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9.5 Types of Body Movements

Learning objectives.

By the end of this section, you will be able to:

Define and identify the different body movements

  • Demonstrate the different types of body movements
  • Identify the joints that allow for these motions

Synovial joints allow the body a tremendous range of movements. Each movement at a synovial joint results from the contraction or relaxation of the muscles that are attached to the bones on either side of the articulation. The degree and type of movement that can be produced at a synovial joint is determined by its structural type. While the ball-and-socket joint gives the greatest range of movement at an individual joint, in other regions of the body, several joints may work together to produce a particular movement. Overall, each type of synovial joint is necessary to provide the body with its great flexibility and mobility. There are many types of movement that can occur at synovial joints ( Table 9.1 ). Movement types are generally paired, with one directly opposing the other. Body movements are always described in relation to the anatomical position of the body: upright stance, with upper limbs to the side of body and palms facing forward. Refer to Figure 9.5.1 as you go through this section.

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Watch this video to learn about anatomical motions. What motions involve increasing or decreasing the angle of the foot at the ankle?

This multi-part image shows different types of movements that are possible by different joints in the body.

Flexion and Extension

Flexion and extension are movements that take place within the sagittal plane and involve anterior or posterior movements of the body or limbs. For the vertebral column, flexion (anterior flexion) is an anterior (forward) bending of the neck or body, while extension involves a posterior-directed motion, such as straightening from a flexed position or bending backward. Lateral flexion is the bending of the neck or body toward the right or left side. These movements of the vertebral column involve both the symphysis joint formed by each intervertebral disc, as well as the plane type of synovial joint formed between the inferior articular processes of one vertebra and the superior articular processes of the next lower vertebra.

In the limbs, flexion decreases the angle between the bones (bending of the joint), while extension increases the angle and straightens the joint. For the upper limb, all anterior motions are flexion and all posterior motions are extension. These include anterior-posterior movements of the arm at the shoulder, the forearm at the elbow, the hand at the wrist, and the fingers at the metacarpophalangeal and interphalangeal joints. For the thumb, extension moves the thumb away from the palm of the hand, within the same plane as the palm, while flexion brings the thumb back against the index finger or into the palm. These motions take place at the first carpometacarpal joint. In the lower limb, bringing the thigh forward and upward is flexion at the hip joint, while any posterior-going motion of the thigh is extension. Note that extension of the thigh beyond the anatomical (standing) position is greatly limited by the ligaments that support the hip joint. Knee flexion is the bending of the knee to bring the foot toward the posterior thigh, and extension is the straightening of the knee. Flexion and extension movements are seen at the hinge, condyloid, saddle, and ball-and-socket joints of the limbs (see Figure 9.5.1 a-d ).

Hyperextension is the abnormal or excessive extension of a joint beyond its normal range of motion, thus resulting in injury. Similarly, hyperflexion is excessive flexion at a joint. Hyperextension injuries are common at hinge joints such as the knee or elbow. In cases of “whiplash” in which the head is suddenly moved backward and then forward, a patient may experience both hyperextension and hyperflexion of the cervical region.

Abduction and Adduction

Abduction and adduction motions occur within the coronal plane and involve medial-lateral motions of the limbs, fingers, toes, or thumb. Abduction moves the limb laterally away from the midline of the body, while adduction is the opposing movement that brings the limb toward the body or across the midline. For example, abduction is raising the arm at the shoulder joint, moving it laterally away from the body, while adduction brings the arm down to the side of the body. Similarly, abduction and adduction at the wrist moves the hand away from or toward the midline of the body. Spreading the fingers or toes apart is also abduction, while bringing the fingers or toes together is adduction. For the thumb, abduction is the anterior movement that brings the thumb to a 90° perpendicular position, pointing straight out from the palm. Adduction moves the thumb back to the anatomical position, next to the index finger. Abduction and adduction movements are seen at condyloid, saddle, and ball-and-socket joints (see Figure 9.5.1 e ).

Circumduction

Circumduction is the movement of a body region in a circular manner, in which one end of the body region being moved stays relatively stationary while the other end describes a circle. It involves the sequential combination of flexion, adduction, extension, and abduction at a joint. This type of motion is found at biaxial condyloid and saddle joints, and at multiaxial ball-and-sockets joints (see Figure 9.5.1 e ).

Rotation can occur within the vertebral column, at a pivot joint, or at a ball-and-socket joint. Rotation of the neck or body is the twisting movement produced by the summation of the small rotational movements available between adjacent vertebrae. At a pivot joint, one bone rotates in relation to another bone. This is a uniaxial joint, and thus rotation is the only motion allowed at a pivot joint. For example, at the atlantoaxial joint, the first cervical (C1) vertebra (atlas) rotates around the dens, the upward projection from the second cervical (C2) vertebra (axis). This allows the head to rotate from side to side as when shaking the head “no.” The proximal radioulnar joint is a pivot joint formed by the head of the radius and its articulation with the ulna. This joint allows for the radius to rotate along its length during pronation and supination movements of the forearm.

Rotation can also occur at the ball-and-socket joints of the shoulder and hip. Here, the humerus and femur rotate around their long axis, which moves the anterior surface of the arm or thigh either toward or away from the midline of the body. Movement that brings the anterior surface of the limb toward the midline of the body is called medial (internal) rotation . Conversely, rotation of the limb so that the anterior surface moves away from the midline is lateral (external) rotation (see Figure 9.5.1 f ). Be sure to distinguish medial and lateral rotation, which can only occur at the multiaxial shoulder and hip joints, from circumduction, which can occur at either biaxial or multiaxial joints.

Supination and Pronation

Supination and pronation are movements of the forearm. In the anatomical position, the upper limb is held next to the body with the palm facing forward. This is the supinated position of the forearm. In this position, the radius and ulna are parallel to each other. When the palm of the hand faces backward, the forearm is in the pronated position , and the radius and ulna form an X-shape.

Supination and pronation are the movements of the forearm that go between these two positions. Pronation is the motion that moves the forearm from the supinated (anatomical) position to the pronated (palm backward) position. This motion is produced by rotation of the radius at the proximal radioulnar joint, accompanied by movement of the radius at the distal radioulnar joint. The proximal radioulnar joint is a pivot joint that allows for rotation of the head of the radius. Because of the slight curvature of the shaft of the radius, this rotation causes the distal end of the radius to cross over the distal ulna at the distal radioulnar joint. This crossing over brings the radius and ulna into an X-shape position. Supination is the opposite motion, in which rotation of the radius returns the bones to their parallel positions and moves the palm to the anterior facing (supinated) position. It helps to remember that supination is the motion you use when scooping up soup with a spoon (see Figure 9.5.2 g ).

Dorsiflexion and Plantar Flexion

Dorsiflexion and plantar flexion are movements at the ankle joint, which is a hinge joint. Lifting the front of the foot, so that the top of the foot moves toward the anterior leg is dorsiflexion, while lifting the heel of the foot from the ground or pointing the toes downward is plantar flexion. These are the only movements available at the ankle joint (see Figure 9.5.2 h ).

Inversion and Eversion

Inversion and eversion are complex movements that involve the multiple plane joints among the tarsal bones of the posterior foot (intertarsal joints) and thus are not motions that take place at the ankle joint. Inversion is the turning of the foot to angle the bottom of the foot toward the midline, while eversion turns the bottom of the foot away from the midline. The foot has a greater range of inversion than eversion motion. These are important motions that help to stabilize the foot when walking or running on an uneven surface and aid in the quick side-to-side changes in direction used during active sports such as basketball, racquetball, or soccer (see Figure 9.5.2 i ).

Protraction and Retraction

Protraction and retraction are anterior-posterior movements of the scapula or mandible. Protraction of the scapula occurs when the shoulder is moved forward, as when pushing against something or throwing a ball. Retraction is the opposite motion, with the scapula being pulled posteriorly and medially, toward the vertebral column. For the mandible, protraction occurs when the lower jaw is pushed forward, to stick out the chin, while retraction pulls the lower jaw backward. (See Figure 9.5.2 j .)

Depression and Elevation

Depression and elevation are downward and upward movements of the scapula or mandible. The upward movement of the scapula and shoulder is elevation, while a downward movement is depression. These movements are used to shrug your shoulders. Similarly, elevation of the mandible is the upward movement of the lower jaw used to close the mouth or bite on something, and depression is the downward movement that produces opening of the mouth (see Figure 9.5.2 k ).

Excursion is the side to side movement of the mandible. Lateral excursion moves the mandible away from the midline, toward either the right or left side. Medial excursion returns the mandible to its resting position at the midline.

Superior Rotation and Inferior Rotation

Superior and inferior rotation are movements of the scapula and are defined by the direction of movement of the glenoid cavity. These motions involve rotation of the scapula around a point inferior to the scapular spine and are produced by combinations of muscles acting on the scapula. During superior rotation , the glenoid cavity moves upward as the medial end of the scapular spine moves downward. This is a very important motion that contributes to upper limb abduction. Without superior rotation of the scapula, the greater tubercle of the humerus would hit the acromion of the scapula, thus preventing any abduction of the arm above shoulder height. Superior rotation of the scapula is thus required for full abduction of the upper limb. Superior rotation is also used without arm abduction when carrying a heavy load with your hand or on your shoulder. You can feel this rotation when you pick up a load, such as a heavy book bag and carry it on only one shoulder. To increase its weight-bearing support for the bag, the shoulder lifts as the scapula superiorly rotates. Inferior rotation occurs during limb adduction and involves the downward motion of the glenoid cavity with upward movement of the medial end of the scapular spine.

Opposition and Reposition

Opposition is the thumb movement that brings the tip of the thumb in contact with the tip of a finger. This movement is produced at the first carpometacarpal joint, which is a saddle joint formed between the trapezium carpal bone and the first metacarpal bone. Thumb opposition is produced by a combination of flexion and abduction of the thumb at this joint. Returning the thumb to its anatomical position next to the index finger is called reposition (see Figure 9.5.2 l ).

Chapter Review

The variety of movements provided by the different types of synovial joints allows for a large range of body motions and gives you tremendous mobility. These movements allow you to flex or extend your body or limbs, medially rotate and adduct your arms and flex your elbows to hold a heavy object against your chest, raise your arms above your head, rotate or shake your head, and bend to touch the toes (with or without bending your knees).

Each of the different structural types of synovial joints also allow for specific motions. The atlantoaxial pivot joint provides side-to-side rotation of the head, while the proximal radioulnar articulation allows for rotation of the radius during pronation and supination of the forearm. Hinge joints, such as at the knee and elbow, allow only for flexion and extension. Similarly, the hinge joint of the ankle only allows for dorsiflexion and plantar flexion of the foot.

Condyloid and saddle joints are biaxial. These allow for flexion and extension, and abduction and adduction. The sequential combination of flexion, adduction, extension, and abduction produces circumduction. Multiaxial plane joints provide for only small motions, but these can add together over several adjacent joints to produce body movement, such as inversion and eversion of the foot. Similarly, plane joints allow for flexion, extension, and lateral flexion movements of the vertebral column. The multiaxial ball and socket joints allow for flexion-extension, abduction-adduction, and circumduction. In addition, these also allow for medial (internal) and lateral (external) rotation. Ball-and-socket joints have the greatest range of motion of all synovial joints.

Interactive Link Questions

Dorsiflexion of the foot at the ankle decreases the angle of the ankle joint, while plantar flexion increases the angle of the ankle joint.

Review Questions

1. Briefly define the types of joint movements available at a ball-and-socket joint.

2. Discuss the joints involved and movements required for you to cross your arms together in front of your chest.

Answers for Critical Thinking Questions

  • Ball-and-socket joints are multiaxial joints that allow for flexion and extension, abduction and adduction, circumduction, and medial and lateral rotation.
  • To cross your arms, you need to use both your shoulder and elbow joints. At the shoulder, the arm would need to flex and medially rotate. At the elbow, the forearm would need to be flexed.

This work, Anatomy & Physiology, is adapted from Anatomy & Physiology by OpenStax , licensed under CC BY . This edition, with revised content and artwork, is licensed under CC BY-SA except where otherwise noted.

Images, from Anatomy & Physiology by OpenStax , are licensed under CC BY except where otherwise noted.

Access the original for free at https://openstax.org/books/anatomy-and-physiology/pages/1-introduction .

Anatomy & Physiology Copyright © 2019 by Lindsay M. Biga, Staci Bronson, Sierra Dawson, Amy Harwell, Robin Hopkins, Joel Kaufmann, Mike LeMaster, Philip Matern, Katie Morrison-Graham, Kristen Oja, Devon Quick, Jon Runyeon, OSU OERU, and OpenStax is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

Module 10: Joints

Types of body movements, learning objectives.

  • Define the different types of body movements
  • Identify the joints that allow for these motions

Synovial joints allow the body a tremendous range of movements. Each movement at a synovial joint results from the contraction or relaxation of the muscles that are attached to the bones on either side of the articulation. The type of movement that can be produced at a synovial joint is determined by its structural type. While the ball-and-socket joint gives the greatest range of movement at an individual joint, in other regions of the body, several joints may work together to produce a particular movement. Overall, each type of synovial joint is necessary to provide the body with its great flexibility and mobility. There are many types of movement that can occur at synovial joints (Table 1). Movement types are generally paired, with one being the opposite of the other. Body movements are always described in relation to the anatomical position of the body: upright stance, with upper limbs to the side of body and palms facing forward.

Watch this video to learn about anatomical motions. What motions involve increasing or decreasing the angle of the foot at the ankle?

Flexion and Extension

Flexion  and  extension  are movements that take place within the sagittal plane and involve anterior or posterior movements of the body or limbs. For the vertebral column, flexion (anterior flexion) is an anterior (forward) bending of the neck or body, while extension involves a posterior-directed motion, such as straightening from a flexed position or bending backward.  Lateral flexion  is the bending of the neck or body toward the right or left side. These movements of the vertebral column involve both the symphysis joint formed by each intervertebral disc, as well as the plane type of synovial joint formed between the inferior articular processes of one vertebra and the superior articular processes of the next lower vertebra.

In the limbs, flexion decreases the angle between the bones (bending of the joint), while extension increases the angle and straightens the joint. For the upper limb, all anterior-going motions are flexion and all posterior-going motions are extension. These include anterior-posterior movements of the arm at the shoulder, the forearm at the elbow, the hand at the wrist, and the fingers at the metacarpophalangeal and interphalangeal joints. For the thumb, extension moves the thumb away from the palm of the hand, within the same plane as the palm, while flexion brings the thumb back against the index finger or into the palm. These motions take place at the first carpometacarpal joint. In the lower limb, bringing the thigh forward and upward is flexion at the hip joint, while any posterior-going motion of the thigh is extension. Note that extension of the thigh beyond the anatomical (standing) position is greatly limited by the ligaments that support the hip joint. Knee flexion is the bending of the knee to bring the foot toward the posterior thigh, and extension is the straightening of the knee. Flexion and extension movements are seen at the hinge, condyloid, saddle, and ball-and-socket joints of the limbs (see Figure 1).

This multi-part image shows different types of movements that are possible by different joints in the body.

Figure 1. Flexion and extension. (a)–(b) Flexion and extension motions are in the sagittal (anterior–posterior) plane of motion. These movements take place at the shoulder, hip, elbow, knee, wrist, metacarpophalangeal, metatarsophalangeal, and interphalangeal joints. (c)–(d) Anterior bending of the head or vertebral column is flexion, while any posterior-going movement is extension.

Hyperextension  is the abnormal or excessive extension of a joint beyond its normal range of motion, thus resulting in injury. Similarly,  hyperflexion  is excessive flexion at a joint. Hyperextension injuries are common at hinge joints such as the knee or elbow. In cases of “whiplash” in which the head is suddenly moved backward and then forward, a patient may experience both hyperextension and hyperflexion of the cervical region.

Abduction, Adduction,  and Circumduction

This multi-part image shows different types of movements that are possible by different joints in the body.

Figure 2. Abduction, adduction, and circumduction.

Abduction and adduction are motions of the limbs, hand, fingers, or toes in the coronal (medial–lateral) plane of movement. Moving the limb or hand laterally away from the body, or spreading the fingers or toes, is abduction. Adduction brings the limb or hand toward or across the midline of the body, or brings the fingers or toes together. Circumduction is the movement of the limb, hand, or fingers in a circular pattern, using the sequential combination of flexion, adduction, extension, and abduction motions.

Adduction, abduction, and circumduction take place at the shoulder, hip, wrist, metacarpophalangeal, and metatarsophalangeal joints.

Abduction and Adduction

Abduction  and  adduction  motions occur within the coronal plane and involve medial-lateral motions of the limbs, fingers, toes, or thumb. Abduction moves the limb laterally away from the midline of the body, while adduction is the opposing movement that brings the limb toward the body or across the midline. For example, abduction is raising the arm at the shoulder joint, moving it laterally away from the body, while adduction brings the arm down to the side of the body. Similarly, abduction and adduction at the wrist moves the hand away from or toward the midline of the body. Spreading the fingers or toes apart is also abduction, while bringing the fingers or toes together is adduction. For the thumb, abduction is the anterior movement that brings the thumb to a 90° perpendicular position, pointing straight out from the palm. Adduction moves the thumb back to the anatomical position, next to the index finger. Abduction and adduction movements are seen at condyloid, saddle, and ball-and-socket joints (see Figure 2).

Circumduction

Circumduction  is the movement of a body region in a circular manner, in which one end of the body region being moved stays relatively stationary while the other end describes a circle. It involves the sequential combination of flexion, adduction, extension, and abduction at a joint. This type of motion is found at biaxial condyloid and saddle joints, and at multiaxial ball-and-sockets joints (see Figure 2).

This multi-part image shows different types of movements that are possible by different joints in the body.

Figure 3. Rotation.

Rotation  can occur within the vertebral column, at a pivot joint, or at a ball-and-socket joint. Rotation of the neck or body is the twisting movement produced by the summation of the small rotational movements available between adjacent vertebrae. At a pivot joint, one bone rotates in relation to another bone. This is a uniaxial joint, and thus rotation is the only motion allowed at a pivot joint. For example, at the atlantoaxial joint, the first cervical (C1) vertebra (atlas) rotates around the dens, the upward projection from the second cervical (C2) vertebra (axis). This allows the head to rotate from side to side as when shaking the head “no.” The proximal radioulnar joint is a pivot joint formed by the head of the radius and its articulation with the ulna. This joint allows for the radius to rotate along its length during pronation and supination movements of the forearm.

Rotation can also occur at the ball-and-socket joints of the shoulder and hip. Here, the humerus and femur rotate around their long axis, which moves the anterior surface of the arm or thigh either toward or away from the midline of the body. Movement that brings the anterior surface of the limb toward the midline of the body is called  medial (internal) rotation . Conversely, rotation of the limb so that the anterior surface moves away from the midline is  lateral (external) rotation  (see Figure 3). Be sure to distinguish medial and lateral rotation, which can only occur at the multiaxial shoulder and hip joints, from circumduction, which can occur at either biaxial or multiaxial joints.

Turning of the head side to side or twisting of the body is rotation. Medial and lateral rotation of the upper limb at the shoulder or lower limb at the hip involves turning the anterior surface of the limb toward the midline of the body (medial or internal rotation) or away from the midline (lateral or external rotation).

Supination and Pronation

Supination and pronation are movements of the forearm. In the anatomical position, the upper limb is held next to the body with the palm facing forward. This is the  supinated position  of the forearm. In this position, the radius and ulna are parallel to each other. When the palm of the hand faces backward, the forearm is in the  pronated position , and the radius and ulna form an X-shape.

Supination and pronation are the movements of the forearm that go between these two positions.  Pronation  is the motion that moves the forearm from the supinated (anatomical) position to the pronated (palm backward) position. This motion is produced by rotation of the radius at the proximal radioulnar joint, accompanied by movement of the radius at the distal radioulnar joint. The proximal radioulnar joint is a pivot joint that allows for rotation of the head of the radius. Because of the slight curvature of the shaft of the radius, this rotation causes the distal end of the radius to cross over the distal ulna at the distal radioulnar joint. This crossing over brings the radius and ulna into an X-shape position.  Supination  is the opposite motion, in which rotation of the radius returns the bones to their parallel positions and moves the palm to the anterior facing (supinated) position. It helps to remember that supination is the motion you use when scooping up soup with a spoon (see Figure 4).

Dorsiflexion and Plantar Flexion

Dorsiflexion  and  plantar flexion  are movements at the ankle joint, which is a hinge joint. Lifting the front of the foot, so that the top of the foot moves toward the anterior leg is dorsiflexion, while lifting the heel of the foot from the ground or pointing the toes downward is plantar flexion. These are the only movements available at the ankle joint (see Figure 4).

This multi-part image shows different types of movements that are possible by different joints in the body.

Figure 4. Supination and pronation. (a) Supination of the forearm turns the hand to the palm forward position in which the radius and ulna are parallel, while forearm pronation turns the hand to the palm backward position in which the radius crosses over the ulna to form an “X.” (b) Dorsiflexion of the foot at the ankle joint moves the top of the foot toward the leg, while plantar flexion lifts the heel and points the toes.

Inversion and Eversion

Inversion and eversion are complex movements that involve the multiple plane joints among the tarsal bones of the posterior foot (intertarsal joints) and thus are not motions that take place at the ankle joint.  Inversion  is the turning of the foot to angle the bottom of the foot toward the midline, while  eversion  turns the bottom of the foot away from the midline. The foot has a greater range of inversion than eversion motion. These are important motions that help to stabilize the foot when walking or running on an uneven surface and aid in the quick side-to-side changes in direction used during active sports such as basketball, racquetball, or soccer (see Figure 5).

Protraction and Retraction

Protraction  and  retraction  are anterior-posterior movements of the scapula or mandible. Protraction of the scapula occurs when the shoulder is moved forward, as when pushing against something or throwing a ball. Retraction is the opposite motion, with the scapula being pulled posteriorly and medially, toward the vertebral column. For the mandible, protraction occurs when the lower jaw is pushed forward, to stick out the chin, while retraction pulls the lower jaw backward. (See Figure 5.)

This multi-part image shows different types of movements that are possible by different joints in the body.

Figure 5. Inversion, eversion, protraction, and retraction. (a) Eversion of the foot moves the bottom (sole) of the foot away from the midline of the body, while foot inversion faces the sole toward the midline. (b) Protraction of the mandible pushes the chin forward, and retraction pulls the chin back.

Depression and Elevation

Depression  and  elevation  are downward and upward movements of the scapula or mandible. The upward movement of the scapula and shoulder is elevation, while a downward movement is depression. These movements are used to shrug your shoulders. Similarly, elevation of the mandible is the upward movement of the lower jaw used to close the mouth or bite on something, and depression is the downward movement that produces opening of the mouth (see Figure 6).

This multi-part image shows different types of movements that are possible by different joints in the body.

Figure 6. Depression, elevation, and opposition. (a) Depression of the mandible opens the mouth, while elevation closes it. (b) Opposition of the thumb brings the tip of the thumb into contact with the tip of the fingers of the same hand and reposition brings the thumb back next to the index finger.

Excursion is the side to side movement of the mandible.  Lateral excursion  moves the mandible away from the midline, toward either the right or left side.  Medial excursion  returns the mandible to its resting position at the midline.

Superior Rotation and Inferior Rotation

Superior and inferior rotation are movements of the scapula and are defined by the direction of movement of the glenoid cavity. These motions involve rotation of the scapula around a point inferior to the scapular spine and are produced by combinations of muscles acting on the scapula. During  superior rotation , the glenoid cavity moves upward as the medial end of the scapular spine moves downward. This is a very important motion that contributes to upper limb abduction. Without superior rotation of the scapula, the greater tubercle of the humerus would hit the acromion of the scapula, thus preventing any abduction of the arm above shoulder height. Superior rotation of the scapula is thus required for full abduction of the upper limb. Superior rotation is also used without arm abduction when carrying a heavy load with your hand or on your shoulder. You can feel this rotation when you pick up a load, such as a heavy book bag and carry it on only one shoulder. To increase its weight-bearing support for the bag, the shoulder lifts as the scapula superiorly rotates.  Inferior rotation  occurs during limb adduction and involves the downward motion of the glenoid cavity with upward movement of the medial end of the scapular spine.

Opposition and Reposition

Opposition  is the thumb movement that brings the tip of the thumb in contact with the tip of a finger. This movement is produced at the first carpometacarpal joint, which is a saddle joint formed between the trapezium carpal bone and the first metacarpal bone. Thumb opposition is produced by a combination of flexion and abduction of the thumb at this joint. Returning the thumb to its anatomical position next to the index finger is called  reposition  (see Figure 6).

  • Chapter 9. Authored by : OpenStax College. Provided by : Rice University. Located at : http://cnx.org/contents/[email protected]@7.1. . Project : Anatomy & Physiology. License : CC BY: Attribution . License Terms : Download for free at http://cnx.org/content/col11496/latest/
  • 9.5 Types of Body Movements
  • Introduction
  • 1.1 Overview of Anatomy and Physiology
  • 1.2 Structural Organization of the Human Body
  • 1.3 Functions of Human Life
  • 1.4 Requirements for Human Life
  • 1.5 Homeostasis
  • 1.6 Anatomical Terminology
  • 1.7 Medical Imaging
  • Chapter Review
  • Interactive Link Questions
  • Review Questions
  • Critical Thinking Questions
  • 2.1 Elements and Atoms: The Building Blocks of Matter
  • 2.2 Chemical Bonds
  • 2.3 Chemical Reactions
  • 2.4 Inorganic Compounds Essential to Human Functioning
  • 2.5 Organic Compounds Essential to Human Functioning
  • 3.1 The Cell Membrane
  • 3.2 The Cytoplasm and Cellular Organelles
  • 3.3 The Nucleus and DNA Replication
  • 3.4 Protein Synthesis
  • 3.5 Cell Growth and Division
  • 3.6 Cellular Differentiation
  • 4.1 Types of Tissues
  • 4.2 Epithelial Tissue
  • 4.3 Connective Tissue Supports and Protects
  • 4.4 Muscle Tissue and Motion
  • 4.5 Nervous Tissue Mediates Perception and Response
  • 4.6 Tissue Injury and Aging
  • 5.1 Layers of the Skin
  • 5.2 Accessory Structures of the Skin
  • 5.3 Functions of the Integumentary System
  • 5.4 Diseases, Disorders, and Injuries of the Integumentary System
  • 6.1 The Functions of the Skeletal System
  • 6.2 Bone Classification
  • 6.3 Bone Structure
  • 6.4 Bone Formation and Development
  • 6.5 Fractures: Bone Repair
  • 6.6 Exercise, Nutrition, Hormones, and Bone Tissue
  • 6.7 Calcium Homeostasis: Interactions of the Skeletal System and Other Organ Systems
  • 7.1 Divisions of the Skeletal System
  • 7.2 The Skull
  • 7.3 The Vertebral Column
  • 7.4 The Thoracic Cage
  • 7.5 Embryonic Development of the Axial Skeleton
  • 8.1 The Pectoral Girdle
  • 8.2 Bones of the Upper Limb
  • 8.3 The Pelvic Girdle and Pelvis
  • 8.4 Bones of the Lower Limb
  • 8.5 Development of the Appendicular Skeleton
  • 9.1 Classification of Joints
  • 9.2 Fibrous Joints
  • 9.3 Cartilaginous Joints
  • 9.4 Synovial Joints
  • 9.6 Anatomy of Selected Synovial Joints
  • 9.7 Development of Joints
  • 10.1 Overview of Muscle Tissues
  • 10.2 Skeletal Muscle
  • 10.3 Muscle Fiber Contraction and Relaxation
  • 10.4 Nervous System Control of Muscle Tension
  • 10.5 Types of Muscle Fibers
  • 10.6 Exercise and Muscle Performance
  • 10.7 Cardiac Muscle Tissue
  • 10.8 Smooth Muscle
  • 10.9 Development and Regeneration of Muscle Tissue
  • 11.1 Interactions of Skeletal Muscles, Their Fascicle Arrangement, and Their Lever Systems
  • 11.2 Naming Skeletal Muscles
  • 11.3 Axial Muscles of the Head, Neck, and Back
  • 11.4 Axial Muscles of the Abdominal Wall, and Thorax
  • 11.5 Muscles of the Pectoral Girdle and Upper Limbs
  • 11.6 Appendicular Muscles of the Pelvic Girdle and Lower Limbs
  • 12.1 Basic Structure and Function of the Nervous System
  • 12.2 Nervous Tissue
  • 12.3 The Function of Nervous Tissue
  • 12.4 The Action Potential
  • 12.5 Communication Between Neurons
  • 13.1 The Embryologic Perspective
  • 13.2 The Central Nervous System
  • 13.3 Circulation and the Central Nervous System
  • 13.4 The Peripheral Nervous System
  • 14.1 Sensory Perception
  • 14.2 Central Processing
  • 14.3 Motor Responses
  • 15.1 Divisions of the Autonomic Nervous System
  • 15.2 Autonomic Reflexes and Homeostasis
  • 15.3 Central Control
  • 15.4 Drugs that Affect the Autonomic System
  • 16.1 Overview of the Neurological Exam
  • 16.2 The Mental Status Exam
  • 16.3 The Cranial Nerve Exam
  • 16.4 The Sensory and Motor Exams
  • 16.5 The Coordination and Gait Exams
  • 17.1 An Overview of the Endocrine System
  • 17.2 Hormones
  • 17.3 The Pituitary Gland and Hypothalamus
  • 17.4 The Thyroid Gland
  • 17.5 The Parathyroid Glands
  • 17.6 The Adrenal Glands
  • 17.7 The Pineal Gland
  • 17.8 Gonadal and Placental Hormones
  • 17.9 The Endocrine Pancreas
  • 17.10 Organs with Secondary Endocrine Functions
  • 17.11 Development and Aging of the Endocrine System
  • 18.1 An Overview of Blood
  • 18.2 Production of the Formed Elements
  • 18.3 Erythrocytes
  • 18.4 Leukocytes and Platelets
  • 18.5 Hemostasis
  • 18.6 Blood Typing
  • 19.1 Heart Anatomy
  • 19.2 Cardiac Muscle and Electrical Activity
  • 19.3 Cardiac Cycle
  • 19.4 Cardiac Physiology
  • 19.5 Development of the Heart
  • 20.1 Structure and Function of Blood Vessels
  • 20.2 Blood Flow, Blood Pressure, and Resistance
  • 20.3 Capillary Exchange
  • 20.4 Homeostatic Regulation of the Vascular System
  • 20.5 Circulatory Pathways
  • 20.6 Development of Blood Vessels and Fetal Circulation
  • 21.1 Anatomy of the Lymphatic and Immune Systems
  • 21.2 Barrier Defenses and the Innate Immune Response
  • 21.3 The Adaptive Immune Response: T lymphocytes and Their Functional Types
  • 21.4 The Adaptive Immune Response: B-lymphocytes and Antibodies
  • 21.5 The Immune Response against Pathogens
  • 21.6 Diseases Associated with Depressed or Overactive Immune Responses
  • 21.7 Transplantation and Cancer Immunology
  • 22.1 Organs and Structures of the Respiratory System
  • 22.2 The Lungs
  • 22.3 The Process of Breathing
  • 22.4 Gas Exchange
  • 22.5 Transport of Gases
  • 22.6 Modifications in Respiratory Functions
  • 22.7 Embryonic Development of the Respiratory System
  • 23.1 Overview of the Digestive System
  • 23.2 Digestive System Processes and Regulation
  • 23.3 The Mouth, Pharynx, and Esophagus
  • 23.4 The Stomach
  • 23.5 The Small and Large Intestines
  • 23.6 Accessory Organs in Digestion: The Liver, Pancreas, and Gallbladder
  • 23.7 Chemical Digestion and Absorption: A Closer Look
  • 24.1 Overview of Metabolic Reactions
  • 24.2 Carbohydrate Metabolism
  • 24.3 Lipid Metabolism
  • 24.4 Protein Metabolism
  • 24.5 Metabolic States of the Body
  • 24.6 Energy and Heat Balance
  • 24.7 Nutrition and Diet
  • 25.1 Physical Characteristics of Urine
  • 25.2 Gross Anatomy of Urine Transport
  • 25.3 Gross Anatomy of the Kidney
  • 25.4 Microscopic Anatomy of the Kidney
  • 25.5 Physiology of Urine Formation
  • 25.6 Tubular Reabsorption
  • 25.7 Regulation of Renal Blood Flow
  • 25.8 Endocrine Regulation of Kidney Function
  • 25.9 Regulation of Fluid Volume and Composition
  • 25.10 The Urinary System and Homeostasis
  • 26.1 Body Fluids and Fluid Compartments
  • 26.2 Water Balance
  • 26.3 Electrolyte Balance
  • 26.4 Acid-Base Balance
  • 26.5 Disorders of Acid-Base Balance
  • 27.1 Anatomy and Physiology of the Testicular Reproductive System
  • 27.2 Anatomy and Physiology of the Ovarian Reproductive System
  • 27.3 Development of the Male and Female Reproductive Systems
  • 28.1 Fertilization
  • 28.2 Embryonic Development
  • 28.3 Fetal Development
  • 28.4 Changes During Pregnancy, Labor, and Birth
  • 28.5 Adjustments of the Infant at Birth and Postnatal Stages
  • 28.6 Lactation
  • 28.7 Patterns of Inheritance

Learning Objectives

By the end of this section, you will be able to:

  • Define the different types of body movements
  • Identify the joints that allow for these motions

Synovial joints allow the body a tremendous range of movements. Each movement at a synovial joint results from the contraction or relaxation of the muscles that are attached to the bones on either side of the articulation. The type of movement that can be produced at a synovial joint is determined by its structural type. While the ball-and-socket joint gives the greatest range of movement at an individual joint, in other regions of the body, several joints may work together to produce a particular movement. Overall, each type of synovial joint is necessary to provide the body with its great flexibility and mobility. There are many types of movement that can occur at synovial joints ( Table 9.1 ). Movement types are generally paired, with one being the opposite of the other. Body movements are always described in relation to the anatomical position of the body: upright stance, with upper limbs to the side of body and palms facing forward. Refer to Figure 9.12 as you go through this section.

Interactive Link

Watch this video to learn about anatomical motions. What motions involve increasing or decreasing the angle of the foot at the ankle?

Flexion and Extension

Flexion and extension are typically movements that take place within the sagittal plane and involve anterior or posterior movements of the neck, trunk, or limbs. For the vertebral column, flexion (anterior flexion) is an anterior (forward) bending of the neck or trunk, while extension involves a posterior-directed motion, such as straightening from a flexed position or bending backward. Lateral flexion of the vertebral column occurs in the coronal plane and is defined as the bending of the neck or trunk toward the right or left side. These movements of the vertebral column involve both the symphysis joint formed by each intervertebral disc, as well as the plane type of synovial joint formed between the inferior articular processes of one vertebra and the superior articular processes of the next lower vertebra.

In the limbs, flexion decreases the angle between the bones (bending of the joint), while extension increases the angle and straightens the joint. For the upper limb, all anterior-going motions are flexion and all posterior-going motions are extension. These include anterior-posterior movements of the arm at the shoulder, the forearm at the elbow, the hand at the wrist, and the fingers at the metacarpophalangeal and interphalangeal joints. For the thumb, extension moves the thumb away from the palm of the hand, within the same plane as the palm, while flexion brings the thumb back against the index finger or into the palm. These motions take place at the first carpometacarpal joint. In the lower limb, bringing the thigh forward and upward is flexion at the hip joint, while any posterior-going motion of the thigh is extension. Note that extension of the thigh beyond the anatomical (standing) position is greatly limited by the ligaments that support the hip joint. Knee flexion is the bending of the knee to bring the foot toward the posterior thigh, and extension is the straightening of the knee. Flexion and extension movements are seen at the hinge, condyloid, saddle, and ball-and-socket joints of the limbs (see Figure 9.12 a-d ).

Hyperextension is the abnormal or excessive extension of a joint beyond its normal range of motion, thus resulting in injury. Similarly, hyperflexion is excessive flexion at a joint. Hyperextension injuries are common at hinge joints such as the knee or elbow. In cases of “whiplash” in which the head is suddenly moved backward and then forward, a patient may experience both hyperextension and hyperflexion of the cervical region.

Abduction and Adduction

Abduction and adduction motions occur within the coronal plane and involve medial-lateral motions of the limbs, fingers, toes, or thumb. Abduction moves the limb laterally away from the midline of the body, while adduction is the opposing movement that brings the limb toward the body or across the midline. For example, abduction is raising the arm at the shoulder joint, moving it laterally away from the body, while adduction brings the arm down to the side of the body. Similarly, abduction and adduction at the wrist moves the hand away from or toward the midline of the body. Spreading the fingers or toes apart is also abduction, while bringing the fingers or toes together is adduction. For the thumb, abduction is the anterior movement that brings the thumb to a 90° perpendicular position, pointing straight out from the palm. Adduction moves the thumb back to the anatomical position, next to the index finger. Abduction and adduction movements are seen at condyloid, saddle, and ball-and-socket joints (see Figure 9.12 e ).

Circumduction

Circumduction is the movement of a body region in a circular manner, in which one end of the body region being moved stays relatively stationary while the other end describes a circle. It involves the sequential combination of flexion, adduction, extension, and abduction at a joint. This type of motion is found at biaxial condyloid and saddle joints, and at multiaxial ball-and-sockets joints (see Figure 9.12 e ).

Rotation can occur within the vertebral column, at a pivot joint, or at a ball-and-socket joint. Rotation of the neck or body is the twisting movement produced by the summation of the small rotational movements available between adjacent vertebrae. At a pivot joint, one bone rotates in relation to another bone. This is a uniaxial joint, and thus rotation is the only motion allowed at a pivot joint. For example, at the atlantoaxial joint, the first cervical (C1) vertebra (atlas) rotates around the dens, the upward projection from the second cervical (C2) vertebra (axis). This allows the head to rotate from side to side as when shaking the head “no.” The proximal radioulnar joint is a pivot joint formed by the head of the radius and its articulation with the ulna. This joint allows for the radius to rotate along its length during pronation and supination movements of the forearm.

Rotation can also occur at the ball-and-socket joints of the shoulder and hip. Here, the humerus and femur rotate around their long axis, which moves the anterior surface of the arm or thigh either toward or away from the midline of the body. Movement that brings the anterior surface of the limb toward the midline of the body is called medial (internal) rotation . Conversely, rotation of the limb so that the anterior surface moves away from the midline is lateral (external) rotation (see Figure 9.12 f ). Be sure to distinguish medial and lateral rotation, which can only occur at the multiaxial shoulder and hip joints, from circumduction, which can occur at either biaxial or multiaxial joints.

Supination and Pronation

Supination and pronation are movements of the forearm. In the anatomical position, the upper limb is held next to the body with the palm facing forward. This is the supinated position of the forearm. In this position, the radius and ulna are parallel to each other. When the palm of the hand faces backward, the forearm is in the pronated position , and the radius and ulna form an X-shape.

Supination and pronation are the movements of the forearm that go between these two positions. Pronation is the motion that moves the forearm from the supinated (anatomical) position to the pronated (palm backward) position. This motion is produced by rotation of the radius at the proximal radioulnar joint, accompanied by movement of the radius at the distal radioulnar joint. The proximal radioulnar joint is a pivot joint that allows for rotation of the head of the radius. Because of the slight curvature of the shaft of the radius, this rotation causes the distal end of the radius to cross over the distal ulna at the distal radioulnar joint. This crossing over brings the radius and ulna into an X-shape position. Supination is the opposite motion, in which rotation of the radius returns the bones to their parallel positions and moves the palm to the anterior facing (supinated) position. It helps to remember that supination is the motion you use when scooping up soup with a spoon (see Figure 9.13 g ).

Dorsiflexion and Plantar Flexion

Dorsiflexion and plantar flexion are movements at the ankle joint, which is a hinge joint. Lifting the front of the foot, so that the top of the foot moves toward the anterior leg is dorsiflexion, while lifting the heel of the foot from the ground or pointing the toes downward is plantar flexion. These are the only movements available at the ankle joint (see Figure 9.13 h ).

Inversion and Eversion

Inversion and eversion are complex movements that involve the multiple plane joints among the tarsal bones of the posterior foot (intertarsal joints) and thus are not motions that take place at the ankle joint. Inversion is the turning of the foot to angle the bottom of the foot toward the midline, while eversion turns the bottom of the foot away from the midline. The foot has a greater range of inversion than eversion motion. These are important motions that help to stabilize the foot when walking or running on an uneven surface and aid in the quick side-to-side changes in direction used during active sports such as basketball, racquetball, or soccer (see Figure 9.13 i ).

Protraction and Retraction

Protraction and retraction are anterior-posterior movements of the scapula or mandible. Protraction of the scapula occurs when the shoulder is moved forward, as when pushing against something or throwing a ball. Retraction is the opposite motion, with the scapula being pulled posteriorly and medially, toward the vertebral column. For the mandible, protraction occurs when the lower jaw is pushed forward, to stick out the chin, while retraction pulls the lower jaw backward. (See Figure 9.13 j .)

Depression and Elevation

Depression and elevation are downward and upward movements of the scapula or mandible. The upward movement of the scapula and shoulder is elevation, while a downward movement is depression. These movements are used to shrug your shoulders. Similarly, elevation of the mandible is the upward movement of the lower jaw used to close the mouth or bite on something, and depression is the downward movement that produces opening of the mouth (see Figure 9.13 k ).

Excursion is the side to side movement of the mandible. Lateral excursion moves the mandible away from the midline, toward either the right or left side. Medial excursion returns the mandible to its resting position at the midline.

Superior Rotation and Inferior Rotation

Superior and inferior rotation are movements of the scapula and are defined by the direction of movement of the glenoid cavity. These motions involve rotation of the scapula around a point inferior to the scapular spine and are produced by combinations of muscles acting on the scapula. During superior rotation , the glenoid cavity moves upward as the medial end of the scapular spine moves downward. This is a very important motion that contributes to upper limb abduction. Without superior rotation of the scapula, the greater tubercle of the humerus would hit the acromion of the scapula, thus preventing any abduction of the arm above shoulder height. Superior rotation of the scapula is thus required for full abduction of the upper limb. Superior rotation is also used without arm abduction when carrying a heavy load with your hand or on your shoulder. You can feel this rotation when you pick up a load, such as a heavy book bag and carry it on only one shoulder. To increase its weight-bearing support for the bag, the shoulder lifts as the scapula superiorly rotates. Inferior rotation occurs during limb adduction and involves the downward motion of the glenoid cavity with upward movement of the medial end of the scapular spine.

Opposition and Reposition

Opposition is the thumb movement that brings the tip of the thumb in contact with the tip of a finger. This movement is produced at the first carpometacarpal joint, which is a saddle joint formed between the trapezium carpal bone and the first metacarpal bone. Thumb opposition is produced by a combination of flexion and abduction of the thumb at this joint. Returning the thumb to its anatomical position next to the index finger is called reposition (see Figure 9.13 l ).

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  • Authors: J. Gordon Betts, Kelly A. Young, James A. Wise, Eddie Johnson, Brandon Poe, Dean H. Kruse, Oksana Korol, Jody E. Johnson, Mark Womble, Peter DeSaix
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lateral excursion meaning

TMJ Movements

        Normal movements of the jaw during function, such as chewing, are known as excursions. There are two lateral excursions ( left and right ) and the forward excursion, known as protrusion, the reversal of which is retrusion.

        When the jaw is moved into protrusion, the lower incisors or front teeth are moved so that they first come edge to edge with the upper incisors, and then move past them, producing a temporary underbite. This is accomplished by sliding of the condyle down the articular eminance ( in the upper portion of the TMJ ) without any more than the slightest amount of rotation taking place ( in the lower portion of the TMJ ), other than that necessary to allow the lower incisors to come in front of the upper incisors without running into them.

        During chewing, the jaw moves in a specific manner as delineated by the two TMJs. The side of the mandible that moves sideways is referred to as either the working or rotating side, while the other side is referred to as either the balancing or orbiting side. The latter terms, although a bit outdated, are actually more precise, as they define the sides by the movements of the respective condyles.  When the jaw is moved into a lateral excursion, the working side condyle ( the condyle on the side of the jaw that moves outwards ) only performs rotation ( in the horizontal plane ), while the balancing side condyle performs translation. During actual functional chewing, when the teeth are not only moved side to side, but also up and down when biting of the teeth is incorporated as well, rotation ( in a vertical plane ) also plays a part in both condyles.

        The jaw is moved primary by four muscles: the masseter, medial pterygoid, lateral pterygoid and the temporalis. These four muscles work in different groups to move the mandible in different directions. Contraction of the lateral pterygoid acts to pull the disc and condyle forward; thus, the action of this muscle serves to open the mouth. The other three muscles close the mouth; the masseter and the medial pterygoid by pulling up the angle of the mandible and the temporalis by pulling up on the coronoid process.

        When the mouth opens, two distinct motions occur at the joint. The first motion is ROTATION around a horizontal axis through the condylar heads. The second motion is TRANSLATION.  The condyle and meniscus move together interiorly beneath the articular eminence.

        In the closed mouth position, the thick posterior band of the meniscus lies immediately above the condyle. As the condyle translates forward, the thinner intermediate zone of the meniscus becomes the articulating surface between the condyle and the articular eminence. When the mouth is fully open, the condyle may lie beneath the anterior band of the meniscus.

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Body Movement Terms – Anatomy Body Planes of Motions

In this anatomy lesson, I’m going to cover all of the major body movement terms for anatomy (also called the planes of motion ) that can occur at the synovial joints. You’ll come across these in your anatomy or kinesiology courses, and if you pursue a career in healthcare, you’ll use these terms during documentation or patient assessments.

After you review these notes and the corresponding video, you can take a comprehensive quiz on anatomy body movement terms .

Categories of Body Movement Terms in Anatomy

There are four major categories of body movements that can occur at the synovial joints:

  • Gliding movement
  • Angular movements
  • Rotational movements
  • Special movements

Gliding Movement in Anatomy

What is gliding ? Gliding occurs when the surfaces of bones slide past one another in a linear direction, but without significant rotary or angular movement.

An example of this movement is moving your hand back and forth (left to right) in a waving motion, which causes gliding to occur at the joints of the carpals ( wrist bones ). When you move your hand back and forth in a waving motion, it can help you remember that gliding joint movements primarily take place in the carpals of the wrist and the tarsals of the ankle.

gliding, anatomy, carpals, gliding bones, plane joint

However, gliding can also occur in the other plane joints (also called planar joints) of the body. Just as airplanes glide through the air, the plane joints of the body allow a gliding motion.

Other plane joints that allow gliding include the sacroiliac joint of the pelvis , the acromioclavicular joint of the shoulder, the femoropatellar joint , tibiofibular joint , sternocostal joints for ribs 2-7, vertebrocostal joints , and the intervertebral joints of the spine (at the articular processes).

Angular Movements in Anatomy

The next category of body movement terms consists of the angular movements, which consist of the following movements:

  • Flexion and Extension
  • Abduction and Adduction
  • Circumduction

Flexion and Extension in Anatomy

Because flexion and extension are angular movements, I find it really helpful to visualize an angle during the actual movement. Flexion decreases the angle between two structures or joints as they bend or move closer together, whereas extension increases the angle between them as they straighten and move apart.

Elbow Flexion and Extension

Elbow flexion (also called forearm flexion ) occurs when the angle between the forearm and arm decreases, allowing the ulna of the forearm to move closer to the humerus bone of the arm.

In contrast, elbow extension ( forearm extension ) occurs when the forearm moves away from the arm, increasing the angle between those bones.

elbow flexion, elbow extension, forearm flexion, forearm extension

Shoulder Flexion and Extension

Shoulder flexion , also called arm flexion , occurs when the angle at the humerus of the arm and the scapula decreases as the arms move anteriorly. In contrast, shoulder extension (or arm extension ) occurs when the angle at the humerus of the arm and the scapula increases, causing the arm to move posteriorly. The joint here allows movement past the anatomical position. Some anatomists call arm movement beyond the anatomical position extension , whereas some call it hyperextension .

shoulder extension, arm extension, shoulder flexion, arm flexion

Wrist Flexion and Extension

Wrist flexion (also called hand flexion ) occurs when the angle between the palm of the hand and the anterior surface of the forearm decreases, while wrist extension (or hand extension ) is moving the palm of the hand away from the anterior surface of the forearm, hence the angle increases. This is another joint that can continue to move past the anatomical position in a posterior direction, which some anatomists call hyperextension.

wrist flexion, wrist extension, hand flexion, hand extension

Finger Flexion and Extension

Finger flexion occurs when the angle between the fingers and the palm decreases, as the fingers move toward the palm. When the angle between the fingers and the palm increases, finger extension occurs.

finger flexion, finger extension, digit flexion, digit extension, anatomy

Flexion and extension also occur with the interphalangeal joints of the fingers (digits 2-5), including the distal interphalangeal joint (dip) and proximal interphalangeal joint (pip).

interphalangeal flexion, pip flexion,dip flexion, pip extension, dip extension, anatomy

Thumb Flexion and Extension

The thumb (pollex) can confuse people because thumb flexion and extension occur in the frontal plane , which is a different direction than flexion of the fingers, which occurred in the sagittal plane. Thumb flexion moves the thumb toward the pinky finger, whereas extension moves the thumb away from the pinky finger. Think of your palm as a windshield and your thumb as the windshield wiper for this movement.

thumb flexion, thumb extension, anatomy, body movement terms, kinesiology

Flexion and extension can also occur at the interphalangeal joint of the thumb.

thumb interphalangeal joint, thumb flexion, pollex flexion, extension, anatomy

Hip Flexion and Extension

Hip flexion (or thigh flexion ) occurs when the angle between the femur of the thigh and hipbone decreases as the thigh moves anteriorly (forward). Hip extension ( thigh extension ) occurs when the angle between the femur and the hip bone increases, as the hip joint straightens. This joint also allows posterior movement past the anatomical position, which some anatomists call hyperextension.

thigh flexion, thigh extension, hip flexion, hip extension, anatomy

Knee Flexion and Extension

Knee flexion ( leg flexion ) occurs when the tibia bone moves toward the femur, causing the angle to decrease between those two structures. Knee extension (or leg extension ) occurs as the angle between the leg bones increases, causing the leg to straighten.

knee flexion, knee extension, leg extension, leg flexion, anatomy, kinesiology

Toe Flexion and Extension

Like the fingers, toe flexion and extension can also occur. Toe flexion involves bending the toes toward the sole of the foot, decreasing the angle between these two structures, while toe extension involves increasing the angle and straightening the toes.

toeo flexion, toe extension, hallux flexion, hallux extension

Note : instead of using flexion and extension for the movement of the foot at the ankle joint, anatomists prefer to use the terms plantarflexion and dorsiflexion .

Neck Flexion and Extension

Neck flexion occurs as the angle between the head and the trunk of the body decreases as those two structures move closer together, whereas neck extension occurs as the head moves away from the trunk of the body, thus increasing the angle. The neck is another structure that can continue posteriorly, beyond the anatomical position, which some anatomists call hyperextension of the neck .

neck flexion, neck extension, hyperextension

Vertebral Column Flexion and Extension

Vertebral column flexion at the trunk, (spine flexion) occurs when the angle between the trunk and the hip joint decreases. Vertebral column (spine) extension at the trunk occurs as the spine straightens and the angle between the hip joint and spine increases.

spine flexion, spine extension, vertebral column extension, vertebral column flexion

By the way, you might have noticed that most of these movements so far are occurring within (or parallel to) the sagittal plane. However, just like the thumb, flexion can also occur in the frontal (coronal) plane for the vertebral column. For example, if you bend the spine to the left or right, that’s called lateral flexion , and movement back toward the anatomical position is called lateral extension .

lateral flexion spine, lateral extension spine, vertebral column lateral flexion, reduction

Note: you might want to watch our other lecture if you are unfamiliar with the different body planes .

Hyperextension

Finally, when extension of a structure moves beyond a certain point, anatomists call it hyperextension. However, anatomists differ on what constitutes hyperextension when it comes to body movement terms.

hyperextension neck, hyperextension thigh, hyperextension wrist, hyperextension arm

For example, some anatomists say that when the arm , neck , wrist , or thigh moves past the anatomical position in a posterior motion, it becomes hyperextension . Other anatomists only consider these movements hyperextension if the movement exceeds the normal range of motion permitted by the joint. For test-taking purposes, follow your anatomy teacher’s definition!

Abduction and Adduction in Anatomy

Unlike flexion and extension movements, which mostly take place within the sagittal plane , you’ll notice that abduction and adduction motions mostly take place within the frontal, or coronal, plane. However, the thumb is a notable exception to this rule, as it moves within the sagittal plane during abduction and adduction when in the anatomical position .

What is Abduction?

Abduction (think: ABDUCT ion) is the movement of a structure away from its midline reference point. Let the name help you out. What does “abduct” mean? When you hear on the news that a man was abducted, you know it means that someone took him away . That’s exactly what’s going on with this movement. The structure is being moved away from its midline reference point.

What is Adduction?

Adduction (think: ADD uction) occurs as the structure is ADDED back toward its midline reference point.

Let’s take a look at examples of abduction and adduction on the body.

Arm Abduction and Adduction

During arm abduction (also called shoulder abduction), the arms move away from the body’s midline. During arm adduction (or shoulder adduction), you ADD them right back toward the midline.

arm abduction, arm adduction, shoulder adduction, shoulder abduction, anatomy

Finger Abduction and Adduction

Finger abduction occurs when the fingers move away from the midline reference of the hand, whereas finger adduction occurs when you add them back toward the hand’s midline reference.

finger abduction, finger adduction, anatomy

When the middle finger (3rd digit), which serves as the midline reference of the hand, deviates to the away from the body, it’s called lateral abduction . When it deviates toward the body, it’s called medial abduction .

lateral abduction, medial abduction, middle finger, 3rd digit

Thumb Abduction and Adduction

The thumb (pollex) is different from the fingers. Abduction of the thumb has it moving within the sagittal plane, in an anterior motion. Adduction of the thumb has it added back to the hand.

thumb abduction, thumb adduction, anatomy body movement terms

Wrist Abduction and Adduction (Ulnar Deviation & Radial Deviation)

When determining abduction and adduction of the wrist, I find that it helps to stand in the anatomical position. Abduction of the wrist has it moving away from the body’s midline, in the same direction as arm abduction. Adduction of the wrist has it going in the opposite direction, toward the body’s midline.

wrist adduction, wrist abduction

These movements are also referred to as radial deviation and ulnar deviation .  Remember, the radius is on the thumb side, which where you check the radial pulse. So radial deviation is movement on the radial side, whereas ulnar deviation occurs on the opposite side.

radial deviation, ulnar deviation, anatomy

Thigh Abduction and Adduction

During thigh abduction (also called hip abduction or leg abduction), the lower limb moves away from the body’s midline. During adduction of the thigh , you ADD the lower limb right back toward the body’s midline.

thigh abduction, thigh adduction, hip abduction, hip adduction

Toes Abduction and Adduction

When the toes move away from the midline of the foot, toe abduction occurs. Toe adduction adds them right back together.

toe abduction, toe adduction, anatomy

Just like with the hand, devation of the 2nd toe away from the body’s midline is called lateral abduction , whereas movement toward the midline is called medial abduction .

lateral abduction toe, medial abduction toe, anatomy

Circumduction in Anatomy

The final body movement term in this category is circumduction , which is an angular movement that blends the motions of flexion , abduction , extension, and adduction to create a circular or conical motion of the attached structure.

The word circ umduction starts with the same letters as the word “ circ le,” so that will tip you off that this movement creates a circular, or conical, movement in the structure extending beyond the joint.

Circumduction Movement Demonstrated

Because circumduction is a combined movement, I find it helpful to think about the individual movements in slow motion. Looking at the shoulder joint, I’ll begin with arm flexion and then arm abduction. Next is arm extension , followed by arm adduction . When you combine those movements into one smooth motion, you can see how it forms a cone or circle.

The mnemonic “FABEA” might help you remember the order:

You could also reverse that order, but the movements have to alternate in a similar succession to create the circular motion that characterizes the circumduction movement.

Joints Capable of Circumduction

Where can circumduction occur on the body? Because it requires the motions of flexion, extension, abduction, and adduction, the joint will generally have to be capable of all four of those sequential movements. Below are examples of joints/structures that can perform the circumduction movement.

Circumduction of the Hip Joint (Thigh)

hip joint circumduction,thigh circumduction, anatomy

Circumduction of the Shoulder Joint (Arm)

circumduction of shoulder joint, arm circumduction, anatomy

Circumduction of the Wrist Joint (Hand)

circumduction of wrist joint, hand circumduction, anatomy, kinesiology

Circumduction of the Thumb (Pollex)

circumduction of thumb, pollex, anatomy

Circumduction of the Fingers

Finger circumduction, anatomy, kinesiology

Circumduction of the Toes

Toe circumduction, anatomy, kinesiology

Circumduction of the Ankle Joint (Foot)

ankle circumduction, foot circumduction, anatomy

Circumduction of the Head

head circumduction, cervical circumduction, anatomy

Rotation in Anatomy

The next category of the body planes of motion is rotation , which is a body movement term that describes a bone moving around a central axis.

Rotation Body Movement Term in Anatomy

When I think of the rotation body movement , I like to picture a screw turning to either the right or left, as that is similar to the rotation movement that can occur in the body.

Rotation can occur at the head/neck, vertebral column, and the ball-and-socket joints of the upper and lower limbs (shoulder joint and hip joint). Let’s take a look at these movements, starting with the head.

Head and Neck Rotation

The head can rotate laterally to either the left or right, thanks to the pivot joint between vertebrae C1 (atlas) and C2 (axis). Moving the head back toward the anatomical position is medial rotation of the head.

Head Rotation, rotation anatomy, neck rotation, body movement terms

Trunk Rotation

The vertebral column can also rotate laterally to either the left or right. Returning the trunk back toward the anatomical position is medial rotation of the trunk.

vertebral column rotation, spine rotation, trunk rotation, anatomy, lateral, medial

Arm Rotation (Medial and Lateral)

The ball-and-socket joint of the shoulder allows the humerus of the arm to rotate laterally, or away from the body’s midline , which is also called external rotation. It can also rotate medially, or toward the body’s midline, which is also called internal rotation.

arm rotation, shoulder rotation, humerus rotation, lateral, internal, external rotation, medial

Thigh/Leg Rotation (Medial and Lateral)

The ball-and-socket joint of the hip allows rotation of the thigh’s femur . Like the humerus, it can rotate laterally, or away from the body’s midline, which is also called external rotation. It can also rotate medially, or toward the body’s midline, creating an internal rotation movement.

hip rotation, thigh rotation, femur rotation, lateral rotation, medial rotation, internal, external

Tip for Medial vs Lateral Limb Rotation

Be sure to focus on the anterior surface of the femur or humerus when you do this movement, because that’s the focal point for determining medial vs lateral rotation.

thigh rotation, hip rotation, leg rotation

Special Body Movement Terms in Anatomy

The final category of body movement terms include the “special movements.” These movements don’t fall neatly into the categories I’ve already listed, so they are placed in their own unique category. The special movements involve the following:

Supination and Pronation

  • Dorsiflexion and Plantarflexion (also spelled plantar flexion)

Inversion and Eversion

Elevation and depression.

  • Protraction and Retraction
  • Protrusion, Retrusion, and Excursion
  • Opposition and Reposition

Supination and pronation are special movements involving rotation of the forearm .

Supination of Forearm and Hand

During supination , the distal end of the radius bone rotates over the ulna bone in a lateral direction . Lateral rotation means it is rotating away from the body’s midline.

I like to watch the thumb during this movement, because it is on the same side as the radius (hence, the radial pulse is located below the thumb). When the thumb is rotating away from the body’s midline, supination is occurring.

supination, supinate, anatomy, body movements, supinate forearm, hand

Pronation of Forearm and Hand

In contrast, pronation is the opposite movement: the distal end of the radius rotates over the ulna medially, and the two bones cross. Medial rotation is toward the body’s midline. So when the thumbs point toward the middle of the body, you know that pronation has occurred.

Pronation, pronate, anatomy, body movements

Palm Orientation During Supination and Pronation

You can also look at the orientation of the palms. During supination, the palms will face anteriorly (forward), which is their natural orientation in the anatomical position. However, if you flex the elbow about 90 degrees, the palms would then be facing up (superiorly).

supination palms, supination hand, palms forward

Pronation has the palms facing the opposite direction: posteriorly (toward the back) when in the anatomical position, or down (inferiorly) when the elbow flexes to around 90 degrees. This is another reason why I like to look at the thumbs during this movement. Thumbs will point away from the body’s midline during supination, and toward the body during pronation, regardless of how the elbow is flexed.

pronation palms, pronation hands, pronate, prone, anatomy

Supination vs Pronation Mnemonic

Here’s a simple mnemonic (memory trick) to help you remember pronation vs supination special movements:

At the grocery store, you pro nate to pick up your pro duce, and you sup inate to eat it for sup per.

pronation, supination, mnemonic, anatomy, body movements

Also, if you want to take your vitamins, you pro nate to p our, and you sup inate to take your sup plements.

Plantarflexion and Dorsiflexion

In this continued series on body movements of anatomy, I’m going to demonstrate dorsiflexion and plantarflexion (or plantar flexion), which are special movements involving the foot and ankle joint.

Dorsiflexion vs Plantarflexion

To help you understand this special movement, let’s break down the words.

Dorsal Side of the Foot (Dorsum)

Dorsal refers to the back (or upper) side of something. In my video on body cavities and membranes , I used the example of a dorsal fin of a dolphin to help you remember that dorsal refers to the backside of a surface. Your toenails are on the dorsal side of the foot, because they are on the back (or upper) side of it.

Plantar Side of Foot (Sole)

In contrast, plantar refers to the sole (or bottom) of the foot. If you’ve ever had a plantar wart, then you’ve had a wart on the sole of your foot (ouch!).

Flexion Meaning

Flexion refers to the movement that decreases the angle between two surfaces or joints, usually within the sagittal plane of the body. Now, let’s put all these words together, and you’ll be able to remember the difference between plantarflexion vs dorsiflexion .

Dorsiflexion Example

dorsiflexion, anatomy movement terms, nursing dorsiflexion, clonus ankle

During dorsiflexion , the back (upper) side of the foot moves toward the shin, decreasing the angle between these two surfaces, leaving the toes pointing closer toward your head. When you try to walk on your heels only, you dorsiflex the foot.

Plantar Flexion (Plantarflexion) Example

Plantar flexion, plantarflexion, anatomy, nursing, anatomy movement terms,body movements

During plantar flexion , the sole of the foot angles downward toward the calf, decreasing the angle between those two surfaces, leaving the toes pointing farther away from the body. When you perform calf raises in the gym or walk on your tip toes, you plantar flex the foot.  If you need help remember the direction of this movement, just remember this phrase: “Plantarflexion helps you stand on your toes and walk in any direction!”

Next, I’m going to demonstrate inversion and eversion , which are special movements that cause the foot to move relative to the body’s midline.

Inversion of the Foot

During inversion , the bottom of the foot (sole) turns so that it faces toward the body’s midline, in a medial orientation. Inversion starts with the word “in,” so that’s the dead giveaway that the sole is pointing in wardly (medially).

inversion, inversion of foot, ankle inversion, inversion sprain

Eversion of the Foot

During eversion , the opposition motion occurs: the bottom of the foot turns so that it faces away from the body’s midline (laterally). The word “evert” literally means to “turn outward,” which is exactly what happens during eversion!

eversion, eversion of ankle, eversion of foot,

Now lets’s examine elevation and depression, which are special body movement terms that describe motion in a superior (up) or inferior (down) direction.

Elevation in Anatomy

Elevation refers to movement of a body part in a superior direction, or moving upward. When you walk into a hotel lobby, you have to get on the elevator to go up, right? We’d also say that a mountain has a peak “elevation” of 20,000 feet.  Therefore, the term is pretty self-explanatory: elevation has a structure moving up, or superiorly.

Depression in Anatomy

Depression refers to movement of a body part in an inferior direction, or moving downward. When you are depressed, you feel down in the dumps, right? Therefore, depression is easy to remember as movement in an inferior, or downward direction.

Elevation and Depression in Anatomy

In anatomy, elevation and depression most commonly describe movements of the mandible (lower jaw) or scapulae (shoulder blades) within the frontal plane . When you move your lower jaw (mandible) in a downward direction, depression occurs. When you move your mandible upward, elevation occurs.

elevation, depression, anatomy, elevation mandible, depression mandible

Similarly, when you move your scapulae up, elevation of the shoulder girdle occurs. When you move them back down, depression of the shoulder girdle occurs.

elevation scapula, depression scapula, elevation, depression, anatomy

Protraction and Retraction in Anatomy

Now let’s discuss protraction and retraction , which are special body movements in anatomy that most commonly involve the scapulae (shoulder blades).

Protraction Movement

Protraction moves the scapula forward (anteriorly) and toward the side of the body (laterally) in an anterolateral direction.

protraction, protraction scapula, protraction shoulder, protraction anatomy, protraction body movement

Retraction Movement

Retraction is the opposite movement. It causes the shoulder blades to move back (posteriorly) and toward the body’s midline (medially). This movement is known as a posteromedial movement.

retraction, retraction anatomy, retraction scapula, retraction body movement

Protraction and Retraction Mnemonic

Here’s a simple way to remember protraction and retraction body movements in anatomy:

  • You Retract when you Reach Back !
  • You P unch to P rotract! In fact, the serratus anterior muscles assist with protraction of the scapulae, and they even call this muscle the boxer’s muscle for that very reason.

Protrusion, Retrusion, and Excursion in Anatomy

In this anatomy lesson, I’m going to demonstrate protrusion, retrusion, and excursion , which are special body movement terms in anatomy that refer to forward (anterior), backward (posterior), or side to side movements.

Protrusion in Anatomy

Protrusion refers to the movement of a structure in an anterior (forward) direction. In fact, the word protrude means “projecting something forward.”

I call protrusion the kissing movement because it occurs when you pucker your lips like you’re going to give someone a kiss or stick out your tongue. Moving the mandible (lower jaw) forward is also an example of protrusion.

protrusion of mandible, protrusion lips, protrusion tongue

Retrusion in Anatomy

Retrusion is the opposite of protrusion. It refers to the movement of a structure in a posterior, or backward, direction. Putting your tongue back in your mouth, moving the lips back, or moving the mandible back are all examples of retrusion in anatomy.

Retrusion of tongue, retrusion lips, retrusion mandible, retrusion anatomy

Excursion in Anatomy

Finally, we have excursion , which refers to the side-to-side movement of the lower jaw (mandible). If you’ve ever heard of a character named Ernest P. Worrell, then you’ve definitely seen the excursion movement. He’s the character in those movies such as Ernest Goes to Camp, Ernest Goes to Jail, etc. When Ernest saw something nasty, he’d move his jaw back and forth and say, “Ewwww.”

ernest movies, ernes p worrell

Excursion can occur in either direction, and anatomists use directional terms to specify the type of excursion. When the mandible moves to either the left or right, it’s moving away from the body’s midline, so it’s called lateral excursion . When the mandible moves closer to the midline of the body, it’s called medial excursion .

excursion anatomy, lateral excursion, medial excursion, excursion of mandible

Protrusion and Retrusion vs Protraction and Retraction

What about protraction and retraction ? Some anatomy textbooks will refer to the forward movement of the mandible, lips, or tongue as protraction (instead of protrusion), and the backward (posterior) movement will be called retraction (instead of retrusion). The terms are sometimes used interchangeably, so use whatever method your anatomy professor suggests (they give you the grade, not me!).

However, some anatomists today use protraction and retraction to refer almost exclusively to the scapulae, as it is a combined movement (protraction is anterolateral, and retraction is posteromedial). In contrast, protrusion and retrusion are more of an anterior/posterior movement. Then again, some anatomists prefer not to use protraction and retraction at all, even when describing shoulder blade movement.

Opposition and Reposition of the Thumb: Anatomy

Finally, I’ll demonstrate opposition and reposition , which are special movements involving the thumb.

The thumb, also known as the pollex or digit one, articulates (forms a joint) with the trapezium bone of the wrist (carpus) via a saddle joint, which is a type of synovial joint featuring interlocking convex and concave surfaces. They call it a saddle joint because, well, it kinda looks like a saddle (yee-haw, cowboy!).

Thanks to this saddle joint, the thumb can perform circumduction, flexion and extension, abduction and adduction, as well as special movements called opposition and reposition .

Opposition of the Thumb

Opposition of the thumb occurs when the tip of the thumb comes to meet (and oppose) the tip of another finger from the same hand. A super easy way to remember this is that you’ve probably heard someone say that humans have opposable thumbs. Oppos ition is the special movement of our oppos able thumbs.

opposition thumb, reposition thumb, anatomy body movements

In fact, think about this: when the opposition movement occurs, what happens? In the picture above, did you notice how the thumb and finger created a shape similar to the letter ‘O’? The ‘O’ stands for opposition! Now you can easily remember this motion of our opposable thumbs!

Reposition of the Thumb

Reposition is the opposite action of opposition. During reposition, the thumb and finger return to their original position.

opposition, reposition, opposition thumb, reposition thumb, anatomy

Free Quiz and More Anatomy Videos

Take a free comprehensive quiz on body movement terms to test your knowledge, or review our anatomy body movement terms video . In addition, you might want to watch our anatomy and physiology lectures on YouTube, or check our anatomy and physiology notes .

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lateral excursion meaning

Introduction to Occlusion

image_pdf

Definitions and Terminology

What is occlusion.

  • Occlusion = contacts between teeth 
  • This includes the repair, removal and movement of teeth
  • Consequently, this involves orthodontics, restorative, paediatric and prosthetic dentistry. Seems important now doesn't it?
  • Tooth system is made-up of the Enamel, Dentine and Pulp
  • Periodontal System is made-up of the Gingivae, Bone and Periodontal Membrane
  • Example: If a patient recently has a filling which is slightly too high (interfering with their occlusion). This can result in them complaining of jaw pain (TMJ), and the tenderness of their masticatory muscles.
  • For more information of the Articulatory system, check out the next lesson!

How do we look at someones occlusion?

This is called Occlusal Analysis, and it takes into consideration several aspects of a persons occlusion which needs to be noted during an examination. This includes;

  • Static Occlusion 

Ideal Occlusion

  • Dynamic Occlusion

The various classifications and ways to describe someones occlusion based on these headings are discussed below.

Static Occlusion

  • To revise Angles classification, check out the orthodontic section!
  • If you bite together naturally, you will find that a lot of the time you will bite together in exactly the same position each time; this is called CO. Whereas if you change this bite slightly, it may feel uncomfortable or strange.
  • To understand a patients CO, they therefore must have teeth. However exodontia, orthodontics, prosthetics and restorative interventions can all change the CO therefore throughout a lifetime it can changed considerably. It also brings in the question for edentulous patients, how do we work out their occlusion?
  • Practically: One to which the patient is adapted and is not showing parafunction, causing pathology (eg tooth surface loss) or symptoms such TMJ pain. 
  • Freedom in centric means that the mandible can move forward for a short distance in the same sagittal and horizontal plane (no deviation) whilst maintaining tooth contact. 
  • Simply: if front teeth hit together harder or as hard as posteriors = NO freedom in centric. Eg: Class 2 div 2 anteriors would hit if pt asked to slide jaw purely forwards or  Anterior PFMs with a palatal surface which is too thick 

Dynamic Occlusion 

  • Dynamic Occlusion refers to occlusal contacts made whilst the mandible is moving relative to the maxilla.   
  • Posterior guidance refers to the guidance of movement due to the TMJ, not the posterior teeth!
  • Anterior guidance refers to the guidance of movement due to the tooth contacts. This means if teeth touch during lateral or protrusive movements, they are guiding the mandibles direction in relation to the maxilla.
  • Canine guidance - this means during lateral excursion of the mandible the canines are the teeth which guide the mandibles movement and the last to disclude
  • The working side is the side which the jaw is moving towards.
  • The non-working side is the side which the jaw is moving from.
  • Working side interferences - heavy or early occlusal contact towards the back of the mouth on the side the jaw is moving towards.
  • Non-working side interferences - heavy or early occlusal contact towards the back of the mouth on the side the jaw is moving away from.

lateral excursion meaning

Guidance System Theory

Posterior guidance.

  • The TMJ provide the posterior guidance system for the mandible
  • The angle of downward movement is named the Condylar angle. This is the movement of the NWS condyle in the HORIZONTAL plane.
  • The angle of medial movement is called Bennetts angle. This is the movement of the NWS condyle in the VERTICAL plane.
  • In contrast, on the WS of the condyle, the movement is described as a non-progressive lateral movement. This is referred to as Bennett movement.

lateral excursion meaning

Anterior Guidance

  • This refers to every tooth contact during excursive movements of the mandible. Also referred to as the dynamic occlusion.
  • It is described that anterior guidance is preferable in the anterior tooth region, as it is is furtherest from the posterior guidance system. This could be described as a component indicative of the Ideal Occlusion .
  • In restorative dentistry, anterior guidance is confused with meaning the front teeth are involved in excursive movements.  

Relevance of Guidance systems in occlusion 

  • Most dental treatments involve occlusal surfaces of teeth.
  • Meaning this can change the guidance system of the mandible.
  • If incorrect, this leads to tooth wear/movement and fracture. 

Neuromuscular Control of Occlusion

  • Hence, understanding each muscle movements is essential!
  • Reflexes occur due to feedback by  proprioreceptors  in muscles and periodontal ligament.  
  • Jaw-closing reflex – protects mandible and associated structures during violent and whole body movement.  
  • For example, when you try to bite into a gobstopper and your jaw opens rather than biting through it.
  • Consequently, changes of a patients occlusion are theoretically at risk of being 'sensed' by the patients nervous system.

Posselts Envelope

This is a term commonly used to describe the various movements of the mandible and its range of motion. As discussed, the mandibles ability to move is restricted based on the articular surfaces of the TMJ, occlusion and also by ligaments .

Posselt found that the outer range of movements were reproducible, and named them Border Movements which represent the envelope of motion. The various movements are described in three directions to which they are then not capable for further movement;

The diagrams below, alongside the key, represent these movements described. When all three planes are combined, a 3D space is created for which all individuals are typically able to move their jaw between.

  • RCP - Retruded Contact Position
  • ICP - Intercuspal Position
  • E - Edge to Edge position of incisors
  • PR - Maximum Protrusion
  • R - Maximal Mandibular Opening, with rotation only of the condyle heads
  • T - Maximal Mandibular Opening, with translation of the condyle heads

lateral excursion meaning

Specific References:

(1) Davies, S. and Gray, R.M.J., 2001. What is occlusion?. British dental journal , 191 (5), pp.235-245.

General References:

Atkinson ME. Anatomy for dental students. Oxford University Press; 2013 Mar 14.

Berkovitz BK, Holland GR, Moxham BJ. Oral Anatomy, Histology and Embryology E-Book. Elsevier Health Sciences; 2017 Jul 11.

Davies, S. and Gray, R.M.J., 2001. What is occlusion?. British dental journal , 191 (5), pp.235-245.

Davies, S.J. and Gray, R.M.J., 2001. The examination and recording of the occlusion: why and how. British dental journal , 191 (6), pp.291-302.

Davies, S.J., Gray, R.M.J. and Smith, P.W., 2001. Good occlusal practice in simple restorative dentistry. British dental journal , 191 (7), pp.365-381.

Norton NS. Netter's head and neck anatomy for dentistry e-book. Elsevier Health Sciences; 2016 Sep 13

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Medicine LibreTexts

9.6: Types of Body Movements

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Learning Objectives

By the end of this section, you will be able to:

  • Define the different types of body movements
  • Identify the joints that allow for these motions

Synovial joints allow the body a tremendous range of movements. Each movement at a synovial joint results from the contraction or relaxation of the muscles that are attached to the bones on either side of the articulation. The type of movement that can be produced at a synovial joint is determined by its structural type. While the ball-and-socket joint gives the greatest range of movement at an individual joint, in other regions of the body, several joints may work together to produce a particular movement. Overall, each type of synovial joint is necessary to provide the body with its great flexibility and mobility. There are many types of movement that can occur at synovial joints (Table \(\PageIndex{1}\) ). Movement types are generally paired, with one being the opposite of the other. Body movements are always described in relation to the anatomical position of the body: upright stance, with upper limbs to the side of body and palms facing forward. Refer to Figure \(\PageIndex{1}\) as you go through this section.

Interactive Link

Watch this video to learn about anatomical motions. What motions involve increasing or decreasing the angle of the foot at the ankle?

This multi-part image shows different types of movements that are possible by different joints in the body.

Flexion and Extension

Flexion and extension are typically movements that take place within the sagittal plane and involve anterior or posterior movements of the neck, trunk, or limbs. For the vertebral column, flexion (anterior flexion) is an anterior (forward) bending of the neck or trunk, while extension involves a posterior-directed motion, such as straightening from a flexed position or bending backward. Lateral flexion of the vertebral column occurs in the coronal plane and is defined as the bending of the neck or trunk toward the right or left side. These movements of the vertebral column involve both the symphysis joint formed by each intervertebral disc, as well as the plane type of synovial joint formed between the inferior articular processes of one vertebra and the superior articular processes of the next lower vertebra.

In the limbs, flexion decreases the angle between the bones (bending of the joint), while extension increases the angle and straightens the joint. For the upper limb, all anterior-going motions are flexion and all posterior-going motions are extension. These include anterior-posterior movements of the arm at the shoulder, the forearm at the elbow, the hand at the wrist, and the fingers at the metacarpophalangeal and interphalangeal joints. For the thumb, extension moves the thumb away from the palm of the hand, within the same plane as the palm, while flexion brings the thumb back against the index finger or into the palm. These motions take place at the first carpometacarpal joint. In the lower limb, bringing the thigh forward and upward is flexion at the hip joint, while any posterior-going motion of the thigh is extension. Note that extension of the thigh beyond the anatomical (standing) position is greatly limited by the ligaments that support the hip joint. Knee flexion is the bending of the knee to bring the foot toward the posterior thigh, and extension is the straightening of the knee. Flexion and extension movements are seen at the hinge, condyloid, saddle, and ball-and-socket joints of the limbs (see Figure \(\PageIndex{1}\) a-d ).

Hyperextension is the abnormal or excessive extension of a joint beyond its normal range of motion, thus resulting in injury. Similarly, hyperflexion is excessive flexion at a joint. Hyperextension injuries are common at hinge joints such as the knee or elbow. In cases of “whiplash” in which the head is suddenly moved backward and then forward, a patient may experience both hyperextension and hyperflexion of the cervical region.

Abduction and Adduction

Abduction and adduction motions occur within the coronal plane and involve medial-lateral motions of the limbs, fingers, toes, or thumb. Abduction moves the limb laterally away from the midline of the body, while adduction is the opposing movement that brings the limb toward the body or across the midline. For example, abduction is raising the arm at the shoulder joint, moving it laterally away from the body, while adduction brings the arm down to the side of the body. Similarly, abduction and adduction at the wrist moves the hand away from or toward the midline of the body. Spreading the fingers or toes apart is also abduction, while bringing the fingers or toes together is adduction. For the thumb, abduction is the anterior movement that brings the thumb to a 90° perpendicular position, pointing straight out from the palm. Adduction moves the thumb back to the anatomical position, next to the index finger. Abduction and adduction movements are seen at condyloid, saddle, and ball-and-socket joints (see Figure \(\PageIndex{1}\) e ).

Circumduction

Circumduction is the movement of a body region in a circular manner, in which one end of the body region being moved stays relatively stationary while the other end describes a circle. It involves the sequential combination of flexion, adduction, extension, and abduction at a joint. This type of motion is found at biaxial condyloid and saddle joints, and at multiaxial ball-and-sockets joints (see Figure \(\PageIndex{1}\) e ).

Rotation can occur within the vertebral column, at a pivot joint, or at a ball-and-socket joint. Rotation of the neck or body is the twisting movement produced by the summation of the small rotational movements available between adjacent vertebrae. At a pivot joint, one bone rotates in relation to another bone. This is a uniaxial joint, and thus rotation is the only motion allowed at a pivot joint. For example, at the atlantoaxial joint, the first cervical (C1) vertebra (atlas) rotates around the dens, the upward projection from the second cervical (C2) vertebra (axis). This allows the head to rotate from side to side as when shaking the head “no.” The proximal radioulnar joint is a pivot joint formed by the head of the radius and its articulation with the ulna. This joint allows for the radius to rotate along its length during pronation and supination movements of the forearm.

Rotation can also occur at the ball-and-socket joints of the shoulder and hip. Here, the humerus and femur rotate around their long axis, which moves the anterior surface of the arm or thigh either toward or away from the midline of the body. Movement that brings the anterior surface of the limb toward the midline of the body is called medial (internal) rotation . Conversely, rotation of the limb so that the anterior surface moves away from the midline is lateral (external) rotation (see Figure \(\PageIndex{1}\) f ). Be sure to distinguish medial and lateral rotation, which can only occur at the multiaxial shoulder and hip joints, from circumduction, which can occur at either biaxial or multiaxial joints.

Supination and Pronation

Supination and pronation are movements of the forearm. In the anatomical position, the upper limb is held next to the body with the palm facing forward. This is the supinated position of the forearm. In this position, the radius and ulna are parallel to each other. When the palm of the hand faces backward, the forearm is in the pronated position , and the radius and ulna form an X-shape.

Supination and pronation are the movements of the forearm that go between these two positions. Pronation is the motion that moves the forearm from the supinated (anatomical) position to the pronated (palm backward) position. This motion is produced by rotation of the radius at the proximal radioulnar joint, accompanied by movement of the radius at the distal radioulnar joint. The proximal radioulnar joint is a pivot joint that allows for rotation of the head of the radius. Because of the slight curvature of the shaft of the radius, this rotation causes the distal end of the radius to cross over the distal ulna at the distal radioulnar joint. This crossing over brings the radius and ulna into an X-shape position. Supination is the opposite motion, in which rotation of the radius returns the bones to their parallel positions and moves the palm to the anterior facing (supinated) position. It helps to remember that supination is the motion you use when scooping up soup with a spoon (see Figure \(\PageIndex{1}\) g ).

Dorsiflexion and Plantar Flexion

Dorsiflexion and plantar flexion are movements at the ankle joint, which is a hinge joint. Lifting the front of the foot, so that the top of the foot moves toward the anterior leg is dorsiflexion, while lifting the heel of the foot from the ground or pointing the toes downward is plantar flexion. These are the only movements available at the ankle joint (see Figure \(\PageIndex{1}\) h ).

Inversion and Eversion

Inversion and eversion are complex movements that involve the multiple plane joints among the tarsal bones of the posterior foot (intertarsal joints) and thus are not motions that take place at the ankle joint. Inversion is the turning of the foot to angle the bottom of the foot toward the midline, while eversion turns the bottom of the foot away from the midline. The foot has a greater range of inversion than eversion motion. These are important motions that help to stabilize the foot when walking or running on an uneven surface and aid in the quick side-to-side changes in direction used during active sports such as basketball, racquetball, or soccer (see Figure \(\PageIndex{1}\) i ).

Protraction and Retraction

Protraction and retraction are anterior-posterior movements of the scapula or mandible. Protraction of the scapula occurs when the shoulder is moved forward, as when pushing against something or throwing a ball. Retraction is the opposite motion, with the scapula being pulled posteriorly and medially, toward the vertebral column. For the mandible, protraction occurs when the lower jaw is pushed forward, to stick out the chin, while retraction pulls the lower jaw backward. (See Figure \(\PageIndex{1}\) j .)

Depression and Elevation

Depression and elevation are downward and upward movements of the scapula or mandible. The upward movement of the scapula and shoulder is elevation, while a downward movement is depression. These movements are used to shrug your shoulders. Similarly, elevation of the mandible is the upward movement of the lower jaw used to close the mouth or bite on something, and depression is the downward movement that produces opening of the mouth (see Figure \(\PageIndex{1}\) k ).

Excursion is the side to side movement of the mandible. Lateral excursion moves the mandible away from the midline, toward either the right or left side. Medial excursion returns the mandible to its resting position at the midline.

Superior Rotation and Inferior Rotation

Superior and inferior rotation are movements of the scapula and are defined by the direction of movement of the glenoid cavity. These motions involve rotation of the scapula around a point inferior to the scapular spine and are produced by combinations of muscles acting on the scapula. During superior rotation , the glenoid cavity moves upward as the medial end of the scapular spine moves downward. This is a very important motion that contributes to upper limb abduction. Without superior rotation of the scapula, the greater tubercle of the humerus would hit the acromion of the scapula, thus preventing any abduction of the arm above shoulder height. Superior rotation of the scapula is thus required for full abduction of the upper limb. Superior rotation is also used without arm abduction when carrying a heavy load with your hand or on your shoulder. You can feel this rotation when you pick up a load, such as a heavy book bag and carry it on only one shoulder. To increase its weight-bearing support for the bag, the shoulder lifts as the scapula superiorly rotates. Inferior rotation occurs during limb adduction and involves the downward motion of the glenoid cavity with upward movement of the medial end of the scapular spine.

Opposition and Reposition

Opposition is the thumb movement that brings the tip of the thumb in contact with the tip of a finger. This movement is produced at the first carpometacarpal joint, which is a saddle joint formed between the trapezium carpal bone and the first metacarpal bone. Thumb opposition is produced by a combination of flexion and abduction of the thumb at this joint. Returning the thumb to its anatomical position next to the index finger is called reposition (see Figure \(\PageIndex{2}\) l).

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Measurement of Joint Motion: A Guide to Goniometry, 4e

Chapter 13:  The Temporomandibular Joint

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Structure and function.

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Temporomandibular Joint

The temporomandibular joint (TMJ) is the articulation between the mandible, the articular disc, and the temporal bone of the skull ( Fig. 13.1A , B ). The disc divides the joint into two distinct parts, which are referred to as the upper and lower joints. The larger upper joint is formed by the convex articular eminence, concave mandibular fossa of the temporal bone, and the superior surface of the disc. The lower joint consists of the convex surface of the mandibular condyle and the concave inferior surface of the disc. 1 , 2 , 3 The articular disc helps the convex mandible conform to the convex articular surface of the temporal bone. 2

FIGURE 13.1

A: Lateral view of the skull showing the temporomandibular joint (TMJ) and surrounding structures. B: A lateral view of the TMJ showing the articular disc and a portion of the joint capsule.

image

The TMJ capsule is described as being thin and loose above the disc but taut below the disc in the lower joint. Short capsular fibers surround the joint and extend between the mandibular condyle and the articular disc and between the disc and the temporal eminence. 3 Longer capsular fibers extend from the temporal bone to the mandible.

The primary ligament associated with the TMJ is the temporomandibular ligament. The stylomandibular and the sphenomandibular ligaments ( Fig. 13.2 ) are considered to be accessory ligaments. 4 , 5 The muscles associated with the TMJ are the medial and lateral pterygoids, temporalis, masseter, digastric, stylohyoid, mylohyoid, and geniohyoid.

FIGURE 13.2

A: A lateral view of the temporomandibular joint showing the oblique fibers of the temporomandibular ligament and the stylomandibular and sphenomandibular ligaments. B: A medial view of the temporomandibular joint showing the medial portion of the joint capsule and the stylomandibular and sphenomandibular ligaments.

image

Osteokinematics

The upper joint is an amphiarthrodial gliding joint, and the lower joint is a hinge joint. The TMJ as a whole allows motions in three planes around three axes. All of the motions except mouth closing begin from the resting position of the joint in which the teeth are slightly separated (freeway space). 3 , 6 The amount of freeway space, which usually varies from 2 mm to 4 mm, allows free anterior, posterior, and lateral movement of the mandible.

The functional motions permitted are mandibular depression (mouth opening), mandibular elevation (mouth closing), protrusion (anterior translation; Fig. 13.3 ) and retrusion (posterior translation; Fig. 13.4 ), and right and left lateral excursion or laterotrusion (lateral deviation; Fig. 13.5 ). Maximal contact of the teeth in mouth closing is called centric occlusion.

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Mitral annular plane systolic excursion

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  • Mitral annular plane systolic excursion (MAPSE)
  • Mitral annulus excursion
  • Mitral ring displacement
  • Left atrioventricular plane displacement

Mitral annular plane systolic excursion (MAPSE) refers to the displacement of the mitral valvular plane in the z-direction and reflects left ventricular longitudinal contraction or shortening, which has been attributed to account for about 60% of the stroke volume 1 .

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Terminology, measurement, interpretation.

Mitral annular plane systolic excursion is also known as mitral annulus excursion , mitral ring displacement , left atrioventricular plane displacement or similar terms 2 .

Mitral annular plane systolic excursion can be measured for the evaluation of cardiac function in particular global longitudinal function which can be affected in various cardiovascular conditions earlier than other parameters e.g. ejection fraction .

Traditionally mitral annular plane systolic excursion is assessed in echocardiography but it can be also easily assessed in cardiac magnetic resonance cine imaging 2-4 . Compared to strain imaging, it depends less on image quality and can be easily obtained with both methods 2-4 .

Mitral annular plane systolic excursion can be used for the assessment of prognosis in the following clinical settings 2-6 :

  • hypertensive heart disease
  • aortic stenosis : in particular isolated low-grade aortic stenosis
  • hypertrophic cardiomyopathy
  • myocardial infarction
  • heart failure
  • tetralogy of Fallot
  • atrial fibrillation

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Mitral annular plane systolic excursion can be evaluated in any long-axis view in M-mode echocardiography or cardiac MRI by measuring the displacement of the mitral annulus in relation to the left ventricular apex.

Echocardiography

One way to determine mitral annular plane systolic excursion in M-mode echocardiography is to define the mitral annular plane from the lateral and/or septal wall of the annulus in the apical four-chamber view and measure the displacement in relation to the ventricular apex 2,7,8 :

  • mitral annular plane extraction from the septal and lateral part of the mitral annulus
  • M-mode has to be aligned perpendicular to the annulus
  • from the lowest point in early diastole to the highest point during systole
  • the post-systolic motion should not be included in the measurement

In cardiac MRI, mitral annular plane systolic excursion can be evaluated in four-chamber cine images similar to the echocardiographic method by measuring the displacement of the lateral and/or septal mitral annular attachments in end-diastolic and end-systolic positions 3-5 .

Mitral annular plane systolic excursion reflects global longitudinal function and is a significant independent predictor of mortality in left ventricular dysfunction and major adverse cardiovascular events (MACE) 3-5 .

It is usually greater at the lateral attachment than at the septal attachment site 5,9 .

A decrease of mitral annular plane systolic excursion indicates longitudinal systolic dysfunction and is seen in myocardial ischemia or myocardial fibrosis . It has been associated with poor outcomes in various cardiovascular diseases 2 .

Echocardiographic assessment suffers from angle dependence 4 . Average normal values have been reported in the range of 12-15 mm. 

Mitral annular plane systolic excursion ≥10 mm indicates a preserved ejection fraction, <8 mm indicates impaired, and <7 mm indicates severely impaired left ventricular function in normal or dilated left ventricles and was associated with an ejection fraction of <50% and <30% respectively 2 .

Average normal values have been reported in the range of 13±3 to 17±3 mm to the location of the measurement with a displacement of the septal and anterior annular rim being lower than at the lateral and inferior edges 9 .

For lateral MAPSE a cut-off value of <9-11 mm has been associated with unfavorable outcomes 3-6 .

For septal MAPSE a cut-off value of <9 mm has been proposed as a negative predictor in patients with STEMI 5 .

  • cardiac function
  • cardiac strain imaging
  • tricuspid annular plane systolic excursion
  • 1. Carlsson M, Ugander M, Mosén H, Buhre T, Arheden H. Atrioventricular Plane Displacement is the Major Contributor to Left Ventricular Pumping in Healthy Adults, Athletes, and Patients with Dilated Cardiomyopathy. American Journal of Physiology-Heart and Circulatory Physiology. 2007;292(3):H1452-9. doi:10.1152/ajpheart.01148.2006 - Pubmed
  • 2. Hu K, Liu D, Herrmann S et al. Clinical Implication of Mitral Annular Plane Systolic Excursion for Patients with Cardiovascular Disease. European Heart Journal - Cardiovascular Imaging. 2012;14(3):205-12. doi:10.1093/ehjci/jes240 - Pubmed
  • 3. Rangarajan V, Chacko S, Romano S et al. Left Ventricular Long Axis Function Assessed During Cine-Cardiovascular Magnetic Resonance is an Independent Predictor of Adverse Cardiac Events. J Cardiovasc Magn Reson. 2016;18(1):35. doi:10.1186/s12968-016-0257-y - Pubmed
  • 4. Romano S, Judd R, Kim R et al. Left Ventricular Long-Axis Function Assessed with Cardiac Cine MR Imaging Is an Independent Predictor of All-Cause Mortality in Patients with Reduced Ejection Fraction: A Multicenter Study. Radiology. 2018;286(2):452-60. doi:10.1148/radiol.2017170529 - Pubmed
  • 5. Mayr A, Pamminger M, Reindl M et al. Mitral Annular Plane Systolic Excursion by Cardiac MR is an Easy Tool for Optimized Prognosis Assessment in ST-Elevation Myocardial Infarction. Eur Radiol. 2019;30(1):620-9. doi:10.1007/s00330-019-06393-4 - Pubmed
  • 6. Romano S, Judd R, Kim R et al. Prognostic Implications of Mitral Annular Plane Systolic Excursion in Patients with Hypertension and a Clinical Indication for Cardiac Magnetic Resonance Imaging. JACC Cardiovasc Imaging. 2019;12(9):1769-79. doi:10.1016/j.jcmg.2018.10.003 - Pubmed
  • 7. Vermeiren G, Malbrain M, Walpot J. Cardiac Ultrasonography in the Critical Care Setting: A Practical Approach to Asses Cardiac Function and Preload for the “non-Cardiologist”. Anaesthesiol Intensive Ther. 2015;47(J):89-104. doi:10.5603/ait.a2015.0074 - Pubmed
  • 8. Støylen A, Mølmen H, Dalen H. Relation Between Mitral Annular Plane Systolic Excursion and Global Longitudinal Strain in Normal Subjects: The HUNT Study. Echocardiography. 2018;35(5):603-10. doi:10.1111/echo.13825 - Pubmed
  • 9. Ochs M, Fritz T, André F et al. A Comprehensive Analysis of Cardiac Valve Plane Displacement in Healthy Adults: Age-Stratified Normal Values by Cardiac Magnetic Resonance. Int J Cardiovasc Imaging. 2017;33(5):721-9. doi:10.1007/s10554-016-1058-y - Pubmed

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Introduction, methods and materials, conclusions, acknowledgments, effect of lateral excursive movements on the progression of abfraction lesions.

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I. D. Wood , A. S. A. Kassir , P. A. Brunton; Effect of Lateral Excursive Movements on the Progression of Abfraction Lesions. Oper Dent 1 May 2009; 34 (3): 273–279. doi: https://doi.org/10.2341/08-100

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The results of this randomized controlled trial have direct relevance to clinical practice and provide some evidence that occlusal adjustment to prevent further progression of abfraction lesions cannot be supported currently.

The theory of abfraction suggests that tooth flexure arising from occlusal loads causes the formation and progression of abfraction lesions. The current study investigated whether reducing occlusal loading by adjusting the occlusion on a tooth during lateral excursive movements had any effect on the rate of progression of existing abfraction lesions. Recruited were 39 subjects who had two non-carious cervical lesions in the maxillary arch that did not need restoration and were in group function during lateral excursive movements of the mandible. One of the teeth was randomly selected to have the excursive occlusal contacts reduced by using a fine grain diamond bur. Centric occlusal contacts were not reduced. Impressions of the lesion were taken over a 30-month period to enable monitoring of the wear rate, and duplicate dies were poured into epoxy resin to allow for sectioning. The size of the lesions was measured using stereomicroscopic analysis of the sectioned epoxy resin dies, and the results were analyzed using an Independent t -test. No statistically significant difference in wear rates between the adjusted and non-adjusted teeth was found ( p >0.05).

Within the limitations of the current study, it was concluded that occlusal adjustment does not appear to halt the progression of non-carious cervical lesions; consequently, this procedure cannot be recommended.

As an aging population retains its teeth longer, the issue of tooth wear or non-carious tooth tissue loss is becoming increasingly important to the dental profession. The phrase “non-carious cervical tooth surface loss” has arisen in an attempt to embrace these kinds of lesions, which occur at the neck of the tooth. Unfortunately, far more confusion arises from the use of other terminologies, such as erosions and abrasions, which have been used at different times and in different locations to describe similar lesions.

In 1908, Black, in his seminal work on Operative Dentistry, discussed the problematic etiology of what he termed “erosions” and stated that, “Our information regarding erosion is far from complete and much time may elapse before its investigation will give satisfactory results.” 1 Black identified eight possible causes:

Faults in the formation of teeth

Friction from an abrasive toothpowder

Action of an unknown acid

Secretion of a diseased salivary gland

Physiological resorption, as with deciduous teeth

Acid associated with gouty diarethis

Action of alkaline fluids on calcium salts

Action of enzymes released by micro-organisms

After going through each hypothesis, in turn, finding fault with all, he concluded that he had no theory of his own to offer that did not have features that rendered it impossible.

Other researchers in the early part of the 20 th century also considered these lesions. Miller, in 1907, looked at “wastings” and concluded that brushing with coarse toothpowder was the likely cause. 2 In 1931, Ferrier was unable to find a reasonable explanation and, in 1932, Kornfeld made the observation that, in all cases of cervical erosion, he noticed heavy wear facets on the articulating surfaces of the teeth involved and that the erosion tended to be at the opposite side of the tooth to the wear facet. 3–4  

The confusing use of the term erosion to describe a lesion that may actually be caused by mechanical abrasion is further compounded by the fact that, to a chemical engineer, the process described by dentists as erosion is known as corrosion. 5 Use of such imprecise terminology has contributed to both the difficulty of carrying out good quality research and making accurate diagnoses that enable appropriate treatments to be both recommended and provided.

Many practitioners have felt that over enthusiastic toothbrushing and the use of abrasive toothpastes were the primary causes of these lesions, but Lee and Eakle, in 1984, put forward the hypothesis that tensile stresses created in the tooth during occlusal loading may have a role in the etiology of cervical erosive lesions. 6 They described three types of stress placed on teeth during mastication and parafunction:

Compressive—the resistance to compression

Tensile—the resistance to stretching

Shearing—the resistance to twisting or sliding

The authors were of the opinion that, in a “non-ideal” occlusion, large lateral forces could be created that would result in compressive stresses on the side being loaded and tensile stresses on the opposite side. As enamel is strong in compression but weak in tension, it was suggested that those areas in tension were prone to failure. The region of greatest stress is found at the fulcrum of the tooth. The characteristic lesion described was wedge-shaped, with sharp line angles and was situated at or near the fulcrum of the tooth. It was suggested that the direction of the lateral force governed the position of the lesion, while its size was related to the amount of force and its duration.

Grippo put forward a new classification of hard tissue lesions of teeth. 7 He defined four categories of tooth wear as follows:

Attrition—the wearing away of tooth substance as a result of tooth-to-tooth contact during normal or parafunctional masticatory activity.

Abrasion—the pathological wear of tooth substance through biomechanical frictional processes, such as toothbrushing.

Erosion—the loss of tooth substance by acid dissolution of either an intrinsic or extrinsic origin; for example, gastric acid or dietary acids.

Abfraction—the pathologic loss of tooth substance caused by biomechanical loading forces. It was postulated that these lesions were caused by flexure of the tooth during loading, leading to fatigue of the enamel and dentin at a location away from the point of loading. The word “abfraction” was derived from the Latin “to break away.”

Grippo then further described five categories of abfraction:

Hairline cracks

Striations—horizontal bands of enamel breakdown

Saucer shaped—a lesion entirely within enamel

Semi-lunar shaped—a crescent shaped lesion entirely within enamel

Cusp tip invagination—a depression on the cusp tip seen in molars and premolars

By 1994, Lambert and Lindenmuth considered that the profession should now consider occlusal stress as a primary factor in the creation and progression of cervical notch lesions and a considerable body of theoretical work had accumulated to support this hypothesis. 8 A comprehensive review of abfraction lesions has recently been published, which concluded that the etiology of these lesions is multifactorial but that occlusal factors are a primary etiological factor. 9  

This study investigated whether or not reducing excursive occlusal loading had any impact on the rate of progression of abfraction lesions in vivo . The test hypothesis (H t ) was that a reduction in lateral excursive loads would result in a reduction in the rate of abfraction lesion development. The null hypothesis (H o ) for this study was that there was no difference in the rate of abfraction lesion progression when excursive occlusal loads were reduced.

Subject Selection

Following ethical approval obtained from the local research ethics committee (Leeds East REC, Leeds, UK), 39 patients were recruited into the current study. They ranged in age from 18 through 75 years and had two abfraction lesions that did not require operative intervention. In addition, the test teeth had to be in group function during lateral excursive movements, with no mobility of the test or antagonist teeth being detectable clinically. In contrast, subjects were excluded from the study if:

The abfraction lesions were in teeth that had no antagonist

There was canine guidance in lateral excursion

There was more than 3 mm of pocketing

The teeth were mobile

There was poor oral hygiene

Other restorative treatment was required of the teeth included in the current study

The subject had poor general health

This study was designed as a randomized controlled trial, with each patient acting as his/her own control. In order to minimize operator bias, the tooth to be adjusted was allocated at random. This was achieved by recording each tooth according to FDI notation. For example, an upper right second premolar was recorded as 15 and an upper left first premolar as 24. Equal numbers of opaque envelopes were prepared with either the word “High” or “Low” in them. No identifying marks were present externally. The patient chose an envelope at random from within a box and opened it. If it contained the word “High,” then the tooth with the higher notation, for example, 24, as in the example above, was adjusted. Conversely, if the envelope contained the word “Low,” the tooth with the lower notation, that is, 15, was adjusted.

Operative Procedures

All subjects recently had full mouth examinations, including clinically appropriate radiographs and a periodontal screening, to check for attachment loss, gingival bleeding and mobility of the relevant teeth. The dynamic and static occlusal contacts of the test teeth were marked using red and blue Bausch 40 micron articulating paper (Dr Jean Bausch KG, Seefeld, Germany) respectively, after having dried the occlusal surfaces of the teeth with tissue held in Miller's forceps (Unodent, Witham, UK). The areas marked red were reduced using Hi-Di fine grain diamond finishing burs (Hi Di Burs, Dentsply, Weybridge, UK) in a water-cooled air turbine. Care was taken to leave the blue centric stops and the red point of maximum excursive contact intact to ensure occlusal stability. The adjusted area was lightly polished with Shofu abrasive cones (Shofu Dental GmbH, Ratingen, Germany) to reduce any surface roughness, and the occlusion was rechecked with articulating paper. Further adjustment, if required, was carried out as described above.

Full-arch impressions were taken using a polyether impression material (Impregum, 3M ESPE, Seefeld, Germany) in polycarboxylate disposable trays (Polytrays, Dentsply). The impressions were rinsed, disinfected and cast up immediately in blue die stone (Skillstone, Whip Mix Corporation, Louisville, KY, USA). The investigative procedures are summarized in Figure 1 .

Flow chart summarizing investigative procedures.

The subjects were followed-up at six, 18 and 30 months after baseline. At the follow-up appointments, routine full mouth examinations were carried out, along with appropriate radiographs and periodontal screening. The occlusion of the test teeth was marked again with red and blue articulating paper to check whether there had been any change. If the dynamic markings were heavy or if new dynamic markings were identified, these were adjusted as before and repolished. At each visit, impressions were also taken as described previously.

Model Analysis

To minimize operator error in the processing and measuring of the models, all the models were measured at the same time. In order to keep the original models intact, the test teeth were duplicated using a polyvinylsiloxane putty and wash (Provil Novo, Heraeus Kulzer GmbH, Hanau, Germany) and replica dies were cast in epoxy resin (Exacto-Form Model Resin, Bredent, Senden, Germany). Three points were marked on each model ( Figure 2 ) as follows:

Tip of the cusp

Midpoint of the lesion in the long axis of the tooth

Soft tissues along the same axis

A scalpel blade was used to make the marks, as it is thinner than a pencil.

The models were then sectioned using a low-speed sectioning machine (Model 650, South Bay Technology Inc, San Clemente, CA, USA) with a water-cooled diamond wheel saw (76.2 x 0.4 mm, Saint Gobian Abrasive, Gloucester, UK) according to the sectioning plan. The two sides were labeled A and B. This enabled both sides of the slice to be measured in order to provide an average value for the size of the lesion. The sections were then ready to be measured ( Figure 3 ).

Abfraction Area Measurement

The sections were washed under running water to remove any debris from the sectioning process. They were then examined by light-reflecting microscopy using a stereomicroscope (Type S Wild M3Z, Wild Heerburgg, Heerburgg, Switzerland) at 10× magnification. Each section was fixed to a glass slide and positioned under the microscope in such a way that the entire cross section of the abfraction area could be viewed and examined at right angles to the microscope lens. Live images from the microscope were transferred to a computer (Dell Latitude D510, Dell, Inc, Round Rock, TX, USA) by a built-in digital video camera (PEC 3010, Pulmix, Basingstoke, England). A digital micrograph was obtained from each section. The abfraction area measurement was carried out using image analysis with SigmaScan Software (SigmaScan Pro 5.0.0, Aspire Software International, Leesburg, VA, USA). The software counts the number of pixels enclosed within a defined boundary. In order to do this, the operator must define those boundaries around the lesion using a mouse and pointer on the computer screen. To minimize potential error, sequential lesions were measured at the same time, and two readings were taken from each side of the sample in an effort to get consistent values. The mean of the two measurements of abfraction area from each section was calculated. The mean of the two measurements from side A and side B was then worked out and recorded. In order to blind the operator, no means of identifying which tooth had been adjusted was made available at the time of analysis.

Data Analysis

Data was input into SPSS and the results were analyzed with a paired-samples t -test with the level of significance set at 0.05.

In total, 39 subjects were recruited into the study. They ranged in age from 35 years to 70 years, with a mean of 51 years and 3 months, sd ± 9.1 years. Two subjects failed to return and one patient was eliminated from the study because one of the test teeth sustained a cusp fracture and had to be restored. The distribution of the lesions is summarized in Table 1 . The abfraction area from models for five patients could not be measured for several reasons; therefore, data were obtained from a total number of 31 patients.

Distribution of Lesions

Statistical analysis revealed that there was no statistically significant difference between the rate of lesion progression for teeth that had been adjusted and those that had not at the six-, 18- and 30-month reviews ( p =0.510, p =0.682 and p =0.669, respectively). The results of the current study are summarized in Tables 2 and 3 . The test hypothesis that, reducing the occlusal load in lateral excursion would reduce the rate of progression of abfraction lesions, was therefore rejected.

Change in Mean Values of Area of Abfraction Lesions From Baseline

Change in Area of Abfraction Lesions in Square Millimeters From Baseline: Distribution of Lesions

The current study primarily investigated the hypothesis that reducing excursive occlusal loads on a tooth in lateral excursion would lead to a reduction in the rate of progression of abfraction lesions. The study was carried out in a primary care setting, in this case, a predominantly private general dental practice, with most of the subjects regularly attending the practice. It is often stated that, “real world research will lead to real world findings.” It was envisioned that, carrying out research in practice would make it easier to follow patients over a longer period of time than it is in a hospital setting, let alone test the feasibility of using this intervention in primary dental care to produce findings of clinical application in everyday practice. The relatively low dropout rate in this study is generally supportive of this principal.

The age range of the patients recruited, 31 to 70, with an average age of 51, tends to support the findings of Levitch and others, namely, that the prevalence of abfraction lesions increases with age. 10 In contrast to the findings of Pegoraro, no paired lesions were identified in patients under the age of 30. 11 That is not to say that lesions were not present in small numbers, but, if they were, they may not have been in group function in lateral excursion, which would have excluded them from the study. 11  

The data in Table 1 is not, of course, strictly an accurate indicator of lesion distribution, as the mouths of the subjects were examined from the right side first, when initially screened, and, if lesions were identified in that quadrant, the left side was not included in the study. The data does, however, give some indication of the spread between premolar and molar lesions, which is slightly at variance with reports by Pegoraro and others and Radentz and others, which found maxillary molars to be the most frequently affected teeth. 11–12 It is, of course, possible that this slightly different distribution, when compared with the published literature, has arisen, because only teeth that were in group function during lateral excursion were eligible for inclusion in the current study.

During the recruitment period, it was interesting to note how many lesions were seen that were ineligible for inclusion, because they were either not in group function in lateral excursion or not at all in occlusion. Several patients had classic wedge-shaped lesions on teeth that had never been in occlusion, for example, anterior open bites caused by skeletal discrepancies, which would indicate that occlusal forces could have played no part in their etiology. This calls into question Kornfeld's observation that all teeth with cervical erosions had heavy occlusal wear facets and similarly throws into doubt Lee and Eakle's theory about the possible role of tensile stress in the etiology of NCCL. 4 , 6 It does, however, tend to support the theory that, not only abfraction lesions are multifactorial in etiology, but that clinically identical lesions may have different etiologies. Much like Black, the authors of the current study still do not have an explanation that satisfactorily explains the etiology of all these lesions without having some feature that renders it impossible. 1  

Within the design of the current study, the centric occlusal stop and the stop in the position of maximum excursion were both maintained to prevent occlusal instability. These markings were checked at each review appointment and adjusted, if necessary.

It was noted that some patients had re-established full sliding contacts by the review visit, requiring further occlusal adjustment. This would have had the effect of reintroducing occlusal stresses into their lateral excursive movements and lessening the effect of adjustments done in the current study. This might explain the results obtained from the current study. As the centric stop was maintained in all cases of distortion under vertical loading, for example, barreling effects, as described by Goel and others, would still be active, so that the influence of occlusal forces cannot be ruled out completely. 13 It is possible that reducing the occlusal loads in lateral excursion by re-establishing canine guidance as suggested by Murray and others would be a more effective intervention. 14  

A further factor not taken into account by the current study was the restorative condition of the teeth being monitored. It has been established by Rees that the presence of occlusal restorations in lower pre-molars significantly increases the cervical area stresses that occur during excursive loading, and it is not unreasonable to assume that the same effect would be found in maxillary teeth and could have had an influence on wear rates. 15  

It was interesting to note that both sets of lesions continued to increase in size. This indicates that the measuring technique was subtle and effective enough to detect small changes and illustrates the progressive nature of the lesions being measured. As adjusting the excursive occlusal load did not affect the rate of progression, other factors, such as toothbrush abrasion and or acid erosion, may be contributing to this wear. Further research is still needed to improve diagnosis and allow for differentiation between the different etiologies, which may result in the formation clinically of very similar lesions, let alone allow for the investigation of interventions designed to stop the formation and progression of abfraction lesions.

Within the limitations of the current study, the results do not support removal of lateral excursive contacts by occlusal adjustment to reduce the rate of progression of abfraction lesions in maxillary teeth.

This study was sponsored by the Department of Health, Manchester, UK and was presented at the 35 th Annual Meeting and Exhibition of the AADR, the 30 th Annual Meeting of the CADR and the 83 rd Annual Meeting and Exhibition of ADEA, Orlando, Florida, March 8–11, 2006.

Author notes

Ian David Wood, general dental practitioner, Sale, Cheshire, UK

Ali Sabet Abbas Kassir, research fellow, Department of Fixed and Removable Prosthodontics, Leeds Dental Institute, Leeds, UK

Paul Anthony Brunton, professor and head of department, Department of Fixed and Removable Prosthodontics, Leeds Dental Institute, Leeds, UK

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12 2.2.3 Types of Body Movements

Synovial joints allow the body a tremendous range of movements. Each movement at a synovial joint results from the contraction or relaxation of the muscles that are attached to the bones on either side of the articulation. The type of movement that can be produced at a synovial joint is determined by its structural type. While the ball-and-socket joint gives the greatest range of movement at an individual joint, in other regions of the body, several joints may work together to produce a particular movement. Overall, each type of synovial joint is necessary to provide the body with its great flexibility and mobility. There are many types of movement that can occur at synovial joints ( Table 1 ).

Human movements are complex. In order to describe movements we typically break down the movement and describe what is occurring at every joint. At each joint, we can break down the movement into three planes. Planes describe the direction of the movement. The sagittal plane lies vertically and divides the body into right and left parts. Forward and backward movements fall into this plane (flexion, extension). The frontal plane also lies vertically but divides the body into anterior and posterior parts. Lateral movements that involves the limbs moving away and towards the body fall under this plane (adduction, abduction). The transverse plane lies horizontally and divides the body into superior and inferior. Rotations and twisting motions fall under this plane (internal rotation, external rotation).

An axis is a straight line around which a limb rotates. Movement at a joint takes place in a plane about an axis. There are three axes of rotation that correspond to each of the three planes:

  • Sagittal plane: medio-lateral axis
  • Frontal plane: anteroposterior axis
  • Transverse plane: longitudinal axis

There is a tendency when describing a movement to refer it to the particular plane that it is dominated by. For example, running is often considered to be a movement in the sagittal plane. In reality, all movements involves movements in more than one dimension.

Movement types are generally paired, with one being the opposite of the other. Body movements are always described in relation to the anatomical position of the body: upright stance, with upper limbs to the side of body and palms facing forward. Refer to Figure 1 as you go through this section.

QR Code representing a URL

Watch this video to learn about anatomical motions. What motions involve increasing or decreasing the angle of the foot at the ankle?

This multi-part image shows different types of movements that are possible by different joints in the body.

Flexion and Extension

Flexion and extension are movements that take place within the sagittal plane and involve anterior or posterior movements of the body or limbs. For the vertebral column, flexion (anterior flexion) is an anterior (forward) bending of the neck or body, while extension involves a posterior-directed motion, such as straightening from a flexed position or bending backward. Lateral flexion is the bending of the neck or body toward the right or left side. These movements of the vertebral column involve both the symphysis joint formed by each intervertebral disc, as well as the plane type of synovial joint formed between the inferior articular processes of one vertebra and the superior articular processes of the next lower vertebra.

In the limbs, flexion decreases the angle between the bones (bending of the joint), while extension increases the angle and straightens the joint. For the upper limb, all anterior-going motions are flexion and all posterior-going motions are extension. These include anterior-posterior movements of the arm at the shoulder, the forearm at the elbow, the hand at the wrist, and the fingers at the metacarpophalangeal and interphalangeal joints. For the thumb, extension moves the thumb away from the palm of the hand, within the same plane as the palm, while flexion brings the thumb back against the index finger or into the palm. These motions take place at the first carpometacarpal joint. In the lower limb, bringing the thigh forward and upward is flexion at the hip joint, while any posterior-going motion of the thigh is extension. Note that extension of the thigh beyond the anatomical (standing) position is greatly limited by the ligaments that support the hip joint. Knee flexion is the bending of the knee to bring the foot toward the posterior thigh, and extension is the straightening of the knee. Flexion and extension movements are seen at the hinge, condyloid, saddle, and ball-and-socket joints of the limbs (see Figure 1 a-d ).

Hyperextension is the abnormal or excessive extension of a joint beyond its normal range of motion, thus resulting in injury. Similarly, hyperflexion is excessive flexion at a joint. Hyperextension injuries are common at hinge joints such as the knee or elbow. In cases of “whiplash” in which the head is suddenly moved backward and then forward, a patient may experience both hyperextension and hyperflexion of the cervical region.

Abduction and Adduction

Abduction and adduction motions occur within the coronal plane and involve medial-lateral motions of the limbs, fingers, toes, or thumb. Abduction moves the limb laterally away from the midline of the body, while adduction is the opposing movement that brings the limb toward the body or across the midline. For example, abduction is raising the arm at the shoulder joint, moving it laterally away from the body, while adduction brings the arm down to the side of the body. Similarly, abduction and adduction at the wrist moves the hand away from or toward the midline of the body. Spreading the fingers or toes apart is also abduction, while bringing the fingers or toes together is adduction. For the thumb, abduction is the anterior movement that brings the thumb to a 90° perpendicular position, pointing straight out from the palm. Adduction moves the thumb back to the anatomical position, next to the index finger. Abduction and adduction movements are seen at condyloid, saddle, and ball-and-socket joints (see Figure 1 e ).

Circumduction

Circumduction is the movement of a body region in a circular manner, in which one end of the body region being moved stays relatively stationary while the other end describes a circle. It involves the sequential combination of flexion, adduction, extension, and abduction at a joint. This type of motion is found at biaxial condyloid and saddle joints, and at multiaxial ball-and-sockets joints (see Figure 1 e ).

Rotation can occur within the vertebral column, at a pivot joint, or at a ball-and-socket joint. Rotation of the neck or body is the twisting movement produced by the summation of the small rotational movements available between adjacent vertebrae. At a pivot joint, one bone rotates in relation to another bone. This is a uniaxial joint, and thus rotation is the only motion allowed at a pivot joint. For example, at the atlantoaxial joint, the first cervical (C1) vertebra (atlas) rotates around the dens, the upward projection from the second cervical (C2) vertebra (axis). This allows the head to rotate from side to side as when shaking the head “no.” The proximal radioulnar joint is a pivot joint formed by the head of the radius and its articulation with the ulna. This joint allows for the radius to rotate along its length during pronation and supination movements of the forearm.

Rotation can also occur at the ball-and-socket joints of the shoulder and hip. Here, the humerus and femur rotate around their long axis, which moves the anterior surface of the arm or thigh either toward or away from the midline of the body. Movement that brings the anterior surface of the limb toward the midline of the body is called medial (internal) rotation . Conversely, rotation of the limb so that the anterior surface moves away from the midline is lateral (external) rotation (see Figure 1 f ). Be sure to distinguish medial and lateral rotation, which can only occur at the multiaxial shoulder and hip joints, from circumduction, which can occur at either biaxial or multiaxial joints.

Supination and Pronation

Supination and pronation are movements of the forearm. In the anatomical position, the upper limb is held next to the body with the palm facing forward. This is the supinated position of the forearm. In this position, the radius and ulna are parallel to each other. When the palm of the hand faces backward, the forearm is in the pronated position , and the radius and ulna form an X-shape.

Supination and pronation are the movements of the forearm that go between these two positions. Pronation is the motion that moves the forearm from the supinated (anatomical) position to the pronated (palm backward) position. This motion is produced by rotation of the radius at the proximal radioulnar joint, accompanied by movement of the radius at the distal radioulnar joint. The proximal radioulnar joint is a pivot joint that allows for rotation of the head of the radius. Because of the slight curvature of the shaft of the radius, this rotation causes the distal end of the radius to cross over the distal ulna at the distal radioulnar joint. This crossing over brings the radius and ulna into an X-shape position. Supination is the opposite motion, in which rotation of the radius returns the bones to their parallel positions and moves the palm to the anterior facing (supinated) position. It helps to remember that supination is the motion you use when scooping up soup with a spoon (see Figure 2 g ).

Dorsiflexion and Plantar Flexion

Dorsiflexion and plantar flexion are movements at the ankle joint, which is a hinge joint. Lifting the front of the foot, so that the top of the foot moves toward the anterior leg is dorsiflexion, while lifting the heel of the foot from the ground or pointing the toes downward is plantar flexion. These are the only movements available at the ankle joint (see Figure 2 h ).

Inversion and Eversion

Inversion and eversion are complex movements that involve the multiple plane joints among the tarsal bones of the posterior foot (intertarsal joints) and thus are not motions that take place at the ankle joint. Inversion is the turning of the foot to angle the bottom of the foot toward the midline, while eversion turns the bottom of the foot away from the midline. The foot has a greater range of inversion than eversion motion. These are important motions that help to stabilize the foot when walking or running on an uneven surface and aid in the quick side-to-side changes in direction used during active sports such as basketball, racquetball, or soccer (see Figure 2 i ).

Protraction and Retraction

Protraction and retraction are anterior-posterior movements of the scapula or mandible. Protraction of the scapula occurs when the shoulder is moved forward, as when pushing against something or throwing a ball. Retraction is the opposite motion, with the scapula being pulled posteriorly and medially, toward the vertebral column. For the mandible, protraction occurs when the lower jaw is pushed forward, to stick out the chin, while retraction pulls the lower jaw backward. (See Figure 2 j .)

Depression and Elevation

Depression and elevation are downward and upward movements of the scapula or mandible. The upward movement of the scapula and shoulder is elevation, while a downward movement is depression. These movements are used to shrug your shoulders. Similarly, elevation of the mandible is the upward movement of the lower jaw used to close the mouth or bite on something, and depression is the downward movement that produces opening of the mouth (see Figure 2 k ).

Excursion is the side to side movement of the mandible. Lateral excursion moves the mandible away from the midline, toward either the right or left side. Medial excursion returns the mandible to its resting position at the midline.

Superior Rotation and Inferior Rotation

Superior and inferior rotation are movements of the scapula and are defined by the direction of movement of the glenoid cavity. These motions involve rotation of the scapula around a point inferior to the scapular spine and are produced by combinations of muscles acting on the scapula. During superior rotation , the glenoid cavity moves upward as the medial end of the scapular spine moves downward. This is a very important motion that contributes to upper limb abduction. Without superior rotation of the scapula, the greater tubercle of the humerus would hit the acromion of the scapula, thus preventing any abduction of the arm above shoulder height. Superior rotation of the scapula is thus required for full abduction of the upper limb. Superior rotation is also used without arm abduction when carrying a heavy load with your hand or on your shoulder. You can feel this rotation when you pick up a load, such as a heavy book bag and carry it on only one shoulder. To increase its weight-bearing support for the bag, the shoulder lifts as the scapula superiorly rotates. Inferior rotation occurs during limb adduction and involves the downward motion of the glenoid cavity with upward movement of the medial end of the scapular spine.

Opposition and Reposition

Opposition is the thumb movement that brings the tip of the thumb in contact with the tip of a finger. This movement is produced at the first carpometacarpal joint, which is a saddle joint formed between the trapezium carpal bone and the first metacarpal bone. Thumb opposition is produced by a combination of flexion and abduction of the thumb at this joint. Returning the thumb to its anatomical position next to the index finger is called reposition (see Figure 2 l ).

Chapter Review

The variety of movements provided by the different types of synovial joints allows for a large range of body motions and gives you tremendous mobility. These movements allow you to flex or extend your body or limbs, medially rotate and adduct your arms and flex your elbows to hold a heavy object against your chest, raise your arms above your head, rotate or shake your head, and bend to touch the toes (with or without bending your knees).

Each of the different structural types of synovial joints also allow for specific motions. The atlantoaxial pivot joint provides side-to-side rotation of the head, while the proximal radioulnar articulation allows for rotation of the radius during pronation and supination of the forearm. Hinge joints, such as at the knee and elbow, allow only for flexion and extension. Similarly, the hinge joint of the ankle only allows for dorsiflexion and plantar flexion of the foot.

Condyloid and saddle joints are biaxial. These allow for flexion and extension, and abduction and adduction. The sequential combination of flexion, adduction, extension, and abduction produces circumduction. Multiaxial plane joints provide for only small motions, but these can add together over several adjacent joints to produce body movement, such as inversion and eversion of the foot. Similarly, plane joints allow for flexion, extension, and lateral flexion movements of the vertebral column. The multiaxial ball and socket joints allow for flexion-extension, abduction-adduction, and circumduction. In addition, these also allow for medial (internal) and lateral (external) rotation. Ball-and-socket joints have the greatest range of motion of all synovial joints.

Interactive Link Questions

Dorsiflexion of the foot at the ankle decreases the angle of the ankle joint, while plantar flexion increases the angle of the ankle joint.

Answers for Review Questions

Answers for Critical Thinking Questions

  • Ball-and-socket joints are multiaxial joints that allow for flexion and extension, abduction and adduction, circumduction, and medial and lateral rotation.
  • To cross your arms, you need to use both your shoulder and elbow joints. At the shoulder, the arm would need to flex and medially rotate. At the elbow, the forearm would need to be flexed.

Biomechanics of Human Movement by OpenStax is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Stepforce

The Centre of Pressure Excursion Index

Measuring dynamic foot function, where we’ve come from.

In 1977 I bought my copy of the landmark text Normal and abnormal function of the foot by Root, Orien and Weed [1].  This work would define foot function for the next 30+ years and has provided the principles we still use today.

It provided values for a normal foot by using an ideal set of criteria that was thought would allow the foot to function normally. These criteria were based, however, on static examinations; for a structure that functions mainly as a dynamic structure, managing the loads of body weight due to gravity, muscle torques and joint moments and the reflective ground reaction forces.

In 1995, McPoil and Hunt[2] provided a definition of what we now know is the Tissue Stress Theory to provide a model that took into account the effects of tissue loading and suggested it as an alternative model for evaluating and treating foot disorders.

During the next 10 years there would be a substantial amount of research that would refocus our attention on foot function from the kinematic to the kinetic. Some of the more well known include:

  • Kirby’s subtalar joint axis location and rotation equilibrium theory [3]
  • Dananberg’s Sagittal plane theory [4],
  • Payne’s work on the resupination test [5],
  • Williams et al, on how orthotics work [6] supported by
  • MacLean’s work on orthotic intervention in runners [7] (8]

Throughout this period a number of static weight bearing assessment tools were being designed with the aim of predicting dynamic function. Some foot specific examples are: The subtalar joint axis, re supination, functional hallux limitus and Jack’s tests.

Tests aimed at predicting dynamic function, taking into account a number of factors, would include the arch index test [9] which developed into the modified arch index test [10] and perhaps the most popular, the foot posture index [11].

The foot posture index measured:

  • Talar head position
  • Supra and infra lateral malleolar curvature
  • Calcaneal frontal plane position
  • Prominence in the region of the talonavicular joint
  • Height and congruence of the medial longitudinal arch
  • Abduction/adduction of the forefoot on the rear foot

For each of these measurements values of +1 or +2 are given for a pronated position, values of -1 or -2 are given for a supinated position and scores of zero are given for a neutral position. A final score is a number between -12 and +12. The more negative the total number, the more supinated the foot is and the more positive the total number, the more pronated the foot is. A foot that is considered “normal” will have a value of 0 to +5.

The focus of the foot posture index is to define the level of pronation or supination of the foot when weight bearing. This is because excessive motion in the frontal plane has been theorised and validated by research to be associated to a number of pathologies.

Research has found a significant association between excessive pronated foot posture and:

  • Tibialis Posterior Tendinopathy[8]
  • Arch and heel pain [12]
  • Metatarsal Stress fractures [13]

As well as dysfunction in the anatomical structures of the foot:

  • Reduced gliding of the tibialis posterior tendon and associated fascia [14]
  • Increased Talonavicular joint motion leading to reduced stability [15]
  • Increased dorsal compression forces in the midfoot [15]

Research comparing the outcome of the foot posture index test against plantar pressure analysis, however, shows low to moderate pressure variability. [16] So, while the foot posture index is helpful to gain an understanding of the weight bearing foot posture, and possibly a potential prediction of function, it still doesn’t give us a completely accurate picture of dynamic foot function.

What is the situation now?

The viewpoint of analysing foot function using exclusively non-weightbearing assessment and video capture (noting the angular relationships of the joints in the feet) began to be substantially questioned as to it being a valid and reliable assessment.

In 2017, Nester et al published a paper,”Challenging the foundations of the clinical model of foot function: further evidence that the root model assessments fail to appropriately classify foot function” [17] This paper went so far as to recommend such tests not be relied upon.

A very real paradox emerged. Practitioners who had been using the techniques outlined in the model provided by the normal and abnormal function of the foot had achieved good outcomes with their treatment strategies. So, even with this new information, they did not feel comfortable in abandoning them.

Complicating this, is that there has been no clear replacement for Root, Orien and Weed’s definition of normal foot structure and function. The more we have researched the function of the rear foot, midfoot and forefoot joint systems, then multiple axis of motion, how they adapt to the various tissue strains of force, et cetera the more complex a simple definition becomes. Craig Payne ventured a definition on an online forum as, “the normal foot is the foot in which the forces are below the threshold for tissue damage” [18]. Of course, we do not know what the individual’s threshold for tissue damage is and as far as I can see the only research that is bold enough to define such a thing is the 200 KPA threshold for diabetics with high risk feet [19] [20]

How important is CPEI in analysing foot function?

We understand the association of foot posture and increased loading on tissue resulting in at least a risk of injury.

So is there a research validated dynamic, rather than static, weight bearing method of measuring pressure during gait?

Is there also a method of measuring the forces being applied to these tissues and perhaps one that also indicates the individual areas of dysfunction in the rearfoot – midfoot and rearfoot? And is this available to the practitioner in daily practice or only those working with highly complex equipment in research?

I am pleased to say that there is!

The centre of pressure excursion index, CPEI, was developed in the gait study centre of the Pennsylvania College of podiatric medicine and was first used in a research paper to test whether different foot types had distinguishable foot function. Their 1996 study assessed excessively pronated and rectus foot types.

This new index measured the degree of deviation of the centre of pressure trajectory in a lateromedial deviation from a reference line drawn from the initial to the final centres of pressure during the stance phase of gait. The study showed that the CPEI had excellent intra-and inter-testing reliability. [21]

The Framingham foot research published in 2013 [22-25] used CPEI as a variable to measure the characteristics of dynamic foot function in four of the studies. Since then, the CPEI measurement has been used in a further four major studies [26] [27] [28] [29]

The CPEI is based on the shape of the centre of pressure trajectory providing an indication of function. While it also provides a research validated measurement of foot posture, the CoP trajectory is the key indicator for foot function because it shows us:

  • the change of weight-bearing from the lateral column to the medial column that was described in the Bojsen-Møller model as low gear and high gear [30] which is an indication of how well the auto-supportive mechanisms are functioning, and
  • possible areas of joint dysfunction through the hesitations and actual blockages seen in the centre of pressure trajectory from initial contact through to pre-swing.

These features in the centre of pressure trajectory can be easily measured using in-shoe, pressure mat and pressure treadmill equipment to gain objective data which can be directly compared to with the patient wearing different types of shoes or with different corrections applied in the clinic. Any changes are visually discernible and can be objectively quantified because we are looking at the position, speed, fluidity and transition of the centre of pressure trajectory.

It begs the question why the CPEI is not being used as the gold standard for dynamic gait function measurement, considering it has been validated by its use in research and provides such important information so quickly and easily. And, is repeatable for comparison so value judgements on treatments can be made.

If the use of the CPEI measurement becomes a standard feature in clinical assessment of foot pain and dysfunction generally in clinical practice, I believe that we could start an informed process of once again being able to define foot function using dynamically validated processes providing the best outcome for our patients and much greater confidence for treating practitioners.

As far as I’m aware, only Novel and Tekscan equipment provides, at present, this most important measurement of CPEI. However, Sensor Medica will have this feature by the end of 2021 and I am working with other manufacturers of pressure measuring equipment to make this feature available in all software so that this proven measurement is available to all clinicians using plantar pressure measurement.

' title=

Paul Graham

B.app.sc.(pod) f.a.a.p.s.m., m.a.pod.a, s.m.a, current member of the australian pain society.

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Biology LibreTexts

12.6: Types of Body Movements

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  • Page ID 34490

Learning Objectives

  • Define the different types of body movements
  • Identify the joints that allow for these motions

Synovial joints allow the body a tremendous range of movements. Each movement at a synovial joint results from the contraction or relaxation of the muscles that are attached to the bones on either side of the articulation. The type of movement that can be produced at a synovial joint is determined by its structural type. While the ball-and-socket joint gives the greatest range of movement at an individual joint, in other regions of the body, several joints may work together to produce a particular movement. Overall, each type of synovial joint is necessary to provide the body with its great flexibility and mobility. There are many types of movement that can occur at synovial joints (Table 1). Movement types are generally paired, with one being the opposite of the other. Body movements are always described in relation to the anatomical position of the body: upright stance, with upper limbs to the side of body and palms facing forward.

Watch this video to learn about anatomical motions. What motions involve increasing or decreasing the angle of the foot at the ankle?

Thumbnail for the embedded element "Anatomical Terms of Movement"

A YouTube element has been excluded from this version of the text. You can view it online here: pb.libretexts.org/aapi/?p=248

Flexion and Extension

Flexion and extension are movements that take place within the sagittal plane and involve anterior or posterior movements of the body or limbs. For the vertebral column, flexion (anterior flexion) is an anterior (forward) bending of the neck or body, while extension involves a posterior-directed motion, such as straightening from a flexed position or bending backward. Lateral flexion is the bending of the neck or body toward the right or left side. These movements of the vertebral column involve both the symphysis joint formed by each intervertebral disc, as well as the plane type of synovial joint formed between the inferior articular processes of one vertebra and the superior articular processes of the next lower vertebra.

In the limbs, flexion decreases the angle between the bones (bending of the joint), while extension increases the angle and straightens the joint. For the upper limb, all anterior-going motions are flexion and all posterior-going motions are extension. These include anterior-posterior movements of the arm at the shoulder, the forearm at the elbow, the hand at the wrist, and the fingers at the metacarpophalangeal and interphalangeal joints. For the thumb, extension moves the thumb away from the palm of the hand, within the same plane as the palm, while flexion brings the thumb back against the index finger or into the palm. These motions take place at the first carpometacarpal joint. In the lower limb, bringing the thigh forward and upward is flexion at the hip joint, while any posterior-going motion of the thigh is extension. Note that extension of the thigh beyond the anatomical (standing) position is greatly limited by the ligaments that support the hip joint. Knee flexion is the bending of the knee to bring the foot toward the posterior thigh, and extension is the straightening of the knee. Flexion and extension movements are seen at the hinge, condyloid, saddle, and ball-and-socket joints of the limbs (see Figure 1).

This multi-part image shows different types of movements that are possible by different joints in the body.

Hyperextension is the abnormal or excessive extension of a joint beyond its normal range of motion, thus resulting in injury. Similarly, hyperflexion is excessive flexion at a joint. Hyperextension injuries are common at hinge joints such as the knee or elbow. In cases of “whiplash” in which the head is suddenly moved backward and then forward, a patient may experience both hyperextension and hyperflexion of the cervical region.

Abduction, Adduction, and Circumduction

This multi-part image shows different types of movements that are possible by different joints in the body.

Abduction and adduction are motions of the limbs, hand, fingers, or toes in the coronal (medial–lateral) plane of movement. Moving the limb or hand laterally away from the body, or spreading the fingers or toes, is abduction. Adduction brings the limb or hand toward or across the midline of the body, or brings the fingers or toes together. Circumduction is the movement of the limb, hand, or fingers in a circular pattern, using the sequential combination of flexion, adduction, extension, and abduction motions.

Adduction, abduction, and circumduction take place at the shoulder, hip, wrist, metacarpophalangeal, and metatarsophalangeal joints.

Abduction and Adduction

Abduction and adduction motions occur within the coronal plane and involve medial-lateral motions of the limbs, fingers, toes, or thumb. Abduction moves the limb laterally away from the midline of the body, while adduction is the opposing movement that brings the limb toward the body or across the midline. For example, abduction is raising the arm at the shoulder joint, moving it laterally away from the body, while adduction brings the arm down to the side of the body. Similarly, abduction and adduction at the wrist moves the hand away from or toward the midline of the body. Spreading the fingers or toes apart is also abduction, while bringing the fingers or toes together is adduction. For the thumb, abduction is the anterior movement that brings the thumb to a 90° perpendicular position, pointing straight out from the palm. Adduction moves the thumb back to the anatomical position, next to the index finger. Abduction and adduction movements are seen at condyloid, saddle, and ball-and-socket joints (see Figure 2).

Circumduction

Circumduction is the movement of a body region in a circular manner, in which one end of the body region being moved stays relatively stationary while the other end describes a circle. It involves the sequential combination of flexion, adduction, extension, and abduction at a joint. This type of motion is found at biaxial condyloid and saddle joints, and at multiaxial ball-and-sockets joints (see Figure 2).

This multi-part image shows different types of movements that are possible by different joints in the body.

Rotation can occur within the vertebral column, at a pivot joint, or at a ball-and-socket joint. Rotation of the neck or body is the twisting movement produced by the summation of the small rotational movements available between adjacent vertebrae. At a pivot joint, one bone rotates in relation to another bone. This is a uniaxial joint, and thus rotation is the only motion allowed at a pivot joint. For example, at the atlantoaxial joint, the first cervical (C1) vertebra (atlas) rotates around the dens, the upward projection from the second cervical (C2) vertebra (axis). This allows the head to rotate from side to side as when shaking the head “no.” The proximal radioulnar joint is a pivot joint formed by the head of the radius and its articulation with the ulna. This joint allows for the radius to rotate along its length during pronation and supination movements of the forearm.

Rotation can also occur at the ball-and-socket joints of the shoulder and hip. Here, the humerus and femur rotate around their long axis, which moves the anterior surface of the arm or thigh either toward or away from the midline of the body. Movement that brings the anterior surface of the limb toward the midline of the body is called medial (internal) rotation . Conversely, rotation of the limb so that the anterior surface moves away from the midline is lateral (external) rotation (see Figure 3). Be sure to distinguish medial and lateral rotation, which can only occur at the multiaxial shoulder and hip joints, from circumduction, which can occur at either biaxial or multiaxial joints.

Turning of the head side to side or twisting of the body is rotation. Medial and lateral rotation of the upper limb at the shoulder or lower limb at the hip involves turning the anterior surface of the limb toward the midline of the body (medial or internal rotation) or away from the midline (lateral or external rotation).

Supination and Pronation

Supination and pronation are movements of the forearm. In the anatomical position, the upper limb is held next to the body with the palm facing forward. This is the supinated position of the forearm. In this position, the radius and ulna are parallel to each other. When the palm of the hand faces backward, the forearm is in the pronated position , and the radius and ulna form an X-shape.

Supination and pronation are the movements of the forearm that go between these two positions. Pronation is the motion that moves the forearm from the supinated (anatomical) position to the pronated (palm backward) position. This motion is produced by rotation of the radius at the proximal radioulnar joint, accompanied by movement of the radius at the distal radioulnar joint. The proximal radioulnar joint is a pivot joint that allows for rotation of the head of the radius. Because of the slight curvature of the shaft of the radius, this rotation causes the distal end of the radius to cross over the distal ulna at the distal radioulnar joint. This crossing over brings the radius and ulna into an X-shape position. Supination is the opposite motion, in which rotation of the radius returns the bones to their parallel positions and moves the palm to the anterior facing (supinated) position. It helps to remember that supination is the motion you use when scooping up soup with a spoon (see Figure 4).

Dorsiflexion and Plantar Flexion

Dorsiflexion and plantar flexion are movements at the ankle joint, which is a hinge joint. Lifting the front of the foot, so that the top of the foot moves toward the anterior leg is dorsiflexion, while lifting the heel of the foot from the ground or pointing the toes downward is plantar flexion. These are the only movements available at the ankle joint (see Figure 4).

This multi-part image shows different types of movements that are possible by different joints in the body.

Inversion and Eversion

Inversion and eversion are complex movements that involve the multiple plane joints among the tarsal bones of the posterior foot (intertarsal joints) and thus are not motions that take place at the ankle joint. Inversion is the turning of the foot to angle the bottom of the foot toward the midline, while eversion turns the bottom of the foot away from the midline. The foot has a greater range of inversion than eversion motion. These are important motions that help to stabilize the foot when walking or running on an uneven surface and aid in the quick side-to-side changes in direction used during active sports such as basketball, racquetball, or soccer (see Figure 5).

Protraction and Retraction

Protraction and retraction are anterior-posterior movements of the scapula or mandible. Protraction of the scapula occurs when the shoulder is moved forward, as when pushing against something or throwing a ball. Retraction is the opposite motion, with the scapula being pulled posteriorly and medially, toward the vertebral column. For the mandible, protraction occurs when the lower jaw is pushed forward, to stick out the chin, while retraction pulls the lower jaw backward. (See Figure 5.)

This multi-part image shows different types of movements that are possible by different joints in the body.

Depression and Elevation

Depression and elevation are downward and upward movements of the scapula or mandible. The upward movement of the scapula and shoulder is elevation, while a downward movement is depression. These movements are used to shrug your shoulders. Similarly, elevation of the mandible is the upward movement of the lower jaw used to close the mouth or bite on something, and depression is the downward movement that produces opening of the mouth (see Figure 6).

This multi-part image shows different types of movements that are possible by different joints in the body.

Excursion is the side to side movement of the mandible. Lateral excursion moves the mandible away from the midline, toward either the right or left side. Medial excursion returns the mandible to its resting position at the midline.

Superior Rotation and Inferior Rotation

Superior and inferior rotation are movements of the scapula and are defined by the direction of movement of the glenoid cavity. These motions involve rotation of the scapula around a point inferior to the scapular spine and are produced by combinations of muscles acting on the scapula. During superior rotation , the glenoid cavity moves upward as the medial end of the scapular spine moves downward. This is a very important motion that contributes to upper limb abduction. Without superior rotation of the scapula, the greater tubercle of the humerus would hit the acromion of the scapula, thus preventing any abduction of the arm above shoulder height. Superior rotation of the scapula is thus required for full abduction of the upper limb. Superior rotation is also used without arm abduction when carrying a heavy load with your hand or on your shoulder. You can feel this rotation when you pick up a load, such as a heavy book bag and carry it on only one shoulder. To increase its weight-bearing support for the bag, the shoulder lifts as the scapula superiorly rotates. Inferior rotation occurs during limb adduction and involves the downward motion of the glenoid cavity with upward movement of the medial end of the scapular spine.

Opposition and Reposition

Opposition is the thumb movement that brings the tip of the thumb in contact with the tip of a finger. This movement is produced at the first carpometacarpal joint, which is a saddle joint formed between the trapezium carpal bone and the first metacarpal bone. Thumb opposition is produced by a combination of flexion and abduction of the thumb at this joint. Returning the thumb to its anatomical position next to the index finger is called reposition (see Figure 6).

Contributors and Attributions

  • Anatomy & Physiology. Authored by : OpenStax College. Provided by : Rice University. Located at : cnx.org/contents/[email protected] . License : CC BY: Attribution . License Terms : Download for free at cnx.org/contents/[email protected]

IMAGES

  1. What is lateral excursion?

    lateral excursion meaning

  2. What is lateral excursion?

    lateral excursion meaning

  3. What is lateral excursion?

    lateral excursion meaning

  4. Protrusion, Retrusion, and Excursion Anatomy Body Movement Terms

    lateral excursion meaning

  5. Definitive prosthesis. (A) Working side during right lateral excursion

    lateral excursion meaning

  6. Right lateral excursion (RLE) viewed in the horizontal plane. A

    lateral excursion meaning

VIDEO

  1. Lateral displacement

  2. ◄╣ Anterior & Lateral Compartments of the Leg ╠►

  3. star balance excursion lateral view

  4. IT HITS DIFFERENT 5.0

  5. Lateral Entry Meaning in Kannada

  6. TRANSITIONS w/ consideration of lateral movement. #FieldcraftSurvival

COMMENTS

  1. What is lateral excursion?

    Lateral excursion is the second key step when we chew our food. Once the mouth opens and the food enters the oral cavity, the jaw moves sideways and grinds the food, closes gradually and finally the teeth meet each other before the mouth comes back in a state of rest. Lateral excursion might be hampered due to problems in the gnathic system.

  2. 9.5 Types of Body Movements

    Define and identify the different body movements. Demonstrate the different types of body movements; ... Lateral excursion moves the mandible away from the midline, toward either the right or left side. Medial excursion returns the mandible to its resting position at the midline.

  3. Types of Body Movements

    Define the different types of body movements; Identify the joints that allow for these motions; Synovial joints allow the body a tremendous range of movements. Each movement at a synovial joint results from the contraction or relaxation of the muscles that are attached to the bones on either side of the articulation. ... Lateral excursion moves ...

  4. Protrusion, Retrusion, and Excursion Anatomy

    Excursion can occur in either direction, and anatomists use directional terms to specify the type of excursion. When the mandible moves to either the left or right, it's moving away from the body's midline, so it's called lateral excursion. When the mandible moves closer to the midline of the body, it's called medial excursion.

  5. Lateral excursion

    lateral excursion: [ ek-skur´zhun ] a range of movement regularly repeated in performance of a function, e.g., excursion of the jaws in mastication. adj., adj excur´sive. lateral excursion sideward movement of the mandible between the position of closure and the position in which cusps of opposing teeth are in vertical proximity.

  6. Lateral excursion

    Define lateral excursion. lateral excursion synonyms, lateral excursion pronunciation, lateral excursion translation, English dictionary definition of lateral excursion. adj. 1. Of, relating to, or situated at or on the side. 2. Of or constituting a change within an organization or hierarchy to a position at a similar level,...

  7. 9.5 Types of Body Movements

    Define the different types of body movements; ... Excursion. Excursion is the side to side movement of the mandible. Lateral excursion moves the mandible away from the midline, toward either the right or left side. Medial excursion returns the mandible to its resting position at the midline.

  8. Range of Motion: Temporomandibular (TMJ) Lateral Excursion

    Learn the proper technique to measure lateral excursion range of motion for the temporomandibular (TMJ) joint using a ruler.

  9. TMJ Movements

    TMJ Movements. Normal movements of the jaw during function, such as chewing, are known as excursions. There are two lateral excursions ( left and right ) and the forward excursion, known as protrusion, the reversal of which is retrusion. When the jaw is moved into protrusion, the lower incisors or front teeth are moved so that they first come ...

  10. Body Movement Terms

    Excursion can occur in either direction, and anatomists use directional terms to specify the type of excursion. When the mandible moves to either the left or right, it's moving away from the body's midline, so it's called lateral excursion. When the mandible moves closer to the midline of the body, it's called medial excursion.

  11. 9.5: Types of Body Movements

    Lateral excursion moves the mandible away from the midline, toward either the right or left side. ... Q. Briefly define the types of joint movements available at a ball-and-socket joint. A. Ball-and-socket joints are multiaxial joints that allow for flexion and extension, abduction and adduction, circumduction, and medial and lateral rotation. ...

  12. Occlusion (dentistry)

    Lateral excursions. It is important to define the movement of the condyles in lateral excursions: - Working condyle: This is the condyle closest to the side which the mandible is moving (e.g. if the mandible moves laterally to the right, the right condyle is the working side condyle)

  13. TMJ: Arthrokinematics and Pathology Review

    Lateral Excursion: Side to side translation of the disc and condyle on the fossa. The ipsilateral condyle has minimal motion, while the contralateral condyle moves anteriorly and medially. The ipsilateral condyle almost acts as a pivot point. Depression: Made up of two phases. During the early phase (35-50%), the condyle rolls posteriorly on ...

  14. Introduction to Occlusion

    Canine guidance - this means during lateral excursion of the mandible the canines are the teeth which guide the mandibles movement and the last to disclude ; Group function - this means during lateral excursion of the mandible, the tooth contact which guides the movement is shared between multiple teeth on the working side.

  15. Dental Occlusion

    Lateral excursion. Lateral excursions are a form of dynamic occlusion which occurs when the mandible moves left or right with teeth in contact. They can be described as: Canine guidance: canine protected articulation. The canines on the working side are the only occluding teeth whilst all other teeth become discluded when carrying out lateral ...

  16. Muscles of mastication: Anatomy, functions, innervation

    Definition and function: The muscles of mastication are muscles that attach to the mandible and thereby produce movements of the lower jaw. Muscles: Temporalis, masseter, medial pterygoid and lateral pterygoid ... The lateral pterygoid muscle is a triangular muscle that lies in the infratemporal fossa. Like the medial pterygoid muscle, the ...

  17. 9.6: Types of Body Movements

    Define the different types of body movements; Identify the joints that allow for these motions; ... Lateral excursion moves the mandible away from the midline, toward either the right or left side. Medial excursion returns the mandible to its resting position at the midline.

  18. Chapter 13: The Temporomandibular Joint

    The functional motions permitted are mandibular depression (mouth opening), mandibular elevation (mouth closing), protrusion (anterior translation; Fig. 13.3) and retrusion (posterior translation; Fig. 13.4), and right and left lateral excursion or laterotrusion (lateral deviation; Fig. 13.5). Maximal contact of the teeth in mouth closing is ...

  19. Mitral annular plane systolic excursion

    Mitral annular plane systolic excursion reflects global longitudinal function and is a significant independent predictor of mortality in left ventricular dysfunction and major adverse cardiovascular events (MACE) 3-5. It is usually greater at the lateral attachment than at the septal attachment site 5,9. A decrease of mitral annular plane ...

  20. Effect of Lateral Excursive Movements on the Progression of Abfraction

    In total, 39 subjects were recruited into the study. They ranged in age from 35 years to 70 years, with a mean of 51 years and 3 months, sd ± 9.1 years. ... The test hypothesis that, reducing the occlusal load in lateral excursion would reduce the rate of progression of abfraction lesions, was therefore rejected. Table 2.

  21. 2.2.3 Types of Body Movements

    lateral flexion bending of the neck or body toward the right or left side lateral (external) rotation movement of the arm at the shoulder joint or the thigh at the hip joint that moves the anterior surface of the limb away from the midline of the body medial excursion side-to-side movement that returns the mandible to the midline

  22. The Centre of Pressure Excursion Index

    This work would define foot function for the next 30+ years and has provided the principles we still use today. ... Supra and infra lateral malleolar curvature; Calcaneal frontal plane position; ... The centre of pressure excursion index, CPEI, was developed in the gait study centre of the Pennsylvania College of podiatric medicine and was ...

  23. 12.6: Types of Body Movements

    Define the different types of body movements; Identify the joints that allow for these motions; ... Lateral flexion is the bending of the neck or body toward the right or left side. These movements of the vertebral column involve both the symphysis joint formed by each intervertebral disc, as well as the plane type of synovial joint formed ...