THERAPEUTIC EXERCISE
DERIVED POSITIONS
P.PONMATHI
Faculty of Physiotherapy
STARTING POSITIONS
The postures from which the movement is initiated are known as starting
positions, these can either be active or passive in nature. There are 5
fundamental starting positions.
Standing
Kneeling
Sitting
Lying
Hanging
.
P.PONMATHI
Faculty of Physiotherapy
DERIVED POSITIONS
Positions used by Modification of arms, legs and
trunk in fundamental positions.
Derivatives of fundamental position used to start
or give exercises-DERIVED POSITIONS
P.PONMATHI
Faculty of Physiotherapy
BENEFITS
1.To increase Base of support
2.To rise and lower the COG
3.To gain general & local relaxation
4.To gain fixation and good control of a specific
area
5.To increase and decrease the muscle work
required to maintain the position
6.To increase and decrease the leverage
P.PONMATHI
Faculty of Physiotherapy
DERIVED POSITIONS
ALTERING
UPPERLIMB IN STANDING
P.PONMATHI
Faculty of Physiotherapy
WING STANDING
• Hands on the crests of the ilium
• Palmar surfaces turned down,
thumbs backward and the fingers
forward
• The elbows ought to be carried so
far back that the arms lie as
nearly as possible in a line with
the clavicle
• The shoulders being lowered and
drawn back.
P.PONMATHI
Faculty of Physiotherapy
MUSCLE WORK
• Deltoid.
• Biceps and Brachialis Anticus.
• Adductors of the shoulder joint (Pectorals, Lat.
Dorsi, etc.)- They press the hands on the crests
of the ilium.
• Triceps-help to press the hands against the iliac
crests, but produce also a passive stretching of
the spine.
P.PONMATHI
Faculty of Physiotherapy
USES
• The arms are fixed and their weight transferred to the crests of the ilium, so that
trunk movements are facilitated.
• The chest is expanded, partly by the increased work for the shoulder muscles ,
partly because the Pectorals and Lat. Dorsi draw up the ribs.
• The spine, especially the lowest part, is passively stretched.
• The trunk is made firm, It is used in many trunk and leg movements
• The position allows the physiotherapist to Grab the patient around the shoulders
during some trunk exercises.
P.PONMATHI
Faculty of Physiotherapy
EXAMPLES
P.PONMATHI
Faculty of Physiotherapy
BEND STANDING
POSITIONS
• Flexing the elbow joints as
far as possible.
• The finger and wrist joints
are slightly flexed, the
elbows close to the sides
• The shoulders lowered and
drawn back.
P.PONMATHI
Faculty of Physiotherapy
MUSCLE WORK
• Outward rotators of the arm (shoulder
joint), Supra- and Infra-spinatus and
Teres Minor.
• Outward rotators of the forearm
(radio-ulnar joint), Brachio-Radialis
and Supinator Brevis.
• The flexors of the elbow (Biceps,
Brachialis Anticus, Brachio-Radialis).
• Retractors and depressors of scapulae
• Flexors of wrist and fingers
P.PONMATHI
Faculty of Physiotherapy
USES
• The outward rotation of the arms causes
increased stretching of the pectorals, so that
the ribs are raised and the chest expanded.
• This position in itself has no special effect, but
is of great importance, because it is taken in all
arm stretchings and must therefore be
practised before these.
P.PONMATHI
Faculty of Physiotherapy
EXAMPLES
P.PONMATHI
Faculty of Physiotherapy
REACH STANDING
• Arms forward to the horizontal
plane.
• The shoulders are lowered and
drawn back; they must not be
raised or pushed forward.
• The elbow, hand and finger
joints are extended, the fingers
closed; hands the width of the
shoulders apart, palms facing
each other.
P.PONMATHI
Faculty of Physiotherapy
MUSCLE WORK
• Coraco-brachialis and • Shoulder flexors-hold
the anterior fibres of arm against gravity
Deltoid act on the • Transverse back muscles
humero-scapular joint. control forward
• Trapezius and Serratus movement of scapula
act on the sterno- and • Extensors of
acromioclavicular elbow,radial flexors of
joints. wrist and flexors of
fingers act.
P.PONMATHI
Faculty of Physiotherapy
USES
• Used to assist balance while walking
sideways
• Used for arm and trunk exercises in sagittal
plane
• If hands grips an instrument to control the
trunk,head and leg exercises can be intiated.
P.PONMATHI
Faculty of Physiotherapy
EXAMPLES
P.PONMATHI
Faculty of Physiotherapy
YARD STANDING
• Arises by abduction of the
arms to the horizontal plane.
• The shoulders must not be
raised, but kept lowered and
drawn back.
• The arms are carried so far
back that they are in a line
with the shoulders.
• Hand and finger joints
extended, palms turned down,
fingers closed.
P.PONMATHI
Faculty of Physiotherapy
MUSCLE WORK
• Abductors,Extensors and lateralrotators of
shoulder work and rotators of scapula
stabilises arm
• Extensors of elbow,wrist and fingers act to
hold arm in straight line
• Scapula depressors act to stabilise scapula
P.PONMATHI
Faculty of Physiotherapy
USES
• Used for correction of upper back posture
• Facilitates balance
• Useful for arm swinging exercises
• The position is used for the above reasons in
the treatment of flat chest and "winged"
shoulders.
P.PONMATHI
Faculty of Physiotherapy
EXAMPLES
P.PONMATHI
Faculty of Physiotherapy
HEAVE STANDING
• Arises from yard-
standing by: -
• (a) Outward rotation of
the arms and supination
of hands.
• (b) Flexion of elbow
joint to a right angle
between the arm and
forearm.
P.PONMATHI
Faculty of Physiotherapy
MUSCLE WORK
Same as in yard-standing.
1.Outward rotators of the arm Supra- and Infra-spinatus
and Teres Minor).
2.Supinators of hand and forearm (Supinator Brevis,
Brachio-Radialis).
3.Flexors of the elbow and their antagonists (Biceps,
Brachialis Anticus, Triceps).
P.PONMATHI
Faculty of Physiotherapy
USES
• It is used in many chest expansions, to facilitate the
expansion.Expansion of the chest is somewhat
stronger (stretching of the Pectorals and Lat. Dorsi
being increased by outward rotation of the arms).
• Heave position of the arms is used also in many trunk
movements to give the operator a long lever and thus
make the exercise harder for the patient.
P.PONMATHI
Faculty of Physiotherapy
EXAMPLES
P.PONMATHI
Faculty of Physiotherapy
STRETCH STANDING
• Arises when the arms from bend,
reach, or yard position are carried up
to vertical position.
• Elbow, wrist, and finger joints
extended.
• Distance between the hands equal to
or rather greater than shoulders-
width, palms facing each other,
fingers closed
P.PONMATHI
Faculty of Physiotherapy
MUSCLE WORK
The chief working muscles are:
Deltoid
Trapezius
Serratus Magnus
but all the shoulder muscles are of course more or
less brought into action.
P.PONMATHI
Faculty of Physiotherapy
USES
• The thorax is expanded more than in all the previous
positions; the four lowest ribs especially are raised by
stretching the digitations of Latissimus Dorsi, which arc
attached to them.
• The centre of gravity of the body is raised, making trunk
movements more difficult.
• The operator has a long lever, and at the same time the
shoulder muscles are forced into strong action to maintain
the position of the arms, so that the movement is made
more difficult.
P.PONMATHI
Faculty of Physiotherapy
MUSCLE WORK
P.PONMATHI
Faculty of Physiotherapy
