means that the leg and arm
movements during jumping jacks occur in the
frontal plane and pivot around imaginary
lines that go through the hips and shoulders
from front to back. This is also true when you
tip your head to the side. This movement
occurs on the frontal plane (side to side)
around a sagittal axis (transecting at a right
angle front to back) that goes through the
cervical vertebrae of the neck.
• Finally, the rotational movements that
occur on the transverse plane pivot around
4. Exercise. Indicate, for each of the movements presented in Column A, either the missing
axis of movement in Column B or the missing plane of movement in Column C.
COLUMN A (Movement) COLUMN B (Axis)
the longitudinal axis. For example, the
movement of turning your head to look over
your shoulder occurs in the transverse plane
and pivots around an imaginary line that
runs superiorly-inferiorly through the spine.
Similarly, when you turn your shoulder to
throw a Frisbee, your arm turns on the
transverse plane (rotation) around a
longitudinal axis through the shoulder
(transecting at a right angle up and down).
Joint Movements
Movements that occur along each of the three
planes and their corresponding axes have
unique names. Motions that occur on the
sagittal plane around the frontal axis are
called flexion and extension. Flexion
describes the bending of a joint on this plane
so that the joint angle is made smaller.
Extension describes the movement of a joint
on this plane so that the joint angle is made
larger.
Motions that occur on the frontal plane
around a sagittal axis are called abduction
and adduction. Abduction occurs when an
extremity (arm or leg) or part of an extremity
(hand, fingers, etc.) is moved away from the
center or midline of the body. Adduction
occurs when an extremity or part of an
extremity is moved toward the midline of the
body. Remember, anatomical position is
always the starting point when describing
relative position or movement. Therefore,
abducting the hand describes bending the
wrist toward the thumb and adducting
describes bending the wrist toward the pinky
finger.
Finally, motions that occur on the transverse
plane around the longitudinal axis are simply
called rotation. Rotational movements in the
trunk are differentiated as right rotation
and left rotation, while these same
movements in the extremities are termed
internal rotation and external rotation.
Internal rotation describes turning motions
toward the midline and external rotation
describes turning motions away from the
midline of the body. These same motions are
also called medial (internal) and lateral
(external) rotation.
COLUMN C (Plane)
31
Stride Jump Antero-Posterior

Side Bend Frontal

Elbow extension Sagittal

Nodding head “yes” Bilateral

Twirling Transverse

Shaking head “no” Coronal or Polar

5. Exercise. Different motions are listed below. Match each motion found in Column A with
the correct plane and axis presented in Columns B and C. Answers may be used more than
once.

COLUMN A (Motion) COLUMN B (Plane) COLUMN C (Axis)

1. Lateral rotation a. Sagittal plane A. Frontal axis

2. External rotation b. Transverse plane B. Longitudinal axis

3. Flexion c. Frontal plane C. Sagittal axis

4. Adduction

5. Abduction

6. Medial rotation

6. Exercise. Fill in the blanks with appropriate words.

Axis of rotation is always (a) ____________ to the plane of movement.

In the anatomical position, all flexion/extension occurs in the (b) _________ plane, all
abduction/adduction occurs in the (c) ___________ plane, and all rotation occurs in the (d) __________
plane.

7. Study the following text on range of motion.

RANGE OF MOTION

Range of motion is a term used to describe
the extent of movement possible at a joint.
Each joint has a range of movement that is
normally available at that joint. This normal
range can be limited by several factors
including the shape of the bones that form
the joint, the ligaments that hold the bones
together, the length of the muscles that cross
that joint, the amount of tone or nervous
system control in the same muscles, injury or
a chronic response to injury such as swelling
or scar tissue formation, and other factors
like age and gender.

32
Range of motion can be divided into three
categories: active, passive, and resisted
range of motion.
Active Range of Motion
Active range of motion occurs when a person
moves a given body part through its possible
motions independently. It therefore
demonstrates a client's willingness and
ability to voluntarily perform available
motions at that joint. All structures and
systems must work together in order to
accomplish active movement. Slightly less
motion is possible actively compared to
passively (discussed below) because the
nervous system limits the range of movement
to protect the muscles and tendons around
the joints.
Passive Range of Motion
Passive range of motion occurs when the
client is resting and the therapist moves a
joint through its possible motions.
The joint is taken through its full possible
motion, as the client remains relaxed. The
practitioner is then able to determine the
endfeel (or limiting factor) for that joint.
Endfeel describes the perceived quality of
movement at the end of a joint's available
range of motion. The type of endfeel a joint
displays provides insight into the health and
function of passive or inert stabilizers such as
ligaments and joint capsules, as well as the
muscles and tendons being stretched during
the movement. These would include the
antagonist muscles from the performed
movement (i.e., passive elbow flexion would
assess the health and function of the elbow
extensors).
There are four types of healthy endfeel.
• In bony endfeel, the contact of two bones
is limiting. This is sometimes described as a
hard endfeel and can be found at the end of
elbow extension.
8. Exercise: Answer the following questions:
a) What is range of motion?
b) What are the three categories of range of motion?
c) When does active range of motion occur?
d) When does passive range of motion occur?
e) When does resisted range of motion occur?
• In capsular endfeel, the joint capsule
provides a firm limitation. For example, if you
internally rotate the client's thigh, you will
encounter a "leathery" feel at the end of the
movement.
• In springy (or muscular) endfeel, the
stretching of muscles and tendons limits joint
motion. For example, the latissimus dorsi and
teres major muscles are stretched with
shoulder abduction, creating a more elastic
feel compared to the leathery capsular
endfeel.
• Approximation is a fourth type of healthy
endfeel, in which the body runs into itself, as
when the forearm meets the upper arm,
limiting elbow flexion. Abnormal endfeel is
possible when a joint is injured or diseased.
Muscle spasm (also called guarding), is
characterized by jerky or shaky movements
prior to expected end range. This can result
from muscle or joint injury prompting the
nervous system to limit movement.
Springy block is a rubbery or bouncy
stoppage that occurs prior to end range. It
usually results from torn cartilage such as the
meniscus of the knee occluding joint
movement. Loose or empty endfeel occurs
when abnormal motion is allowed where a
ligament or joint capsule should prevent it.
Finally, spongy endfeel is squishy or boggy
and indicates swelling in a joint. Each
abnormal endfeel indicates injury or
pathology in the joint and should be
evaluated by a physician.
Resisted Range of Motion
Resisted range of motion occurs when the
client meets the resistance of the practitioner
in attempting to produce movement at a
joint. It is used to assess the health and
function of contracting muscles and their
corresponding tendons. The nervous system,
muscle fibers, and tendons all work together
to generate force against gravity and the
practitioner's resistance.
33
Review Exercises

1. Exercise. Body parts: Look at the number in the diagram of the body and write the
corresponding word on the crossword puzzle.

2. Exercise. Body regions: Identify the body regions marked A, B, C....

34
3. Exercise. Match the body parts in Column A with the body regions in Column B.

COLUMN A (Body parts) COLUMN B (Body regions)

1. Forehead 1. Plantar

2. Elbow (posterior) 2. Scapular

3. Thigh 3. Manus

4. Buttocks 4. Sternal

5. Sole of foot 5. Thoracic

6. Wrist 6. Fibular / Peroneal

7. Neck 7. Femoral

8. Shoulder blade area 8. Crural

9. Point of shoulder 9. Patellar

10. Chest 10. Pollex

11. Calf 11. Popliteal

12. Arm 12. Mental

13. Head 13. Olecranal

14. Knee (anterior) 14. Cervical

15. Thumb 15. Tarsal

16. Ear 16. Brachial

17. Hand 17. Sural

18. Hips 18. Calcaneal

19. Elbow (anterior) 19. Antecubital

20. Heel 20. Gluteal

21. Forearm 21. Antebrachial

22. Chin 22. Frontal

23. Knee (posterior) 23. Otic

24. Side of leg 24. Coxal

25. Ankle 25. Buccal

26. Shin 26. Acromial

35
27. Breastbone 27. Hallux

28. Pelvis 28. Carpal

29. Big toe 29. Pelvic

30. Cheek 30. Cephalic

4. Exercise. Body directions. Match the common directional terms in Column A with the
anatomical directional terms in Column B.

COLUMN A (Common directional terms) COLUMN B (Anatomical directional terms)

1. In front of 1. Posterior

2. Behind 2. Distal

3. Above 3. Superior

4. Below line 4. Dorsal

5. Nearer to the trunk 5. Ventral

6. Further from the trunk 6. Inferior

7. Toward the midline 7. Superficial / External

8. Away from the midline 8. Anterior

9. Toward the body surface 9. Medial

10. Away from the body surface 10. Deep / Internal

11. Toward the head 11. Lateral

12. Toward the tail 12. Cephalic

13. Toward the backside 13. Proximal

14. Toward the bellyside 14. Caudal

36
5. Exercise. Body movements. Identify in the following table three movements and their
corresponding axes of rotation and plane of motion and present them in the empty table
below.
Horizontal (Bilateral) Rotation of extremities /Axial Frontal
rotation

Transverse Sagittal Longitudinal (Polar)

Abduction/Adduction Antero-Posterior Flexion/Extension

Relationship Between Axes and Planes

Motion Axis of Rotation Plane of Motion

6. Exercise. Read the instructions below and answer the question that follows.

Start at the left tarsal area.

Travel superior and medial to the umbilical area.

Go lateral and posterior to the lumbar region.

Head in a cephalic direction to the scapular region, then lateral to the acromial.

Now go distal to the third joint down.

Where are you?

7. Exercise. Different anatomical structures are listed below. Match the structures in Column
A with their functions in Column B.

COLUMN A COLUMN B (Functions)

(Anatomical
structures)

1. Bursa A. Facilitates smooth movement, cushions, and reduces friction on the surfaces of
bones.

2. Cartilage B. Carries signals to and from the brain and spinal cord.

37
3. Muscle C. Cleanses excess tissue fluid of foreign particles, viruses, and bacteria.

4. Capillary D. Provides location for blood cell formation and storage of inorganic salts.

5. Nerve E. Decreases friction and creates gliding movement between body structures such
as tendons and bony landmarks.

6. Tendon F. Connects muscles to bones.

7. Fascia G. Protects against outside invaders and interacts with external environment
through sensory receptors.

8. Bone H. Generates force, which produces movements at joints.

9. Skin I. Covers or binds the structures of the body.

10. Lymph J. Location where gases, nutrients, and waste products are exchanged between the
node blood and individual cells.

38