Starting Positions: Fundamental & Derived + 20 Exam MCQs

Starting Positions: Fundamental & Derived

💡 Core Concept: Every exercise begins from a "Starting Position." The position determines the Base of Support (BOS), the Center of Gravity (COG), and the Muscle Work required to maintain it. There are 5 Fundamental Positions; all others are "Derived" from these.

1. The 5 Fundamental Positions

Position	Base of Support (BOS)	Center of Gravity (COG)	Stability
1. Standing	Small (Soles of feet)	High (Anterior to S2)	Least Stable
2. Kneeling	Medium (Knees + Shins)	Lower than standing	Moderate
3. Sitting	Medium (Thighs + Buttocks)	Lower than kneeling	High
4. Lying	Very Large (Posterior body)	Very Low (Near ground)	Most Stable
5. Hanging	Hands (Point contact)	Suspended	Unstable

1. Standing

• Description: Erect posture, heels together (or slightly apart), toes slightly apart, arms by side.
• Muscle Work (Static/Isometric): Minimal activity is needed to balance.
  • Anti-Gravity Muscles: Calf (Soleus), Quadriceps, Gluteus Maximus, Erector Spinae, Neck Extensors.
• Clinical Use: Functional re-education, balance training (High COG, Small BOS).

2. Kneeling

• Description: Upright body weight supported on knees. Feet may be over the edge of the plinth.
• Muscle Work: Lower legs are relaxed. Stronger work for Hamstrings/Quads to stabilize the knee joint compared to standing.
• Clinical Use: Training hip control, trunk balance, preparation for standing.

3. Sitting

• Description: Hips and knees flexed to 90°. Weight on Ischial Tuberosities and posterior thighs.
• Muscle Work: Legs are relaxed. Trunk muscles (Abdominals/Extensors) work to keep spine erect.
• Clinical Use: Good for non-weight bearing exercises of the knee/foot. Good for trunk stability training.

4. Lying (Supine)

• Description: Face up, arms by side, legs straight.
• Muscle Work: Minimal. This is the position of maximum relaxation.
• Clinical Use: Relaxation, early post-op exercises, testing muscles (eliminating gravity for Grade 2 MMT).

5. Hanging

• Description: Body suspended by hands grasping a horizontal bar.
• Muscle Work:
  • Flexors of Fingers (Grip): To hold the bar.
  • Scapular Depressors/Retractors: To prevent shoulder subluxation.
• Effect: Traction force on the spine (separates vertebrae).

2. Derived Positions

Positions modified from the fundamental ones to alter stability, leverage, or comfort.

A. By Altering the Arms

• Wing Standing: Hands on hips. (Fixes shoulder girdle).
• Yard Standing: Arms abducted to 90°. (Shifts COG up, increases leverage).
• Reach Standing: Arms flexed forward. (Shifts COG forward).

B. By Altering the Legs

• Stride Standing: Feet wide apart sideways. (Increases lateral stability).
• Walk Standing: One foot forward. (Increases Antero-posterior stability).
• Cross Standing: Legs crossed. (Very unstable, small BOS).

C. By Altering the Trunk

• Stoop Standing: Trunk flexed at hips, knees straight.
• Fall Out Standing: Lunge position.

🏆 AIIMS "Golden Points"

• Progression of Difficulty (BOS & COG): Lying → Sitting → Kneeling → Standing → Single Leg Stance.
• Pelvic Tilt: In Sitting, the pelvis naturally tends to tilt posteriorly (slump). In Standing, it tends to tilt anteriorly (lordosis).
• Hanging: Is the only position where the body weight creates a traction force rather than a compression force on the spine.

📝 20 High-Yield MCQs

Test your knowledge for AIIMS/JIPMER.

Q1. Which fundamental position provides the maximum stability (widest BOS, lowest COG)?

A. Sitting B. Standing C. Lying D. Kneeling

Rationale: Stability is directly proportional to the size of the Base of Support (BOS) and inversely proportional to the height of the Center of Gravity (COG). Lying has the largest BOS and lowest COG.

Q2. Which position creates a "Traction" force on the spine?

A. Lying B. Hanging C. Standing D. Sitting

Rationale: In hanging, the weight of the lower body pulls downwards due to gravity, creating a distracting (traction) force on the spinal joints. All other positions create compression.

Q3. "Stride Standing" is a derived position where the BOS is increased in which direction?

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

Rationale: In Stride Standing, feet are placed wide apart sideways. This widens the BOS laterally, making it harder to be pushed over from the side.

Q4. Which muscle work is minimal in the "Lying" position?

A. Respiratory muscles B. Anti-gravity postural muscles C. Eye muscles D. Facial muscles

Rationale: In lying, the plinth supports the body weight completely. The anti-gravity muscles (extensors) do not need to contract to maintain posture.

Q5. In the "Sitting" position, the body weight is transmitted chiefly through the:

A. Ischial Tuberosities B. Sacrum C. Coccyx D. Femoral Heads

Rationale: In a proper sitting posture, the weight is borne by the Ischial Tuberosities ("sit bones") and the posterior thighs.

Q6. "Walk Standing" improves stability in which plane?

A. Sagittal (Antero-Posterior) B. Frontal (Lateral) C. Transverse D. None

Rationale: Walk standing involves placing one foot forward. This elongates the BOS front-to-back, preventing falling forward or backward (Sagittal stability).

Q7. Which position has the highest Center of Gravity (COG)?

A. Sitting B. Kneeling C. Standing D. Lying

Rationale: In Standing, the entire body is vertically aligned, placing the COG at its highest point relative to the base. This makes it the most unstable fundamental position.

Q8. "Wing Standing" is a derived position where the hands are placed on the:

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

Rationale: Wing standing fixes the arms by placing hands on the hips (iliac crests). This stabilizes the shoulder girdle.

Q9. Which muscle group is NOT primarily active in the "Hanging" position?

A. Finger Flexors B. Quadriceps C. Scapular Depressors D. Latissimus Dorsi

Rationale: In hanging, the lower body is suspended and relaxed. The Quadriceps are not required to work against gravity. The upper body muscles (grip, shoulder stabilizers) work hard.

Q10. The "Hook Lying" position involves:

A. Supine with knees flexed and feet flat B. Prone with knees flexed C. Side lying with hip flexion D. Sitting with legs crossed

Rationale: Hook lying (Crook Lying) is supine with hips and knees flexed. It relieves tension on the abdominals and hamstrings, and flattens the lumbar lordosis.

Q11. Which position is best for training trunk stability while eliminating the influence of the lower limbs?

A. Standing B. Sitting C. Lying D. Hanging

Rationale: Sitting fixes the pelvis and eliminates the need for leg muscles to balance the body, focusing all stability work on the core/trunk muscles.

Q12. "Plinth" in physiotherapy refers to:

A. A type of pulley B. The treatment couch/table C. A balance board D. A walking aid

Rationale: A Plinth is the standard term for the examination or treatment table used in physiotherapy clinics.

Q13. In the "Kneeling" position, the Base of Support consists of:

A. Knees and Anterior Shins/Legs B. Knees only C. Feet only D. Hips and Knees

Rationale: The weight is distributed through the knees and the anterior aspect of the lower legs (tibia).

Q14. "Stoop Standing" involves flexion at which joint?

A. Knees B. Hips C. Ankles D. Elbows

Rationale: In Stoop Standing, the trunk leans forward by flexing at the hips, while the knees remain relatively straight.

Q15. To progress a patient's balance training, you should move them from:

A. Large BOS to Small BOS B. Small BOS to Large BOS C. Unstable to Stable D. High COG to Low COG

Rationale: Progression makes things harder. Reducing the Base of Support (e.g., Two legs -> One leg) makes maintaining equilibrium more difficult.

Q16. "Relaxed Standing" differs from "Fundamental Standing" because:

A. Requires less muscle work B. Requires more muscle work C. COG is higher D. BOS is smaller

Rationale: Relaxed standing allows for slight slumping or shifting weight to one leg, reducing the strict isometric control needed in the fundamental anatomical position.

Q17. Which position is ideal for training the Quadriceps after knee surgery before full weight bearing?

A. High Sitting B. Standing C. Kneeling D. Walk Standing

Rationale: High Sitting (legs hanging free) allows for open-chain knee extension exercises without placing body weight through the joint.

Q18. "Prone Lying" is:

A. Face up B. Face down C. Side lying D. Half lying

Rationale: Prone lying is lying on the abdomen, face down. (Supine is on the spine, face up).

Q19. "Half Kneeling" involves:

A. Kneeling on both knees with trunk flexed B. Kneeling on one knee, other foot flat on ground C. Squatting D. Sitting on heels

Rationale: Half kneeling is an intermediate position where one leg is kneeling and the other is in a forward lunge position (foot flat). It is less stable than kneeling but more than standing.

Q20. "Long Sitting" is characterized by:

A. Legs hanging over the edge B. Sitting with knees extended straight on the plinth C. Sitting on a high chair D. Sitting for a long time

Rationale: Long sitting involves sitting with the legs straight out in front. This stretches the hamstrings and challenges the lower back extensors.