Chapter 2. Anatomical Terminology: planes, directions, and positions
1. Learning Objectives
By the end of this chapter you will be able to …
- Define the three cardinal anatomical planes and the axes that pass through them.
- Describe the standard directional terms used to locate body structures in text, palpation, and medical imaging.
- Identify and correctly use common patient positions employed in physiotherapy assessment, exercise, and electro-physical modalities.
- Apply these terms to real-life clinical scenarios and chart notes, ensuring clear interdisciplinary communication.
2. The Cardinal (Orthogonal) Planes & Axes
| Plane | Axis Perpendicular to Plane | Description | Physiotherapy Examples |
|---|---|---|---|
| Sagittal (Median when mid-sagittal) | Mediolateral (frontal–horizontal) | Divides body into right & left parts | Hip flexion–extension during gait analysis; forward reach test |
| Coronal / Frontal | Anteroposterior (sagittal–horizontal) | Divides body into anterior (ventral) & posterior (dorsal) parts | Shoulder ab-/adduction in joint play; scapular wall slides |
| Transverse / Horizontal / Axial | Longitudinal / Vertical | Divides body into superior & inferior parts | Cervical rotation range; trunk rotation in PNF patterns |
Clinical Pearl — Plane ≠ Movement
• A motion occurs parallel to a plane and around its perpendicular axis.
• A resistance exercise cue such as “move in the frontal plane” guides both therapist and patient to maintain correct movement trajectory, reducing compensations.
3. Directional Terms (with PT-Specific Context)
| Pair | Meaning | Practical PT Application |
|---|---|---|
| Anterior / Posterior | Toward the front / back of body | Recording thoracic kyphosis as “posterior convexity” |
| Superior / Inferior | Above / below a reference point | Cueing “superior glide of patella” in mobilisations |
| Medial / Lateral | Toward / away from the midline | Describing meniscus tears on MRI report |
| Proximal / Distal | Nearer / farther from limb root | Splint reaches “distal third of forearm” |
| Superficial / Deep | Closer to surface / further inside | Ultrasound head used for deep transverse friction |
| Cranial (Rostral) / Caudal | Toward head / tail end; often embryology, spine | Documenting “caudal traction” in lumbar traction note |
| Ipsilateral / Contralateral | Same side / opposite side of body | Cross-extension reflex training in stroke rehab |
| Palmar / Dorsal (hand) | Anterior hand / posterior hand | Electrode over palmar motor point of abductor pollicis brevis |
| Plantar / Dorsal (foot) | Inferior foot / superior foot | Stretch applied to plantar fascia |
Documentation Tip: Combine terms for accuracy—e.g., “distal-lateral fibula tenderness” pinpoints the anatomy better than “outer ankle pain.”
4. Fundamental Body Positions in Physiotherapy
| Position | Anatomical Features | Typical Uses in PT |
|---|---|---|
| Anatomical Position | Standing, eyes forward, arms at sides, supinated palms | Universal reference for directions & planes |
| Supine | Lying face up | Bridging, SLR strength testing, E-stim for paraspinals |
| Prone | Lying face down | Prone press-ups for McKenzie, scapular re-training |
| Sidelying (Left / Right) | Lying on one side | Hip abductor MMT, modified thoracic rotation mobilisations |
| Hook-lying | Supine, hips & knees flexed, feet flat | Core stabilisation, transversus abdominis activation |
| Crook-lying | Synonym of hook-lying (UK usage) | — |
| Long-sitting | Sitting with knees extended | Hamstring stretch, neurodynamic testing |
| High-sitting | Sitting with hips flexed ≈ 90°, knees dangling | Lower-limb MMT, dynamic balance |
| Fowler’s (Semi-recumbent) | Supine with head elevated 45–60 ° | Pulmonary drainage, semi-upright IMT |
| Trendelenburg | Supine, head lower than feet 15–30 ° | Postural drainage (contraindicated in ↑ICP) |
| Quadruped (All-fours) | Hands & knees on table | Bird-dog exercise, rocking for lumbar mobility |
| Kneeling / Half-kneel | Weight on both knees / single knee | Proprioceptive/balance drills, gait pre-training |
| Standing | Weight-bearing on feet | Gait, posture assessment, CKC strengthening |
Safety Note: Always document any contra-indications to positions (e.g., hypotension in upright, pregnancy in prone) before treatment.
5. Putting It All Together – Charting Example
Subjective: Patient c/o right shoulder pain.
Objective:
– AROM: Glenohumeral abduction in coronal plane limited to 90°.
– Accessory motion: Posterior glide (anteroposterior axis) hypomobile.
– Palpation: Tender at anterosuperior acromion.
Assessment: Sub-acromial impingement.
Plan: Mobilise in sidelying, apply inferior glide (longitudinal axis) grade III, then prescribe closed-chain wall slides maintaining scapular plane alignment.
Correct use of planes, axes, and directions minimizes ambiguity for any clinician reading this note.
6. Quick Visualisation Hacks
- Laser Pointer Method: Imagine a laser fixed perpendicular to each plane—where the beam points is the axis.
- Door & Hinge Analogy: Door moves in a plane; hinge pin is the axis.
- “Salami Slice” MRI Thinking: Each axial MRI slice is a transverse plane; mentally stack slices to reconstruct 3-D relationships.
7. Self-Assessment Quiz
- Which axis corresponds to flexion–extension at the elbow?
- In a right-handed baseball swing, trunk rotation occurs in which plane?
- Name two patient positions unsuitable immediately after total hip replacement (posterior approach) and explain why using directional terminology.
- Define “contralateral” and provide an example from neuro-rehabilitation.
- True/False: The median nerve lies lateral to the brachial artery in the cubital fossa in anatomical position.
Answers of Self-Assessment Quiz
- Mediolateral axis (perpendicular to sagittal plane).
- Transverse (horizontal) plane.
- (i) Low-sitting (hip > 90 ° flexion – risk of posterior dislocation) and (ii) Cross-leg sitting (combined hip flexion, adduction, internal rotation).
- Pertaining to the opposite side; e.g., contralateral hemispheric stroke causing weakness in the left limb if the right cerebral hemisphere is affected.
- False – it lies medial to the brachial artery.
8. Suggested Lab Activities
- Plane Tape Drill: Tape sagittal, coronal, and transverse lines on the floor. Have students perform movement patterns staying within each lane.
- Directional Bingo: Instructor calls a term (“distal-posterior femur”); first student to palpate correctly scores.
- Position Swap Stations: Rotate through treatment plinths set in prone, sidelying, quadruped—document three potential interventions per station.
9. Key Take-Home Points
- Planes and axes form the coordinate system for describing movement.
- Directional terms eliminate vagueness; pair them when necessary.
- Mastery of patient positions underpins safe, effective treatment and accurate documentation.
- Consistency in terminology facilitates teamwork across disciplines and improves patient understanding.