1. Arch-hanging (Fig. 55). - Taken on a horizontal boom at the height of the patient's head or chest (easier in the former).

Hands (pronated) are placed on the apparatus as in Hanging position, after which first one leg and then the other is carried back and supported by the tips of the toes on the ground. At the same time the body is lowered carefully, so that it finally comes to hang with fully extended arms and equally extended knees and forms an arch convex forward. Head carried slightly back with chin in.

Effects And Uses

Stretches the ligaments and muscles in front of the spine and body, and is therefore used in treating kyphosis.

2. Crook-hanging. - - Taken on a wall-bar or double boom, so arranged that the lower boom supports the patient's sacrum.

It arises from the Fundamental position by bending and drawing up the legs so that the thighs form a right angle with the trunk and with the legs. Feet plantar-flexed.

Fig. 55.

The special muscles for taking and maintaining the position are: -

(a) Flexors of hip

(b) Abdominal muscles first concentrically, then statically.

(c) Arm and shoulder muscles (statically).

Effects And Uses

(a) Strengthens and shortens the abdominal muscles, and is used, therefore, in treating lordosis.

(b) Like the positions above described, where the flexors of the hip and the abdominal muscles work, e.g., Crook-half-standing, it aids peristalsis, repletes the pelvis, and impedes respiration.

3. Heave-hanging. - Arises from the Fundamental position by flexion at the elbows and adduction of the upper arms in the joints of the shoulder girdle, so that the body is heaved up to a right angle both between the arm and forearm and between the arm and trunk. Elbows in the frontal plane, and the position of the body otherwise as in Fundamental position.

The working muscles, besides those used in hanging, are : -

(a) Flexors of elbow.

(b) Adductors of the humero-scapular joint (Pect. Major, Lat. Dorsi, Teres Major).

(c) Inward rotators of the scapula at the acromio-clavicular joints (Rhomboids).

(d) Adductors of the sterno-clavicular joint (Pect. Minor and lower part of Trapezius).

Effects And Uses

Chiefly similar to the Fundamental position, but on account of the stronger action of the muscles mentioned it is also used as a strong arm movement in gymnastic training.

Summary of the Effects of the Starting Positions.

By choosing suitable starting positions we can make a movement easier or more difficult: -

(a) By giving the working muscles a more or less firm origin. Trunk rotation is easier in Ride-sitting position than in Knee-stride-standing. (N.B. - The firmer the fixation of the muscle origin the purer and more localised becomes the effect of the exercise.)

(b) By altering the position of the centre of gravity in the part of the body to be moved - e.g., raising from Sit.-ly. position is more difficult in Neck-firm or Stretch position of arms.

(c) By separating the origin and insertion of the working muscles and thus increasing or diminishing their strength - e.g., Knee-extension is much easier in Sit.-ly. than in Half-sit. position.

(d) By giving the operator a shorter or longer lever. Alternate Trunk-rotation is much more difficult if the arms are in Neck-firm than in Wing position, because the resistance, being the same in both cases, is put in the former upon the elbows, i.e., far away from the axis of rotation, in the latter upon the shoulder joint, i.e., nearer the axis.

We can, moreover, by certain starting positions fix the body or the different parts in such a way that passive stretchings can be thoroughly and effectively given, e.g., Grasp positions.

Also we can produce lessened contraction or relaxation in those parts which are to be massaged or treated by passive movements, e.g., Cr.-half-lying position for abdominal massage, etc.

Finally, many starting positions have a quite special effect upon the body, and are used on this account either to modify the effects of an exercise, or are given as exercises, e.g. : -

(a) Stoop positions deplete, Arch positions replete the abdominal and pelvic organs (Brandt).

(b) Leg-forward-lying and Arch-leg-forward-lying exercise equal innervation of the back muscles and the sense of the correct holding of the trunk, and at the same time the back muscles are strengthened, so that these positions are used in treatment of spinal curvatures.

(c) Hanging position exercises a stretching effect on shortened ligaments and muscles.

(d) Most positions derived by altering the arms cause an expansion of the thorax.

Gymnastic Movements.

General Rules for giving Movements.

1. The gymnast must take a suitable position, so that he can easily, and with the minimum expenditure of energy, give the exercise evenly, firmly and continuously. (Experience soon teaches him this.)

2. The gymnast, and especially the patient, must both breathe freely throughout the movement.

3. Respiratory exercises and most trunk exercises must be given in time with breathing. Movements of the extremities may generally be given rather more quickly.

4. All grasps must be with a flexible hand, firm, but without pinching.

5. During the exercise there must be a slight stretching lengthwise by the gymnast of the part moved.

6. As a rule the movements must be taken to the limit.

7. In resistance movements the resistance must be given from the very beginning to the end of the movement.

8. Resistance must be carefully regulated according to the strength of the patient. Shaking or unevenness of the movement shows that the resistance is too strong or that the exercise itself is too hard for the patient.

9. At the limit of the movement a little over-stretching is given, partly to increase the range of movement, partly to stretch passively the muscles which are going to work and so increase their strength.