starting positions
posture from which movement started or initiated
standing, kneeling, sitting, lying, and hanging
fundamental starting positions
standing
the most difficult of the fundamental positions to maintain
standing
heels together, knees together, and straight, hips extended and laterally rotated slightly, pelvis is balanced, spine is stretched/straight, ears level, shoulders down and back, arms hang loosely, palms facing inward
• knee extensors • hip extensors • spine extensors • neck extensors • ankle evertors • ankle plantar flexors • ankle dorsiflexors • scapular retractors • abdominals • intrinsic muscles of the feet • pre-vertebral muscles
anti-gravity muscles
sitting
the position is taken on a chair or stool
• spine extensors • abdominals • pre-vertebral muscles • neck extensors • scapular retractors
muscle work in sitting
comfort and stability
effects of sitting
• when client lacks strength of the lower extremities
• non-weight bearing exercises of the lower extremities can be performed
when is sitting suitable?
kneeling
the body is supported on the knees
• knee flexors • knee extensors • hip extensors • trunk flexors • trunk extensors • neck extensors • head extensors.
muscle work in kneeling
• low COG • more stable compared to standing
effects of kneeling
• a starting position for backward movement • trains control of the hips and lower trunk in preparation for standing
uses of kneeling
lying
the easiest of the fundamental positions as muscle work is minimal
suitable position for exercises in lying position or non-weight bearing exercises
uses for lying
unsuitable for those suffering respiratory or heart conditions as breathing is impeded by the added pressure from abdominal organs
unsuitable for elderly or those who suffer high blood pressure as it hinders the return of blood from the head
when is lying unsuitable?
hanging
the body is suspended by grasping over a horizontal bar
• finger flexors • elbow flexors • shoulder adductors • scapular muscles • neck flexors and extensors • trunk flexors • hip extensors • hip adductors • knee extensors • plantar flexor
muscle work in hanging
spine is straightened and elongated
effects of hanging
suitable for those with good strength of the upper extremities
uses of hanging
unsuitable for weak individuals and those suffering from cardiac or respiratory conditions as thorax is fixed in the inspiratory position and breathing is difficult
when is hanging unsuitable?
pelvic tilt
when the body is erect the pelvis is inclined forwards and balanced on the heads of the femora; anterior-posterior tilt
anterior tilt
the movement of the ASIS anteriorly
posterior tilt
the movement of the ASIS posteriorly
hip flexors and lumbar extensors
muscle work in anterior tilt
hip extensors and lumbar flexors
muscle work in posterior tilt
lateral tilting of the pelvis
• this brings the COG over the base • maintains balance by abd. or add. of the hip which is fixed
rotation of the pelvis
ASIS of one side is thrust forward
rotation of the pelvis
ASIS of one side is thrust forward
rotation of the pelvis
associated with separation of the legs in an anteroposterior direction providing it is more than a few inches and both legs are moved
active movement
movement performed or controlled by the voluntary action of the muscles
• free exercise • assisted exercise • assisted-resisted exercise • resisted exercise
classifications of active movement
localized & generalized
classification of free exercise
localized free exercise
specific effect on a single muscle or single joint (e.g. elbow flexion-extension)
general free exercise
involve several muscles or joints (e.g. running)
• relaxation • maintain joint mobility, maintain • muscle power and tone • improved coordination • increase heart rate (circulation) • increase respiratory rate
effects and uses of general free exercise
assisted exercise
type of exercise that helps relearn to control movement and maintain joint range of motion
resisted motion
external force is applied to oppose the force of muscle contraction
resisted motion
increases power, endurance, size, speed of contraction, and contraction of muscles
PT, patient, weights, pulleys, elastic materials, malleable materials, water
examples of resisting forces
• increase poundage • increase leverage • alteration of speed • increase duration
PRE - four methods of increasing resistance
effects of resistance exercise
increases blood flow, increases blood pressure, inhibits production of heat/vasodilation
relaxation
muscles that are free from tension and at rest
muscle tone
a quality of firmness, resistance felt during passive movement
postural tone
refers to muscular tone of anti-gravity muscles
pathological tension in muscles
a persistent increase in muscular tension or tone; secondary to a lesion of the nervous system
spasticity and rigidity
increased in muscle tone
flaccidity
decrease in muscle tone
• support • comfort • restful atmosphere • progressive relaxation • massage
general relaxation techniques
• lying supine • half-lying • prone lying • side lying
examples of providing support
• deep breathing • warmth • emptying of bladder
examples of providing comfort
• quiet • low light • soft music
examples of providing a restful atmosphere
• Jacobson's exercise
example of providing progressive relaxation
Derived Positions
Aims to provide control or fixation for a particular part of the body so that movement may be localized to a specific area
• wing standing • low wing standing • bend standing • reach standing • yard standing • stretch standing
positions derived from standing by alteration of arms
wing standing
• hands rest on the iliac crest of the ilia
• adductors of the shoulders • extensors of the elbow
what is the muscle work of wing standing?
low wing standing
• fingers placed across the front of the hip joints • feel with the hands the mov’t of the hip joint
bend standing
• shoulders are laterally rotated & adducted strongly, elbows are flexed, FA supinated, wrist & fingers flexed to rest above the lateral acromion process
bend standing
• is corrective for the position of the upper back & thorax is expanded
bend standing
• used prior to arm stretching exercises
reach standing
• shoulders are flexed, elbows extended so that the arms are held parallel, shoulder width apart and at right angles to the body.
yard standing
the arms are straight and elevated sideways to a horizontal position
yard standing
corrective for the posture of the upper back, facilitates body balance, convenient for the arm swinging exercises
• ½ yd. st. • ½ yd. grasp standing • yd. palms forward standing • yd. palms upward standing
variations of yard standing
stretch standing
the arms are fully elevated so that they are in line with the body, parallel to each other
stretch standing
unsuitable for weak patients or those who suffer from respiratory conditions
stretch standing
corrective for the position of the upper back as it gives a feeling of stretching the spine
stretch standing
may be useful in the Tx of scoliosis
positions used to fix the shoulder girdle
• hands may be held to the sides while the hands grasp suitable apparatus, may be laterally rotated strongly or folded across the chest • used during head exercises
close standing
legs are rotated inwards at the hips so that the medial borders of the feet are adjacent
close standing
size of the base is reduced and balance is more difficult
toe standing
• the heels are pressed together & raised from the floor • PF work at the ankle joint
toe standing
used as a balance position
toe standing
Tx of postural flat feet & posture training
stride standing
• legs are abducted so that the heels are two foot-lengths apart • weight is equally distributed
walk standing
one leg is placed directly forwards
half standing
• the whole weight of the body is supported on one leg, the other may be free or supported in a variety of positions
• lax stoop standing • stoop standing
positions derived from standing by alteration of the trunk
• fallout standing • lunge position
positions derived from standing by alteration of the legs & trunk
lax stoop standing
• the hips are flexed, & the trunk, head and arms are relaxed so that they hang forwards & downwards. • balance is maintained by slight PF, causing backward inclination of the leg • DF stabilize the position of the joint • intrinsic foot muscles grip the floor
stoop standing
• hip jts are flexed; trunk, head & arms remain in alignment & are inclined forwards • backward inclination of the legs are greater than lax stoop standing • angle created by the trunk is usually about right angle • trains good posture of the upper back • localizes movement to the joints above this level
fallout standing
• 1 leg is placed directly forwards to a distance of three-foot length & this knee is bent • back leg remains straight & the body is inclined forwards in line with it
fallout standing
It may be used in the tx of spinal curvature
lunge position
similar with fallout standing regards to placing of the legs, but the body always remain in a vertical position
• half kneeling • kneel sitting • prone kneeling • inclined prone kneeling
positions derived from kneeling
half kneeling
• 1 knee supports most of the body weight & the other leg is bent to a right angle @ the hip, knee & ankle so that the foot is supported on the ground in a forward direction • abductors of the hip jt of the supporting leg; lumbar side flexors of the opposite side work to balance the trunk
kneel sitting
• the knees and hips are flexed so that the patient sits on his heels • sometimes used for small children; most people find it uncomfortable
prone kneeling
• trunk is horizontal, supported under the shoulders by the arms & @ the pelvis by the thighs, which must be held vertical • head is held in line with the trunk • pos’n is stable, comfortable & suitable for many trunk & head exercises as the spine is relieved of the weight of the head & shoulders • pelvis is fixed for rotation
inclined prone kneeling
• body is inclined forwards & downwards by abducting the shoulders & bending the elbows • expands the thorax & localizes lateral flexion to the thoracic region • forearms may rest on the floor with the hands together
• stride sitting • ride sitting • crook sitting • long sitting • cross sitting • side sitting • high sitting
positions derived from sitting
• stoop sitting • fallout sitting
positions derived from sitting with trunk alterations
stride sitting
legs are abducted so that the feet are up to two foot-lengths apart
ride sitting
patient sits astride suitable apparatus, such as gymnastic form, which may be gripped between the knees by the adductor muscles of the hips
ride sitting
very steady position for head, arm and trunk exercises
crook sitting
• when sitting on the floor, the knees are bent so that the feet are together & flat on the floor • knees may be together or apart
crook sitting
Tx of kypho-lordosis
long sitting
• knees are extended so that the whole leg is supported • extensors of the knees work to counteract the increased tension of the hams muscles
stride leg sitting
a modification of long sitting
cross sitting
• similar to crook sitting but the ankles are crossed & the hips strongly abducted & laterally rotated so that the lateral aspect of the knees is pressed to the floor • suitable for children during head, arm & trunk exercises