PJK Folio

Name: x
Class: X
Topic: Muscles and Tendons
Teacher: Mr. Low
Acknowledgement

My sincere thanks to Mr Low, my Pendidikan Jasmani dan

Kesihatan teacher, who helped me throughout the completion of my
work. He sacrificed his precious time and explained everything about
the folio in detail.

Next, I owe my parents, Ho Beng Guan and Yong Yoke Chin, thank
you for they have given me much emotional support.

Besides that, I would like to wish a big thank you to Fong Le Yi, my
classmate who has provided me guidance and support at dead-ends of
time.

I would also like to show my gratitude to Eugene Ng for he has

given me much moral supports and ideas so that I am able to complete
my folio successfully on time.
Contents
No. Contents Page Number

1. Introduction of Muscles and Tendons

2. Muscles

a) Diagrams

b) Muscle Injuries

c) Causes and Treatment

d) Strengthening of Muscle Injury

3. Tendons

a) Introductions of Tendons

b) Tendon Injuries
c) Treatment
1.Introduction
Muscles and tendons are one of the important parts in our body. Muscles are the tissues
in our body which produce force and cause motion. Without muscles, we cannot move
around. Muscles can also cause either locomotion of the organism itself or the movement
of the internal organs. Muscles are predominately powered by the oxidation
of fats and carbohydrates, but anaerobic chemical reactions are also used, particularly by
fast twitch fibers. These chemical reactions produce adenosine triphosphate (ATP)
molecules which are used to power the movement of the myosin heads.

On the other hand, tendons are a fibrous connective tissue that usually connects muscle
to bones and are capable of withstanding tension. Tendons and skeletal muscles are joined
together at a structure known as the myotendinous junction, which is remarkable for having
high concentrations of many of the proteins that are similarly concentrated where motor
nerves innervate muscle. Most muscle act across a movable join. This happens because
these muscles are connected, through their tendons, to the bones of the lower leg and
these muscle-tendon insertions pass across the knee joint.

Therefore, muscles and tendons must work together so that we, the human, are able to
move freely. They work together to serve the same function throughout the whole body: to
animate the skeleton, with muscles contracting to generate force and tendons distributing
this force properly.
2.Muscles
(Ai) Diagram of Unipennate Muscle

Caption: Picture A shows the front view of Unipennate muscle

Picture B shows the side view of Unipennate muscle

(Aii) Diagram of Multipennate Muscle

Caption: Picture C shows the front view of Multipennate muscle

(Aiii) Diagram of Calf muscle

Caption: Picture D shows the calf muscle in our body

 (B) Muscle Injuries

i) Muscle Soreness

Muscle soreness usually occurs after exercising. All improvement in any muscle function
comes from stressing and recovering. Our muscles will burn after some hard exercises. The
burning is a sign of damaging muscles. After some time, the muscles will become sore because
they are damaged and need time to recover.

It takes at least eight hours to feel this type of soreness. We used to think that next-day muscle
soreness is caused by a buildup of lactic acid in muscles, but indeed, next-day muscle soreness
is caused by damage to the muscle fibers themselves. Muscle biopsies taken on the day after
hard exercise show bleeding and disruption of the z-band filaments that hold muscle fibers
together as they slide over each other during a contraction.

Scientists can tell how much muscle damage has occurred by measuring blood levels of a
muscle enzyme called CPK. CPK is normally found in muscles and is released into the
bloodstream when muscles are damaged. Those exercisers who have the highest post-exercise
blood levels of CPK often have the most muscle soreness. Using blood CPK levels as a measure
of muscle damage, researchers have shown that people who continue to exercise when their
muscles feel sore are the ones most likely to feel sore on the next day.

Many people think that cooling down by exercising at a very slow pace after exercising more
vigorously, helps to prevent muscle soreness. It doesn't. Cooling down speeds up the removal
of lactic acid from muscles, but a buildup of lactic acid does not cause muscle soreness, so
cooling down will not help to prevent muscle soreness. Stretching does not prevent soreness
either, since post-exercise soreness is not due to contracted muscle fibers.
 ii) Pulled Muscle

Pulled muscle, or known as strained muscle is an injury to the muscle or tendon where
muscles fibers teas as a result of overstretching. The typical symptoms of a strain include
localized pain, stiffness, discoloration and bruising around the strained muscle.

Strains are a result of muscular tears and can happen while doing everyday task and are
not restricted to athletes. Nevertheless, people who play sports are more at risk of developing a
strain due to the increases usage of muscle.

To cure pulled muscle, the first-line treatments are known as R.I.C.E which is

- Rest and stop activities that cause pain.

- Ice should be applied to reduce swelling by reducing blood flow to the injury site.
- Compress and wrap the strained area to reduce swelling.
- Elevate and keep the strained area as close to the level of the heart to keep blood from
pooling in the injured area.

Besides that, it is also recommended to go for therapeutic ultrasound to break down

poorly healed muscle strains and permit them to heal properly.

iii) Muscle Cramp

 Muscle cramps are unpleasant, often painful sensations caused by muscle contraction.
There are three types of cramps, which are the skeletal muscle cramps, smooth muscle
cramps and nocturnal leg cramps. Common causes of skeletal cramps include muscle
fatigue, low sodium and low potassium. Whereas, smooth muscle cramps may be due to
menstruation or gastroenteritis.

Causes of cramping include hyper flexion, hypoxia, and exposure to large change in
temperature, dehydration or low blood salt. Muscle cramps may also be a symptom of
complication of pregnancy, kidney disease, varicose veins or high percentage of lactic acids
in the cells.

- Skeletal Muscle Cramps or Charley horse, those which cramp the most often are the
calves, thighs and arches of the foot. These cramps can be intensely painful and may
take up to 7 days to recover.
- Smooth Muscle Cramps are where smooth muscle contractions lie at treatment which
may be symptomatic of endometriosis or health problem. Menstrual cramps may also
occur before a female’s period.
- Nocturnal Leg Cramps occur in the calves, soles of the feet or other muscles in the body
during the night or while resting. Only a few fibers of the muscle are activated. Muscle
soreness may remain after cramp itself ends. Typically, nocturnal leg cramps will place
the sufferer in a panic. The precise causes of these cramps believe to be dehydration,
low level of certain minerals and reduced blood flow.

To treat these, stretching and massage are widely considered. Besides that, medication
like vitamin B complex can calcium channel blockers may be effective for muscle cramps.

iv) Stitches
 A side stitch is an intense stabbing pain under the lower edge of the ribcage that occurs
while exercising. The pain in usually brought on by vigorous exercise and activity. Side stitches
occur more frequently in sports that require a lot of up and down movement, like running and
horse riding.

The pain is caused by a spasm of the diaphragm muscle. The diaphragm is a dome
shaped muscle that separates the thoracic cavity from the abdominal cavity and moves up and
down when you inhale and exhale. When you inhale, your lungs fill with air and force your
diaphragm downward. Conversely, when you exhale your lungs contract and your diaphragm
rises. This pattern of rising and falling occurs quite rapidly when you're running and as most
side stitches occur on the right hand side, consider what happens to your diaphragm when your
right foot strikes the ground.

Like any other muscle spasm, when a side stitch occurs it is important to stop the
activity that brought the stitch on in the first place, or at the very least reduce the intensity of
the activity. Another effective treatment for a side stitch is to alter your breathing pattern. First
concentrate on taking full, deep breathes and avoid shallow breathing. Then, if you are one of
those people who exhale when your right foot hits the ground, try instead to exhale when your
left foot hits the ground.

There are a number of measures that help to prevent side stitch, which include
improving our cardiovascular fitness, concentrate on breathing during exercise, warm up
properly before exercise, avoid eating before exercise, stretch more, drinking more fluids and
so on.

v) Tennis Elbow
 Tennis elbow or lateral epicondylitis is an extremely common injury that originally got its
name because it is a frequent tennis injury, appearing in a large proportion of tennis
players. Nevertheless it commonly manifests in a vast proportion of people who do not play
tennis at all.

The symptoms associated with tennis elbow are, but are not limited to: radiating pain
from the outside of your elbow to your forearm and wrist, pain during extension of wrist,
weakness of the forearm, a painful grip while shaking hands or truing a doorknob, and not
being able to hold relatively heavy items in the hand. The pain is similar to the pain of the
condition known as Golfer's elbow but the latter occurs at the medial side of the elbow.

During early experiments, it was thought that tennis elbow was primarily caused by
overexertion. Studies have shown that trauma such as direct blows to the epicondyle, a
sudden forceful pull, or forceful extension have caused more than half of these injuries.

To prevent tennis elbow, we are advised the decrease the amount of playing time if
already injures. We should also stay in overall good physical shape. Besides that, increased
muscular strength will also increase the stability of joints such as elbow.

(C) Causes and Treatment of Muscle Injury

 Muscle injury is usually caused by overstretching and result in muscular fibers-tear.
Although running seems to be a safe sport, many people are surprised to learn that it causes
frequent injuries in muscles, tendons, bones and joints. This is because, during running, your
foot strikes the ground with a force equal to three times body weight, a force more than double
that of walking.

Besides that, muscle injuries can also occur due to exposure to large change in
temperature, dehydration or low blood salt. Those who have kidney problems, pregnancy may
also easily have muscle injuries.

On the other hand, to treat muscle injury, you can choose to wait because soreness will
go away in 3 to 7 days without any special treatment. Trying an ice bath or contrast water bath
will also help in curing muscle injuries. Besides that, using active recovery techniques can
perform some easy low-impact aerobic exercise to increase blood flow.

In order to cure muscle injuries, gently massage the affected muscles. We should also
avoid any vigorous activity to allow the soreness to subside. Don’t forget to warm up
completely before next exercise session.

(D) Strengthening of Muscle Injury

 (i) Isometric Exercise

Isometric exercises, also known as static strength training, involve muscular actions in
which the length of the muscle does not change and there is no visible movement at the
joint. Isometric exercises can be used for general strength conditioning and for rehabilitation
where strengthening the muscles without placing undue stress on the joint is warranted.
Some actions within a wide variety of sports require isometric or static strength. Examples
include climbing, mountain biking, Judo, wrestling, shooting, gymnastics and horseback
riding.
Isometric exercises can be completed with sub maximal muscle action - such as holding
a weight steady, out to the side. The force used to hold the weight still is not maximal as this
would lift the weight further causing movement and a change in the muscle length and joint
angle. Static strength training can also involve maximal muscle actions and examples include
pushing against an immoveable object such as a wall or heavy weight.

Examples of Isometric body exercises are:

Plank Bridge
1. Start lying face down on the ground,
place elbows and forearms underneath
chest.
2. Prop yourself up to form a bridge using
your toes and forearms. 
3. Hold for 10-30 seconds or until you can
no longer maintain a flat bridge.

Side Bridge
1. Start on your side and press up with
your right arm.
2. Form a bridge with your arm extended
and hold for 10-30 seconds. Repeat 2-3
times.

Hundred Breaths Exercise

1. Lie face on a mat with arms by your
sides. Bend legs to 90 degrees. Lift your
head and shoulders off mat and take 5
short, consecutive inhales, followed by 5
short, consecutive exhales. 
2. Repeat 10 times for a total of 100
breaths.
 (ii) Isotonic Exercise

In an isotonic contraction, tension remains unchanged and the muscle’s length

changes. Lifting an object at a constant speed is an example of isotonic contractions. It’s also
known as Auxotonic contraction. There are two types of isotonic contractions: concentric and
eccentric.
- Concentric
This type is typical of most exercise. The external force on the muscle is less than the force
the muscle is generating. The effect is not visible during the classic biceps curl, which is in fact
auxotonic because the resistance or the weight being lifted does not remain the same through
the exercise. Tension is highest at a parallel to the floor level, and eases off above and below
this point. Therefore tension changes as well as muscle length.
- Eccentric
There are two main features to note regarding eccentric contractions. First, the absolute
tensions achieved can be very high relative to the muscle’s maximum tension generating
capacity. Second, the absolute tension is relatively independent of lengthening velocity. This
suggests that skeletal muscle are very resistant to lengthening, thereby, allowing very high
levels of tension to develop in isometric exercise.
Both forms of isotonic contractions are of great advantage in strengthening the
muscles and the fact that they are highly inexpensive makes them more popular among
people now a days. However another reason that makes them so high in demand is that they
help put all muscles in use by employing a wide range of exercises .
 (iii) Isokinetic Exercise

Isokinetic exercises are performed with a specialized apparatus, which provides

variable resistance to a movement. Isokinetic exercises often used to test and improve
muscular strength and endurance.
There are two main types of machines which are used to perform isokinetic exercises.
The first type is Dynamometer which has a controlled speed, while resistance is variable
according to the amount of force that is applied throughout the range of movement.
Immaterial, of the force applied by the individual, the speed of the exercise does not change.
Hence, the motion is kept at a predetermined velocity.
The second type of exercise utilizes change in the moment arm of the selected
resistance which coincides with the change in moment arm of the muscle effort and also the
change in tension due to muscle length change. The resistance is hence able to take care of
the continuous changes in muscle force that occur throughout the range of movement of the
muscles. The changes made to the resistance arms on the machine are determined and pre-
set to coincide with the average strength curves for various joint actions.
However, these exercises need not be done only with these machines. They can also
be done using the stationary cycle. When you do this exercise with the cycle, you will only
allow a certain number of revolutions per minute. This helps in setting the level of resistance
and also prevents the individual from pedaling very fast. After you get used to the exercise,
you can accommodate more resistance and the setting can be altered.
 A Comparison Of The Different Types Of Exercise

  Advantages Disadvantages
 Not functional.
Does not aggravate sensitive joint surfaces.
Any improvements are speed and angle
Easy to perform and remember.
specific.
Reproducible.
Many contraindications.
Isometric
Easy to measure.
Not efficient in terms of strength.
Convenient.
No endurance enhancements.
Cost effective.

Functional.
Maximal loading only at specific angles.
Easy to monitor.
Unsafe for joints.
Minimal equipment needed.
Isotonic Highest likelihood of injuries.
Convenient.
Gives delayed onset muscle soreness.
Best strength and endurance
Difficult to monitor accurately.
enhancements.
 
Maximal loading throughout whole range of
motion.
Time consuming.
Muscles easily isolated.
Requires a lot of training and skill to use.
Isokinetic
Safest form of exercise.
Costly.
Few contraindications.
Not functional.
 
 3.Tendons
(A) Introductions

A tendon or sinew is a tough band of fibrous connective tissue that usually connects

muscle to bone and is capable of withstanding tension. Tendons are similar to ligaments
and fasciae as they are all made of collagen except that ligaments join one bone to another
bone, and fasciae connect muscles to other muscles. Tendons and muscles work together and
can only exert a pulling force.

A normal healthy tendon is mostly composed of parallel arrays of collagen fibres closely

packed together. The dry mass of normal tendons, which makes up about 30% of the total mass
with water, is composed of about 86% collagen, 2% elastin, 1–5% proteoglycans, and 0.2%
inorganic components such as copper, manganese, and calcium.

Tendons have been traditionally considered to simply be a mechanism by which muscles

connect to bone, functioning simply to transmit forces. However, over the past two decades,
much research focused on the elastic properties of tendons and their ability to function as
springs. This allows tendons to passively modulate forces during locomotion, providing
additional stability with no active work. It also allows tendons to store and recover energy at
high efficiency. The proteoglycan components of tendons are very hydrophilic, meaning that
they can absorb a large amount of water and therefore have a high swelling ratio. Since they
are non-covalently bound to the fibrils, they may reversibly associate and disassociate so that
the bridges between fibrils can be broken and reformed. 
 (B) Tendon Injuries
(i) Tendon Rupture

A tendon is the fibrous tissue that attaches muscle to bone in the human body. The
forces applied to a tendon may be more than 5 times your body weight. In some rare instances,
tendons can snap or rupture. Conditions that make a rupture more likely include the injection
of steroids into a tendon, certain diseases such as gout or hyperparathyroidism, and having
type O blood.
Although fairly uncommon, a tendon rupture can be a serious problem and may result in
excruciating pain and permanent disability if untreated. Each type of tendon rupture has its
own signs and symptoms and can be treated either surgically or medically depending on the
severity of the rupture and the confidence of the surgeon. In general, tendon rupture occurs in
a middle-aged or older man. In the young, muscle usually tears before the attached tendon will
tear. But in older people and in those with certain disease,tendon rupture may result. 
General causes of tendon rupture are: 

o Direct trauma 

o Advanced age: As we age, our blood supply decreases. This decreased blood
supply to the tendon results in weakness of the affected tendon. 

o Eccentric loading: When your muscle contracts while it is being stretched in the
opposite direction, increased stress is placed on the involved tendon. 

o Steroid injection into tendon: This treatment is sometimes used for severe

tendonitis.

An injury that is associated with the signs or symptoms such as severe pain, rapid or
immediate bruising, s nap or pop you hear or feel, inability to use the affected arm of leg and so
may be a tendon rupture. 
 (ii) Rapture of Achilles tendon

Achilles tendon Rupture is the most common injury of tendon. Commonly occurs as

a sports injury during explosive acceleration e.g. pushing off or jumping up. The male to female
ratio varies between 7 to 1 and 4 to 1 depending on differing studies. The Achilles tendon is the
strongest and thickest tendon in the body and serves a few key functions in the body. It is
roughly about 15 centimeters (5.9 inches) long and begins near the middle portion of the calf. It
plays an important role in the biomechanics of the lower extremity. The contracting calf
muscles lift the heel by this tendon which produces foot action that is basic to walking, running,
jumping, etc. It can withstand large forces, especially during sporting exercises and more
specifically movements involving the pivoting motion.

The most common ways a person can rupture their Achilles tendon are by

sudden plantar flexion, unexpected dorsiflexion, or forced dorsiflexion of the ankle past its
normal range of motion.

Other mechanisms by which the Achilles can be torn involve sudden direct trauma to
the tendon, or sudden activation of the Achilles after-therapy from prolonged periods of
inactivity. Some other common tears can be developed through extreme use of the tendon in
highly intense sporting situations. Other likely ways this can be caused are though twisting or
jerking motions of the ankle.
 (C) Treatment

Treatment options for an Achilles tendon rupture include surgical and non-surgical
approaches. Among the medical profession opinions are divided what is to be preferred.

Non-surgical management traditionally was selected for minor ruptures, less active
patients, and those with medical conditions that prevent them from undergoing surgery. It
traditionally consisted of restriction in a plaster cast for six to eight weeks with the foot pointed
downwards to oppose the ends of the ruptured tendon. But recent studies have produced
superior results with much more rapid rehabilitation in fixed or hinged boots.There are two
different types of surgeries; open surgery and percutaneous surgery.

During an open surgery an incision is made in the back of the leg and the Achilles tendon
is stitched together. In a complete or serious rupture the tendon of plantaris or another
vestigial muscle is harvested and wrapped around the Achilles tendon, increasing the strength
of the repaired tendon. If the tissue quality is poor, e.g. the injury has been neglected; the
surgeon might use a reinforcement mesh.

In percutaneous surgery, the surgeon makes several small incisions, rather than one
large incision, and sews the tendon back together through the incision. Surgery may be delayed
for about a week after the rupture to let the swelling go down. For sedentary patients and
those who have vasculopathy or risks for poor healing, percutaneous surgical repair may be a
better treatment choice than open surgical repair.
References
When completing this project, I did some researches and here are the
references I made.

1. www.google.com.my

2. www.wikipedia.com.my

3. www.emedicinehealth.com

4. Encyclopedia of Body

5. Health Magazines