In most of the positions belonging to this group the posterior shoulder muscles contract more strongly than in the Fundamental position, so that they also produce a stronger expansion of the thorax.

Hips-firm or Wing-standing

1. Hips-firm or Wing-standing (Fig. 40). - In taking this position both hands are carried (along the sides) up to the crests of the ilium, against which they are pressed with the palmar surfaces turned down, thumbs backward and the fingers forward. The elbows ought to be carried so far back that the arms lie as nearly as possible in a line with the clavicle, the shoulders being lowered and somewhat drawn back.

The working muscles for taking and maintaining this position are chiefly: -

(a) Deltoid.

(b) Biceps and Brachialis Anticus.

(c) Adductors of the shoulder joint (Pectorals, Lat. Dorsi, etc.). They press the hands on the crests of the ilium.

(d) Trieeps; help to press the hands against the iliac crests, but produce also a passive stretching of the spine.

Effects And Uses

(a) The arms are fixed and their weight transferred to the crests of the ilium, so that trunk movements are facilitated.

Fig. 40.

(b) The chest is expanded, partly by the increased work for the shoulder muscles spoken of above, partly because the Pectorals and Lat. Dorsi draw up the ribs. Their attachments on the upper arm are more firmly fixed than on the ribs.

(c) The spine, especially the lowest part, is passively stretched.

(d) The trunk is made firm, because the arms act as buttresses. It is used on this account in many trunk and leg movements, to help in maintaining the position of the body during the movement.

Talk-standing

2. Talk-standing. - Arises by rotation outward of the arms and hands.

The working muscles are : -

(a) Outward rotators of the arm (shoulder joint), Supra- and Infra-spinatus and Teres Minor.

(b) Outward rotators of the forearm (radio-ulnar joint), Brachio-Radialis and Supinator Brevis.

Effects And Uses

The outward rotation of the arms causes increased stretching of the pectorals, so that the ribs are raised and the chest expanded.

It is used in order to produce merely a slight expansion of the chest, e.g., at the beginning of the after-treatment of a severe lung illness.

Bend-standing

3. Bend-standing. - Arises from talk-standing, by flexing the elbow joints as far as possible. The finger and wrist joints are slightly flexed, the elbows close to the sides, the shoulders lowered and drawn back.

The working muscles are : -

(a) The same as in the preceding position, the outward rotators of the arm and the supinators.

(b) The flexors of the elbow (Biceps, Brachialis Anticus, Brachio-Radialis).

Effects And Uses

This position in itself has no special effect, but is of great importance, because it is taken in all arm stretchings and must therefore be practised before these.

Yard-standing

4. Yard-standing (Yard c) (Fig. 41). - Arises by abduction of the arms to the horizontal plane. The shoulders must not be raised, but kept lowered and drawn back. The arms are carried so far back that they are in a line with the shoulders. Hand and finger joints extended, palms turned down, fingers closed.

The working muscles are : -

(a) Deltoid; works on the humero-scapular joint.

(b) Trapezius and Serratus Magnus; work upon the acromioclavicular and sterno-clavicular joints.

(N.B. - The movement does not take place only in the humero-scapular joint, but also in the acromioclavicular and sternoclavicular joints. The movement in the latter, however, is not great if the position is correctly taken.)

Effects And Uses

(a) The thorax is expanded more than in the preceding positions, because the origin and insertion of the Pectorals and Lat. Dorsi are further apart.

(b) Because the posterior shoulder muscles must work strongly and in full contraction (shortening), they are strengthened and their tone is improved (i.e., their real length is diminished, so that they become more tightly stretched between their origin and insertion). By this means the position of the shoulders is improved. The position is used for the above reasons in the treatment of flat chest and "winged" shoulders.

Forward-bend-standing

5. Forward-bend-standing (Yard a). - Arises from yard-standing by flexion in the elbow joint. The elbows are held well back.

The working muscles are: -

(a) Same as in the preceding position.

(b) Flexors of elbow.

(c) Posterior fibres of Deltoid, to carry the elbows back.

Effects And Uses

Chiefly similar to the preceding position, but less tiring because the centre of gravity of the arm lies nearer to the shoulder joint.

Heave-standing

6. Heave-standing (Yard e) (Fig. 42). - Arises from yard-standing by: -

(a) Outward rotation of the arms and supination of hands.

(b) Flexion of elbow joint to a right angle between the arm and forearm.

The working muscles are: -

(a) Same as in yard-standing.

(b) Outward rotators of the arm Supra- and Infra-spinatus and Teres Minor).

Fig. 41.

(c) Supinators of hand and forearm (Supinator Brevis, Brachio-Radialis).

(d) Flexors of the elbow and their antagonists (Biceps, Brachialis Anticus, Triceps).

Effects And Uses

Same as in the two preceding positions, but the expansion of the chest is somewhat stronger (stretching of the Pectorals and Lat. Dorsi being increased by outward rotation of the arms).

It is used in many chest expansions, to facilitate the expansion. Heave position of the arms is used also in many trunk movements to give the operator a long lever and thus make the exercise harder for the patient, e.g., in Heave - stoop - stride - sitting Alternate Trunk-rotation.