STARTING POSITIONS & DERIVED POSITIONS

INTRODUCTION:

• There are five fundamental positions which are usually described along with their derivatives as the starting positions from which exercises start or in which they may be given.
• Muscle work is deliberately not described as it is dependent upon the way in which the body components relate to one another. It must be recognized that maintenance of position is dependent on the integration of interplay of iso-tonic muscle action and of some isometric muscle work, but once a position has been assumed the body will reduce its muscle work to the minimum necessary to maintain that position. The abbreviations for each word are also provided.

 

LYING (Ly) or SUPINE (Sup):

 

• The body is supine with the arms by the sides and legs straight. This is the position in which the body is most supported, with a large base and low center of gravity.

 

SITTING (Sitt.):

• The body is erect, arms by the sides, the thighs are fully supported and together. Right angles are maintained at the hips, knees and ankles. 
• The center of gravity is low but near to the rear edge of the base which is the area between both the legs of the seat and the feet.

 

KNEELING (Kn.):

• The body is upright from the knees which are held at a right angle. 
• The arms are by the sides. The base consists only of the legs, the center of gravity is high and the line of gravity falls close to the edge of the base, making the position unstable and difficult to maintain.

 

STANDING (St.):

• The body is erect with arms by the sides.
• The feet are slightly apart at the toes. 
• The base is small and the center of gravity is high. Providing the lower limbs are strong this position is easier to maintain than kneeling.

 

HANGING (Hg.):

• The body hangs from a beam or overhead support. 
• The arms are wide apart (more than shoulder width) and should be braced so that there is no undue traction on the shoulders. 
• This position should only be used for very strong people as the base consists of the hands grasping the beam and supporting the full body weight.

 

POSITIONS DERIVED FROM LYING

 

Side Lying (S. Ly.)

• This position is rarely used as turning onto the side with the under arm by the side and legs straight is very difficult both to perform and to maintain. 
• The base is small and rounded and the position is one through which the body passes in turning movements or is modified by bending the under arm and leg forwards while the upper arm and leg either rest in the straight position or are flexed slightly. 
• This position is then called the right lateral position (lying on the right side) (R. Lat.) or left lateral position (lying on the left side) (L. Lat.).

 

Prone Lying (Pr. Ly.) or Prone (Pr.)

• The body is face down with arms by the side and legs straight. 
• In order to rest comfortably two pillows should be crossed  to support the forehead or the head allowed to turn to the side of the patient's choice.

 

Quarter Turn (1/4 Tn.)

• The body is turned through 45° from either lying, side lying or prone lying and supported by pillows down the raised side of the trunk. 
• The direction of the 1/4 turn is indicated by stating the starting position and direction, e.g. 1/4 Tn.L. from Ly.

 

Half Lying (1/2 Ly.)

• The body is bent at the hips and the trunk is raised from lying to any angle up to 90°. 
• This is the standard position in which most sick people are propped up in bed (Fig. 6.1). More comfortably the legs may be slightly raised or lowered from the horizontal and the knees bent. 
• This modified position is achieved by using ergonomically designed beds or by placing a pillow under the knees.

                                                                                  Prone lying.

 

Side Half Lying (S. 1/2 Ly.)

• The trunk and head are turned to one side so that the patient rests on one buttock and leg and that side of the trunk.

 

POSITIONS DERIVED FROM SITTING

 

Forward Lean Sitting (Fwd. Ln. Sitt.).

• The trunk is inclined forwards and the head is supported on pillows on a table at the front.

 

Half Sitting (1/2 Sitt.)

• Sitting on the side of a seat so that only one buttock is supported. 
• The leg on the side of the unsupported buttock is usually bent at the knee as this position is used when the hip is stiff in extension or for lower limb above-knee amputees to allow exercise of the stump.

Half sitting.

 

 

Long Sitting (Long Sitt.)

• The legs are stretched out in front, knees straight. The trunk is upright and this position is an uncomfortable one to maintain.

 

POSITIONS DERIVED FROM KNEELING

 

Kneel Sitting (Kn. Sitt.)

• From kneeling to sitting back on the heels. A stable position and much used for retraining balance and by children at play.

Side Sitting (Side Sitt.)

• From kneel sitting the buttocks are moved sideways so that one or both buttocks rest on the floor beside the feet.

Side sitting.

 

Prone kneeling.

 

 

Half Kneeling (1/2 Kn.)

• From kneeling, one leg is taken forward to be bent at right angles at the hip, knee and ankle. A stage in rising from kneeling to standing or transferring from floor to stool.

 

Prone Kneeling (Pr. Kn.)

• Kneeling supported by all four limbs. 
• The arms should be straight and the hands in line below the shoulders. 
• Right angles should be maintained at the hip and knee and the ankles may be plantarflexed or dorsiflexed

 

POSITIONS DERIVED FROM STANDING

 

High Standing (High St.)

• Standing on a platform or stool of any height. 
• Normally used when one leg is to be moved and allows the patient to be more accessible to the therapist. 
• The position is usually stabilized by allowing the patient to grasp a support.

 

 

Step Standing (Step. St.).

• Standing with one foot on a higher level than the other. 
• Used for teaching weight transference before walking upstairs .

Step standing.

 

Half Standing (1/2 St.)

• Standing on one leg, i.e. one hip is hitched up or one leg is bent at the hip and knee.

 

Close Standing (Cl. St.)

• The feet are together and parallel. 
• Harder to maintain than standing, not only because the base is slightly smaller but because the axes of the ankle joints are no longer at an angle to each other, but together form a single long axis which results in increased interplay of muscles in front of and behind the joints.

 

Toe Standing (T. St.)

• The body is raised onto the toes. The smallest possible base is now in use.

 

POSITIONS DERIVED FROM HANGING

 

Arch Hanging (Arch Hang.)

• The starting position for forward and backward swinging of the trunk or for bar somersaults.

 

Half Hanging (1/2 Hang.)

• Hanging by one arm. The position achieved during lateral travel on the beam.

THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND WEBSITES..

(Practical Exercise Therapy - Margaret Hollis)

THANK YOU,

 SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER