Starting and Derived Position

              STARTING AND DERIVED POSITION

Starting position:

Sherrington stated that:

“Posture follows movement like a shadow”.

Means every movement begins in posture end in posture.

The position which adopted, by the patients or individual to perform exercise or movement to gain relaxation and stabilize their body. OR The posture from which movement is initiated i.e. called starting position.

They may be either active or passive in character. Starting position is applicable for day to day activities.

FOR EXAMPLE: Drinking bed tea. The person has to come out of the lying posture and attain sitting posture to drink the tea.

So every activity which we do our daily life activity starts in one posture end in other posture.

TO MAINTAIN STARTING POSITION

  v      To balance of force acting up on the body.

  v      Balance muscular isometric contraction it means there is no              change in length of the muscle but change in muscle tension,           starting position to maintain increase in muscle tone.
  v      Postural reflexes control the strength and distribution of                    muscle contraction.

TYPES OF STARTING POSITION

There are two types of starting position.

1.   Derived position

2.   Fundamental position

1.   DERIVED POSITION

Derived position is derived from starting position. This position is used by modification of arms, legs or trunk in each of fundamental position.

                                    

                                        OBJECTIVES

    1. To increase or decrease the muscle work required to maintain their position by use of derived position.

    2.  To increase or decrease base of support (BOS). If increase base of support it means increase area supported beneath the object. Whenever BOS is more the stability will be more.

EXAMPLE:  In standing the BOS is lesser because of less area supported beneath the object.

In lying the BOS is greater because of greater area supported beneath the object.

    3.   To gain local or general relaxation.

    4.   To increase or decrease of centre of gravity (COG). If COG is more the stability will be more.

EXAMPLE: In standing position COG is more because force of gravity is directly acted on centre of body.

2.   FUNDAMENTAL POSITION  

Fundamental position is derived from starting position.

There are five basic fundamental positions.

    1.   Standing

    2.   Sitting

    3.   Lying

    4.   Kneeling

    5.   Hanging

OBJECTIVES

    1.   Maintain or improve posture.

    2.   Modify the effect of an exercise to improve range of          motion or strength.

    3.   Maintain or improve posture.

    4.  Utilize support essential for relaxation.

1.  STANDING POSITION

The whole body is supported by lower base of support. So this position is most difficult to adopt for longer period. So that a lot of co ordinate muscle activity to maintain posture in standing. The position is not steady partly, because of base of support is small and centre of gravity is high lie at the centre of body (COG). (COG lie between third and fourth sacral vertebra).

POSITION:

         ·         Foot is place together and toes place slightly apart.

         ·         Knee is extended and straight.

         ·         Hip is in neutral position and spine is erect.

         ·         Shoulder is adducted and retracted. Eyes look forward and neck is straight.

 DERIVED POSITION FROM STANDING

Many of derived position can be derived from standing by alternating arm, trunk and lower limb. This position can be performed different types of exercise to gain relaxation and stability.

                   BY ALTERNATING LOWER LIMB

Many of derived position can be derived from standing that are:

    a.   High standing

    b.   Walk standing

    c.    Stride position

    d.   Step position

a. HIGH STANDING

          ·        

High standing is occurring on the stool or any raised platform.

Movement as mentioned in standing. To perform upper and lower limb exercise it is difficult posture to adopt longer period of time.

          ·         T perform hanging, swinging the arm and the leg exercise.

EXAMPLE:

         ·         To take some object from the high.

         ·         Fitting the fan in the ceiling.

b.WALK STANDING

One leg is standing forward and other is at their neutral position. One leg is forward means base is increase so stability will be more in this position.

MOVEMENT:

          ·         Hip flexion, knee extension and knee plantar flexion occur in this position.

          ·         Starting position for jogging.

          ·         To perform hip, knee, ankle and trunk muscles self stretching.

EXAMPLE:

         ·         Balancing on rope or rod.

         ·         Walk on the road.

c.   STRIDE STANDING

Both foot kept apart in sideways. In this position centre of gravity is high at centre of body that is why it stable position for longer period of time. It gives lateral stability.

MOVEMENT:

         ·         In this position Hip abduction and knee extension occur.

         ·         To perform the trunk, hip knee exercises.

         ·         Help to stretch the hip adductor.

EXAMPLE:

         ·         Sailors standing position.

         ·         Standing posture while travelling in bus. Stride the foot to stabilize unquotable posture.

                               d. STEP STANDING

         ·         One foot is kept on the stool or in height. Hip and knee is flexed.

         ·         This is one of most stable position.

MOVEMENT:

   ·    In this position hip flexion and knee flexion.

 ·    This position is useful for stretching the knee, ankle, hip and  trunk muscles.

      
EXAMPLE:

    ·  Position adopted to tie the shoelace.

    · Position adapted to cutting the toenails.

2.  SITTING POSITION

The position adopted while sitting on stool or the chair. Sitting is fundamental position. The thighs and the legs are relaxed and foot is resting on the floor. From the trunk to head the position is same as standing posture. The base of support is more and centre of gravity lies down. Centre of gravity lies at downward the position gets more stability than standing and the muscle work required is also less.

DERIVED POSITION OF SITTING

         ·         Cross sitting

         ·         Side sitting

         ·         Crook sitting

         ·         Long sitting

         ·         Stride sitting

         ·         Foot sitting

3.  LYING POSITION

Lying on the floor or on the bed in supine position with arm by side of the body and legs are kept straight. It is most stable position than other fundamental position due to lower placement of the centre of gravity (COG). This posture can be adopted for longer period than other starting position. In this posture the muscle work is minimal. But some muscles are not relaxed that is:

            ·         Neck side flexors counter balanced to keep the head in neutral position.

              ·         Flexors of lumbar spine counteract with the spinal extensor to maintain the lumbar lordosis.

               ·         Medial rotators of the hip keep the hip in neutral position.

DERIVED POSITION OF LYING

         ·         Prone lying

         ·         Half lying

         ·         Crook lying

         ·         Side lying

4. KNEELING POSITION

Kneeling position is fundamental position of standing but weight is transmitted through the knee joint due to right angle alignment of knee to the body. The leg is resting on the floor and ankle is plantar flexed. The position is very difficult position to maintain for longer period because centre of gravity fall down and larger base of support. It is inconvenient to adopt due to the weight transmitted through the knee joint.

  ·    The leg is relaxed except plantar flexors of the ankle, which keep the ankle in plantar flexion state.

DERIVED POSITION OF KNEELING

                ·         Half kneeling

                ·         Kneel sitting

                ·         Prone kneeling

                ·         Inclined prone kneeling

5.  HANGING POSITION

Hanging position is fundamental position of standing. Total body is suspended by grasping a horizontal bar with the hand.

MOVEMENT:

   ·           Shoulder flexed, adducted and medially rotated.

   ·           Elbow is extended, fingers is flexed and grasping the rod.

    ·          Adductor and medial rotators of the shoulder work strongly.

 ·  Flexors of elbow carry more weight and also strain. Finger flexors work strongly and grasping the bar.

    ·       Plantar flexors keep the ankle in plantar flexed position.

                   FRENKEL  EXERCISE

Professor Heinrich Sebastian proposed a series of exercises specifically for the treatment of ataxia called as Frenkel exercises which are slow and makes a system of repetitious exercises . The hands or arms movement are being observed critically by the patient and amended if necessary. These exercises require no equipments and can simply be carried out by the patient with focus and determination. The patients with ataxia may feel difficulty while performing Frenkel exercises but this set of movements helps the patients to restore their coordination. The purpose of these exercises is to restore the rhythmic movements for coordination in the patients. The human brain is made such a way that it recognizes all the discrepancies and provide motor problems in the spinal cord where needed. The patients with ataxia may use one or multiple mirrors to learn the accurate way of head movements.

Frenkel stated in his text book that while treating the patients by performing exercises, the sense of visualizing plays a great role, describing that it is necessary for the patients to watch their movements. He also suggested that by putting a timer while performing exercises for three minutes also helps in making the treatment less hectic for the patient. After three minutes, patients should take a gap for 15 minutes and do some other activities such as talking to someone or reading a book, as this gap provokes the development of new neural connections. These sets of exercises are suggested to be carried out every day for at least six months. A patient may perform the exercises but it is recommended that a physiotherapist must be present with the patient for the proper guidance so that the patient can watch his/her own movements and motivates the patient by talking and encouraging him/her. Apathy or the lack of motivation and clinical stress during treatment has been observed in cerebellar ataxic patients.

Frenkel exercises were formerly proposed in 1885 for the treatment of such patients facing difficulties of sensory ataxia leading to loss of proprioception. These exercises may be carried out in sitting, standing or walking position.

The fundamentals of Frenkel exercises

The fundamentals of Frenkel exercises are as follows:

Concentration or attention
It is a set of exercises to promote patients to enhance their ability to tell the position of their arms and legs without looking.

General instructions for Frenkel exercises

1.Exercises are not developed for the strengthening, but only for coordination
2.  Instructions given by the physiotherapist should be in slow voice, in a gradual manner and to the counting.
3.The area should be lit enough that the patient can watch the movements in their legs.
4. There should be some gap between each exercise and every exercise should be performed only four times.
5. Over stretching should be avoided.
6. The simple exercises should be performed first, followed by gradual transition into more difficult exercises
7. The exercises should be in smooth timing manner carried out at a slow pace by counting out a bit louder.
8. The uniformity of exercises should be maintained and a specific range can be focused.
9. Lying, sitting, standing and walking are the four basic positions to carry out exercises.
10. The part may be supported or unsupported, unilaterally or bilaterally.
11. The exercises are performed with eyes closed once the patient has voluntary control improvement.

Exercises for lower limb

Exercises for the legs in lying position

1. Stretch the leg by the heel and place it on the table.
2. Abduct and adduct the hip smoothly with the knee bent placing the heel on the table.
3. Now abduct and adduct the leg with knee and hip protracted by placing the leg on table.
4. Stretch and extend the hip and knee with heel
5. Stretch and extend both legs together with the heel on table.
6. Stretch one leg and extend the other one.
7. Now stretch and extend one leg while abduct and adduct the other one.
8. Heel one limb to the other leg (toe, ankle, shine)
9. Heel one limb to other knee by sliding down the crest of tibia to ankle.

Exercises for the legs in sitting position

1. Lift one leg to place the heel on the marked area, while the other one is stretched to slide the heel on the mark on floor.
2. Patient is asked to stand and sit again from a sitting posture.
3. Abduct and adduct the hip in sitting position.

Exercises for the legs in standing position

1. The weight of patient is transferred from one foot to another.
2. Foot is moved forward and backward on a straight line.
3. The patient is asked to walk along a winding strip.
4. Walk between two lines.
5. Walk sideways by placing the feet on a mark.
6. Walk forward and come to the mark back again.
7. Walk and switch the directions.

Exercises for upper limb

The exercises performed for lower limb may be practiced for the upper limb in a way that the patient places his/her hands on the mark on the table or the board to improve coordination and movements in upper limb.

HUMAN POSTURE

Human Posture

                                                                    

In this article we defined about human posture. In our research we found that  What is posture?

 Posture is a term used to describe a position of the body or the arrangements of body parts relative to one another .

POSTURE  has been described by the American Academy of Orthopaedic Surgeons (1947).

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Ideal postures are those assumed to perform an activity in the most efficient manner utilizing the least amount of energy.

 All activity begins with posture and ends with a posture. The relationships between body parts can be controlled voluntarily but to do this would require too much concentration.During normal functioning one's postures and adjustments to postures are automatic and occur quickly you are probably thinking that standing up straight is not easy.

 Most people would intuitively consider postural muscles as those that hold a body upright, standing, against gravity. For perfectly erect standing, however, very little muscle activity is needed. 

Joints are balanced on one another in such a way as to minimize the work necessary to hold one upright against gravity. Posture in these terms is thought of as static. How often do we just stand there?

 People need to move to function and to work, so I will talk of posture on this page as the positions we assume during the day in preparation for other positions we assume. We are always preparing to move whether beta pick up a mouse or walk to the store. In this way we can think of posture as dynamic always changing.                                                                                                                                                                          In order to function optimally, muscles must work at their optimum length and be long enough to allow for coordinated movement.

 Obviously a muscle that is tight will not allow a joint to move through its full range of motion. To avoid joint injury, joints must work within a range that they can maintain stability.

As we move from one posture to another we must learn to do it efficiently, within this stable range or risk injury. A physical therapist will assess dynamic posture by examining each posture assumed individually and observing how an individual transitions between each posture. Why is examining dynamic posture important?

It is usually during these transitions from one posture to another that injury occurs. Probably one of the most important times for one to maintain good posture is during lifting. The chest is up, feet shoulder width apart, head centered over the shoulders, the item to be lifted close to one's base of support, and hips an angle so that one feels like one is pushing through the floor. Deviation from takes one's joints and muscles outside of their optimal range of performance and increase risk of injury.  

Posture requires coordination

                                                                                                         The movement between one static posture and another requires the coordinated timing  and recruitment of muscles specific to the task at hand.

 It is a programmed pattern of muscle activity that the body counts on to maintain stability.

 Some of these programmed patterns of movement are hard wired in the central nervous system, others are learned.

 For instance, when we open a heavy door there is a coordinated sequence of muscle contractions in your abdominal, back and lower extremity muscles that occurs even before you start pulling on the door with your hand.

 CNS needs to control multiple muscles simultaneously based on corresponding Multi sensory inputs.

The movements controlled by normal reflex mechanisms are very small alterations in the position of the skeleton, shoulders, and pelvis.

  Includes:-

1) Vision input

☆ It can be easily modified by opening & closing the eyes, results in changes in posture stability.

2) Vestibular input

☆  vestibular information transmitted to brain provides the head orientation relative to gravity.

3) Proprioceptive input

☆it gives us information on the static & dynamic components of joint position /orientation for posture control.

4) Tactile somatosensory input

☆ tactile cues are conveyed to the information from the soles of feet.

Information is based on pressure on the sole,& center of pressure is very important cue for the maintenance of stable stance.

☆Because of this we cannot look at the muscles' functioning without looking at the sensory input. 

   
 Poor movement patterns can result from any of the following: 

Causes Of Poor Posture 

Joint dysfunction

Pain

Stress

Central nervous system disorder/injury

Overwork or over training

Prolonged postures or repetition of the same activity

The movements controlled by normal reflex mechanisms are very small alterations in the position of the skeleton, shoulders, and pelvis.

 These normal reflex mechanisms are learned as an infant and become automatic reactions to changes in posture.