Locomotor System – A term originally used by European neurologists in the field of movement disorders. In Norht America a term Musculoskeletal system is more frequently used by physicians and general public. Locomotor system is a system of the human organism which creates, ensures and controls movement and stability of the human body .It controls gate (locomotion), posture, dynamic stability and purposeful movement. It is controlled by the intricate interplay of different structures in the human brain. It creates movement by sending neural signals through the spinal cord and peripheral nerves to the muscles which move the bones of the spine and extremities against the gravity in space. This system is in direct relationship with internal organs of the organism by maintaining their integrity, providing support and participating in function of respiration, mastication, speech, swallowing, and excretion of urine and stool as well as facilitating the movement of blood and other fluids throughout the body. It doesnt only influence other organs within the human body, but it is influenced by alteration of function or pathology of other organs in the human body. The maintenance of health of this system is paramount for ones well being and longevity.

The major elements of the locomotor system are: central and peripheral nervous system, muscles, bones, joints, ligaments, fascias and skin.

Structural pathology of the locomotor system – Irreversible damage to the elements of locomotor system which doesnt always results in pain, but could be a sign of aging. Ex., joint and bone arthritic changes, disc bulging and herniation, ligamentous and muscular trauma resulting in permanent damage, paralysis and etcThese changes must be visible and objectified by radiographic means.

Functional pathology of the locomotor system – Reversible changes of the locomotor system, which always occur throughout the whole body and are in direct connection with each other throughout the body by motor control the central nervous system. Changes in the function cannot be objectified by radiographic means, however are constant and proven by clinical examination.

Motor control – The way in which the Central Nervous System controls motor performance.

Motor learning – The ability of the human nervous system to learn and modify motor programs.

Uprighting -An ability of the child to move up against the gravity.

Verticalization – The gradual transformation of an infant from completely horizontal positions to standing and walking. These positions include: head lift, elbow support, palm support, oblique sitting, sitting, crawling, standing, sided walking, and finally walking.


Manual medicine – This is relatively a new medical science of treatment of pain which mainly originates in within the spine and other parts of the locomotor system. This pain is considered to be of a reflex and/or mechanical origin. The methods of dealing with this pain are: soft tissue, muscle and vertebral manipulation, remedial exercise and rehabilitative exercise. Manual medicine is most helpful for treatment of functional disorders, although most of the structural pathologies initially originate from neglected dysfunction. Its use is unfortunately limited to private practices, although in many European countries it is already a part of conventional medical education and is provided in major Hospital settings. The popularity and success of manual medicine has moved it into a special, although sometimes conflicting place within the medical disciplines. In some countries (Switzerland, France and Sweden) manual medicine specialist are considered among the elite where in others they are still fighting for the recognition within the conventional medical world. Manual medicine has different flavors in different countries. In Czech Republic it is a domain of neurologists. In Denmark it is a domain of rheumatologists. In Belgium and Netherlands it is done by highly specialized physiotherapists and in USA chiropractors and the osteopaths are in the foreground .In Russia it is a separate and distinct medical specialty. In other countries it is either done by orthopedist or physical medicine and rehabilitation specialist.


Deconditioning – Diminished ability or perceived ability to perform tasks involved in persons usual activities of daily living.


Developmental kinesiology – A science of studying functional maturation of muscles during postural ontogenesis.


Motor pattern – Reaction of the motor system to afferent stimulation. The nervous system produces motor functions that appear in the same way from one generation to the next. These genetically determined factors of motor behavior are called motor patterns.


Postural ontogenesis – A science of studying maturation of motor component of central nervous system…It is a science of development of postural system during first year of childs life.


Deep muscles – These are muscles which are not under voluntary control. These muscles are mostly activated in orchestrated fashion together with other muscles which act in the stabilization process of the spine. These muscles are called intersegmental because they connect adjacent vertebras. They are: multifidus, intraspinalis, intratransversrii and transversospinales .They also function as dynamic ligaments of the spine.


The principle of joint centration – The position in which there is the most favorable distribution of pressure on the joint facets during every phase of motion, resulting maximum stability and load capacity. This depends exclusively on the normal development of the central nervous system.


Neutral position of spinal joints – Relates to the shape of spinal curvatures where neither lordotic nor kyphotic curves are exaggerated. This ensures that all spinal joins have maximal joint surface contact throughout any movement or static position. See joint centration above.


Reflex locomotion – Motor reaction occurring in well defined and coordinated manner throughout entire skeletal musculature as well as eye movements, swallowing process, bladder and bowel function and breathing.

The genetically predetermined authentic motor reaction is provoked by graded pressure applied on certain body parts which are called stimulation zones, with the patient placed in these specific positions and reproduced at any time.


Zones of support – Areas of the body which help the child to move up against gravity. They serve as support ensuring erect posture during ontogenesis. They are areas with a great number of attachment points of tendons and ligaments; hence they produce a strong proprioceptive input.

These are medial epicondyle at the elbows, the linea nuchae, the spina iliaca anterior superior and etc.


Co-activation – Synchronous activation of agonist and antagonist (cocontraction) in order to centrate and stabilize the joint. This type of contraction is used when movement is slow and performed in order to hold a position or resist against some external force .Unlike reciprocal activation which is a primitive reflex activity on the spinal cord level, co-activation is more complex activity realized above the brain stem.


Neuroplasticity – This is the brains ability to recognize itself by forming new connections. This interaction between the tissues, neurons, and chemicals of the brain is what molds the structure and function of the nervous system.


Agonist antagonist coactivation– Simultaneous activation of two opposing muscles around the joint. This results in increased stability of the joint.


Trigger points– Points of hyperirritability in the muscle which produce a characteristic pattern of referral unique to that muscle.


Functional muscle chains– Muscles which contract in predetermined sequences according to genetically imbedded motor programs.


Functional muscle synergies– The activation of muscles in appropriate sequence, timing, direction and force. These variables are organized as a ratio. They are flexible and soft wired, therefore could be influenced (reprogrammed) by the therapy.


Joint restriction (subluxation) – This is decreased or aberrant movement of the joint which changes mechanical regime of functioning of this joint, reflex changes in the nervous system and ultimately results in pain somewhere in the locomotor system.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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