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Orthotics & Seating
Standing Frames
A surgeon's perspective on standing frames — what they are, who they help, and why they are prescribed and fitted by physiotherapists and orthotists, not by me.
Standing frames are supportive devices that help people who cannot stand independently to spend time upright, and they matter most for people with significant neurological conditions or complex disability. As a spinal surgeon I sometimes look after such patients, and I think it is useful for them and their families to understand where standing programmes fit. I want to be clear from the outset, though, that standing frames are prescribed, fitted and supervised by physiotherapists and orthotists as part of a rehabilitation programme — I am a surgeon, not a physiotherapist or orthotist. This page gives an honest, evidence-based overview from a surgeon's perspective.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
What standing frames are and who they help
A standing frame supports a person in an upright position when they are unable to stand on their own, holding the trunk, hips, knees and feet as needed. They are used mainly for people with conditions such as spinal cord injury, cerebral palsy and other neurological or neuromuscular disorders, both children and adults. The idea is that regular supported standing provides benefits that sitting or lying cannot — for the bones, joints, and various body systems — as part of a broader programme of care.
Why supported standing is used
Regular supported standing is used in the hope of several benefits: helping to maintain range of movement and reduce stiffness or contractures at the hips, knees and ankles; supporting bone health; and assisting with functions such as bowel and bladder management and general wellbeing. The evidence for some of these is stronger than for others, and honest programmes are realistic about what standing can and cannot achieve. It is one component of managing a complex condition, not a treatment in itself.
Who prescribes and supervises them
This is firmly the territory of the rehabilitation team. Physiotherapists assess whether supported standing is appropriate, set the programme (how often and for how long), and monitor it; orthotists and therapists ensure the equipment fits safely. Standing must be introduced carefully, with attention to blood pressure, skin, bone strength and joint position, which is exactly why it is supervised by these specialists. My role, where I am involved in a patient's surgical care, is to understand the programme and to communicate with the team — not to prescribe or run it.
What the evidence shows
The evidence on standing frames is genuinely mixed, and it is right to be honest about that. Systematic reviews in cerebral palsy and in spinal cord injury find some supportive evidence for benefits such as maintaining hip and knee range of movement and possibly bone density, but note that the overall quality of evidence is limited and that effects vary. Clinical guidance and consensus documents therefore recommend supported standing as part of individualised programmes while acknowledging the uncertainty. This balanced picture is why decisions are made individually by the rehabilitation team.
What to expect
If supported standing is being considered, it is assessed and set up by physiotherapists and orthotists, who tailor it to the individual and monitor it over time. Where I am involved in someone's surgical care, I will support and coordinate with that team, but the standing programme itself sits with the rehabilitation specialists.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Mr Madi is a spinal surgeon; standing frames and standing programmes are prescribed, fitted and supervised by physiotherapists and orthotists. Every patient is different, and the suitability, benefits and risks of supported standing depend upon an individual's diagnosis, general health and personal circumstances. Decisions should always be made following consultation with your treating spinal surgeon, physiotherapist, orthotist or healthcare professional.
Evidence & further reading
- —Paleg G, Livingstone R. Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions. BMC Musculoskelet Disord 2015. (PMID 26576548)
- —Newman M, Barker K. The effect of supported standing in adults with upper motor neurone disorders: a systematic review. Clin Rehabil 2012. (PMID 22643724)
- —Paleg GS, et al. Systematic review and evidence-based clinical recommendations for dosing of pediatric supported standing programs. Pediatr Phys Ther 2013. (PMID 23797394)
- —Glickman LB, et al. The role of supported standing for individuals with spinal cord injury. J Spinal Cord Med 2011. (PMID 21791851)
- —Ben M, et al. Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries? Aust J Physiother 2005. (PMID 16321132)
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Every patient is different. The information on this page is a starting point — Mr Madi will tailor any plan to your specific imaging, symptoms and goals.