1

THE SKELETAL SYSTEM

The skeletal system is composed of two types of connective tissue: cartilage and bone. Both are composed of a

structural protein termed collagen. Note that the derivation of coll/a (glue) is related to the nature of the

substance formed when connective tissue is boiled, not any function of the protein itself.

Cartilage is composed of collagen fibers and cartilage cells (chondrocytes). Together, these substances form

its internal structure termed a matrix.

As opposed to cartilage, bones (osseous tissue) are inflexible structures. There are two types of osseous tissue:

cortical (also called compact) and cancellous (also called spongy or trabecular) bone. The cortical bone is the

dense, stronger, outer segment of bones, while cancellous bone is the more open, weaker part.

Once formed, bones are continually engaged in the process of renewing themselves. During the process of

osteogenesis (also called ossification), connective tissue cells are turned into osteoblasts. Osteoblasts are

immature cells that build bone. Osteocytes are mature bone cells, and osteoclasts are cells that break down

bone to release the calcium salts as needed by the body.

A bone’s matrix is formed by a fibrous protein substance that provides a framework in which the mineral

salts (calcium, phosphate, and hydroxide) are deposited. This chemical compound is termed hydroxyapatite

(also spelled hydroxylapatite and apatite), and it is this substance that gives bone its lattice-like structure.

Osteons (also called the Haversian systems) are the cylindrical units within the harder, outer cortical bone that

are built up in layers by this deposition process with a mature osteoblast, now called an osteocyte, in its middle.

The surrounding layers are called lamellae, a term meaning “little plate.” It might help to note the relationship

2

to the word lamination, with its similar meaning of a composition of layers. The bodies of the osteocytes occupy

the spaces (lacunae) in the calcified matrix. Their cytoplasmic processes extend into the tiny canals (termed

canaliculi) that join the lacunae to each other. Unlike cartilage, osseous tissue is vascular, with its required

blood supply furnished through a series of passageways. These passageways are both the Haversian and

Volkman canals. The Haversian canals are located longitudinally to the long axis of the bone, whereas the

Volkman canals join each of the Haversian canals in a horizontal fashion. Cancellous bone is composed of

trabeculae (“little beams”—as in tiny construction girders), in a much less dense, open network, that allows

space for the storage of fat cells and the production of blood.

The Greeks named the skeleton for the dried up remains of a withered corpse. Today we recognize the term

“skeleton” to represent the bones of the body without any of the muscles, ligaments, bursae, or tendons that

accompany the musculoskeletal system, regardless of their state of hydration.

A normal skeleton is composed of 206 bones (slight variation occurs in the tailbone and knee bones), many

of which are paired with a mirrored left or right likeness. For the purposes of assigning accurate codes, it is

necessary to learn the names of each of these 206 bones, categorize them as to their location, and note when a

disease or condition affects either the right, left, or bilateral locations (e.g. right, left, or both knee joints).

The skeleton itself can be divided into two parts: the axial skeleton, which is the skull, vertebrae (back bones),

and rib cage, and the appendicular skeleton, which is the shoulder and pelvic girdles, and the upper and lower

extremities. The shoulder girdle connects the arms to the axial skeleton with the shoulderl blades (scapulae)

and collarbones (clavicles). The pelvic girdle provides attachment for the legs with its two pelvic (coxal) bones.

Bones can be divided by their shapes: long, short, flat, irregular, and sesamoid. Although the shape is often

important to their supportive or protective functions (long—mostly those of the arms, legs, fingers and toes;

short—boxy, cube-shaped like those of the wrist or ankle; flat—like the sternum, scapulae, and most of the

skull bones; irregular—the vertebrae and hip bones; and sesamoid—the kneecap). Long bones, for example, the

upper arm bone, help to explain the different types of osseous tissue and the composition of bone at a

microscopic and macroscopic level.

The shaft of a long bone is termed the diaphysis, while the ends are called the

epiphyses (sing. epiphysis). The end that is closer to the trunk is termed the

proximal epiphysis, while the end that is farther away is called the distal

epiphysis. The growth plate (also called the epiphyseal plate or the physis) is

the site of growth for bone lengthening. This plate is “sealed” when growth

stops, typically around the ages of 18-20 in most people.

3

The tissue that surrounds the bones is called the periosteum which has specialized cells called nociceptors to

provide the sensation of pain when damage occurs.

The inner lining of the center of the bones is called the endosteum. The medullary (medull/o) cavity is the

center of the bone within the endosteum. There are two types of bone marrow in the medullary cavities. Red

bone marrow produces blood cells, while yellow bone marrow stores fat. The yellow bone marrow is stored in

the center of the cortical (compact) bone, while the red marrow is located in the spongy bone of long bones as

well as the flat bones of the body. Stored in the center of long bones, yellow bone marrow is composed of fat,

and red bone marrow gives rise to the stem cells that differentiate into red blood cells, platelets, and most of the

white blood cells.

Bones

4

THE JOINTS

Joints, or articulations as they are sometimes called, are the parts of the body where two or more bones of the

skeleton join. Examples of joints include the knee, which joins the tibia and the femur, and the elbow, which

joins the humerus with the radius and ulna. Joints provide range of motion (ROM), the range through which a

joint can be extended and flexed. Different joints have different ROM, ranging from no movement at all to full

range of movement. Categorized by ROM, they are as follows:

No ROM: Most synarthroses are immovable joints held together by fibrous cartilaginous tissue. The suture

lines of the skull are examples of synarthroses.

Limited ROM: Amphiarthroses are joints joined together by cartilage that are slightly movable, such as the

vertebrae of the spine or the pubic bones.

Full ROM: Diarthroses are joints that have free movement. The most commonly known are ball-and-socket

joints (such as the hip) and hinge joints (such as the knees). Other examples of diarthroses include the

elbows, wrists, shoulders, and ankles.

Diarthroses, or synovial joints, as they are frequently called, are the most complex of the joints. Because these

joints help a person move around for a lifetime, they are designed to efficiently cushion the jarring of the bones

and to minimize friction between the surfaces of the bones. Many of the synovial joints have bursae (sing.

bursa), which are sacs of fluid that are located between the bones of the joint and the tendons that hold the

muscles in place. Bursae help cushion the joints when they move. Synovial joints also have joint capsules that

5

enclose the ends of the bones, a synovial membrane that lines the joint capsules and secretes fluid to lubricate

the joint, and articular cartilage that covers and protects the bone. The menisci (sing. meniscus) consist of

crescent-shaped cartilage in the knee joint that additionally cushion the joint.

Ligaments are strong bands of white fibrous connective tissue that connect one bone to another at the joints.

Bursae are the sacs that appear in some synovial joints with the function of providing additional cushioning.

The sacs are lined with a synovial membrane and filled with synovial fluid, a clear, viscous lubricating liquid.

The term synovial is derived from its similar appearance to egg white.

The names of the bursae and ligaments echo the names of their associated bones and joints. If you have been

working in sequence, the combining forms should help you recognize the location of many of these structures.

6

7

THE MUSCLES

Muscle is a tissue that is composed of cells with the ability to contract and relax. Because of those two

specialized actions, the body is able to move. The muscles in the human body are further specialized into three

different functions:

• Skeletal muscle that allows the skeleton to move voluntarily

• Smooth muscle that is responsible for involuntary movement of the organs

• Heart muscle that pumps blood to the circulatory system.

Muscles are attached to bones by strong fibrous bands of connective tissue called tendons. The bone that is at

the end of the attachment that does not move and is also nearest to the trunk is called the origin (O); the bone

that is at the end that does move and is farthest from the trunk is termed the insertion (I). The function of a

muscle is its action (A). For example, to close your mouth (A), you would need to use the masseter muscle,

which has its origin in the maxilla (upper jaw) and its insertion in the mandible (lower jaw). Note that the upper

jaw does not move, but the lower jaw does, raising that bone upward. Tables and illustrations of the variety of

muscle actions are included to familiarize you with the terms and types of movements you will encounter in

your work. A common abbreviation related to muscle is ROM, which stands for range of motion, the degree to

which a joint can be extended and flexed.

There are three types of muscles: 1) Agonist muscles, which are the primary movers; 2) antagonist muscles,

which have the opposite action of the agonists (they contract when the agonists relax and relax when the

agonists contract) and 3) synergist muscles, groups of muscles that contract together to accomplish the same

body movement. Synergistic muscles are the biceps brachii and the brachialis because they work together to

bend the arm. A muscle that is an antagonist to those is the triceps brachii, which functions to extend the

forearm.

There are some general naming conventions that will help you. Refer to the table below for examples of how

muscles are named by their location, number of insertions, size, shape, and muscle action. The final type of

naming convention that appears in the table is by its origins and insertion. For example, the sternocleidomastoid

muscle originates in the sternum and collarbone and inserts on the mastoid process.

Additionally, the naming themes use synonyms and antonyms. Here are some short cut opposites with their

meanings:

• Brevis is short and longus is long.

• Minimus is small and maximus, magnus, and vastus are large.

• Lateralis is to the side and medialis is to the middle

• Adductors pull toward the midline, while abductors pull away from the midline

• Extensors straighten out, while flexors bend

• Levators raise, while depressors lower

8

Muscles

9

10

11

12

13

THE CENTRAL NERVOUS SYSTEM

The nervous system plays a major role in homeostasis, keeping the other body systems coordinated and

regulated to achieve optimum performance. It accomplishes this goal by helping the individual respond to his or

her internal and external environments.

The nervous and endocrine systems are responsible for communication and control throughout the body.

There are three main neural functions:

1. Collecting information about the external and internal environment (sensing).

2. Processing this information and making decisions about action (interpreting).

3. Directing the body to put into play the decisions made (acting).

14

Nerves are composed of several neurons, or nerve cells. While neurons cannot be seen without a microscope,

some nerves are easily visible. The nerves that extend from the foot to the brain can be over two meters long.

Neural tracts are pathways between different parts of the nervous system. An example is the pyramidal tract

(corticospinal tract) that is named for its triangular shape and which joins the two hemispheres of the cerebral

cortex and the spinal cord.

The nervous system is divided into two main systems. The central nervous system (CNS) is composed of

the brain and the spinal cord. It is the only site of nerve cells called interneurons, which connect sensory and

motor neurons. The peripheral nervous system (PNS) is composed of the nerves that extend from the brain

and spinal cord to the tissues of the body. These are organized into 12 pairs of cranial nerves and 31 pairs of

spinal nerves. The PNS is further divided into sensory and motor nerves. Sensory (afferent) nerves carry

impulses to the brain and spinal cord, whereas motor (efferent) nerves carry impulses away from the brain and

spinal cord.

PNS nerves are further categorized into two subsystems:

Somatic nervous system (SNS): this system is voluntary in nature. These nerves collect information from and

return instructions to the skin, muscles, and joints.

Autonomic nervous system (ANS): mostly involuntary functions are controlled by this system as sensory

information from the internal environment is sent to the CNS, and, in return, motor impulses from the CNS are

sent to involuntary muscles: the heart, glands, and organs.

The nervous system is made up of the following two types of cells:

1. Parenchymal cells, or neurons, the cells that carry out the work of the system.

2. Stromal cells, or glia, the cells that provide a supportive function.

The basic unit of the nervous system is the nerve cell, or neuron (Fig. 11-3). Not all neurons are the same, but

all have features in common. Dendrites, projections from the cell body, receive neural impulses, also called

action potentials, from a stimulus of some kind. This impulse travels along the dendrite and into the cell body,

which is the control center of the cell. This cell body contains the nucleus and surrounding cytoplasm.

From the cell body, the neural impulse moves out along the axon, a slender, elongated projection that carries

the neural impulse toward the next neuron. The terminal fibers result from the final branching of the axon and

are the site of the axon terminals that store the chemical neurotransmitters like dopamine (responsible for

15

affecting voluntary movement regulation) and serotonin (responsible for mood, sleep, and appetite). Many

axons are covered by the myelin sheath, which is a substance produced by the Schwann cells that coats the

axons in the peripheral nervous system. This coating gives the cells a whitish appearance, as opposed to the

gray appearance of unmyelinated axons and cell bodies. The outer cell membrane of the Schwann cell is the

neurilemma. Because the CNS is mostly unmyelinated, it is associated with the phrase “using your gray

matter.”

From the axon’s terminal fibers, the neurotransmitter is released from the cell to travel across the space between

these terminal fibers and the dendrites of thenext cell. This space is called the synapse. The impulse continues

in this manner until its destination is reached.

The supportive, or stromal, glia are also called neuroglia. They accomplish their supportive function by

physically holding the neurons together and also protecting them. There are different kinds of neuroglia,

including astrocytes, ependymal cells, oligodendroglia, microglia, and Schwann cells. Astrocytes connect

neurons and blood vessels and form a structure called the blood-brain barrier (BBB), which prevents or slows

the passage of some drugs and disease-causing organisms to the CNS. Ependymal cells line the ventricles of

the brain and produce cerebrospinal fluid. Oligodendroglia cover the axons of neurons in the central nervous

system, forming their myelin sheath. Microglia perform an active protective function by engulfing and

ingesting infectious organisms. Schwann cells are the only glial cells that appear in the peripheral nervous

system. These cells form a fatty substance called myelin, which insulates the axons in the PNS.

16

As stated previously, the CNS is composed of the brain and the spinal cord.

The brain is one of the most complex organs of the body. It is divided into four parts: the cerebrum, the

diencephalon, the brainstem, and the cerebellum.

The largest portion of the brain, the cerebrum is divided into two halves, or hemispheres. It is responsible for

thinking, reasoning, and memory. The surfaces of the hemispheres are covered with gray matter and are called

the cerebral cortex. Arranged into folds, the valleys are referred to as sulci (sing. sulcus), and the ridges are

called the gyri (sing. gyrus). The cerebrum is further divided into sections called lobes, each of which has its

own functions:

1. The frontal lobe contains the function of speech and the

motor area that controls voluntary movement on the

contralateral side of the body.

2. The temporal lobes contain the auditory and olfactory areas.

3. The parietal lobes control the sensations of touch and taste.

4. The occipital lobe is responsible for vision.

5. The insular lobes, located under the frontal and temporal

lobes, are responsible for empathy, interceptive (internal

sensing) awareness and cognition. The term insula is

derived from the Latin word meaning “island,” probably

because it is not obviously continuous with the other lobes.

Synonyms for insular lobe are the Island of Reil and insular

cortex.

The corpus callosum is the thick band of nerve fibers that joins the two hemispheres of the cerebrum.

The brainstem connects the cerebral hemispheres to the spinal cord. It is composed of three main parts: the

midbrain, pons, and medulla oblongata. The midbrain connects the pons and cerebellum with the hemispheres

of the cerebrum. It is the site of reflex centers for eye and head movements in response to visual and auditory

stimuli. The superior and inferior colliculi of the midbrain are composed of sensory visual and auditory nerve

fibers. The cerebral peduncles of the midbrain are motor nerve fibers that connect to the spinal cord and

cerebellum. The pons serves as a bridge between the medulla oblongata and the cerebrum. The pneumotaxic

and apneustic centers are networks of neurons that function to regulate respiration. The anterior part of the

pons is the basis pontis, which has a role in motor function. The locus ceruleus (Latin for blue spot) functions

in the physiologic response to stress. The superior olivary nucleus is involved in hearing. Finally, the lowest

part of the brainstem, the medulla oblongata, regulates heart rate, blood pressure, and breathing.

Located inferior to the occipital lobe of the cerebrum, the cerebellum coordinates voluntary movement but is

involuntary in its function. For example, walking is a voluntary movement. The coordination needed for the

muscles and other body parts to walk smoothly is involuntary and is controlled by the cerebellum.

THE PERIPHERAL NERVOUS SYSTEM

The peripheral nervous system is divided into:

• 12 pairs of cranial nerves that conduct impulses between the brain and head, neck, thoracic, and abdominal

areas, and

• 31 pairs of spinal nerves that closely mimic the organization of the vertebrae and provide innervations to the

rest of the body.

17

The peripheral nerves are a combination of afferent (sensory) nerves and efferent (motor) nerves. The motor

nerves are either voluntary or involuntary. The autonomic nervous system (ANS) consists of nerves that

regulate involuntary function such as cardiac or smooth muscle. The ANS is further divided into the

sympathetic and parasympathetic nervous systems, two opposing mechanisms that provide balance in the body:

• The sympathetic nervous system is capable of producing a “fight-or-flight” response. This is the part of the

nervous system that helps the individual respond to perceived stress. The heart rate and blood pressure

increase, digestive processes slow, and sweat and adrenal glands increase their secretions.

• The parasympathetic nervous system tends to do the opposite of the sympathetic nervous system—slowing

the heart rate, lowering blood pressure, increasing digestive functions, and decreasing adrenal and sweat

gland activity. This is sometimes called the “rest and digest” system. An example of a sensory response

follows:

“Eight-year-old Joey is hungry. He decides to sneak some cookies before dinner. Afraid his mother will see

him, he surreptitiously takes a handful into the hall closet and shuts the door. As he begins to eat, the closet door

flies open. Joey’s heart begins to race as he whips the cookies out of sight. When he sees it’s only his sister, he

relaxes and offers her a cookie as a bribe not to tell on him.”

Joey’s afferent (sensory) somatic neurons carried the message to his brain that he was hungry. This message

was interpreted by his brain as a concern, and the response was to sneak cookies from the jar and hide himself

as he ate them. When the closet door flew open, his sensory neurons perceived a danger and triggered a

sympathetic “fight-or-flight” response, which raised his heart rate and blood pressure and stimulated his sweat

glands. When the intruder was perceived to be harmless, his parasympathetic nervous system took over and

reduced his heart rate, bringing it back to normal. The same afferent fibers perceived the intruder in two

different ways, with two different sets of autonomic motor responses (sympathetic and parasympathetic).

Cranial nerves are named by their number and also their function or distribution.

18

19

If the nerve fibers from several spinal nerves form a network, it is termed a plexus. Collections of cell

bodies in the PNS are referred to as ganglia (sing. ganglion). Spinal nerves are named by their location

(cervical, thoracic, lumbar, sacral, and coccygeal) and by number. These nerves are either sensory (often

referred to as cutaneous) or muscular. Dermatomes are skin surface areas supplied by a single afferent spinal

nerve. These areas are so specific that it is actually possible to map the body by dermatomes. This specificity

can be demonstrated in patients with shingles, who show similar patterns as specific peripheral nerves are

affected. Myotomes are the areas of muscles that are supplied by a single efferent spinal nerve.

Dermatomes

20

COMPLEMENTARY HEALTHCARE

Chiropractic

Chiropractic is an alternative medicine based on diagnosis, treatment and prevention of problems of the neuro-

musculoskeletal system. Chiropractors emphasize manual therapy including spinal manipulation and other joint

and soft tissue techniques. Exercises and lifestyle counseling is also common practice. Traditional chiropractic,

based on vitalism, assumes that spine problems interfere with the body's general functions and innate

intelligence, a notion that brings criticism from mainstream health care.

Some modern chiropractors now incorporate conventional medical techniques, such as exercise, massage, and

ice pack therapy, in addition to chiropractic's traditional vitalistic underpinnings. Chiropractic is well

established in the U.S. It overlaps with other manual-therapy professions, including massage therapy,

osteopathy, and physical therapy. Chiropractic care is most often used for low back pain.

Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment", is the most

common treatment used in chiropractic care. Spinal manipulation is a passive manual maneuver during which a

three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the

joint. Its defining factor is a dynamic thrust, which is a sudden force that causes an audible release and attempts

to increase a joint's range of motion. Other techniques used include muscle stimulation using TENS units.

Physical Therapy

Physical therapy or physiotherapy (sometimes abbreviated to PT) is a health care profession primarily

concerned with the remediation of impairments and disabilities and the promotion of mobility, functional

ability, quality of life and movement potential through examination, evaluation, diagnosis and physical

intervention. It is carried out by physical therapists (known as physiotherapists in most countries)

and physical therapist. In many settings, physical therapy services may be provided alongside, or in

conjunction with, other medical or rehabilitation services.

Because the body of knowledge of physical therapy is extremely large, PTs usually specialize in a specific

clinical area.

Cardiovascular and pulmonary rehabilitation respiratory practitioners and physical therapists treat a wide

variety of cardiopulmonary disorders or pre and post cardiac or pulmonary surgery. Primary goals of this

specialty include increasing endurance and functional independence. Manual therapy is used in this field to

assist in clearing lung secretions experienced with cystic fibrosis.

Clinical electrophysiology encompasses electrotherapy/physical agents, electrophysiological evaluation

(EMG/NCV), physical agents, and wound management.

Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging

but is usually focused on the older adult. There are many conditions that affect many people as they grow older

and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and

joint replacement, balance disorders, incontinence, etc. Geriatric physical therapists specialize in treating

conditions in older adults.

21

Integumentary (treatment of conditions involving the skin and all its related organs). Common conditions

managed include wounds and burns. Physical therapists may utilize surgical instruments, mechanical lavage,

dressings and topical agents to debride necrotic tissue and promote tissue healing. Other commonly used

interventions include exercise, edema control, splinting, and compression garments.

Neurological physical therapy is a field focused on working with individuals who have a neurological

disorder or disease. These can include stroke, chronic back pain, Alzheimer's disease, Charcot-Marie-Tooth

disease (CMT), ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, facial palsy and spinal

cord injury. Common impairments associated with neurologic conditions include impairments of vision,

balance, ambulation, activities of daily living, movement, muscle strength and loss of functional independence.

Neurological physiotherapy is also called neurophysiotherapy or neurological rehabilitation.

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal

system including rehabilitation after orthopedic surgery. This specialty of physical therapy is most often found

in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopedic

procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions, and

amputations.

Physical therapists can be involved in the care and wellbeing of athletes including recreational, semi-

professional (paid) and professional (full-time employment) participants. This area of practice encompasses

complete athletic injury management under 6 main categories:

1. acute care - assessment and diagnosis of an initial injury;

2. treatment - application of specialist advice and techniques to encourage healing;

3. rehabilitation - progressive management for full return to sport;

4. prevention - identification and address of deficiencies known to directly result in, or act as precursors to

injury

5. education - sharing of specialist knowledge to individual athletes, teams or clubs to assist in prevention

or management of injury

Physical therapists who work for professional sport teams often have a specialized sports certification issued

through their national registering organisation. Most Physical therapists who practise in a sporting environment

are also active in sports medicine programs too.

Acupuncture

Acupuncture is the stimulation of specific acupoints along the skin of the body involving various methods such

as the application of heat, pressure, or laser or penetration of thin needles. It is a key component of traditional

Chinese medicine (TCM), which aims to treat a range of conditions. It is a form of complementary and

alternative medicine. According to traditional Chinese medicine, stimulating specific acupuncture points

corrects imbalances in the flow of qi through channels known as meridians.

Although minimally invasive, the puncturing of the skin with acupuncture needles poses problems when

designing trials that adequately control for placebo effects.

22

Acupuncture is the stimulation of precisely defined, specific acu-points along the skin of the body involving

various methods such as the application of heat, pressure, or laser or penetration of thin needles. In a modern

acupuncture session, an initial consultation is followed by taking the pulse on both arms, and an inspection of

the tongue.

The skin is sterilized, e.g. with alcohol, and the needles are inserted, frequently with a plastic guide tube.

Needles may be manipulated in various ways, e.g. spun, flicked, or moved up and down relative to the skin.

Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended.

Acupuncture can be painful. The skill level of the acupuncturist may influence how painful the needle insertion

is, and a sufficiently skilled practitioner may be able to insert the needles without causing any pain.

The related practices include: Acupressure, a non-invasive form of acupuncture, uses physical pressure applied

to acupressure points by the hand, elbow, or with various devices. Acupuncture is often accompanied

by moxibustion, the burning of cone-shaped preparations of mugwort on or near the skin, often but not always

near or on an acupuncture point. Traditionally acupuncture was used to treat acute conditions while

moxibustion was used for chronic diseases.

Massage Therapy

Massage therapy has a long history in cultures around the world. Today, people use many different types of

massage therapy for a variety of health-related purposes. In the United States, massage therapy is often

considered part of complementary and alternative medicine (CAM), although it does have some conventional

uses.

Massage therapists work in a variety of settings, including private offices, hospitals, nursing homes, studios, and

sport and fitness facilities. Some also travel to patients' homes or workplaces. They usually try to provide a

calm, soothing environment. Therapists usually ask new patients about symptoms, medical history, and desired

results. They may also perform an evaluation through touch, to locate painful or tense areas and determine how

much pressure to apply. Typically, the patient lies on a table, either in loose-fitting clothing or undressed

(covered with a sheet, except for the area being massaged). The therapist may use oil or lotion to reduce friction

on the skin. Sometimes, people receive massage therapy while sitting in a chair. A massage session may be

fairly brief, but may also last an hour or even longer.

Homeopathy

Homeopathy, or homeopathic medicine, is a medical philosophy and practice based on the idea that the body

has the ability to heal itself. Homeopathy was founded in the late 1700s in Germany and has been widely

practiced throughout Europe. Homeopathic medicine views symptoms of illness as normal responses of the

body as it attempts to regain health.

Homeopathy is based on the idea that "like cures like." That is, if a substance causes a symptom in a healthy

person, giving the person a very small amount of the same substance may cure the illness. In theory, a

homeopathic dose enhances the body's normal healing and self-regulatory processes.

Historically, people have used homeopathy to maintain health and treat a wide range of long-term illnesses,

such as allergies, atopic dermatitis, rheumatoid arthritis, and irritable bowel syndrome. They have also used it to

treat minor injuries, such as cuts and scrapes and muscle strains or sprains. Homeopathic treatment is not

considered appropriate for illnesses, such as cancer, heart disease, major infections, or emergencies.