Integumentary

Movement and Fascial System

restriction leads to inactivity, stiffness, tension, pain

• decreased ROM, trigger points, reduced muscle function

• movement and stretching are important for elasticity and mobility

Fascia and Aging

• denser fascia causing stiffness

• degenerates, dries up, tightens, develops knots

• thicker fascia in lumbar spine

Keeping Fascia Healthy

• stretching and frequent movement

• good posture

• healthy weight

• hydrate

• allow time to heal with fascia injuries

Integumentary System

• body’s largest organ and primary protective organ

• skin, glands, hair , nails

Sudoriferous gland

sweat

sebaceous gland

oil/sebum; microbial function

ceruminous gland

specialized sweat glands in ears; produce ear wax

mammary glands

produce milk; found in males and females but mostly only functional in women

Palpation Methods

One hand on top of the other, one hand, two fingers (most typical)

• work smart- practice finding on yourself

• gentle vs. firm contact- know when either is appropriate

  • identify the pain; don’t worsen it

• rolling and strumming- across vs down

• movement and stillness- keep still and move with the joint

3 principles- move slowly, avoid using excess pressure, focus on awareness of what you’re feeling (be present)

Hair

• roots are deep in dermis of skin

• hair shaft grows vertically out of root

• growth dependent on hormones

• thicker hair grows in axilla and pubic region

Nails

• grow in layers

• growth begins at nail matrix and pushes new growth out

• 4-8 weeks for a new nail to fully grow in

• nail plate (visible portion) covers nail bed

tendon

muscle to bone

ligament

bone to bone

retinaculum

hold organs and tissues in place

bursa

fluid filled sacs surrounding joints

• reduce friction

Integumentary system functions

• protection- 1st line of defense against infection and injury

• sensation

• mobility- smooth movement

• endocrine and exocrine activity

• immunity

• temperature regulation

• vitamin D and bone reabsorption

• would healing

• resists mechanical stress

• cosmetic covering

Epidermis

outer layer of skin; protects, avascular, waterproof, pigment, hair follicles, sebaceous glands; 5 layers

stratum corneum

first layer of the epidermis; waterproof, shedding process every 30 days on average

Stratum lucideum

2nd layer of epidermis; found in areas of thick skin; calluses

stratum granulosum

3rd layer of epidermis; greatest number of free nerve endings; living cells

stratum spinosum

4th layer of epidermis; langerhans cells and lymphocytes for immunity

stratum basale

continuous mitosis for new cell production; melanocytes produce melanin contributing to skin color; merkel cells

Dermis

• middle layer of skin

• vascular, sweat glands, nerve endings, enclosed epidermal appendages

• 2 layers

papillary layer

• 1st layer of the dermis

• ridges give rise to fingerprints

• fibroblasts produce collagen, elastin, and proteins for skin strength and flexibility

• mast cells, macrophages, and leukocytes

reticular layer

• 2nd layer of the dermis

• collagen, blood vessels, nerve endings, hair follicles, and glands

• injuries results in pain due to nerve exposure and damage

hypodermis

• 3rd layer of skin

• subcutaneous tissue, loose connective tissue, and adipose tissue

• well vascularized, well innervated

• insulation and cushioning

• helps attach skin to muscles and bones

• AKA superficial fascia

somatic nerves

transmit pain, temperature, light touch, discriminative touch, vibration, pressure, and proprioceptive sensation

autonomic nerves

vasculature tone, hair root pilomotor, stimulation, sweating

Hairy skin

hair follicles nerve endings detect velocity of air movement

glabrous skin

hairless skin at palms, soles of feet, lips, ears

• Meisner- detects movement across skin with/without vision

both hair and glabrous skin

pacinian corpuscle- high frequency vibration

merkel cells- discriminates touch aiding in spatial imaging

ruffini endings- detect skin stretch and pressure

Blood supply

• 2 plexuses found in dermal layer

• between papillary and reticular dermal layers

• between dermis and subcutaneous tissue

• superfiscial arteriovenous plexus- epidermis

• temperature regulation

• ANS controls blood flow changes

Skin changes over time

• epidermis thins

• melanocytes decrease in number; remaining cells increase in size

  • skin appears thinner, paler, and translucent

  • age spots appear in sun-exposed areas

• CT changes with strength and elasticity

• blood vessels of the dermis become fragile

• sebaceous glands produce less oil with age (women > men)

• subcutaneous fat layer thins with less insulation and padding and impacting how medicines work with absorption changes

• sweat glands produce less sweat making it harder to keep cool

• skin tags, warts, brown rough patches

Aging Skin

• increased risk for injury- thinner, fragile, loss of fat layer, less sensation for touch

• rubbing/pulling causes skin tears

• pressure ulcers occur with loss of fat layer, reduced activity, poor nutrition, and illnesses

• repairs itself 4x slower

Fascial System

• multi-layered support for tissue and organs

• lessens friction and eases muscle tension

• tightens reflexivity with stress

• helps bloodstream, bone tissue, and skeletal muscles

• stretches with movement

• mostly collagen, 70% water

• tendons, ligaments, bursae

superficial fascia

layer directly under skin, thicker in stomach and chest areas, thinner in places distal from trunk

• muscle fibers that compose many different body structures

• insulation for thermoregulation, protection, circulation, lymphatic flow and houses interstitium

deep fascia

covers bones, muscle, nerves, and blood vessels

• aponeurotic fascia- thicker and separates more easily from muscles

• epimysial fascia- thinner and more tightly connected to muscles

• visceral fascia- tissue layer around certain organs

• parietal fascia- lines body cavity

structure and function of fascia

• appears passive but it’s very active

• reduces friction

• supports underlying nerves, vessels, lymphatics

• supports organs and tissues

• transmits tension generated by muscles or external forces

• relaxed and wavy in a healthy state

• tightly packed bundles of collagen oriented in one direction to avoid laxity

• improves venous return

myofascial force transmission

muscles produce force, force transmitted toward joint direction of muscle surface, myofascial connections assist in 30% of force transmission

receptors in skin

mechanorecpetors- pressure

chemoreceptors- pH, carbon dioxide levels, and other chemical compositions

therporeceptors- temperature

nociceptors- pain

enteroception- internal organ sensation