derieved position 1

• Derived positions

  Positions used by modification of the arms, legs or trunk in each of fundamental position
• Derived positions

  • Position of the arms, legs or trunk may be altered in the fundamental positions to modify the effects of the position or the exercises
  • Voluntary efforts of muscle be required
• Functions of derived positions

  • Increase or decrease the size and stability of the Base of support (BOS) of the body
  • Raise or lower the center of gravity (COG)
  • Ensure maximum local or general relaxation
  • Provide fixation for a particular part of the body to localize movement to a specific area
  • To alter the position of body in relation to gravity
  • Increase or decrease the muscle work required to maintain the position
  • Avoid muscle shortening and contractures
  • Avoid joint stiffness and intra-articular adhesions
  • To increase or decrease the leverage
  • To provide a convenient position from which a particular exercise is to be performed
• Derived positions from lying

  • Side lying
  • Prone lying
  • Three Quarter Prone Lying
  • Half lying
  • Side half lying
  • Crook lying
  • Sit lying
• Side lying

  Commonly used as turning on to the side with the under arm by the side and leg straight, but is very difficult to perform and maintain by the patients
• Side lying

  1. Patient rolls on to the side from lying or prone lying, using the under arm to support the head

  2. Shoulders may be stabilized by the upper extremity, which is below the body is flexed and kept under the head

  3. The legs being free for movement, and placed forward to reduce inconvenient
• Side lying

  • Useful especially in sling exercise
  • Lower limb stabilized, shoulder exercise can be performed
  • Breathing exercises and postural drainage can be done
  • An ideal position for relaxation
• Side lying

  • 3 pillows are required: 1 head, 1 uppermost arm to support it and free the chest and to assist respiration, 1 to support the upper most leg which is bent
  • It is an unsteady position used for strong trunk side bending exercise
• Prone lying

  • Anterior portion body is turned towards the couch/floor
  • Lying face downwards, the body is fully supported anteriorly on the plinth or floor
  • Head is turned to one side and rested on the hands, while the heels roll apart
• Prone lying

  • Spinal and neck extensor exercises can be performed
  • Position can be used for back massage
  • Some of the upper and lower extremity exercises can be done
  • Corrective position of spine
• Prone lying - relaxed position

  • No muscle work. The head is usually turned to one side and rested on the hands for comfort and ease in breathing, while the heels roll apart
  • Placing a pillow under the abdomen and another under the lower leg (so that the hip and knee joints are slightly flexed)
  • Feet rest free from pressure may still further reduce tension
• Prone lying - active position

  • 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
• Muscles involved in active prone lying

  • The pre and post-vertebral neck muscles work to maintain the position of the head
  • The scapulae work to brace the upper back (Retractors and Depressor)
  • The Lateral Rotators of the Hips keep the heels together
• Prone lying

  • Breathing is some what restricted by the pressure of the weight of the body on the chest and abdomen, making the position unsuitable for those with heart or respiratory disease
  • This position is inconvenient and very much difficult for elderly patients
• Three Quarter Prone Lying

  The body is turned through 45° from either lying, side lying or prone lying and supported by pillows down raised side by the trunk
• Three Quarter Prone Lying

  • Breathing exercises (altered position) and postural drainage can be done
• Half Lying

  • Body in supination position, back supported
  • The body is bent at the hips and the trunk is raised (or prop up) from lying to any angle up to 90°
• Half Lying

  • This is the standard position in which most sick people are propped up in bed
  • MOSTLY used for ward exercise and in the treatment of many chest condition
  • For relaxed and comfortable position
  • Suitable for weak and elderly people because breathing is easier than in lying, the thorax being less fixed by the weight of the trunk
• Half Lying - leg position

  • The legs may be slightly raised or lowered from the horizontal and the knees bent
  • The knees may be bent to increase relaxation of the abdominal wall, or the lower leg may hang over the end of the plinth with the feet resting on the floor
• Side Half Lying

  • Body in supination position, back supported
  • The body is bent at the hips and the trunk is raised (or prop up) from lying to any angle up to 90
  • The trunk and head are turned to one side so that the patient rests on the buttock and leg and that side of the trunk
• Side Half Lying

  • An altered position (if the patient could not perform half lying) to improve expansion of lungs
  • Breathing exercises (altered position) and postural drainage can be done
• Crook Lying

  • From Lying, the hips and knees are bent so that the feet rest on the floor or plinth
  • Provided the feet are fixed by friction
• Crook Lying - muscle work

  • Very little muscles work is required apart from that of the abductors
  • Medial rotators of the hips to prevent the knees from falling apart
• Crook Lying

  • Reduce the tension from the anterior structures to the hip joint - So that the pelvis rolls backwards and the lumbar spine is relaxed on to the supporting surface
  • To train relaxation posture - As the whole trunk is relaxed and supported horizontally
  • For pelvic and back exercises
• Sit Lying

  • The patient lies supine with the knees bent
  • The lower legs hanging vertically over the end of the plinth
• Sit Lying

  • The body is firmly fixed, e.g., for a strong Arm-downdrawing exercise
  • Knee-extension is easier
  • Because of the increased stretching of Rectus Femoris the pelvic tilt is increased, so that a slight lordosis arises
• Sit Lying

  • There is a tendency for the lumbar region to extend owing to tension of the hip flexors
  • It is a difficult position due to hyperlordosis of the lumbar region
• Derived positions from sitting

  • Forward lean sitting
  • Long sitting
  • Half sitting
  • Crook sitting
  • Cross sitting
  • High sitting
• Forward Lean Sitting

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

  • Provide comfort during respiratory distress
  • Relaxes the upper shoulder muscles such as sternocleidomastoids during respiratory distress
• Long Sitting

  • The legs are stretched out in front, knees fully extended, supported
  • The trunk is upright
• Long Sitting - muscle work

  • Abdominal muscles
  • Hip flexors
  • Extensors of the knee
• Long Sitting

  • This position is an uncomfortable one to maintain - increase tension of hamstring
  • Patients with back pain may feel discomfort
  • Unsuitable for adult patients
• Half Sitting

  • 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
• Half Sitting

  • Use mostly for one movement, such as knee-bending and stretching
• Crook Sitting

  • When sitting on the floor or plinth
  • The knees are bent so that the feet are together and flat on the floor
  • The knees may be together or apart
• Crook Sitting - muscle work

  • The flexors of the hip work strongly
  • The flexor of the knees and Planter flexors of the ankles may also work to afford fixation of the legs
  • The longitudinal and transverse back muscles work strongly to maintain the upright position of the trunk
• Crook Sitting

  • The position is used to increase lateral mobility of the lumbar spine or for fixation in the side bend position when treating scoliosis
• Cross Sitting

  • Similar to crook sitting
  • Ankles are crossed
  • Hips abducted and laterally rotated, so that the lateral aspect of knees is pressed to the floor
• Cross Sitting - muscle work

  Tension on the Hamstrings is reduced but the adductors of the hip are stretched