Asst. Prof. Claire A.

Salera, PTRP, MPH

“Every movement begins in
posture and ends in posture.”
 Starting Positions – posture from which movement
started or initiated!

Fundamental Starting Positions:

 Standing, Kneeling, Sitting, Lying and Hanging
Standing Position
 The most difficult of the fundamental positions to
maintain.
Description:
 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.
Anti-Gravity Muscles
 Intrinsic muscles of the feet
 Ankle plantarflexors
 Ankle dorsiflexors
 Ankle evertors
 Knee extensors
 Hip extensors
 Spine extensors
 Abdominals
 Pre-vertebral muscles
 Neck extensors
 Scapular retractors
Effects and Uses
 Small base of support
 High COG; :Less stable equilibrium
 Suitable for starting position for exercises in upright
positions.
Kneeling
 The body is supported on the knees.
 Muscle Work:
Knee flexors, knee extensors, hip extensors,
trunk flexors, trunk extensors, neck extensors,
head extensors.
Effects and Uses: Low COG, more stable compared
to standing; a starting position for backward
movement and to train control of hips and lower
trunk in preparation for standing.
Sitting
 The position is taken on a chair or stool.
 Muscle work: same with standing from the lower trunk
up to the head.
 Effects and Uses: a comfortable and stable position;
suitable for those who lack strength of lower
extremities.Non-weight bearing exercises of the lower
extremities can be performed.
Lying Position
 The easiest of the fundamental positions.
 Muscle work is minimal.
 Effects and Uses: suitable positions for exercises in
lying positions (non-weight bearing exercises);
unsuitable for elderly or those who suffer high blood
pressure
Hanging
 Muscle Work: finger flexors, elbow flexors,
shoulder adductors, scapular muscles, neck flexors
and extensors, trunk flexors, hip extensors, hip
adductors, knee extensors, plantarflexors.
 Effects and Uses: suitable for those with good
strength of upper extremities; spine are
straightened and elongated. Unsuitable for weak
individuals and those suffering from cardiac or
respiratory conditions.
Pelvic Tilt
 Anterior-posterior Tilt
 Anterior tilt is the movement of the ASIS anteriorly;
posterior tilt is the movement of the ASIS posteriorly.
 Anterior tilt muscle work: hip flexors and lumbar
extensors.
 Posterior tilt muscle work: hip extensors and lumbar
flexors
Lateral Tilting of the Pelvis
 To bring the COG over the base
 Maintain balance by abd or adduction of the hip which
is fixed
Rotation of the Pelvis

 ASIS of one side is thrust forward

 Associated with separation of the legs in an antero-
posterior direction providing it is more than a few
inches & both legs are moved.
ACTIVE MOVEMENT
 Movement performed or controlled by the voluntary
action of the muscles.
 Classifications:
 Free Exercise, Assisted Exercise, Assisted-Resisted
Exercise, Resisted Exercise
Classification of Free Exercise
 Localized
specific effect on a single muscle or single joint. EX:
elbow flexion-extension
 General
Involve several muscles or joints. EX: running
Effects and Uses: relaxation, maintain joint mobility,
maintain muscle power and tone, improved
coordination, increase heart rate (circulation), increase
respiratory rate
Assisted Exercise
 Effects and Uses:
relearn to control the movement, joint range of
motion is maintained
Resisted Motion
 External force is applied to oppose the force of muscle
contraction.
 Effects of Resistance Exercise:
increase power, endurance, size, speed of contraction,
and coordination of muscles.
Resisting Forces: PT, patient, weights, pulleys, elastic
materials, malleable materials, water.
Progressive Resistance Exercise
 Four Methods Of Increasing Resistance:
Increase poundage
Increase in leverage
Alteration of speed
Increase in duration of exercise
Other effects of Resistance Exercise
 Increase blood flow, increase blood pressure,
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
General Relaxation Techniques
 Support: Lying supine, half-lying, prone lying, side
lying
 Comfort: Deep breathing, warmth, emptying of
bladder
 Restful Atmosphere: quite, low-light, soft music
 Progressive Relaxation: Jacobson’s Exercise
 Massage
Purpose:
 To increase or decrease the size and stability of the
base
 To raise or lower the COG
 To ensure maximum local or general relaxation
 To alter the position of the body in relation to gravity
 To provide control or fixation for a particular part of
the body so that movement may be localized to a
specific area
 To increase or decrease the muscle work required to
maintain the position
 To increase or decrease the leverage
 To provide a convenient position from which a
particular exercise is to be performed
Positions Derived From Standing
 Wing Standing
 Hands rest on the iliac crest of the ilia
 Muscle work: adductors of the shoulder, extensors of the
elbow
 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
 Is corrective for the position of the upper back &
thorax is expanded
 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
 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
 Stretch Standing
 The arms are fully elevated so that they are in line with
the body, parallel to each other
 Unsuitable for weak patients or those who suffer from
respiratory conditions
 Corrective for the position of the upper back...gives a
feeling of stretching the spine
 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
By Alteration of the Legs
 Close Standing
 Legs are rotated inwards at the hips so that the medial
borders of the feet are adjacent
 Size of the base is reduced and balance is more difficult
 Progression in the standing position
 Toe Standing
 The heels are pressed together & raised from the floor
 PF work at the ankle joint
 Used as a balance position
 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
By Alteration of the 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
Alteration of the Legs & Trunk
 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
 It may be used in the tx of spinal curvature
 Lunge Position
 Similar with regards to placing of the legs, but the body
always remain in a vertical position
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
Positions Derived from Sitting
 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
 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
 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 muslces
 Modification: stride leg 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
 Side Sitting
 For left side sitting, the left leg remains as in cross sitting
& this hip supports the main weight of the trunk
 Used to increase lateral mobility of the lumbar spine or
for fixation in the side bend position when treating
scoliosis
 High Sitting
 Fundamental sitting position is taken on a high plinth or
table but the feet remain unsupported
 Convenient for some foot and knee exercises
 Positions of the Trunk:
 Stoop Sitting
 Easier & more stable than stoop standing position
 Useful for arm and upper back exercises when
hollowing of the lumbar region is to be avoided
 Fallout Sitting
 Same as fallout standing except that the hip and thigh of
the forward leg are supported across a stool
 Balance is easier
 Positions Derived from Lying
Positions of the Legs:
 Crook Lying
 Hips & knees are bent so that the feet rest on the floor or
plinth
 Tension is removed from the structures anterior to the
hip joint so that the pelvis rolls backwards & the lumbar
spine is relaxed on the supporting surface
 Crook Lying with Pelvis Lifted
 Pelvis is elevated so that the trunk rests on the shoulders
 Useful during re-education of the muscles of the Pelvic
Floor in such cases as visceroptosis or after childbirth
 Half Lying
 Trunk is supported in oblique position by inclination of
the long end of the plinth
 Avoid slumping and so impeding respiration
 Suitable for weak and elderly people
 Much used for ward exercises & in the tx of chest
conditions
 Prone Lying
 Lying face downwards
 Unsuitable for those with heart or respiratory disease
 Active Position
 Relaxed position
 Leg Prone Lying
 Taken on a high plinth, legs being supported from the
ASIS to the feet and stabilized by a strap
 Stool is position under the trunk to afford support by
the arms in the resting position
 Side Lying
 Used under arm to support the head
 It is an unsteady position used sometimes for strong
trunk side bending exercises
 3 pillows are required
 Sit Lying
 Patient lies supine with the knees bent & the lower leg
hanging vertically over the end of the plinth
 There is a tendency of the lumbar spine to extend owing
to the tension of the hip flexors
Positions Derived from Hanging
 Fall Hanging
 Body is supported in the oblique position by the arms
which grasp a horizontal bar, and by the feet which rest
on the floor
 Arms are vertical; rest of the body is inclined and
straight
 Requires very strong scapulae
retractors
Other Positions in which Some of
the Weight is Taken on the Arms
 Crouch Sitting
 Hips and knees are fully bent while the trunk is straight
and inclined forwards to allow the hands to rest on the
floor.
 Weight is mainly supported by
the toes, heels being together &
the knees pressed apart
 Balance is maintained by the
arms which are shoulder width
apart & vertical
 Prone Falling
 The legs are extended in line with the trunk from the
crouch position so that the body is supported on the
arms which are vertical and on the toes
 only suitable for those whose arms are strong in relation
to their body length and weight
 The body may be taken through a quarter turn so that
the weight is supported on the lateral border of one foot
and on one hand (side falling); balance is difficult
Thanks for listening!!!