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  <head>
    <title>032-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Musculoskeletal foundations">
      <outline text="Orientation">
        <outline text="Converts chemical energy into transmitted force"/>
        <outline text="Supports organs, stores mineral, houses marrow"/>
        <outline text="Disease from contractile, matrix, mineral, nerve failure"/>
      </outline>
      <outline text="Skeletal-muscle organisation">
        <outline text="Muscle, fascicle, fibre, myofibril, sarcomere"/>
        <outline text="Thin filaments: actin, tropomyosin, troponin"/>
        <outline text="Titin centres thick filaments, passive elasticity"/>
        <outline text="Actin slides past myosin; filaments keep length">
          <outline text="Adenosine triphosphate binding releases, hydrolysis recocks"/>
          <outline text="Without adenosine triphosphate, cross-bridges stay attached"/>
        </outline>
        <outline text="Force depends on filament overlap"/>
        <outline text="Parallel fibres: excursion and speed"/>
        <outline text="Pennate fibres: more material, greater force">
          <outline text="Physiological cross-sectional area predicts force"/>
        </outline>
        <outline text="Tendon compliance stores elastic energy"/>
      </outline>
      <outline text="Excitation-contraction coupling">
        <outline text="Acetylcholine at the neuromuscular junction"/>
        <outline text="Action potential along sarcolemma and T tubules">
          <outline text="Ryanodine receptors release calcium"/>
          <outline text="Calcium binds troponin C, moves tropomyosin"/>
        </outline>
        <outline text="Calcium pumps permit relaxation"/>
        <outline text="Repeated stimuli summate force">
          <outline text="Rapid stimulation produces tetanus"/>
        </outline>
        <outline text="Recruitment and firing rate set whole-muscle force"/>
      </outline>
      <outline text="Fibre types and metabolism">
        <outline text="Slow oxidative: economical, fatigue resistant"/>
        <outline text="Fast oxidative-glycolytic: power, moderate endurance"/>
        <outline text="Fast glycolytic: high power, rapid fatigue"/>
        <outline text="Phosphocreatine rapidly buffers adenosine triphosphate"/>
        <outline text="Oxidative phosphorylation powers sustained work"/>
        <outline text="Lactate is fuel and gluconeogenic substrate"/>
        <outline text="Fatigue: metabolic, neural, central, thermal causes"/>
        <outline text="Delayed soreness is microinjury, not lactate"/>
      </outline>
      <outline text="Mechanical actions and adaptation">
        <outline text="Concentric, eccentric, isometric contraction"/>
        <outline text="Moment arm and angle change joint torque"/>
        <outline text="Resistance: neural first, then hypertrophy"/>
        <outline text="Endurance: mitochondria, enzymes, capillaries"/>
        <outline text="Recovery needs sleep, energy, protein, time"/>
        <outline text="Disuse rapidly weakens muscle, tendon, bone">
          <outline text="Early progressive loading when safe"/>
        </outline>
        <outline text="Ageing loses motor units, training still works"/>
      </outline>
      <outline text="Bone composition and architecture">
        <outline text="Collagen gives toughness, mineral stiffness"/>
        <outline text="Cortical shells, trabecular load-aligned network"/>
        <outline text="Osteocytes sense strain via canaliculi"/>
        <outline text="Osteoclasts resorb, coupled to formation"/>
        <outline text="Hormones, signals, and load regulate turnover"/>
        <outline text="Strength beyond mass: geometry, quality, falls"/>
      </outline>
      <outline text="Growth and fracture healing">
        <outline text="Endochondral ossification at growth plates"/>
        <outline text="Sex steroids accelerate growth, close plates"/>
        <outline text="Haematoma, soft callus, hard callus, remodelling"/>
        <outline text="Stability and blood supply are essential">
          <outline text="Motion, infection, smoking impair union"/>
        </outline>
        <outline text="Primary healing with little callus"/>
      </outline>
      <outline text="Cartilage and synovial joints">
        <outline text="Collagen resists shear, proteoglycans compression"/>
        <outline text="Loading expresses fluid, unloading recovers"/>
        <outline text="Avascular cartilage has limited repair"/>
        <outline text="Synoviocytes make hyaluronan, clear debris"/>
        <outline text="Menisci and labra distribute load"/>
        <outline text="Stability from shape, ligaments, muscle, proprioception">
          <outline text="Laxity invites injury, stiffness concentrates load"/>
        </outline>
        <outline text="Movement nourishes cartilage"/>
      </outline>
      <outline text="Tendon, ligament, and matrix">
        <outline text="Tendons transmit force, ligaments constrain"/>
        <outline text="Toe region, linear region, then failure"/>
        <outline text="Matrix adapts more slowly than muscle"/>
        <outline text="Tendinopathy: disordered matrix and load response">
          <outline text="Rest without reloading fails"/>
        </outline>
        <outline text="Fibroblasts: fibrosis or fragility"/>
        <outline text="Type one in bone, type two in cartilage"/>
        <outline text="Flexibility alone is not a syndrome"/>
      </outline>
      <outline text="Integrated movement and reserve">
        <outline text="Many failures feel like weakness">
          <outline text="Separate force loss from pain, stiffness, instability"/>
        </outline>
        <outline text="Power declines faster than strength with age">
          <outline text="Critical for falls and rising from a chair"/>
        </outline>
        <outline text="Load is injury risk and adaptive signal"/>
      </outline>
    </outline>
  </body>
</opml>
