Name: Rehma.

Class: DPT (2nd Semester).

Subject: Kinesiology-II

Seat No: B22117007036

TOPIC: DERIVED POSITIONS.

Derived positions, also known as modified or alternative positions, are specific body
positions used in physical therapy and healthcare to optimize patient comfort, safety,
and therapeutic effectiveness during treatment or assessment.

1.Positions Derived From Standing:

i. WING STANDING:
The hands rest on the crests of the ilia, the fingers, which are extended and adducted, being anterior
and the thumbs posterior. The wrists are extended, forearms pronsted, elbows flexed and shoulders
abducted. The elbows point straight sideways.

Muscle Work:

The Adductors of the Shoulder Joint and Extensors of the Elbows work slightly to press the hands to
the trunk.

Effects and Uses:

As the arms are held away from the trunk from the axilla to the iliac crests, the position allows the
physiotherapist to grasp the patient round the shoulders during some trunk exercises. The fixed
positon of the arms prevents their swinging during trunk exercises. As this swing usually amplifies
the movement and leaves the thorax free, the position should be avoided unless it serves some
definite and useful purpose. It was at one time used extensively just to make the exercise appear
tidy.

ii. LOW WING STANDING:

This is similar to the previous position, the fingers being placed across the front of the hip joints.

Effects and Use:

This is a position of control as the patient is able to feel with the hands the movement of flexion at
the hip joint, tilting and lateral swing or any rotation of the pelvis, which may occur during the
performance of an exercise.

iii. UNDER BEND STANDING:

The fists are pressed against the lateral wall of the chest, the forearms being pronated and the
cibows flexed and the shoulders are abducted and medially rotated. The elbows point straight
sideways. Muscle Work The Flexors and Extensors of the Wrist work reciprocally to stabilise the joint.

●The Flexors of the Elbows keep the fists well up towards the axillae.

●The Adductors of the Shoulders press the fists to the sides.

Effects and Uses:

This too is a position of control which enables the site of the movement to be felt with the hands. It
is used to localise movement during lateral flexion of the thoracic spine.

2.Positions Derived From Sitting:

i. 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 un-
comfortable for most adults, but suitable for children during head, arm and trunk exercises as the
pelvis is fixed and stable.

ii. SIDE SITTING:

For left side sitting the left leg remains as in cross sitting and this hip supports the main weight of the
trunk, while the right leg is abducted and medially rotated so that the lower leg is bent and to the
side. The pelvis is tilted laterally to the left, and the Lumbar Side Flexors on the right side work to
keep the trunk upright. The position is used to increase lateral mobility of the lumbar spine or for
fixation in the side bend position when treating scoliosis.

3.Positions Derived From Kneeling:

i. KNEEL SITTING:
The knees and hips are flexed so that the patient sits on his heels. The position is sometimes used for
small children, but most people find it very uncomfortable.

ii. 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.

Muscle Work:

The muscles round the Shoulder and Hip Joints work to stabilise the supporting limbs at right angles
to the trunk. (1) The Flexors of the Lumbar Spine prevent hollowing of the back. (m) The Extensors of
the Neck and Head, controlled by the Pre- vertebral Neck Muscles, keep the head in alignment.

Effects and Uses:

The position is stable and comfortable and suitable for many trunk and head exercises as the spine is
relieved of the weight of the head and shoulders and therefore it tends to straighten and elongate.
The pelvis is free for antero-posterior and lateral movement, but fixed for rotation. The body may be
inclined forwards and downwards by abducting.

4.Positions Derived From Hanging:

i. FALL HANGING:
The body is supported in the oblique position by the arms which grasp a horizontal bar, and by the
feet which rest on the floor. The arms are vertical so that the shoulders fall directly below the hands,
while the rest of the body is inclined and straight.

Muscle Work:

●The Flexors of the Fingers grasp the bar and the Wrist, Elbow and Shoulder Muscles work to reduce
tension on these joints.

●The Retractors of the Scapulae work strongly to draw the trunk upwards between the arms.

● The Flexors of the Atlanto-occipital Joint and of the Cervical Spine prevent the head from falling
backwards.

●The longitudinal and transverse Back Muscles support the trunk.

●The Extensors of the Hips keep the trunk in alignment and the plantarflexors press the feet to the
floor.

Effects and Uses:

The position requires very strong muscle work for the Back Muscles, especially the Scapulae
Retractors, which work against gravity and the weight of the body.

5.Positions Derived From Lying:

i. LEG PRONE LYING:
This is taken on a high plinth, the legs being supported from the anterior superior spines to the feet
and stabilised by a strap. The body is held in line with the legs 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.

Muscle Work

●The Pre-vertebral and posterior Neck Muscles, the Extensors of the Hips, and the longitudinal and
transverse Back Muscles work strongly to maintain the position of the trunk against gravity. (ii) The
Extensors of the Shoulders and Elbows hold the arms to the sides.

●The Flexors of the Lumbar Spine control the lumbar region which tends to become hollowed.
Effects and User. The muscle work is strong and corrective for the position of the trunk, and strong
arm, head and back exercises can be added to increase this effect.For group exercises, the thighs only
may be supported across a form, the feet being fixed between wall-bars or by living support. Care
must be taken in this case to see that the fixation of the feet is firm and that it is main- tained until
the body is supported on the arms for the resting position.

ii. SIDE LYING:

Details of this position vary considerably according to the purpose for which it is to be used.

●The patient rolls on to the side from lying or prone lying, using the under arm to support the head.
It is an unsteady position used sometimes for strong trunk side bending exercises.

● Alternatively the shoulders may be stabilised by support from the upper arm resting on the ground
or plinth in front, the legs being free for movement. When the under hip and knee are fully flexed
the pelvis is relatively well-fixed, so that movements of flexion and extension can be localised to the
hip joint of the uppermost leg. This is useful especially in sling exercises. Conversely, if the pelvis is
stabilised by resting the upper- most knee on the plinth, shoulder exercises for this side of the body
can be performed.

● An ideal position for relaxation for many people is provided by adapting. Three pillows are
required, one for the head, one for the uppermost arm to support it and free the chest and so assist
respiration, and a third to support the uppermost leg which is bent.

iii. PRONE LYING:

Lying face downwards, the body is fully supported anteriorly on the 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
exercise, the head is slightly raised from the supporting surface and the shoulders are drawn down
and backwards, the heels being held together and the toes stretched.

Muscle Work:

●The Pre- and Post-vertebral Neck Muscles work to maintain the position of the head.

●The Retractors and Depressors of the Scapulae work to brace the upper back.

●The Lateral Rotators of the Hips keep the heels together. The Relaxed Position. No muscle work is
required for the relaxed position. In this case the head is usually turned to one side and rested on the
hands for comfort and ease in breathing, while the heels roll apart. Tension may be still further
reduced by placing a pillow under the abdomen and another under the lower leg, so that the hip and
knee joints are slightly flexed and the feet rest free from pressure.

Effects and Uses:

Breathing is somewhat 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. The active
position gives a feeling of the correct alignment of the body which is required in upright positions
and as the spine is relieved of weight.

It tends to elongate and straighten. The relaxed version of the position is only comfortable for some
people, usually the young and the slim.