Fundamental and

Derived positions
Presented by
Dr. Anaz A (MPT – MSS)
Starting position
• “Posture follows movement like a shadow. Every movement begins in
posture & ends in posture”.
-
Sherrington
• The posture from which a movement is initiated is known as the starting
position and they may either be active or passive in Character.

STARTING POSITION

Fundamental starting position Derived position

Fundamental position
• There are five basic fundamental starting positions. These are:

1. Standing
2. Kneeling
3. Sitting
4. Lying
5. Hanging
STANDING
1. This is the most difficult starting position to
maintain
2. Joint position
3. The heels are together & on the same line, the toes
slightly apart
4. The knees are together and straight
5. The hips are extended & laterally rotated slightly
6. The pelvis is balanced on the femoral heads
7. The spine is stretched to its maximum length
8. The vertex is thrust upwards, eyes look straight
forwards
9. The shoulders are down and back
10. The arms hang loosely to the sides, palms facing
inwards towards the body.
MUSCLE WORK:
• Ankle planter flexors: Balance the lower leg on the foot
• Ankle dorsiflexors: Counter balance the action of the planter flexors &
support the medial longitudinal arch of the foot
• Knee extensors: Work slightly
• Hip extensors: Maintain hip extension & balance the pelvis on the femoral
heads
• The extensors of the lumber spine: Work to keep the trunk upright
• Flexors of the lumber spine (abdominal muscle): Prevent over action of
extensors, also maintain the correct angle of pelvic tilt & support the
abdominal viscera.
• Prevertebral neck muscle: Control excessive extension of the neck &
straighten the cervical spine
• Flexors & extensors of the A-0 joint: Reciprocally balance the head
Effects & Uses:
• As the base of support (BOS) is small & gravity is high so it is effective
starting position for exercise for those who can maintain it correctly.
• The muscle work is minimal when perfect balance is achieved, therefore
practice in attaining & holding in a satisfactory pattern of standing posture
reduce fatigue & also condition the postural reflex.
• In this position the thorax is free & the abdominal viscera are well
supported.
• Patient feels joy & efficiency during performing exercise in standing
position
KNEELING
• Joint position:
• Body is supported on the knees which may be
together or slightly apart
• The low leg rests on the floor with the feet planter
flexed.3. The hips are extended
• The pelvis is balanced on the femoral heads
• The spine is stretched to its maximum length
• The vertex is thrust upwards, the eyes look straight
forwards
• The shoulders are down & back. The arms hang
loosely to the sides, palms facing inwards towards
the body
Muscles work:
• Flexors & extensors of knees: Balance the femur vertically on the knee.
• Knee extensors: Work slightly.
• Hip extensors: More strongly maintain the hip extension & balance the
pelvis on the femoral heads.
• Spine extensors: Working to keep the trunk upright.
• Flexors of lumbar spine: Prevent more strongly the action of the extensors
& maintain the correct angle of pelvic tilt.
• Prevertebral neck muscle: Control the excessive extension of neck &
straighten the cervical spine.
• Flexors & extensors of A-0 joint: Reciprocally balance the head.
• Stability: the body is stabilized on both knees

• Effects & uses : use for controlling the hip joint & lower trunk in
preparation for the standing position
SITTING
• Joint position:
• Position is taken on a chair or stool
• Hip & knee is flexed at right angle
• Femurs are parallel & the feet rest on the floor
• Pelvic is anteriorly tilted
• The spine is straight & maintains appropriate
curvature in each region
• The arms either hang loosely to the sides or rest
on both thigh
MUSCLE WORK:
• No muscle work for holding the leg
• Hip flexors: Maintain right angle flexion & prevent the
tendency to slump
• Extensors of the spine: Keep the trunk upright
• Prevertebral neck muscles: Control excessive extension
of the neck & straighten the cervical spine
• Flexors & extensors of A-0 joint: Working reciprocally to
balance the head.
Effects & uses:
• Comfortable, neutral, stable position
• Commonly used for those who, lack the necessary strength & control to
maintain a more difficult position.
• For pelvic mobility
• Effective for those who have contraindication in knee & ankle weight-
bearing
LYING
Joint position:
• Same as the standing position but on the bed (Supine lying)
• In this position the body is completely supported

Muscle work:
• Minimal muscles are involved to maintain this posture
• Head rotators: Work reciprocally to stabilize the head
• Hip medial rotators: Keep the leg in a neutral position
Effects & uses:
• Most relaxed position
• For treatment of spinal deformity
• Effective for those who are suffering from respiratory & cardiac problems
• Patient who has low muscle tone after stroke
HANGING
Joint position:
• Body is supported by griping over the horizontal bar.
• Fore arm: Pronated
• Shoulder: Full flexion & apart
• The trunk & legs: Hang straight
• Knees: Together, Extension & maintain traction.
• Ankle: Together & planter flexed

Muscle work:
• Fingers flexors: Work strongly to grip the bar.
• Wrist Muscles around the wrist work as synergists to prevent strain of
finger joints.
• Elbow flexor: Reduce the strain of the joint
• Shoulder abductors: Work strongly to lift the body to the arms.
• Pre-vertebral neck muscles: Work reciprocally to maintain the position of
the head & neck.
• The flexors of the lumber spine & the extensors of the hip: Work to
correct the tendency to arch the back as the result of the overaction of the
Latissimus dorsi, working on the sacrum.
• Hip adductor: Keep the hip together
• Knee extensors: Maintain knee extension
• Ankle plantar flexors: Work to point the toes to the floor

Effects & uses:

• Useful for those, who have well muscle strength & balance
• Useful for limb traction
• Useful for gymnasts
• Contraindicated for those who have respiratory & cardiac problems
Derived Positions
• Sometimes we need to change or modify the fundamental position by
altering the arm, leg & trunk position for some exercise purpose. In this
way a new starting position comes out which is called the derived position

Purpose of derived position

• To increase or decrease the size & stability of the base (BOS)
• To raise or low the center of gravity
• To ensure the maximum local or general relaxation
• To provide a convenient position from which a particular exercise is to be
performed
• To increase or decrease leverage
Position derived from standing:
by alteration of the arms
WING STANDING
Joint position
• Hands rest on the iliac crest
• Shoulder: Abducted
• Elbow: Flexed
• Wrist: Extended
• Finger: Extended, Abducted finger face anteriorly
&thumb in posterior side
Muscle work:
• Shoulder abductor (Deltoid, Supraspinatus)
• Elbow extensors work slightly to press a hand on the iliac
crest
Effects &uses:
• As the shoulder is abducted so during some trunk exercises it is easy for the
therapist to grasp the trunk
• Prevent the swinging of the hand during trunk exercise
REACH STANDING
Joint position
• Shoulder: Forward flexed, Parallel right angles to the
body
• Elbow: Extended
• Wrist & finger: Neutral position
Muscle work:
• Shoulder: Flexors maintain position against gravity
• Elbow extensors
• Finger & wrist extensors work slightly
Effects & uses:
• Assists balance during balance walking sideways
• As the hand is forward so is gravity & there is a natural
tendency to overcompensate for this by extension of the
lumbar spine
YARD STANDING
Joint position
• Shoulder: Abducted
• Elbow: Extended
• Fore arm: pronated
• Wrist: Neutral position
• Finger: Neutral position
• Other position is same as fundamental standing position
Muscle work:
• Shoulder: Abductor, Extensors, Lateral rotators, and Rotator of scapula work to
stabilize the arms
• Elbow: Extensors keep the elbow straight
• Wrist, Finger: Extensors to hold the limbs in a straight line
Effects & uses:
• Facilitates body balance
• Convenient for arm swing exercise
STRETCH STANDING
Joint position:
• The arm is fully elevated so that they are in line with
the body, parallel to each other & with palm facing.
• Elbow: Extended
• Wrist & finger: Neutral position

Muscle work:
• Shoulder abductors, extensors & lateral rotators
• Lateral rotators of the scapula to hold the arms position
• Elbow extensors: Keep straight
• Wrist & fingers extensors
By alteration of leg
CLOSE STANDING
Joint position
• The hip joints are rotated internally so that both are adjacent
together
• The rest of the joint position is the same as the fundamental
standing position
Muscles work:
• Leg muscles work more strongly than fundamental standing
position
Effects & uses:
• For advanced standing training
TOE STANDING
Joint position:
• The heel are closed together & raised from the floor
• DIP: Extended
• Ankle: planter flexion

Muscles work:
• Ankle planter flexors work strongly

Effects & uses:

• More balanced exercise
• Useful for postural flat feet patient
STRIDE STANDING
Joint position
• Both hip joints are abducted (Body weight equally
distributed)

Muscles work
• Hip abductor: work strongly to prevent further sliding

Effects & uses:

• More stable position when performing exercise in the
frontal plane
WALK STANDING
Joint position
• One leg is forward just two foot-length apart
• Another leg is backward in the same line

Muscles work:
• Extensors of hip & knee of rare leg work strongly to
maintain this position

Effects & uses:

• Useful for sagittal plane exercise
• Useful for localized rotation of spine
HALF STANDING
Joint position:
• The whole weight of the body is supported on one leg
• The other leg may be free or supported in variety in
position
Muscles work:
• Abductor of hip: maintain COG by slightly lateral tilting
of pelvic
• Opposite lumbar side flexors: Bring the trunk
alignment
• Supportive leg muscles work more strongly than
fundamental position
Effects & uses:
• Unsupported leg is free, so useful for some one leg
exercise
• For more balance exercise
By alteration of trunk
LAX STOOP STANDING
Joint position:
• Hip & trunk flexion
• Head & arms are relaxed so that they hang forward &
downward
Muscle work:
• Ankle dorsiflexors stabilise the position & intrinsic
foot muscles grip the floor
Effects & uses:
• For local relaxation of the upper limb
• For expiration
STOOP STANDING
Joint position
• Hip joints are flexed
• Head, trunk & arm remain in alignment & are inclined
forward
Muscle work:
• Ankle dorsiflexors stabilized the position & intrinsic
foot muscles grip the floor
• Back muscles, extensors of shoulders & elbow maintain
the position against pull of gravity
• Pre-vertebral neck muscles support the head
Effects & uses:
• For strong work of back muscles
FALLOUT STANDING
Joint position:
• One leg is placed directly forward to the distance of
three foot lengths & knee is bent
• The back leg is remaining straight & the body is
inclined forwards in line with it
Muscles work:
• Forward leg: extensors & foot muscles work strongly
• Back leg: extensors work to keep the trunk straight,
dorsiflexors keep heel on ground
• Head & trunk muscles work as stoop standing
Effects and uses
• Useful for treatment of spine curvature
Position derived from kneeling
HALF KNEELING
Joint position
• One knee supports most of the weight, other leg
bent forward right angle at hip. knee, ankle
Muscle work:
• Supported leg: abductors & lumbar spine flexors of
opposite side
• Opposite leg: extensors of hip & knee
Effects & uses:
• For trunk side bending & rotation exercise
KNEEL SITTING

Joint position
• Knees & hip are flexed so that patient sits on
heels

Effects & uses:

• This position is comfortable for children
• But uncomfortable for adult
PRONE KNEELING
Joint position
• Trunk is horizontal & supported under the shoulders
by the arms
• Pelvis supported by the thighs
Muscles work:
• Shoulder & hip joint muscles stabilize the supporting
limb
• Lumbar spine flexors prevent the hollowing the back
• Extensors of head neck & preventable neck muscles
Effects and uses
• For trunk & head exercise
Position derived from sitting
STRIDE SITTING
Joint position:
• 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.

Effects & uses:

• This position increases the stability
CROOK SITTING
Joint position:
• The knees are bent so that the feet are together & flat on the floor
• The knees are together or apart
Muscles work:
• Hip flexors: work strongly to prevent the excessive flexion of the
lumbar region & to support the thighs
• The flexors of the knees & the planter flexors of ankle to maintain
this position
• The longitudinal & transverse back muscles work strongly to
maintain the upright position of the trunk
Effects & uses:
• As the pelvis is posteriorly tilted & the lumbar spine is flexed so
useful for upper trunk localized exercise
• Treatment for kypho-lordosis
• Strong work for the extensors of thoracic spine
LONG SITTING
Joint position: Long sitting
• Both hips are flexing as right angle to the trunk
• Both knees are extended & ankles are in neutral position
• The legs are totally supported to the ground

Muscles work:
• Hip flexors: keep the trunk right angle to the lower limb
• Knee extensors: keep the both leg straight

Effects & uses:

• Useful for sitting balance practice
CROSS SITTING

Joint position:
• Both hip are flexed, strongly abducted & laterally
rotated
• Both knees are flexed & the both ankles cross each
other so that the lateral part of both knees touch
the floor

Effects & uses:

• To stretch the adductors of hip
• Useful for children during sitting balance practice
SIDE SITTING
Joint position
• In right side sitting the right leg position is same as
cross sitting
• Left leg: hip is flexed & medially rotated & knee is
flexed so that the medial aspect of the left leg touch
the floor
• The pelvis is tilted in to the right side
• The lumbar flexed left side to keep the balance
• Total body weight on the right side
Effects & uses
• Useful for increase lateral mobility of the lumbar
spine
• Useful for weight transferring
STOOP SITTING

Joint position:
• Same as fundamental sitting position except the
trunk is lean forward by maintaining it curvature

Effects & uses:

• Useful for arms & upper back exercise
• Sometimes useful for giving back massage when
prone lying is impossible
FALLOUT SITTING

Joint position:
• Same as fallout standing except the hip & thigh of
the forward leg are supported across a stool.

Effects & uses:

• Here balance is easier than the fallout standing
Position derived from lying
CROOK LYING
Joint position:
• From lying hip & knee are bent so that the feet rest on
the floor
Muscles work:
• Adductor & medial rotators of hip work together to
prevent the knees from falling apart
Effects & uses:
• Reduce tension of anterior aspect of knee & thigh,
pelvis & lumbar spine
• Useful for relaxation exercise
• Appropriate for chest physiotherapy
BRIDGING
Joint position
• From the crook lying elevate the trunk from the ground so that the trunk
rests on the shoulders & is brought in to line with the thighs
Muscles work:
• Hip & lumbar extensors
Effects & uses:
• Useful for re-education of muscles in pelvic floor
• Useful for pelvic control of stroke patient
HALF LYING
Joint position
• The trunk is supported in the oblique position by inclination of the long
end of the plinth, or by the arrangement of pillows
• Both knees may be extended of flexed

Effects & uses

• Relaxed & comfortable in this position
• Breathing is easier in this position so useful for breathing exercise
• Useful for word exercise
PRONE LYING
Joint position
• Lying face downward, the body is fully supported anteriorly on the plinth
• It may be active & passive
• When this position is used as an exercise purpose at that time the head is
kept slightly raise
Muscles work (During active position):
• The pre & post vertebral neck muscles work together to maintain the head
position
• The retractors & depressors of the scapula work to brace the upper back
• The lateral rotators of the hips keep the heel together
Effects & uses:
• Useful for patient who have a back pain
• Some unloading lumbar extension exercise
• Contraindicated for cardiac patient
LEG PRONE LYING
Joint position:
• Same as prone lying except from the ASIS to the leg is supported on the
plinth & strap
• The rest of the trunk is free in the space
• A stool is placed under the trunk for safety
Muscles work:
• The Prevertebral neck muscles, extensors of hip & longitudinal & transverse
back muscles work strongly to maintain the position of the trunk against
gravity
• The extensors of shoulder & elbow hold the arm to the side
Effects & uses:
• Advance back muscle strengthening exercise
• For sports man
SIDE LYING
Joint position:
• From lying roll on side
• Under arm support the head
• Some times rotates the trunk more & keep the upper hip & knee flex
Effects & uses:
• Useful for relaxation
• Sometimes use for gravity elimination position of limb
SEMINAR
• POSITION DERIVED FROM HANGING
• OTHER POSITIONS, IN WHICH SOME OF THE WEIGHT IS TAKEN ON THE ARMS
REFERENCES
• The principles of exercise therapy – M Dena Gardner
• Chapter 2
• (APPENDIX – I)
THANK YOU