3 Skeletal system and

common pathologies

FAST FACT The skeletal system consists of the bones and joints of the
body. There are 206 bones in the adult body. However, children
99% of calcium is found
in the bones and teeth.
are born with over 300 bones. Bones begin to develop before
However, the remaining 1% birth and continue to grow up to the age of 18–25. After 25,
is very important and its uses the bones stop growing, although they can continue to thicken.
include muscle contraction The bones together make up the skeleton, which has important
and the passing of nerve
functions for the body.
messages in the body.

FAST FACT
Functions of the skeleton
There are 206 bones in the S – Shape/support. The skeleton gives the body its shape and
adult body. supports the weight of all the other tissues.

A – Attachment for muscles and tendons. Bones provide the

attachment point for the tendons of most skeletal muscles.

don’t forget D – Development of blood cells. Red blood cells, white blood
Understanding the skeletal cells and platelets are produced within the red bone marrow
system, including the of the bone.
joints, will help you to work
safely and confidently when P – Protection. Bones help to protect vital organs from injury.
carrying out treatments. For example, the ribs protect the heart and lungs and the
skull protects the brain.

A – Allows movement of the body. When skeletal muscles

MEMORY JOGGER contract, they pull on bones to produce a movement. The
bones provide leverage.
Use the words SAD PAM M – Mineral store. Bones store the minerals calcium and
to help you remember the
functions of the skeleton.
phosphorus, which are important for the strength of the
bone. If these minerals are required elsewhere in the body,
the bones can release them into the bloodstream.
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 Chapter 3: Skeletal system and common pathologies

Bones
Bone is living tissue and is constantly being built up and broken
down. It is the hardest of all connective tissue in the body. It
is made up of 30 per cent living tissue, such as collagen, and
70 per cent minerals and water. The minerals include mainly
calcium and phosphorus. There are various types of bone in
the body and these include long bones, short bones, flat bones,
irregular bones and sesamoid bones.

Types of bone
Almost all bones, except the coccyx (tail bone), are designed to
meet a particular need in the body. There are five main types of
bone.

Long bones, such as the humerus in the arm, have a long

shaft and two wider ends. They act as levers to enable the
body to move. Other examples of long bones include the
femur (thigh bone), tibia, fibula (both found in the lower leg),
radius, ulna (both found in the lower arm), metacarpals (in
the hand) and phalanges (found in fingers and toes).

Short bones are roughly cube-shaped. They are found where

strength, rather than mobility, is required. Bones of the wrists
(carpals) and ankles (tarsals) are examples of short bones.

Flat bones help to protect vital organs in the body. Flat bones,
such as the skull, protect the brain, and the ribs protect
the heart and lungs. Other flat bones include the scapulae
(shoulder blades) and the sternum (breast bone).

Irregular bones, such as the vertebrae of the spine

(backbone), are found in places where extra strength is
needed and also make good attachment points for muscles.

Sesamoid bones are small, rounded bones that develop in

the tendons. They enable the tendon to move smoothly over
certain bones. An example is the patella (kneecap), which
prevents wear and tear on the tendon of the front thigh muscle,

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Anatomy, Physiology and Pathology for Complementary Therapists

which is attached to the tibia. It keeps the tendon in place

when the knee is bent. Sesamoid bones are also found in the
palms of the hands and soles of the feet. For example, these
bones can be found in tendons lying over the joint, under
the head of the first metatarsal in the foot. Their purpose is to
protect the tendon as it moves over the joint. They may vary in
number from person to person and mostly measure only a few
millimetres.

Skull
(flat bone)

Sternum
Scapula (flat bone)
(flat bone)

Ribs
Humerus (flat bones)
(long bone)

Vertebra
(irregular
Radius/ Radius bones)
ulna
(long
bones) Ulna Metacarpals

Carpals Metacarpals/
(short bones) phalanges
(long bones)
Femur
Phalanges
(long bone)

Patella Fibula
(sesamoid bone)
Tibia
Tibia/fibula
(long bones)

Metatarsals
Tarsals
(short bones) Metatarsals/
phalanges
Phalanges (long bones)

Figure 3.1 Types of bone

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ACTIVITY 3.1
Which types of bone are the following, and what are their
functions?

Type of bone Function

Carpals
Vertebrae
Humerus
Skull
Patella

Formation of bone
The formation of bone is known as ossification and continually
happens throughout human life. It is more active during the
period of body growth and following the fracture of a bone.

In the developing embryo, rods of cartilage covered by a

membrane can be seen and will eventually become the long
bones. After birth, calcium is added to the cartilage. This is
known as calcification. Bone-making cells, called osteoblasts,
make collagen and lay down calcium phosphate to form
new bone. They produce bone in the middle of the cartilage,
which eventually becomes the shaft of the long bone. don’t forget
Ossification then occurs at the ends of the bones. Red and white blood cells,
and also platelets, are made
The membrane surrounding the bone becomes the
within the bone marrow.
periosteum, and bone and mineral salts are laid down. This
results in an increase of thickness and length of the bone. Cells
known as osteoclasts break down areas within the bone. A
cavity is formed that will become filled with red bone marrow. A don’t forget
thin layer of cartilage will remain to cover each end of the bone. Bone is a living structure.
At birth, all bone marrow is red. As we get older, more of it is As bone cells die, others
will be made to replace
turned into yellow marrow because of the addition of fat cells. them.
This fills the cavities of many bones, especially long bones.
By adolescence a lot of the bone marrow is yellow.

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A long bone
A long bone has a shaft and two rounded ends, such as the
bone in the thigh (femur). The shaft contains yellow bone
marrow and the ends have red bone marrow. Compact bone
covers them and helps provide strength. Spongy (cancellous)
bone is found at each end.

ACTIVITY 3.2

3 ............................... 2 ...............................

7 ...............................

8 ...............................

6 ...............................
1 ...............................
4 ...............................

5 ...............................

2 ...............................

Figure 3.2 A long bone

Label the diagram in Figure 3.2 using the information in the table below.

Table 3.1 Showing bone structures and their function

Bone Structure Function

1 Diaphysis (dye-ah-fis-sis) The shaft of a long bone, which contains yellow bone marrow.

2 Epiphysis (eh-pif-fi-sis) The rounded end of a long bone.

3 Articular (hyaline) cartilage Covers the ends of the bones to stop them rubbing together
and also helps to absorb shock.

4 Medullary cavity/marrow cavity Contains the yellow bone marrow. This is where white blood
cells are made.

5 Periosteum (pear-ree-oss-tee-um) A layer that surrounds the bone. Ligaments and tendons
attach to the periosteum.

6 Compact bone tissue Helps give strength to the bone.

7 Spongy (cancellous) bone tissue Contains red bone marrow. This is where blood cells are made.

8 Artery Carries oxygen and nutrients to the bone.

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Bone tissue Lacunae

There are two types of bone tissue: compact and cancellous

Osteocyte
(spongy).
Nerve

Blood
Compact bone tissue vessel
Compact bone tissue is hard and dense. It provides strength, Lamellae
support and protection. It forms the outer layer of all bones and
Canaliculi
most of the shaft of long bones, such as the thigh bone (femur). Haversian
canal
Under a microscope, compact bone looks like honeycomb
and many circles can be seen, known as Haversian (ha-ver- Figure 3.3 Haversian system in
compact bone
shan) systems. In the centre of these circles are channels
running lengthways through the bone, called the Haversian FAST FACT
canals. The Haversian canals contain nerves, lymph
Red bone marrow produces
capillaries and blood vessels. billions of red blood cells
every day in adults.
The lamellae are rings of bone consisting of mineral salts
(mostly calcium phosphates), which gives the bone its
hardness. Rope-like collagen fibres give the bone its strength.
FAST FACT
The lacunae are the small spaces between the lamellae and Osteocytes account for 90%
of all cells in the skeleton.
contain cells called osteocytes (fully grown osteoblasts), which
help to maintain bone tissue. Narrow canals, called canaliculi,
radiate from the lacunae. The canaliculi are filled with tissue ASK FRAN...
fluid containing oxygen and nutrients for the bone tissue. Q. How does exercise help to
ensure the health of bones?
A. Regular exercise is
Cancellous bone tissue essential – not only does it
prevent loss of bone but it
Cancellous bone has a spongy appearance and so is often called
also stimulates the formation
spongy bone. The spongy bone helps to give great strength but of new, stronger bone tissue.
also keeps the skeleton light. Spongy bone is found in the end Bones adapt to the stress of
of long bones and in short, flat and irregularly shaped bones. exercise by laying down more
The cancellous bone is filled with red bone marrow. Red bone calcium and other minerals,
and also by increasing the
marrow produces billions of red blood cells every day in adults. amount of collagen fibres,
which helps to strengthen
bones. The best exercises
Ligaments for the bones are ones that
involve weight-bearing, such
as weight training, walking
Ligaments consist of bands of strong, fibrous connective tissue
and tennis, so that the body
that are silvery in appearance. They prevent dislocation by works against gravity.
holding the bones together across joints, rather like straps, but

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stretch slightly to allow movement. When excess strain is put on

don’t forget a joint, especially the ankle or knee, the ligaments can become
sprained or torn. Injuries to ligaments can be minor or severe,
Ligaments attach bone to
bone. and result in bruising, tenderness and swelling. Minor injury
Tendons attach muscle to can be treated with ice packs, to reduce the swelling, and then
bone. bandaged to support the joint. As ligaments have a relatively
poor blood supply when damaged, they can take a long time to
heal.
Back of
leg

Tendons
Tendons consist of white, strong, almost inelastic, fibrous bands.
Most muscles are attached to bones by tendons. They vary
in length and thickness. When a muscle contracts, the force
Collagen transmitted through the tendon creates movement at the bone.
fibres
An example of a tendon is the Achilles tendon that attaches the
Achilles calf muscle to the back of the foot.
tendon

Figure 3.4 Achilles tendon

Figure 3.5 Bones of the skeleton

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A tendon can become injured if stretched beyond its limit. This MEMORY JOGGER
happens in twisted ankles and sprained wrists as the bodyweight
is suddenly concentrated in one small area, putting strain on the
Memorise the following
tendon. The tendon may partially tear when some fibres are torn. sentence to remember the
The remaining intact fibres hold the torn ends in contact so, with bones of the skull:
rest, the ends reunite and the area heals. There can also be a Orange Tree Provides
complete tearing, in which the tendon is severed. The tendon can Edible Sweet Fruit
(occipital, temporal,
tear away from the bone or muscle and this is extremely painful.
parietal, ethmoid,
sphenoid, frontal)

The bones of the skeleton

ACTIVITY 3.3

Label the bones of the skull in

Figure 3.6.

Use this key to colour the

diagram.
Blue – frontal and occipital
bones
Yellow – parietal and temporal
bones
Green – sphenoid and ethmoid Figure 3.6 Bones of the skull

1 Frontal (fron-tall) bone. One frontal bone forms the forehead.

2 Parietal (pa-rye-eh-tal) bone. Two parietal bones form the

sides and top of the skull.
3 Temporal (tem-por-all) bone. Two temporal bones are found
at the sides of the skull, under the parietals.
4 Occipital (ox-sip-pee-tal) bone. One occipital bone forms the
back of the skull.
5 Sphenoid (sfee-noid). One sphenoid bone helps to form the
base of the skull.
6 Ethmoid (eth-moid). One ethmoid bone helps to form the eye
socket and nasal cavities.

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ACTIVITY 3.4
Label the bones of the face in Figure 3.7.
Use this key to colour the
diagram.

Green – turbinate and zygomatic

bones
Red – mandible and vomer
Orange – maxilla and nasal

Figure 3.7 Bones of the face

1 Zygomatic (zy-go-mah-tic) bone. Two zygomatic bones form

the cheekbones.
2 Maxilla (mak-sil-ah). The maxilla forms the upper part of the
jaw.
3 Mandible (man-dee-ball). The mandible forms the lower part
of the jaw. It is the only movable bone of the skull.
4 Nasal (nayz-al). Two nasal bones form the bridge of the nose.

5 Lacrimal (lah-kruh-mul) bone. Two lacrimal bones make up

part of each eye socket.
6 Turbinates (tur-bin-nuts). Two turbinate bones make up part
of the nasal cavity.
7 Vomer (voh-mer). One vomer extends upwards from the
hard palate to make the nasal septum.
don’t forget
8 Palatine (pa-la-tyne). Two palatine bones help make up the
There is a bone in the neck roof of the mouth, wall of the nasal cavity and floor of the eye
called the hyoid (hi-oyd).
It is horseshoe-shaped
sockets.
and is not joined to any
other bone. However, it is
attached to the temporal Bones of the shoulder girdle
bone by ligaments.
1 Clavicle. This is a long, slender bone also known as the
collar bone.

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2 Scapula (plural: scapulae). This is a large, triangular, flat

MEMORY JOGGER
bone also known as the shoulder blade.

To help you remember

Bones of the thorax the bones of the skull, try
blowing up a balloon, tying
The thoracic cavity contains organs such as the heart and lungs, its end, and using a thick,
which are protected by the ribcage. black felt-tip to draw on
the bones of the skull and
3 Ribs. There are 12 pairs of ribs. face (but not the names).
You can use the balloon to
4 Sternum. This is also known as the breast bone. practise remembering the
bone names.

Bones of the upper limbs

5 Humerus. This is the long bone of the upper arm.

ACTIVITY 3.5

1 4

2
3
5

8
9
10

Figure 3.8 Bones of the upper body

Label the diagram in Figure 3.8 using the information on pages 86–88. Use this key to
colour the diagram.

Yellow – clavicle Green – radius

Blue – scapula Orange – carpals, metacarpals and phalanges
Pink – humerus Brown – sternum
Red – ulna Purple – ribs

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Anatomy, Physiology and Pathology for Complementary Therapists

6 Radius. This bone is situated on the thumb side of the

don’t forget forearm.
The axial skeleton is made 7 Ulna. This bone is situated on the little-finger side of the
up of the skull, spine, ribs
forearm.
and sternum.
The appendicular skeleton 8 The carpals consist of eight small bones in each wrist (see
is made up of the shoulder
girdle, arms and hands, the
Figure 3.9).
pelvic bones and the legs 9 The metacarpals consist of five metacarpal bones (long
and feet.
bones), which form the palm of each hand.
10 There are 14 phalanges in each hand, three in each finger
and two in the thumb.

Bones of the hand and wrist

ACTIVITY 3.6
Label the diagram in Figure 6
7
3.9 using the information 1
2
below. Use this key to
5
colour the diagram. 3
4
Blue – scaphoid and trapezium
Red – lunate and trapezoid Sesamoid
bones 8
Brown – hamate and triquetral
Green – pisiform and capitate
Yellow – phalanges
Orange – metacarpals

Thumb

Figure 3.9 Bones of the hand and wrist

The carpals are: 1 scaphoid (scaf-oid), 2 lunate (lune-ate),

3 triquetral (tri-kwee-tral), 4 pisiform (pie-see-form),
5 trapezium (trap-ee-zee-um), 6 trapezoid (trap-ee-zoid),
7 capitates (cap-ee-tates), 8 hamate (hay-mate).

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They are closely fitted together and held in position by ligaments. MEMORY JOGGER
Tendons of muscles in the forearm cross over the wrist joint and
are held close to these bones by strong fibrous bands called
To help you remember
retinacula. the bones of the hand,
make up a memorable
sentence, such as: ‘Sally
Bones of the pelvic girdle Likes To Play The Tiny
The pelvic girdle consists of three bones fused together Chocolate Harmonica’
(scaphoid, lunate,
(innominate bones). triquetral, pisiform,
1 The ilium (ill-lee-um) is the largest of the three bones. The trapezium, trapezoid,
capitate, hamate).
iliac crest can be felt by placing the hand on the hip.
2 The ischium (iss-kee-um) forms the posterior aspect of the
pelvis.
3 The pubis is situated on the anterior aspect of the pelvis.
The female’s pelvis is wider and shallower, and so has more
space than the male’s. This is because of the requirements
of pregnancy and childbirth.

Bones of the lower limbs

ACTIVITY 3.7

3
2

Figure 3.10 The pelvic girdle

Label the diagram in Figure 3.10 using the information above. Use this key to colour the
diagram.

Red – ilium
Orange – ischium
Brown – pubis

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Anatomy, Physiology and Pathology for Complementary Therapists

MEMORY JOGGER ACTIVITY 3.8

Creating flashcards can

help you to remember 1
bone names. Using cards,
write a bone name on one
side, and on the other 4
side write a clue, for
example: ‘A bone found in 3
the arm that begins with
the letter “r”.’ 2
You may like to draw a
5
diagram that shows the
specific bone or bones 6
you are referring to. Use
the cards regularly to test 7
yourself.
Figure 3.11 Bones of the lower limbs

Label the diagram in Figure 3.11 using the information

MEMORY JOGGER below. Use this key to colour the diagram.

Red – femur
To remember that carpals
Orange – patella
are found in the wrist and
tarsals are below, in the Blue – tibia
ankle, think of CAR on the Yellow – fibula
TAR. Green – tarsals, metatarsals and phalanges

1 Femur. The thigh bone; this is the longest bone in the body.

2 Tibia. The bone situated on the anterior aspect of the lower

leg, also known as the shin bone.
3 Fibula. The bone situated on the lateral side of the tibia; it is
thinner than the tibia.
4 Patella. This is the kneecap, which articulates with the femur.

5 Tarsals. These are the seven bones of the ankle.

6 Metatarsals. There are five metatarsal bones in each foot.

7 Phalanges. There are 14 phalanges in each foot; these form

the toes.

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Bones of the vertebral column (spine)

ACTIVITY 3.9
Label the diagram in
1
Figure 3.12 using the
information below.
Use this key to colour
the diagram. 2
Yellow – cervical spine
Green – thoracic spine
Blue – lumbar region
Orange – sacrum 3
Red – coccyx

4
5
Figure 3.12 Bones of the vertebral column

The vertebral column supports the upper body and encloses FAST FACT
and protects the spinal cord. It consists of 33 bones, which are
The sacroiliac joint is the
divided into five groups: cervical, thoracic, lumbar, sacral and
joint found between the
coccygeal. sacrum and the ilium (hip
bone).
1 The cervical spine consists of seven vertebrae.
2 The thoracic spine consists of twelve vertebrae.
MEMORY JOGGER

3 The lumbar spine consists of five bones; these are the largest To remember the bones of
vertebrae. the vertebrae, think of the
following sentence.
4 The sacrum consists of five vertebrae fused together, known ‘Serve four lumps from the
as sacral bones. sack of coal.’
Serve is similar to
5 The coccyx consists of four bones fused together, known as cervical.
coccygeal bones. Four sounds like thoracic.
Lump is similar to lumbar.
In total: 33 bones. Sack is similar to sacrum.
Coal has the first two
letters of coccyx.

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Intervertebral discs
don’t forget Between the bones of the spine are pads of white fibrocartilage
The first cervical vertebra is
known as intervertebral discs. The intervertebral discs are
a ring of bone known as the thicker in the lumbar region than in the cervical region and are
atlas. kept in place by ligaments. Their functions are to act as shock
The second vertebra is absorbers and to give the spine some flexibility so movement
known as the axis.
can take place.

Bones and arches of the feet

The foot is made up of seven tarsals (the ankle bones), which
are irregular bones and glide over each other to provide
movement. There are five metatarsals (sole bones) and
14 phalanges (bones in toes).

ACTIVITY 3.10

5
1

Figure 3.13 Bones of the feet

Label the diagram in Figure 3.13 using the information on page 93. Use this key to colour
the diagram.

Green – calcaneus Orange – cuneiforms

Red – talus Pink – metatarsals
Blue – cuboid Yellow – phalanges
Brown – navicular

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The bones of the feet make up a bridge-like structure. There are MEMORY JOGGER
seven tarsal (ankle) bones, which form the posterior part of the
foot:
To help you remember the
1 calcaneus (kal-kay-nee-us) – one bone. number of bones in each
group, use the following
2 talus (ta-lus) – one bone. memory aid.
‘Steven’s unattractive
3 cuboid (cue-boyd) – one bone. shoes smell damp.’
Steven’s – letters for the
4 navicular (na-vik-cue-ler) – one bone. seven cervical vertebrae.
Unattractive – 12 letters
5 cuneiforms (cue-nee-forms) – three bones (medial, for the twelve thoracic
intermediate, lateral). vertebrae.
Shoes – 5 letters
6 metatarsals – five bones. (five lumbar bones).
Smell – 5 letters
7 phalanges (fah-lan-jez) – 14 bones, which form the toes.
(five sacral bones).
Damp – 4 letters
(four coccygeal bones).
Arches of the foot
The bones of the feet fit together to make arches. The arches
help to support the weight of the body and provide leverage
when walking. Strong ligaments and tendons support the bones
that form the arches.

ACTIVITY 3.11

2 1

Figure 3.14 Arches of the foot

Label the diagram in Figure 3.14 using the information on page 94. Use this key to colour
the diagram.

Red – medial longitudinal arch

Green – transverse arch
Blue – lateral longitudinal arch

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There are arches of the foot.

1 The medial longitudinal arch is the highest arch on the
big-toe side of the foot. It begins at the calcaneus, rises to
the talus and descends through the navicular, the three
cuneiforms and the three medial metatarsals.
2 The lateral longitudinal arch is on the little-toe side of the
foot and begins at the calcaneus. It rises at the cuboid and
descends to the two outer metatarsal bones.
3 The transverse arch runs between the medial and lateral
aspect of the foot and is formed by the navicular, the
cuneiform bones and the bases of the five metatarsals.

Posterior tibialis muscle

Tibia

Talus
Navicular
Tendon of posterior tibialis muscle
Medial cuneiform

1st metatarsal
Phalanges

Spring Short Long

Calcaneus ligament plantar plantar
ligament ligament

Figure 3.15 Tendons and ligaments supporting the arches of the foot

Joints of the body

A ‘joint’ describes the joining (articulation) of two or more bones
of the body. All of the bones, except the hyoid in the neck, form
a joint with another bone. Joints hold bones together and allow
movement.

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There are three main types of joint. MEMORY JOGGER

Fibrous or immovable joints are fixed joints in which no
movement between the joints is possible. Examples are the To remember the three
sutures, or joints, between the skull bones. types of main joints, think
of the following sentence.
Cartilaginous joints are slightly movable joints in which ‘Carol told a fib which
only limited movement is possible. Examples are the joints is a syn’ (cartilaginous,
fibrous and synovial).
between the bones of the vertebral column, with their
intervertebral discs of fibrocartilage.

Synovial joints are freely movable joints, of which there are

several types, all having similar characteristics. An example is
the joint of the knee.

Synovial joints
ACTIVITY 3.12

1
3

4
2
5

Figure 3.16 Structure of a synovial joint

Label the diagram in Figure 3.16 using the information on page 96 . Use this key to colour
the diagram.

Yellow – bones Green – ligaments

Blue – articular cartilage, joint capsule Orange – joint cavity and synovial fluid

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Anatomy, Physiology and Pathology for Complementary Therapists

MEMORY JOGGER In a freely movable joint, ends of the 1 bones are mostly covered
by 2 articular cartilage. The cartilage helps to reduce friction
and acts as a shock absorber during movement. 3 Ligaments
The following sentence
will help you to remember are needed to bind the bones together and help prevent
the synovial joint dislocation. The space between the bones is called the 4 joint
structures. cavity and is enclosed by a capsule of fibrous tissue, the joint
Hy (Hi) Symen (Simon), capsule, which is made of two layers. The inner layer is the
Jo’s li (lie) is a syn (sin).
5 synovial membrane which produces 6 synovial fluid to
Hy – hyaline
Symen – synovial lubricate the joint and provide the hyaline cartilage with nutrients.
membrane
Jo – joint
li – ligament
Ball and socket joint
syn – synovial fluid
If you make up your own A rounded head of a bone fits into a cup-shaped cavity that
sentence you will find it allows a lot of movement. Movements possible are flexion,
easier to remember. extension, adduction, abduction, rotation and circumduction.

Examples are the shoulder and hip joints.

Hinge joint
Pivot A round surface fits into the hollow surface of another bone and
allows movement similar to the opening and closing of a hinged
door.

Examples are the elbow and knee joints.

Hinge

Ball
and Saddle joint
socket
Ellipsoidal/ Similar to a hinge joint, a saddle joint allows more movement.
condyloid Movements possible are flexion, extension, abduction, adduction
Saddle and slight circumduction.

Examples include the joint between the thumb and carpals and
the joint between the skull and lower jaw.
Gliding

Figure 3.17 Types of synovial joint

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Ellipsoidal/condyloid joint
Ellipsoid/condyloid joints allow flexion, extension, abduction and don’t forget
adduction, but rotation is limited. This joint is at the metacarpals See Chapter 1 for more
and phalanges. information regarding joint
movements.

Pivot joint
A socket in one bone rotates around a peg on another so a
rotation movement is possible.

An example is the first cervical vertebra, which rotates around

the second to turn the head (atlas/axis).

Gliding joint
Two flat surfaces of bone glide over each other to allow
adduction and abduction movements. Examples are the joints
between the carpals (wrist) and tarsals (ankle).

ACTIVITY 3.13
State whether the following synovial joints are ball and socket, hinge, saddle, ellipsoidal/
condyloid pivot or gliding joints.

Joint Type
Hip
First and second vertebrae
Elbow
Between tarsals
Knee
Shoulder
Between carpals
Between bones of thumb and carpal
Between metacarpals and phalanges

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Anatomy, Physiology and Pathology for Complementary Therapists

Midline

Abduction
Flexion

Adduction Extension

Inversion

Rotation of head

Circumduction

Eversion

Outward
rotation Inward
rotation

Supination Pronation
(palm of hand (palm of hand
forwards) backwards)

Figure 3.18 Joint movements

Conditions associated with bones and joints

Ankylosing spondylitis
Ankylosing spondylitis (AS) is a type of arthritis that affects the
spine, including the muscles and ligaments around the spine.
Many people will suffer back pain and stiffness, but some cases
can be severe and result in disability. AS mostly affects men,

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but rarely starts in old age. There is no cure, but most sufferers
can be treated with medication and physiotherapy. The cause is
unknown, but there appears to be a genetic link and it can run
in families.

Arthritis
The term ‘arthritis’ refers to many different diseases, most of
which are characterised by inflammation of one or more joints.
Pain and stiffness may also be present in muscles near the joint.
The two main kinds are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is the most common form of arthritis and is

caused by wear and tear on the joint. It causes the cartilage
to become damaged and so it wears away. Osteoarthritis is
more common in people who regularly take part in vigorous
exercise. It causes pain and restricted movement, and
particularly affects movable joints that tend to be weight-
bearing, such as the knees and hips.

Rheumatoid arthritis is less common but is a more severe

type of arthritis. It is more common in females and can affect
all ages. It is a condition where the body attacks its own
tissues and is therefore known as an autoimmune disease.
The membrane that lines the joint becomes completely
swollen. The cause may be viral infection or hereditary
factors. There will be inflammation and swelling around the
joints. There may also be pain and loss of function. It mostly
affects the joints of the hands and feet.

Artificial joints
An artificial joint usually consists of plastic and metal parts,
which are used to replace a natural joint, often the hip or knee
joint. Reasons for replacing a joint can include damage caused
by osteoarthritis, injury or infection, which can cause pain and
stiffness and make joint movement difficult.

Bone cancer
Bone cancer destroys healthy bone tissue, which can cause

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pain to the sufferer. Secondary bone cancer is more common

than primary bone cancer. The cause of this type of cancer is
unclear; however, some people may be more susceptible owing
to hereditary factors and previous cancer treatment involving
radiation therapy.

Bursitis
Some synovial joints contain a sac-like structure called a bursa,
Figure 3.19 Bursitis which helps to provide padding where tendons rub against
bones or other tendons. Bursitis is inflammation of the bursa,
which may be caused by injury or repetitive stress. Examples
include tennis elbow and housemaid’s knee.

Fractures
When a bone breaks it is called a fracture. There
are different types of fracture.

A simple fracture occurs if the bone breaks but

the skin remains intact and the tissue around it
is not broken.

A compound fracture means the broken ends of

the bone protrude through the skin.

A comminuted fracture occurs if the bone breaks

in two or more places.

A greenstick fracture is a partial fracture,

occurring only in children since their bones are
soft; when stress is placed on the bone, one side
of it may bend enough to cause the other side to
splinter.

An impacted fracture is when part of a broken

Figure 3.20 Types of fracture bone impacts into another.

Frozen shoulder
This is inflammation of the shoulder joint, which may be a result
of muscle injury. There is inflammation and thickening of the
lining of the joint capsule in which the shoulder is held. It causes
pain and stiffness around the shoulder and movement becomes
increasingly difficult.

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Gout
Gout is a common type of arthritis and involves the build up of
uric acid crystals around joints, tendons and other tissues of the
body. Crystals form when the levels of uric acid in the body are
abnormally high. Gout usually begins with pain and inflammation
in the joint of the big toe, but it can develop in any joint of the
body. Risk factors for gout include drinking alcohol (especially
beer) and also consuming a diet rich in purines, which are
chemicals found in foods such as red meat and seafood.

Figure 3.21 Gout

Osteoporosis
Bones contain living tissue and so are constantly changing,
losing and gaining protein and calcium to and from the
bloodstream. Bones are naturally being built up and broken
down. Osteoporosis causes the bone to break down faster than it
is being formed. This causes the bones to become porous, weak
and thin and so there is an increased risk of fracture.

It mainly affects middle-aged and older people and is more

common in women than men. Hormones, such as oestrogen
in women and testosterone in men, help stimulate the bone-
forming cells, osteoblasts, to produce new bone tissue. Women
produce smaller amounts of oestrogen after the menopause,
and men produce smaller amounts of testosterone as they age.
As a result, the osteoblasts become less active, and there is a
decrease in bone mass.

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A well-balanced diet, which includes plenty of vitamin D

and calcium, as well as exercise, can help protect against
osteoporosis later in life.

Paget’s disease
Paget’s disease is a condition that causes bone to be broken
down more quickly than it can rebuilt. The body responds by
quickly trying to build new bone, which causes the bone to
become softer and weaker than ordinary bone. Over time, the
affected bones may become weak and misshapen. It is more
common in older people, and sufferers may experience pain
and tingling and weakness. In most cases, the disease can be
managed effectively with painkillers and medications that help to
control bone growth. The cause is unknown; however, hereditary
factors seem to play a role.

Postural defects
Postural defects include lordosis, kyphosis and scoliosis. A small
amount of kyphotic and lordotic curving of the spine is normal,
but too much leads to the conditions lordosis and kyphosis. For
further information see Chapter 4 on muscles.

MEMORY JOGGER

To remember the
difference between
lordosis and kyphosis
think of the following.
Lordosis – Lumbar
(hollow lumbar region)
KYphosis – HY up on
the spine (shoulders are
hunched forward)

Kyphosis Scoliosis Lordosis

Figure 3.22 Postural defects

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Kyphosis is a condition involving an outward curve of the

thoracic spine, which leads to rounded shoulders.

Scoliosis is a sideways curving of the spine and is always abnormal.

Lordosis is a condition involving an inward curving of the spine,

which affects the lumbar region. This causes the abdomen and
buttocks to stick out.

Repetitive strain injury

Repetitive strain injury (RSI) includes conditions caused by
the constant repetition of particular movements. It often affects
typists, and there may be pain, aching, weakness or tingling
when the fingers are moved. It is caused by irritation of the
flexor and extensor tendons in the wrist and hand. RSI can lead
to another condition called carpal tunnel syndrome (CTS). This
is the result of pressure and a build-up of fluid in the tissue
(oedema) that affects the median nerve as it passes through a
gap under a ligament at the front of the wrist. It causes pain,
numbness and tingling sensations in the fingers and hands.

Rickets
This is a rare disease that affects the bone growth in children,
and often results in bowed legs and curvature of the spine.
Rickets causes weak and softened bones, which can be painful.
It is commonly caused by a lack of vitamin D or calcium in
the diet, as these minerals are required to produce strong and
healthy bones. Rickets in adults is called osteomalacia.

Slipped disc
Discs are pads of fibro-cartilage that have a tough casing and are
found between the vertebrae. They help to absorb shock, such
as when jumping. A slipped disc is one that splits causing the
gel-like substance inside it to leak, creating a bulge. The bulge
creates pressure on the nerves and causes back pain, as well as
pain in other areas of the body. A slipped disc is often caused
by the breaking down of the connective tissue surrounding the

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disc; however, it is unclear why this happens. The likelihood of

suffering with a slipped disc increases with age.

Sprain
A sprain can be caused by wrenching or twisting a joint, causing
injury to its ligaments. It occurs when ligaments are stressed
beyond their normal capacity.

FAST FACT Spondylosis

Spondylosis is spinal arthritis and occurs as we age owing to
Cervical spondylosis is
caused by wear and tear of wear and tear of joints and bones of the spine. Most people
the cervical bones and discs over the age of 60 will have spondylosis, but will not have any
in the neck. It is caused by symptoms. However, in some people it can cause stiffness and
ageing and doesn’t usually pain. Occasionally, it can cause nerves to be pinched and so
result in any symptoms.
lead to pain and pins and needles in the arms, and also loss of
feeling in the hands and legs.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE), often known as lupus, is
an uncommon condition affecting most of the body’s tissues and
organs. It mostly affects women and causes symptoms such as
chronic fatigue, skin rash and pain and swelling in joints. It is
an autoimmune disorder, which means the body attacks its own
tissues. The cause is unknown, but genetic and environmental
factors are believed to be involved.

Synovitis
This is inflammation of the synovial membrane, which is the
membrane that lines joints. It causes pain in the affected joint.
Causes include injury and arthritis.

Tendonitits
Tendonitis is inflammation of a tendon, which results in swelling.
It is caused by injury, such as a sports injury, and is also a result
of tendon overuse (repetitive strain injury). The affected area
may be stiff and painful.

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Tennis elbow
Tennis elbow is a painful condition in which there is
inflammation of the tendon that attaches the muscle of the
forearm to the bone of the upper arm. The sufferer will feel
discomfort if the elbow is straightened. It can be caused by
wrenching, or the overuse of muscles, such as when playing
tennis or weightlifting. It also affects people whose work involves
activities such as lifting or using heavy tools.

Whiplash
Any sudden and vigorous movement involving the head may
cause a neck injury (whiplash). This is owing to injury of the
tendons and ligaments in the neck, and overstretching of the
neck muscles. There may stiffness and pain in the neck, and
movement involving the neck may be difficult. Road accidents,
in which the head is jolted, are a common cause of whiplash.

Conditions associated with the foot

Bunions (hallux valgus)
A bunion is a bone deformity of the joint at the base of the big
toe, which causes pain, tenderness and swelling. The big toe
points towards the smaller toes. Causes include ill-fitting shoes
(the condition is more common in women) and hereditary
factors. It may also be the result of arthritis, injury or weak
ligaments. It can be painful, so the foot should be handled
carefully.

Flatfoot
Weakening of the ligaments and tendons that hold the arches in
place can cause the medial longitudinal arch to flatten and the
result is flatfoot. Some sufferers find their foot ‘rolls’ to the inner
side, and there may also be discomfort. The causes include
injuries to the foot and ankle, excessive weight, hereditary factors
or a postural abnormality. Figure 3.23 Bunion

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Hammer toes
This is a deformity of the toes in which the middle joints are
bent, resulting in bent toes. Corns will often develop on the
joints of the toes because of rubbing against footwear, and the
condition can be painful. The causes include arthritis, bunions,
ill-fitting shoes or hereditary factors.

Plantar fasciitis
This is inflammation of a ligament, called the plantar fascia, that
runs from the heel to the ball of the foot. There is pain at the
heel or arch when standing. Causes include conditions in which
the feet are not aligned correctly, such as fallen arches, and it
may also be caused by injury.

ACTIVITY 3.14
Which condition is being described?

Read each description and decide which condition is being discussed.

1. A disease that affects children’s bone growth and can be caused by a lack of vitamin
D and calcium in the diet. ....................................................

2. Outward curve of the thoracic spine leading to rounded shoulders. ..................................................

3. Constant repetition of a particular movement can lead to pain and tingling.

....................................................

4. Breakage of bone. ....................................................

5. Vigorous movement to the head that causes injury to the tendons and ligaments in the
neck. ....................................................

6. Inflammation of one or more joints, causing pain and stiffness. ....................................................

7. Wrenching or twisting of a joint that causes injury to its ligaments. ....................................................

8. Bones become porous, weak and thin and so there is an increased risk of fracture.
....................................................

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What you should know

Functions of the skeleton Location, structure and

Shape and support function of joints
Attachment for muscles and tendons; leverage Classifications – fibrous/immovable,
Development of blood cells cartilaginous/slightly moveable, synovial/freely
Protection movable
Allows movement of the body Synovial joint – joint capsule, ligaments, synovial
Mineral store fluid, articular cartilage, bone
Types of synovial joint – gliding, ellipsoidal/
condyloid, hinge, saddle, pivot, ball and socket
Location, structure and Range of movement associated with joint
function of bones types (see Chapter 1) – flexion, extension,
Skeletal system – axial, appendicular circumduction, rotation, adduction, abduction,
Bones of the head – frontal, parietal, temporal, pronation, supination, dorsiflexion, plantar
occipital, sphenoid, ethmoid, nasal, turbinates, flexion, eversion, inversion
palatine, zygomatic, maxilla, mandible
Bones of the neck – cervical, vertebrae, atlas,
axis, hyoid Growth and repair
Bones of the spine – thoracic vertebrae, lumbar Definition and function – osteoblasts,
vertebrae, sacrum, coccyx, intervertebral discs osteocytes, osteoclasts
Bones of the torso – ribs, sternum, clavicle, Process of ossification
scapula, pelvic girdle
Bones of the pelvic girdle – ilium, ischium, pubis
Bones of the upper limbs – humerus, radius, Pathologies
ulna Conditions (pathologies) associated with the
Bones of the hands – carpals, metacarpals, bones, joints and foot, including their causes,
phalanges signs and symptoms – fractures, breaks,
Bones of the lower limbs – femur, patella, tibia, osteoarthritis, rheumatoid arthritis, gout,
fibula osteoporosis, repetitive strain injuries (for
Bones of the feet – tarsals, metatarsals, example, tendonitis, bursitis, carpal tunnel
phalanges syndrome), spinal injuries (for example,
Bones of the arches of the foot – medial whiplash, slipped disc), postural defects (for
longitudinal, lateral longitudinal, transverse arch example, lordosis, kyphosis, scoliosis), foot
Types of bones – compact, cancellous, long, problems (for example, bunion, hammer toes,
short, flat, irregular, sesamoid plantar fasciitis), artificial joints, systemic lupus
Components of long bone – diaphysis, erythematosus, synovitis, rickets, bone cancer,
epiphysis, cartilage, articular cartilage, ankylosing spondilitis, spondylosis, Paget’s
medullary cavity, periosteum disease

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