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Evolve Student Resources for Muscolino: The Muscular System Manual:
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The Skeletal Muscles of the Human Body, 4th edition, include the
following:
• Interactive Muscle Program: A study tool that
allows you to learn and study the muscles by
placing them in any combination on illustrations.
• Stretching Customization: Create customized
stretching instructions with images for clients
to use at home.
• Interactive Exercises: Activities such as Name that
Muscle and Drag ‘n’ Drop Exercises aid in your review
of the muscles, and 200 practice test questions help you
prepare for exams.
• Flashcard app: Over 250 flashcards in this portable resource include coverage of muscles,
muscle locations, pronunciations, attachments, actions, and innervation information.
• Video Demonstrations: 130 video clips bring the palpation of every muscle to life.
• Supplementary Appendices: 6 appendices provide valuable information for study of
muscles on the following topics: soft tissue attachments, palpation guidelines,
overview of innervation, overview of arterial supply, additional skeletal muscles, and
mnemonics for remembering muscle names.

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2015v1.0
THE
MUSCULAR SYSTEM MANUAL
The Skeletal Muscles of the Human Body

Basic Kinesiology Terminology, 1 1

Musculoskeletal System The Skeletal System, 33 2

How Muscles Function, 79 3

Muscles of the Shoulder Girdle Joints, 91 4

Muscles of the Glenohumeral Joint, 112 5

Muscles of the Elbow and Radioulnar Joints, 144 6

Upper Extremity
Muscles of the Wrist Joint, 172 7

Extrinsic Muscles of the Finger Joints, 200 8

Intrinsic Muscles of the Finger Joints, 238 9

Muscles of the Spinal Joints, 283 10

Muscles of the Rib Cage Joints, 382 11

Axial Body
Muscles of the Temporomandibular Joints, 411 12

Muscles of Facial Expression, 443 13

Muscles of the Hip Joint, 490 14

Muscles of the Knee Joint, 553 15

Lower Extremity Muscles of the Ankle and Subtalar Joints, 586 16

Extrinsic Muscles of the Toe Joints, 613 17

Intrinsic Muscles of the Toe Joints, 631 18

Functional Mover Groups Functional Groups of Muscles, 666 19

This page intentionally left blank
 THE
MUSCULAR
SYSTEM
MANUAL
The Skeletal Muscles
of the Human Body

FOURTH
EDITION
JOSEPH E. MUSCOLINO, DC
Instructor, Purchase College, State University of New York (SUNY)
Purchase, New York
Owner, The Art and Science of Kinesiology
Stamford, Connecticut
(www.learnmuscles.com)
3251 Riverport Lane
St. Louis, Missouri 63043

THE MUSCULAR SYSTEM MANUAL: ISBN: 978-0-323-32770-1

THE SKELETAL MUSCLES OF THE HUMAN BODY,
FOURTH EDITION

Copyright © 2017, Elsevier Inc. All Rights Reserved.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center
and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than
as may be noted herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer of
each product to be administered, to verify the recommended dose or formula, the method and
duration of administration, and contraindications. It is the responsibility of practitioners, relying on
their own experience and knowledge of their patients, to make diagnoses, to determine dosages
and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.

Previous editions copyrighted 2010, 2005, 2003.

Library of Congress Cataloging-in-Publication Data

Names: Muscolino, Joseph E., author.

Title: The muscular system manual : the skeletal muscles of the human
body /
Joseph E. Muscolino.
Description: Fourth edition. | St. Louis, Missouri : Elsevier, [2017] |
Includes bibliographical references.
Identifiers: LCCN 2015039008 | ISBN 9780323327701 (pbk. : alk. paper)
Subjects: | MESH: Musculoskeletal System—anatomy & histology—Atlases. |
Muscles—physiology—Atlases.
Classification: LCC QM151 | NLM WE 17 | DDC 612.7/4—dc23 LC record available at
http://lccn.loc.gov/2015039008

Content Strategist: Shelly Stringer, Jennifer Janson

Content Development Manager: Ellen Wurm-Cutter
Associate Content Development Specialist: Kelly Skelton
Publishing Services Manager: Julie Eddy
Book Production Specialist: Celeste Clingan
Manager, Art & Design: Julia Dummitt

Printed in Canada

Last digit is the print number: 9 8 7 6 5 4 3 2 1

This book is dedicated
to Simona Cipriani,
my wife and angel.
This page intentionally left blank
REVIEWERS

Jennifer Apodaca, LMT Karen M. Hobson, MSHE, LMT

Albuquerque, New Mexico Executive Director
The International Professional School of Bodywork
Patty Berak, NCBTMB, AMTA, ABMP San Diego, California
Program Director for Therapeutic Massage and BHSA
Baker College of Clinton Township Jane Irving
Clinton Township, Michigan
Matt Isolampi, LMT, CNMT, MMP
Jennifer Boal, M.Ed, LMT Massage Therapy Instructor, OCPS Wellness Representative
School of Healthcare Team Leader Orange County Schools, Westside Tech Campus
Pittsburgh Technical Institute Winter Garden, Florida
Pittsburgh, Pennsylvania
Kathy Lee, LMT, BS
Jill Burynski, LMBT, NCTMB Owner
Massage Therapy Educator Catalina Massage Therapy
Living Sabai Continuing Education Tuscon, Arizona
Asheville, North Carolina
David MacDougall, MA, LMT, CSHE
Andrea Claire Caplan, BA, LMT Director/Associate Professor of Massage Therapy
Owner North Country Community College
The Body Politic, LLC Saranac Lake, New York
Chevy Chase, Maryland
Serenity Martinez, CPI, NCTM, ACMT
Michelle Carbonneau, BA Chemistry, LMT, RYT Medical Instructor
Massage Therapy, Anatomy & Physiology Instructor Omega Institute Inc.
Program Director Pennsauken, New Jersey
Yogissage, LLC
Honolulu, Hawaii Patricia C. Nuovo, LMT, Naturopath
Massage Instructor
Denise Cugini, BBA, LMT, NCTMB Beacon Wellness Arts Center
Massage Instructor Petaluma, California
Beacon Wellness Arts Center
Petaluma, California Tracey Obeda, MS, LMBT, NCTMB
Massage Therapist, CEO/Owner
Angelica De Geer, LMT, CA, BA, BFA, Dental Hygiene Miller Motte College
Certificate-Sweden Cary, North Carolina
Clinic Supervisor
Midwest Institute Roger Olbrot
Earth City, Missouri Director of Education
Myotherapy College of Utah
Jeanne deMontagnac-Hall, BS, AHI, LMT Salt Lake City, Utah
Allied Health Instructor
Sinclair Community College-Courseview Campus Julie Onofrio
Mason, Ohio Licensed Massage Practitioner, Author
www.massageschoolnotes.com, www.
Gautam J. Desai, DO, FACOFP massagepracticebuilder.com
Professor, Department of Primary Care Medicine Seattle, Washington
Kansas City University of Medicine and Biosciences
Kansas City, Missouri Kevin Pierce, MBA, NCBTMB

REVIEWERS vii
Elan Schacter, LMBT Terri Lynn Visovatti, BS, LMT, BCTMB, RockDoc, FMT,
Elan Schacter Massage Therapy PMT, CKTP, CES
Charlotte, North Carolina Movement Specialist/Massage Therapist/Business Owner
Urban Wellness Chicago
Michelle Tramm, NCTM Chicago, Illinois
Certified in Prenatal, Infant, Fertility, Therapeutics and
KinesioTape Jeffery B. Wood, LMT, COTA/L, BS
Instructor Massage Therapy Educator
Indiana Therapeutic Massage School Massage Smart: Education in Action
Indianapolis, Indiana Inverness, Florida

viii REVIEWERS
FOURTH EDITION FOREWORDS
Thomas Myers
Every attempt to set in order the unified, mysterious,
and seemingly miraculous symphony required for human
movement is bound to fall short. Books are limited to a
flat page, video to a linear narrative, and even the newest
interactive applications, with all their ‘Wow!’ factor, can
cause more confusion than enlightenment. The design of
the human body is organic—we are grown from a seed, not
assembled from parts.
To elucidate this design, however, we must take the
body apart to see how it is put together—it is a conundrum
that faces every anatomist. In dissection, every concept
demonstrated necessarily obscures another. My life work
has been dedicated to exposing the design concepts
currently going under the buzzword ‘fascia’, which have
been obscured over the centuries of earnest anatomists
throwing out the fascia to clarify the concepts contained in
the organ of ‘muscle’. But it is the same with every choice
in the design of each illustration, every book, and all our
curricula—maps emphasize certain features of the terrain at
the expense of others.
Hence, no one book can fulfill all our needs, and thus my
shelves, my wallet, and my wife all groan at the number of
anatomical atlases I seem to need. The clarity of Netter, the
artistry of Sobotta, the portability of Platzer, the encyclopedic
inclusiveness of Gorman, the ease of use of Trail Guide—all
these and many more have added to my knowledge with
their unique presentation of the neuromyofascial web.
Nevertheless, I am pleased to add whatever
‘endorsement’ a foreword provides to the singular effort
of Dr. Joe Muscolino in the steadily improving editions of
The Muscular System Manual. Joe has worked to make
his anatomical explanations succinct but accurate, and the
design of the book allows maximum applicability for the
working manual or movement therapist without sacrificing
the inevitable complexity that comes from synergetic,
stabilizing, and force transmitting functions that go beyond
the simple ‘bringing the two ends together’ manner in which
muscles are defined in so many of these atlases.
As far as I know, I am the therapist who said to Bob
King, “To really develop your intuition, know your anatomy!”
Science and intuition are merely two ways of knowing, and
they do not oppose but rather reinforce each other. This
book provides a number of services to the reader who
wants to develop both in tandem. I find ‘studying’ anatomy
to be an activity that is boring in the extreme, and is a good
way to find elusive sleep. Exploring anatomy, however, with
this book and a colleague to palpate, for instance, can be
an eye-opening thrill as the flat page leaps into the palpating
fingers as three-dimensional, never-to-be-lost palpatory
certainty - “This is what I am on, and I know it, and I can feel
what to do.”
Once myofascial anatomy is generally mastered—a
snowball of a process that starts slowly and painfully
but soon accumulates in a rush—further motivation for
deepening your anatomy usually comes from problem
clients—“What was that odd thing I just felt?” Such
explorations—motivated by the desire to help a particular
individual—have led me to far more knowledge than my
formal studies or late-night exam cramming.
There is also a broader motivation for learning: We are
on the threshold of a revolution in biomechanics, as models
drawn from cybernetics, complexity mathematics, and
tensegrity engineering include Newtonian leverage- and
compression-based biomechanics in a more complex,
perhaps difficult, but also more accurate picture. What we
have assumed to be true about muscles and their individual
actions is being revealed as only one part of a very dynamic
whole-body process of adaptation to myriad flickering
forces. Joe Muscolino is forthright and adroit in dealing with
the controversies and uncertainties of this transitional time.
The functional advantages of this book are well-
catalogued on the book cover and introduction. Suffice it
for me to say that its clarity, comprehension, and variety,
reflect a tremendous amount of work that has resulted in a
useful tool for any therapist or educator wanting more of the
calm confidence that comes from thoroughly knowing your
subject.
Thomas Myers
October 13, 2014
Thomas Myers, LMT, NCTMB, ARP
Thomas Myers is the author of Anatomy Trains (Elsevier
2001, 2014) and co-author of Fascial Release for Structural
Balance (North Atlantic 2010), as well as numerous articles
for trade magazines and journals. Tom and his faculty
provide continuing education worldwide for a variety
of professions. Tom studied directly with Buckminster
Fuller, Ida Rolf, and Moshe Feldenkrais and has practiced
integrative bodywork for 40 years. Tom lives, writes, and
sails on the coast of Maine in the United States with his
partner Quan and a number of animals.
FOURTH EDITION FOREWORDS ix
Joe Tatta
Physical therapists, and in fact all manual and movement
therapists, work primarily in the realm of neuromuscular
conditions, whether they are overuse conditions, postural
or movement dysfunction patterns, and/or injury or post-
surgery rehabilitation. When working with our patients, a
fundamental understanding of the anatomy and physiology
of the musculoskeletal system in imperative. Knowing
anatomy allows one to understand physiology, which leads
to an understanding of pathophysiology, and by extension,
assessment and treatment. Indeed, effective and incisive
clinical orthopedic work, whether it is manual therapy,
therapeutic exercise, or self-care advice for the patient, relies
not on memorization of cookbook recipes for treatment, but
on an understanding of underlying pathologic mechanism(s)
of the client’s condition. This requires critical thought that
is, by necessity, based on a fundamental knowledge of the
anatomy and physiology of the musculoskeletal system.
This is where Dr. Joseph Muscolino’s The Muscular
System Manual: The Skeletal Muscles of the Human Body,
4th edition, becomes so invaluable. Many muscle atlases
are available to the student and therapist, but Joseph
Muscolino has created a fully referenced, evidence-based
work that is not only the most thorough atlas of muscle
structure and function that exists, but also one that presents
the content in a manner that invites true understanding of
how the muscular system works.
Instead of simply stating the attachments and
actions of the muscles, The Muscular System Manual
explains why each muscle has the actions that it does. In
addition to the concentric joint actions, it also presents
the isometric stabilization functions and the eccentric
restraining functions of each muscle. Further, unique to
this book, it presents a full description of not only the
open-chain standard actions, but also the closed-chain
reverse actions of the muscle. And new to this edition,
and unique to this book, it presents and explains the
distinction between a muscle’s actions and its oblique
plane motion pattern. And relationships to myofascial
meridians and applications to musculoskeletal conditions
are given as well.
x FOURTH EDITION FOREWORDS
All of this information is accompanied by the most beautiful
and clear illustrations that can be found: photographs of a
real person with the bones and muscles overlaid onto the
photograph. Further, an on-line digital program accompanies
the book that allows the reader/viewer to work with thirty-
three figure views of the body and place into the figure, any
combination of muscles that would be seen from that view.
Fancier digital apps are available on the web, but none of
them are as easy and clear to use. This is a tremendous
feature not only for the beginning student to initially learn
the muscles, but also invaluable for the seasoned therapist
who desires a greater and subtler understanding of the
relationships between muscles. And other digital resource
that accompany The Muscular System Manual are video
demonstration of the author showing and explaining
the palpation for each of the muscles in the book, and a
customized digital program that allows the therapist to print
out full color stretches for the patient’s self-care program.
For any practicing therapist who wants to be able to
critically think through their patient’s condition and then
creatively apply the appropriate treatment techniques, there
is no stronger foundation for effective clinical orthopedic
work than Joseph Muscolino’s The Muscular System Manual,
4th edition! I am more than thrilled to attest to this great
work and recommend it to you.
Joe Tatta
June 11, 2015
Joe Tatta, PT, DPT, CNN
Joe Tatta is a doctor of physical therapy and certified
clinical nutritionist. He is Co-Founder of Premier Physical
Therapy & Wellness, one of the largest outpatient physical
therapy providers in the New York Tri-State area. He is board
certified in orthopedics from the American Board of Physical
Therapy Specialties and studied nutrition at the Clinical
Nutrition Certification Board and Functional Medicine at
the Institute for Functional Medicine. His greatest success
stems from the growth of his practice and the thousands
of clients healed annually. He also actively lectures and
mentors health and professionals on subjects pertaining to
injury prevention, nutrition, and functional medicine.
THIRD EDITION FOREWORD
Bob King
Although I often wonder why some texts go through
second and third editions, such was not the case with Joe
Muscolino’s The Muscular System Manual! This new and
spectacularly upgraded edition certainly establishes the
author as the leading muscular system expert for manual
therapists in this country. Indeed, the upgrades, resources,
and knowledge base of this text are nothing short of
brilliant.
Initially, Chapters 1 to 3 provide new and innovative
material on how the muscular system works with a detailed
overview of the roles of bones, joints, and connective
tissues. Dr. Muscolino’s valuable perspective on the
muscular system, the primary user of body energy, provides
a perspective and background that would be of value
to any manual or movement therapy student, even the
individual with a very limited knowledge base. The location
terminology, color drawings, bony structure, and movement
presentations provide a basic kinesiology foundation that
serves as a cornerstone for the rest of the book.
All of the muscles featured (yes, all of them!) are now
re-ordered to their respective joints, making the flow and
portability of this edition superior to other texts. Furthermore,
it coincides with the way that most muscular/myology/
kinesiology classes are taught in massage and other
bodywork schools. This is an especially useful adjunct for
today’s student of the healing arts, offering a more systematic
portrayal of muscular system and body functioning.
Remarkably enough, this edition is even more thorough
than its predecessor in the presentation of muscle function.
The author painstakingly presents not only the muscular
attachments, but also expands the functional information
of each muscle to include the concentric, shortening
mover actions, and the reverse mover actions, as well
as the eccentric lengthening and isometric stabilization
actions. Incredible! These features alone are missing from
other bodywork texts, and this material provides a more
comprehensive understanding of muscle functioning at all
levels.
Reverse mover actions are important because they
explain, for instance, why the tensor fasciae latae (TFL)
is not only a flexor of the thigh at the hip joint and an
abductor and medial rotator of the thigh at the same joint,
but also how its reverse actions anteriorly tilt the pelvis and
ipsilaterally rotate and depress that side of the pelvis as
well. This alone marks TFL as an overlooked source of low
back pain, scoliotic compensation, sacroiliac dysfunction
and a vitally essential muscle to release in the classic
lower crossed syndrome. Useful hands-on and palpatory
insights such as this abound throughout this exciting new
edition. Simply reviewing this copy generated new clinical
insights for me for several clients with whom I currently
provide clinical massage. It will be a primary resource in my
treatment room for years to come.
Consequently, not only will the student, but also the
experienced manual therapist, benefit from this clinically
relevant information, presented, once again, in a clear
and systematic fashion. Fully expect your knowledge of
challenging therapeutic cases to increase with this new
edition, which is the most thorough book on muscle
functioning currently available. I believe this text will also
upgrade, if not revolutionize, the teaching of the muscular
system, moving away from useless memorizations
and dogma to functionally important information,
descriptions, and solid explanations plotted out with
careful reasoning.
New and improved color drawings are ubiquitous
throughout this edition. Full-color drawings are featured
individually, within muscle or function groups and also
drawn on real persons, giving learners a vivid presentation
of location, palpation, and attachment points. This feature
alone will clarify concepts, and stimulate the visual learner
to an even deeper awareness of the spectacular movements
of the human body and the intricate combination of forces
that generate optimal functioning.
An interactive CD is included with the textbook that is
a first of its kind! Each of the base illustrations is given
showing the body and the skeleton along with a list of
all the muscles of that region. The student can then
build the muscular system on the illustration, choosing
any combination of muscles to show next to each
other. Do you want to see the TFL next to the sartorius?
Perhaps add in the gluteus medius and/or iliopsoas? You
choose. This CD alone will greatly enhance the beginner
student’s ability to learn the muscles, as well as challenge
seasoned therapists to better learn their anatomy. It helps
students and therapists alike, not only learn the individual
muscles, but also begin the incredibly important and
needed clinical task of putting the muscular system back
together! This along with audio files of the attachments
and actions that allow the student to burn CDs and MP3
files to study on-the-go are alone worth the price of
admission to the book.
The newly added Chapter 19 contains functional mover
groups of muscles illustrating the concentric, reverse,
eccentric, and isometric stabilization functions—once again
showcased with excellent new drawings. The second part
of this chapter illustrates (with the gracious permission of
rolfer and myofascial innovator Tom Myers) the essential
myofascial meridians depicting the fascial webbings and
relationships of connective tissue that assist with movement
and posture. This is yet another feature of The Muscular
THIRD EDITION FOREWORD xi
System Manual that underlies its premier status as the
most complete book available on this wondrous and
vital system of the human body.
The author has truly created a work of science and
art masterfully blended for optimal results!
Bob King
August 3, 2009
SECOND EDITION FOREWORD
Bob King
The more than 650 muscles of the human body, when
optimally stabilized and integrated, generate an elegant
functioning that is truly extraordinary. The static hold of
the weightlifter … the leaping twirl of the ballet dancer
… the rotational decompression of the pole vaulter at
eighteen feet … the stunning accuracy of a left hook …
a touchdown pass … or the joyous flip of an exuberant
cheerleader. Muscles in motion are the very essence of
health, performance, and life itself. Unfortunately, this kinetic
symphony sometimes comes to an abrupt halt when pain
and injury impact the soft tissues.
As a practicing massage therapist for the past 30 years,
I am still often intrigued and amazed by the “stuff” of the
athletic injury or the muscular system breakdown: the
muscles, tendons, skin, fascia, and ligaments are both
promising and puzzling to the dynamics of healing.
This soft tissue “stuff” provides the physiological basis
and the therapeutic significance of our hands-on clinical
endeavors.
In witnessing the mysterious process of healing, it would
seem that the successful hands-on bodyworkers must be
adept and comfortable with their right-brain skills. These
skills might include postural analysis, revealing global rather
than isolated segmental relationships.
Therapeutic compassion and care can jump start the
placebo effect. Intuitive hunches often prove more reliable
than high tech testing protocols. Clinical reasoning is
seldom linear. Skillful palpation includes wandering around
in myofascial neighborhoods—and wandering doesn’t mean
you’re lost. Novel explorations and vital discoveries within
the soft tissue realm are often guided by literate palpation
and three-dimensional visualization.
However, the left-brain skills of anatomical knowledge
and objective accuracy are equally vital for successful
outcomes. The charismatic extrovert, no matter how
xii THIRD EDITION FOREWORD
Bob King, LMT, NCTMB
Bob King authored manuals, books, videos, curricula, and
numerous clinical articles in a massage therapy career
spanning more than three decades. He was a Cortiva
Educational Consultant and conducted advanced myofascial
trainings throughout the country. He was the founder and
past president of the Chicago School of Massage Therapy,
served two terms as AMTA National President, and was
widely regarded as a successful innovator, activist, and
educator within the profession. In 2009, Bob was named
to the Massage Therapy Hall of Fame. In 2004, he received
the Distinguished Service Award for the Massage Therapy
Foundation for visionary leadership.
reassuring and cheerful, requires a clear understanding of
rotator cuff functioning to best serve the client with upper
quarter pain. The introverted wisdom of the energy worker is
more clinically effective when the attachments and function
of the quadratus lumborum are clearly understood. Effective
palpation is clearly an art and a science.
Fortunately, compassion and competency are not
mutually exclusive skills. Neither are accuracy and artistry.
A noted neuromuscular therapist once told me, “To really
develop your intuition, know your anatomy!” How true.
So how do we creatively bring the objectivity, the detail
and the accuracy of scientific anatomy into the learning
process and the ongoing education of the bodywork
practitioner?
Some 20 years ago, a groundbreaking event occurred
with the publication of Drs. Travell and Simons’ Myofascial
Pain and Dysfunction, Volume I. Physical medicine,
manipulative medicine, and bodywork therapies were
gifted with a lavishly illustrated and referenced guide to the
human muscular system. Massage school curricula began
to change. Anatomical competencies were elevated and
anatomically-based clinical accuracy was the foundation
for many advanced trainings and specialties within the field.
“Neutralizing Trigger Points!” became the battle cry for a
whole generation of massage therapists. As the therapeutic
quest deepened and evolved, it became apparent
that trigger points were only one mechanism of pain,
dysfunction, and injury … and certainly not the only clinically
important aspect of the healing process.
Mystery, nuance, perspective, and experimentation,
all valid to the therapeutic encounter, seldom develop
within rigid formulas. Inquiry, research and dialogue come
together to compose a reflective landscape. In recent years,
more thoughtful and inclusive bodywork approaches have
emerged, encompassing muscle, fascia, function, structure,
energetics, mobilization, breathwork, and self-stabilization in
forming a new and clinically potent therapeutic philosophy.
It became evident that a new foundational textbook,
reference and muscular system manifesto was needed …
one that would encompass attachments, movement, layers,
synergists, palpation skills, an image bank, discussion
questions, an instructor’s manual, crossword puzzles, and
review questions in a four color, user-friendly, and Power
Point convertible format.
Such a book has arrived.
The newly revised The Muscular System Manual, by Dr.
Joseph Muscolino, is a comprehensive, all-in-one resource
that scientifically and artfully introduces the student,
reinforces the educator, and validates the practitioner in
learning and effectively treating the muscular system.
The book’s remarkable commitment to precision and
detail is underscored by the author’s sense of wonder and
intellectual curiosity.
The use of color, layout, design, methodology, and
muscle group illustration enables the learner to absorb
essential information while simultaneously seeing the “big
picture” of global and regional relationships. Truly, this is
a text that will integratively support the education, clinical
practice, and continuing education of the manual therapist.
While conducting a clinical symposium on the iliopsoas
complex recently, I used The Muscular System Manual
as a teaching reference. The drawings, pronunciations,
attachments, multiple actions, and learning methodology of
this manual greatly facilitated learning outcomes, expertly
organized the clinical information, and accurately supported
the student learning of palpation and assessment skills.
The author’s explanation of reverse actions was especially
useful, given the multiple action possibilities of this muscle
group. The book also documented that psoas minor is
absent in 40% of the population, the lumbar plexus is
located within the belly of psoas major, and the tenderloin
cut of steak is actually the cow’s psoas major!
I believe massage therapy education should be
informative, interactive and fun. The Muscular System
Manual not only supports these goals, it stands on its own
as a superb teaching reference book.
The author is a practicing chiropractor, massage
school anatomy instructor, and an activist for professional
standards of competency. He has served as a test
specification expert in the fields of anatomy, physiology,
and kinesiology for the National Certification Board of
Therapeutic Massage and Bodywork Job Analysis Survey
Task Force. He is the author of numerous anatomical and
clinical features in Journal of Bodywork and Movement
Therapies and Massage Therapy Journal.
Perhaps equally important, Dr. Muscolino has a twinkle
in his eye and a profoundly animated response whenever
discussions veer into the realm of muscles and movement.
I believe The Muscular System Manual reflects his vast
knowledge, his creative vision, and the twinkle in his eye.
The Muscular System Manual is the most current and
informative reference for the human muscular system and
its potential for function and creative movement.
This book will last you a lifetime.
Robert K. King
August 11, 2004
SECOND EDITION FOREWORD xiii
PREFACE
The Muscular System Manual: The Skeletal Muscles of the
Human Body, 4th edition, is meant to be the most thorough
atlas of muscle function that is available. Instead of simply
listing muscle attachments and actions that are typically
taught, The Muscular System Manual comprehensively
covers all muscle functions of each muscle. Shortening
action functions with their reverse actions are addressed,
as well as eccentric and stabilization functions. By offering
the student the full picture of muscle function, it actually
makes the task of learning the muscles easier, not harder.
Students can grasp the information more quickly because
they understand it and do not have to memorize it.
WHO WILL BENEFIT FROM THIS BOOK?
This book is primarily written for students and practicing
therapists of manual and movement therapies, including
massage therapy, physical therapy, chiropractic,
osteopathy, orthopedists, athletic training, yoga, Pilates,
and Feldenkrais. However, anyone who needs to learn the
skeletal muscles of the body will find this book invaluable
and essential. Unlike many books, you will not outgrow
The Muscular System Manual. It will be your guide as you
first learn the muscles of the body, and it will remain an
invaluable resource on your bookshelf for as long as you are
in practice.
CONCEPTUAL APPROACH
The approach taken by The Muscular System Manual is
unique. Instead of simply listing information, it teaches the
information and makes it understandable, allowing for true
critical thinking. The beginning chapters set the framework
for how muscles work as well as give a five-step approach
to learning muscles. Each individual muscle then has notes
that explain how the actions can be reasoned out instead of
memorized. The goal of this book is to enable the student/
therapist/trainer/physician to be able to critically think
through muscle functioning when working clinically with
clients and patients.
ORGANIZATION
The Muscular System Manual is organized into five Parts. Part
1 covers the basic language of kinesiology that the student
needs to be able to understand muscle attachments and
functions and also communicate with other members of the
health care and fitness fields. Parts 2 through 4 systematically
cover each of the major muscles of the body, presenting in
a clear and organized manner the essential information of
every muscle. The beginning of each chapter in these parts
opens with large group illustrations of the muscles of the joint
region. Each muscle then has an individual layout in which
the muscle’s attachments, functions, innervation, arterial
supply, palpation, relationship to other structures, and other
xiv PREFACE
miscellaneous information that is intellectually and clinically
relevant are given. Part 5 presents illustrations of all the major
functional joint action mover groups of muscles as well as
illustrations of the muscles of the pelvic floor and myofascial
meridians of the body.
DISTINCTIVE FEATURES OF THIS BOOK
There are many features that distinguish this book:
• The most thorough coverage of muscle function
available.
• Explanations to understand the muscle’s actions that
promote critical thinking.
• Full referencing for all joint actions.
• Information presented in a layered à la carte approach
that allows each student or instructor to determine what
content is covered.
• Beautiful illustrations in which the bones and muscles are
placed on a photograph of a real person.
• Large group illustrations for every functional group.
• Myofascial meridian information for every muscle.
• Bulleted clear and easy-to-follow palpations for each
muscle.
• An interactive digital program on Evolve that allows for
any combination of muscles to be placed on the skeleton
and body.
NEW TO THIS EDITION
All features of the 3rd edition have been preserved; the 4th
edition of The Muscular System Manual has many new
features:
• Evidence-based full referencing for all joint actions of the
muscles.
• Expanded coverage of muscle function to address the
oblique plane motion patterns of the muscles.
• A flashcard app that offers a portable resource for
studying more than 250 flashcards, which include
coverage of muscles, muscle locations, pronunciations,
attachments, actions, and innervation information.
• New illustrations for the muscle attachments and
myofascial meridians, as well as for many of the
muscles.
• A concise review of all organ systems of the body.
• Digital access to video demonstrations of the palpation
of all the muscles of the body.
• An interactive customized digital program that allows
stretches of the individual muscles to be printed out for
self-care use or for use with patients/clients.
LEARNING AIDS
• The attachment and functions information is presented in
a layered à la carte approach that allows the student to
decide at what depth to learn the information.
• This book is meant to be used not only as a textbook,
but also as an in-class manual. For this reason,
checkboxes are provided for each muscle layout as well
as each piece of information. This allows the student
to check off exactly what content will be learned.
Instructors, having students check off content covered,
allows for extremely clear expectations of what they are
responsible for.
• Arrows are placed over the muscle for each individual
muscle illustration so that the line of pull of the muscle
can be seen and visually understood. This allows for
the actions of the muscle to be understood instead of
memorized.
• A Miscellaneous section is provided that offers
interesting insights to each muscle. Many of these are
clinical applications that flesh out and make learning the
muscle more interesting.
EVOLVE ONLINE RESOURCES
This book is backed up by an Evolve website that includes
the following student resources:
• An interactive digital program that is simple, thorough,
and easy to use. A base photograph of the region of the
body is presented with the skeleton drawn in. A list of
every muscle of that region is given and you can choose
any combination of muscles and place them onto the
illustration, allowing you to not only see that muscle’s
attachments, but more importantly, to be able to see the
relationship between all the muscles of the region. Any
combination of muscles can be chosen!
• Video demonstrations by the author showing palpation of
each and every muscle of the book.
• An audio feature in which the author reads aloud the
names, attachments, and major actions of all the
muscles. This allows for studying while commuting or for
use with an MP3 device. Ideal for studying and learning
while on the go!
• Interactive review exercises such as Drag ‘n’ Drop
labeling exercises and Name That Muscle quizzes for
further review of the skeletal muscles of the human
body.
• 200 short-answer review questions to reinforce
knowledge learned in the book.
• An interactive customized digital program that allows
stretches of the individual muscles to be printed out for
self-care use or for use with patients/clients.
• A concise review of all organ systems of the body.
• Supplemental appendices featuring valuable information
on the following topics: soft tissue attachments,
palpation guidelines, overview of innervation, overview
of arterial supply, additional skeletal muscles, and
mnemonics for remembering muscle names.
OTHER RESOURCES
For instructors, the entire book is available in 50-minute
PowerPoint lectures, with learning outcomes, discussion
topics, and critical thinking questions. There is also an
instructor’s manual that provides step-by-step approaches
to leading the class through learning the muscles, as well
as case studies that allow for a critical thinking application
of the muscles to common musculoskeletal conditions.
Further, a complete image collection that contains every
figure in the book, and a test bank in ExamView containing
1,500 questions, are provided.
RELATED PUBLICATIONS
The Muscular System Manual is also supported by an
excellent coloring book and set of flash cards that can be
purchased separately. Look for Musculoskeletal Anatomy
Coloring Book, 2nd edition, and Musculoskeletal Anatomy
Flash Cards, 2nd edition, published by Mosby/Elsevier. For
more on muscle palpation, look for The Muscle and Bone
Palpation Manual, With Trigger Points, Referral Patterns, and
Stretching, 2nd edition (Mosby/Elsevier, 2015).
NOTE TO THE STUDENT
This book is thick and packed with information. You can
choose exactly how much you want to learn. If you are a
beginner to learning muscles, the outstanding illustrations
and the simple and clear explanations will make learning
muscles easy. If you are an advanced student of the
muscular system, the depth of information will help you
reach new levels of knowledge and clinical application. You
will not outgrow this book. Whether as an in-class manual or
a reference text for your bookshelf, you will find this book to
be an ideal and essential book now and into the future!
PREFACE xv
HOW TO USE THIS BOOK
Muscle and Group Name (if applicable),
1 1
covered in a 2- to 3-page spread.
Illustration of individual muscle, with
2
arrows indicating lines of pull. Bony at-
tachments are shaded in brown for easy
identification. Muscle is deep to (behind)
a bone from this. Figures are full color an-
atomic illustrations of muscles and bones
drawn over photographs to help identify
positions of the structures. The positions
of muscles and bones in the human body
are unmistakable in this overlay artwork.
Checkboxes are used throughout the 2-
3 Standard Mover Actions
to 3-page individual muscle spreads so
you can mark information to be covered
or check it off once you have learned the
material.
A first look at the name of the muscle to see
4 the ScC joint
what free information the name gives us.
Derivation and proper pronunciation of the
5 11 Standard Mover Action Notes
muscle are provided here.
Simple attachment (origin) information.
6 abducts) the scapula at the scapulocostal joint. (action 1)
(Note: For illustrations of bones, bony
landmarks, and muscle attachment sites,
see Chapter 2.)
More detailed attachment (origin)
7 serratus anterior upwardly rotates the scapula at the
information.
Simple attachment (insertion) information.
8
(Note: If more detailed attachment [inser-
tion] information is present, it will follow
directly after this section.)
Functions section: This section covers ev-
9
ery contraction function of the muscle. This
information serves to make The Muscular
System Manual more complete, giving a
comprehensive presentation of musculo-
skeletal function. (Note: For an explanation
of muscle function, see Chapter 3.)
Concentric (Shortening) Mover Actions
10
table: The actions (standard and reverse)
xvi HOW TO USE THIS BOOK
3 †Serratus Anterior
The name, serratus anterior, tells us that this muscle has a serrated appearance and is anterior (anterior to the serratus
4
posterior superior and serratus posterior inferior).
5 †Derivation 2
serratus: L. a notching
anterior: L. in front
†Pronunciation
ser-A-tus
an-TEE-ri-or
ATTACHMENTS
† Ribs one through nine 6
† anterolaterally
7
to the
† Anterior Surface of the Entire Medial Border of the
Scapula 8
FUNCTIONS 9
10 Concentric (Shortening) Mover Actions
Reverse Mover Actions Serratus
anterior
† 1. Protracts the scapula at † 1. Retracts the trunk at the ScC
the ScC joint joint
† 2. Upwardly rotates the † 2. Depresses the trunk at the
scapula at the ScC joint ScC joint
† 3. Elevates the scapula at the
ScC joint
† 4. Depresses the scapula at the † 3. Elevates the trunk at the ScC
ScC joint joint
† 5. Medially tilts the scapula at
† 6. Downwardly tilts the scapula
at the ScC joint Figure 4-7 Lateral view of the right serratus anterior.
ScC joint = scapulocostal joint
• Upward rotation of the scapula is a coupled motion that
must accompany any abduction and/or flexion of the
• The costal (i.e., rib) attachment of the serratus anterior is arm at the glenohumeral joint. The serratus anterior is
more anterior than the scapular attachment. When the especially engaged to upwardly rotate the scapula when
serratus anterior contracts, it pulls the scapula anteriorly the arm is flexed at the glenohumeral joint. (action 2)
toward the ribs; therefore the serratus anterior protracts (i.e., • The serratus anterior is the prime mover of scapular
protraction, upward rotation, and medial tilt. (actions 1, 2, 5)
• Scapular protraction is important when pushing, punching, • Only the upper fibers of the serratus anterior can elevate
and reaching forward with the upper extremity. (action 1) the scapula. (action 3)
• When the serratus anterior contracts, it pulls on the • Only the lower fibers of the serratus anterior can depress
scapula, causing the inferior angle of the scapula to the scapula. (action 4)
swing anteriorly and superiorly toward the rib attachment • When the scapula moves at the scapulocostal joint,
of the serratus anterior (this is especially true of the the clavicle also moves at the sternoclavicular joint.
fibers attaching to the inferior angle of the scapula). This (actions 1, 2, 3, 4)
causes the glenoid fossa to orient upward; therefore the • Medial tilt (also known as lateral rotation) is a motion of
the scapula that brings its medial border back against the
scapulocostal joint. (action 2) body wall. In anatomic position, the scapula should be fully
104 PART 2 The Skeletal Muscles of the Upper Extremity
ELS-MSM4_CH04.indd 104 12/12/15 1:35 AM
that are usually taught at a beginning or
intermediate level are in bold print within
the table. The remaining actions within
the table are for more advanced levels of
learning. (Note: For illustrations of joint
actions, see Chapter 1.)
Standard Mover Action notes:
11
Methodology information that explains the
reasoning behind each of the muscle’s
standard actions.
 Reverse Mover Action notes: Methodology
12
information that explains the reasoning
behind each of the muscle’s reverse
actions.
Motions: The oblique plane motion(s) of the
13
muscle is given here to better understand
the true motion pattern(s) of the muscle.
Eccentric and Isometric Functions and
14
Notes: The importance of core stabiliza-
tion (isometric contraction) in exercise and
rehabilitation has become increasingly
understood in recent years, and negative
(eccentric) contractions are used more
and more in exercise. Coverage of this
information is unique to this book.
Additional notes on the muscle’s actions
15
are given here.
Innervation section: Two levels of detail
16
are provided, with the predominant spinal
levels shown in bold print.
Arterial Supply section: Two levels of detail
17
are provided. (Note: Arterial supply to
muscles is extremely variable. Although
specific information is provided here, this
variability must be kept in mind when
learning this material.)
Palpation section: Easy-to-follow num-
18
bered steps to palpate the muscle. See
the Evolve website for more in-depth video
palpation protocols for the muscle palpa-
tion guidelines.
Relationship section: Gives information re-
19
garding the muscle’s anatomic relationship
to other musculoskeletal structures.
Miscellaneous section: In this section, in-
20
teresting information about the muscle and
clinical applications are given.
medially tilted. If the serratus anterior muscles are weak, the
client may have a posture of winged scapulae (laterally tilted
scapulae). The fact that the serratus anterior is a strong
protractor and medial tilter is especially important because
the scapula tends to laterally tilt when it protracts. (action 5)
• Downward tilt of the scapula is a motion wherein the
inferior angle of the scapula is pulled back against the
body wall. In anatomic position, the scapula should be
fully downwardly tilted. (action 6)
Reverse Mover Action Notes 12
• The reverse action of retracting the trunk (i.e., moving it
posteriorly) relative to the scapula at the scapulocostal
joint is best seen when performing a push-up. At the
point in a push-up when the body has been pushed
up away from the ground and the elbow joints are fully
extended, there is a small additional degree of upward
movement of the body. This motion is created by the
serratus anterior pulling the trunk up (posteriorly) toward
the scapulae, which are now fixed due to the hands
being placed on the floor. (reverse action 1)
• The reverse action of depression of the trunk relative to
the scapula at the scapulocostal joint might occur if the
arms are flexed 180 degrees overhead with the hands
fixed to an immovable object when lying down and the
body is pulled downward away from the immovable
object. (reverse action 2)
• The reverse action of elevation of the trunk relative to
the scapula at the scapulocostal joint is not very likely to
occur. (reverse action 3)
13 Motion
1. The serratus anterior has one line of pull in an oblique
plane and therefore creates one motion, which is a
combination of protraction, upward rotation, medial tilt,
and downward tilt of the scapula at the scapulocostal
joint. (Note: Its upper fibers also elevate the scapula and
its lower fibers also depress the scapula.)
14 Eccentric Antagonist Functions
1. Restrains/slows scapular retraction, downward rotation,
depression, elevation, lateral tilt, and upward tilt
2. Restrains/slows protraction, elevation, and depression of
the trunk
14 Isometric Stabilization Functions
1. Stabilizes the scapula
2. Stabilizes the rib cage
Isometric Stabilization Function Note
• The stabilization of the scapula function of the serratus
anterior is particularly important for maintaining a healthy
posture of the scapula. The serratus anterior is the most
important muscle for preventing lateral tilt (winging) and
upward tilt of the scapula.
ELS-MSM4_CH04.indd 105
Serratus Anterior—cont’d
20 MISCELLANEOUS
1. The serrated appearance comes from attaching onto
separate ribs, which creates the notched look of a
serrated knife.
2. In very well-developed individuals, the serratus anterior
looks like ribs standing out in the anterolateral trunk.
3. The serratus anterior can be considered to have three
parts: the first part attaching from ribs one and two to
the superior angle of the scapula, the second part from
ribs two and three to the length of the medial border of
Serratus Anterior—cont’d
15
Additional Notes on Actions
1. Some sources state that the uppermost fibers of the
serratus anterior can downwardly rotate and laterally tilt
the scapula.
2. There is controversy regarding whether or not the
serratus anterior is involved with respiration by moving
the ribcage. Given its attachments onto the ribs, an
accessory respiratory action seems likely.
3. The pull of the serratus anterior upon the scapula at the
scapulocostal joint is also exerted upon the clavicle at
the sternoclavicular joint.
16 INNERVATION
† The Long Thoracic Nerve
† C5, C6, C7
17 ARTERIAL SUPPLY
† The Dorsal Scapular Artery (a branch of the
Subclavian Artery) and the Lateral Thoracic Artery
(a branch of the Axillary Artery)
† and the Superior Thoracic Artery (a branch of the
Axillary Artery)
18 PALPATION
1. With the client supine and the arm flexed to 90
degrees at the shoulder joint (hand pointed toward
the ceiling), place palpating hand on the rib cage on
the lateral trunk between the anterior and posterior
axillary folds of tissue.
2. Have the client protract the scapula by pushing the
hand toward the ceiling and feel for the contraction of
the serratus anterior. Resistance may be added.
3. Once located, try to follow the serratus anterior as far
anterior as possible (deep to the pectoralis major) and
as far posterior as possible (deep to the latissimus
dorsi and the scapula).
19 RELATIONSHIP TO OTHER STRUCTURES
† From the posterior perspective, the majority of the
serratus anterior lies deep to the scapula and the
latissimus dorsi. From the anterior perspective, much of
the muscle lies deep to the pectoralis major and minor.
† The serratus anterior is superficial anterolaterally on the
trunk where it meets the external abdominal oblique.
† The lowest four to five slips of the costal (i.e., rib)
attachments of the serratus anterior interdigitate with the
external abdominal oblique.
† The serratus anterior lies next to (anterior to) the
subscapularis.
† The serratus anterior is located within the spiral line
myofascial meridian.
105
PART 2 The Skeletal Muscles of the Upper Extremity
12/12/15 1:35 AM
the scapula, and the third part from ribs four through nine
to the inferior angle of the scapula. The third part (most
inferior part) of the serratus anterior is the strongest.
4. The serratus anterior blends into the rhomboids on the
anterior side of the scapula (as part of the spiral line
myofascial meridian). Because of this blending, the
rhomboids and serratus anterior are sometimes referred
to as the rhomboserratus muscle. The rhomboserratus
musculature acts as a sling that holds and balances the
posture of the scapula.
HOW TO USE THIS BOOK xvii
ACKNOWLEDGMENTS
No book of this magnitude can be achieved without help.
I would like to express my gratitude to so many people who
aided and supported me in the production of this book. This
book would not exist today if it were not for the help and
support that all of you have given me.
Much of the beauty and success of this book rests in
the beautiful illustrations of muscles and bones drawn over
photographs of models. Photography was done by Yanik
Chauvin and the principle model is Audrey Van Herck, both
of Montreal, Canada. The artists are Frank Forney and
Dave Carlson of Colorado and Giovanni Rimasti of Canada.
A big thank you is also due to Jodie Bernard of Lightbox
Visuals in Canada. Many of the illustrations from Chapters
1 and 3 were artfully done by Jean Luciano of Connecticut
and Jeanne Robertson of St. Louis and borrowed from my
Kinesiology textbook.
The art direction and layout set the tone of this book.
Thank you to Julia Dummitt for making a muscle book
so attractive to look at and so easy to negotiate. Putting
together a book of this size is no small feat. Thank you to
the Production people at Elsevier. And a special thank you
to the Editorial team at Elsevier, Shelly Stringer and Kelly
Skelton, who worked hand in hand with me throughout
this entire project. One could not ask for a more devoted
managing editor than Shelly; she was truly my partner in the
creation of this edition. And Kelly skillfully attended to every
detail along the way. And continuing appreciation to Jennifer
Watrous, my original editor, for all her work and assistance
with the earlier editions of this book.
A continuing thank you to Dr. Sharon Sawitzke, Ph.D.,
Associate Professor, Division of Anatomical Sciences at
the University of Bridgeport, College of Chiropractic, who
lent her expertise to provide the information regarding the
arterial supply to the muscles. I could not have simplified
xviii ACKNOWLEDGMENTS
and organized this material without her. And continuing
thanks to David Elliot, PhD of the Touro University College
of Osteopathic Medicine, my content editor, who combed
through the original edition of this book, ensuring that the
informational content was correct. He also fielded countless
questions from me, helping me organize the content, and
provided needed information when the boundaries of my
knowledge had been reached.
Thank you also to Tom Myers of Maine who graciously
lent of his knowledge and was generous with illustrations
from the third edition of his book, Anatomy Trains.
I would like to thank Dr. Michael Carnes, my first anatomy
instructor, of Western States Chiropractic College in
Portland, Oregon. He first whetted my appetite for learning,
understanding, and appreciating the beauty of anatomy and
physiology.
I believe that textbook writing is essentially “teaching on
pages.” I am so lucky to have had the best field training that
anyone could ask for. Teaching at the Connecticut Center for
Massage Therapy (CCMT) under the guidance of Steve Kitts
shaped me as a writer. I don’t think my students realized just
how much I was learning along with them. Thank you to the
many teaching assistants I was lucky enough to have through
the years. So many of them not only assisted in the classroom,
but also improved my teaching by showing me ways of more
clearly explaining and demonstrating the material to our
students. And I always reserve a special acknowledgement to
one student (and now a fellow instructor), William Courtland,
who one day uttered the simple words, “You should write a
book.” Those words began my writing career.
Lastly, I must express my love and appreciation to
my entire family for their unending love, support, and
understanding as I sat at my computer hour after hour after
hour working on this book.
ABOUT THE AUTHOR
Dr. Joe Muscolino has been teaching
musculoskeletal and visceral
anatomy and physiology, kinesiology,
neurology, pathology, and hands-
on manual and movement therapy
courses for 30 years.
Dr. Muscolino has also published
the following titles with Elsevier:
• Kinesiology: The Skeletal System
and Muscle Function, 2nd edition.
• The Muscle and Bone Palpation
Manual, with Trigger Points,
Referral Patterns, and Stretching
• Musculoskeletal Anatomy Coloring
Book
• Know the Body: Muscle, Bone,
and Palpation Essentials
• Workbook for Know the Body:
Muscle, Bone, and Palpation
Essentials
• Musculoskeletal Anatomy
Flashcards
• Flashcards for Bones, Joints, and Actions of the
Human Body
• Flashcards for Palpation, Trigger Points, and Referral
Patterns
• Mosby’s Trigger Point Flip Chart with Referral Patterns
and Stretching.
And he has also self published the following two titles:
• Advanced Treatment Techniques for the Manual
Therapist: Neck
• Manual Therapy for the Low Back and Pelvis: A Clinical
Orthopedic Approach
In addition, Dr. Muscolino has published numerous DVDs
for the manual and movement therapist on such topics as
orthopedic assessment, palpation, body mechanics, soft
tissue manipulation, stretching, and arthrofascial stretching
(Grade IV Joint Mobilization).
Dr. Muscolino writes the column article, “Body
Mechanics,” in The Massage Therapy Journal (MTJ) and
has written for the Journal of Bodywork and Movement
Therapies (JBMT) as well as many
other journals, both in the United
States and overseas.
Dr. Muscolino teaches continuing
education workshops in the world
of manual and movement therapies,
including a Certification in Clinical
Orthopedic Manual Therapy (COMT).
He teaches these workshops
throughout the United States, Europe,
Australia, New Zealand, and Asia.
He also runs instructor in-services
for kinesiology instructors. He is
an approved provider of continuing
education (CE); and CE credit is
available through the NCBTMB
for Massage Therapists and
Bodyworkers toward certification
renewal.
Dr. Joe Muscolino holds a
Bachelor of Arts degree in Biology
from the State University of New
York at Binghamton, Harpur College. He attained his Doctor
of Chiropractic Degree from Western States Chiropractic
College in Portland, Oregon, and is licensed in Connecticut,
New York, and California. Dr. Muscolino has been in
private practice in Connecticut for more than 30 years and
incorporates soft tissue work into his chiropractic practice
for all of his patients.
If you would like further information regarding
The Muscular System Manual: The Skeletal Muscles
of the Human Body or any of Dr. Muscolino’s other
Elsevier publications, or if you are an instructor and
would like information regarding the many supportive
materials such as PowerPoint slides, test banks of
questions, or TEACH instructor’s manuals, please visit
http://www.us.elsevierhealth.com. If you would like
information regarding Dr. Muscolino’s other publications,
DVDs, and workshops, or if you would like to contact
Dr. Muscolino directly, please visit his website:
www.learnmuscles.com.
ABOUT THE AUTHOR xix
CONTENTS

PART 1 8 Extrinsic Muscles of the Finger Joints, 200

Flexors,
The Musculoskeletal System, 1 Flexor digitorum superficialis, 210
Flexor digitorum profundus, 213
1 Basic Kinesiology Terminology, 1
Flexor pollicis longus, 215
2 The Skeletal System, 33
Extensors,
3 How Muscles Function, 79
Extensor digitorum, 218
Extensor digiti minimi, 221
PART 2 Deep Distal Four Group, 224
The Skeletal Muscles of the Upper Extremity, 91 Abductor pollicis longus, 225
Extensor pollicis brevis, 228
4 Muscles of the Shoulder Girdle Joints, 91 Extensor pollicis longus, 231
Trapezius, 96 Extensor indicis, 234
Rhomboids major and minor, 100
Levator scapulae, 102 9 Intrinsic Muscles of the Finger Joints, 238
Serratus anterior, 104 Thenar Eminence Group, 250
Pectoralis minor, 107 Abductor pollicis brevis, 252
Subclavius, 109 Flexor pollicis brevis, 254
Opponens pollicis, 256
5 Muscles of the Glenohumeral Joint, 112 Hypothenar Eminence Group, 258
Deltoid, 119 Abductor digiti minimi manus, 260
Coracobrachialis, 123 Flexor digiti minimi manus, 262
Pectoralis major, 125 Opponens digiti minimi, 264
Latissimus dorsi, 128 Central Compartment Group, 266
Teres major, 131 Adductor pollicis, 268
Rotator Cuff Group, 133 Lumbricals manus, 271
Supraspinatus, 135 Palmar interossei, 273
Infraspinatus, 137 Dorsal interossei manus, 276
Teres minor, 139 Superficial Fascial Muscle,
Subscapularis, 141 Palmaris brevis, 279

6 Muscles of the Elbow and Radioulnar Joints, 144 PART 3

Elbow Joint,
Biceps brachii, 152 The Skeletal Muscles of the Axial Body, 283
Brachialis, 155
Brachioradialis, 157 10 Muscles of the Spinal Joints, 283
Triceps brachii, 160 Full Spine,
Anconeus, 163 Erector spinae group, 299
Radioulnar Joints, Iliocostalis, 302
Pronator teres, 165 Longissimus, 305
Pronator quadratus, 167 Spinalis, 308
Supinator, 169 Transversospinalis group, 310
Semispinalis, 313
7 Muscles of the Wrist Joint, 172 Multifidus, 316
Wrist Flexor Group, Rotatores, 319
Flexor carpi radialis, 185 Interspinales, 321
Palmaris longus, 187 Intertransversarii, 323
Flexor carpi ulnaris, 190 Neck and Head,
Wrist Extensor Group, Sternocleidomastoid (SCM), 325
Extensor carpi radialis longus, 192 Scalene group, 328
Extensor carpi radialis brevis, 194 Anterior scalene, 330
Extensor carpi ulnaris, 197 Middle scalene, 332

xx CONTENTS
 Posterior scalene, 334 Eye,
Prevertebral group, 336 Orbicularis oculi, 454
Longus colli, 338 Levator palpebrae superioris, 456
Longus capitis, 340 Corrugator supercilii, 457
Rectus capitis anterior, 342 Nose,
Rectus capitis lateralis, 344 Procerus, 459
Splenius capitis, 346 Nasalis, 461
Splenius cervicis, 348 Depressor septi nasi, 463
Suboccipital group, 350 Mouth,
Rectus capitis posterior major, 352 Levator labii superioris alaeque nasi, 465
Rectus capitis posterior minor, 354 Levator labii superioris, 467
Obliquus capitis inferior, 356 Zygomaticus minor, 469
Obliquus capitis superior, 358 Zygomaticus major, 471
Low Back, Levator anguli oris, 473
Quadratus lumborum, 360 Risorius, 475
Anterior abdominal wall muscles, 363 Depressor anguli oris, 477
Rectus abdominis, 366 Depressor labii inferioris, 479
External abdominal oblique, 369 Mentalis, 481
Internal abdominal oblique, 373 Buccinator, 483
Transversus abdominis, 377 Orbicularis oris, 485
Psoas minor, 379 Platysma, 487

11 Muscles of the Rib Cage Joints, 382

PART 4
External intercostals, 390
Internal intercostals, 393 The Skeletal Muscles of the Lower Extremity, 490
Transversus thoracis, 396
Diaphragm, 398 14 Muscles of the Hip Joint, 490
Serratus posterior superior, 402 Hip Joint Flexors,
Serratus posterior inferior, 404 Psoas major, 502
Levatores costarum, 406 Iliacus, 506
Subcostales, 408 Tensor fasciae latae (TFL), 508
Sartorius, 510
12 Muscles of the Temporomandibular Joints, 411 Adductor Group, 512
Major Muscles of Mastication, Pectineus, 516
Temporalis, 416 Adductor longus, 518
Masseter, 418 Gracilis, 520
Lateral pterygoid, 420 Adductor brevis, 522
Medial pterygoid, 422 Adductor magnus, 524
Lesser Muscles of Mastication—the Hyoid Group, Gluteal Group, 527
Hyoid Group, 424 Gluteus maximus, 528
Suprahyoids, Gluteus medius, 531
Digastric, 426 Gluteus minimus, 534
Mylohyoid, 428 Deep Lateral Rotator Group, 537
Geniohyoid, 430 Piriformis, 539
Stylohyoid, 432 Superior gemellus, 542
Infrahyoids, Obturator internus, 544
Sternohyoid, 434 Inferior gemellus, 546
Sternothyroid, 436 Obturator externus, 548
Thyrohyoid, 438 Quadratus femoris, 550
Omohyoid, 440
15 Muscles of the Knee Joint, 553
13 Muscles of Facial Expression, 443 Quadriceps Femoris Group, 562
Scalp, Rectus femoris, 564
Occipitofrontalis, 449 Vastus lateralis, 566
Temporoparietalis, 451 Vastus medialis, 568
Auricularis group, 452 Vastus intermedius, 570

CONTENTS xxi
 Articularis genus, 572 Plantar Surface: Layer I,
Hamstring Group, 573 Abductor hallucis, 644
Biceps femoris, 575 Abductor digiti minimi pedis, 646
Semitendinosus, 578 Flexor digitorum brevis, 648
Semimembranosus, 580 Plantar Surface: Layer II,
Popliteus, 583 Quadratus plantae, 650
Lumbricals pedis, 652
16 Muscles of the Ankle and Subtalar Joints, 586 Plantar Surface: Layer III,
Anterior Compartment, Flexor hallucis brevis, 654
Tibialis anterior, 596 Flexor digiti minimi pedis, 656
Fibularis tertius, 598 Adductor hallucis, 658
Lateral Compartment, Plantar Surface: Layer IV,
Fibularis longus, 600 Plantar interossei, 660
Fibularis brevis, 602 Dorsal interossei pedis, 662
Superficial Posterior Compartment,
Gastrocnemius, 604
Soleus, 606 PART 5
Plantaris, 608
Deep Posterior Compartment,
Functional Mover Groups of Muscles, 666
Tibialis posterior, 610
19 Functional Groups of Muscles, 666
Functional Mover Groups:
17 Extrinsic Muscles of the Toe Joints, 613
Upper Extremity, 667
Anterior Compartment,
Axial Body, 686
Extensor digitorum longus, 622
Lower Extremity, 702
Extensor hallucis longus, 624
Muscles of the Pelvic Floor, 716
Deep Posterior Compartment,
Myofascial Meridians, 719
Flexor digitorum longus, 626
Flexor hallucis longus, 628
References, 725
Index, 737
18 Intrinsic Muscles of the Toe Joints, 631
Dorsal Surface,
Extensor digitorum brevis, 640
Extensor hallucis brevis, 642

CONTENTS xxii
PART I: The Musculoskeletal System

CHAPTER 1

Basic Kinesiology Terminology

http://evolve.elsevier.com/Muscolino/muscular 1

OBJECTIVES
After completing this chapter, the student should be able to perform the following:
1. Define the key terms of this chapter.
2. Describe the importance of clear communication using precise terminology.
3. Describe the major divisions of the body.
4. List the specific divisions of the axial and appendicular body.
5. Describe anatomic position and its role as a reference point for location and movement
terminology.
6. List and define all pairs of location terminology.
7. Describe the major planes of the body.
8. Describe the axes and their relation to the planes of the body.
9. List and define all pairs of movement terminology.
10. Identify which movements occur at each of the major joints of the body.

It is not possible to discuss muscle function without
fluency in the language of kinesiology (Box 1-1). The
reason why specific kinesiology terms exist is that
they help us to avoid the ambiguities of lay language.
Therefore embracing and using these terms is extremely
important in the health care field, where someone’s
health depends on clear communication. The purpose
of this chapter is to provide an overview of the basic
terms of kinesiology that are needed. Further explanation
of kinesiology terminology is provided on the Evolve
website that accompanies this book. For an in-depth and
thorough discussion of the terminology of kinesiology,
see Kinesiology: The Skeletal System and Muscle
Function, 2nd edition (Elsevier, 2010).
MAJOR BODY PARTS
Motions of the body involve movement of body parts. To
be able to describe the body part’s motion, we must be
able to accurately name it. Figure 1-1 illustrates the major
divisions and body parts of the human body. The two
major divisions are the axial body and the appendicular
body. The appendicular body can be divided into the upper
extremities and the lower extremities.
The names of most body parts are identical to the lay
English names for them. However, there are a few cases in
which kinesiology terms are very specific and need to be
observed. For example, the term arm is used to refer to the
region of the upper extremity that is located between the
glenohumeral (GH) (shoulder) and elbow joints. The term
forearm refers to the body part that is located between the
elbow and wrist joints; the forearm is a separate body part
and not considered to be part of the arm. Similarly, the
term leg describes the region of the lower extremity that
is located between the knee and ankle joints, whereas the
term thigh is used to describe an entirely separate body
part that is located between the hip and knee joints; the
thigh is not part of the leg. The precise use of these terms
is essential so that movements of the leg and thigh are not
confused with each other, and movements of the arm and
forearm are not confused with each other. Another term
that should be noted is pelvis. The pelvis is a separate
body part from the trunk and is located between the trunk
and thighs.

PART 1 The Musculoskeletal System 1

 LOCATION TERMINOLOGY
BOX 1-1
Basic Kinesiology Terminology

Now that anatomic position has been defined, it can be

The term kinesiology literally means the study of motion.
Given that motion of our body occurs when bones move
at joints, and that muscles are the primary creator of the
forces that move the bones, kinesiology is the study of
the musculoskeletal system. Because the muscles are
controlled and directed by the nervous system, it might
be more accurate to expand kinesiology to be the study
of the neuromusculoskeletal system. And when we
consider the importance of fascia to musculature and
movement, perhaps the best way that we can define
kinesiology is to describe it as the study of the neuro-
1 to the back. These terms can be used for the entire body,
myo-fascio-skeletal system!
ANATOMIC POSITION
Anatomic position is a standard reference position used to
define terms that describe the physical location of structures
of the body and points on the body. In anatomic position,
the person is standing erect, facing forward, with the arms at
the sides, the palms facing forward, and the fingers and toes
extended (Figure 1-2). Note: Given that movement terminology
is based on location terminology, anatomic position is
ultimately the foundation for movement terminology as well.
used as the reference position for location terms that
describe the relative locations of body parts, structures,
and points on the body to each other. Location
terminology is composed of directional terms that come
in pairs, each member of the pair being the opposite of
the other.
Pairs of Terms
Anterior/Posterior
Anterior means farther to the front; posterior means farther
axial and appendicular.
Note: The term ventral is sometimes used for anterior,
and the term dorsal is sometimes used for posterior. The
true definition of ventral is the soft belly surface of a body
part; dorsal refers to the harder surface on the other side of
the body part. In the lower extremity, anterior/ventral and
posterior/dorsal are not synonymous. The ventral surface
of the thigh is the medial surface, of the leg is the posterior
surface, and of the foot is the plantar surface.
Medial/Lateral
Medial means closer to an imaginary midline that divides
the body into left and right halves; lateral means farther from

Head

Neck
Axial Shoulder girdle
body parts

Arm

Trunk Upper extremity

body parts
Forearm
Pelvis

Hand

Thigh

Lower extremity
body parts

Leg

Foot
A
Figure 1-1 The three major divisions of the body are the axial body and the two divisions of the appendicular
body. The appendicular body is composed of the upper extremities and lower extremities. Furthermore, the
body parts within these major divisions are shown. A, Anterior view.

2 PART 1 The Musculoskeletal System

 Basic Kinesiology Terminology
Head

Neck
Axial
Shoulder girdle body parts

Arm
Upper extremity Trunk
body parts
Forearm

Pelvis
Hand
1

Thigh

Lower extremity
body parts

Leg

Foot
B

Head

Neck
Shoulder girdle Axial
body parts

Upper Arm
extremity Trunk
body
parts Forearm
Pelvis

Hand

Thigh

Lower
extremity
body parts
Leg

C Foot

Figure 1-1, cont’d B, Posterior view. C, Lateral view.

PART 1 The Musculoskeletal System 3


Basic Kinesiology Terminology
1 Cranial/Caudal
Figure 1-2 Anatomic position is a reference position of the body in
which the person is standing erect, facing forward, with the arms at the
sides, the palms facing forward, and the fingers and toes extended.
this imaginary midline. These terms can be used for the
entire body, axial and appendicular.
Superior/Inferior
Superior means above (toward the head); inferior means
below (away from the head). These terms are usually used
for the axial body only.
Proximal/Distal
Proximal means closer (i.e., more proximity) to the axial
body; distal means farther (i.e., more distance) from the axial
body. These terms are used for the appendicular body only.
Superficial/Deep
Superficial means closer to the surface of the body; deep
means farther from the surface of the body (i.e., more
internal). These terms can be used for the entire body,
axial and appendicular. Note: When employing the terms
superficial and deep, it is recommended to always state
from which perspective you are viewing the body.
Radial/Ulnar
The terms radial and ulnar can be used for the forearm and hand
in place of the terms lateral and medial, respectively. The radius
is the lateral bone of the forearm; the ulna is the medial bone.
Tibial/Fibular
The terms tibial and fibular can be used for the leg and
sometimes the foot in place of the terms medial and lateral,
4 PART 1 The Musculoskeletal System
respectively. The tibia is the medial bone of the leg; the
fibula is the lateral bone.
Palmar/Dorsal
The terms palmar and dorsal can be used for the hand in
place of the terms anterior and posterior, respectively.
Plantar/Dorsal
The terms plantar and dorsal can be used for the foot. The
plantar surface of the foot is the undersurface that is planted
on the ground. The dorsal surface is the top or dorsum of
the foot.
Cranial means toward the head; caudal means toward the
“tail” of the body. These terms are used for the axial body
only. Note: The term cephalad is often used in place of
cranial.
Combining Terms of Location
These terms that describe location can be combined
together. Similar to combining terms such as north and
west to create northwest, location terms can be combined.
When doing this, the end of the first word is usually dropped
and the letter o is placed to connect the two words.
For example, anterior and lateral combine to become
anterolateral. Although no hard-and-fast rule exists, anterior
and posterior are usually placed first when combined with
other terms.
Figure 1-3 is an anterior view of a person, illustrating
the terms of relative location as they pertain to the body.
PLANES
Planes are flat surfaces that cut through and can be used
to map three-dimensional space. Because space is three-
dimensional, there are three major planes, known as
cardinal planes. The three cardinal planes are the sagittal
plane, frontal plane, and transverse plane (Box 1-2).
A sagittal plane divides the body into left and right portions.
A frontal plane divides the body into front and back (anterior
and posterior) portions. A transverse plane divides the
body into upper and lower (superior and inferior or proximal
and distal) portions. Each of the three cardinal planes
is perpendicular to the other two cardinal planes. Any
plane that is not perfectly sagittal, frontal, or transverse is
described as an oblique plane. Therefore an oblique plane
has components of two or three cardinal planes. Figure 1-4
illustrates two examples each of the three cardinal planes
and oblique planes.
Motion of the Body within Planes
Planes become extremely important when we describe the
motion of a body part through space, because the body
part moves within a plane. Hence, by defining the planes of
space, we can describe the path of motion of a body part
when it moves. Note that the sagittal and frontal planes are
 ANATOMIC POSITION

Basic Kinesiology Terminology

Superior
(axial body only)

Proximal
(appendicular
body only)

Inferior
(axial body only)
Distal Proximal
(appendicular (appendicular
body only) body only)
Anterior toward the front
(entire body)
Ulnar Radial
Posterior toward the back
(entire body) (forearm and
hand only)

Palmar often used in place of

anterior on the hand.

Dorsal often used in place of

posterior on the hand.

Plantar used for the inferior

surface of the foot.

Dorsal used for the superior

surface of the foot.
Distal
(appendicular
Tibial Fibular body only)
(leg and
Lateral Medial
perhaps foot)
(entire body) (entire body)
Figure 1-3 Various terms of location relative to anatomic position.

vertical and the transverse plane is horizontal. Therefore
motions within the sagittal and frontal planes move vertically
up and down, and motions within the transverse plane move
horizontally. Figure 1-5 illustrates examples of motion within
the three cardinal planes and oblique planes.
AXES
An axis (plural: axes) is an imaginary line around which a
body part moves. If a body part moves in a circular path
BOX 1-2
The frontal plane is also known as the coronal plane. The
transverse plane is also known as the horizontal plane.
around an axis, it is described as an axial motion. If the
body part moves in a straight line, it is described as a
nonaxial motion. Both axial and nonaxial motions of a
body part move within a plane. However, an axial motion
moves within a plane and moves around an axis. The
orientation of the axis for an axial movement is always
perpendicular to the plane within which the movement is
occurring.
Each plane has its own corresponding axis; therefore
there are three cardinal axes. The axis for sagittal plane
movements is oriented side to side and described as the
mediolateral axis, the axis for frontal plane movements is
oriented front to back and described as anteroposterior,
and the axis for transverse plane movements is oriented
up and down and described as superoinferior or simply
vertical. Each oblique plane also has its own corresponding

PART 1 The Musculoskeletal System 5

Basic Kinesiology Terminology

A B

C D
Figure 1-4 Anterolateral views of the body, illustrating the three cardinal planes (sagittal, frontal, and
transverse) and oblique planes. A, Two examples of sagittal planes. B, Two examples of frontal planes.
C, Two examples of transverse planes. D, Two examples of oblique planes. (Note: The upper oblique
plane has frontal and transverse components to it; the lower oblique plane has sagittal and transverse
components to it.)

6 PART 1 The Musculoskeletal System


A B
D within the frontal plane. C, Motions of the head
C arm within an oblique plane.
axis, which is perpendicular to it. Figure 1-6 illustrates
axial motions that occur within planes and around their
corresponding axes.
MOVEMENT TERMINOLOGY
Using anatomic position, we are able to define terms that
describe static locations on the body. We now need to
Basic Kinesiology Terminology
1
Figure 1-5 Examples of motion of body parts
within planes. A, Motions of the head and
neck and the forearm within the sagittal plane.
B, Motions of the head and neck and the arm
and neck and the arm within the transverse
plane. D, Motions of the head and neck and the
define terms that describe dynamic movements of the
body. These movement terms are called joint actions
(Box 1-3). Similar to location terms, they come in pairs in
which each member of the pair is the opposite of the other.
However, different from location terms, movement terms
do not describe a static location, but rather a direction
of motion. The major pairs of joint action terms are
defined here.
PART 1 The Musculoskeletal System 7
Basic Kinesiology Terminology

A B C D
Figure 1-6 A to D, Anterolateral views that illustrate the corresponding axes for the three cardinal planes
and an oblique plane; the axes are shown as red tubes. A, Motion occurring in the sagittal plane around a
mediolateral axis. B, Motion occurring in the frontal plane around an anteroposterior axis. C, Motion occur-
ring in the transverse plane around a superoinferior axis, or more simply, a vertical axis. D, Motion occurring
in an oblique plane; around an oblique axis.

It should be noted that joint actions usually describe
cardinal plane motions of a body part. For example, the
brachialis muscle brings the forearm anteriorly in the sagittal
plane at the elbow joint, so its action is described as flexion of
the forearm at the elbow joint. If a muscle creates an oblique
plane motion, this motion is described by breaking it into its
component cardinal plane joint action motions. An example is
the coracobrachialis muscle, which moves the arm anteriorly
(in the sagittal plane) and medially (in the frontal plane). When
describing this motion, it is said that the coracobrachialis
flexes and adducts the arm at the glenohumeral joint. It
actually causes one motion, but this one motion is described

BOX 1-3
It is extremely important to point out that joint action terms
describe cardinal plane motions. For example, flexion and
extension of the arm at the shoulder (glenohumeral) joint occur
within the sagittal plane, abduction and adduction of the arm
at the glenohumeral joint occur within the frontal plane, and
right rotation and left rotation of the arm at the glenohumeral
joint occur within the transverse plane. If a body part were to
move in an oblique plane, then as a general rule, to describe its
motion, its cardinal plane motion components must be stated.
For example, if the arm moves in a straight line that is forward
and toward the midline, it would be described as flexing and
adducting, even though it moves in only one direction.
Understanding this concept is crucial to understanding
oblique plane motions created by a muscle. For example, the
coracobrachialis muscle moves the arm at the glenohumeral
joint forward into flexion and toward the midline into
adduction as described above. Therefore, when its one “joint
motion” is described in joint actions terms, it is stated that
it flexes and adducts the arm at the glenohumeral joint. This
is often misconstrued to mean that the coracobrachialis
can create two separate joint motions; that it can either flex
or adduct the arm. It cannot (or at least it cannot do pure
flexion or pure adduction). When it contracts, it must bring
the arm into the oblique plane movement that is comprised
of the sagittal plane component of flexion and the frontal
plane component of adduction.
Therefore, when learning the movement that a muscle
creates, it is important to discern between the actual
motion that it creates and its joint actions. Because a joint
action is a cardinal plane motion, if a muscle creates one
motion within a cardinal plane, its motion and action are
synonymous. But if it creates one motion within an oblique
plane, this oblique plane motion must be described as its
multiple component cardinal plane actions.

8 PART 1 The Musculoskeletal System

as having two cardinal (sagittal and frontal) plane components.
For more information on this, please go to the Evolve website
that accompanies this book or see Kinesiology: The Skeletal
System and Muscle Function, 2nd edition (Elsevier, 2010).
Following the definitions of joint action terms is a joint
action atlas with illustrations that demonstrate all the joint
actions of the body.
Pairs of Terms
Flexion/Extension
Flexion is generally an anterior movement of a body part
within the sagittal plane; extension is generally a posterior
movement within the sagittal plane.
Exceptions include movements of the legs, feet, toes,
and thumbs. From the knee joint and further distally, flexion
of a body part moves posteriorly (extension is therefore an
anterior movement). The thumb moves medially within the
frontal plane when it flexes, and laterally within the frontal
plane when it extends.
The terms flexion and extension can be used for the
entire body, axial and appendicular.
Abduction/Adduction
Abduction is generally a lateral movement within the frontal
plane that is away from the imaginary midline of the body;
adduction is a medial movement toward the midline.
Exceptions include the toes and fingers, including the
thumbs.
The toes adduct toward an imaginary line through the
center of the second toe when the second toe is in anatomic
position; they abduct away from this imaginary line. Toe
number two can only abduct; it can do tibial abduction and
fibular abduction.
Fingers two through five adduct toward an imaginary
line that goes through the center of the middle finger when
the middle finger is in anatomic position; they abduct away
from this imaginary line. The middle finger can only abduct;
it can do radial abduction and ulnar abduction. The thumb
abducts within the sagittal plane by moving away from the
palm of the hand; it adducts within the frontal plane by
moving back toward the palm.
The terms abduction and adduction are used only for the
appendicular body.
Right Lateral Flexion/Left Lateral Flexion
Right lateral flexion is a side-bending movement of the
head, neck, and/or trunk toward the right within the frontal
plane. Left lateral flexion is the opposite. These terms are
used only for the axial body.
Lateral Rotation/Medial Rotation
Lateral rotation is a movement within the transverse
plane in which the anterior surface of the body part
moves to face more laterally (away from the midline);
medial rotation moves the anterior surface to face more
medially (toward the midline). Lateral rotation is also
known as external rotation; medial rotation is also known
BOX 1-4
Basic Kinesiology Terminology
De-rotation is a term that is sometimes used to describe
the function of a muscle that, when the body is in anatomic
position, cannot do rotation, but when the body part to
which the muscle is attached is first rotated, the muscle
can then create rotation to bring the body part back to
anatomic position. Hence it “de-rotates” the body part and
can be described as a “de-rotator.” This occurs because in
anatomic position, the muscle attaches onto the bone over
the axis for transverse plane (rotation) motion; but when the
bone is first rotated, the muscle’s line of pull relative to the
axis changes such that it can now rotate the bone back.
1
as internal rotation. These terms are used only for the
appendicular body.
Right Rotation/Left Rotation
Right rotation is a movement within the transverse plane in
which the anterior surface of the body part moves to face
more to the right; left rotation moves the anterior surface to
face more to the left. These terms are used for the axial body
only. (Note: They are also used to describe rotation motions
of the pelvis.)
Note: The terms ipsilateral rotation and contralateral
rotation are often used to describe motions created by
muscles that produce right or left rotation. Ipsilateral rotation
and contralateral rotation are not joint action terms. Rather,
they are ways to describe that a muscle on one side of the
body either produces rotation to that same (ipsilateral) side
or to the opposite (contralateral) side (Box 1-4).
Elevation/Depression
Elevation is a movement wherein the body part moves
superiorly; depression occurs when the body part moves
inferiorly.
Protraction/Retraction
Protraction is a movement wherein the body part moves
anteriorly; retraction is a posterior movement of the body
part (Box 1-5).
BOX 1-5
The term protraction of the head is often used to
describe a postural dysfunctional pattern in which the
head is held excessively anterior. The consequence
is that the center of weight of the head is imbalanced
over thin air such that posterior cervicocranial extensor
musculature (e.g., upper trapezius, semispinalis capitis)
must isometrically contract to maintain this posture.
Although the head can protract at the atlanto-occipital
joint, this postural pattern is actually a pattern of the
entire cervicocranial region, involving flexion of the lower
neck and extension of the head and upper neck.
PART 1 The Musculoskeletal System 9
 Right Lateral Deviation/Left Lateral Deviation
Basic Kinesiology Terminology
Lateral deviation is a linear movement that occurs in the
lateral direction.
Pronation/Supination
The terms pronation and supination can be applied to
motion of the forearm at the radioulnar joints and motion of
the foot at the subtalar (tarsal) joint.
Pronation of the forearm results in the posterior surface
of the radius facing anteriorly (when in anatomic position);
supination is the opposite. Note: It is easy to confuse
forearm pronation with medial rotation of the arm at the
glenohumeral joint, and forearm supination with lateral
1 rotation of the arm.
Pronation of the foot at the subtalar joint is an oblique
plane motion made up primarily of eversion; it also includes
dorsiflexion and lateral rotation (also known as abduction)
of the foot at the subtalar joint. Pronation drops the arch
structure of the foot. Supination of the foot is primarily
made up of inversion; it also includes foot plantarflexion and
medial rotation (also known as adduction) at the subtalar
joint. Supination raises the arch structure of the foot.
Inversion/Eversion
The foot inverts at the subtalar (tarsal) joint when it turns
its plantar surface toward the midline of the body; it everts
when its plantar surface is turned outward away from the
midline. Inversion is the principal component of supination
of the foot; eversion is the principal component of pronation
of the foot.
Dorsiflexion/Plantarflexion
The foot dorsiflexes when it moves superiorly (in the
direction of its dorsal surface); it plantarflexes when it moves
inferiorly (in the direction of its plantar surface). Technically,
dorsiflexion is extension and plantarflexion is flexion.
Opposition/Reposition
The thumb opposes at the saddle (carpometacarpal) joint
when its pad meets the pad of another finger; it repositions
when it returns back toward anatomic position. Opposition
is actually a composite of abduction, flexion, and medial
rotation of the thumb; reposition is a composite of
adduction, extension, and lateral rotation of the thumb.
The little finger can also oppose and reposition at its
carpometacarpal joint. Little finger opposition is composed
of flexion, adduction, and lateral rotation of the little finger;
little finger reposition is composed of extension, abduction,
and medial rotation.
Upward Rotation/Downward Rotation
The scapula upwardly rotates when its glenoid fossa is
moved to face more superiorly; downward rotation is the
opposite motion.
10 PART 1 The Musculoskeletal System
The clavicle upwardly rotates when its inferior surface moves
to face anteriorly; downward rotation is the opposite motion.
Note: These actions of the scapula and clavicle cannot
be isolated. Rather, they must couple with motions of the
arm at the glenohumeral joint.
Lateral Tilt/Medial Tilt and Upward Tilt/Downward Tilt
The scapula laterally tilts when its medial border lifts away
from the body wall; medial tilt is the opposite motion,
wherein the medial border moves back toward the body
wall. Lateral tilt of the scapula is also known as medial
(internal) rotation. Medial tilt of the scapula is also known as
lateral (external) rotation.
The scapula upwardly tilts when its inferior angle lifts
away from the body wall; downward tilt is the opposite
motion, wherein the inferior angle moves back toward the
body wall.
Horizontal Flexion/Horizontal Extension
Horizontal flexion is a movement of the arm or thigh in
which it begins in a horizontal position (i.e., abducted to
90 degrees) and then moves anteriorly toward the midline
of the body. Horizontal extension is the movement in the
opposite direction.
Note: Horizontal flexion is also known as horizontal
adduction; horizontal extension is also known as horizontal
abduction. The terms horizontal flexion/extension are
generally used for motion of the arm at the glenohumeral
joint; the terms horizontal adduction/abduction are generally
used for motion of the thigh at the hip joint.
Hyperextension and Circumduction
Hyperextension
The term hyperextension is often used to describe
extension beyond anatomic position. This text does not use
hyperextension in this manner. Extension beyond anatomic
position is called extension, just as flexion and abduction
beyond anatomic position are called flexion and abduction.
The prefix hyper denotes excessive; therefore the term
hyperextension would be better and more consistently
defined as a range of extension motion that occurs beyond
what is normal or beyond what is healthy.
Circumduction
Circumduction is not a joint action. Rather, circumduction
is a sequence of four joint actions performed one after the
other. For example, if a person moves his or her arm at
the glenohumeral joint into flexion, then abduction, then
extension, and then adduction, and does this by rounding
the corners of the four motions, it creates a circular motion
pattern that is called circumduction. It should also be noted
that circumduction does not contain any rotation motion.
Any joint that allows motion within two or more planes
(biaxial or triaxial joints) can allow circumduction to occur.
JOINT ACTION ATLAS

Basic Kinesiology Terminology

Upper Extremity
Scapula at the Scapulocostal Joint

A B

C D
Figure 1-7 Nonaxial actions of elevation/depression and protraction/retraction of the scapula at the
scapulocostal (ScC) joint. A, Elevation of the right scapula. B, Depression of the right scapula. C, Protraction
of the right scapula. D, Retraction of the right scapula. The left scapula is in anatomic position in all figures.
(Note: All views are posterior.)

PART 1 The Musculoskeletal System 11

Basic Kinesiology Terminology

Figure 1-8 Upward rotation of the right scapula at the scapulocostal (ScC) joint. The left scapula is in
anatomic position. (Note: The scapular action of upward rotation cannot be isolated. It must accom-
pany humeral motion. In this case, the humerus is abducted at the glenohumeral joint.) (Note: This is a
posterior view.)

A B
Figure 1-9 Tilt actions of the scapula at the scapulocostal (ScC) joint. A, Upward tilt of the right scapula;
the left scapula is in anatomic position. B, Lateral tilt (medial/internal rotation) of the right scapula; the left
scapula is in anatomic position. (Note: Both views are posterior.)

12 PART 1 The Musculoskeletal System

Clavicle at the Sternoclavicular Joint

Basic Kinesiology Terminology

1

A B
Figure 1-10 A, Elevation of the right clavicle at the sternoclavicular (SC) joint. B, Depression of the right
clavicle. (Note: The left clavicle is in anatomic position. Both views are anterior.)

A B
Figure 1-11 A, Protraction of the right clavicle at the sternoclavicular (SC) joint. B, Retraction of the right
clavicle. (Note: Both views are anterosuperior.)

Figure 1-12 Anterior view that illustrates upward rotation of the right clavicle at the sternoclavicular (SC)
joint; the left clavicle is in anatomic position. (Note: Upward rotation of the clavicle cannot be isolated. In this
figure, the arm is abducted at the glenohumeral joint, resulting in the scapula upwardly rotating, which results
in upward rotation of the clavicle.)

PART 1 The Musculoskeletal System 13

 Arm at the Glenohumeral Joint
Basic Kinesiology Terminology

AA BB
Figure 1-13 Sagittal plane actions of the arm at the glenohumeral (GH) joint. A, Flexion. B, Extension.
(Note: Both views are lateral.)

A BB
A B Figure 1-15 Transverse plane actions of the arm at the glenohumeral
Figure 1-14 Frontal plane actions of the arm at the glenohumeral (GH) joint. (GH) joint. A, Lateral rotation. B, Medial rotation. (Note: Both views
A, Abduction. B, Adduction. (Note: Both views are anterior.) are anterior.)

14 PART 1 The Musculoskeletal System

Reverse Action of the Scapula and Trunk at the Glenohumeral Joint

Basic Kinesiology Terminology

1

A B

C D

E F
Figure 1-16 Reverse actions in which the trunk moves relative to the arm at the glenohumeral (GH) joint
are also possible. In the accompanying illustrations, the trunk is seen to move relative to the arm at the GH
joint. A and B illustrate neutral position and right lateral deviation of the trunk at the right GH joint, respec-
tively. C and D illustrate neutral position and right rotation of the trunk at the right GH joint, respectively.
E and F illustrate neutral position and elevation of the trunk at the right GH joint, respectively. In all three
cases, note the change in angulation between the arm and trunk at the GH joint (for lateral deviation B and
elevation F, the elbow joint has also flexed). (Note: All views are anterior.)

PART 1 The Musculoskeletal System 15

 Forearm at the Elbow and Radioulnar Joints
Basic Kinesiology Terminology

A B
Figure 1-17 Sagittal plane motions of the forearm at the elbow joint. A, Flexion of the forearm at the elbow
joint. B, Extension of the forearm at the elbow joint. (Note: Both views are lateral.)

A B
Figure 1-18 Pronation and supination of the right forearm at the radioulnar (RU) joints. A, Pronation.
B, Supination, which is anatomic position for the forearm. Pronation and supination are joint actions
created by a combination of motions at the proximal, middle, and distal RU joints and occur within the
transverse plane. (Note: Both views are anterior.)

16 PART 1 The Musculoskeletal System

Hand at the Wrist Joint

Basic Kinesiology Terminology

1

A B

D
Figure 1-19 Motions of the hand at the wrist joint (radiocarpal and midcarpal joints). A and B, Lateral
views illustrating sagittal plane flexion and extension of the hand, respectively. C and D, Anterior views
illustrating frontal plane radial deviation and ulnar deviation, respectively. Radial deviation of the hand is also
known as abduction; ulnar deviation is also known as adduction.

PART 1 The Musculoskeletal System 17

 Fingers Two through Five at the Metacarpophalangeal and Interphalangeal Joints
Basic Kinesiology Terminology

A B

C D

E F
Figure 1-20 Actions of fingers two through five at the metacarpophalangeal (MCP) joints of the hand.
A and B, Radial (i.e., lateral) views illustrating sagittal plane flexion and extension, respectively. Flexion of
the fingers at the interphalangeal joints is also seen. C and D, Anterior views illustrating frontal plane ab-
duction and adduction, respectively. E and F, Anterior views illustrating frontal plane radial abduction and
ulnar abduction of the middle finger at the third MCP joint, respectively.

18 PART 1 The Musculoskeletal System

Thumb at the Carpometacarpal Joint

Basic Kinesiology Terminology

Figure 1-21 Actions of the thumb at the first carpo-
metacarpal (CMC) joint (also known as the saddle joint of
the thumb). A and B, Anterior views that illustrate oblique
plane opposition and reposition of the thumb, respective-
ly. Opposition and reposition are actually combinations of
cardinal plane actions; the component actions of oppo-
sition and reposition are shown in C to F. C and D, An-
terior views that illustrate flexion and extension, respec-
tively; these actions occur within the frontal plane. E and
F, Lateral views that illustrate abduction and adduction,
respectively; these actions occur within the sagittal plane.
Medial rotation and lateral rotation in the transverse plane
are not shown separately, because these actions cannot
occur in isolation; they must occur in conjunction with 1
flexion and extension, respectively. (Note: Flexion of the
phalanges of the thumb and/or little finger at the meta-
carpophalangeal joint is also seen in A and C; flexion of
the thumb at the interphalangeal joint is also seen in C).

A B

C D E F

PART 1 The Musculoskeletal System 19

 Axial Body
Basic Kinesiology Terminology

Head at the Atlanto-Occipital Joint

A B
Figure 1-22 Lateral views illustrating sagittal plane motions of the head at the atlanto-occipital joint (AOJ).
A illustrates flexion; B illustrates extension. The sagittal plane actions of flexion and extension are the
primary motions of the AOJ.

A B
Figure 1-23 Posterior views illustrating frontal plane lateral flexion motions of the head at the atlanto-occipital
joint (AOJ). A illustrates left lateral flexion; B illustrates right lateral flexion.

A B
Figure 1-24 Posterior views illustrating transverse plane rotation motions of the head at the atlanto-occipital
joint (AOJ). A illustrates left rotation; B illustrates right rotation.

20 PART 1 The Musculoskeletal System

Neck at the Cervical Spinal Joints

Basic Kinesiology Terminology

Figure 1-25 Motions of the neck at the cervical spinal joints.
A and B are lateral views that depict sagittal plane flexion and
extension, respectively. C and D are posterior views that depict
frontal plane left lateral flexion and right lateral flexion, respec-
tively. E and F are anterior views that depict transverse plane
right rotation and left rotation, respectively. Note: A to F depict
motions of the entire craniocervical region (i.e., the head at the
atlanto-occipital joint and the neck at the cervical spinal joints).

A B

C D

E F

PART 1 The Musculoskeletal System 21

Another random document with
no related content on Scribd:
"We are going to the Emerald City ourselves," he exclaimed in
surprise. "It's in the opposite direction from the one you are taking."
"We're hunting a Queen," explained Benny, deciding it was about time
he got into the conversation.

"Why, so are we!" cried the medicine man, leaning so far out to the
side that his chest flew open and spilled half its contents in the road.
Trot and the Scarecrow were extremely shocked at this unexpected
happening, but immediately went to Herby's assistance and when the
last pill box was in place, the medicine man slammed his chest and,
with a wide wave of his arms, announced:
"This is Prince Philador of the Ozure Isles, on a quest to find his royal
mother and save his father's Kingdom. I am a medicine man and—"
"I am a high horse!" neighed High Boy, pawing up the dust with his
hoof and tossing back his mane. "The only high horse in Oz!"
All of these announcements, as you can well imagine, filled Trot and
her companions with astonishment.
"Why, we've just left the Ozure Isles," burst out Trot breathlessly. "A
bird-man carried us to Quiberon's cave and—"
"Let's all sit down," beamed the Scarecrow, "and talk this over
comfortably." Before Philador or Herby could dismount, High Boy
dropped down upon his haunches and, putting one hoof behind his
ear, begged the Scarecrow to proceed with the story.
"Why don't you tie yourself up?" he muttered impatiently to the
medicine man, who in rolling off his back had again upset his
medicine chest.
"I'll lend you my belt," volunteered Trot, as Phil, who had also fallen
off High Boy, picked himself up and sat down beside the straw man.
"Now then!" exclaimed Trot, after she had again restored the contents
of Herby's chest and fastened it securely with her belt, "tell us
everything that has happened!"
"Ladies first," murmured High Boy, showing both rows of teeth. "You
travel in strange company, my dear." His eyes rolled at Benny and
came to rest so hungrily on the Scarecrow that that agitated
gentleman began stuffing in his stray wisps of hay as fast as possible.
"Trot out your tale, little girl," invited High Boy, swallowing hard and
removing his eyes from the Scarecrow with evident effort. As Philador
added his entreaties to High Boy's, Trot began at once to recount
their amazing experiences in Quiberon's cave.
"Why, it all fits together!" exclaimed the little Prince, jumping up
excitedly. "Quiberon demands a mortal maiden or threatens to
destroy our Kingdom in three days. Somehow or other someone or
other flew off to the Emerald City for you, though I cannot imagine my
father allowing such a thing and there are no bird-men on the Ozure
Isles."
"What is your name, child?" asked High Boy, waving his hoof
reprovingly at Phil. "Let the young lady finish her story, Princeling." So
Philador sat down, and Trot, after telling her name and explaining the
strange coming to life of Benny, went on with their further adventures,
their meeting with Orpah and their final escape by explosion to the
mainland.
"Orpah told us all about Mombi's wickedness," finished Trot, in an
anxious voice, "and we were on our way to the Emerald City to ask
Ozma to help your father when we bumped into you."
"And I shall carry you there," promised High Boy with a little snort of
pleasure. "A girl named Trot can ride me any day. A fine, horsey
sounding, name! Do you care for riding, my dear?" Trot nodded
enthusiastically and smiled up at this most comical beast. Then
Philador, stepping out into the center of the ring, told everything that
had happened to him since the blue gull left him at the good witch's
hut. Trot and the Scarecrow were both astonished and alarmed to
learn of Tattypoo's disappearance, and as interested in the medicine
man as Philador had been in Benny. Benny himself listened gravely
to the whole recital and at the conclusion began rubbing his chin in
deep perplexity.
"If Mombi stole Philador's mother when he was two years old," he
muttered in a puzzled voice, "and Mombi has not been witch of the
North for twenty years, how is it that Philador is not grown up?" They
all laughed heartily at the stone man's question.
"Because we stay one age as long as we wish, in Oz," answered the
little Prince gaily. "I like being ten, so I've been ten for ever so long."
"So have I," declared Trot. "Nobody grows up here unless they want
to, Benny. Isn't that fine?"
"Fine, but funny," acknowledged the stone man, looking from one to
the other.
"Everything in Oz is fine but funny," admitted the Scarecrow, turning
an exuberant somersault. "Look at High Boy and look at me!"
"You'd make a fine lunch," observed High Boy, lifting his nose
hungrily.
"Don't you think we'd better start on?" asked Trot, as the Scarecrow,
with an indignant glance at High Boy, sprang behind a tree. "Even
though Quiberon cannot get out to destroy the Ozure Isles,
Cheeriobed must be worried about Philador and Ozma ought to know
about the good witch's disappearance right away."
"Right you are!" Pulling himself to his feet, High Boy capered and
pranced, first stretching his telescope legs up till his body was out of
sight and then decreasing their length till his stomach rested on the
ground.
"Do you consider him safe?" whispered Benny, observing High Boy's
antics with a worried frown. "Had we not better walk?"
"Far better," quavered the Scarecrow, from behind his tree.
"Oh come, get on!" coaxed High Boy. "I was only teasing. I wouldn't
harm a hay of your head," he promised merrily. "So long as Trot likes
you, I'll carry you anywhere."
"Better get on while he's down," advised the medicine man, making
ready to mount.
"He's a very fast runner," added Philador, smiling at Trot.
"And will save you breath, steps and time," whinnied High Boy,
shaking his mane impatiently. "Up with you my brave Kingdom
savers!" Realizing that they would reach the Emerald City much
faster on High Boy, Trot spoke a few words to the Scarecrow and
after a little coaxing he consented to come, climbing up after all the
others so he would be as far from High Boy's teeth as possible.
Fortunately the high horse's back was long so that there was plenty of
room for them all. First came the little Prince of the Ozure Isles, then
Herby, then Trot, then Benny, and last of all the Scarecrow.
"Now hold tight," warned High Boy, rolling his eyes back gleefully,
"and all ready!" Slapping the reins on his neck, Philador ordered him
to get up. Whirling 'round in the direction indicated by the Scarecrow,
High Boy not only got up but shot up so high they could see over the
tree tops, and ran so fast that they clung breathlessly together.
"How's that?" inquired the King's steed, looking proudly around at
Trot.
"Fu—fine!" stuttered the little girl, "but couldn't you trot a little slower,
High Boy?"

"I'll trot slower for Trot,

Though I'd much rather not,
I can pace, I can race
And I canter, a lot!"

chortled High Boy, snapping up his umbrella tail as he gave a sample

of each gait.
"He's awfully smart," confided Philador in a loud whisper. "And we
ought to reach the Emerald City to-night at the very latest." Trot
nodded enthusiastically and as she became more accustomed to the
jerky gait of the high horse she found it strangely exhilarating.
Imagine being able to look over the tree tops as you gallop along the
road! Every once in a while High Boy would drop down to a lower
level so his riders could see whether anyone was passing. While he
was jogging along about five feet from the ground, a farmer turned
into the lane. He was driving a huge herd of cattle and called loudly
for High Boy to get out of the way. Instead, High Boy merely turned
sideways and shot upward, allowing the whole procession to pass
under his body.
Leaning over, Trot and Philador saw the farmer sitting in the middle of
the road mopping his forehead, and they laughingly agreed that
traveling on High Boy was the most interesting experience they had
yet had. The Scarecrow was still uneasy about his stuffing, but even
he was enjoying the ride, pointing out all the sights to Benny and the
medicine man, and explaining all the treats in store when they
reached the Emerald City.
"I cannot imagine who carried you to the Ozure Isles. Are you sure it
was not the blue gull?" questioned Philador, as High Boy jogged
comfortably along the blue highway.
"No, it was a man with golden wings," insisted Trot positively, "and he
must have been terribly strong to have carried Benny all that way."
As Philador still puzzled over the strange bird-man, she called out
suddenly: "Why, we must have gone right by Jinjur's house!"
"So we have!" muttered the Scarecrow, looking back regretfully.
"She'd have given you some fine ginger-bread, too."
"Never mind," neighed High Boy. "We'll be in the Emerald City in time
for tea and there's a village just ahead. Maybe they'll have some
fresh cake or buns." Stretching up his long legs, High Boy looked
over the walls of the little town at the next turn of the road. It seemed
entirely deserted and all the houses had shuttered windows and
tightly locked doors. Dropping down to regular horse size, High Boy
trotted up to the wooden door in the wall and butted his head three
times against the panels.
For a moment there was absolute silence, and then a muffled voice
called out crossly: "Can't you read?"
"It says 'Keep Out!'" whispered Trot, leaning over so she could read
the sign nailed on the door.
"Can't you let us in?" bellowed High Boy, beginning to stamp with
impatience at the delay. "We're in a hurry and have to go through this
town. Let us in, do you hear?"
"I hear!" shouted the voice defiantly, "But I'll not let you in. I'm the Out
Keeper."
"Hah, hah!" roared the Scarecrow. "I've often heard of an Inn Keeper
but never an Out Keeper. Come out, Keeper, and let's have a look at
you!"
Almost instantly the top section of the door flew open and the upper
half and head of the Out Keeper appeared.
"Help!" gasped Trot, clutching the medicine man. And no wonder!
 CHAPTER 15
The Shutter Faces
The face of the Out Keeper was entirely hidden behind blue shutters.
They seemed to sprout out behind the ears on each side of his head
and fasten securely in front with two bolts.
"I suppose he hears through the slats," said Philador, leaning back to
whisper this observation to the medicine man.
"Perfectly!" answered the Out Keeper.
"Can you see through the slats, too?" asked Herby, quite interested in
the fellow's singular appearance.
"No!" snapped the Out Keeper crossly. "But who wants to see? Most
people are not worth looking at. Presently I shall shut my shutters
tight and then I shall neither see you nor listen to you," he finished
triumphantly.
"But we'll still be here!" whinnied High Boy, with a mischievous
prance. Leaning forward he thrust his head through the opening,
seized the Out Keeper by the seat of his pantaloons and, withdrawing
his head, stretched up his telescope legs and stepped calmly over the
wall. "That's the way to handle an O.K.," snickered High Boy,
dropping the Out Keeper carelessly in a clump of pickle bushes.
"I'm not an O.K.!" shrieked the Out Keeper, springing furiously out of
the pickle bushes. "I'm a Shutter Face!" Pulling back the bolts that
fastened his shutters, he glared out at the travelers. The face back of
the blue shutters was pale, flat and disagreeable. After a long,
horrified, look at High Boy and the others, the Out Keeper jumped a
foot into the air and then ran screaming down the street, his shutters
flapping and slamming against the sides of his head. "Bandits!
Robbers! Donkeys and thieves!" he cried shrilly. "Here they come!
Shut the shutters! Bolt the windows and lock the doors. Shut up! Shut
up! Everybody shut up!"
"Shut up your ownself!" yelled the Scarecrow gleefully, as High Boy,
letting himself down to a lower level, cantered mischievously after the
frightened little man. Although the whole town was shut up to begin
with, at the gate keeper's loud cries the travelers could hear extra
bolts being shot into place.
"What's the matter, Tighty?" called a gruff voice. Looking up in
surprise, Trot saw a huge Shutter Face, sitting cross legged on a tall
chimney.
"Bandits, Your Majesty!" Panting with exhaustion, the Out Keeper
looked imploringly up at the chimney.
"How did they get in?" asked the chimney squatter, opening the slats
on one side so he could hear.
"Stepped over the wall," choked Tighty, looking apprehensively over
his shoulder at High Boy.
"Ridiculous and impossible," sniffed His Majesty, crossing his legs
comfortably. "I neither saw nor heard anyone come over the wall."
"How do you expect to see or hear, hid behind those blue blinkers?"
inquired the Scarecrow, as High Boy came to a stop in front of the
chimney.
"Fall down the chimney! Fall down the chimney!" quavered the Out
Keeper, dashing into a doorway. "And don't say I never warned you!"
For a moment Trot thought His Majesty was going to follow Tighty's
advice, but thinking better of it, the King called pompously: "I refuse to
hear, see or believe such nonsense!" Shutting the slats in his shutters
the King folded his arms and continued to sit defiantly on the
chimney.
"Shall I shove him down?" whispered High Boy, looking around at
Philador. "If he cannot see or hear, perhaps he can feel."
"No!" laughed the little Prince, "they've really done us no harm, so
why should we hurt them? Look! Everything's shutting up, even the
hedges!" The hedges surrounding the small, closely shuttered houses
were real box hedges and as High Boy clattered through the streets
they began slamming their lids as fast as they could. Even the flowers
growing in the stiff little gardens, promptly shut up as the travelers
passed and it was with real relief that they reached the other side of
the town.
Not a Shutter Face was in sight and the dingy houses, with their blue
shuttered windows and doors, gave the town such a very gloomy
appearance.
"The poor silly things look half starved!" exclaimed Trot, glancing
down and back at Shutter Town, as High Boy, without bothering to
shorten his legs, stepped over the wall and briskly down the road on
the other side.
"They're worse than the Round-abouties," decided Benny, "and I
suppose if we had stayed any longer they would have insisted upon
us growing shutters, too!"
"Not a bad idea, when you come to think of it," observed the
Scarecrow. "With shutters one need never be bored or shocked."
"Shutters would be extremely becoming to you," chuckled High Boy,
with a vigorous shake of his umbrella tail.
"Hush!" whispered Trot, who did not like anyone to make fun of her
old friend.
"You mean shut up, I suppose?" wheezed High Boy. "But remember
I'm not a Shutter Face, my girl."
"That's so," giggled Trot. "If anyone tells them to shut up, they really
can. I'm going to bring Dorothy and Betsy back here some day and
see what they do to us."
"Here's a river," announced Philador, who was looking anxiously for
the first signs of the Emerald City. "And I have a magic jumping rope
to help us cross." Holding up the good witch's rope, the little Prince
quickly explained how it worked. High Boy listened in silence, and
when Philador finished tossed his head impatiently.
"I've never jumped rope in my life," declared High Boy stubbornly,
"and I'm not going to begin now. Besides it's not necessary. Stay
where you are! Keep quiet and hold tight!"
Rather worried and undecided whether to stay on or tumble off, the
little company looked uncertainly at one another. But before they
could dismount, High Boy shot up two hundred feet and then carefully
stepped down into the river. Trot gasped and expected to find herself
under water. But only the toes of her shoes touched the water, and
when High Boy, looking around, saw this, he raised himself higher still
and, with his whole body out of the water and his feet on the river
bed, carried them safely and slowly across.
"Why, you're better than a bridge!" exclaimed Philador, leaning
forward to give him a good hug. "I wish I could keep you always."
"Joe couldn't spare me," announced High Boy, self consciously, "but
I'll come to see you often, Phil, when this adventure is over. Hold on
now, I'm going to step out."
The great length of High Boy's legs made his body almost vertical, as
he scrambled up the bank. But so tightly did his riders hold on to the
saddle and to one another, nobody fell off. Bringing his legs down
with a few sharp clicks, High Boy put up his umbrella tail and was
about to start on when a series of splutters made him look back. The
high horse had closed his umbrella tail when he stepped into the
river, but in spite of this a lot of water had got in. Therefore, when he
snapped it up, a perfect deluge had come down on his luckless
passengers.
"This is the third shower I've had to-day," coughed the Scarecrow
dolefully. Benny didn't mind the water at all and Herby, after peering
into his medicine chest and discovering that none of the contents
were wet, merely gave himself a good shake. As for Philador and Trot
—what could they do but laughingly accept High Boy's apologies? It
was late afternoon by now, and the sun sinking lower and lower
behind the hills. Since their meeting on the blue highway, High Boy
had come many a long mile, and everyone but Benny and the
Scarecrow began to feel tired as well as hungry.
"I'd give my gold tooth for a pail of yummy jummy," confessed High
Boy, as he slowly mounted a small hill. "I'm hungry enough to eat a
—" He did not finish his sentence, but glanced longingly over his
shoulder at the Scarecrow, who immediately ducked behind Benny
and began feverishly stuffing in his stray wisps of straw.
"How about a sandwich?" suggested Philador, pulling out the lunch
basket Queen Hyacinth had filled so generously.
"A sandwich would be no more than a cracker crumb to me,"
exclaimed High Boy disdainfully.
"Well, what's yummy jummy?" asked Trot, accepting with a smile the
chicken sandwich the little Prince held out to her.
"Oats, hay, bran, brown sugar and grape juice," explained High Boy,
smacking his lips and closing his eyes. "Do you think they'd mix me
up a pail when we reach this Emerald City of yours?"
"Of course they will," promised Trot, "but couldn't you stop and eat a
little grass or tree leaves?"
"Grass is too short, besides, I never eat grass or leaves at night,"
announced High Boy, turning up his nose. "Gives me grasstreetus."
For a time the little company progressed in silence, Herby, Trot and
Philador contentedly munching the dainty sandwiches and Benny
enjoying the scenery. As it grew darker, an overpowering drowsiness
stole over Trot and Philador. High Boy, too, began to yawn so
terrifically that his passengers were nearly thrown out of the saddle.
"If he does that again, I'll fall off," quavered the Scarecrow, clasping
his arms 'round Benny's waist.
"Wait," whispered Herby, "I have a remedy." Unbuckling Trot's belt,
Herby opened his medicine chest and drew out a box of pills. "These
are my famous 'Keep Awake' pills," he explained proudly, swallowing
two, "and these others will prevent yawning."
"Whoa!" gasped Philador as High Boy's last "Hah, hoh, hum!" lifted
them a foot into the air. "Whoa!" The high horse was glad enough to
whoa and, looking around with half closed eyes, inquired the reason
for their stop.
"Take these," directed Philador, slipping two Keep Awake pills and
three yawn lozenges down High Boy's throat. Sleepily High Boy
swallowed the dose. The effect was startling and instantaneous. His
eyes opened wide, his teeth clicked together and next minute he was
streaking down the road so fast that Trot's hair blew straight out
behind and the little Prince's cloak snapped in the wind.
"Better take some yourselves," advised Herby holding out the boxes
to Trot. "For if you fall asleep you'll fall off and then where'll you be?"
A little nervously, Trot swallowed the Keep Awake pills and yawn
lozenges. Philador then took two of each and immediately they both
felt wide awake and full of energy.
"You are a real wizard, Herby," admitted the Scarecrow, noting
admiringly the effect of the pills, "and ought to make a great hit at the
capital."
"Do you think so?" puffed Herby breathlessly, as he bounced up and
down. "Are we almost there?" It was hard to see, for it was night and
only a few stars twinkled in the sky. But presently Trot gave a little
shout of relief and satisfaction.
"See that green glow?" cried the little girl with an excited wave.
"They're the tower lights of the castle. Hurry up, High Boy. We're
almost there!" At Trot's words, High Boy gathered his long legs
together and fairly flew over hills and across fields, so that in less
than an hour they reached the Emerald City itself. It was still fairly
early, and the lovely capital of Oz shimmered as only a jeweled city
can.
 CHAPTER 16
The Lost Queen Returns

On the same evening that Trot and her companions were arriving at
the Emerald City, Cheeriobed and his councilors sat talking in the
great blue throne room of the palace. All day the King had watched
for the coming of Ozma and the return of Philador, and as the hours
dragged on he had become more and more restless and uneasy.
Shortly after lunch, as he was pacing anxiously up and down one of
the garden paths, he was amazed to see Orpah hobbling rapidly
toward him.
It was nearly twenty years since the keeper of the King's sea horses
had been carried off by Quiberon, and Cheeriobed had never
expected to see his faithful servitor again. Rubbing his eyes to make
sure he was not dreaming, the astounded monarch rushed forward to
greet the old mer-man. After a hearty embrace, which wet His
Majesty considerably, Orpah having stepped directly out of the water,
they sat down on a sapphire bench and the King begged Orpah to tell
him at once all that had happened.
Brushing over his long weary imprisonment in Cave City, Orpah
hurried on to the coming of Trot and her strange friends. His lively
description of their encounter with the Cave Men, the way they had
outwitted and trapped Quiberon in the narrow passageway, filled
Cheeriobed with wonder and relief. And when the mer-man went on
to tell him of the explosion of the blue ray that had carried them
across the bottom of the lake to the mainland, Cheeriobed smiled for
the first time since Quiberon had threatened his kingdom.
"Now," declared the good King, slapping his knee happily, "we have
nothing to worry us. Quiberon is a prisoner, the mortal child has
escaped injury and Akbad has saved my son and persuaded Ozma to
come here, save the kingdom, and restore the Queen."
Here he stopped to tell Orpah how the Court Soothsayer had picked
the golden pear and flown with Philador to the capital, invoking
Ozma's aid and carrying the mortal maid to Quiberon's cavern.
"I expect Ozma any moment now," puffed Cheeriobed, shading his
eyes and looking out over the lake. At these words, Akbad, who was
hiding behind the King's bench, covered his ears and slunk miserably
away. How could he ever explain the failure of Ozma to appear, or
account for the strange disappearance of the little Prince? Again and
again he tried to fly away from the Ozure Isles, but the golden wings
refused to carry him beyond the edge of the beach and when in
despair he cast himself into the water, they kept him afloat, so that
even drowning was denied the cowardly fellow. Dragging his wings
disconsolately behind him, he trailed about the palace, or perched
forlornly in the tree tops, and when, in the late evening, Cheeriobed
summoned all of his advisors to the throne room, the Soothsayer
came slowly and unwillingly to the conference. Orpah, with his tail in
a bucket of salt water, sat on the King's right and Toddledy, thumbing
anxiously over an old book of maps, sat on the King's left. Umtillio,
nearby, strummed idly on a golden harp and Akbad, after a longing
glance at the chair set out for him, flew up on the chandelier where he
would have plenty of place for his wings and where he could sit down
with some comfort. Ranged 'round the conference table were the
officers of the Guard and members of the King's household, and they
all listened attentively as Cheeriobed began his address.
"To-morrow is the day Quiberon has threatened to destroy us," began
His Majesty gravely, "and as he may escape it were best to devise
some means of defense."
They all nodded approvingly at these words but said nothing. "Has
anyone a suggestion to make?" asked Cheeriobed, folding his hands
on his stomach and looking inquiringly over his spectacles.
"I suggest that we all go to bed," yawned the Captain of the Guard.
"Then we'll be rested and ready for a battle, if a battle there is to be!"
"Why bother to plan when Quiberon is stuck fast in the cavern?"
asked Akbad impatiently.
"That's so," mused Toddledy. "At least not before Ozma arrives.
When did Her Highness say she would come?" he asked, squinting
up at the Court Soothsayer.
"Just as soon as the Wizard of Oz returns from the blue forest,"
answered Akbad sulkily.
"When Trot and her friends reach the Emerald City, they will persuade
her to come right away," put in Orpah, "and they promised to come
back with her. You will be astonished at the stone man," finished
Orpah solemnly.
At Orpah's casual remark, Akbad could not restrain a groan. However
would he explain to the little ruler of all Oz his own foolish and
deceitful conduct? Dropping heavily from the chandelier he bade the
company good-night and made for the door, his wings flapping and
dragging behind him. As he put out his hand to turn the knob, the
door flew violently open and Jewlia burst into the room.
"A boat!" panted the little girl, throwing her apron over her head, "a
boat is coming 'round Opal Point."
"It is Ozma!" exclaimed His Majesty, thumping the table with both
fists. "Where are my spectacles, hand me my crown, spread the red
rug and call out the Guard of Honor!"
Without waiting for any of these commands to be carried out,
Cheeriobed plunged from the palace through the gardens and down
to the shore of Lake Orizon. Orpah reached the beach almost as
soon as His Majesty, followed closely by Toddledy and all the King's
retainers. A little murmur of disappointment went up from the crowd
as they stared in the direction indicated by Jewlia. A boat was
rounding the point, but only a fisherman's dory. Opposite the man at
the oars sat a closely wrapped figure and, as the boat came nearer,
this figure arose, cast off the cloak and, standing erect, extended both
arms.
"Why!" panted Jewlia, beginning to jump up and down, "it's the Queen
—Queen Orin, herself!"