Wing Neck-rest Stretch Lying.

B. By altering the Position of the Legs.

1. Stride-lying. - Used in massage treatment of the inner side of the thigh, perineum, etc.

2. Crook-lying. - Arises from the Fundamental position by flexion at the hip and knee joints, so that the feet are drawn up against the buttocks and the whole sole rests on the supporting surface.

Effects And Uses

The anterior abdominal wall is relaxed, so that the abdominal organs are more easily accessible by massage.

3. Sit-lying. - Arises if the patient is placed so that the legs hang freely down beyond the edge of the supporting surface.

Effects And Uses

(a) The body is firmly fixed, e.g., for a strong Arm-downdrawing.

(b) Because the origin and insertion of Rectus Femoris are separated from one another Knee-extension is easier.

(c) Because of the increased stretching of Rectus Femoris the pelvic tilt is increased, so that a slight lordosis arises.

C. By altering the Position of the Trunk.

1. Half-lying. - Patient rests on a bed, low plinth, or other apparatus, so arranged that the trunk takes a position half-way between sitting and lying positions. The legs may either be straight or rest on the support or some suitable extension of the same, or they may be flexed at the knee joints with the feet resting on the ground (or a stool of suitable height).

Effects And Uses

(a) The position is comfortable and restful, and is therefore used for weak and delicate patients.

(b) Because it does not require the use of any muscles, but is firm in itself, it allows the effect of a movement to be as pure as possible, and is on this account much used in medical gymnastics.

2. Crook-half-lying. - Arises by combination of Crook-lying and Half-lying. It is more comfortable than Crook-lying position and relaxes the abdominal wall better, so that it is nearly always used when the abdominal viscera are to be treated by massage of one kind or another.

3. Forward-lying. - The patient lies prone on a plinth or other support. Used for massage of back. (N.B. - Impedes respiration, and must therefore not be used for patients with heart disease.)

4. Leg-forward-lying (Fig. 52). - Patient lies prone on a (high) plinth, with only the legs resting on it, while the trunk lies beyond the edge of the plinth in a line with the legs. The feet and legs are fixed by a strap, or a so-called "over-sitter."

It is best taken by letting the patient kneel on the apparatus as far back as the length of the thighs. He puts his hands on the shoulders of the operator, who stands in front and holds him in the axilla. The over-sitter now takes his place on the patient's legs. (N.B. - Patient's feet rotated out.) The patient then falls forwards in the hip and knee joints and is gently carried down to the horizontal position. The position of the head and trunk is now corrected so that it resembles Standing Fundamental position.

Recovery from the position takes place either by rotation of the trunk when the patient gets up to Sitting position, or the patient goes back to Knee-standing position, care being taken to flex the hips first, while the operator, by support in the axilla or with the hands, helps the patient up.

The working muscles for maintaining the position are: -

(a) Extensors of hip.

(b) Back muscles.

(c) Neck muscles. That is, all the muscles at the back of the body working statically.

Effects And Uses

(a) The feeling of equal innervation to both sides of the back is exercised, so that the position is of great value and use in treatment of scoliosis or a tendency to it.

(b) The back muscles are exercised and strengthened, so that a good position of the body is made easier.

Fig. 52.

5. Arch-leg-forward-lying Position (Fig. 53). - Arises from the preceding position by bending backwards in the joints of the spine. The working muscles are the same, but they are contracted as strongly as possible.

Effects And Uses

(a) Same as in the preceding.

(b) There is especially produced a stretching of the soft parts on the front of the body and spine, while the back muscles are shortened, so that the position is effectual in kyphosis and flat chest. (N.B. - It easily produces lordosis, which must be counteracted by suitable positions.)

6. Leg-side-lying and Arch-leg-side-lying (Fig. 54). - The patient is placed on one side on a high plinth, so that the leg of the under side rests upon the plinth in its whole length from the great trochanter to the foot. The other leg is placed immediately behind the first. An over-sitter sits on patient's legs and feet and fixes them. The trunk extends beyond the edge of the plinth and is supported by the operator with its frontal plane vertical; the lower arm in Neck-firm position, the other along the side of the body. The head should not be bent towards the upper side, but must be kept in such a position that the cervical spine does not diverge from the direction of the spinal column, but forms a direct continuation of it. If the patient from this position makes a side-bending of the trunk upwards and holds there, Arch-leg-side-lying position arises. To maintain the position all the longitudinal muscles on the upper side work statically.

Fig. 53.

Fig. 54.

Effects And Uses

(a) Ligaments of the spine on the lower side are stretched.

(b) Muscles of the upper side are exercised, developed, and shortened. On this account the position is used in simple scoliosis.

D. By Combination.

Here also a number of different positions arise, e.g., Stretch-half-lying, Neck-firm-arch-leg-forward-lying, etc.