Rehabilitation Science DepartmentTherapeutic Exercises

Course name: Physical therapy procedure IICourse code & number: 322 RHSLecture Name: Therapeutic exercisesLectures Name: Dr. Ashraf Ramadan HafezDate:Objective of Lecture: After studying this lecture, the student must be able;To define the basic fundamental positionsTo define the derived positionsTo define the effects and uses

Content of lecture basic fundamental positions Lying position and its uses Derived position from lying Sitting position and its uses Derived position from sitting Standing position and its uses Derived position from standing Kneeling position and its uses Derived position from kneeling Hanging position and its uses Derived position from hanging

Fundamental and derived PositionsThere are five Fundamental Positions which are usually described with their derivatives as the starting positions from which exercises start or in which may be given.Starting Positions:

1- Lying position.2-Sitting position.

3 -Standing position .4 -Kneeling position.5 -Hanging position.

Derived positionsDerived positions are positions used by modification of the arms, legs or trunk in each of fundamental position.The aims of derived positions are:

1 -To increase or decrease the base of support.

2 -To rise or lower the center of gravity (COG).3 -To gain local or general relaxation.

4 -To gain fixation and good control of specific area.5 -To increase or decrease the muscle work required to maintain the position.

6 -To increase or decrease the leverage.1 - Lying

This is the easiest position as the body can completely supported in the supine position and as stable as possible .

The body lies stretched out upon a horizontal surface, arms to the sides and legs straight with muscles relaxed. There is actually no real muscle work necessary for maintaining this position. The body is most supported with large base and low centre of gravity .This position is Used:

-For weak patients. - For small children, because they often do not understand how to maintain other starting positions .

it is suitable for many exercises. --Frequantly for massage .

-Positions Derived From Lying.1 -Side Lying:

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 and one to

support leg which is bent. - -Used in sling exercises.

2-Prone Lying: Uses:

Unsuitable for heart and respiratory diseased patients as breathing is so restrict.- -Used as corrective position for spine.

May be comfortable for young and slim people.-

3 -Half Lying: The trunk is supported in the oblique position by inclination of the long end of the plinth, or by the arrangements of the pillows .Effect:

The knees may be bent to increase relaxation of the abdominal wall .Uses :

1 -It is much used forward exercises.2 -Relaxed and comfortable position for weak and elderly people.

3 -Breathing is easier than in lying, so it is used in many chest conditions .

4 -Crook Lying: -From lying, the hip and knees are bent so that the feet rest on the floor or plinth.

Very little muscle work is required Tension is removed from the structure anterior to the hip joint so that the pelvis rolls backward and the lumbar spine is relaxed on to the supporting surface.Uses:

1 -To train relaxation and posture.2 -In pelvic and back exercises.

2- Sitting position

It is taken on a chair. In this position the body rests chiefly on the tuberosities of the ischium, but the back of the thighs should also be supported and the feet should rest upon the floor. The hip, knee, and ankle joints should all form right angles. The knees should be slightly apart so that the position of the legs is easy. The working muscles for maintaining the position are principally the neck, back, and posterior shoulder muscles. Your weight should be evenly distributed on both buttocks.

Effects And Uses:1 .General steadiness in this position is considerably greater, because- :

) a (The base is larger;) b (The centre of gravity lies nearer the base;

2 .The pelvis is also firmer, because it rests on the supporting surface.3 .The leg muscles work little.

Positions Derived From Sitting: 1 -Long Sitting:

This is similar to the previous position, but the knees are extended so that the whole leg is supported.Effect:It leads to increase tension of hamstring.Uses:Position is difficult due to instability.

2 -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 hamstring muscle is reduced but the adductors of the hip are stretched.

3 -High Sitting: The fundamental sitting position is taken on a high plinth or table but the feet remain unsupported.Uses:It is convenient some foot and knee exercise.

3 - Standing Position :1 -The heels are on ground with angle not exceed 45°.

2 -Keep your knee straight but not locked.3 -The hips are in extension and slightly rotated laterally.

4 -The pelvic is balanced on the femoral head.5 -The spine is stretched to its maximum length

6 -The head is hold up straight with chin in. do not tilt your head forward, backward, or sideways.

7 -Keep your shoulder back .8 -The arms are hanged loosely to the sides, palms facing sides of the body.

9 -Your weight should be evenly distributed on both legs.

Effects And Uses- The chest is expanded (the shoulders being drawn back and the spine extended).

-The internal organs have ample space, so that they are not hampered in their functions by undue pressure.

-The position is not steady partly, because the base is small, because the centre of gravity lies so high above the base (centre of gravity lies between third and fourth sacral vertebrae).

It is used as starting position for a number of free-standing exercises . -Positions Derived From The Standing:

1 -Toe standing:The heels are pressed together and raised from the floor.Effect:

The base is reduced and the center of gravity is raised .Uses :

1 -It is used as a balance position.2 -There is a tendency for the whole body to stretch so it is used as

treatment.

2 -Stride standing:

The legs are abducted and the heels are apart and remain in 45°.Effect :

Large base lead to easy and stable position.Uses:Used as starting easy position for many exercises.

:3 -Walk standing

One leg is placed forward to the same line of the other leg.Effect:

The base is much enlarged in the antro-posterior direction stabilizing the body for exercises in a sagittal plane. Rotation of the pelvis towards the side of the forward leg is prevented by the position of the back leg.Uses:

1 -Localize the hamstrings rotation of the spine.2 -Tension on of the forward leg prevents forward tilting of the pelvis in trunk flexion

exercises.

4 -Half standing:The whole weight of the body is supported on one leg, the other may be free or supported in a variety of the positions.Effects:

Balance is very difficult with one leg. The free leg can rest in many positions like stool with flexed hip and knee (step st.). This position reflexes the tension of the abdominal operations .Uses in:

Increase tension of the hamstring of the lower leg and straightening of the lumbar spine.

4 - KNEELING The body is supported on the knees which may be together or slightly apart.

1 -The lower leg rests on the floor with the feet planter flexed.2 -The feet may be in the mid position over the edge of the plinth.

Effect: uncomfortable position for most people due to difficult balance.Uses: as starting position for backward movements.Positions Derived From The kneeling:

1 -Half KneelingOne knee supports most of the weight and other leg is bent to a right angle at

hip, knee and ankle so that the foot is supported on the ground in a forward direction.

2 -Kneel SittingThe knees and hips are flexed so that patient sits on his heels.Uses:

Sometimes used for small children, but most people find it very uncomfortable.

3 -Prone KneelingThe 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.

Effect and Uses: The position is stable, comfortable and suitable for many trunk and head

exercises. The pelvis is free for antro-posterior and lateral movement, but fixed rotation. The body may be inclined forwards and downwards .

5 - HANGING The body is suspended by grasping over horizontal bar.The arms straight & at least shoulder width apart and forearm being pronated. The legs and trunk hang straight with the heels together and the ankle planter flexed .

Uses: it is suitable for athletic persons with high muscle strength .

Produces a passive stretching of the spine and its ligaments, especially in the lower part, and is therefore used in treating spinal curvatures.Raises the ribs by stretching the shoulder muscles, and is therefore used in the treatment of flat chest.

Derived Positions From Hanging

Hanging - Half The body is supported in the oblique position by the arms which grasp a horizontal bar, while the rest of the body is inclined and straight .Effect and Uses:

The position requires very strong muscle work for the back muscle, especially the scapulae retractors, which work against gravity and the weight of the body.