[PT11] Starting & Derived Positions

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