Fundamental and derived positions

1. 25/06/1433 RHS 322 1 Fundamental and derived positions Dr. Afaf A.M Shaheen Lecture 2 RHS 322

2. 25/06/1433 RHS 322 2 Outlines Fundamental and derived positions

3. 25/06/1433 RHS 322 3 Fundamental Positions They Also called Starting positions And include five positions. Standing position. Kneeling position. Sitting position. Lying position. Hanging position.

4. 25/06/1433 RHS 322 4 Standing position It is the most difficult position to maintain because the body is balanced and stabilized on a small base of support. which needs coordination work of many muscle groups.

5. 25/06/1433 RHS 322 5 Correct Standing Position The heels are on ground with angle not exceed 45°. Keep your knee straight but not locked. The hips are in extension and slightly rotated laterally. The pelvic is balanced on the femoral head. The spine is stretched to its maximum length and stomach flat.

6. 25/06/1433 RHS 322 6 Correct Standing Position. Cont., The head is hold up straight with chin in. do not tilt your head forward, backward, or sideways. Keep your shoulder blades back.

7. 25/06/1433 RHS 322 7 Correct Standing Position. Cont., The arms are hanged loosely to the sides, palms facing sides of the body. Your weight should be evenly distributed on both legs.

8. 25/06/1433 RHS 322 8 Kneeling position The body is supported on the knees which may be together or slightly apart. 1- The lower leg rests on the floor with the feet planter flexed. 2- The feet may be in the mid position over the edge of the plinth.

9. 25/06/1433 RHS 322 9 Sitting position the position is taken on chair or stool. 1- It is preferable to leave 2 or 3 inches of space between the back of your knees and the edge of the seat.

10. 25/06/1433 RHS 322 10 3- Sitting position cont., 2- The height and width of seat must allow the thighs to be fully supported. 3- The hips and knees are flexed to right angle. 4- The knees are apart and feet rest on the floor. 5- Your weight should be evenly distributed on both buttocks.

11. 25/06/1433 RHS 322 11 3- Sitting position cont., Effect: comfortable, natural, and very stable position. Uses: for many non-weight bearing knee and foot exercises.

12. 25/06/1433 RHS 322 12 4- Lying position This is the easiest position as the body can completely supported in the supine position and as stable as possible.

13. 25/06/1433 RHS 322 13 4- Lying position. Cont., The alignment of the body is as in standing. Effect: Breathing is impeded slightly by pressure on the posterior aspect of thorax and the pressure of the abdominal viscera on the under surface of the diaphragm is increased. Uses: it is suitable for many exercises.

14. 25/06/1433 RHS 322 14 5- Hanging position The body is suspended by grasping over horizontal bar. The arms straight & at least shoulder width apart and forearm being pronated.

15. 25/06/1433 RHS 322 15 5- Hanging position. Cont., The head is held high and the scapulae are drowning down together. The legs and trunk hang straight with the heels together and the ankle planter flexed. Uses: it is suitable for athletic persons with high muscle strength.

16. 25/06/1433 RHS 322 16 Derived Positions Derived positions are positions used by modification of the arms, legs or trunk in each of fundamental position. The aims of derived positions are to: 1- Increase or decrease the base of support. 2- Rise or lower the center of gravity (COG). 3- Gain local or general relaxation. 4- Gain fixation and good control of specific area. 5- Increase or decrease the muscle work required to maintain the position. 6- Increase or decrease the leverage.

17. 25/06/1433 RHS 322 17  A.By alternation of the arm Wing Standing Low wing Standing Bend Standing Reach Standing Yard Standing Stretch Standing

18. 25/06/1433 RHS 322 18 1. Hip firm or Wing Standing The hands rest on the crests of the iliac. The fingers, which areextended and adducted, being anterior and the thumbs posterior. The wrists are extended Forearms are pronated Elbows flexed Shoulders adducted. The elbow point straight sideways

19. 25/06/1433 RHS 322 19 Bend Standing The shoulders are laterally rotated and adducted strongly The elbows are flexed, The forearms are supinated with wrists and fingers flexed to rest above the lateral border of the acromion process.

20. 25/06/1433 RHS 322 20 Reach Standing The shoulders are flexed The elbows extended so that the arms are held parallel, Shoulder width apart and at right angle to the body

21. 25/06/1433 RHS 322 21 Yard Standing The arms are straight and elevated sideways to a horizontal position.

22. 25/06/1433 RHS 322 22 Stretch Standing The arms are fully elevated so that they are in line with the body Parallel to each other and with palms facing

23. 25/06/1433 RHS 322 23 Positions derived from standing. Cont., B. By alternation of the legs Close Standing Toe standing Stride Standing Walk Standing Half Standing High standing Step standing

24. 25/06/1433 RHS 322 24 Close Standing The legs are rotated inwards at the hips so that the medial borders of the feet are adjacent.

25. 25/06/1433 RHS 322 25 Toe standing The heels are pressed together and raised from the floor.

26. 25/06/1433 RHS 322 26 Stride Standing The legs are abducted so that the heels are two foot-lengths apart. The feet remain at the same angle as in the fundamental position The weight is equally distributed between them.

27. 25/06/1433 RHS 322 27 Walk Standing One leg is placed directly forwards so that the heels are two-foot length apart and are on the same line. The body weight is equally distributed between them.

28. 25/06/1433 RHS 322 28 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.

29. 25/06/1433 RHS 322 29 Step standing Standing with one foot on a higher level than the other. Used for teaching weight transference before walking upstairs

30. 25/06/1433 RHS 322 30 Positions derived from standing. Cont., C. By alternation of the Trunk Lax Stoop standing Stoop Standing

31. 25/06/1433 RHS 322 31 Lax Stoop standing The hips are flexed and the trunk, head and arms are relaxed so that they hang forwards and downwards. Balance is maintain by a slight plantar flexion at the ankle joints, causing a backward inclination of the leg

32. 25/06/1433 RHS 322 32 Stoop Standing The hip joints are flexed while the trunk; head and arms remain in alignment and are inclined forwards.

33. 25/06/1433 RHS 322 33 Positions derived from standing. Cont., D. By alternation of the legs and Trunk Fallout Standing Lunge sideways Standing

34. 25/06/1433 RHS 322 34 Fallout Standing One leg is placed directly forwards to a distance of three foot-lengths and this knee is bent; The back leg remains straight and the body is inclined forward in line with it.

35. 25/06/1433 RHS 322 35 Lunge sideways Standing Lunge positions are similar with regarding to the position of the legs, but the body always remains in a vertical position.

36. 25/06/1433 RHS 322 36 Position derived from Kneeling Half Kneeling Kneel Sitting Side sitting Prone Kneeling

37. 25/06/1433 RHS 322 37 Half Kneeling One knee supports most of the body weight and the other leg is bent to a right angle at hip, knee and anKle so that the foot is supported on the ground in a forward direction

38. 25/06/1433 RHS 322 38 Kneel Sitting The knees and hip are flexed so that the patient sits on his heels. The position is some time used for small children, but most people find it very uncomfortable

39. 25/06/1433 RHS 322 39 Side sitting From the kneel sitting the buttocks are moved sideways so that the one or both buttocks rest on the floor

40. 25/06/1433 RHS 322 40 Prone Kneeling The Trunk is Horizontal, supported under the Shoulders by the arms, and at the pelvis by the thighs, which must be held vertical. The head is held in line with the trunk

41. 25/06/1433 RHS 322 41 Position derived from Sitting Stride Sitting Ride Sitting Crook Sitting Long Sitting Cross Sitting High Sitting Half sitting

42. 25/06/1433 RHS 322 42 Stride Sitting This is exactly similar to the fundamental position, except that the legs are abducted so that the feet are up to two foot-lengths apart. This increases the stability of the position, especially if, the feet are pressed to the floor.

43. 25/06/1433 RHS 322 43 Ride Sitting The patient sits astride suitable apparatus, such as a gymnastic form, which may be gripped between the knees by the adductor muscles of the hips, making it a very steady position for head arm and trunk exercises. When the position is taken on a high plinth, the thigh may be strapped to the plinth to afford additional fixation, in which case no muscles work is required in the legs

44. 25/06/1433 RHS 322 44 Crook Sitting When sitting on the floor, the knees are bent so that the feet are together and flat on the floor. The Knees may be together or apart.

45. 25/06/1433 RHS 322 45 Long Sitting This is similar to the previous position, but the knees are extended so that the whole leg is supported. The Extensors of the knees work to counteract the increased tension of the Hamstring muscles. When the legs are apart this tension is somewhat reduced, but the position is difficult and unsuitable for most adults.

46. 25/06/1433 RHS 322 46 Cross Sitting This is also similar to crook sitting, but the ankles are crossed and the hips strongly abducted and laterally rotated, so that the lateral aspect of the knees is pressed to the floor. Tension on the Hamstrings is reduced but the adductors of the hip are stretched. For this reason the position is uncomfortable for most adults, but suitable for children during head, arm and trunk exercise, as the pelvis is fixed and stable.

47. 25/06/1433 RHS 322 47 High Sitting The fundamental sitting position is taken on a high plinth or table but the feet remain unsupported. This is convenient for some foot and knee exercises.

48. 25/06/1433 RHS 322 48 Half sitting Sitting on the side of the seat so that only one buttock is supported The leg on the side of the unsupported buttock is usually bent at the knee Uses: when the hip is stiff in extension or for lower limb above-knee amputees to allow exercise of the stump

49. 25/06/1433 RHS 322 49 Position derived from Sitting. Cont., By alternation the Position of the Trunk Stoop Sitting Fallout Sitting

50. 25/06/1433 RHS 322 50 Stoop Sitting This is similar to but easier and more stable than stoop standing position, and is therefore very useful for arm and upper back exercises when hollowing of the lumbar region is to be avoided The arms may be folded and supported on a table allowing the back muscles to relax. This arrangement is convenient for giving back massage when prone lying is impracticable

51. 25/06/1433 RHS 322 51 Fallout Sitting The position is same as fallout standing except that the hip and thigh of the forward leg are supported across a stool, balance is therefore easier and the patient is able to concentrate on movements, which may be added.

52. 25/06/1433 RHS 322 52 Position derived from Lying Crook lying Crook Lying with pelvis lifted Half Lying Prone Lying Leg prone Lying Side Lying Sit Lying

53. 25/06/1433 RHS 322 53 Crook lying From Lying, the hips and knees are bent so that the feet rest on thefloor or plinth. Provided the feet are fixed by friction, very little muscles work is required apart from that of the abductors and medial rotators of the hips to prevent the knees from falling apart.

54. 25/06/1433 RHS 322 54 Crook Lying with pelvis lifted From the previous position the pelvis is elevated so that the trunk rests on the shoulders and is brought into line with the thighs. A firm pillow may be used to support the buttocks, or the Extensors of the hips may work to hold the position.

55. 25/06/1433 RHS 322 55 Half Lying The Trunk is supported in the oblique position by inclination of thelong end of the plinth, or by the arrangement of pillows, while the leg is supported horizontally. It is important to see that the trunk is in an alignment to avoid slumping and so impeding respiration

56. 25/06/1433 RHS 322 56 Prone Lying Lying face downwards, the body is fully supported anteriorly on the plinth or floor. The position may be active or relaxed. The Active position. When this is used as a static holding for posture training or prior to exercises, the head is slightly raised from the supporting surface and the shoulder are drawn downward and backwards, The heels being held together and the toes stretched

57. 25/06/1433 RHS 322 57 Leg prone Lying This is taken on a high plinth, the legs being supported from the anterior superior spines to the feet and stabilized by a strap. The body is held in line with the leg and is unsupported over the end of the plinth. A stool is in position under the trunk to afford support by the arms in the resting position.

58. 25/06/1433 RHS 322 58 Side Lying Details of this position vary considerably according to the purpose for which it is to be used.

59. 25/06/1433 RHS 322 59 Sit Lying The patient lies supine with the knees bent and the lower leg hanging vertically over the end of the plinth. There is a tendency for the lumbar region to extend owing to tension of the hip flexors.

60. 25/06/1433 RHS 322 60 Position derived from Hanging Half Hanging

61. 25/06/1433 RHS 322 61 Half hanging Hanging by one arm. The position achieved during lateral travel on the beam.