Fundamental+and+Derived+Positions

Fundamental and Derived Positions Dr Hoda Mohyee Page 1

Fundamental and Derived Positions

for Starting exercises

Introduction

Movement can be initiated from a wide variety of starting

positions or static positions. These positions are maintained by

static contraction of the muscles which stabilize the joints and

by support of apparatus. These are five basic or fundamental

positions; standing, sitting, kneeling, lying, and hanging

positions. All other positions that are used are modified from

these five basic positions and are known as derived positions.

Fundamental Positions

Standing, kneeling, sitting, lying and hanging are the

fundamental positions. Selection of the suitable position is made

according to the purpose for which they are required. This may

be to:

1. Utilize support essential for relaxation

2. Train balance

3. Achieve adequate fixation, when movement is to be

localized to a specific joint.

4. Modify the effect of an exercise to improve ROM or

strength.

5. Maintain or improve posture.

Derived Positions:

The position of the arms, legs or trunk may be altered in

each of the fundamental positions to modify the effects of the

position or that of the exercise.

The purpose for modifications may be to:

1. Increase or decrease the size and stability of the base of

support of the body.

2. Raise or lower the center of gravity (COG)


3. Ensure maximum local or general relaxation.

4. Provide a control or fixation for a particular part of the

body to localize movements to a specific area.

5. Increase or decrease the muscle work required to maintain

the position.

6. Avoid muscle shortening and contractures.

7. Avoid joint stiffness and intraarticular adhesions.

8. Avoid respiratory and circulatory complications as

pneumonia, pressure ulcers, DVT.

9. Increase or decrease the leverage.

Types of derived positions:

1) From lying position: Crook lying, half lying (30º), prone

lying, half prone lying, side lying, or modified side lying

(45º).

2) From sitting position: stride sitting, long sitting, cross

sitting (tailor), crook sitting, side sitting, sitting on the

edge of the table with side arm support, sitting in a chair,

sitting on a chair, sitting on chair with back support, half

sitting.

3) From kneeling position: half kneeling, kneel sitting,

prone kneeling.

4) From standing position: wing standing, yard standing

(wand standing), stride standing, walk standing, half

standing, step standing, toe standing.

5) From hanging position: half hanging (hanging with one

hand).

Common pressure points

From supine lying

From side lying


Positions for starting exercises

There are fundamental positions which are usually

described along with their derivatives as the starting positions

from which exercises start.

Selection of the starting position

When selecting a starting position for an exercise, the

following points should be considered

1- The ability of the patient to assume the position.

2- The need to stabilize one segment of the body to permit

safe and efficient movement.

3- The use of gravity for assistance or resistance.

4- The presence of pain or discomfort (the position should be

pain free to assure relaxation of the patient).

5- The use of a short lever arm versus a long lever arm.

6- Modification of the effect of the exercise.

1) Lying Position

Characteristics

It is the easiest of the whole fundamental positions. The

body is completely supported with a large base of support and

low center of gravity. It is considered the most stable position.

Description:

The patient lies on his back fully supported either on a

plinth or on the floor and the body is erect (Figure 1) with:

Head and neck erect in neutral position.


Eyes look up, ears at the same line

Shoulders at the same level.

Trunk is relaxed on bed in neutral position.

Arms by the side of the body supported on bed.

Palms in contact with table.

Pelvis at the same level.

Lower limbs (hips and knees) straight together.

The feet free from the bed or in neutral position.

Figure (1): Lying (supine or back lying).

Effects and uses

As the trunk is relaxed by its own weight, it is a suitable

position for many arm and leg exercises. As the alignment is the

same as in standing position, static postural training can be

carried out in this position once adequate control of the pelvis

tilt is established. The spine is relieved from transmitting the

weight of the head and shoulders when it is in a horizontal

position. Therefore, it tends to elongate and straighten, and this

is an advantage in the treatment of spinal deformities.


Breathing is impeded slightly by pressure on the posterior

aspect of the thorax and by increased pressure of the abdominal

viscera on the undersurface of the diaphragm, often making the

position unsuitable for those suffering from respiratory or heart

diseases. Lying position hinders the return of blood from the

head and so may be unsuitable for the elderly, or those who

suffer from high blood pressure.

Positions derived from lying

Prone lying (Face lying) (Figure 2)

The body is face down rested on the forehead with

chin tucked in. also the head may be turned to one

side for ease of respiration.


Trunk is relaxed on bed.

Arms by the side of the body palms facing up.


Lower limbs (hips and knees) straight.

The feet free from the bed or in planter flexion.

Figure (2): Prone lying position.


Side lying (Figure 3)

The body is lying on the side with the arms by the side and

the legs straight.

This position is difficult to assume as the base of support is

small and rounded, some modification is made to make

this position suitable for exercises performance.

The under arm is bent forward or placed under the head.

The upper arm is for balance and to prevent trunk rotation.

The under leg is bent forward (flexed 45 degrees at hip and

knee) for balance and increase base of support.

The upper leg is extended.

Figure (3): Side lying position.

Hook lying (Crook lying) (Fig. 4)

It is as supine lying position but hips and knees are flexed

with the feet rested on the table.


Figure (4): Crook lying position.

2) Sitting Position

Characteristics

It is comfortable, natural and very stable position. The

center of gravity is low but near to the edge of the base of

support which is the area between both the legs of the seat and

the feet. Description:

The position is taken with the body is resting on a chair (with

back support) or stool (without back support). The height and

width of which allow the thighs to be fully supported and hips

and knees to be flexed in a right angle.

Head in neutral position.

Eyes look forward,

Ears at the same line


Back is straight. The back is supported in case of sitting on

chair with back support. While when sitting on stool the


back is unsupported making the position less stable and

need effort of the subject to maintain back straight.

Arms by the side of the body.


Thighs fully supported and together on the chair.

Hips, knees, and ankles at right angle flexion.

Knees are apart sufficiently to allow the femora to be

parallel.

The feet rested on the floor with the heels vertically below

the knees. In case of sitting on stool, according to the

height of the stool the feet may be rested or not on the

floor.

Effects and uses

Sitting Position is a comfortable, natural and very stable

position which is much used. It is particularly suitable for those

who lack the necessary strength and control to maintain a more

difficult position. Lateral and rotatory mobility of the pelvis is

eliminated by the weight of the body and the positions of the

legs so that lateral movements can be localized to the spine.

As none of the body weight is transmitted to the legs,

many non weight-bearing exercises for knees and feet can be

performed in this position. It is also suitable for training correct

alignment of the upper part of the body in the habitual sitting

position, which is used by the majority more than any other

position in everyday life.


Positions derived from sitting Long Sitting (Figure 5)

As in supine position but the body is bent at the hips and

the trunk is raised from lying to an angle of 90 degree.


Eyes look forward,

Ears at the same line.


Back is straight.

Arms by the side

Knees are extended

Ankles are relaxed.

Figure (5): Long sitting position.

Forward Lean Sitting (Figure 6)

Trunk is inclined forwards in sitting position and the head

is supported on pillows on a table at the front.


3) Standing Position (Position of attention)

Characteristics

Standing position is the most difficult of the fundamental

positions to maintain, as the whole body must be balanced and

stabilized in correct alignment on a small base of support by the

coordinated work of many muscle groups. The interaction of the

muscles concerned is controlled by a complex series of reflexes

known collectively as Postural reflexes. The base of support is

very small and the center of gravity is high.

Description:

The body is erect with:

Head and neck are erect in neutral position.

Eyes look straight forward.

Ears are leveled at the same line.

Shoulders are drawn down and back.


Arms hang loosely by the side of the body

Palms facing inwards towards the thigh.

Figure (6): Forward Lean

Sitting Position.


The back is straight and stretched to its maximum length.

Pelvis is balanced on the femoral heads with both ASIS at

the same level.

Hips are in midline and slightly lateral rotated.

Knees are together and extended.

The heels are together at the same level.

The toes are slightly apart and turned out with the angle

between the feet does not exceed 45º.

It is usually preferable to modify the position of the legs

with the heels are slightly apart and the inner borders of the feet

are parallel, as this is the natural functional position of the feet

when it is used as a lever to propel the body forewards.

Effects and uses

As the base of support is relatively small and the COG is

high, the state of equilibrium of the body is relatively less stable

than in other fundamental positions. Therefore, the standing

position is only suitable as a starting position for exercises for

those who can maintain it correctly. The muscle work is

minimal when perfect balance is achieved. Therefore, practice in

attaining and holding a satisfactory pattern of standing posture

reduces fatigue and also conditions the postural reflexes. The

erect position of the whole body is the position of alertness, in

which the thorax is free and the abdominal viscera are well

supported.


Positions derived from standing

a) Stride Standing

It is the most commonly used position assumed by the

physical therapists during treatment of patients.

It is the same as standing, but the feet are sideways apart and the

base of support is therefore wide side to side giving good lateral

stability.

b) Walk Standing

It is the same as standing, but the feet are a forward pace

apart and the base of support is therefore wide from front to

back giving good anteroposterior stability.

4) Kneeling position

Characteristics

The position is unstable and difficult to maintain as the

center of gravity is high and the line of gravity falls close to the

edge of the base which the area of the legs only.

Description:

In this little used position, the body is supported upright on

the knees which are held at right angle.


Eyes look forward,

Ears at the same line.


Arms by the side of the body


Palms facing inward.

The back is straight.


Hips in midline and straight

Knees flexed right angle.

Knees and legs are together or slightly apart and supported

on the floor.

The feet are planter flexed. Or, if a plinth is used, the feet

may be in the mid-position over the edge of the bed.

Effects and uses

Although the COG of the body is relatively lower than in

standing, kneeling position is only slightly more stable and is

uncomfortable for most people. It is therefore, seldom used

except as a starting position for backward movements in a

sagittal plane, during which the feet are pressed to the floor by

the extensors of the knees and dorsiflexors, so that the lower leg

acts as a bracket. As there is tendency to hollow the back, this

position may be of value for the patient with flat back.

Positions derived from kneeling

a) Kneel Sitting

The position is stable. From kneeling position, the subject

sits back on the heels.


b) Prone Kneeling (cat position) (Figure 7)

Kneeling position supported by the four limbs. The arms

should be straight and the hands in line below the shoulders.

Right angle should be maintained at the hips and knees. The

ankles are planter flexed.

Figure (7): Prone Kneeling Position.

5) Hanging Position

Description

The body is suspended by grasping over a horizontal bar or

wall bars, which is arranged on such that the patient’s feet are

just off the floor:

The forearms being pronated

Hands overgrasp and not less than shoulder width apart.

The arms straight, directed upwards and at least shoulder

width apart.

The head is held high and in neutral position.

The scapulae are drawn down and together.

The neck appears as long as possible.


The trunk and legs are straight in neutral position.

Heels together.

Ankles plantar flexed.

The body is slightly lifted between the arms without any

bending of the elbow.

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Fundamental+and+Derived+Positions