Derived Positions: Classification, Uses & Practice MCQs

Derived Positions: Principles & Practice

💡 Core Concept: Derived positions are modifications of the 5 Fundamental positions (Standing, Sitting, Kneeling, Lying, Hanging). They are created by altering the position of the Arms, Legs, or Trunk to change the Base of Support (BOS), Center of Gravity (COG), and leverage.

1. Purpose of Derived Positions

• Increase/Decrease Base of Support (BOS): To challenge balance or provide more stability.
• Raise/Lower Center of Gravity (COG): To alter stability.
• Fixation: To localize movement to a specific joint.
• Leverage: To increase or decrease the difficulty of an exercise.
• Relaxation: To place a muscle in a shortened/relaxed position.

2. Positions Derived from STANDING

A. By Altering the Arms

• Wing Standing: Hands on hips (Iliac crests). Use: Fixes shoulder girdle, allows better trunk movement.
• Reach Standing: Arms flexed forward to 90°. Use: Shifts COG forward, counter-balance for squats/lunges.
• Yard Standing: Arms abducted to 90°. Use: Raises COG, increases leverage for lateral flexion exercises.
• Stretch Standing: Arms overhead. Use: Raises COG maximally (very unstable), stretches lats/pectorals.

B. By Altering the Legs

• Stride Standing: Legs wide apart sideways. Use: Increases lateral stability (Wide BOS).
• Walk Standing: One foot forward. Use: Increases Antero-Posterior stability.
• Toe Standing: Heels raised. Use: Very small BOS, highly unstable, strengthens calf muscles.
• High Standing: One leg on a stool/step. Use: Relaxes the pelvis and lumbar spine on the raised side.

C. By Altering the Trunk

• Stoop Standing: Flexion at hips, knees straight, trunk flat. Use: Training spinal extensors.
• Fallout Standing: Lunge position. Use: Intense muscle work for the forward leg.

3. Positions Derived from SITTING

Position	Description	Clinical Use
High Sitting	Sitting on a high plinth, feet not touching floor.	Knee swinging exercises, non-weight bearing quads strengthening.
Long Sitting	Sitting on plinth with knees extended.	Stretches hamstrings. Difficult if hamstrings are tight (causes posterior pelvic tilt).
Crook Sitting	Sitting with knees bent, feet flat.	Relaxes abdominal muscles.
Side Sitting	Legs to one side.	Spinal rotation/mobility exercises.

4. Positions Derived from KNEELING

• Half Kneeling: One knee down, other foot flat (Lunge position). Use: Intermediate balance training (between kneeling and standing).
• Kneel Sitting: Sitting back on heels. Use: Stable, increases knee flexion range.
• Prone Kneeling (Quadruped): On hands and knees (4-point). Use: "Cat & Camel" exercises, core stability, crawling re-education. It has a Large BOS and is very stable.

5. Positions Derived from LYING & HANGING

Lying (Supine)

• Crook Lying (Hook Lying): Knees bent, feet flat. Use: Relaxes abdominals, reduces lumbar lordosis (Pelvic Tilt exercises).
• Half Lying: Trunk supported by pillows/backrest. Use: Respiratory patients (COPD), weak patients.
• Prone Lying: Face down. Use: Hip extension exercises, stretching hip flexors.

Hanging

• Fall Hanging: Body inclined backward, holding a bar, feet on floor. Use: Re-education of scapular retractors.
• Arch Hanging: Back extended while hanging.

🏆 AIIMS "Golden Points"

• Passive Insufficiency: In Long Sitting, tight hamstrings pull the pelvis into posterior tilt, rounding the back. This is an example of passive insufficiency affecting posture.
• Progression: A classic stability progression is: Prone → Quadruped → Kneeling → Half Kneeling → Standing.
• Most Stable Derived Position: Prone Kneeling (Quadruped) is extremely stable due to 4 points of contact.

📝 20 High-Yield MCQs

Test your knowledge for AIIMS/JIPMER.

Q1. "Wing Standing" involves placing the hands on the:

A. Shoulders B. Iliac Crests (Hips) C. Head D. Knees

Rationale: Wing standing fixes the shoulder girdle and arms, allowing the patient to focus on trunk or leg movements.

Q2. Which derived position is best for stretching tight Hamstrings?

A. High Sitting B. Long Sitting C. Crook Sitting D. Kneel Sitting

Rationale: In Long Sitting, the knees are extended while the hips are flexed (90 degrees). This places maximum stretch on the hamstrings.

Q3. "Reach Standing" shifts the Center of Gravity (COG):

A. Forward (Anteriorly) B. Backward (Posteriorly) C. Upward D. Downward

Rationale: By extending the arms forward, the mass of the arms moves anteriorly, shifting the total body COG forward.

Q4. Which position offers the largest Base of Support (BOS) among the following?

A. Standing B. Walk Standing C. Prone Kneeling (Quadruped) D. Kneeling

Rationale: Prone Kneeling utilizes 4 points of contact (2 hands, 2 knees) spread out, creating a very large and stable BOS.

Q5. "Crook Lying" is indicated for:

A. Increasing Lumbar Lordosis B. Relaxing Abdominals & decreasing Lordosis C. Stretching Quadriceps D. Hamstring strengthening

Rationale: Flexing the hips and knees (Crook Lying) tilts the pelvis posteriorly, flattening the lumbar spine and relaxing the abdominal wall.

Q6. "High Standing" involves:

A. Standing on tiptoes B. One foot on the floor, one foot on a stool/step C. Standing on a high table D. Jumping

Rationale: High Standing is used to relax the tension in the lateral trunk and hip on the side of the raised leg.

Q7. "Yard Standing" implies arms are:

A. By the side B. Abducted to 90 degrees C. Overhead (180 degrees) D. Crossed over chest

Rationale: Yard standing creates a "T" shape, raising the COG and increasing the lever arm for trunk lateral flexion exercises.

Q8. Which position is best for training balance in the "Step Phase" of gait?

A. Half Kneeling B. Prone Kneeling C. Sitting D. Lying

Rationale: Half Kneeling mimics the stability requirements of the stance phase and the hip position of the step phase, making it ideal for pre-gait training.

Q9. "Stoop Standing" is characterized by:

A. Flexion of knees B. Flexion of hips, trunk inclined forward, knees straight C. Extension of trunk D. Lateral flexion

Rationale: This position fixes the pelvis via hamstring tension and is used to strengthen the spinal extensors (anti-gravity) in the upper back.

Q10. Which position creates the highest instability (smallest BOS)?

A. Stride Standing B. Toe Standing C. Walk Standing D. Kneel Sitting

Rationale: In Toe Standing, the BOS is reduced to just the metatarsal heads and toes, and the COG is raised, creating maximum instability.

Q11. "High Sitting" is indicated for:

A. Balance training B. Non-weight bearing Knee swinging/extension C. Trunk flexion D. Squats

Rationale: High sitting allows the feet to dangle freely, making it perfect for open-chain knee mechanics and mobilization.

Q12. "Stretch Standing" (Arms overhead) is used to:

A. Stretch Pectorals and Lats, Raise COG B. Lower COG C. Relax the back D. Fix the pelvis

Rationale: Raising arms overhead shifts the COG higher (destabilizing) but provides a strong stretch to the chest and side muscles (useful for scoliosis).

Q13. Which position is typically used for "Cat and Camel" spinal mobilization?

A. Prone B. Lying C. Prone Kneeling (Quadruped) D. Standing

Rationale: Quadruped position stabilizes the hips and shoulders while allowing the spine to move freely against gravity (flexion/extension).

Q14. "Stride Standing" improves stability in which direction?

A. Antero-Posterior B. Lateral (Sideways) C. Vertical D. Rotational

Rationale: Widening the feet sideways (Stride) increases the lateral Base of Support. (Walk standing increases Antero-Posterior stability).

Q15. "Fallout Standing" is another name for:

A. Squat B. Lunge C. Jump D. Sitting

Rationale: Fallout standing involves stepping forward and bending one knee while keeping the back leg straight (Lunge). It uses body weight to strengthen the leg.

Q16. "Prone Lying" is the starting position for:

A. Abdominal crunches B. Back Extension exercises C. Quadriceps sets D. Hamstring stretch

Rationale: Prone (face down) allows the patient to lift the trunk against gravity, strengthening the Erector Spinae (Back extensors).

Q17. In "Cross Standing" (legs crossed), the Base of Support is:

A. Widened B. Narrowed and Unstable C. Unchanged D. Most stable

Rationale: Crossing the legs reduces the effective width of the BOS, challenging balance significantly.

Q18. "Ride Sitting" (Straddle sitting) stabilizes the pelvis because:

A. Adductors are active and fix the pelvis B. Abductors are active C. Knees are straight D. Feet are off the ground

Rationale: In Ride Sitting (like on a horse), the adductors grip the plinth, mechanically fixing the pelvis so movement is localized to the spine.

Q19. A derived position using "Fixation" by holding a bar/table is:

A. Grasp Standing B. Free Standing C. Walk Standing D. High Standing

Rationale: Grasp standing involves holding a support, which fixes the shoulder/arms and provides extra stability for leg exercises.

Q20. "Half Lying" differs from "Lying" because:

A. Only one leg is on the bed B. Trunk is supported at an angle (reclined) C. Patient is on their side D. Knees are bent

Rationale: Half Lying uses pillows or a backrest to support the trunk in a semi-reclined position. It helps breathing and allows the patient to see their exercises.