The document describes various starting positions for movement in physical therapy, including standing, kneeling, sitting, lying, and hanging. For each position, it outlines the muscle groups involved in maintaining proper alignment, the stability and effects of the position, and some variations or derived positions. The main positions allow different levels of stability and load on the body to train control and range of motion in different joints.

1. STARTING POSITIONS

2. Starting Positions
• Posture from which movements initiated are k/s Starting Position.
• It can be passive or active
• 5 basic positions:
• Standing,
• Kneeling,
• Sitting,
• Lying, and
• Hanging

4. Standing
• Balanced and stabilized in correct alignment
• Small base of support
• Achieved only by coordinated work of muscle groups which are
involved
• Heels are together, toes slightly apart
• Knees together and straight
• Hips are extended and LR slightly

5. Cont..
• Pelvis balanced on femoral head
• Spine is stretched to its maximun length
• Ears are level and eyes look straight forward
• Shoulders are down and back
• Arms hand loosely to the sides, palms facing inwards

6. Muscle Work
• Intrinsic muscles of feet
• Plantarflexors of Ankle
• DF of ankle, working to counterbalance the action of the PF
(provide support to arch of foot)
• Evertors, working to counterbalance the action of Invertors
• The Extensors of the Knee may work slightly
• Extensors of Hip
• Extensors of Spine

7. Cont..
• Flexors of Lumbar Spine
• Pre-vertebral Neck Muscles
• Flexors and Extensors of Atlanto-Occipital Joint (works
reciprocally to balance the head)
• Retractors of Scapulae
• Arms are relaxed

8. Effects and Uses
• Less Stable-As base is small and COG is high
• Suitable only for those who can maintain it.
• Reduces fatigue because of muscle work
• Thorax is free and abdominal viscera are well supported

9. Derived Positions
• Wing standing
• Low wing standing
• Yard standing
• Stride Standing
• Walk standing
• Step standing
• Fallout standing
• Lunge sideways standing

11. Kneeling
• Body supported on knees which may be together or slightly apart
• Lower leg rests on the base with feet Plantarflexed
• Rest of the body is held as in standing

12. Muscle Work
• Lower leg is relaxed, body stabilised on the knee
• Interplay between the flexors and extensors of the knee
• The extensors of the hip and flexors of the lumbar spine work
more strongly to maintain the correct angle of pelvic tilt.

13. Effects and Uses
• COG is relatively lower of the body as compare to standing,
position is slightly stable and is uncomfortable for most of the
people
• This position is used to train control of hip joints and lower trunk.

14. Derived Positions
• Half kneeling
• Prone kneeling
• Kneel sitting
• Inclined prone kneeling

16. SITTING
• The position is taken on a chair or stool; the height and width of
which allow the thighs to be fully supported and the hips and
knees to be flexed to a right angle

17. Muscle Work
• No muscle work to hold the position of the legs.
• Flexors of the Hips work to maintain a right angle at these joints
and to prevent the tendency to slump.
• Rest of the body is same as in standing.

18. Effects and Uses
• This is comfortable and very stable position which is used.
• Stuitable for those who lack the necessary strength and control to
maintain more difficult positions
• No body weight is transmitted to the legs, many non-bearing knee
and foot exercises can be performed in the position.

19. Derived Positions
• Ride sitting
• Side sitting
• Long sitting
• Crook sitting
• Stoop sitting

21. LYING
• Easiest position
• Completely supported and stable

22. Muscle Work
• Minimal
• Head Rotators of both sides work reciprocally to stabilise the
position of the head.
• Extensors of the hips and Flexors of the lumbar spine work to
combat the tendency to hollow the back
• The medial rotators of the hips work to keep the legs in neutral
position.

23. Effects and Uses
• Easy Position
• Trunk is relaxed and fixed by its own weight,
• Alignment of body is same as of standing.
• The spine is relieved of burden of transmitting the weight of head and
shoulders when it is in horizontal position.
• Breathing is impeded slightly by pressure on the posterior aspect of the
thorax. Therefore this position is unsuitable for patients with respirator
and heart conditions.
• Position hinders the return of blood from the head and so may be
unsuitable for elderly , and those who suffer from high BP.

24. Derived Positions
• Half lying
• Crook lying
• Prone lying (FA supported)
• Crook lying with pelvis lifted
• Side lying
• Sit lying

25. Hanging
• Body is suspended by grasping over a horizontal bar, FA is
pronated, the arms straight and at least shoulder width apart.
• Head is held high and scapulae are drawn and together, so neck
appears as long as possible.
• Trunk and legs hang straight with the heels together and ankles
plantarflexed.

26. Muscle Work
• The flexors of the fingers work strongly to grasp the bar
• All muscles round the wrist work strongly to reduce the strain on
the joints
• Elbow flexors work to reduce the strain on the joint
• Shoulder adductors work strongly to lift the body on the arms
• The depressors, retractors and MR of the scapulae work strongly to
fix the scapulae and brace the upper back
• Pre-vertebral and post. neck muscles work reciprocally to
maintain position of head and neck

28. Cont..
• Flexors of lumbar spine and extensors of hips work to correct the
tendency to arch the back as the result of over section of
latissimus dorsi
• Adductors of hips work to keep the legs together
• Extensor of the knee
• PF work to point the toes to the floor

29. Effects and Uses
• Muscle work for the arms and upper back is extensive.
• As the weight of the shoulder is taken of the spine and weight of
legs exert traction upon it, it straightened and elongated.
• Thorax is fixed in inspiratory position and breathing is difficult.
• Effect of Stretching the body is stimulating and much enjoyed,
especially in children.

30. Derived Position
• Fall hanging
• Prone falling
• Side falling

31. Any Questions?

32. Thank You!
Dr. Kangana Kuneja (PT)