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Chapter Outline


  • General Characteristics

  • Prerequisite Requirements

  • Interventions to Improve Intermediate Trunk and Hip Control in Kneeling

  • Movement Transitions: Heel-Sitting or Side-Sitting and Kneeling

  • Kneel-Stepping and Kneel-Walking

  • Strategies to Improve Balance Control in Kneeling

  • Practice and Feedback


  • General Characteristics

  • Interventions to Improve Intermediate Trunk and Hip Control in Half-Kneeling

  • Half-Kneeling: Diagonal Weight Shifting

  • Movement Transitions: Half-Kneeling to Standing


Student Practice Activities

This chapter focuses on interventions to improve intermediate trunk and hip control using kneeling postures. Kneeling offers the benefit of improving trunk and hip control without the demands of controlling the knee and ankle that are required during standing. Inherent to these upright, antigravity postures are important prerequisite requirements for standing. For example, kneeling postures are particularly useful for developing initial upright postural control and for promoting hip extension and abduction stabilization control required for standing. By eliminating the demands of upright standing, patient anxiety and fear of falling are typically diminished. Kneeling activities are also important lead-up skills for independent floor-to-standing transfers.

The postures addressed in this chapter are kneeling (Fig. 7.1A) and half-kneeling (Fig. 7.1B). In kneeling, both hips are extended with bilateral weight-bearing occurring primarily at the knees and upper tibia, with the legs and feet resting on the support surface. This creates a wider base of support (BOS) than standing, but not as wide as seen in half-kneeling. In half-kneeling, one hip remains extended, with weight-bearing at the knee and upper tibia with the opposite hip and knee flexed to approximately 90 degrees. Weight-bearing occurs at the foot placed forward on the supporting surface. In kneeling and half-kneeling postures, height of the center of mass (COM) is intermediate.


Kneeling and half-kneeling postures (A) Kneeling posture. Both hips are extended, with bilateral weight-bearing on the knees and legs; the BOS is narrow. (B) Half-kneeling posture. One hip is extended, with weight-bearing on the knee and leg. The opposite hip and knee are flexed to approximately 90 degrees with slight abduction; the foot is placed flat on the support surface. The BOS is wide and angled on a diagonal between the posterior and anterior limbs.

Clinical Note:

Patients with significant cerebellar dysfunction and ataxia (e.g., those with traumatic brain injury [TBI], multiple sclerosis [MS], or cerebellar degeneration) benefit from practice in these more stable postures. For these patients, kneeling and half-kneeling are functionally important as transitional activities in preparation for upright standing.


General Characteristics

In kneeling, the COM is intermediate; it is higher than in supine or prone positions and lower than in standing. In kneeling, control of the knee is decreased and foot and ankle control is not required to maintain upright trunk and hip control. This reduces the degrees of freedom compared ...

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