,u,o,.

nA p p l i e d
Physiology
Journal of

Eur J Appl Physiol (1989) 58:687-692

and Occupational Physiology

9 Springer-Verlag 1989

The influence of initial posture on the sit-to-stand movement

C. Stevens 1, F. Bojsen-Meller 2, and R. W. Soames 1
1 Department of Anatomy & Human Biology, King's College London, England, and
2 Anatomy Department C, University of Copenhagen, Denmark

Summary. Head movements, ground reaction

forces and electromyographic activity of selected
muscles were recorded simultaneously from two
subjects as they performed the sit-to-stand manouevre under a variety of conditions. The influence of initial leg posture on the magnitude of
the various parameters under investigation was
examined first. A preferred initial leg posture resulted in smaller magnitudes of head movement
and ground reaction forces. EMG activity in some
muscles, trapezius and erector spinae, decreased,
while in others, quadriceps and hamstrings, it increased in the preferred leg posture. The decreases seen correlate with reductions in head
movement observed. The effect of inhibiting habitual postural adjustments of the head and neck,
by comparing "free" and "guided" movements
was also examined. In guided movements there
are significant reductions in head movement,
ground reaction forces and EMG activity in trapezius, sternomastoid and erector spinae. It
would appear that both initial leg posture and the
abolition of habitual postural adjustment have a
profound influence on the efficiency of the sit-tostand manouevre. This preliminary study highlights the practical importance of head posture in
the diagnosis and treatment of movement disorders, as well as in movement education.
Key words: Postural adjustment -- Head movement -- Ground reaction forces -- Sit-to-stand

Introduction
There is within any gross change of posture a
process of postural adjustment which precedes
Offprint requests to: R. W. Soames, Department of Anatomy &
Human Biology, King's College London, Strand, London
WC2R 2LS, England

and/or accompanies the voluntary movement

(Belenkii et al. 1967; Bouisset and Zattara 1981;
Gahery and Massion 1981). Bouisset and Zattara
(1981) have observed anticipatory movements
present in the lower limbs and trunk before the
beginning of voluntary arm movements. These
movements, which contribute to the dynamic organisation of balance and serve to reduce the postural disturbance due to the forthcoming movement, are thought to be specific to the intended
movement. If indeed this is the case then these
postural adjustments must be preprogrammed,
furthermore they appear to be organised at two
levels (Gahery and Massion 1981). The lowest
level provides for postural adjustment when the
movement is triggered, this in turn being controlled by higher centres which adapt the adjustment to each intentional movement. This dual
control system can be presumed to work during
whole body movements as well as for single limb
movements.
Jones and his colleagues (Jones et al. 1959;
Jones 1965) using kinematic and force platform
data have attempted to analyse the postural adjustments preceeding the sit-to-stand manoeuvre.
He has shown that objective measures can be
used to distinguish between well and badly coordinated movements (Jones and Hanson 1961;
Jones et al. 1963), and thus lead to a clinical diagnosis of abnormal patterns of movements. More
recent studies of the sit-to-stand manoeuvre have
typically used standard leg positions (Baid et al.
1982; Christiansen et al. 1982; Yoshida et al.
1983). However, as this may not correspond to the
normal position of the subject, the subsequent
movement may not be typical. If, as suggested
earlier, the pattern of postural adjustments is
movement specific, then the execution of the
movement will be influenced by the initial posture.

688

The present study attempts to determine the

influence of initial posture, with respect to leg position, on the magnitude and pattern of postural
adjustments, and on the total movement pattern.
In addition the inhibition of postural adjustments
of the head is examined with respect to the execution of the movement.

C. Stevens et al.: Sit-to-Stand

Methods

standard leg position (S) the thighs were horizontal and the
calves vertical with the ankle joint immediate below the knee
and the foot flat on the floor. In the preferred leg position (P)
the seat height was in S above, but subjects were allowed to
place their legs in any position, with the proviso that the thigh
remained horizontal. Figs. 1 and 2 show the standard and typical preferred leg positions respectively. For the postural preparation trials, the subject adopted their own preferred leg position. Eight recordings were taken for the subject performing
the sit-to-stand movement free and a further eight when guided. In the free trials, subjects were allowed to make their habitual head posture preparations prior to and during the move-

During the sit-to-stand manoeuvre the trajectories of the head,

shoulder, pelvis and knee were recorded, as well as the three
orthogonal ground reaction forces and the electromyographic
activity of selected muscles.
The trajectories of the head, shoulder, pelvis and knee
were recorded photographically using a 50 Hz pulsed light emitting diode (LED) system developed at the University of Copenhagen. The pulse to the diodes was also fed to a pen recorder for display alongside the electromyographic (EMG)
and force platform data. The diodes are not lit for one pulse
each second thus establishing a time link between the photography and the EMG and force plate records, The diodes were
attached to the following sites; two on the zygomatic arch, one
on the acromion, one on the highest part of the iliac crest and
one on the lateral femoral condyle. A plumb line, with two
markers 250 mm apart, was placed in front of the subject in
line with the right shoulder. To minimise parallax errors, the
subject-camera distance was 3 m.
The following measures were taken from the photographs
of the patterns of movement: viz., the maximum forward horizontal movement of the head from the final standing position,
and the maximum vertical descent of the head from the initial
seated position. In addition to these measures the duration of
the movement was calculated from the pulse train of the diode
patterns, and confirmed using the vertical ground reaction
force.
The three orthogonal ground reaction forces were measured using an AMTI biomechanical measuring platform
(model OR6-3). From the records the maximum forces in the
following directions were determined; from Fz, up and down;
from Fy, anterior and posterior; and from Fx, left and right.
Standard surface electrodes were used to monitor the electromyographic activity during the execution of the sit-to-stand
movement. The centres of the electrodes were placed 2 cm
apart over the muscle belly in line with the direction of muscle
fibres. Bilateral recordings were taken from the upper part of
the trapezius, erector spinae (at L3), rectus femoris for the
quadriceps group and biceps femoris for the hamstring group
when examining the influence of leg position on the pattern of
movement, while unilateral recordings were taken from upper
trapezius, sternomastoid, erectores spinae (at L3) and rectus
abdominis when observing the influence of inhibition of the
postural adjustments of the head prior to the movement. No
attempt was made to compare and contrast the level of muscular activity observed between different muscle groups, only
comments with respect to individual muscles under the various activities are made.
Simultaneous measures of ground reaction forces, E M G
activity and photographic records were taken from each subject as they stood up from the seated position. The subjects
performed eight standard leg position and eight preferred leg
position trials, and were asked to do so as naturally as possible
and at their own speed, For each of the leg position trials the
trunk was vertical with the Frankfurt plane horizontal. In the

Fig. 1. The sit-to-stand manouevre performed with the legs at

90 ~, together with three ground reaction force records
(Fx=mediolateral; Fy=anteroposterior; Fz=vertical)

C. Stevens et al.: Sit-to-Stand

689

fluence of leg position being considered initially,

followed by an examination of guided and unguided movements.

Le9 position

Fig. 2. The sit-to-stand manouevre performed with legs in the

preferred position, together with the three ground reaction
(Fx = mediolateral; Fy = anteroposterior;
force
records
Fz = vertical)

ments, while during the guided trials these preparations were

inhibited by one of us (CS) using a method developed by Alexander (Alexander 1985; Stevens 1987). As a check that the
experimenter did not aid the movement recordings were taken
from an accelerometer placed on the subject's head. In total 64
sit-to-stand movements were recorded and analysed.

Results

The data is presented in two parts with the in-

Major differences are seen in the patterns of body

movement, particularly of the head, and of the
ground reaction forces between standing from the
seated posture when the legs are either in a standard position or the individual's preferred.
Changes in EMG activity proved difficult to evaluate because of the wide range of preferred leg
positions adopted by the subjects. However, it appears that with the standard leg position there is a
higher level of activity in the upper trapezius and
erector spinae muscles compared with that seen
with the preferred leg position. These differences
in muscle activity correlate with the differences
seen in head movement, and therefore upper
trunk movement, between the two test conditions.
In contrast greater activity was generally observed
in the hamstring and quadriceps muscles in the
preferred leg position trials.
Examples of the overall patterns of movement
are shown in Fig. 1 for the standard leg position
and Fig. 2 for the preferred leg position. Using
the horizontal and vertical movements of the head
as indicators of the overall pattern of movement, significant differences (P< 0.01) were found
between the two leg positions. For the preferred
leg position there was a 35% reduction in vertical
displacement of the head observed at the beginning of the manouevre (from :~=3.15 to ~=2.05
cm), and an 18% reduction in horizontal head displacement with respect to final head position
(from X=8.84 to ~=7.38 cm). Examination the
the photographs also revealed that the movement
in the preferred leg position was much smoother.
The ground reaction forces also showed some
significant decreases (P< 0.01), particularly in the
vertical and anteroposterior directions. The patterns of these forces are shown in Figs. 1 and 2 for
the standard and preferred leg positions respectively. It can be seen from these figures that during the initial part of the movement there is a dip
in the vertical (Fz) record followed by an increase
as the weight is taken by the feet. The anteroposterior (Fy) record shows an anteriorly directed
force followed by a larger posterior force which
coincides with the increase in Fz. In general the
transverse (Fx) records show fluctuations from
side to side. Most subjects showed slightly larger
fluctuations to the right than to the left.

690

Fig. 3. The sit-to-stand manouevre performed unguided, together with integrated E M G activities, the vertical ground
reaction force, and an accelerometer recording. (Fz=vertical
ground reaction force; UT= upper trapezius; S M = sternomastoid; E S = erector spinae; RA = rectus abdominis; A = accelerometer)

C. Stevens et al.: Sit-to-Stand

Fig. 4. The sit-to-stand manouevre performed with guidance,

together with integrated E M G activities, the vertical ground
reaction force, and an accelerometer recording. (Fz=vertical
ground reaction force; U T = u p p e r trapezius; S M = s t e r n o m a s toid; E S = erector spinae; RA = rectus abdominis; A = accelerometer)

c. Stevenset al.: Sit-to-Stand

When standing from the preferred leg position
there is a significant (P<0.01) 24% reduction in
the magnitude of the initial dip in the vertical direction compared with the standard leg position.
However, there is no difference in maximum vertical force between these conditions. The major
change seen is in the Fy force record, with there
being a 70% reduction (P< 0.01) in the magnitude
of the initial anteriorly directed force, in the preferred leg position. Non significant changes were
observed in the remaining force parameters.

Guided and unguided movements

In view of the above findings regarding leg position all guided and unguided tests were performed with the subject adopting their preferred
leg positions. Head movements, force records and
EMG activity all showed major differences between the test types. Examples of the movement
patterns, EMG activity, and force records are
given in Figs. 3 and 4 for the unguided and
guided movements respectively. In Fig. 3 the postural adjustment comprising an extension of the
head during the early part of the movement can
be clearly seen. It is not present in Fig. 4.
The maximum descent of the head was significantly reduced (P< 0.01) when the movement was
guided. It decreased from a mean of 0.7 cm to a
mean of 0.4 cm, a reduction of 43%. The extent of
horizontal head movement also decreased significantly in guided movements (P<0.01) from a
mean value of 6.2 cm to 5.2 cm, a decrease of 16%.
Although the time taken to perform the sit to
stand manoeuvre was the same in guided and unguided trials the maximum acceleration of the
head during guided movements was a third lower
than when unguided. Such a reduction is in accord with the smaller range of movements being
made in the guided trials.
Of the ground reaction forces, only the vertical
Fz was consistently recorded during this part of
the study. Nevertheless significant (P<0.01) reductions were observed in both the initial dip and
the maximum vertical force when the movement
was guided. These reductions were of the order of
77% and 16% respectively.
The EMG activity in all muscles examined in
this part of the study showed significant (P< 0.01)
changes between the two test types. In the guided
trials activity in upper trapezius, sternomastoid
and erector spinae decreased by 53%, 38% and
19% respectively compared with their activity in
unguided trials. Activity in rectus abdominus,
however, increased by a massive 80% in guided

691
trials. The decreases in trapezius, sternomastoid
and erector spinae correlate with the abolition of
habitual postural adjustments during the early
part of the movement.
Discussion

The data collected in the present study suggest

that both leg posture and the abolition of habitual
postural adjustments of the head have a profound
influence on the pattern of the sit-to-stand manoeuvre. It can be argued that because of the different preferred leg positions adopted by the subjects that any data relating to this factor may be
misleading. Alternatively it can be argued that
given differences in body size, strength, handedness, eye dominance and general fitness, then individuals through experience will adopt a preferred leg position which they find most effective
and efficient for them. In this way all preferred
leg positions can be considered comparable. On
the other hand imposing a standard, non-preferred leg position will place additional demands
upon the subjects when the movement is executed. The latter seems to have occurred as shown
by increased muscle activity and a greater excursion of head movement. At the beginning of the
movement the weight of the body is brought forward over the base of support. Consequently the
further forward the feet then the greater the movement of the head and trunk. The additional effort
required may reset the thresholds of habitual postural adjustments so that they become more pronounced. The resetting is likely to be related to
changes in neck posture when leaning forwards.
There is some evidence in support of this from
the second part of the study, in which head movements were restricted. By inhibiting head movements, and therefore changes in neck posture,
then the pattern of movement appears to be
smoother, with the level of associated muscle activity much reduced. It has long been known that
the neck musculature is important in the control
of posture and movement. Longet (1845) was able
to show that surgical interference with the neck
muscles produced generalised disturbances in
posture and movement in a wide range of animals. Later Sherrington (1897) established that
neck receptors have a profound effect on head
posture. Building on this earlier work Magnus
(1924) has shown that neck afferents, particularly
in association with labyrinthine reflexes, can produce extensive changes in whole body posture. It
has been suggested that the neck receptor system
may be as important as the labyrinthine system

692

for the control of posture (Lindsay et al. 1976).

Cervical ataxia has been produced in many species, including man (Cohen 1961; de Jong et aL
1977; Lund 1980); the effects, however, are not
thought to be due to loss of motor control of the
head but to a more generalised disorder (de Jong
et al. 1977).
The precise location of the receptors responsible for controlling head position is the subject of
much discussion. McCouch et al. (1951) and
Wyke (1979) believe them to be located in the cervical vertebral joints, but their studies have been
criticised by Abrahams (1982) and Richmond and
Bakkar (1982). Others have stressed the importance of the neck muscles (Cooper and Daniel
1963; Abrahams 1977). Indeed the numbers and
arrangements of the spindles is impressive. For example in the cat the number of spindles per gram
range from 100 for large to 500 for small neck muscles (Bakker and Richmond 1982); in comparison
lateral gastrocnemius only contains five spindles
per gram (Bakker and Richmond 1982).
It is interesting to note that the spindles in the
neck are arranged in complexes (Richmond and
Abrahams 1975) suggesting that they may subserve special functions. Furthermore, afferents
leaving the neck muscles have profound effects
on hindtimb motoneurons excitability (Abrahams
and Falchetto 1969). This latter observation, although not in man, may be a possible explanation
of the lack of preparatory leg retraction observed
in the guided trials in the present study.
Although the present study was conducted using two subjects only, it does draw attention to the
practical importance of head posture in the diagnosis and treatment of movement disorders, as
well as in movement education. A further series of
experiments is planned in which some of the observations made here will be tested and hopefully
elucidated.
Acknowledgements. Particular thanks to Keld Stub for his expert photographic work and to Bengt Andersen for his design
and construction of the diode system used in the study.

References
Abrahams VC (1977) The physiology of neck muscles; their
role in head movement and maintenance of posture. Can J
Physiol Pharmacol 55:332-338
Abrahams VC (1982) Neck muscle proprioception and motor
control. In: Garlick D (ed) Proprioception, posture and
emotion, Committee for Postgraduate Eduction. University
of NSW, Kensington, NSW, Australia
Abrahams VC, Falchetto S (1969) Hindlimb ataxia of cervical
origin and cerr
interactions with a supratentoriaI pathway. J Physiol 203:435-447

C. Stevens et al.: Sit-to-Stand

Alexander FM (1985) The use of the self'. Golancz, London
Baid T, Krali A, Turk R (1982) Standing up of a healthy subject and a paraplegic patient. J Biomech 15:1-10
Bakker DA, Richmond FJR (1982) Muscle spindle complexes
in muscles around upper cervical vertebrae in the cat. J
Neurophysiol 48: 62-74
Belinkii VYe, Gurfinket VS, Paltsev YeI (1981) Elements in
control of voluntary movements. Biophysics 12: 263-270
Bouisset S, Zattara M (1981) A sequence of postural movements precedes voluntary movement. Neurosci Lett
22: 263-270
Christiansen AF, Kardorf U, Bojsen-Moller F (1982) Concentric and eccentric contractions of hip and trunk muscles
while seating oneself and rising. Zdvar Vestn [Suppl 1]
51:41-42
Cohen LA (1961) Role of eye and neck proprioceptive mechanisms in body orientation and motor coordination. J Neurophysiol 24:1-11
Cooper S, Daniel PM (1963) Muscle spindles in man; their
morphology in the lumbricals and the deep muscles of the
neck. Brain 86:563-594
de Jong PT, de Jong JM, Cohen B (1977) Ataxia and nystagmus induced by injection of local anaesthetics in the neck.
Ann Neurol 1:240-246
Gahery Y, Massion J (1981) Coordination between posture
and movement. TINS 4:t99-202
Jones FP (1965) Method for changing stereotyped response
patterns by the inhibition of certain postural sets. Psychol
Rev 72:196-214
Jones FP, Hanson JA (1961) Time-space pattern in a gross
body movement. Percept. Motor Skills 12:35-41
Jones FP, Gray FE, Hanson JA, O'Connell DN (1959) An experimental study of the effect of head balance on patterns
of posture and movement in man. J Psychol 47:247-258
Jones FP, Hanson JA, Miller JK, Bossom J (1963) Quantitative
analysis of abnormal movement: the sit to stand pattern.
Am J Phys Med 42:208-218
Lindsay KW, Roberts TD, Rosenberg JR (1976) Asymmetric
tonic labyrinth reflexes and their interactions with neck reflexes in the decerebrate cat. J Physiol 261:583-601
Longet FA (1845) Sur les troubles qui surviennent dans l'equilibrium, la station la locomotion des animaux, aprrs la section des parties molles de la nuque. Gaz Med (Paris)
13:565-567
Lund S (1980) Postural effects of neck muscle vibration in
man. Experientia 36:1398
McCouch GP, Deering ID, Ling TH (1951) Location of receptors for tonic neck reflexes. J Neurophysiol 14:191-195
Magnus R (1924) Korpustellung, Springer, Berlin
Richmond FJR, Abrahams VC (1975) Morphology and distribution of muscle spindles in dorsal muscles of the cat neck.
J Neurophysiot 38:1322-1329
Richmond FJR, Bakker DA (1982) Anatomical organisation
and sensory receptor content of soft tissues surrounding
upper cervical vertebrae in the cat. J Neurophysiol 48:4961
Sherrington CS (1897) Decerebrate rigidity and reflex coordination of movement. J Physiol 22:3t9-332
Stevens CH (1987) The Alexander Technique, Macdonald,
London
Wyke BD (1979) Neurology of cervical spinal joints. Physiotherapy 65:72-76
Yoshida K, Iwakure H, Inoue F (1983) Motion analysis in the
movements of standing up from sitting down on a chair.
Scand J Rehab Med 15:133-140
Accepted January 20, 1989